The question of whether or not one should procreate is rarely cast as a personal choice in philosophical discourse; rather, it is presented as an ethical choice made against a backdrop of aggregate concerns. But justifications concerning procreation in popular culture regularly engage with the role that identity plays in making procreative decisions; specifically, how one’s decision will affect who they are and who they might be in the future. Women in particular cite the personally transformative aspects of becoming a (...) parent — personal circumstances, including socioeconomic status, age, health, and relationship status — as the most important considerations for the decision they make regarding possible parenthood, and not the more aggregate concerns that an ethics of procreation prioritizes. I highlight women because when women undergo a transformative experience related to parenthood, they do so in contexts where the social, economic, and emotional effects related to pregnancy and motherhood are extensive and impose greater effects on women than men. These harmful material effects threaten a woman’s economic stability, career development, social relationships, and emotional health. Because of this, I argue that an ethics of procreation must engage with the ways in which women’s identities are transformed through procreative decisions. (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)
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.
I discuss two interrelated ways in which disgust functions in motherhood. First, relaxation of the mother’s sense of disgust allows her to nurture her child more effectively. Second, others’ responses of disgust are used to enforce social norms regarding the “good” mother. If the mother acquiesces, she must continually monitor and tidy her child, which may interfere with the child’s exploration of the world. If she does not, she is subject to ongoing signs that she is flawed or failing as (...) a mother. (shrink)
Being born into a family structure—being born of a mother—is key to being human. It is, for Jacques Lacan, essential to the formation of human desire. It is also part of the structure of analogy in the Thomistic thought of Erich Przywara. AI may well increase exponentially in sophistication, and even achieve human-like qualities; but it will only ever form an imaginary mirroring of genuine human persons—an imitation that is in fact morbid and dehumanising. Taking Lacan and Przywara at a (...) point of convergence on this topic offers important insight into human exceptionalism. (shrink)
Shortly following the Second World War, and under the medical direction of ex-army psychiatrist T. F. Main, the Cassel Hospital for Functional Nervous Disorders emerged as a pioneering democratic ‘therapeutic community’ in the treatment of mental illness. This definitive movement away from conventional ‘custodial’ assumptions about the function of the psychiatric hospital initially grew out of a commitment to sharing therapeutic responsibility between patients and staff and to preserving patients’ pre-admission responsibilities and social identities. However, by the mid-1950s, hospital practices (...) had come to focus pre-eminently on patients’ relationships with family members, and staff had developed a social model of mental health that focused on the family as the irreducible unit of mental treatment. By the late 1950s, this culminated in the in-patient admission of entire families for mental treatment, even when only one family member was exhibiting symptoms. At the heart of this growing post-war social-psychiatric preoccupation with the family was a new emphasis on the close relationship between mental health and individuals’ successful development toward mature responsible adulthood. The family came to be conceived as the quintessential space where both were forged. This article examines the process through which the Cassel’s social-psychiatric commitment to ‘therapeutic community’ became focused on the family as a key therapeutic site. While the family had become a central point of focus in social, political and psychological discussions of the foundation for stable democratic culture and political peace in post-war Britain, the Cassel Hospital actively experimented with these connections in therapeutic practice. This article thus illuminates the important, but frequently overlooked, role of psychiatric practices in the development of a post-war psychopolitics that established important links between the nuclear family, mental health and democratic social life. (shrink)
Since the development of assisted reproductive technologies, infertile individuals have crossed borders to obtain treatments unavailable or unaffordable in their own country. Recent media coverage has focused on the outsourcing of surrogacy to developing countries, where the cost for surrogacy is significantly less than the equivalent cost in a more developed country. This paper discusses the ethical arguments against international surrogacy. The major opposition viewpoints can be broadly divided into arguments about welfare, commodification and exploitation. It is argued that the (...) only valid objection to international surrogacy is that surrogate mothers may be exploited by being given too little compensation. However, the possibility of exploitation is a weak argument for prohibition, as employment alternatives for potential surrogate mothers may be more exploitative or more harmful than surrogacy. It is concluded that international surrogacy must be regulated, and the proposed regulatory mechanism is termed Fair Trade Surrogacy. The guidelines of Fair Trade Surrogacy focus on minimizing potential harms to all parties and ensuring fair compensation for surrogate mothers. (shrink)
The gestational surrogate – and her economic and educational vulnerability in particular – is the focus of many of the most persistent worries about paid surrogacy. Those who employ her, and those who broker and organize her services, usually have an advantage over her in resources and information. That asymmetry exposes her to the possibility of exploitation and abuse. Accordingly, some argue for banning paid surrogacy. Others defend legal permission on grounds of surrogate autonomy, but often retain concerns about the (...) surrogate. In response to the dilemma of a ban versus bald permission, we propose a 'soft law' approach: states should require several hours of education of surrogates – education aimed at informing and enhancing surrogate autonomy. (shrink)
Principle-based formulations of bioethical theory have recently come under increasing scrutiny, particularly insofar as they give prominence to personal autonomy. This essay critiques the dominant conceptualization of autonomy and urges an alternative formulation freed from the individualistic assumptions that pervade the prevailing framework. Drawing on feminist perspectives, I discuss the need for a vision of patient autonomy that joins relational experiences to individuality and acknowledges the influence of patterns of power and authority on the exercise of patient agency. Deficiencies in (...) the current models of science and social relations guiding medical practice are analyzed, particularly (1) the tendency to disregard the patients self-knowledge and (2) failure to recognize limitations on the generalizability of medical knowledge. Models of social relations such as mothering and friendship are explored to advance a conception of autonomy better suited to the practical activities of medicine. In conclusion, I consider how acknowledgement of the specificity and complexity of social relations can contribute to reconfiguration of other principles comprising the standard framework of bioethics, particularly beneficence, justice, and equality. (shrink)
: It is argued that in many cases surrogate mothers are exploited when they participate in altruistic surrogacy arrangements, since their altruistic personality structure is not in the relevant sense "their own." The question of whether paternalistic interference is justified in these cases is discussed. Such interference seems to be acceptable on condition that the person interfering is someone belonging to the woman's intimate sphere.
This article aims to lay out the ‘for money’ and ‘for dignity’ arguments that feminist ethicists have given about the reproductive labour women perform in providing oocytes or in getting pregnant for others. Feminist arguments about the morality of these two practices overlap significantly because, from a feminist perspective, the morally relevant facts about them are quite similar. Still, there are dissimilarities, stemming from the obvious fact that one practice involves giving up oocytes while the other involves giving up a (...) baby after a pregnancy. Some arguments by feminists reflect this core difference, in that they apply specifically to one practice but not to the other. The article highlights when the relevance of a particular argument differs for these different reproductive practices. (shrink)
Radical feminists have argued for both the radical potential of assisted reproductive technology (ART) and its oppressive and damaging effects for women. This paper will address the question of what constitutes a radical feminist position on ART; I will argue that the very debate over whether ART liberates or oppresses women is misguided, and that instead the issue should be understood dialectically. Reproductive technologies are neither inherently liberating nor entirely oppressive: we can only understand the potential and effects by considering (...) how they are actually taken up within a culture. The internal contradictions, tensions, and inconsistencies within ART and the way it is addressed within the law points to a dialectic that resists a simple reductivist understanding. (shrink)
Standard views on surrogate decision making present alternative ideal models of what ideal surrogates should consider in rendering a decision. They do not, however, explain the physician''s responsibility to a patient who lacks decisional capacity or how a physician should regard surrogates and surrogate decisions. The authors argue that it is critical to recognize the moral difference between a patient''s decisions and a surrogate''s and the professional responsibilities implied by that distinction. In every case involving a patient who lacks decisional (...) capacity, physicians and the treatment team have to make judgments about the appropriateness of both the surrogate and the surrogate''s decision. They have to assess the surrogate''s decisional capacity and attitude toward the patient as well as the reasons that support the surrogate''s decision. This paper provides a model for acceptable surrogate decisions and a standard for blocking inappropriate surrogates. Only decisions based on widely shared reasons are allowable for surrogate refusal of highly beneficial treatment. (shrink)
It is argued that there are good reasons for believing that commercial surrogacy is often exploitative. However, even if we accept this, the exploitation argument for prohibiting (or otherwise legislatively discouraging) commercial surrogacy remains quite weak. One reason for this is that prohibition may well 'backfire' and lead to potential surrogates having to do other things that are more exploitative and/or more harmful than paid surrogacy. It is concluded, therefore, that those who oppose exploitation should concentrate on: (a) improving the (...) conditions under which paid surrogates 'work'; and (b) changing the background conditions (in particular, the unequal distribution of power and wealth) which generate exploitative relationships. (edited). (shrink)
Disputes between separated couples over whether frozen embryos can be used in an attempt to create a child create a moral dilemma for public policy. When a couple create embryos intending to parent any resulting children, New Zealand’s current policy requires the consent of both people at every stage of the ART process. New Zealand’s Advisory Committee on Assisted Reproductive Technology has proposed a policy change that would give ex-partners involved in an embryo dispute twelve months to come to an (...) agreement before the embryos are destroyed. New Zealand’s current policy and the proposed policy both favour the person who wishes to avoid procreation. Two alternative policy approaches that do not favour procreative avoidance are considered. Using pre-fertilisation contracts to determine the decision reached in embryo disputes allows the couple’s wishes at the time the embryos are created to determine what happens to the embryos if they separate. However, pre-fertilisation contracts are agreements about healthcare and personal relationships, and changing circumstances can make enforcing such agreements unjust. Finally, it is argued that New Zealand’s Family Court system should be used to reach decisions that balance the interests of those involved in the dispute. (shrink)
Reproductive ageing has effects on individual and public health, now and in generations to come. This volume of presentations from a conference at the Royal College of Obstetricians and Gynaecologists brings together a diverse but timely set of contributions.. in ny chapter I specifically examine the responsibilities of the College to women outside normal reproductive age.
A ‘should’ question normally signals work for an ethicist but this ethicist’s task is complicated by the normative dimension of all the chapters in this volume. Each author was asked to come up with three recommendations from their own subject area – ’should’ statements deriving from the ‘is’ analysis that they present. If those prescriptions cover the relevant topics, what more is there for an ethicist to do? I have had a personal interest in obstetricians’ relationship with ‘older women’ since (...) being classified as an ‘elderly primigravida’ at the superannuated age of 26 years. Apart from that, however, what original contribution can I make? The convenors of the 56th RCOG Study Group gave me plentiful suggestions – perhaps a little too plentiful: How should the RCOG approach its constituencies, medical ethics, regulation and its relationship to government and the rest of the medical profession, i.e. the NHS and the market, vested interests, individuals or consumers, families, the unborn, doctors, drug companies, surrogacy, the unborn, trafficking, global adoption, law, research? I have to admit this was just too much for me. Instead, I want to argue for what may seem a self-evidently simple point. The RCOG describes its mission as ‘setting standards to improve women’s health’ – presumably all women. In the 6 years that I have served on the RCOG Ethics Committee, however, we have almost always been concerned with that minority of the female population who are of reproductive age. (shrink)
Konrad Lorenz's popularity in the United States has to be understood in the context of social concern about the mother‐infant dyad after World War II. Child analysts David Levy, René Spitz, Margarethe Ribble, Therese Benedek, and John Bowlby argued that many psychopathologies were caused by a disruption in the mother‐infant bond. Lorenz extended his work on imprinting to humans and argued that maternal care was also instinctual. The conjunction of psychoanalysis and ethology helped shore up the view that the mother‐child (...) dyad rests on an instinctual basis and is the cradle of personality formation. Amidst the Cold War emphasis on rebuilding an emotionally sound society, these views received widespread attention. Thus Lorenz built on the social relevance of psychoanalysis, while analysts gained legitimacy by drawing on the scientific authority of biology. Lorenz's work was central in a rising discourse that blamed the mother for emotional degeneration and helped him recast his eugenic fears in a socially acceptable way. -/- . (shrink)