Assessing what counts as infertility has practical implications: access to (state-funded) fertility treatment is usually premised on meeting the criteria that constitute the chosen definition of infertility. In this paper, I argue that we should adopt the expression “involuntary childlessness” to discuss the normative dimensions of people’s inability to conceive. Once this conceptualization is adopted, it becomes clear that there exists a mismatch between those who experience involuntary childlessness and those that are currently able to access fertility treatment. My concern (...) in this article is explaining why such a mismatch deserves attention and what reasons can be advanced to justify addressing it. My case rests on a three-part argument: that there are good reasons to address the suffering associated with involuntary childlessness; that people would decide to insure against it; and that involuntary childlessness is characterized by a prima facie exceptional kind of desire. (shrink)

The benefits of full ectogenesis, that is, the gestation of human fetuses outside the maternal womb, for women ground many contemporary authors’ arguments on the ethical desirability of this practice. In this paper, I present and assess two sets of arguments advanced in favour of ectogenesis: arguments stressing ectogenesis’ equality-promoting potential and arguments stressing its freedom-promoting potential. I argue that although successfully grounding a positive case for ectogenesis, these arguments have limitations in terms of their reach and scope. Concerning their (...) limited reach, I contend that ectogenesis will likely benefit a small subset of women and, arguably, not the group who most need to achieve equality and freedom. Concerning their limited scope, I contend that these defences do not pay sufficient attention to the context in which ectogenesis would be developed and that, as a result, they risk leaving the status quo unchanged. After providing examples of these limitations, I move to my proposal concerning the role of ectogenesis in promoting women’s equality and freedom. This proposal builds on Silvia Federici’s, Mariarosa Dalla Costa’s and Selma James’ readings of the international feminist campaign ‘Wages for Housework’. It maintains that the political perspective and provocation that ectogenesis can advance should be considered and defended. (shrink)

This paper explores the ethics of introducing genome-editing technologies as a new reproductive option. In particular, it focuses on whether genome editing can be considered a morally valuable alternative to preimplantation genetic diagnosis (PGD). Two arguments against the use of genome editing in reproduction are analysed, namely safety concerns and germline modification. These arguments are then contrasted with arguments in favour of genome editing, in particular with the argument of the child’s welfare and the argument of parental reproductive autonomy. In (...) addition to these two arguments, genome editing could be considered as a worthy alternative to PGD as it may not be subjected to some of the moral critiques moved against this technology. Even if these arguments offer sound reasons in favour of introducing genome editing as a new reproductive option, I conclude that these benefits should be balanced against other considerations. More specifically, I maintain that concerns regarding the equality of access to assisted reproduction and the allocation of scarce resources should be addressed prior to the adoption of genome editing as a new reproductive option. (shrink)

In this paper, we argue that lesbian couples who wish to have children who are genetically related to both of them should be allowed access to mitochondrial replacement techniques (MRTs). First, we provide a brief explanation of mitochondrial diseases and MRTs. We then present the reasons why MRTs are not, by nature, therapeutic. The upshot of the view that MRTs are non-therapeutic techniques is that their therapeutic potential cannot be invoked for restricting their use only to those cases where a (...) mitochondrial DNA disease could be ‘cured’. We then argue that a positive case for MRTs is justified by an appeal to reproductive freedom, and that the criteria to access these techniques should hence be extended to include lesbian couples who wish to share genetic parenthood. Finally, we consider a potential objection to our argument: that the desire to have genetically related kin is not a morally sufficient reason to allow lesbian couples to access MRTs. (shrink)

In a recent article in this journal, Kathryn MacKay advances a defence of ectogenesis that is grounded in this technology’s potential to end—or at least mitigate the effects of—gender‐based oppression. MacKay raises important issues concerning the socialization of women as ‘mothers’, and the harms that this socialization causes. She also considers ectogenesis as an ethically preferable alternative to gestational surrogacy and uterine transplantation, one that is less harmful to women and less subject to being co‐opted to further oppressive ends. In (...) this article, I challenge some of the assumptions that underlie MacKay’s case in favour of ectogenesis by questioning whether the relationship between women’s capacity to gestate and birth children and gender‐based oppression is as strong as MacKay makes it out to be. I subsequently argue that—even if MacKay’s reading of this relationship is accurate—ectogenesis is not a desirable means to end gender‐based oppression. It embodies a strategy that could be used to pursue liberating projects that follow what Iris Marion Young defines as ‘the ideal of assimilation’, but that must be resisted. I then concur with MacKay’s contention that ectogenesis is better than gestational surrogacy and uterine transplantation. My argument is that many of the problematic issues that MacKay herself sees as features of these practices will not disappear with ectogenesis. Finally, I conclude that MacKay’s narrow focus on women’s biology and ectogenesis as a solution to gender‐based oppression results in the overlooking of broader systemic issues that contribute to the upholding of oppressive norms. (shrink)

Eugenics is often referred to in debates on the ethics of reproductive technologies and practices, in relation to the creation of moral boundaries between acceptable and unacceptable technologies, and acceptable and unacceptable uses of these technologies. Historians have argued that twentieth century eugenics cannot be reduced to a uniform set of practices, and that no simple lessons can be drawn from this complex history. Some authors stress the similarities between past eugenics and present reproductive technologies and practices (what I define (...) throughout the paper as ‘the continuity view’) in order to condemn the latter. Others focus on the differences between past and present practices (what I define throughout the paper as ‘the discontinuity view’) in order to defend contemporary reproductive technologies. In this paper, I explore the meanings of the word ‘eugenics’ and the relationship between its past and present uses in terms of contemporary debates on reproductive technologies and practices. I argue that moral disagreement about present technologies originate in divergent views of condemnable and justifiable features of the past. (shrink)

BackgroundThis article explores the reasons in favour of revising and extending the current 14-day statutory limit to maintaining human embryos in culture. This limit is enshrined in law in over a dozen countries, including the United Kingdom. In two recently published studies, scientists have shown that embryos can be sustained in vitro for about 13 days after fertilisation. Positive reactions to these results have gone hand in hand with calls for revising the 14-day rule, which only allows embryo research until (...) the 14th day after fertilisation.Main textThe article explores the most prominent arguments in favour of and against the extension of the 14-day limit for conducting research on human embryos. It situates these arguments within the history of the 14-day limit. I start by discussing the history of the 14-day limit in the United Kingdom and the reasons behind the decision to opt for a compromise between competing moral views. I then analyse the arguments that those who are generally in favour of embryo research put forward in support of extending the 14-day rule, namely the argument of the beneficence of research and the argument of technical feasibility. I then show how these two arguments played a role in the recent approval of two novel techniques for the replacement of faulty mitochondrial DNA in the United Kingdom. Despite the popularity and widespread use of these arguments, I argue that they are ultimately problematic and should not be straightforwardly accepted. I end by making a case for respecting value pluralism in the context of embryo research, and I present two reasons in favour of respecting value pluralism: the argument of public trust and the argument of democracy.ConclusionI argue that 14-day limit for embryo research is not a valuable tool despite being a solution of compromise, but rather because of it. The importance of respecting value pluralism needs to be considered in any evaluation concerning a potential change to the 14-day rule. (shrink)

Fertility treatment enables involuntary childless people to have genetically related children, something that, for many, is a valuable life project. In this paper, I respond to two sets of objections that have been raised against expanding state-funded fertility treatment provision for existing treatments, such as in vitro fertilisation (IVF), and against funding new treatments, such as uterine transplantation (UTx). Following McTernan, I refer to the first set of objections as the ‘one good among many’ objection. It purports that it is (...) unjustifiable for the state to prioritise the funding of the life project of becoming a parent through fertility treatment provision over the funding of other life projects that people might have. Following Lotz, I refer to the second set of objections as the ‘norm-legitimation’ objection. It maintains that the provision of costly forms of fertility treatment, such as UTx, would legitimise problematic social norms concerning genetic relatedness, reproduction and parenting, and that states should not engage in such a legitimation. In response to these objections, I defend the view that (reproductive) preferences ought to be taken more seriously when discussing fertility treatment provision and parental projects, and that not doing so can be costly, especially for women. The approach defended in this paper seeks to avoid disregarding and policing preferences and to reconcile their fulfilment with political projects aimed at improving the material and social conditions of sub-fertile people: people who, for social or biological reasons (or an intersection of the two), are unable to reproduce unassisted. (shrink)

Reproductive freedom plays a pivotal role in debates on the ethics of procreation. This moral principle protects people’s interests in procreative matters and allows them discretion over whether to have children, the number of children they have and, to a certain extent, the type of children they have. Reproductive freedom’s theoretical and political emphasis on people’s autonomy and well-being is grounded in an individual-centred framework for discussing the ethics of procreation. It protects procreators’ interests and significantly reduces the permissible grounds (...) for interference by third parties. In this article I show that procreative decisions have far-reaching effects on the composition and size of the population. The upshot of considering these effects allows for the appreciation of the inadequacy of a framework that solely considers individual (i.e. procreators’) interests to discuss the ethics of procreation. To address such inadequacy, I assess costs and benefits of past and present proposals to reflect on procreation in such a way as to consider its far-reaching effects. I conclude by arguing that reproductive freedom should be defended as an imperfect but instrumentally necessary tool. This framing would enable those participating in debates on the ethics of procreative decisions to work towards an ethical framework that accounts for the cumulative effects of these decisions. (shrink)

In Pregnancy and superior moral status: A proposal for two thresholds of personhood, Robinson argues that pregnant women are unique beings with superior moral status (MS) to that of other adult human beings. Robinson’s defence of this view relies on metaphysical and moral claims. The first set of claims concerns the ontological status of the pregnant woman, whom she considers a ‘unique organism’,‘more than just one person’and ‘numerically increased’.1 The second set of claims concerns the ‘superior’ MS of the pregnant (...) woman. In this commentary, we address this second set of claims and argue that Robinson’s view rests on a misunderstanding of the concept of MS and its role in supplying reasons for action (and forbearance from action). While we welcome the conclusion of Robinson’s argument—which we take to be that pregnant women ought to be treated with more consideration—on an appropriate understanding of MS, her argument does not yield that conclusion at all. We feel strongly that medical ethics needs to be grounded in good philosophy and worry that too much of the literature falls short of this ideal. As such, the spirit in which we write this commentary is that of constructive criticism. ### One plus one equals one plus one and the grounds of MS The philosophical literature on the grounds of MS essentially addresses the question of what properties (Ps) determine whether an agent (A) has MS.1 Examples of Ps are: sophisticated cognitive capacities,2 such as the capacity to value, being self-aware or rational, or more controversially, …. (shrink)

How should we regulate genome editing in the face of persistent substantive disagreement about the moral status of this technology and its applications? In this paper, we aim to contribute to resolving this question. We first present two diametrically opposed possible approaches to the regulation of genome editing. A first approach, which we refer to as “elitist,” is inspired by Joshua Greene’s work in moral psychology. It aims to derive at an abstract theoretical level what preferences people would have if (...) they were committed to implementing public policies regulating genome editing in a context of ethical pluralism. The second approach, which we refer to as the democratic approach, defended by Francoise Baylis and Sheila Jasanoff et al., emphasizes the importance of including the public’s expressed attitudes in the regulation of genome editing. After pointing out a serious shortcoming with each of these approaches, we propose our own favored approach—the “enlightened democracy” approach—which attempts to combine the strengths of the elitist and democratic approaches while avoiding their weaknesses. (shrink)

The authority of bioethics as a field of inquiry and of bioethicists as scholars with a distinctive expertise is being questioned on various fronts. Sarah Franklin’s 2019Naturecommentary ‘Ethical research – the long and bumpy road from shirked to shared’ is the latest example. In this paper, we respond to these challenges by focusing on two key issues. First, we discuss the theory and practice of bioethics. We argue that both of these endeavours are fundamental components of this field of inquiry (...) and that bioethics cannot be reduced to the contribution that it makes to the production of biopolicy, as Franklin suggests. Second, we contend that bioethicists have distinctive skills and knowledge that place them at an epistemic advantage in discussing normative questions. Hence, we reject views that deny the specific contribution that bioethicists can bring to assessing the ethics and governance of science and technology. We conclude by arguing that—despite formal and substantive differences between disciplines—philosophers, social scientists and other scholars should join forces and engage in critical friendships rather than turf wars to move towards the just governance of science and technology. (shrink)

Access to state-funded fertility treatments is age-restricted in many countries based on epidemiological evidence showing age-associated fertility decline and aimed at administering scarce resources. In this article, we consider whether age-related restrictions can be considered ageist and what this entails for a normative appraisal of access criteria. We use the UK as a case study due to the state-funded and centrally regulated nature of in vitro fertilization provision. We begin by reviewing concepts of ageism and age discrimination in gerontological scholarship (...) and contend that it is analytically useful to differentiate between them when considering age-restricted health services. We then argue that criteria to access IVF could be considered indirectly ageist so far as they rely on an age-related evidence base that manifests ageist categorizations of persons. Lastly, we examine whether there could be more normatively desirable alternatives to devise criteria to access fertility treatment, considering “lifestyle” as a potential candidate. We conclude, however, that lifestyle-based discrimination is problematic because, unlike age-based discrimination, it risks exacerbating existing socioeconomic and ethnic inequalities. (shrink)

In a recent paper –Lesbian motherhood and mitochondrial replacement techniques: reproductive freedom and genetic kinship– we argued that lesbian couples who wish to have children who are genetically related to both of them should be allowed access to mitochondrial replacement techniques (MRTs). Françoise Baylis wrote a reply to our paper –‘No’ to lesbian motherhood using human nuclear genome transfer– where she challenges our arguments on the use of MRTs by lesbian couples, and on MRTs more generally. In this reply we (...) respond to her claims and further clarify our position. (shrink)

A proper understanding of the moral and political significance of migration requires a focus on global inequalities. More specifically, it requires a focus on those global inequalities that affect people’s ability to participate in the production of economic goods and non-economic goods. We call cooperative infrastructures the complex material and immaterial technologies that allow human beings to cooperate in order to generate human goods. By enabling migrants to access high-quality cooperative infrastructures, migration contributes to the diffusion of technical and socio-political (...) innovations. In this way, it positively affects the ability of individuals from poorer countries to participate in the production of human goods, to benefit from such production, and to contribute to human development. Migration can also damage the material and immateri al components of the cooperative infrastructures accessible in both the host and sending countries; these potential downsides of migration should not be ignored, although arguably they can often be neutralized, alleviated, or compensated. (shrink)

Elizabeth Barnes’ new book, Health Problems, seeks to show that health is philosophically distinctive and that no account of “health” can explain its biological, normative, political and phenomenological significance. Barnes argues that we should engage in the project of understanding this concept, but she is skeptical about its feasibility. Her skepticism is nevertheless ameliorative: it seeks to improve our understanding of this concept while accepting that, depending on the context and our purposes, its meaning will shift. In this paper, I (...) examine and respond to two claims that Barnes defends in her book. The first concerns her skepticism toward the possibility of developing an explanatory and extensionally adequate account of health. To assess whether her skepticism is justified, I examine the objections that she raises against existing theories of health and disease. I argue that, while her objections are compelling, they do not justify her skeptical stance. The second concerns the relationship between health and well-being. Barnes argues against two views: that health is constitutive of well-being and that health contributes to well-being. In response to her concerns, I show that – on a richer understanding of “well-being” – these views can accommodate most of her concerns. (shrink)

J. Benjamin Hurlbut’s book Experiments in Democracy: Human Embryo Research and the Politics of Bioethics is an historiographical analysis of the American debate over embryo research. It covers more than four decades of this debate and uses key actors, bodies, and events as empirical evidence for its analysis. At a first glance, it might seem like a book that tells a story, but Experiments in Democracy is much more than that. Hurlbut uses the chapters of this narrative as case studies (...) through which to examine practices of deliberative democracy and the role played by scientists and ethicists in the deliberative processes concerning embryo research and the governance thereof. (shrink)

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

In the paper Assisted Gestative Technologies, Elizabeth Chloe Romanis advocates for the creation of a new category, which includes technological interventions that allow ‘persons who want to reproduce, potentially using their own genetic material, but are unable, or potentially unwilling, to undertake gestation’.1 Romanis conceptualises these technologies as a unified kind, a ‘genus’, and argues that they ‘collectively raise distinct ethical, legal and social issues from those related to assisted conception’.1 As I understand Romanis’ paper, her aims are twofold. The (...) first is conceptual: Romanis construes assisted gestative technologies as a separate kind with shared attributes and purposes, which differ from those of technologies that enable conception. The second is normative: Romanis champions the distinction between AGTs and other technologies as a useful way to tease apart relevant ‘ethical, legal and social issues’ that specifically concern AGTs. The reason for this, according to Romanis, is that gestation is ‘such a unique and demanding form of labour’.1 I agree with Romanis: gestation is indeed a unique and demanding form of labour, one with associated biological, cultural and political specificities with distinctive moral significance. It is for this very same reason that I believe that AGTs should not conceptually be considered as a unified category and should not be morally appraised as such, for relevant political and moral aspects of these technologies would be overlooked in the process. To clarify: Romanis’ use of genealogy to aid normative inquiry is a worthy endeavour. And I concur with the very convincing case she makes for the distinction between conception and gestation. My disagreement with Romanis rather concerns the conceptualisation of technologies such as gestational surrogacy, uterine transplantation and artificial placentas as a unified category, and the normative inquiry grounded in …. (shrink)

In this chapter, I discuss the possibility of using genome editing technologies in the context of assisted reproduction. I present the most prominent arguments in favour of and against this use of genome editing technologies, and explore two strategies used in bioethics in the event of moral disagreement to analyse the questions at hand and to develop morally sound policies. These strategies are: the clarification of the facts regarding a new technology and the formulation of the best philosophical argument. I (...) contend that both approaches are theoretically flawed and might result in states of affairs that fail to promote peoples’ well-being. I then argue that we should focus instead on finding at least some common ground in order to move forward in the debate on genome editing, building a regulatory framework that lightens “the burden of human existence”, whilst still accommodating opposing views as much as possible. Furthermore, I argue that insights from moral psychology and democratic governance can assist us in these challenges. (shrink)

Let me begin by thanking the Journal of Medical Ethics editors and the four commentators for taking time to read, reflect and offer thoughtful comments on my paper. The issues they raise warrant careful attention. Regrettably, I am only able to address some of their key concerns due to space constraints. In my paper, ‘Gestation, Equality and Freedom: Ectogenesis as a Political Perspective’, I outline two sets of critiques of liberal defences of ectogenesis and contend that these defences are limited (...) in their reach and scope. Building on Federici’s,1 and Dalla Costa’s and James’2 readings of the of the international feminist campaign ‘Wages for Housework’, I argue that the value of ectogenesis is to similarly advance a political perspective and a provocation. Framing ectogenesis in these terms enables to critically engage with the physical and social burdens of pregnancy, childbirth and childrearing, which all too often are borne by women. It also allows to demand for better medical and social services for mothers and women more generally, as well as better working and living conditions for these and other disadvantaged groups. Lisa Campo-Engelstein thoughtfully broadens my reading of liberal defences of ectogenesis and contextualises them within the history of ‘reproductive advancements and technologies’.3 She illustrates that …. (shrink)