Thesis advisor: Lisa S. Cahill / Weaving qualitative interview analysis together with ethical inquiry, this project traces the trajectories of Catholic women and couples who hope to form families but contend with infertility and consider whether and how to treat it. Motivating this study is the challenge of balancing individual agency with the role of powerful social forces that shape agency. Examining and critiquing the social forces that shape the circumstances in which Catholic women and couples in the U.S. contend with infertility, this dissertation demonstrates how agential freedom is conditioned by familial, clinical, and ecclesial cultures and structures. It harnesses sociological tools and theological resources to argue for an account of agency that prioritizes critical engagement of contextual factors and suggests that the Church as a moral teacher ought to support the cultivation of this agency. Chapter one challenges the model of moral agency found in magisterial teachings that oppose the use of contraception and reproductive technologies, which suggests that lay Catholics ought to obey magisterially prescribed norms regardless of context. The chapter argues that the magisterial model of moral agency does not adequately account for the role of context in shaping agency, and it instead proposes an account of contextually situated agency that resonates with Pope Francis’ prioritization of contextual realties in his apostolic exhortation Amoris Laetitia. The second chapter demonstrates how various social forces, including structures supporting heterosexual marriage, cultural ideals related to biological childbearing, and ecclesial structures of marital formation all contribute to U.S. Catholic couples’ family formation choices and can intensify burdens of infertility. The chapter proposes a reorientation of Catholic support for families centered on justice in relationships and Christian discipleship instead of family structure. The third chapter examines how cultural ideals related to childbearing, the medicalization of infertility, and social location all contribute to shaping how Catholic women in the U.S. make sense of infertility. Contesting the cultural notion that women are responsible for infertility with reference to a criterion of justice, it describes infertility as a kind of biological bad luck also shaped by systemic forces. Structural injustices related to sexism and racism in healthcare function to distribute the bad luck of infertility unjustly based on societal vulnerabilities, which constitutes a kind of social sin. The fourth chapter considers how two different understandings of Catholic identity shape treatment trajectories of Catholics contending with infertility toward either secular fertility clinics or Catholic clinics. It then examines these two clinical settings, demonstrating how contextual pressures shape how Catholics make treatment choices and underscoring how Catholic moral commitments can support moral agents’ resistance to these pressures. Its final section considers the social forces at work in adoption and fostering. The final chapter turns to the role of the Church in supporting the moral agency of Catholics making decisions regarding family formation and infertility treatment. After analyzing and critiquing the dominant ideals found in Catholic and secular support group settings, it suggests that synodal commitments of mutual listening and inclusive dialogue can support the development of new structures of moral discernment in the Church. It concludes by considering how the social witness of the Church can contribute to the transformation of sinful social forces that constrain the freedom of women and couples contending with infertility. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Theology.

The question of whether there might be a moral obligation to select against disability in our offspring has received considerable attention and attracted great controversy within both the philosophical community and beyond over the last couple of decades. Within this thesis I examine this question, taking as a basis for discussion the view that prospective parents should be formally free to choose whether or not to select against disability in their offspring in the absence of adequate justifying reasons to the contrary. I then move on to examine and outline arguments that suggest variously and for a plethora of different reasons that selection against disability should be condemned morally or required. After this is done and it is noted that the sheer volume of different positions and arguments requires a more specific focus I, in my thesis articles take what I view to be the strongest of moral reasons, person-affecting reasons, and look to the question of whether it is possible ground a moral obligation to select against disability in our offspring in the person affecting harms that our reproductive choices might produce. In the first paper I ask whether the non- identity problem really poses such an insurmountable obstacle to the claim that to select against disability may harm those that are created as a result of our selection choices. This leads to the conclusion that on certain accounts of personal identity over time and trans-world identity it is possible to determine harm in a number of previously non-identity cases of which the selection against disability case is one. In the second paper I broaden my focus slightly by looking to the possible harms that our procreative choices might impose on others than the children we may create: ourselves, our existing dependents and existing members of society. In doing this it is shown that our reproductive choices do, at least in societies with advanced social and medical welfare systems, have the potential to impose significant burdens on others. However, whilst this is so, it is also demonstrated that this is not necessarily a decisive reason to condemn a reproductive choice to select for or to fail to select against disability in our offspring. In my final paper I take a slightly different approach, focusing less on the question of whether there should be a moral obligation to select against disability in our offspring and more on the question of whether there should exist a legal imperative to do so. Taking as a basis a liberal approach to the moral limits of law I suggest that impingements on individual liberty may only be justified when it can be shown that our reproductive choices cause significant harms or offence to others, I ask whether the recent insertion into English and Welsh Law of a prohibition on selection for disability can be justified. In line with the findings of the previous two papers which are far from conclusive and by examining the reasons given in legal and policy documents in England and Wales relating to this prohibition I suggest that as it stands such a prohibition cannot be justified. This ultimately leads to a rather unsatisfying – but perhaps inevitable, in light of the messy nature of reproduction – conclusion: It is possible to discuss the ethics of selection against and for disability on person-affecting accounts of morality and to discuss the matter in this way offers sensitive and sensible prescriptions. However, such discussions turn out to be, in virtue of the many competing claims of those affected by reproductive decisions and policy, far more complex than might be assumed and do not fit neatly with the commonly held moral intuition that it is always morally preferable to select against disability in our offspring.