This special issue of the Journal of Medicine and Philosophy focuses on unintended intrauterine death (UID) and preterm delivery (both phenomena that are commonly—and unhelpfully—referred to as “miscarriage,” “spontaneous abortion,” and “early pregnancy loss”). In this essay, I do two things. First, I outline contributors’ arguments. Most contributors directly respond to “inconsistency arguments,” which purport to show that abortion opponents are unjustified in their comparative treatment of abortion and UID. Contributors to this issue show that such arguments often rely on (...) a grossly oversimplified picture of abortion opponents’ views. Furthermore, contributions in this issue weigh in on issues regarding UID with theoretical import and therapeutic implication beyond the inconsistency argument debate. These papers can be mined for principles that better inform us about anembryonic pregnancies (i.e., nonviable pregnancies in which a gestational sac exists but no embryonic pole can be seen via transvaginal ultrasound), UID-prevention research, the law concerning UID (especially post-Dobbs), policies for handling embryonic remains, and moral psychology as it relates to UID, emotion, and empathy. In each case, conceptual philosophical analysis might bring about therapeutic benefits for those affected by UID. Philosophers, therefore, are in position not only to provide clarity—careful analysis and discussion of UID and related phenomena—but are also in position to genuinely help people affected by UID. (shrink)

In the first part of this paper, I argue that the positions set out in traditional debates about abortion are focused on the status of the fetus to the extent that they ignore the value and meaning of pregnancy as something involving persons other than the fetus. -/- In the second part of the paper, I build on Hilde Lindemann’s ideas by arguing that recognition of the related activities of calling a fetus into personhood and creating an identity as a (...) parent allow us to make sense of a variety of reactions to pregnancy and pregnancy loss while recognizing that pregnancy can and does have meaning for many people in many cases. (shrink)

In this paper I take up (what I call) the pregnancy loss objection to defenses of abortion that deny fetal moral status. Though versions of this objection have been put forth by others—particularly Lindsey Porter’s in a 2015 paper—I argue that the existing versions of the objection are unsuccessful in various ways: failing to explain the ground of moral considerability that would apply to embryos/fetuses in very early pregnancy, lack of clarity about what it means to take grief after miscarriage (...) seriously, and implausible implications regarding pre-embryo and infertility cases. I go on to offer a more plausible version of the objection, which I apply only to mid-pregnancy and fetuses, by drawing on personal narratives of later pregnancy loss and abortion and emphasizing practices that indicate the relevant kind of mourning. I then take up the question of how experience of the sort I have in mind can function as evidence, by situating my version of the objection in a pragmatist ethical view. Finally I consider and respond to some worries about the very idea of taking experience of pregnancy loss to be evidence regarding fetal moral status. (shrink)

In this article, I seek to address an aspect of the general inattention to miscarriage by examining a pressing topic: the moral meanings of pregnancy loss. I focus primarily on the import of such meanings for women in their ethical relationship with themselves, while also finding significant the meaning of miscarriage in community, that is, for our shared moral lives. Exploring miscarriage as a moral phenomenon is critical for figuring out miscarriage’s impact on our ethical self-conception—on how we understand ourselves (...) as moral agents—and in forming and deforming how we understand one another in the broader context of our moral communities—in intimate realms, in public realms, and in various realms in between. -/- I begin by articulating the need for a dedicated perinatal ethics, then developing an overview of this approach. It is against this backdrop that miscarriage’s complex moral meaning can best emerge. I then consider a few promising yet problematic concepts for comprehending the moral meanings of miscarriage, including moral agency, reactive attitudes (in this case, betrayal and guilt), moral responsibility, and moral standing. (shrink)

Abortion remains a controversial topic, with pro-life and pro-choice advocates clashing fiercely. However, public polling demonstrates that the vast majority of the Western public holds a middle position: being in favour of abortion but not in all circumstances nor at any time. The intuitions held by the majority seem to imply a contradiction: two early foetuses at the same point in development have different moral statuses. Providing coherent philosophical grounding for this intuition has proved challenging. Solutions given by philosophers such (...) as Feinberg, Harman and Räsänen are complex and do not fully account for the lived experience of pregnancy loss. This article argues for a relational ontological construction of human personhood as the basis of foetal personhood. This approach takes seriously the literature of pregnancy loss and the lived experiences of pregnant persons. Focusing on the manner in which persons relate to early foetuses (especially pregnant persons), provides a coherent ground for distinct foetal value. Importantly, this approach is both simple and intuitive. Therefore, it can be more easily adopted by middle. To counter an implied equality of human relationality, the article argues for a clear hierarchy based on relational proximity that affirms pregnant persons? primary role in deciding the moral significance of foetal termination. (shrink)

In this essay, I analyze pregnancy loss from a feminist phenomenological perspective. I draw upon relational accounts of personhood wherein a person's status and identity are formed through a lived history and the activity of “calling into personhood” a being a woman may seek to know or become. I draw upon the work of Simone de Beauvoir, who advances a feminist phenomenology that grounds the status and identity of women within embodied situations. Her important work sheds light on the varied (...) perceptions and processes that inform experiences of pregnancy and pregnancy loss. (shrink)

The placenta has played an important role in feminist theories of subjectivity; however, the placenta of feminist theory has been the fully functional placenta of what is considered a successful full-term pregnancy. Pregnancy loss, a topic that has been generally overlooked within feminist scholarship, is absent from feminist theories of the placenta. This article uses early placental development, particularly development that takes place before the placenta becomes fully functional as an organ for hormone production and interchange, as a space through (...) which to consider theorising subjectivity, reproduction and relation through pregnancy loss. In so doing, I argue that turning our attention to the placenta’s early development, regardless of outcomes, allows us to reimagine the role of process for feminist theories of subjectivity while also making room for a wider array of pregnancy outcomes, reinvigorating our ability to think about relations and models of hospitality that do not end as we might imagine. (shrink)

Many accounts of the morality of abortion assume that early fetuses must all have or lack moral status in virtue of developmental features that they share. Our actual attitudes toward early fetuses don’t reflect this all-or-nothing assumption: early fetuses can elicit feelings of joy, love, indifference, or distress. If we start with the assumption that our attitudes toward fetuses reflect a real difference in their moral status, then we need an account of fetal moral status that can explain that difference. (...) I argue that we can have or lack relational obligations to early fetuses in light of our own activities or choices, independent of the fetus’s own features or properties. Those relational obligations make the early fetus morally considerable to the persons who stand in a moral relation to it. Pregnant persons (and other participants in the procreative process) can come to have relational obligations to an early fetus just in virtue of their own decision to create a person, either by intentionally getting pregnant or by deciding to continue a pregnancy. That decision not only makes it appropriate for them to care about the fetus, but it also generates obligations to the fetus that they didn’t have before that decision. (shrink)

Despite significant efforts to support those bereaved by intrauterine death, they remain susceptible to avoidable psychological harm such as disenfranchised grief, misplaced guilt, and emotional shock. This is in part because the words available to describe intrauterine death—“miscarriage,” “spontaneous abortion,” and “pregnancy loss”—are referentially ambiguous. Despite appearing to refer to one event, they can refer to two distinct events: the baby’s death and his preterm delivery. Disenfranchised grief increases when people understand “miscarriage” as the physical process of preterm delivery alone, (...) for this obscures the baby’s death and excludes non-gestational parents, such as the father. Additionally, focusing on the delivery reinforces the mistaken idea that a gestational mother bears responsibility for her baby’s death, increasing misplaced guilt. When these terms instead shift the focus to the baby’s intrauterine death rather than the preterm delivery, they can obscure the physically difficult and often traumatic experience women have when they deliver their dead children, leaving women shocked by preterm delivery’s physical reality. Given their outsized role in framing the bereaved’s experiences, and their duty to avoid harming their patients, healthcare practitioners in particular should take special care to discuss intrauterine death and preterm delivery appropriately with patients and their families. Changing language to describe intrauterine death and preterm delivery clearly and precisely helps mitigate disenfranchised grief, misplaced guilt, and shock, while also helping to reframe the social response to intrauterine death, making it more obvious why certain steps, such as allowing bereavement leave following an intrauterine death, promote healing. (shrink)