This paper looks at the Catholic justification of medical interventions in ectopic pregnancies. The paper first shows that the way how Double Effect Reasoning is often applied to ectopic pregnancies is not consistent with the way Aquinas introduces this mode of reasoning. The paper then shows certain problems in common defences of the use of salpingectomies. The paper then re-evaluates the medical interventions used in the management of ectopic pregnancies, with both a focus on the aim of (...) the treatment and the timing of the treatment. (shrink)

Respected Catholic ethicists have recently defended the use of salpingostomy and methotrexate in the management of ectopic pregnancies.This article examines the arguments for the revised assessments to determine whether there are sound reasons to believe that these two methods do not constitute the direct and immediate killing of innocent human beings. National Catholic Bioethics Quarterly 11.1 (Spring 2011): 65–82.

If one accepts a version of absolutism that excludes the intentional killing of any innocent human person from conception to natural death, ectopic pregnancy poses vexing difficulties. Given that the embryonic life almost certainly will die anyway, how can one retain ones moral principle and yet adequately respond to a situation that gravely threatens the life of the mother and her future fertility? The four options of treatment most often discussed in the literature are non-intervention, salpingectomy (removal of (...) tube with embryo), salpingostomy (removal of embryo alone), and use of methotrexate (MXT). In this essay, I review these four options and introduce a fifth (the milking technique). In order to assess these options in terms of the absolutism mentioned, it will also be necessary to discuss various accounts of the intention/foresight distinction. I conclude that salpingectomy, salpingostomy, and the milking technique are compatible with absolutist presuppositions, but not the use of methotrexate. (shrink)

Ectopic pregnancy, when not resolved naturally, can be fatal to the mother if left untreated. A number of medical solutions exist, though none that save the life of the embryo. This article assesses the ethical value of one of these solutions, the salpingostomy, by examining the moral object of the salpingostomy and whether the procedure constitutes a direct abortion. The author responds with William E. May and Maria DeGoede to salpingostomy proponents Albert Moraczewski, Christopher Kaczor, John Tuohey, and (...) others. Because of the lack of moral certitude that the trophoblast is neither a vital organ of the fetus nor a member of the fetus’s body, the author concludes that the salpingostomy may not be considered a licit procedure in the treatment of ectopic pregnancy, and challenges readers to admit that medical science lacks a direct, active solution to ectopic pregnancy. (shrink)

Catholic ethicists faithful to the magisterium of the Church are currently divided on the permissibility of using methotrexate to treat ectopic pregnancies. This paper examines the defenses of Rev. Albert Moraczewski, OP, and Christopher Kaczor, who argue that its use is morally permissible, in an attempt to demonstrate that methotrexate constitutes a direct abortion by virtue of its object. Specifically, the paper challenges the claims that methotrexate is aimed at inhibiting pathological tissues, that the trophoblast is not an organ (...) of the embryo, and that direct removal of a nonviable fetus is not a direct abortion. National Catholic Bioethics Quarterly 14.4 : 625–635. (shrink)

I argue that physicians can save women from life-threatening pregnancies by performing a craniotomy, placentectomy, or salpingotomy without intending death or harm. To support this conclusion, I defend the relevance thesis about intentions (a person intends X only if X explains the action). I then criticize the identity thesis (if a person intends X and knows X is Y then the person intends Y) and three mistakenly strict moral principles: (1) one may not intend something that is a serious harm (...) for an innocent person, (2) one may not intend to terminate pregnancy before viability, which would prohibit, and (3) one may not act on a person’s body in a harmful way in order to benefit another person. (1) would prohibit procuring organs from living donors, (2) would prohibit treating hepatic pregnancies and other ectopic pregnancies, and (3) would prohibit procuring organs from living donors and performing many prenatal surgeries. (shrink)

Questions about the dignity of the human person give rise to many of the most central and hotly disputed topics in bioethics. In _A Defense of Dignity: Creating Life, Destroying Life, and Protecting the Rights of Conscience_, Christopher Kaczor investigates whether each human being has intrinsic dignity and whether the very concept of "dignity" has a useful place in contemporary ethical debates. Kaczor explores a broad range of issues addressed in contemporary bioethics, including whether there is a duty of "procreative (...) beneficence," the ethics of ectopic pregnancy, and the possibility of "rescuing" human embryos with human wombs or artificial wombs. _A Defense of Dignity_ also treats issues relevant to the end of life, including physician-assisted suicide, provision of food and water to patients in a persistent vegetative state, and how to proceed with organ donation following death. Finally, what are the duties and prerogatives of health care professionals who refuse in conscience to take part in activities that they regard as degrading to human dignity? Should they be forced to do what they consider to be violations of the patient's well being, or does patient autonomy always trump the conscience of a health care professional? Grounded in the Catholic intellectual and moral tradition, _A Defense of Dignity_ argues that all human beings from the beginning to the end of their lives should be treated with respect and considers how this belief should be applied in controversial cases. "_A Defense of Dignity_ provides a skillful, informed, and clear philosophical analysis, from a natural law perspective, of a range of controversial, and sometimes complex, bioethical questions concerning the beginning and end of life. Few authors approach bioethics from a natural law perspective, and few do it as well as Christopher Kaczor. The book should be of interest not only to natural law philosophers and their students, but also to anyone interested in bioethics." —_John Keown, Georgetown University__ "Moral questions at the beginning and ending of life and controversies over liberty of conscience are among the most vexing and important issues of our day. Christopher Kaczor brings his characteristic moral seriousness and philosophical good sense to his treatment of these issues, all of which implicate the key concept of human dignity. This eminently readable collection will provide an invaluable resource for educators and students alike." — Christopher Tollefsen, University of South Carolina_ “Indispensable. Kaczor untangles the various meanings of human dignity to undertake a reexamination of the most serious and difficult issues in medical ethics. The book combines clarity with philosophical precision, faithfulness to Catholic teaching with a thorough engagement with critics." —_J. Budziszewski, University of Texas at Austin_. (shrink)

The prospect of dealing with a rapidly and inexorably bleeding patient fills most medical practitioners with alarm. When that patient is a Jehovah's Witness, the knowledge that a blood transfusion is likely to be refused turns that alarm into a state of acute anxiety and conflict. This state is further heightened when the patient is young and otherwise healthy--a situation found particularly in obstetric practice with the occurrence of ante- and post-partum haemorrhage, and ectopic pregnancy. In the last (...) 25 years in England, Wales, Scotland and Northern Ireland, there has been one maternal death in which the refusal to accept a blood transfusion has been considered to be an avoidable factor. In this article I have attempted to identify the magnitude of the problem in obstetric practice and have sought to clarify the moral and legal aspects. (shrink)

The controversial Phoenix Hospital case demonstrates that there is significant disagreement in Catholic casuistry on what constitutes intention. Some hold that a causal closeness entails intention, while others deny that there is any necessary connection between causal closeness and intention. One of the strongest supporters of the causal closeness thesis was Elizabeth Anscombe. It will be argued, however, that her works on intention provide support for a position on certain types of cases, such as the Phoenix Hospital case and the (...) termination of an ectopic pregnancy, which contradict intentional killing. (shrink)

The controversial Phoenix Hospital case demonstrates that there is significant disagreement in Catholic casuistry on what constitutes intention. Some hold that a causal closeness entails intention, while others deny that there is any necessary connection between causal closeness and intention. One of the strongest supporters of the causal closeness thesis was Elizabeth Anscombe. It will be argued, however, that her works on intention provide support for a position on certain types of cases, such as the Phoenix Hospital case and the (...) termination of an ectopic pregnancy, which contradict intentional killing. (shrink)

The Christian tradition has always taken a generally negative view of abortion, but the moral basis and perceived implications of this negative view have varied greatly. In the early Church abortion and contraception were often seen as broadly equivalent, both involving interference with the natural reproductive process (and an association with sexual immorality which even led some to see contraception as the more sinful of the two). But the tendency to conflate abortion with contraception, and even on similar grounds with (...) male masturbation, declined in the face of the biological discovery of the mother's role as more than just an incubator for the male "seed" - with the recognition of conception as a distinct and crucial event, abortion became generally seen as morally far more serious than contraception, potentially involving threat to an innocent life and therefore, arguably, equivalent to homicide. When seen as homicide, abortion has naturally been subject to an almost total prohibition, the only generally agreed exception being where it is necessary to save the mother's life. Within the Roman Catholic communion, moreover, even this exception has tended to be countenanced only when sanctioned by the doctrine of double effect - where the abortion is not directly intended, but is only a foreseen but unintended consequence of a surgical intervention whose primary intention is to save the mother's life (e.g. the removal of a cancerous uterus or of a fallopian tube containing an ectopic pregnancy). (shrink)

When William May first wrote Catholic Bioethics and the Gift of Human Life, his position was that to perform a craniotomy on a child to save the mother’s life constitutes a direct abortion and is not justifiable. In later editions, May rejected his earlier position in favor of one he originally argued against, most notably by Germain Grisez. The author maintains that the argu­ments surrounding craniotomies on the unborn are still of major relevance today, because they relate directly to certain (...) controversial techniques used to manage ectopic pregnancies. He also argues that May’s original conclusion ought to be upheld, and that May’s later conclusion places too much weight on the interior intention of the actor and not enough on the act itself. (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)

We suggest edits to Part Four of the Ethical and Religious Directives (ERDs) to help the US bishops address and clarify essential Church teachings on specific beginning-of-life issues facing Catholic health care today. As a teaching tool, Part Four must be updated so that Catholic health care professionals and the lay faithful can understand and apply Church teachings to new ethical challenges. Further, more direction and clarity from the ERDs is needed in applying general principles to assisted procreative technologies, pre- (...) and post-viability induction of labor, ectopic pregnancies, genetic screening and diagnosis, and contraception. Catholic health care clinicians and administrators also need to receive ongoing instruction on the ERDs’ teachings as well as the theological and philosophical rationales that undergird them. (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)

Making finely crafted distinctions and deploying them in intellectually rigorous and clinically applicable judgments define, to a considerable degree, the art of clinical ethics. The papers in this Clinical Ethics number of the Journal of Medicine and Philosophy demonstrate the art of clinical ethics in their consideration of respect for autonomy vs. respect for persons, the role of risk in triggering assessment of decisional capacity vs. the role of risk in the concept and assessment of decisional capacity, intention vs. foresight (...) in the clinical management of ectopic pregnancy, preserving life vs. relieving suffering in physician-assisted suicide, and what is essential vs. non-essential in defining the core areas of ethics education for members of hospital ethics committees. (shrink)

Is the “act itself” of separating a pregnant woman and her previable child neither good nor bad morally, considered in the abstract? Recently, Maureen Condic and Donna Harrison have argued that such separation is justified to protect the mother’s life and that it does not constitute an abortion as the aim is not to kill the child. In our article on maternal–fetal conflicts, we agree there need be no such aim to kill (supplementing aims such as to remove). However, we (...) argue that to understand “abortion” as performed only where the death of the child is intended is to define the term too narrowly. Respect for the mother, the fetus, and the bond between them goes well beyond avoiding any such aim. We distinguish between legitimate maternal treatments simply aimed at treating or removing a damaged part of the woman and illegitimate treatments that focus harmfully on the fetal body and its presence within the mother’s body. In obstetrics as elsewhere, not all side effects for one subject of intervention can be outweighed by intended benefits for another. Certain side effects of certain intended interventions are morally conclusive. (shrink)

The principle of double effect has a long history, from scholastic disputations about self-defense and scandal to current debates about terrorism, torture, euthanasia, and abortion. Despite being widely debated, the principle remains poorly understood. In Intention, Character, and Double Effect, Lawrence Masek combines theoretical and applied questions into a systematic defense of the principle that does not depend on appeals to authority or intuitions about cases. Masek argues that actions can be wrong because they corrupt the agent's character and that (...) one must consider the agent's perspective to determine which effects the agent intends. This defense of the principle clears up common confusions and overcomes critics' objections, including confusions about trolley and transplant cases and objections from neuroscience and moral psychology. This book will interest scholars and students in different fields of study, including moral philosophy, action theory, moral theology, and moral psychology. Its discussion of contemporary ethical issues and sparse use of technical jargon make it suitable for undergraduate and graduate courses in applied ethics. The appendix summarizes the main cases that have been used to illustrate or to criticize the principle of double effect. (shrink)

Fundamento: Los adolescentes constituyen un grupo vulnerable y la maternidad en esta etapa, una problemática de actualidad. Objetivo: exponer particularidades sociodemográficas y de la maternidad en madres adolescentes del municipio de Cumanayagua, en el período septiembre a mayo del año 2014. Método: estudio descriptivo, corte transversal. Se trabajó con el universo conformado por 35 madres adolescentes y sus hijos. Se operó con un formulario de datos sociodemográficos, el análisis de documentos y la entrevista semiestructurada. Los resultados fueron procesados por el (...) paquete estadístico SPSS 15.0 para Windows y se utilizaron tablas de frecuencia y porcientos. Resultados: predominaron madres adolescentes de la etapa tardía con una media de edad 17,89; deserción escolar, más del 50% conviven con los padres con pareja o sin ella; embarazos deseados ; ocurrencia de nacimiento a términos, partos eutócicos, estados buenos de salud física y psicológica percibidos ; percepción de apoyo familiar. Conclusiones: las madres adolescentes de la etapa tardía que se caracterizaron por una maternidad percibida de manera satisfactoria contaron con apoyo familiar, vínculo de pareja, baja percepción de riesgos para su salud física y psicológica. Basis: Teenagers constitute a vulnerable group and motherhood during this period is a topical problem. Objective: Setting out socio-demographic and motherhood characteristics in teenage mothers from Cumanayagua municipality from September to May 2014. Method: Descriptive study, cross section. The population consisted of 35 teenage mothers and their children. A socio-demographic data form, document analysis as well as semi-structured interview were used. The results were processed by the SPSS statistical package for Windows and frequency and percentage tables were used. Results: Late stage teenage mothers with the average ages of 17, 18 and 19 prevailed; school dropouts ; more than 50 % of them live with their parents with or without a partner; planned pregnancies ; occurrence of full-term births ; ectopic childbirths ; good physical health states ; good psychological states ; family support perception. Conclusions: Those late stage teenage mothers who were characterized by motherhood perceived in a satisfactory way, counted on family support, romantic ties, low physical and psychological health risk perception. (shrink)

SummaryIn 1968, a prospective study was started in collaboration with the Family Planning Association to try to provide a balanced view of the beneficial and harmful effects of different methods of contraception. This investigation is now in progress at seventeen clinics and over 17,000 women are under observation. At the time of recruitment, all these women were married white British subjects, aged 25–39 years, who voluntarily agreed to participate. Fifty-six per cent were using oral contraceptives, 25% were using a diaphragm (...) and 19% were using an intrauterine device. During follow-up each woman is questioned at return visits to the clinic and a record of pregnancies and their outcome, hospital referrals, changes in contraceptive methods and the results of cervical smears, is accumulated. Women who default are sent a postal questionnaire and, if this is not returned, are telephoned or visited in their homes to collect the necessary information.So far, data obtained during 56,000 woman-years of observation are available for analysis. Follow-up has been maintained with an annual lapse rate of about 0.3%due to withdrawal of co-operation or loss of contact; adherence to the method of contraception in use at recruitment has been reasonably good, and the reporting of pregnancies and hospital admissions appears to have been both reliable and unbiased.The present data include only 24 deaths, so the mortality associated with different contraceptive methods cannot yet be estimated. With regard to morbidity, however, our preliminary results closely resemble those obtained in the prospective study carried out by the Royal College of General Practitioners and in the principal retrospective studies carried out in Britain and the United States. Women who used oral contraceptives at the start of the study experienced adeficiencyof hospital referrals for cancer, benign lesions of the breast, menstrual disorders other than amenorrhoea, duodenal ulcer, and retention cysts of the ovary; they showed anexcessof referrals for cerebrovascular disease, cervical erosion, skin disorders, self-poisoning, migraine, venous thrombosis and embolism, hayfever, gallbladder disease, amenorrhoea, and sterility. Women who used a diaphragm showed adeficiencyof hospital referrals for carcinoma-in-situ and dysplastic lesions of the cervix uteri and accidental injury; and anexcessof referrals for haemorrhoids and cystitis. Women who used an IUD experienced anexcessof hospital referrals for anaemia, varicose veins and salpingitis. About half of these differences were predicted from other studies while some suggestive evidence already existed for a further five. Of the remaining six, some probably reflect the influence of selective factors or chance.Multiple pregnancies, stillbirths, malformations, the sex ratio and birthweight showed no consistent relationship to method of contraception. The outcome of unplanned pregnancies occurring in women using an IUD, however, was remarkably unfavourable both in terms of ectopic gestation and miscarriage.Clear evidence was found of impairment of fertility after discontinuation of oral contraceptives. Whether this is likely to lead to permanent sterility in some women is uncertain.The study has provided data on the efficacy of a wide variety of contraceptive methods. In general the failure rates are in keeping with those obtained in other large-scale studies, save that those for the diaphragm and the sheath are much lower than those usually quoted.The available evidence does not yet allow a final balance to be struck between the benefits and risks associated with the new methods of contraception that have become widely used during the last two decades. It seems clear, however, that there are no material risks associated with the use of the diaphragm apart from the risk of pregnancy and that there may be some unintended benefits. (shrink)

It has long been thought that gene expression is tightly regulated in multicellular eukaryotes, so that expression profiles match functional profiles. This conception emerged from the assumption that gene activity is synonymous with gene function. This paradigm was first challenged by comparative protein electrophoresis studies showing extensive differences in expression patterns among related species. The paradigm is now being challenged by evolutionary transcriptomics using microarray technologies. Most gene expression profiles display features that lack any obvious functional significance. The so‐called “ (...) class='Hi'>ectopic” expression refers to the expression of genes at times and locations where the target gene is not known to have a function. However, ectopic expression might be associated with genuine function even if this function is not essential or has yet to be ascertained. Alternatively, ectopic expression might come about as a superfluous by‐product of regulatory systems, which would call for a revision of prevailing ideas about the specificity of gene regulation. We herein review available evidence for ectopic expression and the hypotheses proposed for its origin and evolution. We propose that ectopic expression must be regarded as part of an integrated phenotypic whole. It seems likely that ectopic expression represents a leak in the evolution of regulatory systems, but one that is endowed with considerable evolutionary possibilities. BioEssays 27:592–601, 2005. © 2005 Wiley Periodicals, Inc. (shrink)

Elselijn Kingma argues that, in cases of mammalian placental pregnancy, the foster (roughly, the post-implantation embryo/foetus) is part of the gravida (the pregnant organism). But she does not consider the possibility of proper overlap. I show that this generates a number of serious problems for her argument and trace the oversight to a quite general issue within the literature on biological individuality. Doing so provides an opportunity to pull apart and clarify the relations between some importantly distinct questions concerning (...) organismality and organismic parthood, and to identify the implications that this has for those who want to draw on this literature when making metaphysical or mereological arguments. (shrink)

In this paper, 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)

This paper aims to problematize pregnancy and support the development of a safe alternative method of gestation. Our arguments engage with the health risks of gestation and childbirth, the value assigned to pregnancy, as well as social and medical attitudes toward women’s pain, especially in labor. We claim that the harm caused by pregnancy and childbirth provides a prima facie case in favor of prioritizing research on a method of extra corporeal gestation.

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

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

In cases in which we must choose between either (i) preventing a woman from remaining unwillingly pregnant or (ii) preventing a fetus from being killed, we should prevent the fetus from being killed. But this suggests that in typical cases abortion is wrong: typical abortions involve preventing a woman from remaining unwillingly pregnant over preventing a fetus from being killed. So abortion is typically wrong—and this holds whether or not fetuses are persons.

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)

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

In “The Pregnancy Rescue Case: why abortion is immoral”, Hendricks presents The Pregnancy Rescue Case. In this reply I argue that even if it would be better (i.e. less bad) for the abortion to be prevented in The Pregnancy Rescue Case, that does not mean that typical abortions are impermissible. I also argue that there is a possible explanation, consistent with the pro-choice view and empirically testable, as to why people would think it better for the abortion (...) to be prevented in The Pregnancy Rescue Case. (shrink)

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

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

This highly original book argues for increased recognition of pregnancy, birthing and childrearing as social activities demanding simultaneously physical, intellectual, emotional and moral work from those who undertake them. Amy Mullin considers both parenting and paid childcare, and examines the impact of disability on this work. The first chapters contest misconceptions about pregnancy and birth such as the idea that pregnancy is only valued for its end result, and not also for the process. Following chapters focus on (...) childcare provided in different circumstances and on the needs of both providers and receivers of care. The book challenges the assumption that isolated self-sacrifice should be the norm in either pregnancy or childcare. Instead reproductive labor requires greater social support. Written from the perspective of a feminist philosopher, the book draws on the work of, and seeks to increase dialogue between, philosophers and childcare professionals, disability theorists, nurses and sociologists. (shrink)

In their paper, Romanis and Adkins delve into the potential impact of artificial amnion and placenta technology (AAPT) on cases of pregnancy loss1 that do not involve procreative loss. First, they call for more recognition of the negative feelings a person might have due to the premature end of their pregnant state. They claim that, should AAPT minimise concerns about prematurity as anticipated, individuals might feel pressured to opt for partial ectogestation to preserve their or their fetus’ well-being; moreover, (...) they point out that the feelings of loss in the context of AAPT are likely to be worse than the ones reported in neonatal intensive care units cases. Finally, they advocate for care pathways focusing on how the transfer of a fetus to the AAPT could affect the pregnant person, with particular attention to managing the grief potentially caused by the pregnancy loss. I praise the authors for such a call to action—especially since partial ectogestation is expected to become a reality in the short-term future—and I share their demands for additional and more attentive care of (formerly) pregnant patients. However, I am concerned that their approach is so focused on negative feelings towards pregnancy loss that it risks becoming …. (shrink)

This paper develops a phenomenological defense of Ian Hacking's experimental realism about unobservable entities in physical science, employing historically undervalued resources from the phenomenological tradition in order to clarify the warrant for our ontological commitments in science. Building upon the work of Husserl, Merleau-Ponty and Heelan, the paper provides a phenomenological correction of the positivistic conception of perceptual evidence maintained by antirealists such as van Fraassen, the experimental relevance of which is illustrated through a phenomenological interpretation of the 1974 discovery (...) of the J/ ψ particle generally regarded as evidence for the charmed quark. The argument then turns to address known problems in Hacking's account, demonstrating that his own instrumentalist criterion of the real is inadequately rooted in the phenomenology of perception, and as a result, passes over the true ontological significance of experimental phenomena. The paper maintains that the proper criterion, only indirectly related to instrumentality, is the distinctive style of the real encountered in perception: empirical pregnancy. With this notion and Merleau-Ponty's associated reversibility thesis, I show that the phenomenological tradition provides insights into the warrant for our realist commitments that have yet to be adequately acknowledged by philosophers of science. (shrink)

This paper deals with the possible ways of understanding the relation between the reconstruction of history and literary fiction. The transmission of memory across generations – postmemory, and the composition of literary works out of the place of the origin – ectopic literature – facilitate the formation of historical discourse, which is inevitably accompanied by modern interpretation. As interpretation is understanding reality in a subjective manner, literary fiction takes its place in the reconstruction of historical events. And ectopic (...) literature is one of the main narratives, which helps to understand the relation between facts and fantasy. (shrink)

Prenatal and preimplantation testing technologies have offered unprecedented access to information about the genetic and congenital makeup of our prospective progeny. Future developments such as preconception testing, non-intrusive prenatal testing and more extensive preimplantation testing promise to increase that access further still. The result may be greater reproductive choice, but it also increases the burden on women and men to avail themselves of these technologies in order to avoid having a child with a disability. The overwhelming question for legislators has (...) been whether and, if so, how to regulate the use of these technologies in the face of compelling but seemingly contradictory claims about the advancement of reproductive choice and the dangers of eugenic or discriminatory effects. This book examines the evolution of this legislative oversight across a number of jurisdictions and explores the tensions and ambiguities that inform these laws. (shrink)

Individuals with disabilities face significant challenges, both physically and socially. To claim a disability, therefore, is not something one ought to do lightly. Pregnancy, however, presents a very difficult and interesting case. Pain, discomfort, and inconvenience are often daily aspects of pregnancy, and pregnancy itself can cause physical, as well as social, impediments that can substantially interfere with one's day-to-day work and life. In practice, based on our current laws concerning family leave, ailments brought on by (...) class='Hi'>pregnancy can be cited as a temporary disability in certain circumstances. However, the kind of "pregnancyrelated disability" that is built into such leave policies and laws falls short of... (shrink)

Although Plato's notion of spiritual pregnancy has received a great deal of critical attention in recent years, the development of the metaphor in the Symposium has not been fully analysed. Close attention to the details of the image reveals two important points which have so far been overlooked: There are two quite different types of spiritual pregnancy in the Symposium: a ‘male’ type, which is analogous to the build-up to physical ejaculation, and a ‘female’ type, which is analogous (...) to the physical experience of pregnancy as normally understood. (shrink)

Ethical and legal traditions recognize prenatal duties to avoid harm to offspring. However, applying the harm principle to pregnancy requires a careful balancing of a baby's welfare with a pregnant woman's interest in liberty and bodily integrity. In the case of maternal PKU the mother can prevent harm to her baby by returning to the admittedly unpleasant diet that prevented her from being retarded. Informing, counseling, and access to medical care should be the primary policy. Seizures and forced treatment (...) cannot be justified in this case, and only rarely in other situations. (shrink)

In this paper, I reflect on an important article by Bob Veatch in the inaugural issue of the Hastings Center Report, entitled “Experimental Pregnancy.” It is a report and elegant analysis of the Goldzieher Study, in which nearly 400 women were randomized to receive hormonal contraception or placebo absent consent or disclosure about placebo use, resulting in several pregnancies. Noting the study’s limited notoriety, I first consider the narratives that have instead dominated bioethics’ approach to pregnancy and research: (...) thalidomide and diethylstibesterol. These narratives have facilitated a narrow focus on avoiding fetal risk, to the exclusion of other ethically relevant considerations. I then revisit “Experimental Pregnancy” and offer two ways in which Bob’s analysis serves as an important corrective, first, by foregrounding research subjects, and second, by normalizing pregnancy and thus foregrounding foundational ethical considerations that are sometimes lost amidst pregnancy’s presumed exceptionalism. (shrink)

Background: The pregnancy and psychological status of infertile couples has always been a concern, but there is no clear evidence for the efficacy of psychotherapy for infertile couples. This study aimed to summarize the current evidence of the effects of psychotherapy on psychological and pregnancy outcomes for infertile couples. Method: We searched Ovid MEDLINE, Ovid EMbase, The Cochrane Library, and Web of Science for articles published from 1946 to June 26, 2020. The pregnancy outcomes, psychological outcomes, and (...) acceptability were involved in the study. Results: Overall, 29 studies with a combined total of 3,522 adult participants were included in the meta-analysis. Compared with a placebo, psychotherapy was associated with the pregnancy rate [risk ratio = 1.43, 95% CI [1.07, 1.93]], total psychological scales associated with infertility [standardized mean difference = −0.33 95% CI [−0.63, −0.02]], subsymptoms of psychological scores using the 28-item version of GHQ, and the integrative body–mind–spirit ; total psychological scales associated with infertility using other treatments and more than a month; and anxiety using BMS had significant statistical significance. The funnel plots of all outcomes were approximately symmetrical, and no significant publication bias was found. Conclusions: The study showed that psychotherapy can lead to improvements in the pregnancy rate for infertile patients, especially for patients receiving assisted fertility. In addition, it may help improve total psychological scales associated with infertility and depression. CBT and BMS play an important role in improving rate of pregnancy, and BMS is associated with reducing anxiety. Although psychological interventions had limited effects on the pregnancy outcomes of infertility, our study still recommended that psychotherapies, in particular CBT and BMS, were applied to the therapeutic regimen for infertility, especially for patients receiving assisted fertility. (shrink)

L.A. Paul argues that interesting issues for rational choice theory are raised by epistemically transformative experiences: experiences which provide access to knowledge that could not be known without the experience. Consideration of the epistemic effects of pregnancy has important implications for our understanding of epistemically transformative experiences and for debate about the ethics of abortion and applied ethics more generally. Pregnancy is epistemically transformative both in Paul’s narrow sense and in a wider sense: those who have not been (...) pregnant face significant barriers to acquiring the knowledge made accessible through pregnancy. This knowledge is crucial for engaging with the ethics of abortion. The epistemically transformativeWIDE nature of pregnancy may require us to use new methods to try to partially grasp what pregnancy is like such as for example, significant engagement with narrative literature. Because pregnancy is also epistemically transformative in a narrow sense, we need to work out how to engage in ethical reasoning when relevant knowledge is not fully accessible to all. This argument has implications beyond the debate about abortion. Philosophers in many areas of applied ethics will need to work out how to respond appropriately to epistemically transformative experiences. (shrink)