Breastfeeding advocates and global health agencies have been sounding alarms about the dangers of digital marketing practices of the formula-feeding industry. This study comprised a feminist discourse analysis of materials produced (blog, social media posts, comments) in a paid partnership between baby formula brand Enfamil and an influencer, Marilou Bourdon from Trois fois par jour. Our analysis reveals a sophisticated marketing campaign that co-opts feminist critiques of breastfeeding promotion discourse while carefully avoiding explicitly violating the International Code of Marketing of (...) Breast-milk Substitutes. Underlying this campaign is a rhetoric reliant on pathos to assuage maternal guilt and shame for feeding formula. (shrink)

For caregivers of minimally communicative individuals, providing support in the absence of clearly meaningful responses is ethically fraught. We conducted a secondary analysis of qualitative data from caregivers of individuals who are minimally communicative, including persons with advanced dementia and individuals in disorders of consciousness. Our analysis led to two central claims: (1) Personhood is a threshold concept that is situated, relational, and dynamic and (2) in circumstances in which personhood is difficult to judge, caregivers can “fill the gap” to (...) reach the threshold through a repertoire of strategies. Because personhood is in part an attribution from others, a situational loss of personhood does not preclude restoration, nor does it eliminate moral status. (shrink)

Male fertility–related mHealth (MFmHealth), including smartphone applications that allow men to test their fertility at home, is getting some attention now and then. In this commentary, I argue that MFmHealth technology has the potential to undermine established norms around male reproduction but cannot be examined using traditional individualist frameworks in bioethics. Instead, theoretical literature on the concept of vulnerability in feminist bioethics allow a theoretical alliance with critical studies of men and masculinities. Proposed benefits like empowerment, shared responsibility, and democratization (...) may justify disruptive innovation but may also obscure more fundamental ethical concerns about vulnerability and social justice. (shrink)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead to experiences (...) of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

For individuals pursuing medically assisted gender transition, gender-affirming surgical treatments, such as oophorectomy (removal of the ovaries) and orchiectomy (removal of the testicles), cause sterility, and gender-affirming hormone treatment with medications (i.e., testosterone and estrogen) may negatively impact infertility. The major United States (US) medical associations already endorse fertility preservation (FP) through cryopreservation (i.e., “freezing” egg and sperm) for transgender individuals. Despite these endorsements from the relevant medical societies, medical insurance coverage for FP remains very limited in the US. Given (...) the high out-of-pocket costs for FP services, fertility preservation remains financially out of reach for many transgender individuals who may desire it. We present an ethical justification for universal FP coverage for all transgender and gender diverse (TGD) individuals who request this option during medically assisted gender transition. First, we argue that gender-affirming medical care is analogous to other medical interventions and treatment regimens that compromise fertility, such as cancer care, and that both types of interventions need to be afforded the same medical benefits and assistance in pursuing fertility goals. Second, we argue that the lack of FP for transgender individuals contributes to the ongoing and profound transphobia and anti-trans bias that has been exacerbated in the past several years across the healthcare landscape in the United States. We argue that the provision of FP coverage for transgender individuals is necessary for clinicians and third-party payers to state their unequivocal support for TGD patients and their healthcare needs. (shrink)

Access to public healthcare services for Belgium’s undocumented migrants is regulated through a parallel, administrative procedure within the legal framework of Urgent Medical Aid. This imposes several constraints on their access to healthcare services. Drawing on empirical-ethical methodologies, we show how this procedure impacts on the relationship between patients with undocumented status and healthcare workers. We use the concept of relational autonomy to show how the imposed legal constraints reduce the formal treatment options available to healthcare workers, but simultaneously lead (...) to informal care practices, and how the latter increase the discretionary power of the healthcare workers. We argue that in this context, provision becomes unpredictable and arbitrary, with undocumented migrants tending to value strong personal relations with one particular, trusted healthcare worker. Although this leads to increased dependence, it also increases patients’ options and autonomy by providing access to wider professional networks attached to that healthcare worker. (shrink)

As a method of family formation, cross-border surrogacy is controversial and beset by risks of exploitation. This article extends the literature on surrogacy by examining the way Australian surrogacy promotion and information events represent cross-border surrogacy. It examines the emerging phenomenon of surrogacy events held by a not-for-profit surrogacy organization to promote cross-border surrogacy in Australia—a country that prohibits commercial surrogacy. The article draws on observations from a series of surrogacy events in Australia and online during the 2019–21 time period. (...) It examines the presentations given at these events by surrogacy facilitators, surrogate mothers, and intended parents. We observed four themes: (1) Intended parents are positioned as consumers, (2) the benefits of cross-border commercial surrogacy are highlighted relative to other methods of family formation, (3) the positive side of cross-border surrogacy is accentuated, and (4) reproductive rights are emphasized. These representations run counter to feminist framings of cross-border surrogacy as exploitative and risky. This paper understands that the framing of surrogacy that occurs at these promotion events to be neoliberal in nature. The conceptualization helps explain their consumerist peppiness and commodifying subjectivity. (shrink)

Synthetic biology (synbio) involves designing and creating new living systems to serve human ends, using techniques including molecular biology, genomics, and engineering. Existing bioethical analyses of synbio focus largely on balancing benefits against harms, the dual-use dilemma, and metaphysical questions about creating and commercializing synthetic organisms. We argue that these approaches fail to consider key feminist concerns. We ground our normative claims in two case studies, focusing on the public good, who holds and wields power, and synbio research projects’ particularity (...) and context. Attention to feminist concerns is essential for synbio to realize its potential in ethically justifiable ways. (shrink)

An important argument against removing donor anonymity is that such state-mandated policies might validate bionormative attitudes about the importance of genetic relatedness in families. Bionormative attitudes can be unjustly disparaging and harmful to a wide range of families including donor-conceived, adopted, and single-parent families. However, studies show that the majority of donor-conceived individuals want donor anonymity removed. This paper explores the question of how to weigh these desires for knowing the donor—which may be grounded in biased and bionormative assumptions—against the (...) competing concern that removing donor anonymity perpetuates attitudes that may be harmful. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Abortion to Abolition: Reproductive Health and Justice in Canada by Martha PaynterRebecca Simmons (bio)Abortion to Abolition: Reproductive Health and Justice in Canada by Martha Paynter Winnipeg, MB: Fernwood Publishing, 2022Martha Paynter's Abortion to Abolition: Reproductive Health and Justice in Canada is a bold, ambitious work that seeks to not only catalog Canada's meandering and often backtracking path toward reproductive justice, but to act as a manifesto for Paynter's (...) own ideas and goals for reproductive justice. The book takes the form of an anthology of stories, divided into chapters, that are grouped according to a certain right; for example, the right to bodily autonomy. This format effectively guides the reader from abortion to abolition. Paynter adroitly starts the book with white feminist favorites such as bodily autonomy and not having children. Then she logically progresses to more radical ideas such as parenting in prison and the total abolition of prisons. The stories in this book are accompanied by warm, colorful illustrations by Julia Hunt. These drawings help the reader visualize the person behind the story and the very real life that was affected by reproductive law and/or social norms. Paynter holds a PhD in nursing, and it is from this background that she writes, seeking to educate nurses and other healthcare professionals alongside a broader readership garnered through her clear, approachable writing style.Chapter 1 introduces the reader to many of the book's key themes by considering the right and need to have bodily autonomy, and the multiple ways this manifests itself in ordinary (and less-ordinary) life. Paynter considers the disparate stories of five women, all fighting in some way for bodily autonomy. The stories cover events of gender-based gun violence, sexual assault, transgender rights in prison, the legalization of sex work, police violence, and institutional racism. Each story recounted by Paynter catalogs tragedies and injustices with blunt and brutal honesty—perhaps to an unnecessary extent. Every horrific fact is laid bare for the readers as they uncover the intricacies of gender-based, imperialist, and racist violence. Paynter has chosen these stories to display the multitude of ways in which people—especially Black, Indigenous, people of color (BIPOC) and minoritized genders—can be willfully wronged by the state and [End Page 209] the criminal justice system, such that the reader must begin to confront the fact that these structures don't seem to exist to benefit or protect the most marginalized in society.Chapter 2 approaches the right not to have children through a number of stories related to contraception, abortion, and family planning. Paynter sketches some of the key points in Canada's journey toward the decriminalization of abortion, from paradoxical trailblazers, such as Dr. Emily Stowe in the 1800s, to the viral memefied content of art protestor iamkarats. While the unequivocal legality of abortion in Canada suggests incredible progressiveness and support for women's rights, Paynter paints a more complex picture through her chosen narratives. Crucially, the inequitable geographical access to abortion, in particular, throughout the huge landmass of Canada suggests that the right to not have children in Canada is not universal. Moreover, Paynter suggests that access is also bounded by financial constraints, finite public funding, and the limited availability of inclusive clinics that prioritize healthcare for LGBTQ2S+ people.Chapter 3 considers the topic of having children; in particular, the right to reproductive technologies and freedom from forced sterilization. Paynter quickly makes clear that while many white feminists might see having and not having children as diametrically opposed, they are two equally essential parts of reproductive justice. Paynter draws attention to the Sexual Sterilization Act of 1928 that was only overturned in 1972. She describes it as part of the "genocidal colonial project" (84), a collection of laws and policies aimed at fulfilling eugenicist, neoimperial ideals of increasing production of the white "race" and promoting the genocide of Indigenous peoples. Furthermore, Paynter argues that evidence of forced sterilization of Indigenous peoples, and other physical violence and neglect, persists to the present day and must be stopped and reparations made for previous harms. Paynter then considers the complex, often-debated case of commercialized surrogacy, which she defines... (shrink)

This article focuses on a resonant debate initiated by the publication of Judith Jarvis Thomson’s groundbreaking article “On Defense of Abortion” in 1971. It is my contention that philosophers who argued against Thomson based on what has come to be called the “Responsibility Objection” did not fully examine the gender assumptions embedded in their logic. Rather than attempt to prove the flaw in the Responsibility Objection directly, I demonstrate it by applying the same logic used to discuss women’s responsibilities to (...) men to prove that it also supports forcing men to get a vasectomy. What I show is that the Responsibility Objection, when no longer clothed in a set of gendered assumptions, is not logically convincing. Further, given that the Responsibility Objection supports the logic the U.S. Supreme Court recently relied on in Dobbs vs. Jackson Women’s Health in overruling Roe vs. Wade, the examination of the flaws in this logic is timely and important. (shrink)

At healthcare facilities worldwide, women during childbirth undergo medical procedures they haven’t consented to and experience mistreatment and disrespect. This phenomenon is recognized as obstetric violence (OV), a distinct form of gender violence. The resulting trauma carries both immediate and long-term implications, making it vital to address for promoting women’s health. OV is partly shaped by a narrow, paternalistic conception of vulnerability. A flawed conception of the vulnerability of pregnant women and fetuses has opened the door to medical control and (...) coercion during childbirth. In this paper we examine what role notions of vulnerability play in perpetuating OV and consider recent attitudinal shifts in research ethics as a model for addressing it. (shrink)

This paper aims to problematize pregnancy and support the development of a safe alternative method of gestation. Our arguments engage with the health risks of gestation and childbirth, the value assigned to pregnancy, as well as social and medical attitudes toward women’s pain, especially in labor. We claim that the harm caused by pregnancy and childbirth provides a prima facie case in favor of prioritizing research on a method of extra corporeal gestation.

In lieu of an abstract, here is a brief excerpt of the content:Significant Interests and the Right to KnowReuven Brandt (bio)1. IntroductionDaniel Groll's book Conceiving People (2021) attempts a novel and insightful defence of why individuals ought to choose open over anonymous gamete donation, barring any special circumstances. In broad strokes, the overall argument proceeds by defending three main claims: (1) that failing to disclose to children that they are donor-conceived is morally problematic, (2) that children who are informed that (...) they are donor-conceived (either intentionally by their social parents or otherwise) are likely to have a worthwhile, significant, subjective interest1 in having knowledge about their gamete donor(s), and (3) that parents have a duty to advance their children's worthwhile subjective significant interests. Groll's account departs from other criticisms of anonymous gamete donation in that it does not rest on the view that knowledge about one's genetic progenitors is essential to self-knowledge, identity formation, or other elements of wellbeing for creatures like us. The view thus attempts to avoid the pitfalls plaguing other criticisms of anonymous gamete donation, which tend to rely on controversial (and likely false) claims of genetic essentialism and/or genetic exceptionalism.Groll's thesis rests on the much more modest (and likely correct) claim that seeking information about one's genetic progenitors is one of many permissible, fruitful, and valuable routes to identity formation. According to Groll, it just so happens that a large portion of donor-conceived individuals aware of the absence of biological ties to one or more social parents choose this route to identity formation. And this empirical fact combined with plausible views about parents' obligations to promote their offspring's wellbeing gives prospective pro-creators strong reason to choose open donors over anonymous donors.Although many aspects of the picture Groll paints are attractive, I remain unconvinced that the overall argument succeeds. My criticism of the argument is multipronged. I am skeptical that failing to disclose to a child that they were donor-conceived and/or failing to disclose information to a child that they are [End Page 201] likely to find important violates the parental duty to build intimate relationships with one's offspring. This shifts the force of Groll's argument to the empirical claim that donor-conceived children are likely to have a significant subjective interest in knowing information about their biological relations. As I will show, the empirical evidence for this claim is not as strong as Groll presumes. In the absence of a deontic argument for disclosure, Groll must provide more robust empirical evidence that anonymous gamete donation is likely to result in off-spring with their weighty interests frustrated, or else argue that the risk is not worth taking. These are not fatal flaws but show that more empirical and normative work needs to be done to defend this line of argument.A more serious set of worries arise in response to Groll's claim that the interest that donor-conceived individuals have in genetic information is likely to be significant. Little is said about what constitutes a significant interest, except that interests fall along a linear spectrum and that the significance of an interest is a factor of "the space, so to speak, it takes up in a person's mental economy (do they think about it a lot?) and the extent to which they organize their lives around it" (2021, 63). My worries here are three-fold. First, it is unclear whether the empirical data support the claim that donor-conceived individuals are likely to have an interest in genetic knowledge that is significant in the sense that it occupies a large portion of their mental energy and is a locus around which they organize their lives. Second, there is scant discussion about whether an interest can become morally problematic (and so no longer worthwhile on Groll's account) if it is given too much weight. I will argue that a plausible reading of Groll's account requires that we treat overvalued interests as no longer worthwhile. Consequently, Groll's argument risks presuming the kind of genetic chauvinism—the view that genetic knowledge is essential to wellbeing—that he seeks to reject. Third, if... (shrink)

Healthism and ableism intertwine through an imperative of normalcy and the ensuing devaluing of those who fail to meet societally dominant norms and expectations around “normal” health. This paper tracks the effect of that imperative of normalcy through current research into gut microbiome therapies, using therapies targeting fatness and autism as examples. The complexity of the gut microbiome ought to encourage us to rethink our conception of ourselves and our embeddedness in the world; instead, the microbiome is transformed into one (...) more tool for controlling unruly bodies and minds. (shrink)

Abstract:The experience of chronic pain can disrupt an understanding of oneself in terms of ability and possibility. In response, the pain sufferer needs an understanding conversation partner to help reinterpret their sense of self. Yet women in pain often encounter neglect, disbelief, or worse in today's medical institutions. They may end up seeking the authoritative pronouncement of a diagnosis rather than a partner in recovery. We must develop new language and new relationships within the medical field for helping women in (...) pain renegotiate their self-understanding and reinvigorate their engagement with the world and others through dialogue and play. (shrink)

Responses to Brad Skow, Reuven Brandt, Camisha Russell and Amanda Roth's commentaries on *Conceiving People*.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Diagnosing Desire: Biopolitics and Femininity into the Twenty-First Century by Alyson K. SpurgasTheodora K. Hurley (bio)Diagnosing Desire: Biopolitics and Femininity into the Twenty-First Century by Alyson K. Spurgas Columbus: The Ohio State University Press, 2020What are the stakes of research on women's sexuality? Alyson K. Spurgas takes on this deceptively straightforward question with an impressive examination of scientific research on women's sexuality and subsequent treatments for women with (...) low sexual desire. The result, Diagnosing Desire: Biopolitics and Femininity into the Twenty-First Century, merges analysis of clinical sex research and therapeutic discourses, data from interviews with women who consider themselves to have low sexual desire, and a wealth of critical theoretical perspectives on embodiment, sexuality, and disability. This investigation of scientific approaches to women's sexuality hinges on Spurgas's concept of the "feminized responsive desire framework," which integrates several components of "expert" information on women's sexuality: the prominence of research into the "discordance" between women's externally monitored and self-reported arousal; a receptive model of feminine sexuality in which arousal precedes sexual desire; the recent inclusion of female sexual interest/arousal disorder (FSIAD) in the DSM-5; and a suite of therapeutic interventions aimed at rehabilitating women's deficient or discordant sexuality, including mindfulness-based sex therapy. Spurgas's analysis of this multipronged framework for understanding women's sexuality innovatively considers how laypeople internalize and contend with scientific ideas, how sexological and sex therapeutic discourses contribute to neoliberal mandates of bodily improvement, and how scientific discussions of women's sexuality neglect questions of power and trauma.Spurgas opens the book with an incisive examination of how early ideas in sexology, behaviorism, evolutionary psychology, and the sex therapies they inspired framed women's sexuality as inherently responsive, fluid, and restrained. Following sexological discourses into the twenty-first century, chapter 2 examines how contemporary sex researchers and therapists argue that women's desire responds to or follows arousal. With an eye toward governmentality and selfoptimization, Spurgas considers how contemporary sex research paradigms and [End Page 232] therapeutic interventions deliver a new normative model of women's sexuality "based on receptivity, responsiveness, and a willingness to be seduced or coaxed into sex by an initiating male partner" (91). Spurgas's close reading of sexological texts provides a detailed view of the feminization of responsive desire. These texts, however, speak less clearly about why some researchers and practitioners consider the model of feminine sexual receptivity to be "feminist," as the book argues. Despite locating the responsive desire framework within regimes of gender difference and neoliberalism, the book leaves unanswered questions about how the framework fits into larger trends in neoliberal feminism (Rottenberg 2018). Despite this specific underdeveloped claim, these chapters shine in their close readings of texts produced by sex researchers and therapists, and indeed provide a template for how social science scholars might analyze scientific research articles and paradigms.The second half of the book considers how women who report low sexual desire interact with these expert ideas about their sexuality. Tracking how women come to understand their sexual desires and experiences through the prism of scientific and therapeutic discourses (what Spurgas calls "sexual difference socialization"), Diagnosing Desire argues that these discourses construct a population of "women-with-low-desire" and encourage low-desiring women's sexual rehabilitation—and compulsory sexual performance—in service of their partners, who are typically straight cisgender men. Turning the biomedical model of receptive feminine sexuality on its head, chapter 5 considers the pleasures and possibilities of agentic feminine receptivity through sexual submission. In a stirring conclusion, Spurgas insists that models of receptive feminine sexuality paint over the violence, trauma, and power relations that permeate women's experiences of sexuality, calling instead for community-based forms of care that supersede the individualistic foci of current sex research and treatment programs.Throughout the monograph, Spurgas maintains theoretical dialogues with critical lineages including feminist science studies, queer studies, and disability and madness studies; the breadth and richness of theoretical conversation allow Spurgas to robustly contribute to several areas of scholarship. Perhaps most centrally, the book offers a rare view of how patients and would-be patients internalize, modify... (shrink)

We argue the dearth of research on elite ciswomen athletes’ reproductive health is because athletics remains associated with masculinity, and female athletes therefore do not adhere to normative femininity and motherhood. In choosing a masculine career, it is assumed that elite athletes will reject other feminine activities, such as motherhood. We further argue that female athletes are considered especially ineligible for motherhood because their career choice violates normative motherhood by engaging in “risky” behavior (i.e., physical activity). By continuing with their (...) career, athletes are accused of being “bad” mothers by not adhering to the gender norm of mothers as self-sacrificing. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the Symposium on Daniel Groll's Conceiving PeopleAlice MacLachlan (bio)The ethics of donor conception is often framed as a straightforward clash of rights: the right of would-be parents to procreate and parent, the right of donor-conceived children to know and be raised by their genetic parents, and the right of gamete (sperm and egg) donors to privacy. But in this thoughtful, wide-ranging discussion of Daniel Groll's book Conceiving (...) People: Genetic Knowledge and the Ethics of Sperm and Egg Donation (2021), the ethical terrain is revealed to be far richer and more intricate. As contributor Camisha Russell puts it, the book attends to "the types of relationships that foster the emotional health of families" while remaining grounded in "the experiences and desires articulated by donor-conceived people themselves" as well as those who contribute to their creation and to their family. As a result, the pieces in this symposium not only take up crucial questions of genetics, identity, and bionormativity, they also ask what it means to frame family relationships as a philosophical problem—conceptual, ethical, and, ultimately, political.Groll's central claim is that those who intend to create a child using donated gametes should choose a donor whose identity will be available to the resulting child. This is not because, as David Velleman (2005) and others have argued, knowledge of one's genetic parentage is fundamentally important in some objective sense. Rather, Groll argues that whether such knowledge is actually important, donor-conceived children are likely to come to view it as crucial—developing what Groll calls a "significant interest" in knowing their donor's identity. Further, parents ought to help satisfy their children's significant interest assuming it is not morally problematic. This line of argument places Groll squarely in the realm of what feminists and anti-racist philosophers describe as "theorizing the non-ideal" (Tessman 2009); that is, making philosophical arguments that take as their starting point the world as it is, including the realities of social injustice. Following Charlotte Witt, Sally Haslanger, and other feminists, Groll acknowledges the dominance of the "bionormative conception of the family" (Witt 2014). He considers whether interest in knowing one's genetic parentage might express bionormative prejudice but concludes that, even if it does, [End Page 163] "interest in genetic knowledge can—in our world—be rationally grounded apart from the oppressive schema it is embedded in" (Groll 2021, 149). He further concludes that given a prospective child's likely significant interest in their genetic parentage, would-be parents ought to use an open (i.e., non-anonymous) donor. At the same time, he argues that there are good reasons to disrupt the bionormative schema on both a personal and policy level that may lead to a child's significant interest in the first place.If Groll walks the middle ground in this debate, his critics in this symposium are happy to turn his stroll into a balancing act. Both Reuven Brandt and Amanda Roth challenge Groll's significant interest approach. Brandt questions the extent to which parents owe children a truthful, detailed accounting of their origin, making the case for parental privacy. Roth questions whether the interest in genetic knowledge is rationally grounded beyond bionormative prejudice, offering as a counterexample the offspring of same-sex parents, raised in queer communities of largely nontraditional family configurations. Bradford Skow pushes from the opposite direction, challenging both the claim that bionormative prejudice is at work in the interest in genetic knowledge and, more broadly, that the so-called bionormative conception of the family has the prestige that Groll and others attribute to it in the first place.Also, Amanda Roth and Camisha Russell pressure Groll to go further in considering the nonideal circumstances in which families are formed and theorized. They specify that questions of family configuration and validity are not only conceptual and ethical, they are political. Roth challenges Groll to further consider the example of same-sex and other LGBTQ+ families as disruptive exemplars and recognize that there may be reasons to choose anonymous donation that he has not considered. She highlights the value of solidarity across families and resistance to the forces... (shrink)

In this paper, I consider how trust affects the decisions of men who have sex with men (MSM) around using pre-exposure prophylaxis (PrEP) as HIV prevention in their sexual and romantic relationships, and how the use of PrEP affects their relationships with healthcare providers. MSM have to trust their sexual and romantic partners as well as their healthcare providers for PrEP to be successful as a relatively new HIV prevention strategy. This trust includes both interpersonal trust and institutional trust and (...) it is complicated by different kinds of relationship dynamics and the history of prejudice against MSM in healthcare institutions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Anonymous Versus Open Donation and Queerness as Political:Comments on Groll's Conceiving PeopleAmanda Roth (bio)1. IntroductionIn this commentary on Daniel Groll's 2021 book Conceiving People: Genetic Knowledge and the Ethics of Sperm and Egg Donation, I examine a number of the book's major themes, especially around the idea that donor-conceived children have a significant interest in genetic knowledge and therefore, donor-conceiving parents are morally required to use an open donor.1 (...) I point to some concerns about Groll's case for this view and, in doing so, highlight the way in which taking up an LGBTQ+ perspective complicates and undermines the case against anonymous donation. The major theme of my comments is that the open versus anonymous decision is not merely an ethical decision, but a political one.My comments are organized around a few of the book's major themes, so I'll begin with laying out the most relevant themes in some detail. I then take up four points to consider in more depth. In so doing, I'll be drawing on my own scholarly perspective on issues of nontraditional reproduction, which is informed by my own social positionality in relation to family matters; this means that I (not so subtly) bring a queer perspective to the discussion of Groll's book. The through-line of my comments is this: While I agree with and appreciate much of Groll's approach, I want to stress the sense in which gamete donation is not just an ethical issue, but a political one, given its implication in bionormativity (and heteronormativity). I wonder if a deeper acknowledgment of the political nature of the issues might lead to moral conclusions that are different from those that Groll comes to, even assuming similar ethical values as starting points.2. Groll's major claims(1) Claim 1: Disclosure to donor-conceived offspring—in the usual case at least—is morally required given the intimacy argument: [End Page 166]The intimacy argument suggests that keeping "the secret" about donor conception involves intentional deception and undermines the proper intimacy of parent-child relationships (Groll 2021, 36–49).(2) Claim 2: Anonymous donor conception is (generally) morally impermissible because of the significant interest view.Donor-conceiving parents can reasonably foresee that their children will likely develop a significant interest in genetic knowledge. Significant interests "matte[r] quite a lot to the person who has [them]," "tak[e] up a space … in a person's mental economy" and/or "pla[y] a structuring role in a person's life and self-conception" (Groll 2021, 62–3). But not all donor-conceived people take such an interest in genetic information, and this information is not necessary for identity construction or psychological wellbeing (Groll 2021, 58, 61).2 Rather, multiple routes to self-identity exist, the genetic route being one among the options. Moreover, one needn't experience any loss in not taking this route; however, for those who take it up, genetic knowledge is objectively valuable and nonfungible (Groll 2021, 81–9). This is because genetic knowledge is uniquely relevant to the identity-related question "Who am I?" (Groll 2021, 112–3).3Groll argues that donor-conceiving parents should assume that their child will form such an interest because this is empirically a "good bet." Further, significant interests—at least when they are worthwhile (that is, not trivial and not morally objectionable)—are connected to one's wellbeing by the wellbeing principle: In satisfying a non-instrumental significant worthwhile interest, one's life goes better (Groll 2021, 62). It follows, then, that parents ought to choose open donors since (to simplify) parents are obligated to promote their children's wellbeing (ibid).4Counter to what one might expect, Groll does not take his ethical case against anonymous donor conception to justify prohibition of the practice. This is because wronging children in this way is within the realm of (unethical) choices we allow parents to make without societal interference.5 Moreover, to aim regulation at anonymous donor conception could reinforce bionormativity and target already marginalized families for special negative attention (Groll 2021, chapter 8).(3) "Claim" 3: Groll's own personal... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Being the Right Kind of Parent:Conceiving PeopleCamisha Russell (bio)Daniel Groll's Conceiving People makes one central claim regarding the ethics of using egg or sperm donations to create a child (that one intends to parent): "[P]arents should use an open donor because doing so puts their resulting child in a good position to satisfy the child's likely future interest in having genetic knowledge" (Groll 2021, 12, original italics).Amid myriad thorny (...) ethical questions surrounding assisted reproduction, Groll's decision to focus on a choice that intended parents in need of donor gametes must make before their future child is even conceived—a choice that is typically taken very seriously—makes a lot of sense. The question is live, rarely completely determined as a matter of policy or law, and, as Groll demonstrates, important to most donor-conceived people (and therefore to the families of which they are a part). For this increasing number of individuals and families, a cultural shift in how we think about open versus anonymous donors would have a significant (and as Groll argues, positive) impact.Groll's carefully built argument is important not only for the paths of ethical reasoning that it highlights, but for those common rationales it gently but firmly sets aside (e.g., the donor-conceived person's medical need to know their genetic history or the idea that knowledge of one's genetic origins is the best or only way to truly know oneself). Groll's work is attentive to the types of relationships that foster the emotional health of families, and it's grounded in the experiences and desires articulated by donor-conceived people themselves. For this reader, these are the book's greatest strengths, along with the fact that Groll is often quite funny in his examples, which makes the examples highly relatable.Of course, the challenge for philosophers in writing books of ethical importance for "laypeople" is to offer something an average educated adult can understand while addressing the more technical theoretical issues that matter to ethicists. I would expect Groll's text to satisfy ethicists because his definitions and distinctions are scrupulously clear, and he engages the existing philosophical literature well. As for laypeople, there are surely a few moments in which they will find themselves in the theoretical weeds, so to speak, but Groll has [End Page 193] successfully made the book largely modular, such that they should get a lot from just reading the chapters of direct interest (Groll 2021, 29).Chapter 2, "Keeping Secrets," is essential for intended parents seeking ethical guidance. Groll notes that professional opinion on donor conception has shifted from seeing nondisclosure of a child's donor-conceived status as a moral requirement (to protect privacy and avoid family stigma) to recommending disclosure. He then reviews standard arguments for disclosure: (1) the "profound importance" of known genetic origins to health identity formation, (2) the medical importance of knowing to whom you are (and are not) genetically related, and (3) the harm that keeping secrets can do to family members and family functioning. While Groll agrees with the latter two arguments, he introduces and emphasizes a new argument: the Intimacy argument, in which he convincingly argues that keeping a child's genetic origins secret "violates norms of intimacy by creating distance between parents and children that is at odds with the demands of intimacy in the parent-child relationship" (Groll 2021, 44, original italics). Though, in many ways, this chapter's argument is separate from the central argument for the use of open donors constructed in the rest of the book, I find it compelling and wonder whether it could hold up more of the open donor argument, placing less weight on the Significant Interest view that Groll introduces in the next chapter (and the concerns regarding bionormativity that emerge from that view).In the third chapter, Groll moves from disclosure to the information that's available to be disclosed. That is, it is one thing to commit to telling a child they were donor-conceived after conception. It is another to commit before conception to choosing a donor willing to be known to the future child when... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Groll on Bionormativity and the Value of Genetic KnowledgeBradford Skow (bio)1. IntroductionShould people who plan to use donated sperm and/or eggs to conceive a child use an open donor who agrees ahead of time that any resulting children may be told who the donor is? In Conceiving People: Genetic Knowledge and the Ethics of Sperm and Egg Donation (Groll 2021), Daniel Groll answers yes. He argues that using an (...) anonymous donor would be wrong. Groll does not discuss adoption in detail, but his ideas also support the claim that people who adopt a child should adopt from parents who agree ahead of time that their child may be told who their biological parents are. It is not OK to have a closed adoption, in which information about the child's biological parents that would otherwise be public (for example, information on their original birth certificate) is kept secret by the government, and where (in some cases) the biological parents are promised that their children will never learn who they are. I was adopted in a closed adoption and met my biological family when I was twenty, and I think Groll's answer to his main question is right. That, however, does not mean I agree with all of his reasons. Here I examine those reasons and sketch some places where I would depart from them.2. The argument in outlineThe basic outline of Groll's argument, in simple terms, is as follows.1. If a child's knowing who their genetic parents are will likely benefit them—that is, if it will make their life go better, or increase their wellbeing—and if this is foreseeable, then that is a reason for parents to make the child's learning this possible (at some "appropriate" time).2. That knowledge will likely benefit the child …3.. … and this is foreseeable. [End Page 182]4. This reason favoring parents making genetic knowledge possible is strong enough that, except in maybe very special circumstances, parents should make this knowledge possible.The first point is hard to dispute. If the second point is true, then the third point is also plausible, since it is foreseeable that a child born from gamete donation (or an adopted child) will likely try to learn who their genetic (or biological) parents are. These searches are common and widely known to occur. Most of the action, therefore, is in the second point. Why think that knowing who your genetic or biological parents are is likely to make your life go better? Here the path diverges into a wood.3. First try: getting what you want makes your life go betterThe simplest way to argue that knowing who your genetic parents are is a benefit is to note that many, if not most, people conceived through gamete donation (or adoption) will, at some point, want—intensely want—to know who their genetic (or biological) parents are. One can then appeal to the idea that getting what you want makes your life go better, other things being equal.1Groll does not like this justification. His objection is that it does not show "that there is anything resembling a deep connection between genetic knowledge and well-being" (Groll 2021, 65). On Groll's view, knowing who your genetic (biological) parents are is a benefit, but this is not simply because it is something you want to know. I might know ahead of time that my child will want to live in a red house, and they might therefore be better off if they get to, and I might do my best to make that possible; but the reason I have to make genetic knowledge available to them is much stronger and much weightier than my reason to help them live in the right colored house. (It may be that this is where the fourth point of the argument, about the strength of reasons, comes in.)So why is the reason to provide genetic knowledge stronger? Groll, I think, holds that some things are more worth wanting than others. Getting what you want may benefit you, but getting what you want when what you want is something... (shrink)

Unconsented pelvic exams under anesthesia are assaults cloaked in defense of healthcare education. Preemptive linguistic qualifiers “presumed” or “implied” attempt to justify such violations with flippancy toward their oxymoronic implications: to suggest a priori that consent can be assumed undermines its otherwise standalone social, ethical, and medico-legal reverence. In this paper I conceptualize “medical sexual assault” and argue that presumed consent for intimate exams exemplifies its definition. By bluntly describing pelvic exams as “penetration,” this work aims to reify the intimate (...) reality of the clinical label “pelvic exam” and to call attention to cisheteronormative and androcentric assumptions involved in its practice. Additionally, this scholarship seeks to create a foundation toward broader work in conceptualizing clinical rape culture. Given recent national survey data indicating a surprising frequency of unconsented intimate exams, detailed language as to their problematics is necessary for ongoing legal and ethical efforts. Explicit consent for intimate exams must be the standard of care for conscious and unconscious patients. (shrink)