Gender dysphoria (GD) is marked by an incongruence between a person’s biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called “wait-and-see” approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of a “third pathway” for the (...) diagnosis and treatment of GD in youths. To make our case, we draw on a recent development in bioethics: the phenomenological approach. Scholars such as Slatman and Svenaeus have argued that the extent to which the body can (or should be) manipulated or reconstructed through medical intervention is not only determined by consideration of ethical frameworks and social and legal norms. Rather, we must also take account of patients’ personal experience of their body, the personal and social values associated with it, and their understanding of its situation in their life: their narrative identities. We apply this phenomenological approach to medicine and nursing to the diagnosis and treatment of GD in youth. In particular, we discuss Zahavi and Martiny’s conception of the phenomenological interview, in order to show that narrative techniques can assist in the process of gender identification and in the treatment of youth presenting with GD. We focus on two case studies that highlight the relevance of a narrative-based interview in relations between patients, HCPs, and family, to expose the influence of social ideologies on how young people presenting with GD experience their bodies and gender. (shrink)

The Drosophila anterior‐posterior pattern genes of the terminal class, particularly the tailless gene, affect structures derived from the acron and the tail region of the embryo. These domains correspond in position and function to asegmental domains at the termini of annelids and more primitive insect embryos. This suggests that terminal genes in Drosophila may have originated in an ancestor common to both annelids and arthropods, and thus that the specification of termini in these metameric organisms is an ancient, evolutionarily conserved (...) process. (shrink)

Both the diagnosis and medical treatment of gender dysphoria —particularly in children and adolescents—have been the subject of significant controversy in recent years. In this paper, we outline the means by which GD is diagnosed in children and adolescents, the currently available treatment options, and the bioethical issues these currently raise. In particular, we argue that the families and healthcare providers of children presenting with GD currently face two main ethical dilemmas in decision making regarding treatment: the pathway dilemma and (...) the consent dilemma. (shrink)

This article argues that a particular metaphysical model permeates cultural practices surrounding pregnancy: the foetal container model. Widespread uncritical reliance on this view of pregnancy has been highly detrimental to women's liberty and reproductive autonomy. In this article, I extend existing critiques of the medical treatment of pregnant women to the context of the burgeoning commercial surrogacy industry. In doing so, I aim to show that our philosophical analysis in both spheres is constrained by the presupposition that the foetus and (...) pregnant woman are metaphysically and ethically distinct entities. By exploring the similarities and differences between the expectations placed on pregnant women in these two spheres, I show that the foetal container model is not a homogeneous understanding of pregnancy applied consistently across contexts; rather, it has been used to justify various practices and attitudes toward pregnancy and pregnant women through different moral frameworks, in the service of different overarching aims. (shrink)

Assisted reproduction often involves biological contributions by third parties such as egg/sperm donors, mitochondrial DNA donors, and surrogate mothers. However, these arrangements are also characterised by a biological relationship between the child and at least one intending parent. For example, one or both intending parents might use their own eggs/sperm in surrogacy, or an intending mother might conceive using donor sperm or gestate a donor embryo. What happens when this relationship is absent, as in the case of 'double‐donor surrogacy' arrangements (...) (DDS)? Here, a child is conceived using both donor eggs and sperm, carried by a surrogate, and raised by the commissioning parents. In this paper, I critically examine proposals to allow DDS in the United Kingdom, and the intentionalist justification for treating this practice distinctly (morally and legally speaking) from private adoption. I argue that the intentionalist approach cannot plausibly justify such a distinction and that other approaches to moral parenthood are also unlikely to succeed. (shrink)

ABSTRACT Most existing literature on the ethics of full ectogenesis has proceeded under the presupposition that science will at some point produce sophisticated technologies for full‐term gestation (from embryo to infant) outside the human womb, delivering neonate health outcomes comparable with (or even superior to) biological gestation. However, the development of this technology—as opposed to the support systems currently being advanced—would require human subject experiments in embryo‐onwards development using ectogenic prototypes. Literature on ectogenic research ethics has so far focused on (...) ‘backwards’ development of partial ectogenesis: incubation and ectogestation technologies that would allow the support of earlier and earlier neonates and foetuses. However, little has been said about the ethics of ‘forwards’ development of (partial or full) ectogenesis, involving the development of embryos and foetuses in prototype environments. Such a prototype might allow us to produce a gestateling or live neonate from a human embryo, but with poorer expected development and health outcomes than from biological gestation; it might also produce only gestatelings (healthy or otherwise) before the technology was developed to a stage where full‐term gestation was achievable. This paper explicates some of the ethical issues that this raises for the development of ‘full’ ectogenesis, and presents prima facie reasons to consider this research problematic and therefore to require extensive further argument in its defence. (shrink)

A number of countries and states prohibit surrogacy except in cases of “medical necessity” or for those with specific medical conditions. Healthcare providers in some countries have similar policies restricting the provision of clinical assistance in surrogacy. This paper argues that surrogacy is never medically necessary in any ordinary understanding of this term. The author aims to show first that surrogacy per se is a socio-legal intervention and not a medical one and, second, that the intervention in question does not (...) treat, prevent, or mitigate any actual or potential harm to health. Legal regulations and healthcare-provider policies of this kind therefore codify a fiction—one which both obscures the socio-legal motivations for surrogacy and inhibits critical examination of those motivations while mobilizing normative connotations of appeals to medical need. The persisting distinction, in law and in moral discourse, between “social” and “medical” surrogacy, is unjustified. (shrink)

Some National Health Service healthcare boards in the UK will approve a request for female sterilisation only if the patient first accepts a trial period of 1 year with an intrauterine device (IUD), a form of long-acting reversible contraception. In this article, I argue that this requirement is not justified by appeal to any of (or any combination of) promotion of informed consent, paternalistic concerns regarding patient regret in later life and health service budgetary considerations. Informed consent and patient autonomy (...) may be promoted by a mandatory waiting period, but the concomitant imposition of an IUD trial during this period cannot be justified on these grounds. As long as elective vasectomy is offered by the healthcare system, elective female sterilisation should be accessible under reasonably similar—even if not identical—conditions. (shrink)

Ashley’s response to our recent paper argues that a fuller appreciation of the available clinical data, of the rights of children to autonomy, and of the primary purpose of gender-affirming endocrine treatment supports the rejection of both the pathway and consent dilemmas for the treatment of gender dysphoria, as raised in this journal. In this response, we highlight certain misrepresentations of our argument, and defend our conclusions against Ashley’s main objections.

In this paper, I offer a critique of (actual and possible) causal theories of parenthood. I do not offer a competing account of who incurs parental obligations and why; rather, I aim to show that there are fundamental problems for any account of who acquires parental obligations and why by appeal to causal responsibility for a child’s existence. I outline and justify three criteria that any plausible causal account of parental obligation must meet, and demonstrate that attempting to fulfil all (...) three criteria simultaneously will give rise to one or both of two potentially insurmountable dilemmas. (shrink)

In this paper, I explore the ways in which consideration of adolescent parents forces us to confront and question common presuppositions about parental rights. In particular, I argue that recognising the right of adolescent mothers not to be forcibly separated from their newborn children justifies rejecting the notion that parental rights are all acquired in the same manner and acquired as a ‘bundle’ of concomitant moral rights. I conclude that children and adolescents who conceive and give birth have some parental (...) rights concerning their newborn children – in particular, the right not to be forcibly separated from those children – even if they do not have the ‘full complement’ of parental rights as we generally characterise these. (shrink)

The economic crash of 2008 demonstrated the fragility of financial systems throughout the world; COVID-19, as the first pandemic in over a century to wreak global havoc, has demonstrated the fragility of healthcare systems. At the time of writing, the virus has been with us for a little over a year, and concerted vaccination efforts have begun. At the same time, several variants (some significantly more infectious than others) of SARS-CoV2, the virus that causes COVID-19, have emerged in different countries, (...) sparking a new wave of border closures and local lockdowns, and a new wave of debates over the right way for governments and individuals alike to respond to the pandemic. The response of governments around the world has been far from synchronised over the last year, but almost without exception, they have made significant efforts to reduce the public health impact of the pandemic – overall, the preservation of life and health has been prioritised at the cost of material and financial goods and other widely used metrics of socio-political success. In this chapter, I suggest that a taking a care ethics perspective allows us to elucidate the important place of caring duties and caring relationships in ethical evaluation of pandemic management strategies. Government action and public attitudes alike demonstrate that care – concern for the wellbeing of others – has had significant normative force in motivating decision-making and shaping ethical responses to COVID-19. (shrink)

Our understanding of what it means to be a parent is shaped by our biological, social, legal, and moral concepts of parenthood. This book combines traditional philosophical methods with research in the broader social sciences and humanities to explore the dilemmas which challenge our understanding of parenthood today.

Surrogacy and adoption are both family-making measures subject to extensive domestic and international regulation. In this nationally representative survey study (N = 1552), we explore public attitudes to various forms of surrogacy and adoption in the United Kingdom, in response to an early proposal to allow “double donor” surrogacy as part of the ongoing legal reform project. We sought to both gauge public moral support for adoption and surrogacy generally, the effect that prospective parents’ fertility had on this support, and (...) the extent to which the public would find equivalencies between “double donor” surrogacy (DDS) and planned private adoption (PPA) to be morally significant. Our findings indicate that whilst there is broad baseline support for all forms of adoption and surrogacy, this support increases significantly when one or both prospective parents are infertile. These findings also suggest that the language in which a family-making arrangement is characterized has a greater influence on moral support for the arrangement than practical features such as the biological relationship (or absence thereof) between one/both parents and the child. (shrink)

Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how the 'medical (...) consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver. (shrink)

The effectiveness of information retrieval technology in electronic discovery (E-discovery) has become the subject of judicial rulings and practitioner controversy. The scale and nature of E-discovery tasks, however, has pushed traditional information retrieval evaluation approaches to their limits. This paper reviews the legal and operational context of E-discovery and the approaches to evaluating search technology that have evolved in the research community. It then describes a multi-year effort carried out as part of the Text Retrieval Conference to develop evaluation methods (...) for responsive review tasks in E-discovery. This work has led to new approaches to measuring effectiveness in both batch and interactive frameworks, large data sets, and some surprising results for the recall and precision of Boolean and statistical information retrieval methods. The paper concludes by offering some thoughts about future research in both the legal and technical communities toward the goal of reliable, effective use of information retrieval in E-discovery. (shrink)

How are causal judgements such as 'The ice on the road caused the traffic accident' connected with counterfactual judgements such as 'If there had not been any ice on the road, the traffic accident would not have happened'? This volume throws new light on this question by uniting, for the first time, psychological and philosophical approaches to causation and counterfactuals. Traditionally, philosophers have primarily been interested in connections between causal and counterfactual claims on the level of meaning or truth-conditions. More (...) recently, however, they have also increasingly turned their attention to psychological connections between causal and counterfactual understanding or reasoning. At the same time, there has been a surge in interest in empirical work on causal and counterfactual cognition amongst developmental, cognitive, and social psychologists--much of it inspired by work in philosophy. In this volume, twelve original contributions from leading philosophers and psychologists explore in detail what bearing empirical findings might have on philosophical concerns about counterfactuals and causation, and how, in turn, work in philosophy might help clarify the issues at stake in empirical work on the cognitive underpinnings of, and relationships between, causal and counterfactual thought. (shrink)

How are causal judgements such as 'The ice on the road caused the traffic accident' connected with counterfactual judgements such as 'If there had not been any ice on the road, the traffic accident would not have happened'? This volume throws new light on this question by uniting, for the first time, psychological and philosophical approaches to causation and counterfactuals. Traditionally, philosophers have primarily been interested in connections between causal and counterfactual claims on the level of meaning or truth-conditions. More (...) recently, however, they have also increasingly turned their attention to psychological connections between causal and counterfactual understanding or reasoning. At the same time, there has been a surge in interest in empirical work on causal and counterfactual cognition amongst developmental, cognitive, and social psychologists--much of it inspired by work in philosophy. In this volume, twelve original contributions from leading philosophers and psychologists explore in detail what bearing empirical findings might have on philosophical concerns about counterfactuals and causation, and how, in turn, work in philosophy might help clarify the issues at stake in empirical work on the cognitive underpinnings of, and relationships between, causal and counterfactual thought. (shrink)

In our paper we aim at reflecting upon the extent to which educational theory may be used as a framework in the analysis of policy documents. As policy texts are ‘heteroglossic in character’ (Lingard and Ozga, in The Routledge Falmer reader in education policy and politics, Routledge, London and New York, 2007 , p. 2) and create “circumstances in which the range of options available in deciding what to do are narrowed or changed” (Ball in, Education policy and social class: (...) The selected works of Stephen J Ball, Routledge, London and New York, 2006 , p. 46), they need to be theoretically tackled in their underlying assumptions and implications. This proposal draws on an analysis of two sets of documents of the European Union: texts produced between 2000 and 2006, underlying the European Union programmes; and texts produced by a working group focusing on the key competences of Lifelong Learning (2003–2006). Initially, the framework for the analysis of different documents was grounded on the existing research in the field of educational policy. Now we attempt a secondary analysis of the collected data by transposing the borders of this particular and highly prolific field. We argue that what is outside the texts may reshape what is inside the texts. Educational theory allows us to define some conceptual tools in order to question the documents as political apparatus which open and constrain possibilities. Therefore, we will use educational theory as an arena where different matters, perspectives and possibilities may be explored and assembled. We have engaged in a conversation with both the data and some theoretical approaches. Central to this conversation are the concepts of “ignorant schoolmaster” (Rancière, in The ignorant schoolmaster five lessons in intellectual emancipation, Stanford University Press, Stanford, 1991 ), “learning contexts” (Edwards, in Rethinking contexts for learning and teaching, Routledge, Oxon and New York, 2009a , b ), and “experience” (Larrosa, in Revista Brasileira de Educação, 19:20–28, 2002 ). (shrink)