Feminists have argued that the association made between teenage childbearing and long-term lower socioeconomic status hides a multitude of socially constructed inequalities. I extend this position by analyzing how the association is linked in the South African literature on teenage pregnancy to economic security. I utilize Foucault's conceptualization of the method of security. Security refers to institutions and practices that defend and maintain a national population as well as secure the economic, demographic, and social processes of that population. I (...) analyze how the traits of the method of security are deployed with regard to teenage pregnancy; how reproductive adolescents are viewed as disrupting the production of the economic self and fracturing population control, thereby threatening economic security; and how the invocation of economic security allows for the legitimation of various regulatory practices. (shrink)

ABSTRACTIn this paper, we provide a normative analysis of the Women’s Tennis Association revised policy on maternity leave, which is regulated by its special ranking rule. To do so, we first explore how the revised policy functions when probed in relation to the nature of competitive sport. Then, we examine the revised policy through the lens of the literature on maternity discrimination. We argue that, when compared to its previous formulation, the revised special ranking rule is morally defensible because it (...) better protects female players’ interest in being able to combine their professional careers and their personal lives. However, we also identify several pronounced vulnerabilities and criticisms to the revised policy. (shrink)

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

In conjunction with the growing feminist literature on pregnancy and visualization, this paper uses Foucault’s The Birth of the Clinic to demonstrate how the effort to make the interior of the pregnant body visible in medical discourse was a crucial part of the development of the modern medical gaze. In doing so I develop two concurrent arguments. First, I argue that the pathological corpse of the Clinic can conceptually serve as a double for the pregnant body as it emerged (...) in modern medicine in the 20th century. At the same time I use the insights of the Clinic to illustrate changes in pregnancy from early modernity to the 20th century. In early modernity, the pregnant body was understood in terms of generation, as a tree that bears fruit; by the 19th century, the pregnant body was a machine that reproduced the species. This transition can be seen in the overlap of pathology and pregnancy in early modernity, an overlap that continued throughout the 19 century and is inadvertently reinforced through the practice of ultrasound. (shrink)

In this article, I use radiation-shielding maternity clothes as a window to explore motherhood and reproductive uncertainty in urban China. By engaging with literature on scientific uncertainty and intensive mothering, I argue that the scientific uncertainty over the possible negative impact of electromagnetic radiation on pregnancy has led to a situation in which uncertainty is being socially reproduced by experts, markets, and policy makers through different media channels. Middle-class mothers do not fully believe that the cloak is scientifically trustworthy. (...) But under the influence of social networks and the ambient awareness of the reproductive crisis related to environmental pollution and the pressures of modern life, middle-class mothers still choose to wear the clothes for a variable period of pregnancy for psychological feelings of safety. In the end, they choose to cloak their pregnancies but immediately claim their suspicions of the cloak. (shrink)

International media have reported cases of pregnant women who have had their children apprehended by social services, or who were incarcerated or forced into treatment programs based on a history of substance use or lack of adherence to addiction treatment programs. Public discourse on the biology of addiction has been criticized for generating stigma and a diminished perception of self-control in individuals with an addiction, potentially contributing to coercive approaches and criminalization of women who misuse substances during pregnancy. We (...) explored whether this is the case based on literature from social psychology, ethics, addiction research, science communication, and philosophy. The literature shows that the relationship between public discourse on biological aspects of addiction and issues such as stigma and perceptions of diminished self-control are unclear, largely due to the complexity of these phenomena. However, concerns about the biological approach are nevertheless legitimate given the broader social and policy context of women’s health. (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)

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

This essay examines the theory of maternal impressions, the belief that a woman’s experiences or emotions during pregnancy could explain congenital disability or emotional/ behavior differences in her child and asks why this theory circulated as an explanation for disability seen at birth by both medical doctors and in literature for far longer than it did across the Atlantic. By presenting examples from nineteenth-century medical literature, popular fiction, maternal handbooks, and two canonical works of literature, Nathaniel Hawthorne’s The Scarlet (...) Letter and Harriet Jacobs’ Incidents in the Life of a Slave, I argue that maternal impressions worked to maintain anxiety for women, and particular white women, to ensure they felt responsible if anything was “wrong” with their child. Ultimately, I show how maternal impressions was both an ableist and racialized understanding of inheritance that wouldn’t be discarded until the emergence of eugenics in the early twentieth century. (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)

The externality of the inside: body images of pregnancyThis paper draws on literature, empirical data and a range of theoretical perspectives on the maternal body to examine understandings of the relationship between a pregnant woman and her foetus, with a particular focus on the body images used by women to represent this relationship. Psychoanalytic and nursing accounts of the relationship between mother and foetus have often described a symbiotic ‘oneness’ or unity during pregnancy. Such accounts, however, stress the temporary (...) nature of this unity and identify a series of ‘stages’ of separation or ‘polarisation’ between mother and foetus during pregnancy. In contrast, many of the 25 women who participated in our interview study of new motherhood described a confusion of the boundary between self and foetus. For many women the experience of pregnancy and the relationship with the unborn baby was ambiguous and uncertain. Importantly, none of these women described her relationship with the foetus as a series of developmental stages, but rather saw it as fluctuating throughout pregnancy. These findings are more consistent with the work of feminist theorists who describe pregnancy as a dynamic and fluid merging of the inside and the outside of the body/self. (shrink)

In 1930 Husserl wrote that phenomenology is ‘a transcendental idealism that is nothing more than a consequentially executed self-explication in the form of an egological science, an explication of my ego as subject of every possible cognition, and indeed with respect to every sense of what exists, wherewith the latter might be able to have a sense for me, the ego.’ In transcendental-phenomenological theory, according to Husserl, ‘every sort of existent itself, real or ideal, becomes understandable as a “product” of (...) transcendental subjectivity, a product constituted in just that performance.’ This appears so inimical to the fundamental bases of feminist theory that the question of the very possibility of a ‘feminist phenomenology’ inevitably arises, not least because so much associated with the contributions of feminist theory to philosophy concern precisely the critique of the transcendental, isolated, disembodied subject. This chapter explores the different kinds of feminist phenomenology of pregnancy and birth with this problem in mind. Although phenomenology has developed and transformed itself in ways more accommodating to feminist theory we are still entitled to ask what makes it phenomenology? What are the presuppositions of any feminist phenomenology if it is still to count as phenomenology, rather than descriptive social-psychology or feminist metaphysics or feminist ethics? Is phenomenology essentially tied to first-personal description, or can third-person accounts be a legitimate part of its analyses? If third-person descriptions are accepted as a legitimate, what considerations govern the inevitable interpretative aspect of their analysis? Can there be any phenomenology, feminist or otherwise, without some conception of transcendental subjectivity? And what is at stake in the continued use of the transcendental problematic, granted its immanent phenomenological criticism and its various theoretical transformations? This chapter addresses the question of the philosophical specificity of feminist phenomenology by pursuing its distinction from the use of phenomenological research methods in practice disciplines and qualitative psychology, via two of the pivotal questions raised above: can there be any phenomenology, feminist or otherwise, without some conception of transcendental subjectivity? And what is the role of third person testimony in phenomenology? I will argue that the first of these questions remains a problem for feminist phenomenology, in a way that is not easily solved with recourse to third person testimony, the use of which remains under-theorized in the feminist phenomenological literature. Finally, I will show how the problem of transcendental subjectivity is particularly acute for the feminist phenomenology of pregnancy and birth when we consider the generative metaphorics of its philosophical origin in Kant’s philosophy. (shrink)

Women are underrepresented in philosophy. And pregnancy is under-researched in philosophy. Can a connection be made between the two? I will argue that whilst the counterfactual of ‘had women historically been better represented in philosophy then pregnancy would have been too’ may be true, it is not necessarily the case that we can now, in the present day, expect (or desire) a correlation. In order to understand the gap between these two areas of underrepresentation, one need only adopt (...) a non- essentialist understanding of women so as to recognise that not all women experience pregnancy or are interested in pregnancy (philosophically or otherwise). Nevertheless, given the historical silence(ing) of women in philosophy on the topic of pregnancy, it is important now to redress that imbalance by tackling both issues of underrepresentation simultaneously. To demonstrate further I refer to the difference between representational diversity and substantive diversity (which is related to the more commonly known distinction between descriptive representation and substantive representation). This will be the topic of the first section of the paper. Then, in the second and third sections of the paper I will explore the underrepresentation and misrepresentation of women in philosophy, regarding not only the lack of women numerically speaking but also how women, as a general ‘kind’, are (misogynistically) described in philosophy historically. I will then apply the same treatment to pregnancy in the fourth and fifth sections of the paper, exploring both its underrepresentation as a topic of philosophical endeavour and misrepresentation within society at large. The analysis contains a review of the literature, and cites statistical quantitative data and qualitative grounded interviews, to provide evidence for my claims. I will end by hypothesising about the relationship between these under- and mis- representations, and will provide musings on the future for women and pregnancy in philosophy. (shrink)

In Pregnant Embodiment: Subjectivity and Alienation, Iris Marion Young describes the lived bodily experience of women who have “chosen” their pregnancies. In this essay, Lundquist underscores the need for a more inclusive phenomenology of pregnancy. Drawing on sources in literature, psychology, and phenomenology, she offers descriptions of the cryptic phenomena of rejected and denied pregnancy, indicating the vast range of pregnancy experience and illustrating substantial phenomenological differences between “chosen” and unwanted pregnancies.

In Pregnant Embodiment: Subjectivity and Alienation, Iris Marion Young describes the lived bodily experience of women who have “chosen” their pregnancies. In this essay, Lundquist underscores the need for a more inclusive phenomenology of pregnancy. Drawing on sources in literature, psychology, and phenomenology, she offers descriptions of the cryptic phenomena of rejected and denied pregnancy, indicating the vast range of pregnancy experience and illustrating substantial phenomenological differences between “chosen” and unwanted pregnancies.

In recent years, multifetal pregnancy reduction has increasingly been a subject of debate in Norway. The intensity of this debate reached a tentative maximum when the Legislation Department delivered their interpretative statement, Section 2 - Interpretation of the Abortion Act, in 2016 in response to a request from the Ministry of Health that the Legislation Department consider whether the Abortion Act allows for MFPR of healthy fetuses in multiple pregnancies. The Legislation Department concluded that the current abortion legislation [as (...) of 2016] allows for MFPR subject to the constraints that the law otherwise stipulates. The debate has not subsided, and during autumn 2018 it was further intensified in connection with the Norwegian Christian Democratic "crossroads" policy and signals from the Conservatives to consider removing section 2.3c and to forbid MFPR. Many of the arguments in the MFPR debate are seemingly similar to arguments put forward in the general abortion debate, and an analysis to ascertain what distinguishes MFPR from other abortions has yet to be conducted. The aim of this article is, therefore, to examine whether there is a moral distinction between abortion and MFPR of healthy fetuses. We will cover the typical arguments emerging in the debate in Norway and exemplify them with scholarly articles from the literature. We have dubbed the most important arguments against MFPR that we have identified the harm argument, the slippery-slope argument, the intention argument, the grief argument, the long-term psychological effects for the woman argument, and the sorting argument. We conclude that these arguments do not measure up in terms of demonstrating a morally relevant difference between MFPR of healthy fetuses and other abortions. Our conclusion is, therefore — despite what several discussants seem to think — that there is no morally relevant difference between the two. Therefore, on the same conditions as we allow for abortions, we should also allow MFPR. Keywords: abortion, ethics, medical ethics, MFPR, selective MFPR. (shrink)

Consider the following two metaphysical questions about pregnancy: (1) When does a new organism of a certain kind start to exist? (2) What is the mereological and topological relationship between the pregnant organism and with what it is pregnant? Despite assumptions made in the literature, I take these questions to be independent of each other, such that an answer to one does not provide an answer to the other. I argue that the way to connect them is via a (...) maximality principle that prevents one organism being a proper part of another organism of the same kind. That being said, such a maximality principle need not be held, and may not apply in the case of pregnancy. The aims of this paper are thus to distinguish and connect these metaphysical questions, in order to outline a taxonomy of rival mereotopological models of pregnancy that result from the various combinations of their answers. (shrink)

Is a given instance of rape more likely to result in pregnancy than a given instance of consensual sex? This paper undertakes a review and critique of the literature on rape-pregnancy. Next, it presents our own estimation, from U.S. government data, of pregnancy rates for reproductive age victims of penile-vaginal rape. Using data on birth control usage from the Statisticalof the United States, we then form an estimate of rapepregnancy rates adjusted for the substantial number of women (...) in our sample who would likely have been protected by oral contraception or an IUD. Our analysis suggests that per-incident rape-pregnancy rates exceed per-incident consensual pregnancy rates by a sizable margin, even before adjusting for the use of relevant forms of birth control. Possible explanations for this phenomenon are discussed, as are its implications to ongoing debates over the ultimate causes of rape. (shrink)

Issues surrounding pregnancy loss are rarely addressed in Christian philosophy. Yet a modest estimate based on the empirical and medical literature places the rate of pregnancy loss between fertilization and term at somewhere between 40–60%. If miscarriage really is as common as the research gives us to believe, then it would seem a pressing topic for a Christian philosophy of the future to address. This paper attempts to begin this work by showing how thinking more closely about (...) class='Hi'>pregnancy loss understood as a grievable event can have a profound impact on the way we think about particular theoretical debates in Christian philosophy and provide opportunities for the discipline to put its skills to use in the development of helpful conceptual and hermeneutical resources for those grieving such losses. However, this will require seeking out and taking seriously the testimony of those who have undergone pregnancy loss, as well as getting clearer on how best to conceptualize pregnancy and its loss in the first place. (shrink)

BackgroundPrevention of mother to child transmission of HIV remains a key public health priority in most developing countries. The provider Initiated Opt – Out Prenatal HIV Screening Approach, recommended by the World Health Organization lately has been adopted and translated into policy in most Sub – Saharan African countries. To better ascertain the ethical reasons for or against the use of this approach, we carried out a literature review of the ethics literature.MethodsPapers published in English and French Languages between (...) 1990 and 2015 from the following data bases were searched: Pubmed, Cochrane literature, Embase, Cinhal, Web of Science and Google Scholar. After screening from 302 identified relevant articles, 21 articles were retained for the critical review.DiscussionMost authors considered this approach ethically justifiable due to its potential benefits to the mother, foetus and society. The breaching of respect for autonomy was considered acceptable on the grounds of libertarian paternalism. Most authors considered the Opt - Out approach to be less stigmatizing than the Opt - In. The main arguments against the Opt - Out approach were: non respect of patient autonomy, informed consent becoming a meaningless concept and the HIV test becoming compulsory, risk of losing trust in health care providers, neglect of social and psychological implications of doing an HIV test, risk of aggravation of stigma if all tested patients are not properly cared for and neglect of sociocultural peculiarities.ConclusionsThe Opt – Out approach could be counterproductive in case gender sensitive issues within the various sociocultural representations are neglected, and actions to offer holistic care to all women who shall potentially test positive for HIV were not effectively ascertained. The Provider Initiated Opt – Out Prenatal HIV Screening option remains ethically acceptable, but deserves caution, active monitoring and evaluation within the translation of this approach into to practice. (shrink)

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)

Resumen: El objetivo del presente trabajo es acercarnos no ya en clave epistemológica a la pregunta específica que se realiza respecto de la teoría literaria, sino por el contrario, a la pregunta mediada por la idea de verdad que la filosofía le ha hecho a la literatura. Creemos que en los textos de Platón existe una intuición fundamental que de manera implícita ha puesto en marcha múltiples aparatos teóricos que intentaron dar cuenta de la literatura. La intuición, sin dilaciones, es (...) la siguiente: la poesía no es matemática. Nuestro interés entonces es reconocer las periferias del diálogo inaugurado por Platón entre el concepto de verdad y la idea de literatura, como así también sus recíprocas determinaciones, y su pregnancia en los discursos que han abordado a la literatura en clave teórica.: In the present work the objective is not only to approach in an epistemological key to the specific question asked by literary theory but rather the question, mediated by the idea of truth, that philosophy has done to literature. We believe that in Plato's texts there is a fundamental intuition that implicitly has set in motion multiple theoretical devices that tried to account for literature. The intuition, without delay, is the following: poetry is not mathematical. Our interest then is to recognize the peripheries of the dialogue inaugurated by Plato between the concept of truth and the idea of literature, as well as their reciprocal determinations, and their pregnancy in the discourses that have addressed literature in a theoretical key. (shrink)

Introduction: Intimate Partner Violence (IPV) has unfavorable consequences for women as well as for newborn babies, which is very serious and preventable public health problem. It is believed to have an excessive occurrence in lives of women in South Asia. The objective of this study is to describe the prevalence, risk factors and consequences of IPV in Bangladesh. Methods: A scoping review was carried out based on the past 12 years of posted and gray literature about IPV in Bangladesh using (...) Arksey and O’Malley’s framework. Only the literature addressing abuses or violence in households or outside including physical, sexual or mental violence on the married woman in Bangladesh were taken into consideration for the study. Results: The overall prevalence of IPV in Bangladesh, the latest reviews of rates ranging from 15.5-82.7%.Most of the IPV in Bangladesh was based totally on the experience of legally married women. The main risk factors of IPV in Bangladesh were women being younger, from lower socioeconomic reputation, from lower academic attainment and lower education of husband, dowry, child marriage, perceived disobedience of wives, family conflict, children had recently been ill, and incapability of to furnish sexual satisfaction. Maternal depressive symptoms, signs of stress, anxiety and constraint to the better health of young children are the main consequences of IPV in Bangladesh. Besides, IPV causes unwanted pregnancy, pregnancy loss in the form of miscarriage, induced abortion, or stillbirth and termination of pregnancy in Bangladesh. Conclusions: Woman’s empowerment may reduce IPV and understanding attitudes towards IPV in cultural context could be crucial for developing interventions to reduce IPV and its consequences. (shrink)

The book consists of three problem areas which are all connected with the question of creativity, esp. in gthe arts and poetry: It is about the ancient mythopoetic concept of the muses and their collision with the beloved of the poet, about the authority crisis of authorship and the dominance of the author over his creatures and fictional characters as well as their revolt against the father of the text and about a typ of creating and writing which acts against (...) all genetic traditions of authorship in the form of conception and birth, genealogical derivation. In this sense the, anti-generic' creativity doesn't originate and invent a work of art or a cultural phenomenon: the anti-generic product is something made, something constructed and not fgenerated, manufactured and not breed. This anti-oedupus-concept workts in a widespread tradition of the arts and literature, starting from our heroes of deconstructed narrative as Sterne's or Diderot's, over the classics of european realism Dostoevski or Flaubert until Nabokov and his, pregnant muse' Lolita. Wenn es ums Schaffen geht oder gar ums Schöpferische, liegt nichts so nahe wie das scheinbar unerschöpfliche Feld der Geburtsmetaphern, das Reden vom Zeugen und Empfangen, vom Austragen und Gebären eines Werkes, das für das Kind steht - ja dieses gar ersetzen soll. Die in diesem Band versammelten Überlegungen verknüpfen drei Problemkreise: Es geht um die Projektionsfigur der Musen und ihrer Kollision mit der Dichtergeliebten, um die permanente Autoritätskrise im Verhältnis des Autors zu seinen eigenen Geschöpfen und um die Entdeckung eines Kunstschaffens und Schreibens, das alle genetischen wie generischen Modi der Hervorbringung gegen den Strich dichtet und also konsequent antigenerisch verfährt. Vorgeführt werden diese drei Problemkreise an klassischen Texten des antigenerischen. Zuletzt bleibt die Frage nach den Musen der Musen und den Paradoxa der Dame Dichterin mit Blick auf ihre Inspirationsquellen. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:This Birth and ThatSurrogacy and Stratified Motherhood in IndiaAmrita PandeIn 2006, i came across a short newspaper article about the emergence of a new industry in India—the industry of paid birth or commercial surrogacy. People from all over the world could now hire Indian women to give birth to babies for them, for a fraction of the cost of surrogacy elsewhere and with no government regulations. After some digging (...) around, I quickly realized that there was scarcely any objective, academic research about this new industry, and so began my ethnographic journey to the first clinic in not just India but in fact in the entire Global South to have a flourishing trade in both national and transnational surrogacy.1Academic inquiry into surrogacy arrangements is adequately interdisciplinary and has generated feminist, ethical, legal, and social debates for more than three decades (see, for example, Andrews 1987; Anderson 1990; Bailey 2011; Brennan and Noggle 1997; Hochschild 2012; Markens 2007; Oliver 1989; Ragoné 1994; Pande 2011; and Teman 2010). While defenders of surrogacy advocate it as a manifestation of women’s freedom and choice, much of the scholarship has displayed intense anxiety about this practice (Corea 1986; Dworkin 1983; Harding 1991; Neuhaus 1988; Raymond 1993; Roberts 1998b; and Rothman 1988). One view is that surrogacy reduces women to a mere breeder class, to the class of prostitutes, and another is that it is just another form of baby selling. Others consider the development of such reproductive technologies as a form of class and gender-based exploitation of women’s bodies. Two additional trends in this scholarship are worth emphasizing. First, [End Page 50] much of the debating takes place in abstraction and is rarely based on the actual experience of surrogates.2 Second,much of this work is about surrogacy in the Global North. This is not altogether surprising, since commercial surrogacy is a very recent phenomenon outside of the Global North.In this essay, I address these two gaps in the literature by analyzing the birthing narratives of surrogates in a clinic in India. As the surrogates compare their experiences of giving birth as a surrogate mother to their previous pregnancies, they underscore the paradox of an industry based on pro-natal technology in an otherwise anti-natal state. As importantly, these narratives are a clear manifestation of a global trend of “stratified motherhood”—“the hierarchical organization of reproductive fecundity and birth experiences that supports and rewards the maternity of some women while despising or outlawing the mother-work of others” (Rapp 2001, 469).Surrogacy in IndiaThe moral and ethical ambiguity surrounding surrogacy has made many countries, including China, the Czech Republic, France, Germany, Italy, Mexico, Saudi Arabia, Spain, Sweden, Switzerland, Taiwan, Turkey, and some U.S. states ban surrogacy altogether. Some countries have imposed partial bans, for instance Australia (Victoria), Brazil, Hong Kong, Hungary, Israel, South Africa, and the UK. Canada, Greece, South Africa, Israel, and the UK permit gestational surrogacy, subject to regulations. Then there are other countries with no regulations at all, such as Belgium, Finland, and India (Markens 2007; Teman 2010). Apart from the recent spurt of surrogacy in India, commercial surrogacy is most prevalent in California, USA, and Israel, where surrogacy is tightly controlled by the state and restricted to Israeli citizens. The Indian structure is closer to the liberal market model of surrogacy in California, where surrogacy births are primarily managed by private, commercial agencies that screen, match, and regulate agreements according to their own criteria (Pande 2009).India is not the only country to experience a rise in transnational surrogacy. Couples from countries such as the UK, Japan, Australia, and Kuwait, where surrogacy is either illegal or restricted, have hired surrogates in the United States to bear babies for them. However, while the total cost of such transnational packages is roughly between $100,000 and $120,000, in India the package costs one-third of that amount. Another factor that explains the popularity of India as a destination for transnational surrogacy is the informality of the market. Although commercial surrogacy is not illegal in India in 2002, currently there are no laws regulating surrogacy in clinics. Fertility clinics... (shrink)

Feminist scholars have long argued that the pregnant body is erased – both literally and discursively – from mainstream foetal representations. Janemaree Maher argues that the placenta, as point of distinction and connection between pregnant women and foetuses, has the radical potential to refigure understandings of pregnant embodiment and subjectivity, and offer ‘a way to begin thinking through the impasse of pregnant representation’. Drawing on Maher's notion of the ‘placental body’, this article will examine the place of the placenta in (...) the practice of non-diagnostic 4D ultrasound scanning. The analysis seeks to connect Maher's theoretical perspective, and the rich feminist literature around foetal imaging, with observational data from my study of 4D scans. I will argue that the capacity of 3- and 4D sonography to image the placenta and umbilical cord in a way that is newly intelligible to lay viewers might present an opportunity for thinking differently about the interconnections – material and social – between pregnant women and foetuses and to relocate women as the subjects of their pregnancies. (shrink)

In the debate surrounding the introduction of non-invasive prenatal testing in prenatal screening programmes, the concept of routinisation is often used to refer to concerns and potential negative consequences of the test. A literature analysis shows that routinisation has many different meanings, which can be distinguished in three major versions of the concept. Each of these versions comprises several inter-related fears and concerns regarding prenatal screening and particularly regarding NIPT in three areas: informed choice, freedom to choose and consequences for (...) people with a disability. Three of the strongest arguments raised under the flag of routinisation are assessed for their validity: the threat that NIPT poses to informed choice, the potential increase in uptake of first-trimester prenatal screening and its consequences for social pressure to participate in screening or terminate affected pregnancies, and the negative consequences for disabled people. These routinisation arguments lack empirical or normative ground. However, the results of this analysis do not imply that no attention should be paid to possible problems surrounding the introduction of NIPT. At least two problems remain and should be addressed: there should be an ongoing debate about the requirements of informed choice, particularly related to an expanded scope of prenatal screening. Also, reproductive autonomy can only be achieved when expecting parents’ options are variegated, real and valuable, so that they can continue to choose whether or not to screen or to terminate a pregnancy. (shrink)

In recent years, functional connectivity in the developmental science received increasing attention. Although it has been reported that the anatomical connectivity in the preterm brain develops dramatically during the last months of pregnancy, little is known about how functional and effective connectivity change with maturation. The present study investigated how effective connectivity in premature infants evolves. To assess it, we use EEG measurements and graph-theory methodologies. We recorded data from 25 preterm babies, who underwent long-EEG monitoring at least twice (...) during their stay in the NICU. The recordings took place from 27 weeks postmenstrual age until 42 weeks PMA. Results showed that the EEG-connectivity, assessed using graph-theory indices, moved from a small-world network to a random one, since the clustering coefficient increases and the path length decreases. This shift can be due to the development of the thalamocortical connections and long-range cortical connections. Based on the network indices, we developed different age-prediction models. The best result showed that it is possible to predict the age of the infant with a root mean-squared error equal to 2.11 weeks. These results are similar to the ones reported in the literature for age prediction in preterm babies. (shrink)

Noninvasive prenatal screening using cell-free DNA, which analyzes placental DNA circulating in maternal blood to provide information about fetal chromosomal disorders early in pregnancy and without risk to the fetus, has been hailed as a potential “paradigm shift” in prenatal genetic screening. Commercial provision of cell-free DNA screening has contributed to a rapid expansion of the tests included in the screening panels. The tests can include screening for sex chromosome anomalies, rare subchromosomal microdeletions and aneuploidies, and most recently, the (...) entire fetal genome. The benefits of this screening tool are generally framed, by both providers and commercial laboratories, as enhancing reproductive autonomy and choice by providing an earlier, simpler, and more accurate screening while potentially reducing the need for invasive follow-up testing. The majority of the literature has explored these issues empirically or conceptually from a European or North American vantage point, one that assumes normative priorities such as individual reproductive autonomy and the clinical availability of maternal health care or prenatal screening programs within which cell-free DNA screening is offered. While its implementation has raised both challenges and opportunities, very little is known about real-world experiences and the implications of the rapid introduction of cell-free DNA screening outside of North America and Europe, especially in low- and middle-income countries. To begin addressing this gap in knowledge, we organized a four-day international workshop to explore the ethical, legal, social, economic, clinical, and practical implications of the global expansion of cell-free DNA screening. We describe eight key insights that arose from the workshop. (shrink)

Background Non-invasive prenatal testing (NIPT), which can screen for aneuploidies such as trisomy 21, is being implemented in several public healthcare systems across Europe. Comprehensive communication and information have been highlighted in the literature as important elements in supporting women’s reproductive decision-making and addressing relevant ethical concerns such as routinisation. Countries such as England and France are adopting broadly similar implementation models, offering NIPT for pregnancies with high aneuploidy probability. However, we do not have a deeper understanding of how professionals’ (...) counselling values and practices may differ between these contexts. Methods In this paper, we explore how professionals in England and France support patient decision-making in the provision of NIPT and critically compare professional practices and values. We draw on data from semi-structured interviews with healthcare professionals. Results Both English and French professionals emphasised values relating to patient choice and consent. However, understandings and application of these values into the practice of NIPT provision differed. English interviewees placed a stronger emphasis on interpreting and describing the process of counselling patients and clinical care through a “principle” lens. Their focus was on non-directiveness, standardisation, and the healthcare professional as “decision-facilitator” for patients. French interviewees described their approach through a “procedural” lens. Their focus was on formal consent, information, and the healthcare professional as “information-giver”. Both English and French professionals indicated that insufficient resources were a key barrier in effectively translating their values into practice. Conclusion Our findings illustrate that supporting patient choice in the provision of NIPT may be held as an important value in common on a surface level, but can be understood and translated into practice in different ways. Our findings can guide further research and beneficially inform practice and policy around NIPT provision. (shrink)

Information on the factors influencing parents’ decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities. Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden’s thematic synthesis method was used to synthesise (...) data from identified studies. Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled ‘all life is precious’, described parents’ perception of the importance of the fetus’ life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 contained two sub-themes which considered the parent’s own imagined future and the influence of other people’s experiences. Finally, Theme 3 presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments. The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents’ decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other’s quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices. (shrink)

Extensively employed in reproductive science, the term fetal–maternal interface describes how maternal and fetal tissues interact in the womb to produce the transient placenta, purporting a theory of pregnancy where ‘mother’, ‘fetus’, and ‘placenta’ are already-separate entities. However, considerable scientific evidence supports a different theory, which is also elaborated in feminist and new materialist literatures. Informed by interviews with placenta scientists as well as secondary sources on placental immunology and the developmental origins of health and disease, I explore evidence (...) not of interfacing during pregnancy, but of intra-action, or the mutual emergence of entities in simultaneous practices of differentiation and connection. I argue that attending to evidence that can be figured as intra-action enables us to recognize, account for, and attend to diffuse responsibilities for fetal–maternal outcomes that extend beyond mothers to the biosocial milieus of pregnancy. In reimaging the intra-action of placentas, a new understanding of what constitutes a ‘healthy pregnancy’ becomes possible. (shrink)

This article analyzes articles appearing in True Story from 1920 to 1985 that concern women's grief after pregnancy and child loss. They are discussed as a historical link between nineteenth-century consolation literature and current psychological and academic discussions of grief. True Story is a confession magazine marketed for working-class women, whose reproductive losses have generally been minimized or ignored by previous literary and current professional and journalistic treatments of maternal grief. Articles are examined within the constructs of confession literature (...) and within the larger context of women's popular literature. Like working-class women's experiences of reproductive loss, these areas have been largely overlooked, dismissed, or denigrated by literary scholars and sociologists. The moral tone of True Story gives women's first-person narratives about infant death and pregnancy an ambiguous prescriptive quality, in that both self-empowerment and self-blame are recommended. True Story reinforces traditional notions of motherhood and femininity, but subtly challenges patriarchal class relations in American society. (shrink)

The Alice Books, full of illogical thoughts, words, and contradictions, were unrivaled entertainment until the publication of the medical literature promoting electronic fetal monitoring for every pregnancy. The modern-day EFM advocates acknowledge EFM’s decades long failure but simultaneously recommend EFM use for lawsuit protection and because the profession has used EFM for every pregnancy for fifty years, therefore, it must be efficacious. These self-indulgent, illogical rationalizations ignore the half century of evidence-based scientific research proving that EFM is a (...) complete failure as well as ignoring the fact that continued EFM use violates the fundamental principles of modern bioethics. This blind advocacy perpetuates four pernicious EFM harms occurring to mothers, babies, and the medical profession itself. This article sets out these four EFM harms with the goal of abolishing the misguided, illogical, contradictory, arguments used by the twenty-first century EFM Lewis Carroll mimics. (shrink)

Photo by Hannah Busing on Unsplash INTRODUCTION Religion has long provided guidance that has led to standards reflected in some aspects of medical practices and traditions. The recent bioethical literature addresses numerous new problems posed by advancing medical technology and demonstrates an erosion of standards rooted in religion and long widely accepted as almost axiomatic. In the deep soul-searching that pervades the publications on bioethics, several disturbing and dangerous trends neglect some basic lessons of philosophy, logic, and history. The bioethics (...) discourse on medical aid in dying emphasizes similarity over previously recognized important distinguishing features. For example, it overplays a likeness between assistance in dying and the withdrawal of life-saving technology. In many bioethics’ topics, arguments based on a logical continuum are used to question the lines demarcating important moral differences. l. The Line Between Ethical and Not: Logic Based on Continuum Careful case selection, often either end of a continuum, allows the tearing down or ridiculing of many rules and codes across most professions and fields of interest. This situation holds true for traffic laws as well as medical ethics guidelines. It is relatively simple for those who desire to attack a particular viewpoint by selecting a case that makes that position seem untenable. In the ethics realm, good and bad medicine exist at opposite ends of an ethical continuum, with many practices lying in between. For example, much of medical ethics exists between the Nazi criminal physicians and the most sainted nurse or physician. A gradual progression occurred over less than two decades from a utilitarian position that supported limited euthanasia for those with certain mental illnesses to genocide. German society embraced a utilitarian ethic in which the value of human life no longer was intrinsic but instrumental.[1] Many morally significant points on a continuum were then ignored as the misguided utilitarian policy rampantly continued. A point in the continuum to distinguish between ethically justifiable and that which is not can be difficult to identify compared to the two extremes. This continuum is not unique to ethics but can be applied to almost any other aspect of human life and endeavor. Between a severely ill schizophrenic person and a superbly well-adjusted individual, there is a continuum of mental and psychological function. The existence of a continuum should not paralyze thinking and prevent us from drawing lines and identifying moral differences based on objective criteria as well as moral philosophy. Yet, by focusing on a continuum, many bioethicists use logic to disregard dividing lines between an "ethical" and an "unethical" act. Unfortunately, sometimes bioethicists draw revolutionary conclusions that would change the scope of medical practices which is accepted as ethical. There are many examples of similar shifts on the continuum. Many authors argue for the ethical permissibility of abortion by pointing out that the human fetus is no different in various characteristics, one arguing it is as like an ape or chick as it is like a person,[2] and does not achieve unique human and individual characteristics until well into the first year of life.[3] While human fetuses arguably do not have certain distinctive qualities of personhood, most people shy away from the logical next conclusion: permitting infanticide. For example, Joshua Lederberg condemns infanticide, in the face of biological illogic, because of our emotional commitment to infants, to me, a relatively weak explanation. Sir Francis Crick suggests we might consider birth at two days of life in order to decide whether an infant is a "suitable" member of society.[4] Giublini and Minerva suggest that infanticide should be permissible since late pregnancy abortions are permissible, arguing there is no significant difference between a fetus just before birth and an infant just after birth.[5] Clearly the continuum approach would allow for subjective arguments in favor of later infanticide at other points many days post-birth. Years ago, with a cynical tone, I mentioned infanticide as a further step on the continuum beyond abortion, and I was rightly shouted down as being deliberately provocative to assert the logic would ever stretch so far. While it is not an accepted mainstream position, the movement in academic settings from widespread condemnation to limited possible acceptance of infanticide has taken place in an incredibly short time. Public opinion and medical opinion in these areas have shifted dramatically in a short time. In another area, from a biological and chemical point of view, there is a continuum from man down to a single carbon atom. Yet, it would not seem logical to ignore the emotional differences, the meaning of personhood, or the moral distinction between killing an insect and killing a person. ll. A False Continuum: Medical Aid in Dying I assert that there has been an erosion of ethical guidelines in recent years attributable to using continuums to camouflage important distinctions. James Rachels’ work on active and passive euthanasia, which contends that the two are ethically identical, exemplifies that logic.[6] He illustrates this thesis, using a continuum to compare different scenarios with like consequences as morally equivalent, by comparing the deliberate drowning of a child with a deliberate failure to rescue a drowning child when easily able to do so. The author's comparison proposes that since much of the medical profession has already made peace with withholding treatment in order to hasten death, consistency inexorably demands that we permit active euthanasia as well.[7] When permission for active euthanasia was first introduced, it was limited exclusively to patients suffering severely from an intractable, incurable, and irreversible disease. These guidelines have been continuously eroded. There is now a substantial serious consideration for permitting active euthanasia of healthy elderly individuals who feel that they have completed their lives and are "tired of living."[8] There are many moral and factual differences along the ethical continuum. In human life, there is a difference between a live baby and a fetus, between a viable fetus and one that is not, between a fetus and a zygote, and between a zygote and a sperm cell. Similarly, there is a difference between pulling a trigger to kill someone and not interfering in preventing his death, which is reprehensible though both may be. There is a difference between not resuscitating an 80-year-old man with cancer when his heart stops and injecting him with a fatal dose of potassium chloride. I argue that an overt act of taking life repels civilized human beings is to be commended and encouraged as the reverence for human life or even for just a moment of human life is one of the great contributions of our civilization. CONCLUSION As an orthodox Jew, I feel that divinely inspired guidelines that have stood the test of centuries shape my beliefs, and such guidelines contradict medical aid in dying. I cannot speak to the viewpoint of those who do not access religion in defining their moral stance, nor do I implicate them in the current bioethics' trends, as I am not aware of the personal role of religion in the lives of most such authors. While many nonreligious people have a firm philosophical grounding and oppose medical aid in dying, I suggest that in the absence of any religious or other absolute standards, developing logically defensible ethical guidelines may be challenging. At the least, religion may play a role in defining the points on the continuums that are ethically meaningful and refuting the trending beliefs that if the endpoint is the same, allowing different methods of arriving at that end are somehow ethically equal. The continuum of ways death may result does not negate analysis of whether death is brought about in ways that recognize the importance of life. The German philosopher Hans Jonas said, "It is a question whether without restoring the category of the sacred, the category most thoroughly destroyed by the scientific enlightenment, we can have an ethics able to cope with the extreme powers that we possess today and constantly increase and are compelled to use."[9] While countries vary on the role of religion in policy, with many emphasizing freedoms of religion, a recent position paper released by a group of Jewish, Christian, and Moslem leaders suggested the need for agreement on the unique sanctity of human life.[10] I would recommend that such a document serve as an example of consensus on critical foundational bioethical guidelines for democratic secular societies. - [1] Alexander L Medical science under dictatorship. New England Journal of Medicine, 241, p39-47 DOI10.1056/NEJM194907142410201 [2] Lederberg J. A geneticist looks at contraception and abortion, Annals of Internal Medicine 67, sup 2, 25-27. https:/doi.org/10.7326/0003-4819-67-3-25 [3] Ibid. [4] Editorial, Sociology: Logic of biology. Nature 220, 429 https://www.nature.com/articles/220429b0 [5] Giublini A Minerva F After-birth abortion: why should the baby live. J Med Ethics 39, 261- [6] Rachels J Active and passive euthanasia. New England Journal of Medicine 292, 78-80 [7] Ibid. [8] Cohen-Almagor R Euthanizing people who are "tired of life". in Euthanasia and Assisted Suicide-Lessons from Belgium. Ch 11 of Euthanasia and Assisted Suicide, Cambridge University Press pp173-187. 2017 and DOI; https://doi.org/10.1017/9781108182799.012 [9] Hans Jonas, Technology and Responsibility: Reflections on the New Tasks of Ethics, 1972, found as Chapter IX, Philosophical Essays, 1980. https://inters.org/jonas-technology-responsability [10] A position paper of the Abrahamic Monotheistic religions on matters concerning the end-of-life. Vatican Press 28 October 2019 https://press.vatican.va/content/salastampa/en/bollettino/pubblico/2019/10/28/191028f.html. (shrink)

Abortion remains a controversial topic, with pro-life and pro-choice advocates clashing fiercely. However, public polling demonstrates that the vast majority of the Western public holds a middle position: being in favour of abortion but not in all circumstances nor at any time. The intuitions held by the majority seem to imply a contradiction: two early foetuses at the same point in development have different moral statuses. Providing coherent philosophical grounding for this intuition has proved challenging. Solutions given by philosophers such (...) as Feinberg, Harman and Räsänen are complex and do not fully account for the lived experience of pregnancy loss. This article argues for a relational ontological construction of human personhood as the basis of foetal personhood. This approach takes seriously the literature of pregnancy loss and the lived experiences of pregnant persons. Focusing on the manner in which persons relate to early foetuses (especially pregnant persons), provides a coherent ground for distinct foetal value. Importantly, this approach is both simple and intuitive. Therefore, it can be more easily adopted by middle. To counter an implied equality of human relationality, the article argues for a clear hierarchy based on relational proximity that affirms pregnant persons? primary role in deciding the moral significance of foetal termination. (shrink)

The bioethics literature has paid little attention to matters of informed reproductive decision-making among women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant. Women with CKD receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with respect to information about pursuing pregnancy. We identify four factors that might contribute to inadequate and inconsistent reproductive counseling. We argue that women with CKD should receive comprehensive reproductive counseling, (...) including information about the possibility of pursuing pregnancy, and that more rigorous research on pregnancy in women with CKD, including women on dialysis or who have received a kidney transplant, is warranted to improve informed reproductive decision making in this population. (shrink)

abstract It is standardly taken for granted in the literature on the morality of abortion that adoption is almost always an available and morally preferable alternative to abortion — one that does the same thing so far as parenthood is concerned. This assumption pushes proponents of a woman's right to choose into giving arguments that are based almost exclusively around the physicality of pregnancy and childbirth. On the other side of the debate, the assumption that adoption is a real (...) alternative seems to strengthen the contention that a woman who wishes to abort is morally deficient, whatever the status of the foetus: that she is selfish or short‐sighted in her refusal to bear the temporary physical burden of pregnancy. In this article, I will argue that adoption is not a genuine alternative to abortion. It does not ‘do the same thing’, even setting aside the physicality of pregnancy. I will show that on the most successful model of parental obligation — a causal account that formalises the distinction between parent: progenitor, and parent: carer — birth mothers and fathers remain obliged, life‐long, to their birth children even when the child is adopted out. (shrink)

This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK’s Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4 of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: “Is Greater Glasgow and Clyde (...) Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?” The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms “mid-level professionals” such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research. (shrink)

This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK’s Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4 of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: “Is Greater Glasgow and Clyde (...) Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?” The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms “mid-level professionals” such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research. (shrink)

The bioethics literature has paid little attention to matters of informed reproductive decision-making among women of childbearing age who have chronic kidney disease (CKD), including women who are on dialysis or women who have had a kidney transplant. Women with CKD receive inconsistent and, sometimes, inadequate reproductive counseling, particularly with respect to information about pursuing pregnancy. We identify four factors that might contribute to inadequate and inconsistent reproductive counseling. We argue that women with CKD should receive comprehensive reproductive counseling, (...) including information about the possibility of pursuing pregnancy, and that more rigorous research on pregnancy in women with CKD, including women on dialysis or who have received a kidney transplant, is warranted to improve informed reproductive decision making in this population. (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)

Giubilini and Minerva ask why birth should be a critical dividing line between acceptable and unacceptable reasons for terminating existence. Their argument is that birth does not change moral status in the sense that is relevant: the ability to be harmed by interruption of one's aims. Rather than question the plausibility of their position or the argument they give, we ask instead about the importance to scholarship or policy of publishing the article: does it to any extent make a novel (...) or needed addition to the literature? Giubilini and Minerva's argument is remarkably similar to one advanced by Michael Tooley in ‘Abortion and Infanticide,’ almost 40 years ago. There have been immense changes in the intervening 40 years: in the ability to diagnose conditions early in pregnancy, in genetics and in the availability of in vitro fertilization; in understanding of the capabilities of persons with disabilities; in law; in economic support and access to healthcare for pregnant women and their children; in social customs and arrangements; and even in philosophy, with developments in feminist thought, bioethics and cognitive science. Some of these changes have been for the better, but others, such as the unravelling of social safety nets, have arguably been for the worse. Any or all of these changes might give rise to moral reasons for the relevance of birth that were not available 40 years ago. These changes might also be relevant to the identification of cases, if any, in which ‘after-birth abortion’ might be considered. If context is relevant to the applicability of moral reasons—as for theorists of justice in the non-idealised world it surely should be—it is questionable whether a view of the birth-line that ignores contextualising change can be adequate. (shrink)

In order to effectively prepare students for medical decisions with complex, ethical disagreements and value-laden conflicts, a progression from simpler case analysis to multi-layered conflicts is often helpful. Presented here is a unique case of pregnancy in a true hermaphrodite from recent medical literature. The case is artificially layered with additional, medical and discoverable contextual issues to help analyze three distinct questions in medical ethics: 1) Is it ethically permissible to perform an elective termination of pregnancy (ETOP) on (...) a minor, 2) Is it ethically permissible to keep this information from the parents, and 3) are additional and complicating medical features included in confidentiality agreements involving minors? The pedagogical goals include introducing and effectively utilizing the Orr-Shelton, four box method of clinical ethics assessment, demonstrating the need to uncover/discover important contextual (cultural, religious, family, etc.) features not usually incorporated fully into patient charts, to prepare medical students to research and become familiar with the local legal environment, and to illustrate that what appears to be a single a single ethical dilemma is likely far more complex requiring a multi-focused assessment. (shrink)

Feminist scholarship has demonstrated the importance of sustained critical engagement with ultrasound visualizations of pregnant women’s bodies. In response to portrayals of these images as “objective” forms of knowledge about the fetus, it has drawn attention to the social practices through which the meanings of ultrasound are produced. This article makes a novel contribution to this project by addressing an empirical context that has been neglected in the existing feminist literature concerning ultrasound, namely, its use during pregnancies that women decide (...) to terminate. Drawing on semi-structured interviews with women concerning their experiences of abortion in England, I explore how the meanings of having an ultrasound prior to terminating a pregnancy are discursively constructed. I argue that women’s accounts complicate dominant representations of ultrasound and that in so doing, they multiply the subject positions available to pregnant women. (shrink)