Pregnancy

Pregnancy has a profound impact on individuals’ lives, yet the subjective experience is often absent from the discourse on reproductive rights and ethics. Although pregnancy is an epistemically transformative experience, phenomenology can help us describe common structures in the many different subjective experiences of pregnancy. Doing so shows us that the effects of pregnancy go beyond the physical symptoms; they invade the experience of the self and the world and transform identity. If someone wants to formulate an argument against abortion, (...) they will have to include the existential impact of pregnancy. In this paper I will further explore the impact of pregnancy through a phenomenological analysis of birth and birthmothers and show that the existential impact of pregnancy does not cease to exist after birth. Giving birth fundamentally changes the world of the pregnant person and leads to irreversible changes in identity. Their world will never return to the way it was before pregnancy. Arguments against abortion would have to take these existential implications into account as well. Finally, I will argue that a similar argument will also become relevant in the discourse on ectogenesis. (shrink)

of (from Oxford Uehiro Centre for Practical Ethics) Medical Journal of Australia, 188 (2) 100 - 102.

Pallikkathayil argues that restrictions on abortion are inconsistent with the usual demands that states place on their citizens. States don't require their citizens to make their bodies available for the protection of other people's interests. Yet, when abortion is restricted, women who can be pregnant are less entitled than other citizens to decide on how their bodies are to be used; then, states fail to treat women as equal before the law. The argument is supposed to hold even if one (...) assumes that fetuses at various stages of development are as morally considerable as (already born) children, and even if, moreover, fetuses have passive citizenship status – that is, if they have claims to state protection. Pallikkathayil's argument comes at excessive theoretical costs, rulling out (a) general duties to help others in the protection of vital interests via relatively non‐burdening donation, e.g. of blood, and (b) plausible although demanding special duties of procreative parents. Nevertheless, I agree with Pallikkathayil's conclusion that existing legal restrictions on abortion violate the state's duty to treat its citizens as equal, and are hence illegitimate; namely, because they fail to hold all procreators ‐ whether or not gestational ‐ equally liable. (shrink)

I offer a positive argument in defense of the moral permissibility of abortion that relies on the moral concept of self-defense. I argue that given the lack of proportional self-defense options in pregnancy, a pregnant woman is morally permitted to procure a self-defensive abortion so long as the risks/burdens of her pregnancy and childbirth reach a sufficiently high threshold of seriousness. I then argue that even standard pregnancies reach this threshold, because of the expected physical and nonphysical risks/burdens imposed. Finally, (...) I consider three objections—an objection based on the risks/burdens of abortion, an objection based on the fetus’s status as an innocent aggressor, and an objection based on the pregnant woman’s moral responsibility for the creation of the fetus. (shrink)

Uterus transplantation (UTx) is an experimental surgery likely to face the issue of organ shortage. In my article, I explore how this issue might be addressed by changing the prevailing practices around live uterus donor recruitment. Currently, women with children – often the mothers of recipients – tend to be overrepresented as donors. Yet, other potentially eligible groups who may have an interest in providing their uterus – such as transgender men, or cisgender women who do not wish to gestate (...) or to have children – tend to be excluded as potential donors. Moving forward, I recommend that donor inclusion criteria for UTx be broadened to be more inclusive of these latter groups. (shrink)

East Asian countries such as South Korea have recently made headlines for experimenting with different methods to incentivise people to have (more) children, in a bid to reverse declining birth rates. Many such incentives—child benefits, cash bonuses, dating events, and so on—appear morally innocuous at first glance. I will demonstrate in this analysis, however, that they amount to stopgap measures which reveal fundamental shortcomings with the way various nation states are approaching the so-called ‘problem’ of fertility decline.

In the future, full ectogestation – in which artificial placenta technology would be used to carry out the entirety of gestation – could be an alternative to human pregnancy. This article analyzes some underexplored objections to ectogestation which relate to the possibility for new and continuing forms of social oppression. In particular, we examine whether ectogestation could be linked to an unwarranted de-valuing of certain aspects of female reproductive embodiment, or exacerbate objectionable kinds of scrutiny over the reproductive choices of (...) gestating persons. Without discounting the potential benefits of full ectogestation, we conclude that the socially oppressive potential of ectogestation, on top of other concerns, warrants further critical ethical reflection. (shrink)

This book explores how considerations of justice apply to procreative decision-making. -/- Despite its immense personal significance, procreation is an inherently other-regarding endeavor. By its very nature, the decision to procreate is the decision to bring into existence another morally considerable being, one who will be exposed to the full range of harms, benefits, and risks that accompany a typical human life, and one who cannot by its nature ever consent to being born. Moreover, when this decision is undertaken in (...) a community of persons, it is also a decision to affect the lives of others in a host of profound if often underappreciated ways, from its effects on population size and environmental sustainability to its consequences for a community’s distribution of resources. In many ways, of course, these interests coincide: adults need children for their parenting projects, societies need citizens for the maintenance of their institutions, and children themselves are often happy to have been brought into existence. However, as the book demonstrates, the various interests that are implicated by procreative decision-making can also come into conflict as well, and in ways that raise basic questions of justice. Through a systematic examination of six of these questions, the author argues that taking adequate stock of the conflicting interests at stake in procreative decision-making leads to a narrower view of the conditions under which it is morally permissible to procreate and a much more demanding conception of our procreative responsibilities. -/- Procreative Justice will be of interest to researchers and advanced students working on the morality of procreation and related areas of philosophy, including bioethics, intergenerational ethics, environmental ethics, population ethics, and the ethics of the family. (shrink)

The ‘containment view’ of pregnancy is widely held, but it has recently been subjected to sustained criticism by Elselijn Kingma. According to the containment view, human foetuses (among others) are animals in their own right, contained within their mothers. Kingma's alternative to this is the ‘parthood view,’ according to which a foetus is a maternal part. Despite the prevalence of the containment view, there are not a great many arguments in its favour, and Kingma has searchingly criticized several of these. (...) In this paper, I defend an argument for the containment view, which I think is not undermined by Kingma-type considerations. (shrink)

Pregnancy is a one of the most complex phenomena of life and is essential to the life cycle of mammals. Pregnancy is also a crucial aspect of humans' life and experience. But what is pregnancy? This question has received little attention in philosophy until recently, when it got picked up by metaphysicians and philosophers of science. However, the philosophical discussion is still in its infancy. This article provides a survey of the recent debate on the metaphysics of pregnancy. It explores (...) the relation between the pregnant organism and the gestated one, motivating the further study of pregnancy from a philosophical perspective (§1, §2). It summarises the three main models of pregnancy present in the literature, the containment view (§3), the parthood view (§4) and the splitting process view (§5) with their advantages and shortcomings. Then, it explores a recent debate on whether pregnancy is a disease (§6). Lastly, it considers how one can decide between these models, for instance by favouring a given view of biological individuality over another (§7). The article concludes that none of the views is fully satisfactory, and thus inviting to continue the research on pregnancy from a metaphysical and philosophical perspective. (shrink)

Do pregnant mothers have fetuses as parts? According to the “parthood view” they do, while according to the “containment view” they don’t. This paper raises a novel puzzle about pregnancy: if mothers have their fetuses as parts, then wherever there is a pregnant mother, there is also a smaller thinking being that has every part of the mother except for those that overlap with the fetus. This problem resembles a familiar overpopulation puzzle from the personal identity literature, known as the (...) “Thinking Parts Problem”, but it’s not merely a special case of that problem. Rather, the fact that late-term fetuses have a mental life of their own makes the Problem of Pregnant Thinkers, as I will call it, a sui generis and especially recalcitrant problem. (shrink)

Parenting our biological children is a centrally important matter, but how, if it all, can it be justified? According to a contemporary influential line of thinking, the acquisition by parents of a moral right to parent their biological children should be grounded by appeal to the value of the intimate emotional relationship that gestation facilitates between a newborn and a gestational procreator. I evaluate two arguments in defence of this proposal and argue that both are unconvincing.

In their paper, Romanis and Adkins delve into the potential impact of artificial amnion and placenta technology (AAPT) on cases of pregnancy loss1 that do not involve procreative loss. First, they call for more recognition of the negative feelings a person might have due to the premature end of their pregnant state. They claim that, should AAPT minimise concerns about prematurity as anticipated, individuals might feel pressured to opt for partial ectogestation to preserve their or their fetus’ well-being; moreover, they (...) point out that the feelings of loss in the context of AAPT are likely to be worse than the ones reported in neonatal intensive care units cases. Finally, they advocate for care pathways focusing on how the transfer of a fetus to the AAPT could affect the pregnant person, with particular attention to managing the grief potentially caused by the pregnancy loss. I praise the authors for such a call to action—especially since partial ectogestation is expected to become a reality in the short-term future—and I share their demands for additional and more attentive care of (formerly) pregnant patients. However, I am concerned that their approach is so focused on negative feelings towards pregnancy loss that it risks becoming …. (shrink)

Anna Smajdor and Joona Räsänen argue that we have good reason to classify pregnancy as a disease. They discuss five accounts of disease and argue that each account either implies that pregnancy is a disease or, if it does not, it faces problems. This strategy allows Smajdor and Räsänen to avoid articulating their own account of disease. Consequently, they cannot establish that pregnancy is a disease, only that plausible accounts of disease suggest this. Some readers will dismiss Smajdor and Räsänen’s (...) claims as counterintuitive. By analogy, if a mathematical proof concludes ‘2+2=5’, readers will know—without investigation—that an error occurred. Rather than dismiss Smajdor and Räsänen’s work, however, the easiest way to undermine their argument is to describe at least one plausible account of disease that (i) excludes pregnancy and (ii) avoids the problems they raise for it. This is our strategy. We focus on dysfunction accounts of disease. After outlining Smajdor and Räsänen’s main arguments against dysfunction accounts, we explain why pregnancy is not a disease on these accounts. Next, we defend dysfunction accounts against the three problems that Smajdor and Räsänen raise. If successful, then contra Smajdor and Räsänen, at least one plausible account of disease does not imply that pregnancy is a disease. We suspect that defenders of other accounts can respond similarly. Yet, we note that insofar as dysfunction accounts align with the commonsense intuition that pregnancy is not a disease, this, all else being equal, seems like a point in their favour. (shrink)

In ‘The Pregnancy Rescue Case: why abortion is immoral’, Hendricks presents The Pregnancy Rescue Case. In this reply I argue that even if it would be better (i.e., less bad) for the abortion to be prevented in The Pregnancy Rescue Case, that does not mean that typical abortions are impermissible. I also argue that there is a possible explanation, consistent with the pro-choice view and empirically testable, as to why people would think it better for the abortion to be prevented (...) in The Pregnancy Rescue Case. (shrink)

Each one of us who has come into this world (so far) has done so via birth. Everyone therefore has a birthing ‘parent’, but not all would consider that respective person to be their parent. For example, those who have been adopted might instead consider the person (or people) who adopted them to be their parent(s). There are, therefore, ways to become a parent that do not involve giving birth, and instances of giving birth that do not result in becoming (...) a parent. But what about motherhood, more specifically? Must mothers be women, and must mothers have given birth? What makes a ‘mother’ – is it always and only the person who makes us? It is these questions that I explore here, in order to find a trans-inclusive approach to parental designations. (shrink)

Background Respectful maternity care (RMC) emphasizes the social and relational elements of maternity care and is a crucial part of initiatives to improve service accessibility and quality. Women's perceptions have influenced much of what we know about RMC and contempt in the labor ward. In order to understand midwives' perspectives of RMC, this meta-synthesis focused on them. Method For this inquiry, the databases PubMed/Medline, Embase, Web of Science, and Scopus were searched to find studies on midwives' perceptions of RMC written (...) between 2011 and April 20th 2023. The included articles were to English language restriction. The results of the included research were examined using thematic analysis. Using the inclusion criteria, 84 potentially relevant articles were carefully reviewed, and only 22 were ultimately selected for synthesis. The quality of the qualitative study was assessed using the CASP, a tool for quality evaluation and PRISMA guidelines were followed. Using the MAXQDA program, the cited quotes and the original authors' interpretations were combined. Result There were 22 studies total, thematic synthesis was determined to be appropriate for a total of 22 research studies. Following are the topics which we summarized our analysis: in six major themes: Midwives’ conceptualizations of RMC, Midwives commitment to woman’s rights, The value and impact of RMC to midwives, Midwife’s perception of disrespectful care, Challenges in providing respectful maternity care, and Midwives’ recommendations for optimal RMC practice. Conclusion In addition to specific focus on promoting cooperation, policies to enhance health systems and strategic consideration of the midwifery profession's future are required. (shrink)

In cases in which we must choose between either (i) preventing a woman from remaining unwillingly pregnant or (ii) preventing a fetus from being killed, we should prevent the fetus from being killed. But this suggests that in typical cases abortion is wrong: typical abortions involve preventing a woman from remaining unwillingly pregnant over preventing a fetus from being killed. And so abortion is typically wrong—and this holds whether or not fetuses are persons.

In this article, I confront Jessica Flanigan’s recent attempt to show not merely that women have a right to commit prenatal injury, but also that women who act on this right are praiseworthy and should not be criticized for this injury. I show that Flanigan’s arguments do not work, and I establish presumptive grounds against any such right—namely, prenatal injury, by definition, involves intentional or negligent harm and, as such, may be subsumed under a wider class of actions that are (...) presumptively wrong. (shrink)

Ectogenesis technology would make it possible to support the complete gestational development of a human being outside the female body. Proponents argue that this technology offers a welcome opportunity to expand reproductive options for those unable or unwilling to gestate. However, by completely bypassing pregnancy, the use of ectogenesis prevents the formation of gestational family ties. Consequently, it has faced criticism for perpetuating a patriarchal view of the family that undermines the moral significance of gestation. The concern is that the (...) introduction of this technology might result in the loss of reproductive autonomy for those who desire to experience pregnancy, as they face pressures to opt for ectogenesis instead. Existing accounts of family values define parents' rights to rear a child, but they fail to establish a right to gestate that can protect an individual's interest in bearing a child. To provide a more comprehensive account of family values, I argue that pregnancy involves a unique quality of intimacy and can make distinct contributions to one's flourishing. Based on this premise, I defend a fundamental moral right to gestate that can help safeguard the option of pregnancy for those who desire it. In conclusion, I consider how a prospective gestator need not provide optimal conditions for fetal development in the way that ectogenesis promises in order for their choice of pregnancy to be justified. (shrink)

Romanis and Adkins explore the near-term prospect of artificial amnion and placenta technology (AAPT) which is being developed to supplement the gestational process following the premature ending of a pregnancy.1 While fetal-centric narratives prevail in discussions surrounding AAPT, the authors subvert this trend by centering the experience of pregnant persons with respect to pregnancy loss. The overarching aim of their paper is to move beyond a ‘philosophical understanding of pregnancy towards practical-orientated conclusions regarding the care pathways surrounding [AAPT]’ (Romanis and (...) Adkins,1 p1). This commentary will critically examine the viability of this aim. Romanis and Adkins use the term ‘pregnancy loss’ to refer to the phenomenon where individuals experience a complex set of emotions following the premature ending of pregnancy, despite the survival of the gestated entity. Following Golish and Powell, the authors note how parents may experience contradictory emotions, such as joy mixed with grief, as well as a range of negative feelings including shame, disappointment and a sense of failure.2 At present, this phenomenon has been recognised among parents, particularly the (formerly) pregnant person, in the context of neonatal intensive care units (NICUs) when the infant survives preterm delivery and …. (shrink)

When pregnant persons do not behave in the way deemed optimal for their fetus, they are often framed as doing harm. This framing acts as a justificatory bypass for defenses of widespread expectations of pregnant persons, allowing such defenses to avoid substantial questions about special obligations in pregnancy. Our main claim is that this justificatory bypass is unwarranted: in many cases either the pregnant person does not count as doing harm or substantive questions about special obligations cannot be avoided. Our (...) secondary claim is that direct engagement with these substantive questions is unlikely to justify widespread expectations on pregnant people. (shrink)

A global trend of institutionalised pronatalism situates low fertility as a site of demographic disaster – positioning primarily women’s bodies as both its cause and solution. In light of such demographic dread, assisted reproductive technologies (ART) may be utilized by pronatalist states as a strategy for fertility recovery, rather than as a benefit for individual aspiring parents. In other words, ARTs are at risk of being co-opted by nation-states for problematic demographic designs which do not advance emancipatory goals. The underlying (...) issue of pronatalism, however, is not always explicitly acknowledged in feminist bioethics as a barrier to ethical ART usage. In my paper, I argue that it would be a mistake to assume ART can be used for emancipatory ends if we do not, at the same time, critically investigate its connections to institutionalised pronatalism. (shrink)

Artificial womb technology for extracorporeal gestation of human offspring (ectogenesis or ectogestation) has profound ethical, sociological and religious implications for Muslim communities. In this article we examine the usage of the technology through the lens of Islamic ethico-legal frameworks specifically the legal maxims (al-Qawaid al-Fiqhiyyah) and higher objectives of Islamic law (Maqaṣid al-Shariah). Our analysis suggests that its application may be contingently permissible (halal) in situations of dire need such as sustaining life and development of extremely premature newborns, for advancing (...) fetal medicine and avoiding maternal co-morbidities during fetal treatment, and for enabling motherhood for women without functional wombs, or who face grave medical risks in pregnancy. However, its application may be proscribed (haram) for enabling healthy women to avoid pregnancy and childbirth, or to achieve parenthood equity. Specification of these views to particular policy, legal contexts and Fatwa will require multidisciplinary Shariah-based bioethical deliberations between jurists, policymakers, and scientists. (shrink)

Gestational surrogacy is ethically complex, generating very different responses in law and policy worldwide. This paper argues that contemporary surrogacy law and policy, across many jurisdictions, fail to give sufficient attention to the significance of the relationship between the child and the gestational surrogate. This failure risks repeating the mistakes of historical, discredited approaches to adoption and donor‐assisted conception. This paper argues that proper recognition of the significance of gestation must be an organising principle in surrogacy law and policy. The (...) paper begins by pointing to examples of surrogacy law and practice where the role of the gestator is unacceptably minimised, most notably the framing of the surrogate as a mere ‘carrier’. It goes on to examine the nature of gestation, including consideration of contemporary scholarship on the metaphysics of pregnancy and emerging work in epigenetics, and argues that current evidence supports the view that the gestational relationship must be taken more seriously than it currently is. The paper then draws analogies with parenthood in donor‐assisted conception and adoption to argue that approaches to parental status in novel family formations that fail to promote transparency and seek to deny the truth of familial relationships are doomed to fail. The paper concludes by suggesting some implications for law and policy that flow from placing sufficient emphasis on the gestational role. The overarching thesis of this paper is that gestational surrogacy is ethically permissible when these fundamental requirements are adhered to, and that surrogacy law should proceed on this basis. (shrink)

Robinson argues that by certain threshold criteria, pregnant women qualify for a higher moral status by reason of their pregnancies. While her intention is to make this a status upgrade for women, we worry that it may result in a status downgrade for women as a class, by presupposing and reinforcing women’s value in relation to their reproductive labour. Historically, central to feminist analysis is resistance to reductive accounts of women in relation to their reproductivity. For example, de Beauvoir addressed (...) men’s transcendence and contrasted it with women’s immanence, a status distinction possible because women are mired in expectations that they will marry, produce children and remain in the domestic realm; and for her part, Firestone argued that biological reproduction underlies women’s inferiority to men and that ‘The reproduction of the species by one sex for the benefit of both (should) be replaced by…artificial reproduction’1 2 Her concern was to liberate women from expectations of biological reproduction so their productive value in society is not reduced to their reproductive contributions. A formidable body of analysis in this same vein cautions against collapsing the value of women into their pregnancies, so much so that some commentators even distinguish ‘mothering’ from gestation.3 Robinson’s argument that pregnant women qualify at a higher threshold of personhood emphasises …. (shrink)

In their article ’Is Pregnancy a Disease? A Normative Approach’, Anna Smajdor and Joona Räsänen contend that, on several of the most prominent accounts of disease, pregnancy should be considered a disease. More specifically, of the five accounts they discuss, each renders pregnancy a disease or suffers serious conceptual problems otherwise. They take issue specifically with the dysfunction account of disease and argue that it suffers several theoretical difficulties. In this response, we focus on defending the dysfunction account against their (...) main objections and show why a version of the dysfunction account is viable on account of the indispensability of normativity in biology and medicine. After disarming their main objections to the dysfunction account, we briefly respond to their treatment of the normality of pregnancy and then draw a distinction between adverse symptoms and underlying causes to show why even though pregnancy may have ’disease-like’ features, it is not a disease. (shrink)

The development of artificial womb technology is proceeding rapidly and will present important ethical and theological challenges for Christians. While there has been extensive secular discourse on artificial wombs in recent years, there has been little Christian engagement with this topic. There are broadly two primary uses of artificial womb technology—ectogestation as a form of enhanced neonatal care, where some of the gestation period takes place in an artificial womb, and ectogenesis, where the entire gestation period is within an artificial (...) womb. Ectogestation for the latter weeks or months of pregnancy could be possible within a decade or so, while ectogenesis for humans is far more speculative. Ectogestation is likely to significantly decrease maternal and neonatal morbidity and mortality, and so there is a strong case for supporting its development. Ectogenesis, however, may bring a number of challenges, including the commodification of children, and the pathologizing of pregnancy and childbirth. Its long-term effects on those who are created through this process are also unknown. In the event that it becomes ubiquitous, we may also find the central theological significance of pregnancy and birth diminished. The dilemma for Christians is that the development of ectogestation seems likely to normalise the use of artificial gestation, and, in time, pave the way for ectogenesis. (shrink)

Robinson offers the ‘superior personhood’ approach (SPA) to capture the value of gestation and ground justice for women/gestators.1 SPA holds that women/gestators are more than mere persons given the reality of pregnancy and the vital role women/gestators play in reproduction.1 In this commentary, I speak to some background context perhaps relevant to SPA, lay out areas of agreement with Robinson and then raise four worries about the approach. In my view, the devaluing of gestation and injustice for women/gestators need rectifying, (...) but SPA is not the way. It is difficult not to read Robinson’s piece through the lens of 2022’s Dobbs v. Jackson decision and the politics of abortion, with its focus on fetal status. This background offers a certain kind of sympathetic strategic/rhetorical reading of the motivation for SPA—one to which I found students and others with whom I discussed the piece quite open. Perhaps the goal here is to offer an ingenious defence of abortion rights: if women/gestators are more than one person, then the immorality of abortion cannot be easily grounded in claims about fetal personhood.2 However, Robinson downplays abortion, affirming only ‘my approach could support a wide range of positions on abortion’. This is curious. Is SPA compatible with significant restrictions on abortion? Assuming a realistic political context, this would involve mere persons (men/non-gestators) legislating how superior persons can …. (shrink)

This article takes its point of departure in Bracha Ettinger’s discussion on the “matrixial borderspace”: the structure of the experience of “the womb,” both from a “mother-pole” and a “fetus-pole”. Ettinger describes this borderspace as a place of differentiation-in-co-emergence, separation-in-jointness, and distance-in-proximity. The question this article poses is what kind of logic this experience is an expression of, as there seems to be a discrepancy in relation to the classical Aristotelian logic of identity. As an alternative to classical Aristotelian logic, (...) Nicholas of Cusa’s logic of the non-aliud is explored as a paradigm more in line with Ettinger’s description of pregnancy specifically and more generally, to an understanding of life as a co-poietic emergence of structures of pactivity and permeability. (shrink)

Recent discussion on artificial womb technology (AWT) has given rise to a proliferation of terms to denote the subject of AWT. De Bie et al. opt for “fetal neonate” or “fetonate’ as “the best way t...

This chapter provides a historical account of the transformation of pregnancy through philosophical theory and legal practice. What has remained seemingly consistent across history, though, is the lack of rights a pregnant woman can enjoy. Whilst it may manifest differently across time and place, unfortunately misogynistic attitudes persist, and this is reflected in the continual degrading of the gestator (and gestation), which is reinforced by certain philosophical theorising and technological advancement. We thus urge caution in making philosophical claims about the (...) epistemic transformation in pregnancy, given the epistemic (and other) injustices already faced by pregnant people. We recognise that there are transformations that occur because of pregnancy, but we argue that there ought not be with respect to the pregnant person's autonomy, agency, and control over their bodies. Through an analysis of legal cases, we can see that the practice falls out of line with the theory regarding how pregnant people are treated. But perhaps it is both the theory and the practice that need to change so as to bring them in line. How we theorise about pregnancy is intertwined with our cultural views, our technological advancements, and our medical and legal practices, requiring multi-disciplinary study for a more holistic overview. In this chapter, we contribute to this endeavour by bringing some such strands together, regarding the transformation that pregnancy is, that pregnancy makes, and that pregnancy has had historically, in philosophy, and in legal practice. (shrink)

Elselijn Kingma argues that, in cases of mammalian placental pregnancy, the foster (roughly, the post-implantation embryo/foetus) is part of the gravida (the pregnant organism). But she does not consider the possibility of proper overlap. I show that this generates a number of serious problems for her argument and trace the oversight to a quite general issue within the literature on biological individuality. Doing so provides an opportunity to pull apart and clarify the relations between some importantly distinct questions concerning organismality (...) and organismic parthood, and to identify the implications that this has for those who want to draw on this literature when making metaphysical or mereological arguments. (shrink)

In her controversial paper, Anna Smajdor proposes that brain-dead people could be used as gestation units for prospective parents unable or unwilling to undertake the act themselves—what she terms whole body gestational donation (WBGD). She explores the ethical issues of such an idea and, comparing it with traditional organ donation, asserts that such deceased surrogacy could be a way of outsourcing pregnancy’s harms to a populace unable to be affected by them. She argues that if the prospect is unacceptable, this (...) may reveal some underlying problems with traditional cadaveric organ donation. Smajdor’s analysis, however, overlooks several problems arising from WBGD. This paper provides an account of those issues and argues that, in addition to WBGD being viscerally unpleasant, it is also ethically unviable. The paper starts by providing an account of WBGD before acknowledging its negative response within traditional and social media. After arguing that such cursory and gut reactions are insufficient to reject the proposal outright, this paper then provides three concerns regarding WBGD omitted by Smajdor: (i) the co-opting of life-saving organs for reproduction, (ii) the discrepancy between using cadaveric organs to save a life versus creating one, and (iii) the universalization of feminist concerns regarding reproductive body commodification. The paper concludes by tentatively agreeing with Smajdor that considering WBGD may help reveal vulnerable assumptions regarding organ donation and surrogacy, but that the significant ethical issues raised may prove insurmountable and make the intervention—thought experiment or otherwise—untenable. (shrink)

In this article, I critique the commonly accepted distinction between commercial and altruistic surrogacy arrangements. The moral legitimacy of surrogacy, I claim, does not hinge on whether it is paid (‘commercial’) or unpaid (‘altruistic’); rather, it is best determined by appraisal of virtue-abiding conditions constitutive of the surrogacy arrangement. I begin my article by problematising the prevailing commercial/altruistic distinction; next, I demonstrate that an assessment of the virtue-abiding or non-virtue-abiding features of a surrogacy is crucial to navigating questions about the (...) moral legitimacy of surrogacy; in the final part, I reject other moral heuristics that might be proposed as alternatives to the commercial/altruistic dichotomy, and reiterate that a virtue-ethical framework is the most suitable way forward. (shrink)

This paper argues that social contexts of inequality are crucial to understanding the ethics of gestational harm and responsibility. Recent debates on gestational harm have largely ignored the social context of gestators, including contexts of inequality and injustice. This can reinforce existing social injustices arising from colonialism, socio‐economic inequality and racism, for example, through increased regulation of maternal behaviour. To demonstrate this, I focus on the related notions of the ‘future child’ and an obligation of easy rescue, which have been (...) used to discuss the ethics of gestational harm in the context of alcohol consumption during gestation and foetal alcohol spectrum disorder (FASD). I use a feminist perspective to evaluate these ideas and conclude that anyone concerned with remediation of social injustice has good reason to be suspicious of the notion of the future child in the context of gestational harm. (shrink)

It is unarguable that the implementation and use of noninvasive prenatal testing (NIPT) should be critical and appropriate. After all, decisions that influence when and how to have children have ut...

Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the previable and (...) periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness. (shrink)

This commentary addresses the proposal and argumentative line presented in the paper ‘Whole Body Gestational Donation’ (WBGD) by Anna Smajdor (2023), published as an intended ‘outrageous argument’ in a dedicated special issue of Theoretical Medicine and Bioethics. We believe that the paper is fatally flawed due to its lack of engagement with relevant approaches in ethics and essential sources in health sciences as well as its insufficient, superficial, and rash argumentation. Its critical weaknesses include, among others, that it does not (...) take any explicit ethical stance, it does not consider the societal impacts of its premise, and it hastily assumes a large degree of equivalency between WBGD and the usual organ donations. These scholarly flaws are made worse by the fact that the paper is not merely an academic thought experiment but contains important policy change proposals. As a consequence, the paper feeds into more general and systemic worries about the suitability of philosophy for public policy. (shrink)

Gender-based forms of administrative violence, such as reproductive violence, are the result of systems designed to enact population-level harms through the production and forcible imposition of colonial systems of gender. Settler statecraft has long relied on the strategic promotion of sexual and reproductive violence. Patterns of reproductive violence adapt and change to align with the enduring goals and evolving needs of settler colonial occupation, dispossession, and containment. The U.S. Supreme Court’s recent decision to end the constitutional right to abortion in (...) Dobbs v Jackson is but one instance of this larger pattern. We analyze reproductive and obstetric violence and the structural trauma they produce through the lenses of i) historical continuity and ii) the global architectures of neoliberal settler capitalism in order to connect reproductive rights rollbacks in the U.S. with the expansion of reproductive violence across a world connected by colonial globalization. (shrink)

Given Descartes’ metaphysical and natural-philosophic commitments, it is very difficult to theorize the pregnant human being as a human being under his system. Specifically, given (1) Descartes’ account of generation, (2) his commitment to mechanistic explanations where bodies are concerned, (3) his reliance on a subtle individuating principle for human (and animal) bodies, and (4) his metaphysics of human beings, which include minds, bodies, and mind-body unions, there is no available human substance or entity which may clearly be the subject (...) of pregnancy. The incompatibility of any of the three options found in (4) with (1), (2), or (3), together with other undesirable consequences should any be selected, results in what I call the pregnancy problem. The pregnancy problem (henceforth, PP) is a previously unconsidered problem for the Cartesian philosophy. Given PP, commitment(s) (1), (2), (3) or (4), or a combination of these, would have to be revised for Descartes’ system to avoid a variety of tensions; alternately, counterintuitive consequences may have to be accepted. Ironically, given Descartes’ interest in generation and medicine more generally, the Cartesian framework struggles to accommodate pregnancy in human beings. This may have implications for the systematicity and sex-neutrality of dualist metaphysics in general. (shrink)

Whole body gestational donation offers an alternative means of gestation for prospective parents who wish to have children but cannot, or prefer not to, gestate. It seems plausible that some people would be prepared to consider donating their whole bodies for gestational purposes just as some people donate parts of their bodies for organ donation. We already know that pregnancies can be successfully carried to term in brain-dead women. There is no obvious medical reason why initiating such pregnancies would not (...) be possible. In this paper, I explore the ethics of whole-body gestational donation. I consider a number of potential counter-arguments, including the fact that such donations are not life-saving and that they may reify the female reproductive body. I suggest if we are happy to accept organ donation in general, the issues raised by whole-body gestational donation are differences of degree rather than substantive new concerns. In addition, I identify some intriguing possibilities, including the use of male bodies–perhaps thereby circumventing some potential feminist objections. (shrink)

De Bie et al. (2023) propose an organizing framework for different stages of human gestational development from conception to the viable premature. They also identify ethical considerations and con...

In his paper, ‘Twin pregnancy, fetal reduction and the ‘all or nothing problem’, Räsänen sets out to apply Horton’s ‘all or nothing’ problem to the ethics of multifetal pregnancy reduction from a twin to a singleton pregnancy. Horton’s problem involves the following scenario: imagine that two children are about to be crushed by a collapsing building. An observer would have three options: do nothing, save one child by allowing their arms to be crushed, or save both by allowing their arms (...) to be crushed. Horton offers two intuitively plausible claims: it is morally permissible not to save either child and it is morally impermissible to save only one of the children, which taken together lead to the problematic conclusion that if an observer does not save both children, then it is better to save neither than save only one. Räsänen applies this problem to the case of 2-to-1 MFPR, arguing ultimately that, in cases where there is no medical reason to reduce, the woman ought to bring both fetuses to term. We will argue that Räsänen does not provide adequate support for the claim, crucial to his argument, that aborting only one of the fetuses in a twin pregnancy is wrong, so the ‘all or nothing’ problem does not arise in this context. Furthermore, we argue that the scenario Räsänen presents is highly unrealistic because of the clinical realities of 2-to-1 MFPR, making his argument of limited use for real-life decision making in this area. (shrink)

In the UK, it has been proposed that alongside the current advice to abstain from alcohol completely in pregnancy, there should be increased screening of pregnant women for alcohol consumption in order to prevent instances of fetal alcohol spectrum disorder. The Scottish Intercollegiate Guidelines Network published guidelines in 2019 recommending that standardised screening questionnaires and associated use of biomarkers should be considered to identify alcohol exposure in pregnancy. This was followed in 2020 by the National Institute for Health and Care (...) Excellence Draft Quality Standard, which recommended that pregnant women should have information on their alcohol consumption recorded throughout their pregnancy and this information transferred to the child’s health records. Most recently, Public Health England has stated that the alcohol intake of all women should be recorded throughout pregnancy, not just at the initial booking appointment and that tools such as blood biomarkers and meconium testing should be researched in order to determine true prevalence rates of alcohol in pregnancy. We argue that this proposed enhanced screening undermines women’s autonomy and their legal right to be sufficiently informed to consent to screening. We argue that there is no evidence that this kind of screening will result in a reduction of fetal harm and there is a danger that undermining the autonomy of women and the trust relationship between women and healthcare professionals may even increase harm to future children. (shrink)

This article takes the rupturing of normative, linear, reproductive time that occurs in the event of miscarriage as a potentially generative philosophical moment—a catalyst to rethink pregnancy aside from the expectation of child-production. Pregnant time is usually imagined as a linear passage toward birth. Accordingly, the one who “miscarries” appears as suspended within an arrested journey that never arrived at its destination, or indeed, as ejected from pregnant time altogether. But here I propose to rethink both pregnancy and miscarriage through (...) the lens of “suspended time”—a theoretical move that shifts the accent from the future as the dominating frame of reference to the lived present. Drawing on work by Kathryn Bond Stockton, Lauren Berlant, Lisa Baraitser, and others, the article explores overlooked temporalities of pregnancy and miscarriage that operate not in the mode of futural projection or futural loss, but rather through present-oriented forms of adjustment and sensing, attachment and intimacy, maintenance and care. By “suspending the future,” then, we can resist the oppositional framing of pregnancy and miscarriage, because if pregnant time is not represented in exclusively future-oriented terms as being-toward-birth, then miscarriage need not be understood as pregnancy's undoing. (shrink)

In a recent article in this journal, Alex Mullock, Elizabeth Chloe Romanis and Dunja Begović provide an analysis of gestational surrogacy and uterus transplantation (UTx) from the perspective of those who may decide to act as gestational surrogates and womb donors, referred to as ‘womb‐givers’. In this article, I advance two sets of claims aimed at critically engaging with some aspects of their analysis. Firstly, I argue that the expression ‘womb‐givers’ obscures the biologically, socially and politically salient issue that those (...) who engage in these practices are primarily persons and women. My contention is that this is of substance in discussions of the burdens and benefits of gestational surrogacy and UTx, which need to consider the specific position that women occupy in society, and the hierarchies that mediate their lives, experiences and preferences. Second, I argue that, if one were to take seriously the experiences and preferences of the women who may engage in these practices, and their bodily autonomy, then gestational surrogacy and UTx should be regarded as biologically and sociopolitically incommensurable. Mullock et al. overlook important aspects of gestational surrogacy, such as the embodied nature of pregnancy and childbirth, the sociopolitical significance of these experiences, and the often‐oppressive social norms that shape them. Whilst biology is not destiny, I suggest that it is socially and politically ‘sticky’ when it comes to this significance and norms, especially within the sphere of reproduction. Towards the end of the article, I query the authors' conceptualisation of bodily autonomy and of the instruments that enable its respect and promotion. (shrink)