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 (...) class='Hi'>twin 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)

The aim of the study was verifying, whether speech development is conditioned by a preterm birth, multiple pregnancy or pregnancy complicated with TTTS. We examined 52 preterm children, 15 of which were born after a single pregnancy and 42 after a multiple pregnancy. 23 children came from a pregnancy complicated by TTTS. The average age of the subjects was 32.5 months. The research methods used in our study were as follows: analysis of medical documentation, a (...) structured clinical interview and psychological conversation. Speech development of a child was assessed using BSID-III. An analysis of the results we obtained showed that there was a lower level of EC in the TTTS children in comparison to multiple-birth children without TTTS and single-birth children. We also found statistically significant relations between the EC scores and gender, age at the time of testing, disability, gestational age, birth weight. (shrink)

Twelve years ago the British media got wind of a London gynecologist who performed an elective reduction on a twin pregnancy reducing it to a singleton. Perhaps not surprisingly, opinion on the moral status of twin reductions was divided. But in the last few years new evidence regarding the medical risks of twin pregnancies has emerged, suggesting that twin reductions are relevantly similar to the reductions performed on high‐end multi‐fetal pregnancies. This evidence has appeared to (...) resolve the moral debate.In this paper I look at the role of clinical evidence in medical ethics. In particular I examine the role of clinical evidence in determining what counts as a significant harm or risk. First, I challenge the extent to which these empirical claims are descriptive, suggesting instead that the evidence is to some degree normative in character. Second, I question whether such empirical claims should count as evidence for what are essentially difficult ethical decisions – a role they appear to play in the case of elective reductions. I will argue that they should not, primarily because the value‐laden nature of this evidence conceals much of what is ethically at stake. It is important to recognize that empirical evidence cannot be a substitute for ethical deliberation. (shrink)

IntroductionDeep brain stimulation (DBS) is increasingly used to treat the symptoms of various neurologic and psychiatric conditions. People can undergo the procedure during reproductive years but the safety of DBS in pregnancy remains relatively unknown given the paucity of published cases. We thus conducted a review of the literature to determine the state of current knowledge about DBS in pregnancy and to determine how eligibility criteria are approached in clinical trials with respect to pregnancy and the potential (...) for pregnancy.MethodsA literature review was conducted in EMBASE to identify articles involving DBS and pregnancy. Two reviewers independently analyzed the articles to confirm inclusion. Data extracted for analysis included conditions treated, complications at all stages of pregnancy, neonatal/pediatric outcomes, and DBS target. A second search was then conducted using www.clinicaltrials.gov. The same two reviewers then assessed whether each trial excluded pregnant individuals, lactating individuals, or persons of childbearing age planning to conceive. Also assessed was whether contraception had to be deemed adequate prior to enrollment.ResultsThe literature search returned 681 articles. Following independent analysis and agreement of two reviewers, 8 pregnancy related DBS articles were included for analysis. These articles described 27 subjects, 29 pregnancies (2 with subsequent pregnancies), and 31 infants (2 twin pregnancies). There was 1 preterm birth at 35 weeks, and 3 patients who experienced discomfort from the DBS battery (i.e., impulse generator) placement site. All 27 patients had a DBS device implanted before they became pregnant, which remained in use throughout their pregnancy. There was exclusion of pregnant individuals from 68% of 135 interventional trials involving DBS. Approximately 44% of these trials excluded persons of childbearing age not on “adequate contraception” or wishing to conceive in the coming years. Finally, 22% excluded breastfeeding persons.ConclusionThe data from 29 pregnancies receiving DBS treatment during pregnancy was not associated with unexpected pregnancy or post-partum complication patterns. Many clinical trials have excluded pregnant individuals. Documentation of outcomes in larger numbers of pregnancies will help clarify the safety profile and will help guide study designs that will safely include pregnant patients. (shrink)

: This article draws upon the Roman Catholic distinction between "ordinary" and "extraordinary" means of medical treatment to analyze the case of "Jodie" and "Mary," the Maltese conjoined twins whose surgical separation was ordered by the English courts over the objection of their Roman Catholic parents and Cormac Murphy-O'Connor, the Roman Catholic Cardinal Archbishop of Westminster. It attempts to shed light on the use of that distinction by surrogate decision makers with respect to incompetent patients. In addition, it critically analyzes (...) various components of the distinction by comparing the reasoning used by Catholic moralists in this case with the reasoning used in other cases that raise similar issues, including women facing crisis pregnancies who prefer abortion to adoption and the Indiana "Baby Doe" case. (shrink)

Assisted reproductive technology has enabled thousands of infertile couples to experience the joys of parenthood. At various times, however, significant problems have come to light concerning the providing of infertility treatment in the United States. An early problem was misleading advertising by some infertility programs, particularly in regard to pregnancy success rates. This unacceptable activity suggested the need for more oversight of assisted reproductive technology and prompted the passage of a federal law requiring the reporting of success rates in (...) a standardized format. Another problem, one that was especially disturbing, was the transfer of preembryos to infertile women at the University of California, Irvine, without the consent of the progenitor couples. Disclosure of these events added fuel to the debate over whether assisted reproductive technology should be subject to greater governmental regulation. (shrink)

Assisted reproductive technology has enabled thousands of infertile couples to experience the joys of parenthood. At various times, however, significant problems have come to light concerning the providing of infertility treatment in the United States. An early problem was misleading advertising by some infertility programs, particularly in regard to pregnancy success rates. This unacceptable activity suggested the need for more oversight of assisted reproductive technology and prompted the passage of a federal law requiring the reporting of success rates in (...) a standardized format. Another problem, one that was especially disturbing, was the transfer of preembryos to infertile women at the University of California, Irvine, without the consent of the progenitor couples. Disclosure of these events added fuel to the debate over whether assisted reproductive technology should be subject to greater governmental regulation. (shrink)

During recent years we have seen and assisted at a significantly increased number of twin births. The main reason for this increase in the frequency of twin births is the increasing number of so called “induced pregnancies”, whether through hormonal stimulation or artificial insemination techniques.It is well known1 that twins have high mortality and morbidity rates during the perinatal and the following period. The characteristics of conception and pregnancy can determine the development of several pathologies, including prematurity (...) and intrauterine growth retardation, …. (shrink)

The principle of double effect is often used in bioethics as a tool to evaluate significant cases in obstetrics and gynecology. In this article the author, a Catholic priest, presents and interprets St. Thomas Aquinas’s delineation of the principle and discusses several classical applications, namely, to hysterectomy during pregnancy, ectopic pregnancy, and craniotomy. He explains the medical anatomy and physiology of the conjoined Maltese twins, Jodie and Mary, and then examines the arguments of four moralists on their separation. (...) He concludes by arguing that the principle morally justified the surgical separation of Jodie and Mary. National Catholic Bioethics Quarterly 9.1 : 85–96. (shrink)

In the article, Twin pregnancy, fetal reduction and the ‘all or nothing problem’, I argued that there is a moral problem in multifetal pregnancy reduction from a twin to a singleton pregnancy. Drawing on Horton’s original version of the ‘all or nothing problem’, I argued that there are two intuitively plausible claims in 2-to-1 MFPR: aborting both fetuses is morally permissible, aborting only one of the twin fetuses is morally wrong. Yet, with the assumption (...) that one should select permissible choice over impermissible choice, the two claims lead to a counter-intuitive conclusion: the woman ought to abort both fetuses rather than only one. It would be odd to promote such a pro-death view. Begović _et al_ discuss my article and offer insightful criticism, claiming, that there is no ‘all or nothing problem’ present in 2-to-1 MFPR. In this short reply, I respond to some of their criticism. (shrink)

What role should legislation or policy play in avoiding the complications of in-vitro fertilization? In this article, we focus on single versus double embryo transfer, and assess three arguments in favour of mandatory single embryo transfer: risks to the mother, risks to resultant children, and costs to society. We highlight significant ethical concerns about each of these. Reproductive autonomy and non-paternalism are strong enough to outweigh the health concerns for the woman. Complications due to non-identity cast doubt on the extent (...) to which children are harmed. Twinning may offer an overall benefit rather than burden to society. Finally, including the future health costs for children in reproductive policy is inconsistent with other decisions. We conclude that mandatory single embryo transfer is not justified and that a number of countries should reconsider their current embryo transfer policy. (shrink)

There is an ongoing debate about whether multifetal pregnancy reduction from twins to singletons (2-to-1 MFPR) is morally permissible. By applying the all or nothing problem to the cases of reducing twin pregnancies to singletons, Räsänen argues that an implausible conclusion seems to follow from two plausible claims: (1) it is permissible to have an abortion and (2) it is wrong to abort only one fetus in a twin pregnancy. The implausible conclusion is that women considering (...) 2-to-1 MFPR for social reasons ought to abort both fetuses rather than just one. To avoid the conclusion, Räsänen suggests that it is best to carry both fetuses to term and give one for adoption. In this article, I argue that Räsänen’s argument fails for two reasons: the inference from (1) and (2) to the conclusion rests on a bridge principle that does not work in certain circumstances, and there is good reason to reject the claim that it is wrong to abort only one fetus. (shrink)

A fetus may survive an intentional interference with its intrauterine environment (1) if gestational age is mistaken and the procedure of induced abortion does not kill the fetus, (2) if a change of heart takes place after abortifacient drugs are taken and the abortion does not proceed, and (3) if a high-multiple pregnancy is reduced to a singleton or a twin pregnancy to improve the likelihood that the remaining fetuses will reach viability. In each case, through cause (...) or coincidence, an abnormal baby may be born. The well-intentioned physician, responding to a patient's medical or psychological needs, risks a legal action in negligence or assault brought by a deformed surviving child. This hazard means that medical termination of pregnancy and selective pregnancy reduction put the practising physician at substantial risk in a way not usually associated with induced abortion. (shrink)

Feminist social theory and female body experience are the twin themes of Iris Marion Young's twelve outstanding essays written over the past decade and brought together here. Her contributions to social theory raise critical questions about women and citizenship, the relations of capitalism and women's oppression, and the differences between a feminist theory that emphasizes women's difference and one that assumes a gender-neutral humanity. Loosely following a phenomenological method of description, Young's essays on female embodiment discuss female movement, (...) class='Hi'>pregnancy, clothing, and the breasted body. In an introduction that situates her work in the context of shifts in feminist theory and politics over the past decade, Young emphasizes the rootedness of her theorizing in a dedicated and seasoned political activism. (shrink)

Sacrificing one's own interests in order to serve another is, in general, supposed to be a good thing, an example of altruism, the hallmark of morality, and something we should commend to (but not always require of) the entirely-too-selfish human beings of our society. But let me recount a story that I hope will persuade the reader to start questioning this conventional philosophical wisdom. Last year, a friend of mine was talking with me about a mutual acquaintance whose two sons (...) were in the same nursery school as our sons. This woman, whom I will call Terry, had been pregnant with twins, but one of the twins had died during the fourth month of pregnancy, and the other twin had just been born prematurely at six months with a host of medical problems. We were discussing how stressful this woman's life had been while she was pregnant: she was a housewife, and her two boys, aged three and five, were lively, challenging, often unruly--a real handful to raise. Her husband worked long hours in a law firm, so the vast majority of the childcare and household chores fell on her shoulders. "You could see that she was exhausted by end of the first trimester," I maintained, "because her eyes were tired, and her cheeks were sunken--she looked almost like a cadaver." My friend agreed. I went on to blame her exhaustion on the fact that she had to do too much during a pregnancy that anyone would have found difficuIt. "I don't understand her husband," I maintained. "Surely he could how badly she looked. If he had concern for his future children, why didn't he do something to help her so that the pregnancy had a chance of going better? And if he loved her, why didn't he cut down his hours so that he could help out at home? Surely he could see just by looking at her that she was in trouble," My friend said nothing at the time, but after a week she called me, and told me that my criticism of this woman's husband had bothered her all week. "You're wrong about Terry's husband not caring enough about her, They have a good marriage," she insisted, and then she continued: "You know, you're not like us, We accept the fact that we should do most of the childcare and housework.. (shrink)

In 2018, the Chinese scientist He Jiankui presented his research at the Second International Summit on Human Genome Editing in Hong Kong. While it was intended that he facilitate a workshop, he was instead called on to present his research in heritable human genome editing, where he made the announcement that he had taken great strides in advancement of his research, to the extent that he had gene-edited human embryos and that this had resulted in the live births of two (...) children. While his research ethic and methodology was interrogated, he insisted that two children, twin girls, had been born healthy and that there was another pregnancy (at the time) where birth of a third gene edited child would be imminent. This announcement generated a ripple effect in the scientific community and exposed the gaps in regulation and absence of law relating to the technology. This resulted in a flurry of activity and conversation around regulation of the technology, which scientists stated was not ready for human trials. This article reviews the Third Summit which was held in London in March 2023 and comments on the latest developments in the regulation of heritable human genome editing. (shrink)

Reproductive autonomy is central to women’s welfare both because childbearing takes place in women’s bodies and because they are generally expected to take primary responsibility for child rearing. In 2005, the factors that influence their autonomy most strongly are poverty and belief systems that devalue such autonomy. Unfortunately, such autonomy is a low priority for most societies, or is anathema to their belief systems altogether. This situation is doubly sad because women’s reproductive autonomy is intrinsically valuable for women and also (...) instrumentally valuable for the welfare of humankind. This paper takes for granted the moral and practical necessity of such autonomy and digs deeper into the question of what such a commitment might entail, focusing on the mid-level policy making that, at least in the US and Canada, plays a significant role in shaping women’s options. This paper examines a large teaching hospital’s policy on reduction of multifetal pregnancies. The policy permits reduction of triplets to twins, but not twins to a singleton. As there is no morally relevant difference between these two types of reduction, it is evident that inappropriate medicalisation can still limit women’s autonomy in undesirable ways. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 44, no. 3. © 2018 by Feminist Studies, Inc. 699 Jennifer C. Nash The Political Life of Black Motherhood In 1976, Adrienne Rich wrote, “We know more about the air we breathe, the seas we travel, than about the nature and meaning of motherhood.”1 In the four decades since the publication of Rich’s now-canonical Of Woman Born, Andrea O’Reilly has argued for the advent of “maternal theory” (...) as an academic discipline, the maternal memoir has become a highly popular (and profitable) literary genre, and there has been sustained attention to maternal activism with scholarly analyses of such organizations as Mothers Against Drunk Driving and Mothers of the Movement.2 If Mamie Till Bradley boldly “let the world see” her son’s mutilated body in a 1955 public plea to make visible black suffering and antiblack violence, Valerie Castile’s statement after a jury found a police officer not guilty in the death of her son continued in the tradition of 1. Adrienne Rich, Of Woman Born: Motherhood as Experience and Institution (New York: W. W. Norton, 1995), 11. 2. See Andrea O’Reilly, ed., Maternal Theory: A Reader (New York: Demeter Press, 2007); Ann Hulbert, “The Real Myth of Motherhood,” Slate, March 8, 2005; Jennifer C. Nash and Samantha Pinto, “Strange Intimacies: Reading Black Mothering Memoirs,” Public Culture (forthcoming); Danielle Poe, Maternal Activism: Mothers Confronting Injustice (Albany: SUNY Press, 2016); and Ruth Feldstein, Motherhood in Black and White: Race and Sex in American Liberalism, 1930–1965 (Ithaca, NY: Cornell University Press, 2000). 700 Jennifer C. Nash Books Discussed in This Essay Revolutionary Mothering: Love on the Front Lines. Edited by Alexis Pauline Gumbs, China Martens, and Mai’a Williams. Oakland, CA: PM Press, 2016. Laboring Positions: Black Women, Mothering and the Academy. Edited by Sekile Nzinga-Johnson. Bradford, ON: Demeter Press, 2013. How All Politics Became Reproductive Politics: From Welfare Reform to Foreclosure to Trump. By Laura Briggs. Oakland: University of California Press, 2017. Birthing Justice: Black Women, Pregnancy, and Childbirth. Edited by Julia Oparah and Alicia Bonaparte. New York: Routledge, 2016. making black (male) pain visible through grief-stricken black motherhood. Castile said, My son loved this state. He had one tattoo on his body and it was of the twin cities, the state of Minnesota with “TC” on it. My son loved this city, and this city killed my son and the murderer gets away.... We’re not evolving as a civilization, we’re devolving, we have taken steps forward, people have died for us to have these rights and now we’re devolving, we’re going back to 1969.3 Her emotional plea reveals the political currency of black maternal suffering, one of the few spaces in which black pain is readily culturally visible. Indeed, there has been intensified scholarly and popular interest in representing black motherhood as both a site constituted by grief and expected loss and as a political position made visible (only) because of its proximity to death. It is certainly the case that a cultural inattention to motherhood has been replaced by an intense investment in representing at least some aspects of “the nature and meaning of motherhood” and 3. “Philando Castile’s Mother Reacts to Verdict,” Washington Post video on YouTube, posted on June 16, 2017, https://www.youtube.com/watch?v=RJsD4cCpUA. Jennifer C. Nash 701 in representing certain mothers—particularly black mothers—as symbols of trauma and injury, of pain that can be mobilized for “legitimate” political ends and social change. If, as O’Reilly suggests, maternal theory is now a distinct field, it has been fundamentally shaped by the intellectual and political labor of black feminists—Dorothy Roberts, bell hooks, Alice Walker, Patricia Hill Collins, Hortense Spillers, and Audre Lorde—who have captured the myriad ways that black maternity is cast as pathological, excessive, and marked by aberrant performances of gender and heterosexuality that threaten both the nuclear family and the heterosexual state. Drawing on a varied archive from the Moynihan Report to cultural panics about “kids having kids,” from ongoing representations of black women’s “failure” to breastfeed as a public health crisis to the racialized underpinnings of birth control, black feminist theory... (shrink)

When does a human being begin to exist? We argue that it is possible, through a combination of biological fact and philosophical analysis, to provide a definitive answer to this question. We lay down a set of conditions for being a human being, and we determine when, in the course of normal fetal development, these conditions are first satisfied. Issues dealt with along the way include: modes of substance-formation, twinning, the nature of the intra-uterine environment, and the nature of the (...) relation between fetus and mother (connection, parthood, dependence). (shrink)

Leeds Teaching Hospitals NHS Trust v Mr & Mrs A & othersThe decision of Dame Butler-Sloss in the case of Leeds Teaching Hospitals NHS Trust v Mr & Mrs A & Others1 has already achieved notoriety. The disturbing facts have received widespread media coverage and fuelled further legal and political debate surrounding the “reproductive revolution”.2 This short paper assesses the context and potential implications of the recent decision and, in particular, the nature and meaning of parenthood and the family.THE CASETwo (...) couples, referred to Mr and Mrs A and Mr and Mrs B, were attending the assisted conception unit at Leeds General Infirmary to receive infertility treatment. Both couples understood that they were participating in a technique called intracytoplasmic sperm injection , a technique which would use the eggs of the wife and the sperm of the husband in each case. Mrs A had consented to her eggs being mixed with her husband’s sperm to create an embryo which would then be implanted in her, hopefully resulting in pregnancy. Mr A had consented to his wife’s treatment. Mr and Mrs B gave their consent to similar IVF procedures, although Mr B had expressly refused to consent to his sperm being used in treating others.Following a mix up at the unit, which Butler-Sloss referred to as “a ‘mistake’ … despite its inadequacy as a description of what occurred”, Mr B’s sperm was injected into Mrs A’s eggs. She became pregnant and later gave birth to healthy twins. The mistake became apparent only on Mrs A’s delivery of twins of mixed race; Mr and Mrs A are both white, Mr and Mrs B both black. DNA testing subsequently established that Mr B was the biological father of the children. He has had no subsequent contact with them and …. (shrink)

This study identified the influences of maternal socio-demographic and antenatal factors on stillbirths and neonatal deaths in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected antenatal and maternal characteristics with stillbirths and neonatal deaths. The findings of this study showed that stillbirths and neonatal deaths significantly varied by infant sex, maternal age, Aboriginality, maternal country of birth, socioeconomic status, parity, maternal smoking behaviour during pregnancy, maternal diabetes mellitus, maternal hypertension, antenatal care, (...) plurality of birth, low birth weight, place of birth, delivery type, maternal deaths and small gestational age. First-born infants, twins and infants born to teenage mothers, Aboriginal mothers, those who smoked during the pregnancy and those of lower socioeconomic status were at increased risk of stillbirths and neonatal deaths. The most common causes of stillbirths were conditions originating in the perinatal period: intrauterine hypoxia and asphyxia. Congenital malformations, including deformities and chromosomal abnormalities, and disorders related to slow fetal growth, short gestation and low birth weight were the most common causes of neonatal deaths. The findings indicate that very low birth weight (less than 2000 g) contributed 75·6% of the population-attributable risks to stillbirths and 59·4% to neonatal deaths. Low gestational age (less than 32 weeks) accounted for 77·7% of stillbirths and 87·9% of neonatal deaths. The findings of this study suggest that in order to reduce stillbirths and neonatal deaths, it is essential to include strategies to predict and prevent prematurity and low birth weight, and that there is a need to focus on anti-smoking campaigns during pregnancy, optimizing antenatal care and other healthcare programmes targeted at the socially disadvantaged populations identified in this study. (shrink)

What kind of interventions on the body of an innocent human being may be licitly intended? This question arises in relation to maternal–fetal conflicts such as ectopic pregnancy and obstructed labor, and to other cases such as organ harvesting and separation of conjoined twins. Many assume that harm must be intended for absolute moral prohibitions to apply; however, it is not always the case that foreseen harm is merely a factor to weigh against benefits we intend. On the contrary, (...) foreseen harm (and absence of benefit) for someone we affect can be morally conclusive when linked to an immedi­ate intention to affect the person’s body or invade the space it fills. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:NABER on Embryo SplittingMichael B. BurkeMadam:In its interesting Report on Human Cloning through Embryo Splitting: An Amber Light (KIEJ, September 1994), NABER (the National Advisory Board on Ethics in Reproduction) discusses ten potential clinical uses of embryo splitting. With one member dissenting, NABER finds two of the uses to be acceptable in principle: (1) “to improve the chances of initiating pregnancy in those individuals undergoing IVF who produce (...) only a limited number of embryos for transfer and implantation” (p. 267) and (2) “to minimize the number of egg retrieval procedures for those undergoing IVF by providing embryos for cryopreservation and future transfer” (p. 268).However, some members of NABER limit their support for these uses to cases in which none of the embryos into which the originals are split are intentionally destroyed (see pp. 266–68). I find their position puzzling. They consider it “ethically unacceptable to discard cryopreserved embryos” (p. 268). In general, they object to intentional destruction of embryos resulting from embryo splitting. Yet they accept intentional destruction of the original embryos.Does the splitting of an embryo truly destroy it? Yes, it does, at least if the embryo is split into two equal parts—or into more than two parts, none of which contains a majority of the cells contained by the original. Suppose, for instance, that a two-cell embryo has been split into two one-cell embryos. Then the original embryo, although it may not have “died” and although its cells have both survived, has nonetheless ceased to exist. Even though the resulting one-cell embryos are identical genetically to the original embryo, neither of them is that embryo. (There is nothing to confer this honor on one of them rather than the other.) The original embryo has undergone what I will call “destructive splitting.”Now it is possible, even likely, that some splittings are not destructive splittings. Suppose that a four-cell embryo is spilt into a three-cell embryo and a one-cell embryo. At least from my perspective as an identity theorist, there is nothing to stop us from identifying the three-cell embryo with the four-cell original: we could say that the original embryo, although diminished, still exists. In any case, there is no indication that any members of NABER intended to limit their acceptance of embryo splitting to cases in which the original embryo survives.How are we to understand the apparent indifference of conservative members of NABER to the embryo that is split, given their concern for the embryos that result from the split? Perhaps the explanation is found in the following passage:NABER members represent a broad spectrum of views on the moral status of the embryo, and yet virtually all of them find embryo splitting per se ethically permissible if the resulting embryos are not damaged or destroyed in the process. These members maintain that there is nothing inherently wrong with creating several embryos [End Page 210] from a single embryo, providing all the embryos involved [except the original!] remain intact at the conclusion of the procedure. Embryo splitting parallels the spontaneous production of identical twins or triplets at this stage of embryo development, an occurrence that is accepted in our society with equanimity. The fact that embryo splitting is deliberately used to produce multiple embryos does not make it inherently wrong to employ the procedure.(Report, pp. 266–67)This argument appears to rely on the following principle: if something is properly viewed with equanimity when it happens spontaneously, then it is not inherently wrong to bring it about deliberately. At least in its full generality, this is a principle generally and rightly viewed with suspicion (by moral conservatives above all). Although it is proper to view with equanimity, even with relief, the natural deaths of terminally ill patients in great pain, many hold that active euthanasia is inherently wrong.When NABER has occasion to revisit the issue of embryo splitting, those members who object to destruction of embryos resulting from embryo splitting should make clear whether they accept the destructive splitting of embryos. If they do, they should clarify their reasons for accepting it.Michael B. BurkeDepartment of Philosophy Indiana... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Human Cloning by Embryo Splitting:After the HullabalooCynthia B. Cohen (bio)In October 1993, a paper entitled, "Experimental Cloning of Human Polyploid Embryos Using an Artificial Zona Pellucida," was presented at a joint meeting of the American Fertility Society and the Canadian Fertility and Andrology Society. Although it was awarded a prize, its authors, who are affiliated with George Washington University, decided against calling a press conference to (...) announce their findings. Word of their experiment soon leaked out, however, and the New York Times blazoned on its front page that human embryo cloning had been achieved. The story was accompanied by a diagram of cloning by nuclear transplantation.Newspapers and television networks around the world picked up the story and embellished it. The idea of unlimited, xeroxed copies of human beings gripped the public imagination. Wild scenarios of hundreds of Hitlers plotting to take over the world and of clones giving birth to their own twins enlivened media reports. Only gradually did it become clear that the term "polyploid" in the title of the paper referred to abnormal embryos that could never develop into living human beings and that "cloning" referred to embryo splitting or twinning, not to nuclear transplantation or the transfer of a donor nucleus into an enucleated egg. Once this sank into public consciousness, the "hullabaloo," as Dr. Howard W Jones, Jr., called it, died down.It left in its wake unanswered questions about the ethics of splitting embryos. During the height of the publicity given to the George Washington experiment, newspaper and TV stories had not delved in any depth into the ethical issues it raised. Ethicists, given limited time to discuss the ethical questions at stake, had been quoted in quick, simplistic responses. Some had offered little analysis of the rights and wrongs of embryo splitting, but, revealing tremendous creative talent, had spun out [End Page 187] imaginary and frightening applications of the procedure. This was a story essentially about ethics in which ethics was never really discussed.The National Advisory Board on Ethics in Reproduction* (NABER), an independent, multidisciplinary group that addresses ethical issues in modern reproductive science, technology, and care, became concerned about the sparsity of reflective ethical debate about embryo splitting. NABER's chair, Albert Jonsen, observed that "reporters phoning ethicists for comment and ethicists appearing on talk shows do not a debate make. Debate requires face to face (or at least essay to essay) argument among persons sharing the same information. This has yet to take place." Consequently, NABER decided to convene a workshop on human cloning by embryo splitting at the National Academy of Sciences in February 1994. The board invited participants who would provide a broad range of opinion about the ethical and public policy issues entailed by human embryo splitting. Embryologists, ethicists, reproductive biologists, public policy experts, staff from the National Institutes of Health (NIH), legal scholars, journalists, and infertility specialists were among those who participated. The feature articles in this issue of the Kennedy Institute of Ethics Journal derive from that workshop. Their authors were given free rein to take whatever stance they deemed ethically supportable.The first article is designed to provide some understanding of the science of human cloning as a basis for exploring the ethical issues raised by this set of techniques. Jacques Cohen, a leading reproductive embryologist, and Giles Tomkin, a science writer, both of Cornell University Medical School, explain, in a way that is clear to laypersons and biologists alike, the meaning, nature, and function of cloning. They discuss recent: advances in this area and offer an assessment of feasible uses of human cloning procedures, hoping to dispel what they view as mistaken fears about its future applications. Dr. Howard W Jones, Jr., a pioneer infertility specialist, briefly comments on Cohen and Tomkin's paper, pointing out that embryo splitting may not improve pregnancy results if genetic heterogeneity is required for successful embryo transfer and implantation.In the next article, three major ethical arguments against human cloning by embryo splitting are analyzed and rejected by Ruth Macklin, an expert in reproductive ethics from Albert Einstein College of Medicine. She finds the first argument, that the worth of individuals... (shrink)

In vitro fertilisation (IVF) daily practice reveals that couples are willing to take greater risks than doctors if there is a higher chance of pregnancy. Arising from this is a frequently addressed issue regarding the embryo transfer strategy: single or double embryo transfer? The dilemma is faced by patients, as well as physicians, who are caught between the possibility of no pregnancies at all and facing the prospect of iatrogenic twin gestation. How could the couple's preferences concerning how (...) many children they would like be taken into account in determining the number of embryos transferred? How should the physician exercise his medical responsibility towards his patients and the unborn child? An effective approach could be to enhance a couple’s autonomy by advocating a medical beneficence that incorporates patients’ values. This can be achieved through a case-by-case approach in a deliberative process of decision-making which includes real patient-centred communication. (shrink)

When her baby was born last June, Rossana Dalla Corte, age sixty-two, was thought to be the oldest woman ever to have given birth. Her pregnancy was achieved at a private fertility clinic in Italy, the same clinic that treated “Jennifer F.,” a London woman who, on Christmas day, 1993, at the age of fifty-nine, gave birth to twins. The reproductive procedure, likely to become more common during the next few years, has received intense scrutiny from health officials in (...) Great Britain, France, and Italy. Moral questions concerning that procedure already have been taken up by the popular press in the United States. Such questions can be expected to take on a new urgency as the United States considers reshaping its health care system and, specifically, the circumstances under which coverage for infertility treatment will be provided. (shrink)

When things go wrong with assisted reproduction we should look at what’s best for everyone in the particular circumstancesA RTBs, as we must now call them, are becoming more and more frequent. In the recent United Kingdom case Mr and Mrs A, a “white” couple, gave birth to twins described as “black”. The mix up apparently occurred because a Mr and Mrs B, a “black” couple, were being treated in the same clinic and Mrs A’s eggs were fertilised with Mr (...) B’s sperm. Mr and Mrs A love the twins and wish to keep them and the facts seem to be that Mrs A is the genetic mother of the twins but her partner is not the genetic father. Under English law, in assisted reproduction, the woman who gives birth to the child is the legal mother and this is true also in cases of surrogacy. I think there is no doubt in this case that English law has taken the right path and that it would be unconscionable to contemplate taking a child away from the woman who had undergone the risks and pains of pregnancy and childbirth and the bonding process that goes along with that when she wishes to keep the child particularly when there is no substantial and pressing evidence that she would be an unsafe parent. I argued this in my book The Value of Life4 and I think it is still true. So in this case justice, morality, and decency are served by confirming Mr and Mrs A as the parents of the children. Since in English law there is some ambiguity over paternity and how that is to be assigned and since Mr A is apparently not the genetic father, I think it is important …. (shrink)

When does a human being begin to exist? We argue that it is possible, through a combination of biological fact and philosophical analysis, to provide a definitive answer to this question. We lay down a set of conditions for being a human being, and we determine when, in the course of normal fetal development, these conditions are first satisfied. Issues dealt with along the way include: modes of substance-formation, twinning, the nature of the intra-uterine environment, and the nature of the (...) relation between fetus and mother. (shrink)

In this paper, I explore several versions of the bundle theory and the substratum theory and compare them, with the surprising result that it seems to be true that they are equivalent (in a sense of 'equivalent' to be specified). In order to see whether this is correct or not, I go through several steps : first, I examine different versions of the bundle theory with tropes and compare them to the substratum theory with tropes by going through various standard (...) objections and arguing for a tu quoque in all cases. Emphasizing the theoretical role of the substratum and of the relation of compresence, I defend the claim that these views are equivalent for all theoretical purposes. I then examine two different versions of the bundle theory with universals, and show that one of them is, here again, equivalent to the substratum theory with universals, by examining how both views face the famous objection from Identity of Indiscernibles in a completely parallel way. It is only the second, quite extreme and puzzling, version of the bundle theory with universals that is not be equivalent to any other view; and the diagnosis of why this is so will show just how unpalatable the view is. Similarly, only a not-so-palatable version of the substratum theory is genuinely different from the other views; and here again it's precisely what makes it different that makes it less appealing. (shrink)

There have been times in the history of ethical theory, especially in this century, when moral realism was down, but it was never out. The appeal of this doctrine for many moral philosophers is apparently so strong that there are always supporters in its corner who seek to resuscitate the view. The attraction is obvious: moral realism purports to provide a precious philosophical good, viz., objectivity and all that this involves, including right answers to (most) moral questions, and the possibility (...) of knowing those answers. In the last decade, moral realism has re-entered the philosophical ring in powerful-looking naturalistic form. ln this paper we provide a dialectical overview: we situate the new wave position itself, and also our objections to it, in the context of the evolving program of philosophical naturalism in 20th century analytic philosophy. We seek to show that although this new contender might initially look like championship material, it succumbs to punches surprisingly similar to those that knocked out the old-fashioned versions of naturalist moral realism. (shrink)

Journal of Social Philosophy, EarlyView.

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)

Pregnant people are often listed among groups that have been excluded from research on the basis of perceived vulnerability, to the detriment of the entire class. Lack of research among pregnant pe...

What is the metaphysical relationship between the fetus/embryo and the pregnant organism? In this paper I apply a substance metaphysics view developed by Barry Smith and Berit Brogaard to argue, on the basis of topological connectedness, that fetuses/embryos are Lady-Parts: part of the maternal organism up until birth. This leaves two options. Either mammalian organisms begin at birth, or we revise our conception of organisms such that mammalian organisms can be part of other mammals. The first option has some advantages: (...) it is numerically neat; aligns with an intuitive picture of organisms as physically distinct individuals; and ties ‘coming into existence’ to a suitably recognisable and important event: birth. But it denies that the fetus survives birth, or that human organisms existed prior to their birth. The second option allows us to recognise that human organisms exist prior to and survive their birth, but at a cost: it leaves the question of when an organism comes into existence unanswered, and demands potentially far-reaching conceptual revision across a range of domains. (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.

This book introduces the experience and process of gestation into the philosophy of Merleau-Ponty, Levinas and Derrida as a feminist project of maternal emancipation.

We study the foundation of space-time theory in the framework of first-order logic (FOL). Since the foundation of mathematics has been successfully carried through (via set theory) in FOL, it is not entirely impossible to do the same for space-time theory (or relativity). First we recall a simple and streamlined FOL-axiomatization Specrel of special relativity from the literature. Specrel is complete with respect to questions about inertial motion. Then we ask ourselves whether we can prove the usual relativistic properties of (...) accelerated motion (e.g., clocks in acceleration) in Specrel. As it turns out, this is practically equivalent to asking whether Specrel is strong enough to “handle” (or treat) accelerated observers. We show that there is a mathematical principle called induction (IND) coming from real analysis which needs to be added to Specrel in order to handle situations involving relativistic acceleration. We present an extended version AccRel of Specrel which is strong enough to handle accelerated motion, in particular, accelerated observers. Among others, we show that~the Twin Paradox becomes provable in AccRel, but it is not provable without IND. (shrink)