Epistemic Risk, Infertility, and Disease Definitions

Rebecca Kukla, Georgetown University

Philosophers interested in inductive risk have argued that there are ineliminable epistemic risks in inferences from evidence to hypothesis acceptance or rejection, and that these must be balanced in light of values and interests. I argue that the generation of scientific evidence also involves epistemic risks that can’t be managed except by appeal to values and interests. I focus on the example of disease operationalization and definition, and more specifically on infertility. I argue that in the context of medical research and clinical care, we should do away with the category of infertility altogether. Like many or perhaps all disease categories, any operationalization of the category of ‘infertility’ for clinical purposes will require us to make value-laden choices about how to manage a variety of epistemic risks. But in the case of infertility, I argue: (1) that these value-laden choices will almost inevitably push in the direction of reaffirming problematic gendered, heterocentric, and pronatalist assumptions about what ‘normal’ reproductive lives look like; and (2) that from the point of view of clinical care and research methodology, more specific and proximate categories such as low sperm count, endometriosis, vaginismus, and so forth are much more useful.