Bodily Rights

This article argues that consent must be revocable. I present two arguments for this conclusion. On the argument from informed consent, irrevocable consent lacks validity because it cannot be sufficiently informed. On the argument from bodily integrity, irrevocable consent lacks validity because we do not have the authority to deny our future selves the ability to protect our bodily integrity. I explain why the argument from bodily integrity captures unique moral problems raised by irrevocable consent and illuminates an important but (...) undertheorized distinction between autonomy and bodily integrity. (shrink)

As the science and technology of the brain and mind develop, so do the ways in which brains and minds may be surveilled and manipulated. Some cognitive libertarians worry that these developments undermine cognitive liberty, or “freedom of thought.” I argue that protecting an individual’s cognitive liberty undermines others’ ability to use their own cognitive liberty. Given that the threatening devices and processes are not relevantly different from ordinary and frequent intrusions upon one’s brain and mind, strong protections of cognitive (...) liberty may proscribe neurotechnological intrusions, but also ordinary intrusions. Thus, the cognitive libertarian position “hog-ties” others’ use of their own liberties. This problem for the cognitive libertarian is the same problem that ordinary libertarianism faces in protecting individual rights to property and person. But the libertarian strategies for resolving the problem don’t work for the cognitive libertarian. I conclude that the right to mental privacy is weaker than what cognitive libertarians want it to be. (shrink)

This article argues that non-consensual vaccination is morally impermissible, for the same reasons for which sexual assault is not permissible. Likewise, mandatory vaccination is morally akin to sexual harassment, and therefore is not to be allowed.

I argue here that our rights in our bodies are not well explained by self-ownership – and thus, also, that we cannot infer any further distributive implications of self-ownership from intuitions about body rights via inference to the best explanation. And I sketch an alternative view, on which we do indeed own our bodies, but not because we own ourselves. Self-ownership, I argue, provides a satisfying explanation only if we take it seriously: not as a mere metaphor, but as an (...) expression of a literal, reflexive ownership relation between me and myself, whatever I myself am. I go on to canvas the most prominent theories of what human beings like me literally are, arguing that each of these theories makes it hard to see how our self-ownership can ground our rights in our bodies. In the second half I consider and refine alternative, interest-based, explanations of our rights in our bodies, drawing on suggestions in this direction from Kasper Lippert-Rasmussen and Alan Wertheimer. I show how it is possible in principle to affirm that body ownership rights remain (in a sense) natural rights, even on the sort of interest-based view of ownership that many (including myself) take to preclude all or most fully natural property rights. I argue that many body rights can be grounded prefiguratively, in facts about the possible emergence of sufficiently just authority-assigning practices, rather than (as with most property rights) in their actual existence. Finally, I return to the distributive issues that motivated much interest in self-ownership in the first place – particularly, the question of whether and in what way our rights in our bodies generate rights in other things, by labor or otherwise. Without actually answering this question, I show how the account developed here would proceed in doing so: not by positing body rights as a methodologically prior constraint on rights of other kinds, but rather by considering the implications entire systems of rights and duties have for the interests of those who possess and are bound by them. (shrink)

Since March of 2020, the world has been brought to its knees by unscientific and unethical mandates. These mandates have destroyed the world economy and the lives of countless innocent individuals. The “cure” that has been offered by medical bureaucrats and politicians has been more deadly than the disease (COVID-19). The imposition of ludicrous lockdowns, mask-wearing, coerced vaccination, and vaccine passports have not only proved to be ineffective, but also much more harmful than SARS-CoV-2 and all its variants. COVID-19 has (...) a recovery rate of close to 99% for most of the world’s population, however, despite this, institutions and power-hungry individuals have trampled upon our civil liberties and ignored our inalienable human rights. It is precisely as Thomas Paine famously stated: “The greatest tyrannies are always perpetrated in the name of the noblest causes.” -/- Many lives have been gratuitously lost because of the administration of deadly medical treatments, and the rejection of effective treatments that follow genuine science. In the process, informed consent has been disparaged and desecrated. For over two years, we were instructed to “trust the science,” but the “science” advocated by medical bureaucrats and greedy politicians was the reason why the world was turned upside-down. In the face of these crimes against humanity, justice will only be brought by real courts and real judges, but this will require the awakening of a critical mass. This book serves as an instrument for this awakening. (shrink)

La pandemia mundial del coronavirus ha supuesto una de las mayores conmociones de nuestra historia reciente y, como tal, parece obligarnos a repensar nuestros modos de organización y formas de vida e, incluso, como se propone aquí, a plantearnos cómo podríamos habitar el colapso. En este escenario incierto y desconocido, la filosofía, con sus múltiples enfoques y subdisciplinas, se presenta como un lugar privilegiado para analizar las vertiginosas transformaciones que han dado lugar a esta “nueva normalidad”. El presente monográfico aglutina (...) una serie de contribuciones realizadas por distintos investigadores e investigadoras de la Universidad de Oviedo, que han tratado de abordar la crisis sanitaria global desde diversas perspectivas filosóficas y humanísticas. Entre los temas que se estudian en estas páginas, figuran los relativos a la gestión de la pandemia y la comunicación científica sobre la misma, las relaciones entre pobreza, salud mental y suicidio o el alcance de la revalorización del mundo rural. También se utilizan las herramientas del análisis biopolítico para examinar la gestión de los cuerpos durante la pandemia a partir de tres ejes distintos: el tratamiento de los enfermos, los nuevos dispositivos de control y la gestión de la pandemia en las instituciones de encierro. Además, varios de los capítulos se ocupan explícitamente de un tema inherente a la mayoría de las reflexiones que componen este volumen: a saber, el de la necesidad de un cuestionamiento profundo de la sociedad occidental contemporánea y la insostenibilidad de su forma de vida. (shrink)

The rare but severe cerebral venous thrombosis occurring in some AstraZeneca vaccine recipients has prompted some governments to suspend part of their COVID-19 vaccination programmes. Such suspensions have faced various challenges from both scientific and ethical angles. Most of the criticisms against such suspensions follow a consequentialist approach, arguing that the suspension will lead to more harm than benefits. In this paper, I propose a rights-based argument against the suspension of the vaccine rollouts amid this highly time-sensitive combat of COVID-19. (...) I argue that by suspending a vaccine rollout, a government infringes people's right to take the risks they deem worth taking for their health. I also consider four potential objections to my argument and explain why none of them undermines my argument. (shrink)

This article asks whether personal ventilators should be redistributed to maximize lives saved in emergency condition, like the COVID-19 pandemic. It begins by examining extant claims that items like ventilators are literally parts of their user’s bodies. Arguments in favor of incorporation for ventilators fail to show that they meet valid sufficient conditions to be body parts, but arguments against incorporation also fail to show that they fail to meet clearly valid necessary conditions. Further progress on this issue awaits clarification (...) of difficult normative, conceptual, and metaphysical questions about the possible boundaries of a person’s body. Rather than relying solely on incorporation arguments, we propose an argument against reallocation from widely accepted anti-discrimination principles. Possession of a personal ventilator is an obvious marker of disability identity; thus, reallocating ventilators from those that already possess them discriminates on the basis of a stigmatized trait – a paradigm case of presumptively wrongful discrimination. This discrimination claim, taken together with uncertainty about the bodily status of ventilators, yields a strong presumption against personal ventilator reallocation. (shrink)

In Righting Health Policy, MacDougall argues that bioethics has not developed the tools best suited for justifying health law and policy. Using Kant’s practical philosophy as an example, he explores the promise of political philosophy for making normatively justified recommendations about health law and policy.

In “Racial Justice Requires Ending the War on Drugs,” Earp and colleagues argue that the personal use or possession of all currently illicit psychoactive substances should be immediately decriminal...

The debate regarding the role of conscientious objection in healthcare has been protracted, with increasing demands for curbs on conscientious objection. There is a growing body of evidence that indicates that in some cases, high rates of conscientious objection can affect access to legal medical services such as abortion—a major concern of critics of conscientious objection. Moreover, few solutions have been put forward that aim to satisfy both this concern and that of defenders of conscientious objection—being expected to participate in (...) the provision of services that compromise their moral integrity. Here we attempt to bring some resolution to the debate by proposing a pragmatic, long-term solution offering what we believe to be an acceptable compromise—a quota system for medical trainees in specialties where a conscientious objection can be exercised, and is known to cause conflict. We envisage two main objectives of the quota system we propose. First, as a means to introduce conscientious objection into countries where this is not presently permitted. Second, to minimise or eliminate the effects of high rates of conscientious objection in countries such as Italy, where access to legal abortion provision can be negatively affected. (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)

What does it mean to respect life and health in an innocent fellow-human being? Separating conjoined twins where one twin will die as a result need not involve the intention to kill or harm. Arguably, however, not all side-effects are “mere” side-effects which could, in principle, be outweighed by sufficiently good intended effects. Rather, foreseen serious harm for an innocent person we non-therapeutically affect can be morally conclusive when linked to the intention to affect the person’s body or invade the (...) space it fills. In the case of infant conjoined twins, such as the Maltese twins Jodie and Mary, the twin who dies from separation has no unjust, or any, intentions as regards the twin saved. She thus has the moral immunity of any innocent person from lethal bodily invasions and other serious bodily harm. Neither the final act which killed Mary nor previous acts of cutting into Mary, including parts shared with her twin Jodie, were therefore morally permissible. (shrink)

A xurisprudencia constitucional española (STC 37/2011, de 28 de marzo, entre outras) ten establecido como fundamento do consentimento informado o dereito á integridade física e moral (art. 15 CE). O Tribunal Constitucional configura o consentimento informado como un deber de abstención do profesional sanitario, é dicir, como unha negación da competencia do profesional sanitario na terminoloxía de Hohfeld. Así pois, o consentimento informado queda conformado como un dereito negativo ou de defensa, polo que concibilo como liberdade xurídica ou facultade de (...) autodeterminación positiva esixiría a revisión do seu fundamento constitucional. O presente artigo pretende precisamente revisar a natureza iusfundamental do consentimento informado a partir da obra de W.N. Hohfeld e Robert Alexy. (shrink)

We argue that at least some corvids morally ought to be granted a right to bodily liberty in the US legal system and relevantly similar systems. This right would grant immunity to frivolous captivity and extermination. Implementing this right will require new legislation or the expansion of existing legislation including the elimination of various "pest" clauses. This paper proceeds in three parts. First, we survey accounts of the moral grounds of legal rights. Second, to establish an overlapping consensus supporting corvid (...) bodily liberty rights, we survey the empirical literature on corvid cognition. Third, we illustrate what a corvid right to bodily liberty might look like, by looking to recent developments in animal law, as well as previous advocacy on behalf of primates and cetaceans. (shrink)

John Martin Fischer has published a trilogy of papers discussing Judith Jarvis Thomson’s ground-breaking “A Defense of Abortion”. Fischer claims that neither the unconscious violinist nor the people-seeds thought experiment is persuasive, and he concludes that Thomson’s arguments are incomplete in the sense that they require further support to secure the permissibility of abortion in their respective contexts of pregnancy resulting from rape and pregnancy resulting from voluntary intercourse and contraceptive failure. My aim in this paper is to identify three (...) ways in which Fischer fails to faithfully capture the force of arguments in ADA. I also suggest that these failings are indicative of a general under-appreciation of how the arguments in ADA support a feminist strategy for resisting anti-abortionist arguments. The strategy is to emphasize that these arguments fail on their own terms when one takes into consideration the sacrifices expected of women carrying unwanted pregnancies compared to the sacrifices expected from men in other relevantly similar social contexts. To ignore this aspect of ADA shows a failure to appreciate its potential for supporting a feminist argument based on the equitable applications of our concepts of risk and responsibility. (shrink)

This book addresses the endangerment of children’s bodies in affluent societies. Bodily integrity is an important part of a child’s physical and mental well-being, but it can also be violated through various threats during childhood; not only affecting physical health but also causing mental damage and leading to distortions in the development of the self. The authors give an account of three areas, which present different serious dangers: (1) body and eating, (2) body and sexuality, and (3) body and violence. (...) Through an in-depth examination of the available theoretical and empirical knowledge, as well as a thorough ethical analysis, the central injustices in the mentioned areas are identified and the agents with responsibilities towards children displayed. The authors conclude by providing invaluable insight into the necessity of an ethical basis for policies to safeguard children and their bodies. (shrink)

Available from UMI in association with The British Library. Requires signed TDF. ;The language of rights has become highly respectable in Church circles and in the works of Christian ethicists, especially since the end of the Second World War. The literature on this subject is immense, yet much of this writing avoids the basic analytical issues presented by this form of moral language. This thesis begins with the conviction that theologians can learn a good deal about the value of the (...) language of rights from recent literature on the subject in moral philosophy and in jurisprudence or legal philosophy. ;Once one begins to study the analytical issues connected with the language of rights, one is confronted with the possibility of a radical scepticism regarding its value. Thus, the opening chapters of this work attempt to show forth this scepticism and to overcome it. In doing so one is challenged to clarify the concept of rights with the help of various useful distinctions, e.g. between 'human rights' and 'special moral rights', 'mandatory' and 'discretionary' rights; and a 'cluster' of legal concepts borrowed from Wesley Hohfeld and applied in the moral sphere: 'Claims', 'liberties', 'powers' and 'immunities'. These clarificatory distinctions help to overcome scepticism and provide a flexible form of moral language, useful both to philosophers and theologians. ;If philosophy is the 'handmaid of theology' in helping analyse and clarify the language of Christian ethics, it must be recognised that the Christian tradition has much to offer in understanding the proper significance of the human need to claim what is due. Although this thesis is primarily methodological and metaethical, I insist on uncovering basic normative ethical positions underlying the language of rights. In particular, I stress the Christian understanding of human dignity as the foundation of the language of rights. ;In the second part of my thesis I try to show how the clarification of the language of rights helps in discussing the issues involved in the area of reproductive rights. This includes some analysis of the values associated with human procreation and the normative relationships expressed by the language of rights and duties. The complexity of rights-language is shown in the context of a discussion of controversial subjects, from population control to treatment for infertility. (shrink)

This paper examines the reasons why corporal punishment in the judicial sphere has fallen into moral disfavour in recent decades. Standard objections to the practice, both practical and ethical, are considered and found to be inconclusive. It is argued that corporal punishment is not inevitably more cruel or demeaning than conventionally preferred punitive methods and that consideration should be given to its limited experimental reintroduction.

East Asian countries such as South Korea have recently made headlines for experimenting with different methods to incentivise people to have (more) children, in a bid to reverse declining birth rates. Many such incentives—child benefits, cash bonuses, dating events, and so on—appear morally innocuous at first glance. I will demonstrate in this analysis, however, that they amount to stopgap measures which reveal fundamental shortcomings with the way various nation states are approaching the so-called ‘problem’ of fertility decline.

White progressives in the U.S. are currently experiencing two profound reckonings that typically are assumed to be unrelated. On the one hand, the Dobbs verdict overturned the assumption that the right to choose with respect to abortion is too socially entrenched, juridically settled, or politically sacred to be denied. On the other hand, climatological conditions of possibility for comfortable existence are increasingly under threat in locales in which residents have come to expect to enjoy secure lives and livelihoods. This essay (...) highlights what Indigenous communities across the U.S. already know well. Namely, threats to reproductive freedom and climate crisis are neither new nor separable. Both phenomena have common colonial roots that continue to proliferate. Each is a result of the disruption and destruction of Indigenous kinship assemblages. Indeed, in aiming to remediate their current reckonings, white progressives routinely (if unthinkingly) support forms of settler state violence that perpetuate reproductive and climate injustice in Indigenous communities. We appeal to white progressives, notably including white feminists, to embrace the proposition that their reckonings cannot be properly understood, nor successfully addressed without prioritizing Indigenous futurity. We call for centering forms of Indigenous feminist praxis that facilitate robust Indigenous coalitions of anti-colonial resistance. (shrink)

Some physicians in the United States have strong moral objections to the recent bans or near total bans on abortion in this country. The objections are particularly vehement among those who have been abortion providers. They are concerned about the impact of the new restrictions on patients—on their lives and health, especially patients who are socially marginalized and will not be able to travel to “friendly” states to have abortions (i.e., states that legally permit abortions). They are also worried about (...) the status of women, which they fear will be unequal to that of men in a society where women are not permitted to make such intimate decisions about their lives. For these physicians, not to mention their patients, the bans on abortion are morally devastating. They, the physicians, might even feel compelled by their conscience to provide this care—to engage in what some call the “conscientious provision” of care—even though they could lose their careers and their freedom by doing so. There is currently no legal protection for the conscientious provision of abortion care in the U.S., although there is substantial protection for the conscientious refusal of that care. Physicians working in jurisdictions that have abortion bans put themselves at serious legal risk if they defy these bans for reasons of conscience. In general, their freedom of conscience is very low compared to that of physicians who conscientiously refuse to provide abortions in jurisdictions where abortions are still legal. Using theories of conscience and conscientious objection that I develop in Conscience in Reproductive Health Care (Oxford 2020), I argue that this situation is morally untenable. (shrink)

Steven Landsburg argues that from a legal perspective, “most abortions should be unrestricted.” This conclusion, he claims, follows from combining insights from Judith Jarvis Thomson (1971) with a “careful Rawlsian analysis,” where “Rawlsianism is the industry-standard approach” for settling conflicts like those that arise in debates over abortion policy. If correct, then “the right approach to policy questions” implies that abortion access should remain relatively open. Here, I argue that Landsburg has drawn from Rawlsian tools the wrong conclusion about abortion. (...) I defend what he terms “naive Rawlsian”: the view that as a matter of justice, “many abortions . . . should be prohibited.” If correct, then “the industry-standard approach” for settling conflicts (as Landsburg calls it) should lead society to prohibit abortion in most cases. Proponents of abortion who wish to avoid this outcome, therefore, should abandon the “industry standard” approach to conflict resolution. (shrink)

This issue of Christian Bioethics explores theological, metaphysical, and ethical questions surrounding emerging reproductive technologies. Narratives concerning such technologies are often manipulated via “language games.” Language games involve toying with language to ensure that one’s vision of the good gains or retains political prominence. Such games are common in academic discussions of “artificial womb” technologies. Abortion proponents, for example, are already using language to dehumanize subjects within “artificial wombs.” This is unsurprising. Were relevant subjects considered persons, then abortion access (and (...) other forms of “reproductive autonomy”) might be curtailed. Here, I show that abortion proponents’ language games often depend on dubious metaphysical claims. Second, I argue that Christians should oppose dehumanizing language games, since those games undermine “neighbor-love,” which Christians are commanded to show others. I also highlight how discussions of other technologies—such as medication abortion—are affected by confused (or manipulative) language. Ultimately, the language games I critique aim to preserve and expand the “rights” of the powerful to dehumanize, control, and kill vulnerable human beings. Since neighbor-love commands Christians to provide for “the least of these,” however, Christians must expose these manipulative language games, refute them, and resist the corrupt ideologies from which they flow. (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. And so abortion is typically wrong—and this holds whether or not fetuses are persons.

Herjeet Kaur Marway recently proposed the Principle of Procreative Justice, which says that reproducers have a strong moral obligation to avoid completing race and colour injustices through their selection choices. In this article, we analyze this principle and argue, appealing to a series of counterexamples, that some of the implications of Marway's Principle of Procreative Justice are difficult to accept. This casts doubt on whether the principle should be adopted. Also, we show that there are some more principled worries regarding (...) Marway's idea of a strong pro tanto duty not to complete injustices through one's procreative choices. Nonetheless, we believe Marway's arguments point in the right general direction regarding duties and structural injustice. Thus, in the final part, we suggest a positive proposal on how it would be possible to respond to the cases we raise. More specifically, we explore the suggestion that agents have a pro tanto duty to participate in eliminating structural injustice. Importantly, this duty can be satisfied, not only in procreation choices but in multiple ways. (shrink)

This paper reconsiders Tommie Shelby's (2016) analysis of procreation in poor black communities. I identify three conceptual frames within which Shelby situates his analysis—feminization, choice-as-control, and moralization. I argue that these frames should be rejected on conceptual, empirical, and moral grounds. As I show, this framing engenders a flawed understanding of poor black women's procreative lives. I propose an alternative framework for reconceiving the relationship between poverty and procreative justice, one oriented around reproductive flourishing instead of reproductive responsibility. More generally, (...) the paper develops a methodological challenge for nonideal moral and political philosophy, especially concerning the obligations of the oppressed. Specifically, I argue that in the absence of descriptive and conceptual accountability, the moral gaze of the philosopher risks preserving, rather than destabilizing, oppressive ideologies. (shrink)

Uterus transplantation (UTx) is an experimental surgery likely to face the issue of organ shortage. In my article, I explore how this issue might be addressed by changing the prevailing practices around live uterus donor recruitment. Currently, women with children – often the mothers of recipients – tend to be overrepresented as donors. Yet, other potentially eligible groups who may have an interest in providing their uterus – such as transgender men, or cisgender women who do not wish to gestate (...) or to have children – tend to be excluded as potential donors. Moving forward, I recommend that donor inclusion criteria for UTx be broadened to be more inclusive of these latter groups. (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)

Procreative obligations are often discussed by evaluating only the consequences of reproductive actions or omissions; less attention is paid to the moral role of intentions and attitudes. In this paper, I assess whether intentions and attitudes can contribute to defining our moral obligations with regard to assisted reproductive technologies already available, such as preimplantation genetic diagnosis (PGD), and those that may be available in future, such as reproductive genome editing and ectogenesis, in a way compatible with person‐affecting constraints. I propose (...) the parent–child relationship argument, which is based on the moral distinction between creating and parenting a child. Hence, I first argue that intentions and attitudes can play a role in defining our moral obligations in reproductive decisions involving PGD. Second, I maintain that if we accept this and recognize reproductive genome editing and ectogenesis as person‐affecting procedures, we should be committed to arguing that prospective parents may have moral reasons to prefer reproduction via such techniques than via sexual intercourse. In both cases, I observe an extension of our procreative responsibility beyond what is proposed by the consequentialist person‐affecting morality. (shrink)

Responses to Brad Skow, Reuven Brandt, Camisha Russell and Amanda Roth's commentaries on *Conceiving People*.

Is moral or other regret for abortion an indicator that abortion may not be morally or prudentially choice worthy? This paper examines the work of Kate Greasley in this area, who offers an explanation of any asymmetry in openness to regret between women who have abortions and women who give birth. The latter, not unlike Derek Parfit’s 14-year-old who conceives deliberately, may feel duty-bound not to regret their decision (in their case, to continue their pregnancy) and to affirm the life (...) of their child. In response to Greasley, testimonial evidence of one group cannot be dismissed simply because regret may be less available to another group of decision-makers. Moreover, if moral regret for childbearing is uncommon, this is not because mothers have a moral duty, as Greasley argues, not to regret even a morally mistaken choice to conceive. On the contrary, one must separate the evaluation of choices and of the results of these choices, whether positive or negative. Regret, while not infallible, can elucidate values at stake in choices, and testimonial evidence in the form of regret should be taken more seriously in regard to certain kinds of choice. (shrink)

In this article, I critique the commonly accepted distinction between commercial and altruistic surrogacy arrangements. The moral legitimacy of surrogacy, I claim, does not hinge on whether it is paid (‘commercial’) or unpaid (‘altruistic’); rather, it is best determined by appraisal of virtue-abiding conditions constitutive of the surrogacy arrangement. I begin my article by problematising the prevailing commercial/altruistic distinction; next, I demonstrate that an assessment of the virtue-abiding or non-virtue-abiding features of a surrogacy is crucial to navigating questions about the (...) moral legitimacy of surrogacy; in the final part, I reject other moral heuristics that might be proposed as alternatives to the commercial/altruistic dichotomy, and reiterate that a virtue-ethical framework is the most suitable way forward. (shrink)

After the US Supreme Court’s reversal of Roe v. Wade, a number of states have immediately banned abortion. Pro-choice activists are responding by promoting medication abortions – a do-it-yourself form of abortion. Women can take pills at home to induce an abortion in the first few weeks of pregnancy. -/- The Biden Administration [1] has backed the abortion pill, too. Attorney-General Merrick B. Garland and Health and Human Services Secretary Xavier Becerra both issued statements endorsing it. -/- “We stand ready (...) to work with other arms of the federal government that seek to use their lawful authorities to protect and preserve access to reproductive care,” said the Attorney-General. “In particular, the F.D.A. has approved the use of the medication mifepristone. States may not ban mifepristone based on disagreement with the F.D.A.’s expert judgment about its safety and efficacy.” -/- As the New York Times [1] has noted, this sets the scene for legal battles. The obvious one is: will anti-abortion states prosecute medication abortions? -/- But – based on experience in the United Kingdom - the use of the abortion pill could give pro-life doctors headaches as well. -/- In the past year, UK has witnessed the saga of two Catholic doctors who have been brought in front of the professional regulator, the General Medical Council, after accusations of professional misconduct. Their crime? They had supplied abortion pill reversal (APR) treatment to women. Accusations of this misconduct have been brought forward by pro-choice organisations [2]. -/- The problem is that some women might panic when they discover that they are pregnant or are pressured to make a rash decision. They obtain abortion pills, often without seeing a doctor faceto- face, and soon after taking the first pill, they regret their decision. -/- Is it too late for them to save their pregnancy? Not necessarily. -/- A treatment developed in the US works about half the time. It involves the woman taking progesterone after the first abortion pill to counteract the abortifacient action of the drug. -/- Seventy-three women in the UK are reported to have taken a full APR course, of whom, 38 – more than half — successfully remained pregnant. Admittedly, the procedure is controversial [3], with pro-choice writers denouncing it as unproven, unscientific, and unethical. This has triggered some healthcare practitioners and scholars to analyse the commitments of the pro-choice movement to APR. In a recently published paper in The New Bioethics [4], two colleagues, Dominic Whitehouse and Steven Bow, and I argue that those espousing a pro-choice worldview should actually support abortion pill reversal and that the current evidence indicates that they should actually be doing it. -/- While some pro-choice activists might be happy simply to expand women’s reproductive choices, some might also want to ensure that these choices are safe and effective at achieving the desired outcome, which in principle includes maintaining a pregnancy. -/- We then review the scientific evidence with respect to the ability of APR to halt an abortion, look at the potential impact of APR on mental health, as well as its procedural safety. While highlighting that gold-standard evidence is lacking, we note that APR is associated with about two times higher rate of embryo survival compared to not completing the full early medical abortion course, that there is large agreement in the literature that women who are ambiguous about abortion are at risk of poorer mental health outcomes after abortion (and argue that women who request APR fall into this category), and highlight that there is no evidence that APR is more dangerous than abandoning an initiated early medical abortion. -/- The latter fact is important, as the results of the only randomised-controlled trial of APR have been at times misrepresented in the media [5.6], creating the impression that APR is not safe while most of the adverse effects occurred in the study group that did not receive APR. As our paper argues, with respect to APR the two UK doctors were “champions of women’s choice and should be congratulated, not condemned, by pro-choice advocates”. -/- While the cases against the two doctors have now been dropped (and there have even been accusations against a member of one of these pro-choice organisations that they pressurised a patient into complaining about one of the doctors and twisted the patient’s experience of the treatment [7]), we argue that it is important to set-up systems to facilitate the future provision of APR to protect both patients and healthcare staff. -/- Our conclusion is that, while being open to any change in evidence, those espousing a pro-choice outlook should “support calls for an APR framework that will protect women and the healthcare professionals caring for them” “and certainly not oppose” APR. -/- The debate over abortion pill reversal will be heading to the United States soon. It is quite possible that it will be denounced as dangerous misinformation. It’s not. But pro-life defenders should be prepared to defend their ground. -/- This article was first published by Mercatornet. (shrink)

Dear Editor, -/- We are pleased to report that we have recently published an article in a well-established bioethics journal where we briefly review the evidence surrounding abortion pill reversal (APR) and argue that those who identify with the pro-choice standpoint should support APR provision (indeed, the ex-CEO of BPAS, Ann Furedi, has agreed in principle with this conclusion of ours in one of her tweets). We also hope that our article will serve as a record in the peer-reviewed and (...) indexed literature of the struggles our fellow CMA UK members have gone through to support women who eventually decided to keep their pregnancies, and the tribulations they had to endure from their colleagues in the medical establishment. It is perhaps somewhat symbolic that our paper has been published in a special issue dedicated to the ‘feminist ethics of care’ as APR and the sacrifice of our colleagues shows what care for women should really look like.(1) -/- We have made sure to spread the word about this as well. One of us has given an interview to Irish pro-life group Protect Life (still to be published) and we have submitted a post to a pro-life collaborative that also awaits publication. Finally, we have also published a post about this paper and current developments in the USA in a well-established bioethics news site, which has been republished in various online outlets.(2) -/- We believe that this promotion of APR is vital, as recent statements from both the UK and the USA indicate that the pressure against APR might grow. The American College of Obstetricians and Gynecologists have published a post entitled ‘Facts Are Important: Medication Abortion "Reversal" Is Not Supported by Science’.(3) Similarly, the UK Royal College of Obstetricians and Gynaecologists, together with other bodies (including the British Society of Abortion Care Providers) have posted a position statement stating that there is no reputable evidence for using progesterone in APR.(4) One truly wonders why these organisations are pushing this narrative despite the weight of the evidence available being in favour of APR and their organisations’ professed support for women’s choice. (shrink)

Despite having essential health needs regarding sexual and reproductive health services (SRHS), young people (e.g., adolescents) in many countries show low use of such services. The World Health Organization advocates fostering young people’s autonomy to access health services to address this global health problem. However, there are gaps in the literature to understand how young people’s autonomy can be fostered to access SRHS. In 2019–2020, we conducted semi-structured interviews with 45 young people aged 14–23 years old in Colombia to explore (...) how they might wish to have their autonomy fostered in accessing SRHS. Research in different cultural contexts has shown that young people generally do not wish to discuss sex with their parents. By contrast, most of our participants expressed a strong wish for the ability to talk openly with their parents about their sexual and reproductive health. One of the main complaints of these young people was that their parents lacked the necessary knowledge to help them make informed decisions related to their sexual and reproductive health (e.g., choosing a contraceptive option). As a potential solution, participants were enthusiastic about initiatives that could provide parents with comprehensive sex education to assist young people in making informed choices for their sexual and reproductive health, including how to access SRHS. (shrink)

The introduction of pre-exposure prophylaxis (PrEP) for HIV has triggered critical analysis within the social sciences. For example, some have signalled how PrEP may lead to a renewed medicalisation of gay and other homosexually-active men’s sexuality. This chapter challenges some of those accounts. Adopting a public health ethics perspective, it argues that gay men should be understood as agentic in their use of PrEP, as opposed to being the passive victims of medicalisation, and that greater attention should be paid to (...) questions of pleasure in PrEP use. Applying a reproductive justice framework, the chapter argues that the worldwide inaccessibility of PrEP constitutes a more serious ethical issue than the potential problem of the medicalisation of gay men’s sexuality. (shrink)

Objective Our study sought to (1) describe the practices and preferences of Colombian adolescents in accessing sexual and reproductive health services: accompanied versus alone; (2) compare actual practices with stated preferences; and (3) determine age and gender differences regarding the practice and these stated preferences. -/- Methods 812 participants aged 11–24 years old answered a survey in two Profamilia clinics in the cities of Medellin and Cali in Colombia. A cross-sectional analysis was performed to compare participants’ answers based on the (...) variables of gender and age. -/- Results A quarter of participants visited the clinic alone (25.4%). Females were more likely to go alone in comparison to males (26.3% vs 14.1%; p = 0.031), and older participants went alone more often than younger participants (p < 0.001). Most participants – 72.7% (95 %CI: 69.3–75.9) – expressed a preference in being accompanied to the clinic, and more than 90% had their preferences met. The preferences of older participants were, however, less likely to be met than those of younger participants (p < 0.001), notably, because they predominantly wanted to be accompanied. -/- Conclusion Contemporary public health and bioethics literature advocates in favor of developing health services that better meet the preferences of adolescents. The present research highlights an apparent blind spot related to the role that others (e.g., parents, friends, partners) can or should play in accompanying adolescent patients when they access sexual and reproductive health services. Respecting adolescents’ preferences, and hence their autonomy, is not simply a matter of ensuring freedom from constraints (e.g., their right and ability to go alone). Rather, it should also consider the liberty to choose whether to be accompanied when accessing SHRS and by whom. (shrink)

On 24 July 2022, the landmark decision Roe v. Wade (1973), that secured a right to abortion for decades, was overruled by the US Supreme Court. The Court decision in Dobbs v. Jackson Women’s Health Organisation severely restricts access to legal abortion care in the USA, since it will give the states the power to ban abortion. It has been claimed that overruling Roe will have disproportionate impacts on women of color and that restricting access to abortion contributes to or (...) amounts to structural racism. In this paper, we consider whether restricting abortion access as a consequence of overruling Roe could be understood as discrimination against women of color (and women in general). We argue that banning abortion is indirectly discriminatory against women of color and directly (but neither indirectly, nor structurally) discriminatory against women in general. (shrink)

Ableist attitudes and structures regarding disability are increasingly recognized across all sectors of healthcare delivery. After Dobbs, novel questions arose in the USA concerning how to protect reproductive autonomy while avoiding discrimination against and devaluation of disabled persons. As a case study, we examine the Louisiana’s Department of Public Health August 1st Emergency Declaration, “List of Conditions that shall deem an Unborn Child ‘Medically Futile.’” We raise a number of medical, ethical, and public health concerns that lead us to argue (...) the declaration should be rescinded. The ethically objectionable declaration provides valuable lessons concerning how to uphold both reproductive and disability justice in a post-Dobbs landscape. (shrink)

The past few years has seen a resurgence in the public interest in space flight and travel. Spurred mainly by the likes of technology billionaires like Elon Musk and Jeff Bezos, the topic poses both unique scientific as well as ethical challenges. This paper looks at the concept of generation ships, conceptual behemoth ships whose goal is to bring a group of human settlers to distant exoplanets. These ships are designed to host multiple generations of people who will be born, (...) live, and die on these ships long before it reaches its destination. This paper takes reproductive ethics as its lens to look at how genetic enhancement interventions can and should be used not only to ensure that future generations of offspring on the ships, and eventual exoplanet colonies, live a minimally good life but that their births are contingent on them living genuinely good and fulfilling lives. The paper makes the further claim that if such a thesis holds, it also does so for human enhancement on Earth. (shrink)

Surrogacy involves a private agreement whereby a woman who gestates a child attempts to surrender her (putative) moral right to become the parent of that child such that another person (or persons), of the woman’s choice, can acquire it. Since people lack the normative power to privately transfer custody, attempts to do so are illegitimate, and the law should reflect this fact.

It is often assumed that if the fetus is a person, then abortion should be illegal. Thomson1 laid the groundwork to challenge this assumption, and Boonin2 has recently argued that it is false: he argues that abortion should be legal even if the fetus is a person. In this article, I explain both Thomson’s and Boonin’s reason for thinking that abortion should be legal even if the fetus is a person. After this, I show that Thomson’s and Boonin’s argument for (...) legalised abortion fail; they have not given us good reason for thinking abortion should be legal.1 Finally, I argue that—if we play Boonin’s game—abortion should be illegal. When discussing the ethics and politics of abortion, whether the fetus is a person is usually central.3 4.2 However, Thomson1 long ago challenged this view. She argued that abortion is permissible even if the fetus is a person. To do so, she asks us to consider a case in which you are non-consensually taken to a hospital and hooked up to a famous violinist. The violinist, if he is to survive, needs to filter his blood through your body. After 9 months, he will be fine and you can unplug yourself and go on your way. If you unplug yourself prior to this, however, he will die. Is it permissible to unplug yourself? Thomson thinks the answer is ‘yes’. And this, she thinks, shows that abortion is permissible even if the fetus is a person. While the majority of her article focuses on the ethics of abortion, it is clear that she also aims to show that abortion should be legal if the fetus is a person; she would no doubt reject the view that the state is right to coerce you into …. (shrink)