This paper seeks to respond to some of the recent criticisms directed toward bioethics by offering a contribution to a “critical bioethics”. Here this concept is principally defined in terms of the three features of interdisciplinarity, self-reflexivity and the avoidance of uncritical complicity. In a partial reclamation of the ideas of V.R. Potter, it is argued that a critical bioethics requires a meaningful challenge to culture/nature dualism, expressed in bioethics as the distinction between medical ethics and ecological ethics. Such a (...) contesting of the “bio” in bioethics arrests its ethical bracketing of environmental and animal ethics. Taken together, the triadic definition of a critical bioethics offered here provides a potential framework with which to fend off critiques of commercial capture or of being “too close to science” commonly directed toward bioethics. (shrink)

With breakthroughs in science and reproductive technologies, “natural” birthing has undergone change due to the “assisted” use of conceptive technologies. Bodies and their parts have become commodities, to be sold and purchased in medical markets. In the literature, there have been numerous debates on commercialization and commodification, which have addressed the biopolitical and bioethical aspects of organ, egg and sperm donations, and gestational commercial surrogacy. This paper examines the everyday experiences of surrogates and egg donors, coerced and enticed into selling (...) their reproductive services, which become commodities for the larger medical markets of India's In Vitro Fertilization industry. Based on a qualitative study of 4 IVF clinics and 28 surrogates in a state capital city of a southern state in India, this paper addresses the issue of commodification of women's bodies, where the women from lower socio-economic families are either lured or pushed to respond to the demands of reproductive markets. However, legal gestational commercial surrogacy in India, without clear laws and regulations to guide it, is a complex issue and raises many bioethical concerns. This paper limits itself to addressing the commodification of surrogates’ bodies. (shrink)

Feminist criticism of health care and ofbioethics has become increasingly rich andsophisticated in the last years of thetwentieth century. Nonetheless, this body ofwork remains quite marginalized. I believe thatthere are (at least) two reasons for this.First, many people are still confused aboutfeminism. Second, many people are unconvincedthat significant sexism still exists and aretherefore unreceptive to arguments that itshould be remedied if there is no largerbenefit. In this essay I argue for a thin,``core'' conception of feminism that is easy tounderstand and (...) difficult to reject. Corefeminism would render debate within feminismmore fruitful, clear the way for appropriaterecognition of differences among women andtheir circumstances, provide intellectuallycompelling reasons for current non-feminists toadopt a feminist outlook, and facilitatemutually beneficial cooperation betweenfeminism and other progressive socialmovements. This conception of feminism alsomakes it clear that feminism is part of alarger egalitarian moral and political agenda,and adopting it would help bioethics focus onthe most urgent moral priorities. In addition,integrating core feminism into bioethics wouldopen a gateway to the more speculative parts offeminist work where a wealth of creativethinking is occurring. Engaging with thisfeminist work would challenge and strengthenmainstream approaches; it should also motivatemainstream bioethicists to explore othercurrently marginalized parts of bioethics. (shrink)

In this essay, I argue that pronatalism—a social bias in favor of gestational motherhood—and geneticism—a social bias in favor of genetic motherhood—are conceptually and operationally distinct social forces that influence some women's reproductive decision making. Each of these social forces shapes the reproductive landscape, relates differently to women's identities, and causes different social stigmatization and harm. Pronatalism and geneticism warrant feminist concern because they can compromise some women's reproductive autonomy and well-being. I suggest that combating pronatalism and geneticism will require (...) different sets of media, policy, education, and health care practice strategies. (shrink)

In this paper I examine the prevailing assumption that there is a right to procreate and question whether there exists a coherent notion of such a right. I argue that we should question any and all procreative activities, not just alternative procreative means and contexts. I suggest that clinging to the assumption of a right to procreate prevents serious scrutiny of reproductive behavior and that, instead of continuing to embrace this assumption, attempts should be made to provide a proper foundation (...) for it. I argue that the focus of procreative activities and discourse on reproductive ethics should be on obligations instead of rights, as rights talk tends to obfuscate recognition of obligations toward others, particularly those who bear the most significant burdens of the procreative process. I examine some possible foundations of a right to procreate as well as John Robertson’s thoughtful account of “procreative liberty” but conclude that at the present time there exists no compelling account of a right to procreate. Finally, I conclude that in the absence of a satisfactory account of a right to procreate, we should refrain from grounding practices or polices on the assumption that there is such a right. (shrink)

:This article reexamines the “prostitution objection” to paid surrogacy, and argues that rebuttals to this objection fail to focus on surrogates as embodied persons. This failure is based on the false distinction between “selling one’s reproductive services” and “selling one’s body.” To ground the analysis of humans as embodied persons, this article uses Kant’s late ethical theory, which develops the conceptual framework for understanding human beings as embodied selves. Literature on surrogacy commonly emphasizes that all Kantian duties heed to the (...) categorical prohibition to treat persons as mere means. What this literature leaves out is that this imperative commands us more specifically to engage ourselves and others as embodied persons. This article aims to relate this point to a specific issue in assisted reproduction. It argues that a Kantian account of human beings as embodied persons prohibits paid surrogacy on exactly the same grounds as it prohibits prostitution. (shrink)

This essay critically engages the work of John Harris and Jürgen Habermas on the issue of genetic engineering. It does so from the standpoint of women's embodied experience of pregnancy and parenting, challenging the choice–chance binary at work in these accounts.

An enduring ethical dispute accompanies prenatal screening and testing (PST) technologies. This ethical debate focuses on notions of reproductive choice. On one side of the dispute are those who have supported PST as a way to empower women’s reproductive choice, while on the other side are those who argue that PST, particularly when made a routine part of prenatal care, limits deliberate choice. Empirical research does not resolve this ethical debate with evidence both of women for whom PST enhances their (...) choices but also persistent evidence of recurrent problems between PST and women’s autonomous decision-making. While there have been attempts to remove challenges to reproductive choice, it has been argued that these challenges cannot be removed entirely. In this paper I provide a historical review of PST technologies’ development and in doing so provide a detailed insight into the root causes of this tension between the opposing sides of this debate. This historical account provides evidence that those who championed the early use of these technologies did so in order to achieve a number of wholly different goals other than women’s choice and empowerment. These different aims focus on scientific discovery and eugenic goals and, I argue, areirreconcilablewith women’s choice and empowerment. It thus may not be surprising that the resulting practice of PST continues to resist compatibility with women’s choice and empowerment. Ultimately, by understanding the historical foundations of PST we can more effectively assess how toreconcilewomen’s reproductive autonomy with routine prenatal screening. (shrink)

Currently, the preferred accommodation for conscientious objection to abortion in medicine is to allow the objector to refuse to accede to the patient’s request so long as the objector refers the patient to a physician who performs abortions. The referral part of this arrangement is controversial, however. Pro-life advocates claim that referrals make objectors complicit in the performance of acts that they, the objectors, find morally offensive. McLeod argues that the referral requirement is justifiable, although not in the way that (...) people usually assume. (shrink)

Currently, the preferred accommodation for conscientious objection to abortion in medicine is to allow the objector to refuse to accede to the patient’s request so long as the objector refers the patient to a physician who performs abortions. The referral part of this arrangement is controversial, however. Pro-life advocates claim that referrals make objectors complicit in the performance of acts that they, the objectors, find morally offensive. I argue that the referral requirement is justifiable, although not in the way that (...) people usually assume that it is. (shrink)

Reproductive technologies produce new babies and new bioethical concerns. This article analyzes how Danish infertile couples negotiate traveling to Spain for egg donation. Fertility travel is situated in light of Danish bioethical discourses, while feminist cultural analysis is used to understand how Spanish clinical discourses choreograph egg donation to involve an intimate and affective exchange between two like-minded women. The Danish travelers employ love and desire to naturalize transnational egg donation as well as anger and disappointment to invoke notions of (...) reproductive rights. The article concludes that empirical research on fertility travel opens up for discussion bioethical perspectives, such as those involving fair trade and reciprocity. (shrink)

This paper critically engages with how life not worth living (LNWL) and cognate concepts are used in the field of beginning-of-life bioethics as the basis of arguments for morally requiring the application of preimplantation genetic diagnosis (PGD) and/or germline genome editing (GGE). It is argued that an objective conceptualization of LNWL is largely too unreliable in beginning-of-life cases for deriving decisive normative reasons that would constitute a moral duty on the part of intending parents. Subjective frameworks are found to be (...) more suitable to determine LNWL, but they are not accessible in beginning-of-life cases because there is no subject yet. Conceptual and sociopolitical problems are additionally pointed out regarding the common usage of clear case exemplars. The paper concludes that a moral requirement for the usage of PGD and GGE cannot be derived from the conceptual base of LNWL, as strong reasons that can be reliably determined are required to limit reproductive freedom on moral grounds. Educated predictions on prospective well-being might still be useful regarding the determination of moral permissibility of PGD and/or GGE. It is suggested that due to the high significance of subjective experience in the normativity of beginning-of-life bioethics, the discipline is called to more actively realize the inclusion of people with disabilities. This regards for instance research design, citation practices, and language choices to increase the accessibility of societal debates on the reproductive ethics of genetic technologies. (shrink)

In recent decades, the intertwining ideas of self-determination and well-being have received tremendous support in bioethics. Discussions regarding self-determination, or autonomy, often focus on two dimensions—the capacity of the patient and the freedom from external coercion. The practice of obtaining informed consent, for example, has become a standard procedure in therapeutic and research medicine. On the surface, it appears that patients now have more opportunities to exercise their self-determination than ever. Nonetheless, discussions of patient autonomy in the bioethics literature, which (...) focus on individual patients making particular decisions, neglect the social structure within which health-care decisions are made. Looking through the lens of disability and informed by the feminist conception of relational autonomy, this essay argues that the issue of autonomy is much more complex than the individualist model suggests. The social system and the ableist ideology impose various forms of pressure or oppressive power that can affect people’s ability to choose according to their value system. Even if such powers are not directly coercive, they influence potential parents’ decisions indirectly—they structure their alternatives in such a way that certain options are never considered as viable and other decisions must be made. This paper argues that, instead of only focusing on the individual act of decision-making, we need to pay attention to the social structure that frames people’s decision. (shrink)

Background: The availability of assisted reproductive technologies (ARTs) in the medical marketplace complicates our understanding of reproductive public policy in the United States. Political debates over ARTs often are based on fundamental moral principles of life, reproduction, and kinship, similar to other reproductive policies in the United States. However, ARTs are an important moneymaking private enterprise for the U.S. biotechnology industry. This project investigates how the U.S. states regulate these unique and challenging technologies as either moral policies or economic policies. (...) Methods: This study employs ordinary least squares (OLS) regression to estimate the significance of morality and economic policy variables on ART policies at the state level, noting associations between state-level political, economic, and gender variables on restrictive and permissive state-level ART policies. Results: Economic variables (reflecting the biotechnology industry) and advocacy for access to ART on behalf of infertility patients increase the chances of states passing policies that enable consumer use of ARTs. Additionally, individual ART policies are distinct from one another in the ways that morality variables increase the chances of ART regulations. Surprisingly, the role of religious adherence among state residents varied in positive and negative relationships with individual policy passage. Conclusions: In general, these results support the hypothesis that ART laws are associated with economic as well as moral concerns of the states—ARTs lie at the intersection of issues of life and reproduction and of scientific innovation and health. What is most striking about these results is that they do not follow patterns seen in the legislation of abortion, contraception, and sexuality in general—those reproductive policies that are considered “morality policy.” Similarly, economic variables are not consistently significant in the expected direction. (shrink)

Abstract It is common practice to regard participants in assisted and collaborative reproduction (gamete donors, embryologists, fertility doctors, etc.) as simply providing a desired biological product or medical service. These agents are not procreators in the ordinary sense, nor do they stand in any kind of meaningful parental relation to the resulting offspring. This paper challenges the common view by defending a principle of procreative responsibility and then demonstrating that this standard applies as much to those who provide reproductive assistance (...) in the form of medical services or gametes, as it does to coital reproducers or intending parents. Drawing on vocabulary from the common law tradition, I suggest that it may be helpful to refer to the various participants in assisted and collaborative reproduction (ACR) as accessories to procreation. Referring to the participants in ACR as accessories to procreation highlights the fact that these agents are not just providing medical services or products. They are participating in a supply chain designed to bring about new persons. I conclude by arguing that regulative standards in the fertility industry should be structured such that they permit, facilitate, and encourage agents to satisfy the requirements of procreative responsibility. Content Type Journal Article Pages 1-16 DOI 10.1007/s10677-011-9330-7 Authors Melissa Seymour Fahmy, Department of Philosophy, University of Georgia, 107 Peabody Hall, Athens, GA 30602, USA Journal Ethical Theory and Moral Practice Online ISSN 1572-8447 Print ISSN 1386-2820. (shrink)

There are three stages at which procreative outcomes can be prevented or altered: (1) prior to conception (2) during pregnancy and (3) after birth. Daniel Engster (Soc Theory Pract 36(2):233–262, 2010) has ably argued that plans to prevent or alter procreative outcomes at stages (2) and (3)—through abortion and adoption—introduce financial, physical, and emotional hardships to which women are disproportionately vulnerable. In this paper, I argue that plans to prevent or alter undesirable procreative outcomes at stage (1)—through contraception use—similarly disadvantage (...) women. I suggest that accounts proposing moral responsibilities to delay or permanently avoid procreation are insufficiently attentive to the methods through which undesirable procreative outcomes might be prevented and how such methods unfairly burden women. In conclusion, I propose several ways that men and women might more equitably share contraceptive responsibility. (shrink)

In this dissertation I examine ethical issues that concern fertility preservation (FP) technologies for women from a feminist perspective. FP technologies involve the removal, cryopreservation and subsequent storage of reproductive materials for future use. The aim of these technologies is to preserve the option of future genetic reproduction. FP technologies have been developed in the cancer context because infertility is one of the long-term side-effects of many cancers or cancer therapies. Many FP technologies are still experimental, but some technologies are (...) becoming available to healthy women who wish to guard against age-related infertility. Although FP technologies are expanding women’s reproductive options and benefitting some women by satisfying their desires for genetically-related children, these technologies pose numerous physical, emotional and financial risks to women. I maintain that a feminist examination of choice is necessary for the ethical provision of FP technologies within patriarchal contexts. My analysis begins by demarcating two oppressive social biases from one another: namely pronatalism and biologism. I argue that each of these biases can unduly influence women’s reproductive choices about FP technologies. I then consider how these biases might be identified and challenged in the FP decision-making context. I outline an ethical process of informed choice that is equipped to protect patient autonomy when such autonomy is threatened by these biases. I then consider whether the choice to use FP should be available to both women within and without the cancer contexts. I argue that both disease-related FP and age-related FP can be morally permissible. Finally, I consider whether there should be an upper age limit on women’s access to their stored reproductive materials. I argue that age can be morally relevant to reproduction and thus age limits on access to assisted reproduction are morally permissible. I conclude by suggesting how feminist insights might inform policies on FP technologies and related assisted reproductive technologies. In sum, my dissertation shows that a feminist analysis of choices about FP is essential for ensuring the ethical provision of FP technologies. (shrink)