A little more than a decade ago, a powerful short book appeared with what was then the provocative title: Rape Warfare: The Hidden Genocide in Bosnia‐Herzegovina and Croatia. It was written by Beverly Allen. In that book she introduced the term "genocidal rape" to describe rapes that were done as policy for the purpose of genocide by Serb military forces in Bosnia‐Herzegovina and Croatia in the early 1990s. This chapter examines the paradox that Allen articulated and places it in the (...) context of the general question of how war rape can be genocidal, whether aimed at pregnancy or not. Drawing on Allen's amazing insight that sperm so used can and should be regarded as a weapon of biological warfare, it discusses a way to show how rape aimed at enforced pregnancy could indeed be genocidal. (shrink)

Are pregnant women entitled to the same rights of self-determination and bodily integrity as other adults? This is the fundamental question underlying recent highprofile legal interventions in situations when pregnant women and healthcare staff do not agree on management options or appropriate behaviour. Courts on both sides of the Atlantic have sometimes answered that they are not, and the law has at times been manipulated to enforce compliance with medical recommendations. This book offers a comprehensive assessment of healthcare law as (...) applied to the unique situation of pregnancy. (shrink)

Women are routinely subjected to penetrating surveillance during pregnancy. On the surface, this may appear to flow from a cultural commitment to protect babies – a cultural practice of “better safe than sorry” that is particularly vigilant given the vulnerability of fetuses and babies. In reality, pregnancy occasions incursions against human rights and well-being that would be anathema in other contexts. Our cultural practices concerning risk in pregnancy are infused with oppressive norms about women’s responsibility for (...) class='Hi'>pregnancy outcomes and the demands of extreme self-sacrifice from women to protect their fetuses. Of particular concern is our culture’s willingness to enforce norms concerning risk during pregnancy using coercive measures including forced cesarean sections and criminal penalties for exposing fetuses to risk. This chapter will consider assaults on self-determination, bodily integrity and privacy inherent in such interventions, as well as the structural violence and “mangled pieties” that buttress such practices in our unjust society. (shrink)

The conflict between pregnant women freely using cocaine and the well-being of fetuses presents a difficult social problem. Since 1985, at least 200 women, in thirty states, have been criminally prosecuted for using illicit drugs or alcohol during pregnancy. Such policies enjoy considerable public and political support. Nonetheless, treatment programs that include referral to law enforcement officials raise serious ethical and legal issues for hospitals and health care providers. In this paper, we assess the development of one medical university's (...) controversial treatment program for pregnant women addicted to cocaine.In October 1989, the Medical University of South Carolina instituted a new program, called the Interagency Policy on Management of Substance Abuse During Pregnancy, designed “to ensure appropriate management of patients abusing illegal drugs during pregnancy.” This program required some pregnant women to seek drug counseling and prenatal care under the threat of criminal sanctions. (shrink)

The conflict between pregnant women freely using cocaine and the well-being of fetuses presents a difficult social problem. Since 1985, at least 200 women, in thirty states, have been criminally prosecuted for using illicit drugs or alcohol during pregnancy. Such policies enjoy considerable public and political support. Nonetheless, treatment programs that include referral to law enforcement officials raise serious ethical and legal issues for hospitals and health care providers. In this paper, we assess the development of one medical university's (...) controversial treatment program for pregnant women addicted to cocaine.In October 1989, the Medical University of South Carolina instituted a new program, called the Interagency Policy on Management of Substance Abuse During Pregnancy, designed “to ensure appropriate management of patients abusing illegal drugs during pregnancy.” This program required some pregnant women to seek drug counseling and prenatal care under the threat of criminal sanctions. (shrink)

Objective Routine prenatal screening for Down syndrome challenges professional non-directiveness and patient autonomy in daily clinical practices. This paper aims to describe how professionals negotiate their role when a pregnant woman asks them to become involved in the decision-making process implied by screening.Methods Forty-one semi-structured interviews were conducted with gynaecologists–obstetricians and midwives in a large Swiss city.Results Three professional profiles were constructed along a continuum that defines the relative distance or proximity towards patients’ demands for professional involvement in the decision-making (...) process. The first profile insists on enforcing patient responsibility, wherein the healthcare provider avoids any form of professional participation. A second profile defends the idea of a shared decision making between patients and professionals. The third highlights the intervening factors that justify professionals’ involvement in decisions.Conclusions These results illustrate various applications of the principle of autonomy and highlight the complexity of the doctor–patient relationship amidst medical decisions today. (shrink)

January 2018, the American College of Obstetrics and Gynecology issued a position statement opposing the punishment of women for self‐induced abortion. To those unfamiliar with emerging trends in abortion in the United States and worldwide, the need for the declaration might not be apparent. Several studies suggest that self‐induced abortion is on the rise in the United States. Simultaneously, prosecutions of pregnant women for behavior thought to harm the fetus are increasing. The ACOG statement responds to both trends by urging (...) doctors to honor the integrity and confidentiality inherent in the doctor‐patient relationship. Seen in the context of the larger battle over legal abortion, the statement has far broader implications. By acknowledging the role doctors play in enforcing pregnancy‐related crimes, the ACOG position statement wisely anticipates the ways in which doctors will be implicated should access to legal abortion be further restricted. To understand the need for the ACOG directive, you must first understand that the story of what will happen if abortion becomes a crime in the United States is not to be found in history books; it is staring at us across our southern border. (shrink)

This paper argues that cyborg perspectives offer real possibilities for the debate around enforced caesareans and the search for a language to encompass embodied maternal subjectivity. It is suggested, with reference to the fictional narrative of Star Trek, that cyborg figures have the power to disrupt the liberal subject and the body in legal discourse, not least because the plethora of cyborgs challenges simple conceptions of connections/disconnections between bodies. Feminist readings of case law relating to enforced caesarean sections (...) have raised questions about the notion of autonomy at the heart of liberal legalism, have argued that law is complicit with white male techno-medicine's approach to childbirth and focused upon the pregnant woman's lived experience of pregnancy. The recent Court of Appeal decision in St George's Healthcare N.H.S Trust v. S., Regina v. Collins and Others, ex parte S., where the pregnant woman's self-determination was upheld, provides a good opportunity to confront both the liberal story and the idea of connectedness between mother and unborn child. (shrink)

It has become common to distinguish between altruistic and commercial contract motherhood (or ‘surrogacy’). Altruistic arrangements are based on the ‘gift relationship’: a woman is motivated by altruism to have a baby for an infertile couple, who are free to reciprocate as they see fit. By contrast, in commercial arrangements both parties are motivated by personal gain to enter a legally enforceable agreement, which stipulates that the contract mother or ‘surrogate’ is to bear a child for the intending parents in (...) exchange for a fee. She is required to undergo medical examinations and to refrain from behaviour that could harm the foetus. The intending parents are the child's legal parents from the outset. The parties to the contract can, but are not expected to, maintain contact after the transaction is completed. We argue that contract motherhood should not be organized according to the norms of the gift relationship, and that contract mothers should be compensated for their labour. However, we accept that there are good reasons for rejecting the commercial model as a suitable framework for contract pregnancy, and argue, instead, in favour of viewing it as a profession. (shrink)

In this essay, I draw on Kant’s legal philosophy in order to defend the right to voluntary motherhood by way of abortion at any stage of pregnancy as an essential feature of women’s basic rights. By developing the distinction between innate and acquired right in Kant’s legal philosophy, I argue that the viability standard in US law (as established in Planned Parenthood v. Casey) misunderstands the nature of embodied right. Our body is the site of innate right; it is (...) the means through which we can set and pursue ends in the world. The law, therefore, cannot adjudicate the relationship between the will and the body: it cannot require us to allow our bodies to be used against our will. By comparing unwanted pregnancy to sexual assault, I problematize the notion that consent to pregnancy, like consent to sex, can ever be conclusive. I examine Kant’s own account of unwanted pregnancy, in which he describes mother and child finding themselves “in a state of nature” in order to rethink the status of the fetus in law, and I argue that we should understand the fetus’s right to life as provisional, rather than as enforceable by law. (shrink)

This article deals with the discussion of abortion in a number of US presidential and vice-presidential debates, from a scaling perspective. The interest in scales, as constructed and negotiated by participants in the course of interaction, is a component of occasioned semantics. I found that, in the political debates that I examined, there are a number of different scales anchored by the contrast between ‘pro-life’ and ‘pro-choice’ positions. These are as follows: Stage of pregnancy, Prescribed action, Special circumstances, Locus (...) of enforcement and Frequency. These scales are manipulated in various ways by the candidates to make their own stances seem reasonable and moral and their opponents’ unreasonable and immoral. A position may be made to appear more moderate by adding a more extreme alternative to the scale, which is then rejected. Also, common goals may be emphasized. The debaters also use ‘negative downgrading’ – rejection of a more moderate position – to suggest an opponent’s unreasonableness. It is noted that the availability of several scales affords various ways of formulating the reasonableness or unreasonableness of a particular position. The article continues with a close examination of an extended debate sequence, illustrating the crucial role of implicature in the manipulation of scales, the attribution of attitude, and the practice of argumentation, and the possibility of dealing with implicature within a conversation analytic framework. The discussion is, at all points, grounded in and illustrated by the actual talk of the political candidates. It is suggested that viewing specific occasions of interaction in terms of the creation and negotiation of scales can yield a unique and revealing perspective on what is taking place. (shrink)

When an individual is unable or unwilling to become a parent the natural way, he/she can avail of a surrogate mother. Furthermore, when the surrogate pregnancy takes place in a foreign country, the practice is popularly referred to as ‘surrogacy tourism’ or ‘birther tourism’, which is the main topic of this research. In contrast to existing research most of which is confined to the medical angle, here we look at how marketing makes surrogacy tourism more accessible but concomitantly promotes (...) unwanted ethical and marketing practices, even if inadvertently. On one hand, rigorous promotion of surrogacy tourism has successfully spread the word and has made such option available to individuals who would have otherwise been unaware of such opportunity. On the other hand, excessive marketing has resulted in unethical, illegal and in some cases, unhealthy medical practices in which, service providers, clinics and doctors often participate, but on which there appears to be scant research. This analysis, therefore, has two-fold implications: first, the findings can be extended to several other related professions, such as the medical community, administrators, law enforcement agencies and most importantly, potential ‘parents’; secondly, it can aid administrators and regulators tighten extant loopholes in the system, and thereby, provide a more robust and safer option for surrogate tourists. (shrink)

Although a pregnant woman can now refuse any medical treatment needed by the fetus, the Court of Appeal has acknowledged that ethical dilemmas remain, adverting to the inappropriateness of legal compulsion of presumed moral duties in this context. This leaves the impression of an uncomfortable split between the ethics and the law. The notion of a pregnant woman refusing medical treatment needed by the fetus is troubling and it helps little simply to assert that she has a legal right to (...) do so. At the same time, the idea that a pregnant woman fails in her moral duty unless she accepts any recommended treatment or surgery—however great the burdens—is also not without difficulty. This article seeks to find a way between these two somewhat polarized positions by arguing that, instead of being a question primarily about whether legally to enforce moral obligations, the «maternal—fetal conflict» begins with previously unrecognized difficulties in determining when a woman's prima facie moral rights invoked in the treatment context should «give way» to the interests of the fetus. This difficulty is mirrored within the law. Thus, how can we tell when a pregnant woman has the moral or legal duty to submit to a caesarean section? Seen in this way, the conflict is a problem which lies at the interface between moral and legal rights and duties, showing that there are important conceptual links between the ethics and the law. Against this background, this article explores the limits of a pregnant woman's right to bodily integrity by focusing upon the idea of her moral duty to aid the fetus through her body. Here we find difficulties in determining the existence and extent of this somewhat extraordinary duty. Such a duty is contrasted with both negative and positive duties toward others in the course of «general conduct». Attention to the social context of pregnancy and the refusal of treatment within this is also instructive. Overall, the purpose is to foster understanding and acceptance of the current legal position. (shrink)

The 2004 Canadian Assisted Human Reproduction Act bans commercial contract pregnancy and egg provision, but Canadians undertake cross-border reproductive travel to access these services. Feminist bioethicists have argued that the ethical justification for enforcing the ban domestically, namely exploitation, grounds its extraterritorial enforcement. I raise an additional problem when Global Southern or low-income countries are destinations for travel: neocolonialism. Further, I argue that a ban on commercialized reproduction is problematic. Although well-suited to address neocolonial forces of exploitation and commodification, (...) a ban reinforces neocolonialism by paying insufficient attention to the agency of gestational laborers and egg providers. (shrink)

The Grand Chamber of the European Court of Human Rights has recently handed down its judgement in the case of three women contesting the abortion law in the Republic of Ireland, which has one of the most restrictive abortion laws in the world. Although the Court ruled that Ireland had to clarify the current law following the success of one of the three claims, the failure of the other two claims allows Ireland to continue to enforce its law, which has (...) an adverse effect on women's health. This paper, therefore, proposes an amendment to abortion legislation in the Republic of Ireland that would be compatible with safeguarding women's health, highlighting several circumstances in which the continuation of a pregnancy may have a detrimental impact on a woman's physical and/or mental health. (shrink)

Megan1 is a young teenage patient who suffered a stillbirth at 28 weeks, leading to a year long police investigation dropped only after postmortem tests found that her pregnancy was lost due to natural causes. The stress of the investigation and her isolation from friends and support network following the seizure of her mobile and laptop compounded the trauma of the stillbirth, leaving her requiring emergency psychiatric care. Aisha1 is a vulnerable patient who suffered a premature delivery, having experienced (...) similar problems in earlier pregnancies. Things happened so quickly that Aisha delivered on her own at home, only then seeking medical care. She told hospital staff that earlier in her pregnancy she had considered an abortion. As a result, she found herself interviewed under police caution and was required to surrender her phone and tablet, limiting access to friend and family support just when most needed. Aisha was denied unsupervised access to her baby in the intensive care unit, needing to hand over expressed breast milk to a receptionist. These stories, which were reported in a recent meeting in Parliament,1 are sadly far from unusual. They reflect the collateral damage of a growing trend towards more enthusiastic enforcement of the archaic abortion laws of England and Wales.2–5 In such cases, women who present with miscarriage, stillbirth or a premature delivery have aroused the suspicion of health professionals, sometimes because—like Aisha—they speak honestly about having considered abortion earlier in their pregnancies. They then find themselves reported to the police, required to surrender electronic devices and sometimes advised by duty solicitors to speak to no one about events leading to their investigation, thus being denied emotional and full clinical support at a time of significant trauma. These women are not the only victims of British abortion laws: so …. (shrink)

The latest trend in abortion restrictions in the United States targets a woman's reasons for terminating a pregnancy. Fourteen states have attempted to enact laws prohibiting abortion on the basis of fetal sex, race, and/or genetic anomaly. These laws are different from regulations tied to a government interest in protecting women's health. Laws that restrict reasons implicate a different set of government interests to be weighed against a woman's constitutional right first recognized in Roe v. Wade. These laws also (...) seek to reframe the nature of the right asserted by the woman. To date, the Supreme Court has declined to address the constitutionality of laws that restrict reasons, and the Court's most recent abortion decisions provide little guidance. It is possible that a conservative majority of the Supreme Court would uphold a law that prohibits reasons for having an abortion that appear discriminatory. But such laws would be difficult to enforce and therefore may be relegated to policy statements rejecting discriminatory norms as opposed to being effective means of restricting access to abortion. (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.

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 this paper, I suggest that, if we are committed to accepting a threshold approach to personhood, according to which all beings above the threshold are persons with equal moral status, there are strong reasons to also recognise a second threshold that would be reached through human pregnancy, and that would confer on pregnant women a temporary superior moral status. This proposal is not based on the moral status of the fetus, but on the moral status of the pregnant (...) woman. It is not only the fetus which is an organism sui generis: the pregnant woman, also, is a unique being. Following almost any view on the moral status of the fetus, the pregnant woman should be regarded, herself, as more than a singular individual. She is, herself, ‘more than one’. Pregnant women are also necessary for the continued survival of the human species, and there are important justice-based reasons to recognise the higher status. Furthermore, the recognition of a superior moral status for pregnant women does not imply that pregnancy should always be viewed as desirable, or imply any position on the permissibility of abortion. My proposal is not as radical as it might seem, as it does not require that pregnant women should always receive superior treatment, but only that they should to some extent. It could have a range of potential positive practical consequences. Finally, my approach does not threaten, but rather promotes, human equality. (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)

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)

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)

This book provides extensive and critical engagement with some of the most recent and compelling arguments favoring abortion choice. It features original essays from leading and emerging philosophers, bioethicists and medical professionals that present philosophically sophisticated and novel arguments against abortion choice. The chapters in this book are divided into three thematic sections. The first set of essays focuses primarily on unborn human individuals--zygotes, embryos and fetuses. In these chapters it is argued, for example, that human organisms begin to exist (...) at conception and that zygotes, embryos and fetuses are persons. These chapters also explore questions about whether or not zygotes, embryos and fetuses are part of their mothers' bodies. The second set of essays focuses primarily on elective abortion and the debates surrounding it. These chapters consider whether or not opponents of abortion are commonly hypocritical, how opponents of abortion should think about adoption, how emerging technologies may affect the current debate and whether or not those participating in the debate should rely on analogies to support their case. Finally, the third set of essays shifts focus from the legal and moral status of elective abortion to its place in medical practice. In these chapters it is argued that elective abortion embodies a kind of ableism, and that elective abortion is medically unnecessary, harmful to women's mental health and that telemedicine abortion poses significant risks to women's health. Agency, Pregnancy and Persons offers an up-to-date examination of unborn human beings, the debates surrounding elective abortion and the place of elective abortion within medical practice. It will be of interest to medical professionals and those who work in philosophy, bioethics and medical ethics alike. (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.

Public shaming plays an important role in upholding valuable social norms. But, under what conditions, if any, is it morally justifiable? Our aim in this paper is systemically to investigate the morality of public shaming, so as to provide an answer to this neglected question. We develop an overarching framework for assessing the justifiability of this practice, which shows that, while shaming can sometimes be morally justifiable, it very often is not. In turn, our framework highlights several reasons to be (...) concerned about the increasingly widespread phenomenon of online public shaming. (shrink)

I discuss two interrelated ways in which disgust functions in motherhood. First, relaxation of the mother’s sense of disgust allows her to nurture her child more effectively. Second, others’ responses of disgust are used to enforce social norms regarding the “good” mother. If the mother acquiesces, she must continually monitor and tidy her child, which may interfere with the child’s exploration of the world. If she does not, she is subject to ongoing signs that she is flawed or failing as (...) a mother. (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 this paper, we identify some key features of what makes something a disease, and consider whether these apply to pregnancy. We argue that there are some compelling grounds for regarding pregnancy as a disease. Like a disease, pregnancy affects the health of the pregnant person, causing a range of symptoms from discomfort to death. Like a disease, pregnancy can be treated medically. Like a disease, pregnancy is caused by a pathogen, an external organism invading (...) the host’s body. Like a disease, the risk of getting pregnant can be reduced by using prophylactic measures. We address the question of whether the ‘normality’ of pregnancy, its current necessity for human survival, or the value often attached to it are reasons to reject the view that pregnancy is a disease. We point out that applying theories of disease to the case of pregnancy, can in many cases illuminate inconsistencies and problems within these theories. Finally, we show that it is difficult to find one theory of disease that captures all paradigm cases of diseases, while convincingly excluding pregnancy. We conclude that there are both normative and pragmatic reasons to consider pregnancy a disease. (shrink)

The commentaries in response to our feature paper1 are indicative of the varied perspectives that can be taken towards artificial amnion and placenta technology (AAPT) and more specifically its relationship with pregnancy (loss). Kennedy rightly argues that empirical research is essential for understanding the experiences of pregnancy loss and AAPT2 and our own advocacy of empirical research is evident in previous work.3–5 Kennedy also acknowledges the current impossibility of researching AAPT experiences since it has not yet been applied (...) in clinical settings. It is precisely for this reason that we draw on the reported experiences of neonatal intensive care (NICU) parents since they present the closest analogy which can be drawn with the technology.1 What we reject in Kennedy’s response, however, is the claim that the experiences of NICU parents have been ‘exploited’ by us.2 Studies documenting the experiences of NICU parents were drawn on to indicate that our considerations are more than mere speculation. As stated, the experiences of NICU parents, particularly the pregnant individual who experiences pregnancy loss, are the closest indication we have of how AAPT and what it entails may be experienced. To claim that this data is being exploited by us is to undermine the very purpose that such research is undertaken—to indicate how future care may be improved. It would be much more harmful to not use this information. While we believe that experiences of …. (shrink)

Inside and outside of a Christian worldview, bioethicists have discussed ectopic pregnancy at some length as a maternal-fetal vital conflict. Most bioethicists agree that methotrexate and salpingostomy are low-risk, successful interventions for this life-threatening pathology, and are thus beneficent, just, and wholly acceptable. A small cohort of Christian, largely Catholic, bioethicists have reservations about methotrexate and salpingostomy, but cannot resolve their internal disputes about these because of flawed casuistry. This paper aims to settle the issue about whether methotrexate and (...) salpingostomy are acceptable within a Catholic worldview: despite the best arguments in favor of methotrexate as a moral option, it is morally unacceptable, and despite hesitation about salpingostomy related to analogies with previable delivery, it is the optimal procedure for ectopic pregnancy. (shrink)

Part graphic novel, part feminist and philosophical analysis, The Pregnancy ≠ Childbearing Project explores how pregnancy can be a meaningful and distinct phenomenon from childbirth and does not equate with childbearing or the production of children.

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)

Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin (...) class='Hi'>pregnancy. I argue that in the case of a twin pregnancy, there are two intuitively plausible claims: abortion is morally permissible, and it is morally wrong to abort just one of the fetuses. But since we should choose morally permissible acts rather than impermissible ones, the two claims lead to another highly implausible claim: the woman ought to abort both fetuses rather than only one. Yet, this does not seem right. A plausible moral theory cannot advocate such a pro-death view. Or can it? I suggest ways to solve this problem and draw implications for each solution. There are no data in this work. (shrink)

Marshall and colleagues (2024) offer a framework for emergency physicians (EPs) tasked with caring for “resuscitated opioid users”—or patients who have recently overdosed on opioids. This framework...

This chapter argues that governments have a duty to take reasonably effective and humane steps to minimize the occurrence of unauthorized migration and stay. While the effects of unauthorized migration on a country’s citizens and institutions have been vigorously debated, the literature has largely ignored duties of fairness to would-be immigrants. It is argued here that failing to take reasonable steps to prevent unauthorized migration and stay is deeply unfair to would-be immigrants who are not in a position to bypass (...) visa regulations. Importantly, the argument here is orthogonal to the debate as to how much and what kinds of immigration ought to be allowed. (shrink)

Against Patrick Devlin, H. L. A. Hart rejects the enforcement of morals as such. Hart defends an expanded version of John Stuart Mill’s harm principle, but this expanded version is no more defensible than Mill’s original claim. Hart’s discussion fails to clarify what is really at stake in controversies regarding the moral acceptability of criminal prohibition of such activities as suicide and assisted suicide, recreational drug use, prostitution, and so on. Regarding the enforcement of morals as such, we should acknowledge (...) that the jury is still out. (shrink)

Nietzsche employs the concept of pregnancy metaphorically at various points in his writings; discussing the pregnancy of philosophers (GM III 8, BGE 292), spiritual pregnancy (EH, Clever 3; GS 72) and being pregnant with thoughts or deeds (D 552). I explore how Nietzsche uses the notion of pregnancy in Dawn, arguing that it connects to the theme of self-cultivation. I employ the various associations that Nietzsche makes with pregnancy, including the unknown, selfishness, strangeness, and solitude, (...) to elucidate Nietzsche’s understanding of self-cultivation. I show how the metaphor of pregnancy, in which we do not control what we give birth to, both expresses and helps us explore the problem of what, if the self is made up of and directed by many competing drives, shapes and directs self-cultivation. I argue that Nietzsche’s deliberate references to the context of Plato’s discussion of pregnancy involve a self-conscious challenge to Plato’s concept of the philosopher, and of philosophy, and a reimagining of what they will give birth to. The appropriation of Plato’s famous metaphor thus underscores how Nietzsche’s concept and method of self-cultivation contrasts to Plato’s care for the soul and is rooted in attentiveness to the body and its drives. (shrink)

This essay differentiates two approaches to understanding the concept of coercion, and argues for the relative merits of the one currently out of fashion. The approach currently dominant in the philosophical literature treats threats as essential to coercion, and understands coercion in terms of the way threats alter the costs and benefits of an agent’s actions; I call this the “pressure” approach. It has largely superseded the “enforcement approach,” which focuses on the powers and actions of the coercer rather than (...) the perspective of the coercee. The enforcement approach identifies coercion with certain uses of the kinds of powers that agents need to accumulate and wield in order to be able to make significant, credible threats. Though there is considerable overlap extensionally in the instances of coercion recognized by the two approaches, the enforcement approach encompasses some uses of power to coerce that do not involve threats . It also circumscribes which threats should be counted as coercive, though notably it provides a picture of coercion that is non-moralized in its essentials. While there may be specific purposes for which a pressure account is to be preferred, I argue that the enforcement approach better describes how coercion works, and elucidates factors that are often tacitly assumed by pressure accounts. It also is more useful for explaining the social and political significance of coercion, and why coercion is thought to have the implications commonly associated with it. In particular, I argue that it helps us understand why uses of coercion are in general a matter of ethical significance, why state authority depends on commanding a monopoly on the right to use coercion, and why being coerced may reasonably provide one a defense against being held responsible for actions one is coerced into taking. (shrink)

This paper focuses on the relations among critique, destruction and negation, on the one hand, and creation, affirmation, love, and care on the other, in Nietzsche’s writings from Daybreak to Zarathustra. In doing this, it traces a movement in Nietzsche's thought that can be understood as an integration of critique in the process of affirmation, which consolidates in Nietzsche’s project of self-overcoming. In contrast to readings that use the metaphor of art and the creativity of the artist, this paper presents (...) pregnancy as a cipher to understand Nietzsche’s project as well as the dynamics that are involved. A key issue addressed throughout the entire paper concerns the way in which Zarathustra says that he loves those who want their own downfall (Untergang) and go “zu Grunde” (or perish). To fully grasp the meaning of these rather puzzling utterances, the paper analyzes Nietzsche's engagement with Pascal (as a very particular case of “going under”). (shrink)

One of the most influential philosophical arguments in favour of the permissibility of abortion is Judith Jarvis Thomson’s violinist analogy, presented in ‘A Defense of Abortion’. Its appeal for pro-choice advocates lies in Thomson’s granting that the fetus is a person with equivalent moral status to any other human being, and yet demonstrating—to those who accept her reasoning—that abortion is still permissible. In her argument, Thomson draws heavily on the parable of the Good Samaritan, arguing that gestating a fetus in (...) some circumstances is what she calls a Good Samaritan act, and claiming that we are not morally required to be Good Samaritans. Here, I argue that Thomson has subverted the parable to justify an action that is the antithesis of its meaning. I contend that Christians are required to be Good Samaritans, and explain that for Christians, this entails abortion is impermissible in all circumstances. Further, I argue that the parable shows the fetus is our neighbour in need of our mercy and assistance, and consequently Christians should be actively involved in helping to ensure the unborn are protected, whether they are fetuses in danger of induced abortion or miscarriage, or surplus frozen embryos. (shrink)

In this paper, we explore how the prospect of artificial placenta technology (nearing clinical trials in human subjects) should encourage further consideration of the loss experienced by individuals when their pregnancy ends unexpectedly. Discussions of pregnancy loss are intertwined with procreative loss, whereby the gestated entity has died when the pregnancy ends. However, we demonstrate how pregnancy loss can and does exist separate to procreative loss in circumstances where the gestated entity survives the premature ending of (...) the pregnancy. In outlining the value that can be attached to pregnancy beyond fetal-centric narratives, we illustrate how pregnancy loss, separate to procreative loss, can be experienced. This loss has already been recognised among parents who have experienced an unexpected early ending of their pregnancy, resulting in their child being cared for in neonatal intensive care unit. Artificial placentas, however, may exacerbate these feelings and make pregnancy loss (without procreative loss) more visible. We argue that pregnancy is an embodied state in which gestation is facilitated by the body but gestation itself should be recognised as a process—and one that could be separable from pregnancy. In demarcating the two, we explore the different ways in which pregnancy loss can be understood. Our objective in this paper goes beyond contributing to our philosophical understanding of pregnancy towards practical-orientated conclusions regarding the care pathways surrounding the artificial placenta. We make recommendations including the need for counselling and careful consideration of the language used when an artificial placenta is used. (shrink)

In debating the ethics of immigration, philosophers have focused much of their attention on determining whether a political community ought to have the discretionary right to control immigration. They have not, however, given the same amount of consideration to determining whether there are any ethical limits on how a political community enforces its immigration policy. This article, therefore, offers a different approach to immigration justice. It presents a case against legitimate states having discretionary control over immigration by showing both how (...) ethical limits on enforcement circumscribe the options legitimate states have in determining their immigration policy and how all immigrants (including undocumented immigrants) are entitled to certain protections against a state’s enforcement apparatus. (shrink)