The controversial question of whether a future child can be harmed by the use of reproductive technology turns on the way that the future child's identity is understood. As a result, analysis of the ethical and legal obligations to the children of reproductive technology that are based upon the possibility of such harm depends upon the conception of identity that is used. This paper reviews the contributions of two recent books, David DeGrazia's Human Identity and Bioethics (2005) (...) and Philip Peters' How Safe is Safe Enough? (2004) to this area of inquiry. It suggests that the use of a narrative rather than numerical conception of identity makes it possible to coherently claim that future children can be harmed by the use of reproductive technologies and that, as a result, potential parents can have obligations regarding the use of those technologies based upon that possibility of harm. (shrink)

Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or (...) cannot) cause such harm. My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior. (shrink)

Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or (...) cannot) cause such harm. My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior. (shrink)

McLeod's Conscience in Reproductive Health Care offers a number of valuable contributions to the literature, both within and beyond reproductive care. In this commentary, I begin by discussing two potential applications of her argument that healthcare professionals—specifically, those "who are charged with gatekeeping access to healthcare services" —have a fiduciary duty of loyalty to prioritize the interests of their patients over their own. Then, I turn to a couple of concerns one might raise about extending this fiduciary duty (...) to pharmacists who function as gatekeepers of reproductive services. Finally, I pose some questions about the ways in which McLeod conceives of the harms and wrongs of... (shrink)

Advances in reproductive technologies continue to present ethical problems concerning their implementation and use. These advances have preoccupied bioethicists in their bid to gauge our moral responsibilities and obligations when making reproductive decisions. The aim of this discussion is to highlight the importance of a sensibility to differences in moral perspective as part of our ethical inquiry in these matters. Its focal point is the work of John Harrisi, who has consistently addressed the ethical issues raised by advancing (...) reproductive technologies. The discussion is aimed at a central tenet of Harris’s position on reproductive decision-making—namely, that in some instances, giving birth to a worthwhile life may cause harm and will therefore be morally wrong. It attempts to spell out some of the implications of Harris’s position that the author takes to involve a misplaced generality. To support this claim, some examples are explored that demonstrate the variety of ways in which concepts may manifest themselves as moral considerations within the context of reproductive decision-making. The purpose is to demonstrate that Harris’s general conception of the moral limits of reproductive autonomy obscures the issues raised by particular cases, which in themselves may reveal important directions for our ethical inquiry. (shrink)

In his book Reasons and Persons, Derek Parfit suggests that people are not harmed by being conceived with a disease or disability if they could not have existed without suffering that particular condition. He nevertheless contends that entities can be harmed if the suffering they experience is sufficiently severe. By implication, there is a threshold which divides harmful from non-harmful conceptions. The assumption that such a threshold exists has come to play a part in UK policy making. I argue that (...) Parfit’s distinction between harmful and non-harmful conceptions is untenable. Drawing on Kant’s refutation of the ontological argument for God’s existence, I suggest that the act of creation cannot be identical with the act of harming—nor indeed of benefiting—however great the offspring’s suffering may be. I suggest that Parfit is right that bringing children into existence does not usually harm them, but I argue that this must be applied to all conceptions, since Parfit cannot show how the harm threshold can be operationalised. If we think certain conceptions are unethical or should be illegal, this must be on other grounds than that the child is harmed by them. I show that a Millian approach in this context fails to exemplify the empirical and epistemological advantages which are commonly associated with it, and that harm-based legislation would need to be based on broader harm considerations than those relating to the child who is conceived. (shrink)

Some evidence suggests that IVF and other reproductive technologies create serious illness and disorders in a small but significant proportion of children who are born of them. If these technologies were found to do so, it would be wrong to forge ahead with their use.

This book review essay discusses Birth Rights and Wrongs: How Medicine and Technology Are Remaking Reproduction and the Law (2019), by Dov Fox.

Proponents of human reproductive cloning do not dispute that cloning may lead to violations of clones' right to self-determination, or that these violations could cause psychological harms. But they proceed with their endorsement of human reproductive cloning by dismissing these psychological harms, mainly in two ways. The first tactic is to point out that to commit the genetic fallacy is indeed a mistake; the second is to invoke Parfit's non-identity problem. The argument of this paper is that neither (...) approach succeeds in removing our moral responsibility to consider and to prevent psychological harms to cloned individuals. In fact, the same commitment to personal liberty that generates the right to reproduce by means of cloning also creates the need to limit that right appropriately. Discussion of human reproductive cloning ought to involve a careful and balanced consideration of both the relevant aspects of personal liberty – the parents' right to reproductive freedom and the cloned child's right to self-determination. (shrink)

Non-Identity arguments have a pervasive but sometimes counter-intuitive grip on certain key areas in ethics. As a result, there has been limited success in supporting the alternative view that our choices concerning future generations can be considered harmful on any sort of person-affecting principle. However, as the Non-Identity Problem relies overtly on certain metaphysical assumptions, plausible alternatives to these foundations can substantially undermine the Non-Identity argument itself. In this paper, I show how the pervasive force and nature of Non-Identity arguments (...) rely upon a specific adoption of a theory of modality and identity and how adopting an alternative account of modality can be used to reject many conclusions formed through Non-Identity type arguments. By using Lewis’s counterpart-theoretic account to understand ways we might have been, I outline the basis of a modal account of harm that incorporates a person-affecting aspect. This, in turn, has significant implications for ethical decision-making in areas such as reproductive choice and the welfare of future generations. (shrink)

Gender-based forms of administrative violence, such as reproductive violence, are the result of systems designed to enact population-level harms through the production and forcible imposition of colonial systems of gender. Settler statecraft has long relied on the strategic promotion of sexual and reproductive violence. Patterns of reproductive violence adapt and change to align with the enduring goals and evolving needs of settler colonial occupation, dispossession, and containment. The U.S. Supreme Court’s recent decision to end the constitutional right (...) to abortion in Dobbs v Jackson is but one instance of this larger pattern. We analyze reproductive and obstetric violence and the structural trauma they produce through the lenses of i) historical continuity and ii) the global architectures of neoliberal settler capitalism in order to connect reproductive rights rollbacks in the U.S. with the expansion of reproductive violence across a world connected by colonial globalization. (shrink)

Coronavirus-19 (COVID-19) is a trending topic that is currently engaging the attention of scholars all over the globe. Much has been said and written about it in terms of its nature, mode of infection, the ethics, the harm and, of course, the best resource allocation and triaging paradigm. While offering theoretical explanation of why we need to make a distinction between harms in and of COVID-19, this paper, at the same time, exposes the harms in and of COVID-19, as (...) well as offer examples of where both forms could be seen, using three spheres of reality, namely economy, education, and reproductive rights (abortion). Whereas it notes that harms in COVID-19 are those harms that are inherent in it and are direct vis-à-vis its victims, the paper observes that harms of COVID-19 are those harms that are causally, but only indirectly related to COVID-19. It concludes that knowledge of the distinction between harms in and of COVID-19 will be of use to the masses across the globe in checkmating the antics of those state actors in their respective jurisdictions who may wish to hide under the guise of combating the spread and menace of COVID-19 to carry out some hidden, selfish and vindictive agenda. (shrink)

Coronavirus-19 (COVID-19) is a trending topic that is currently engaging the attention of scholars all over the globe. Much has been said and written about it in terms of its nature, mode of infection, the ethics, the harm and, of course, the best resource allocation and triaging paradigm. While offering theoretical explanation of why we need to make a distinction between harms in and of COVID-19, this paper, at the same time, exposes the harms in and of COVID-19, as (...) well as offer examples of where both forms could be seen, using three spheres of reality, namely economy, education, and reproductive rights (abortion). Whereas it notes that harms in COVID-19 are those harms that are inherent in it and are direct vis-à-vis its victims, the paper observes that harms of COVID-19 are those harms that are causally, but only indirectly related to COVID-19. It concludes that knowledge of the distinction between harms in and of COVID-19 will be of use to the masses across the globe in checkmating the antics of those state actors in their respective jurisdictions who may wish to hide under the guise of combating the spread and menace of COVID-19 to carry out some hidden, selfish and vindictive agenda. (shrink)

Coronavirus-19 (COVID-19) is a trending topic that is currently engaging the attention of scholars all over the globe. Much has been said and written about it in terms of its nature, mode of infection, the ethics, the harm and, of course, the best resource allocation and triaging paradigm. While offering theoretical explanation of why we need to make a distinction between harms in and of COVID-19, this paper, at the same time, exposes the harms in and of COVID-19, as (...) well as offer examples of where both forms could be seen, using three spheres of reality, namely economy, education, and reproductive rights (abortion). Whereas it notes that harms in COVID-19 are those harms that are inherent in it and are direct vis-à-vis its victims, the paper observes that harms of COVID-19 are those harms that are causally, but only indirectly related to COVID-19. It concludes that knowledge of the distinction between harms in and of COVID-19 will be of use to the masses across the globe in checkmating the antics of those state actors in their respective jurisdictions who may wish to hide under the guise of combating the spread and menace of COVID-19 to carry out some hidden, selfish and vindictive agenda. (shrink)

Coronavirus-19 (COVID-19) is a trending topic that is currently engaging the attention of scholars all over the globe. Much has been said and written about it in terms of its nature, mode of infection, the ethics, the harm and, of course, the best resource allocation and triaging paradigm. While offering theoretical explanation of why we need to make a distinction between harms in and of COVID-19, this paper, at the same time, exposes the harms in and of COVID-19, as (...) well as offer examples of where both forms could be seen, using three spheres of reality, namely economy, education, and reproductive rights (abortion). Whereas it notes that harms in COVID-19 are those harms that are inherent in it and are direct vis-à-vis its victims, the paper observes that harms of COVID-19 are those harms that are causally, but only indirectly related to COVID-19. It concludes that knowledge of the distinction between harms in and of COVID-19 will be of use to the masses across the globe in checkmating the antics of those state actors in their respective jurisdictions who may wish to hide under the guise of combating the spread and menace of COVID-19 to carry out some hidden, selfish and vindictive agenda. (shrink)

My project here is to argue for situating moral judgments about Indian surrogacy in the context of Reproductive Justice. I begin by crafting the best picture of Indian surrogacy available to me while marking some worries I have about discursive colonialism and epistemic honesty. Western feminists' responses to contract pregnancy fall loosely into two interrelated moments: post-Baby M discussions that focus on the morality of surrogacy work in Western contexts, and feminist biomedical ethnographies that focus on the lived dimensions (...) of reproductive technologies and how they are embodied and negotiated in specific cultural contexts. Both approaches have their shortcomings. Uncritically extending Western moral frameworks (for example, liberal feminist political values) to Indian surrogacy work raises the specter of discursive colonialism; with it, worries arise about how Western normative traditions can distort, erase, or misread non-Western subjects' lived experiences. Feminist biomedical ethnographic approaches correct this, but raise the specter of a weak moral absenteeism; with it, concerns arise about under-theorizing the structural harms and injustices shaping surrogacy worker's lives. I suggest that we might reduce these shortcomings by framing normative and ethnographic engagement with global surrogacy as questions of reproductive justice. (shrink)

The Non-Identity Problem is the problem of explaining the apparent wrongness of a decision that does not harm people, especially since some of the people affected by the decision would not exist at all were it not for the decision. One approach to this problem, in the context of reproductive decisions, is to focus on wronging, rather than harming, one's offspring. But a Non-Person Problem emerges for any view that claims (1) that only persons can be wronged and (...) (2) that the person-making properties allow for there to be human non-persons. Consider an individual human organism that is prevented from ever possessing the person-making properties. On person-only accounts of the victims of wronging, this organism cannot be wronged by anyone. Hence even individuals whose decisions prevent it from ever possessing the person-making properties cannot wrong it. But this is counter-intuitive. We can think of examples where a human organism is wronged by precisely those decisions that prevent it from possessing the person-making properties. The best solution to this problem, in the case where the person-making property is rational self-governance in pursuit of a meaningful life, is to adjust the concept of a person so that it refers, not merely to those with the immediate capacity for rational self-governance in pursuit of a meaningful life, but also to those with a higher-order capacity for such self-governance. Any solution to the Non-Identity Problem that focuses on wronging rather than harming should incorporate this sort of solution to the Non-Person Problem. (shrink)

Issues in reproductive ethics, such as the capacity of parents to ‘choose children’, present challenges to philosophical ideas of freedom, responsibility and harm. This book responds to these challenges by proposing a new framework for thinking about the ethics of reproduction that emphasizes the ways that social norms affect decisions about who is born. The book provides clear and thorough discussions of some of the dominant problems in reproductive ethics - human enhancement and the notion of the (...) normal, reproductive liberty and procreative beneficence, the principle of harm and discrimination against disability - while also proposing new ways of addressing these. The author draws upon the work of Michel Foucault, especially his discussions of biopolitics and norms, and later work on ethics, alongside feminist theorists of embodiment to argue for a new bioethics that is responsive to social norms, human vulnerability and the relational context of freedom and responsibility. This is done through compelling discussions of new technologies and practices, including the debate on liberal eugenics and human enhancement, the deliberate selection of disabilities, PGD and obstetric ultrasound. (shrink)

A serious moral weakness of reproductive ‘surrogacy’ is that it can be harmful to the children who are created. This article presents a proposal for mitigating this weakness. Currently, the practice of commercial ‘surrogacy’ operates only in the interests of the adults involved , not in the interests of the child who is created. Whether ‘surrogacy’ is seen as the purchase of a baby, the purchase of parental rights, or the purchase of reproductive labor, all three views share (...) the same significant flaws. They endorse the transfer, for a fee, of the infant from the woman who gestated it to those who commissioned it, but without justifying such a transfer; they fail to demonstrate that the commissioners have any entitlement to the infant, or, for that matter, suitability to be the infant's parents; and they fail to take any notice of the infant's needs, interests, and wellbeing. A mere genetic connection is not enough to establish that the commissioners are entitled to receive the baby or that they are competent to raise it. Their good intentions, however caring, are not enough. Therefore, just as in the practice of adoption, there should be a formal institutionalized system for screening and licensing the prospective social parents, which would make the infant's needs, interests, and wellbeing paramount. I reply to several potential objections to this proposal, including the objection that genetic parents who raise their own child are not screened and licensed. (shrink)

Has the time come to put to bed the concept of a harm threshold when discussing the ethics of reproductive decision making and the legal limits that should be placed upon it? In this commentary, we defend the claim that there exist good moral reasons, despite the conclusions of the non-identity problem, based on the interests of those we might create, to refrain from bringing to birth individuals whose lives are often described in the philosophical literature as ‘less (...) than worth living’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Invisible HarmKimberly ZieselmanI’m a 48–year–old intersex woman born with Androgen Insensitivity Syndrome (AIS) writing to share my personal experience as a patient affected by a Difference of Sex Development (DSD). Although I appear to be a DSD patient “success story”, in fact, I have suffered and am unsatisfied with the way I was treated as a young patient in the 1980’s, and the continued lack of appropriate care for (...) intersex people even today.As the Executive Director of the advocacy organization Advocates for Informed Choice and a board member of the AIS–DSD Support Group since 2012, I have heard doctors reference the “silent happy majority” of DSD patients all too often. They speak [End Page 122] of patients who were treated in childhood and went on to live (seemingly) contented lives. It appears however that doctors have drawn this conclusion from the fact that most of their patients have not returned to complain about their treatment. While there is little evidence to support the success doctors claim, there is quite a bit of evidence that suggests my suffering is the norm rather than the exception.Medical professionals would likely include me in that “silent majority,” only seeing a woman who identifies and appears typically female, graduated law school, married for over twenty years, with adopted children and a successful career. And while I have been fortunate in many ways, I no longer want my voice to be presumed buried within that silent majority. Instead, I am speaking out today to tell my story.My StoryAt age 15 I was diagnosed with amenorrhea and referred to a reproductive oncologist who told my parents I had a partially developed uterus and ovaries that would likely soon become cancerous. We were told my vagina was abnormally short and might require surgery in order to have heterosexual intercourse.Neither my parents nor I was ever told I had AIS and XY chromosomes, or that the gonads being removed were testes, not ovaries. I was told I needed a “full hysterectomy” to prevent cancer and hormone replacement therapy. That summer I spent my 16th birthday recuperating from surgery. I spent the next 25 years living a lie.A lie that has had a profound and harmful impact on me.At some level, I knew I was not being told the whole truth. My parents’ and the doctors’ actions signaled to me something more might be going on. But I was afraid to ask questions; my parents were distressed and I didn’t want to cause them any more pain. Over the years I have wondered just how much my parents knew but withheld from me (albeit with good intentions). I sensed something awful was being hidden from me, and I didn’t know whom I could trust.When I asked my doctor if I could meet someone else with my condition, I was told I was different, that there was “nobody” with my medical condition in the world, that my situation was “very rare.” I was told to get on with my life and not talk about my surgery because it wasn’t important; I was healthy and could adopt if I wanted to become a parent. I was told I must take a hormone pill each day for the rest of my life to stay healthy.But what I heard was, “you are not a real woman: you are a damaged freak, so go out and fake the rest of your life and be sure nobody knows your secret.” So that’s what I did. I was a “good girl” and took my pills, didn’t ask questions and did what the men in white coats asked me to do. There was no support provided for either my parents or me. No social workers, no therapists. Perhaps most shockingly, there was no true informed consent.A few years ago I was diagnosed with post-traumatic stress syndrome caused by anxiety I had been harboring for over two decades about my past surgery and fear of getting cancer. I decided to obtain my medical records from the hospital and discover the truth.Covering several pages of... (shrink)

The most benign rationale for sex selection is deemed to be “family balancing.” On this view, provided the sex distribution of an existing offspring group is “unbalanced,” one may legitimately use reproductive technologies to select the sex of the next child. I present four novel concerns with granting “family balancing” as a justification for sex selection: families or family subsets should not be subject to medicalization; sex selection for “family balancing” entrenches heteronormativity, inflicting harm in at least three (...) specific ways; the logic of affirmative action is appropriated; the moral mandate of reproductive autonomy is misused. I conclude that the harms caused by family balancing are sufficiently substantive to override any claim arising from a supposed right to sex selection as an instantiation of procreative autonomy. (shrink)

Cross-cultural sex differences in mobility and harm avoidance have been widely reported, often emphasizing fitness benefits of long-distance travel for males and high costs for females. Data emerging from adults in small-scale societies, however, are challenging the assumption that female mobility is restricted during reproduction. Such findings warrant further exploration of the ontogeny of mobility. Here, using a combination of machine-learning, mixed-effects linear regression, and GIS mapping, we analyze range size, daily distance traveled, and harm avoidance among Hadza (...) foragers during middle childhood and adolescence. Distance traveled increased with age and, while male adolescents had the longest daily ranges, average daily distance traveled by each sex was similar. We found few age- or sex-related patterns in harm-avoidant responses and a high degree of individual variation. When queried on the same issues, children and their parents were often in alignment as to expectations pertaining to harm avoidance, and siblings tended to behave in similar ways. To the extent that sex differences in mobility did emerge, they were associated with ecological differences in physical threats associated with sex-specific foraging behaviors. Further, we found no strong association between harm avoidance and mobility. Young Hadza foragers of both sexes are highly mobile, regardless of how harm avoidant they are. Taken together, our findings indicate that the causal arrows between harm avoidance and mobility must be evaluated in ecologically specific frameworks where cultural expectations of juvenile mobility can be contextualized. (shrink)

While the principles of reproductive justice are generally agreed upon in progressive reproductive political circles, other theoretical frameworks such as reparative justice can further foster the goals of the movement. In the literature, however, reparative justice has been insufficiently explored as it relates to reproductive injustice. My concern in this essay is therefore the development of conceptual architecture for understanding reproductive justice as reparative in nature. A reparative approach to reproductive ethics importantly takes up the (...) demand to situate reproduction within ongoing historical and sociopolitical contexts. It makes transparent the harms generated by an oppressive social order and the depths to which conditions must change for reproductive justice to emerge. To construct the relationship between reparative and reproductive justice, I employ Olúfemi Táíwò’s constructivist view of reparations as an ongoing, generative, and ultimately world-building project. For, if reproductive justice is about developing enabling conditions wherein folks can control their birthing options and parent in safe and healthy environments, then a constructivist reparative approach is necessary—one which takes seriously the accumulative harms of history and their relation to transforming social structures in the present. (shrink)

While I am inclined to agree that in most cases a choice to become pregnant and bring to birth a child is an irrational choice, unlike Professor Häyry,1 I believe that choosing to do so is far from being necessarily immoral. In fact I will argue that it is often these irrational choices which make human life the valuable commodity many of us believe it is.Häyry argues that not only is the choice to have children always an irrational choice, but (...) also it is necessarily an immoral choice. Thus, for Häyry “human reproduction is fundamentally immoral”.1 He claims it is important to point out to prospective parents that their urge to have children is irrational. From this, he argues, it follows that once this is accepted the use of advance technologies to assist conception should be reassessed, and furthermore, the irrationality and immorality of having children should become a legitimate part of guidance given to those expressing a wish to have children.According to Häyry the reason it is irrational and immoral to choose to bring to birth a child is that “having a child can always realistically lead to the worse possible outcome, when the alternative is not having a child”.1 He argues that when people consider having children they are faced with the choice between deciding not to have children and thus harming or benefiting no-one , or having children where this life may be good or bad, and thus the value of this choice can be …. (shrink)

New reproductive technologies allow parents some choice over their children. Various moral principles have been suggested to regulate such choices. This article starts from a discussion of Julian Savulescu's Principle of Procreative Beneficence, according to which parents ought to choose the child expected to have the best quality of life, before combining two previously separate lines of attack against this principle. First, it is suggested that the appropriate moral principles of guiding reproductive choices ought to focus on general (...) wellbeing rather than prioritizing that of the child and, second, that they ought to be non-maximizing. Though neither of these suggestions is entirely novel, combining them results in a new, and arguably more plausible, principle to regulate procreative choices, which I call the Principle of Generalized Procreative Non-Maleficence. According to this principle, the primary obligation on parents is not to cause harm to other people through their reproductive choices. (shrink)

We applaud Notini and colleagues for highlighting the clinical and ethical complexities of a case in which a non-binary individual desires indefinite treatment with puberty blockers.1 While we agree discontinuing treatment may cause psychological distress, we believe there are potential physical and neurocognitive harms caused by prolonged treatment that have been underestimated given the limited research conducted to date. Specifically, the impact of permanent pubertal suppression on the brain and decision-making capacity should be considered. In this context, we outline the (...) potential risks of ongoing pubertal suppression on bone and cardiovascular health, sexual and reproductive function, and brain development—all noted in the article but perhaps in an overly simplistic manner.1 First, the authors’ note OPS will almost certainly result in reduced bone density.1 Although we agree the absolute fracture risk is low in studies among older adults, there is less clarity about implications during adolescence and young adulthood when peak bone accrual occurs.2 Further, the authors propose ongoing monitoring with bone density scans, but no clear guidelines for clinicians if bone density becomes critically low—so we ask, at what point would a potential fracture risk outweigh the proposed benefits …. (shrink)

We applaud Notini and colleagues for highlighting the clinical and ethical complexities of a case in which a non-binary individual desires indefinite treatment with puberty blockers. 1 While we agree discontinuing treatment may cause psychological distress, we believe there are potential physical and neurocognitive harms caused by prolonged treatment that have been underestimated given the limited research conducted to date. Specifically, the impact of permanent pubertal suppression on the brain and decision-making capacity should be considered. In this context, we outline (...) the potential risks of ongoing pubertal suppression on bone and cardiovascular health, sexual and reproductive function, and brain development—all noted in the article but perhaps in an overly simplistic manner. 1 First, the authors’ note OPS will almost certainly result in reduced bone density. 1 Although we agree the absolute fracture risk is low in studies among older adults, there is less clarity about... (shrink)

An objection often is raised against the use of reproductive technology to create "nontraditional families," as in ovum donation for postmenopausal women or postmortem artificial insemination. The objection states that conceiving children in such circumstances is harmful to them because of adverse features of these nontraditional families. A similar objection is raised when parents, through negligence or willful disregard of risks, create children with serious genetic diseases or other developmental handicaps. It is claimed that such reproduction harms the children (...) who are created. In reply to this Harm to the Child Argument, it has been pointed out that the procreative acts that supposedly harm the child are the very acts that create the child. This reply has been developed into an argument that, in most of the types of cases under consideration, creating the child does not harm her. This reply, the No Harm Argument, has been stated in three main ways, and it is one of the most misunderstood arguments in bioethics. This paper examines the main rebuttals that have been made to the No Harm Argument and argues that none of them is successful. (shrink)

Much work in contemporary bioethics defends a broadly liberal view of human reproduction. I shall take this view to comprise (but not to be exhausted by) the following four claims.1 First, it is permissible both to reproduce and not to reproduce, either by traditional means or by means of assisted reproductive techniques such as IVF and genetic screening. Second, it is permissible either to reproduce or to adopt or otherwise foster an existing child to which one is not biologically (...) related. Third, it is permissible either to bring into existence a child with the greatest chance of a life of maximum human flourishing or to bring into existence a child with a life worth living but with less than the greatest chance of a life of maximum human flourishing. Fourth, it is impermissible to bring into existence a child whose life is either certain or likely to fall below some baseline of a human life minimally worth living. (shrink)

The common liberal understanding of reproductive autonomy – characterized by free choice and a principle of non-interference – serves as a useful way to analyse the normative appeal of having certain choices open to people in the reproductive realm, especially for issues like abortion rights. However, this liberal reading of reproductive autonomy only offers us a limited ethical understanding of what is at stake in many kinds of reproductive choices, particularly when it comes to different uses (...) of reproductive technologies and third-party reproduction. This is because the liberal framework does not fully capture who benefits from which reproductive options, the extent of the risks and harms involved in various reproductive interventions, and the reasons for why people are driven to make certain reproductive choices. (shrink)

Developmental origins of health and disease and epigenetics have expanded understanding of how the environment affects the health of women before and during pregnancy—with lifelong health consequences for the fetus. This has translated to a narrow focus on women’s lifestyle during pregnancy, especially for women classified as obese. In this study, we show that psychosocial harms such as distress or shame felt by pregnant women are rarely countenanced in these endeavors. To demonstrate this, we examine published documents about a large (...) set of trials of lifestyle interventions united through an international consortium. Yet there is now a literature in which pregnant women with large bodies report feeling humiliated and a wider literature on the stigma of obesity. We argue that shame is produced and reproduced through the discursive and material knowledge-making scientific practices of DOHaD translation. Interventions that intensify the shame of large body size in pregnancy may be stressful, and neurophysiological stress pathways are well-known within DOHaD to have consequences for fetal development, so these interventions potentially undermine the very processes they set out to protect. A feminist response may protect women from shame and redirect attention to the social and structural determinants of health. (shrink)

Human reproductive cloning has not yet resulted in any live births. There has been widespread condemnation of the practice in both the scientific world and the public sphere, and many countries explicitly outlaw the practice. Concerns about the procedure range from uncertainties about its physical safety to questions about the psychological well-being of clones. Yet, key aspects such as the philosophical implications of harm to future entities and a comparison with established reproductive technologies such as in vitro (...) fertilisation are often overlooked in discussions about HRC. Furthermore, there are people who are willing to use the technology. Several scientists have been outspoken in their intent to pursue HRC. The importance of concerns about the physical safety of children created by HRC and comparisons with concerns about the safety of IVF are discussed. A model to be used to determine when it is acceptable to use HRC and other new assisted reproductive technologies, balancing reproductive freedom and safety concerns, is proposed. Justifications underpinning potential applications of HRC are discussed, and it is determined that these are highly analogous to rationalisations used to justify IVF treatment. It is concluded that people wishing to conceive using HRC should have a prima facie negative right to do so. (shrink)

abstract John Robertson has famously argued that the right to reproductive autonomy is exceedingly broad in scope. That is, as long as a particular reproductive preference such as having a deaf child is “determinative” of the decision to reproduce then such preferences fall under the protective rubric of reproductive autonomy rights. Importantly, the deafness in question does not constitute a harm to the child thereby wrought since unless the child could be born deaf he or she (...) would otherwise never have existed— his or her prospective parents would simply have chosen to abort. As such, for this child, being born deaf counts as a benefit, albeit of the “backhanded” variety, since the only other practical alternative is nonexistence. In what follows, I want to investigate this argument in detail. The target of my investigation will be the possible future use of gene therapy technology to “disenhance” one's offspring. I intend to show that the apparently unlimited right to reproductive autonomy, that is, the right to choose both the quantity and qualities of future offspring, entailed by the argument from backhanded benefit can in fact be “sidestepped” through considering what sorts of reproductive practices we as a society ought to allow. (shrink)

In this article I will address the question of determining the moral limits of reproductive decisions. In so doing I will examine the contributions made by John Harris, who has over the years consistently addressed the ethical implications of advancing reproductive technologies. In addressing these matters, Harris has centred his arguments on the principle of harm and with this in mind has set out a specific theoretical framework from which decisions about disability and causing harm, as (...) in the case of reproductive decisions, can be rationally addressed. This discussion will attempt to question the conceptual scheme that he proposes. The aim here is not to present an alternative theoretical contribution to the morality of reproductive choice. Rather, in the attempt to follow some of the directives in Wittgenstein’s later philosophy, the aim is to demonstrate some of the pitfalls of what Wittgenstein has described as the “craving for generality” in contemporary philosophy. I propose that this craving can distort, in this instance, our ordinary usage of concepts such as harm, suffering and disability and their role in the moral vocabulary of reproductive decision making. (shrink)

Conscience in Reproductive Health Care responds to the growing worldwide trend of health care professionals conscientiously refusing to provide abortions and similar reproductive health services in countries where these services are legal and professionally accepted. Carolyn McLeod argues that conscientious objectors in health care should prioritize the interests of patients in receiving care over their own interest in acting on their conscience. She defends this "prioritizing approach" to conscientious objection over the more popular "compromise approach" without downplaying the (...) importance of health care professionals having a conscience or the moral complexity of their conscientious refusals. McLeod's central argument is that health care professionals who are gatekeepers of services such as abortions are fiduciaries for their patients and for the public they are licensed to serve. As such, they owe a duty of loyalty to these beneficiaries and should give primacy to their beneficiaries' interests in accessing care. This conclusion is informed by what McLeod believes is morally at stake for the main parties to the conflicts generated by conscientious refusals: the objector and the patient. What is at stake, according to McLeod, depends on the relevant socio-political context, but typically includes the objector's integrity and the patient's interest in avoiding harm. (shrink)

In this dissertation, I have analyzed some of the problems associated with male reproduction. I discuss basic notions regarding the origin of parental rights concluding that whatever rights parents have regarding their children arise because of the biological connection between the parents and child. A biological parent has prima facie rights to his child because that parent has property-type rights to his own body. ;I suggest that parental responsibilities automatically incur whenever the conception of a child is intentional or voluntary, (...) or when conception is the result of negligent or reckless sexual activity. Only when procreation is involuntary does automatically delegating parental responsibilities to a male seem morally problematic. The category of acts which would constitute involuntary procreation, however, is very narrow. ;I discuss morally problematic issues that arise when a child is born against the wishes of the male progenitor. Focusing specifically on the issue of child support, I conclude that the father should have some responsibility for the support of the child. The only time for which the imposition of parental responsibilities upon a reluctant father is morally questionable would involve the fraudulent misrepresentation of the female regarding her use of contraceptives, combined with some affirmative action by her to undermine the male's attempted effort at contraception. ;Finally, I discuss the moral and legal implications of a woman's decision to obtain an abortion against the wishes of the potential father. I conclude that her abortion could seriously harm the male's procreation interests. But, given the vital role women have in the reproductive process, women should possess rights superior to those males might possess. The evolution of reproductive technology, however, has made these greater rights a contingent fact. (shrink)

Better Never to Have Been argues for a number of related, highly provocative, views: (1) Coming into existence is always a serious harm. (2) It is always wrong to have children. (3) It is wrong not to abort fetuses at the earlier stages of gestation. (4) It would be better if, as a result of there being no new people, humanity became extinct. These views may sound unbelievable--but anyone who reads Benatar will be obliged to take them seriously.

This paper demonstrates that accounting for the moral harm of selecting for deafness is not as simple or obvious as the widespread negative response from the hearing community would suggest. The central questions addressed by the paper are whether our moral disquiet with regard to selecting for deafness can be adequately defended, and if so, what this might entail. The paper considers several different strategies for accounting for the supposed moral harm of selecting for deafness and concludes that (...) the deaf case cannot be treated in isolation. Accounting for the moral harm of selecting for deafness necessarily entails moral implications for other cases of procreation and procreative decision-making, including unassisted coital reproduction. The lesson to be learned from the deaf case is that we need norms that govern not just the use of reproductive technology, but procreation and procreative decision-making in all of its various forms. (shrink)

This article critically evaluates the central claims of the various feminist responses to new reproductive arrangements and technologies. Proponents of a “progressivism” object to naive technological optimism and raise questions about the control of such technology. Others, such as the FINRRAGE group, raise concerns about the potentially damaging consequences of the new technologies for women. While a central concern is whether these technologies reinforce harmful biologically determinist stereotypes of women, it may be that these critiques function with a devastating (...) gender blindness that puts women at risk in other, heretofore unnoticed, ways. (shrink)

Reproductive autonomy is often used as an argument to offer assisted reproduction services to women and to continue research into improving this service. What is often overlooked, however, is the gendered and normative background of parenthood, especially of motherhood. In this paper, I attempt to make women visible and to listen to their voices. Turning to the women’s stories, the ethical perspective might be reversed: the so-called 'side-effects' of the overall successful assisted reproduction with or without genetic diagnosis, are (...) to be considered the 'main effects' of assisted reproduction – true for the majority of couples and women. Autonomy, then, must be reformulated as concept of moral agency in the context of divergent social contexts and cultures of parenthood, of socially shaped images of disability, and in the context of scientific visions of technology which do not necessarily match with the medical practice. (shrink)

Since its inception, donor conception practices have been a reproductive choice for the infertile. Past and current practices have the potential to cause significant and lifelong harm to the offspring through loss of kinship, heritage, identity, and family health history, and possibly through introducing physical problems. Legislation and regulation in Australia that specifies that the welfare of the child born as a consequence of donor conception is paramount may therefore be in conflict with the outcomes. Altering the paradigm (...) to a child-centric model, however, impinges on reproductive choice and rights of adults involved in the process. With some lobby groups pushing for increased reproductive choice while others emphasise offspring rights there is a dichotomy of interests that society and legislators need to address. Concepts pertaining to a shift toward a child-centric paradigm are discussed. (shrink)

Bioethicists often use the “nonidentity problem”—the idea that a child born with a disability would actually be a different child if she were born without the disability—to defend parents' rights to have whatever children they want. After all, a child is not harmed by being brought into the world with a disability; without the disability, she would not be brought into the world at all. But what happens if we turn the moral question around and ask, not about the benefits (...) and harms to the child, but just about parental obligations? Will that lead to a different view of reproductive decisions? (shrink)

A woman's right to know the contents of her own body, and to make a choice about whether to continue her pregnancy or not, should be defended against laws trying to stop prenatal sex selection, either in the developing world or in the developed world. Restrictions on women's reproductive freedom harm the interests of women and girls, and ignore myriad social policy solutions, such as education and income incentives to have girls and universal old age pensions, that provide (...) better answers to the strains of unbalanced sex ratios. The opponents of sex selection trumpet all accounts of increased discrimination against women resulting from unequal sex ratios while ignoring growing evidence of positive cultural change and women's empowerment fromwomen's enhanced marriage prospects. Opponents of sex selection reify a conservative heteronormative model of sexuality, gender roles and family structure, while arguing that unmarried men are social time bombs who can only be controlled by a wife. Eventually the social policy dilemma around sex selection will presumably be made moot since would-be parents will be able to use pre-conceptive technology to determine a conceptus's gender without abortion or in-vitro fertilization. But until the sex selection argument unravels before technological innovation, women's rights to control their bodies must be defended against laws banning - or requiring - prenatal ultrasound and abortion. (shrink)

In recent years, as newborn screening has expanded to include conditions for which treatment is questionable, new rationales for screening have proliferated. One such rationale is the potential reproductive benefit to parents from the detection of a genetic condition or carrier status in infants. An unanticipated consequence of invoking knowledge of reproductive risk as a major benefit of screening has been to open newborn screening to the charge that it constitutes state‐sanctioned eugenics. Thus, an endeavor that had been (...) viewed as the converse of state programs of selective breeding has come to be seen in some quarters as yet another of its incarnations. The result has been serious and self‐inflected harm to the reputation of newborn screening programs. (shrink)