In Rationality and the Genetic Challenge: Making People Better? Matti Häyry provides a clear and informed discussion and analysis of a number of competing answers to the above questions. Häyry describes three main perspectives on the morality of prenatal genetic diagnosis , the “restrictive,” “moderate,” and “permissive” views, and his analysis illuminates that these views can be distinguished in terms of their different “rationalities”—their respective understanding of what counts as a reasonable choice for parents to make in light of PGD.

In this article, I consider recent debates on the notion of procreative liberty, to argue that reproductive freedom can be understood as a form of positive freedom—that is, the freedom to make oneself according to various ethical and aesthetic principles or values. To make this argument, I draw on Michel Foucault’s later work on ethics. Both adopting and adapting Foucault’s notion of ethics as a practice of the self and of liberty, I argue that reproductive autonomy requires enactment (...) to gain meaning within the life contexts of prospective parents. Thus, I propose a shift away from the standard negative model of freedom that sees it solely as a matter of noninterference or nonimpedance, a view advocated by major commentators such as John Harris and John Robertson. Instead, reproduction should be understood as a deeply personal project of self-making that integrates both negative and positive freedom. (shrink)

Many contemporary ethical debates turn on claims about the nature and extent of our alleged procreative moral rights: moral rights to procreate or not to procreate as we choose. In this article, I argue that there are no procreative moral rights, in that generally we do not have a distinctive moral right to procreate or not to procreate as we choose. However, interference with our procreative choices usually violates our nonprocreative moral rights, such as our moral rights (...) to bodily autonomy or to privacy. My argument presents hypothetical cases in which a state interferes with a person's procreative choices in order to promote aggregate social welfare, but this interference does not violate any of the person's nonprocreative moral rights. These cases not only undermine frequently made claims that widely recognized nonprocreative moral rights entail procreative moral rights, they also challenge the intuitively plausible claim that interference with our procreative choices as such violates our moral rights. What at first appear to be substantive moral rights are in fact a kind of illusion created by the frequent overlap of other rights, but lacking in substance beyond that overlap. While this argument against the existence of procreative moral rights has substantive implications for ongoing debates in reproductive ethics, I ultimately suggest that it is consistent with a progressive approach to reproductive justice. (shrink)

The Asymmetry in procreative ethics consists of two claims. The first is that it is morally wrong to bring into existence a child who will have an abjectly miserable life; the second is that it is permissible not to bring into existence a child who will enjoy a very happy life. In this paper, I distinguish between two variations of the Asymmetry. The first is the Abstract Asymmetry, the idealized variation of the Asymmetry that many philosophers have been trying (...) to solve. The second is the Real-World Asymmetry, a non-idealized variation that applies explicitly to cases of ordinary human reproduction. I argue that the Real-World Asymmetry can be defended by properly acknowledging the general wrongness of causing someone else to suffer, the limits of what morality can reasonably demand of us, and the significance of respecting women’s autonomy. I then argue that the Abstract Asymmetry is indefensible. (shrink)

We should not have children because (i) we have no child-regarding reasons to do so, (ii) we have child-regarding reasons not to do so, and (iii) although we have other-regarding reasons to do so, these reasons are not decisive. Objections to (i) include that life is always good and that possible individuals would choose life if given the opportunity. These fail if there is no duty to create even a good life (the argument from asymmetry), all lives are bad (the (...) argument from quality of life), and potential parents are not entitled to produce lives without the permission of the offspring (the argument from assumed consent). The failure of the objections is not, however, self-evidently inevitable if a hedonistic axiology is used. It becomes inevitable with a switch to an autonomy-respecting, need-based theory of value. There is no need to become existent (i), and there is a need to avoid frustration, pain, and suffering once an individual has been brought into existence (ii). Since any life can be or turn out to be very bad, potential parents put their children in harm’s way by creating them (the argument from risk). To see this and to see how the preferences of the potential parents do not change the situation (iii), it is necessary to assume a concept of gambling that allows genuinely serious harm in case the player loses. (shrink)

Reproductive autonomy has been challenged by the availability of genetic information, disability and the ethics of selective reproduction. Utilitarian and rights-based approaches, as well as procreative beneficence fail to provide compelling reasons for infringing RA, and may even be likened to dangerous eugenics. Parents are not morally obliged to prevent the birth of a disabled child. Society should rather adopt inclusivity, recognising and providing persons with disabilities opportunities for capability and worthwhile lives.

The claim that we have a moral obligation, where a choice can be made, to bring to birth the 'best' child possible, has been highly controversial for a number of decades. More recently Savulescu has labelled this claim the Principle of Procreative Beneficence. It has been argued that this Principle is problematic in both its reasoning and its implications, most notably in that it places lower moral value on the disabled. Relentless criticism of this proposed moral obligation, however, has (...) been unable, thus far, to discredit this Principle convincingly and as a result its influence shows no sign of abating. I will argue that while criticisms of the implications and detail of the reasoning behind it are well founded, they are unlikely to produce an argument that will ultimately discredit the obligation that the Principle of Procreative Beneficence represents. I believe that what is needed finally and convincingly to reveal the fallacy of this Principle is a critique of its ultimate theoretical foundation, the notion of impersonal harm. In this paper I argue that while the notion of impersonal harm is intuitively very appealing, its plausibility is based entirely on this intuitive appeal and not on sound moral reasoning. I show that there is another plausible explanation for our intuitive response and I believe that this, in conjunction with the other theoretical criticisms that I and others have levelled at this Principle, shows that the Principle of Procreative Beneficence should be rejected. (shrink)

The prelims comprise: Introduction Types of Gene Selection Issues Relating to Gene Selection and Personal Autonomy Individual Autonomy in a Liberal Society Parental Choice Procreative Autonomy versus Children's Autonomy Conclusion Acknowledgments Note.

In this paper we examine three categories of reasons that have been given against the creation of savior siblings (harm to the child, autonomy violations, and effects on wider society) and argue that all can be defeated. We then outline the conditions under which the practice is morally permissible and argue that these conditions are no different from those under which it is ever morally permissible to procreate. Our surprising conclusion is that savior siblings do not present a special (...) case in procreative ethics and it is permissible to create them whenever it is permissible to create any other child. (shrink)

It is commonly thought that when a patient is unable to make a treatment decision for herself, patient autonomy should be respected by consulting the views of a patient surrogate, normally either the next-of-kin or a person previously designated by the patient. On one view, the task of this surrogate is to make the treatment decision that the patient would have made if competent. But this so-called ‘substituted judgment standard’ (SJS) has come in for has come in for a (...) good deal of criticism recently. For instance, some question whether surrogates are able to reliably predict what the patient would have chosen. Others wonder how respecting a patient's counter-factual, rather than actual, choices is supposed to respect her autonomy. Such concerns have lead some to reject the SJS and argue for alternative characterisations of the role of surrogate decision-makers. (shrink)

Emerging reprogenetic technologies may radically change how humans reproduce in the not-so-distant future. One foreseeable consequence of disruptive innovations in the procreative domain is an increase in the reproductive autonomy of intended parents. Regarding the prospective parental liberty of enhancing non-health–related traits of the offspring, one controversy has particularly dominated the literature. Does parents' choice of genetically enhancing the traits of their descendants compromise children's future personal autonomy? In this article, I will analyse the main arguments which (...) posit that reprogenetic enhancement could be at odds with the child's future autonomy. I will argue that these objections are ill-founded. Moreover, I will present other arguments that show that reprogenetic technologies can enhance the autonomy of future children. Autonomy enhancement is a plausible and pro tanto desirable application of emerging reprogenetic technologies. (shrink)

A few decades ago, there was a lively debate on the problem of overpopulation. Various proposals to limit population growth and to control fertility were made and debated both in academia and in th...

Assisted reproductive technologies have greatly increased our control over reproductive choices, leading some bioethicists to argue that we face unprecedented moral obligations towards progeny. Several models attempting to balance the principle of procreative autonomy with these obligations have been proposed. The least demanding is the minimal threshold model (MTM), according to which every reproductive choice is permissible, except creating children whose lives will not be worth living. Hence, as long as the future child is likely to have a (...) life worth living, prospective parents may be allowed to use preimplantation genetic diagnosis (PGD) to select embryos with genetic diseases or disabilities. Assuming a consequentialist person‐affecting view of morality, this paper investigates whether the MTM is an appropriate tool to guide procreative decisions given the continuous development of reproductive genetic technologies. In particular, I consider germline genome editing (GGE) and I argue that its application in human reproduction, unlike PGD, should be conceived as person‐affecting towards future progeny. I claim that even if we assume the plausibility of the MTM within PGD, we are committed to accepting that a greater moral obligation towards progeny should guide procreative decisions if GGE were available. In this case, the MTM should no longer be considered an appropriate instrument to guide procreative choices. Finally, I investigate when we face this greater moral obligation, concluding that it applies only when prospective parents have already engaged in the in vitro fertilization process. (shrink)

I defend a novel account of the wrong of subjecting people to non-consensual sterilization (NCS), particularly in the context of the state-sponsored eugenics programmes once prevalent in the United States. What makes the eugenic practice of NCS distinctively wrong, I claim, is its dehumanizing core: the fact that it is tantamount to treating people as nonhuman animals, thereby expressing the degrading social meaning that they have the value of animals. The practice of NCS is prima facie seriously wrong partly, but (...) crucially, on these grounds. I consider and reject accounts of the wrong of NCS that make no reference to its animalizing character, such as that it violates victims’ (procreative) autonomy, amounts to treating them merely as a means, inflicts psychological harm on them, or constitutes an affront to their human dignity. My discussion suggests that the critical vocabulary of bioethics should be expanded beyond talk of rights-violations, benefits and harms, and equal treatment—and that the language of dehumanization is indispensable to bioethicists. (shrink)

Expanded universal carrier screening (EUCS) entails a population‐wide screening offer for multiple disease‐causing mutations simultaneously. Although there is much debate about the conditions under which EUCS can responsibly be introduced, there seems to be little discussion about its aim: providing carrier couples with options for autonomous reproductive choice. While this links in with current accounts of the aim of foetal anomaly screening, it is different from how the aim of ancestry‐based carrier screening has traditionally been understood: reducing the disease burden (...) in the population. The reasons why the aim of EUCS is presented in terms of ‘autonomy’ rather than ‘prevention’ have not been spelled out in the literature. This paper seeks to fill this gap by considering the morally relevant similarities and dissimilarities between foetal anomaly screening, ancestry‐based carrier screening and EUCS. When carrier screening is performed in the prenatal period, enhancing autonomy appears the most appropriate aim of EUCS, as the alternative of ‘prevention through selective abortion’ would urge women to terminate wanted pregnancies. However, when screening is conducted in the preconception period, carrier couples can avoid the birth of affected children by other means than selective abortion, for instance preimplantation genetic diagnosis. To the extent that this increased control over passing on a genetic disorder raises questions of parental responsibility, it seems necessary that the account of the aims of EUCS is wider than only in terms of enhancing reproductive autonomy. (shrink)

Orr and Siegler have recently defended a restrictive view concerning posthumous sperm retrieval and conception, which would limit insemination to those cases where the deceased man has provided explicit consent for such a procedure. The restrictive view dominates current law and practice. A permissible view, in contrast, would allow insemination and conception in all but those cases where the posthumous procedure has been explicitly refused, or where there is no reasonable evidence that the deceased person desired children. I describe a (...) phenomenology of procreative desires which supports the permissible view, and which is compatible with requirements concerning the interests of the decedent, concepts of medical infertility, and the welfare of the future child. The account illustrates how our current obsession with individual rights and autonomy can be self-defeating and repressive. (shrink)

When widespread use of sex‐selective abortion and sex selection through assisted reproduction lead to severe harms to third parties and perpetuate discrimination, should these practices be banned? In this paper I focus on India and show why a common argument for a ban on sex selection fails even in these circumstances. I set aside a common objection to the argument, namely that women have a right to procreative autonomy that trumps the state's interest in protecting other parties from (...) harm, and argue against the ban on consequentialist grounds. I perform a pairwise comparative analysis of sex selection and its plausible alternatives and argue that that the ban fails to improve the state of affairs relative to a scenario without a ban. The ban makes the situation worse, especially for mothers and their daughters. India should therefore repeal its ban on sex selection. (shrink)

According to what we call the Principle of Procreative Beneficence, couples who decide to have a child have a significant moral reason to select the child who, given his or her genetic endowment, can be expected to enjoy the most well-being. In the first part of this paper, we introduce PB, explain its content, grounds, and implications, and defend it against various objections. In the second part, we argue that PB is superior to competing principles of procreative selection (...) such as that of procreative autonomy. In the third part of the paper, we consider the relation between PB and disability. We develop a revisionary account of disability, in which disability is a species of instrumental badness that is context- and person-relative. Although PB instructs us to aim to reduce disability in future children whenever possible, it does not privilege the normal. What matters is not whether future children meet certain biological or statistical norms, but what level of well-being they can be expected to have. (shrink)

Over the course of recent years, various scientific advances in the realm of reproduction have changed the reproductive landscape, enhancing women’s procreative rights and the choices available to them. Uterus transplants (UTx) are the latest of such medical innovations aimed at restoring fertility in women suffering from absolute uterine factor infertility, providing them with the possibility not only of conceiving a genetically related child but also of gestating their own pregnancies. This paper critically examines the primacy of reproductive liberty (...) in the context of uterus transplantation. It questions whether and to what extent we should respect the reproductive autonomy of a woman who chooses UTx, given the significant risks that attach to the procedure and existing concerns that UTx may perpetuate potentially troubling gendered norms surrounding pregnancy and the role of women’s bodies in reproduction, which may place undue reproductive pressures on women. (shrink)

Expanded universal carrier screening (EUCS) entails a population‐wide screening offer for multiple disease‐causing mutations simultaneously. Although there is much debate about the conditions under which EUCS can responsibly be introduced, there seems to be little discussion about its aim: providing carrier couples with options for autonomous reproductive choice. While this links in with current accounts of the aim of foetal anomaly screening, it is different from how the aim of ancestry‐based carrier screening has traditionally been understood: reducing the disease burden (...) in the population. The reasons why the aim of EUCS is presented in terms of ‘autonomy’ rather than ‘prevention’ have not been spelled out in the literature. This paper seeks to fill this gap by considering the morally relevant similarities and dissimilarities between foetal anomaly screening, ancestry‐based carrier screening and EUCS. When carrier screening is performed in the prenatal period, enhancing autonomy appears the most appropriate aim of EUCS, as the alternative of ‘prevention through selective abortion’ would urge women to terminate wanted pregnancies. However, when screening is conducted in the preconception period, carrier couples can avoid the birth of affected children by other means than selective abortion, for instance preimplantation genetic diagnosis. To the extent that this increased control over passing on a genetic disorder raises questions of parental responsibility, it seems necessary that the account of the aims of EUCS is wider than only in terms of enhancing reproductive autonomy. (shrink)

The ethical implications of human clones have been much alluded to, but have seldom been examined with any rigour. This paper examines the possible uses and abuses of human cloning and draws out the principal ethical dimensions, both of what might be done and its meaning. The paper examines some of the major public and official responses to cloning by authorities such as President Clinton, the World Health Organisation, the European parliament, UNESCO, and others and reveals their inadequacies as foundations (...) for a coherent public policy on human cloning. The paper ends by defending a conception of reproductive rights of "procreative autonomy" which shows human cloning to be not inconsistent with human rights and dignity. (shrink)

This chapter contains sections titled: Process The Reaction to Cloning Arguments against Human Reproductive Cloning Procreative Autonomy Acknowledgments.

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

In this paper, I review some of the discussions on procreative beneficence and procreative autonomy in the context of postponed motherhood and compare the considerations to the context of advanced paternal age. In doing so, I will give an overview of the main scientific findings with regard to how older age in men affects the health of future offspring. I shall demonstrate how the discrepancy between the media coverage and policies on postponed motherhood and postponed fatherhood mistakenly (...) suggests that women are more responsible than men for the health of offspring. (shrink)

This paper examines dominant arguments advocating for the procreative right to undergo sex selection for social reasons, based on gender preference. I present four of the most recognized and common justifications for sex selection: the argument from natural sex selection, the argument from procreative autonomy, the argument from family balancing, and the argument from children’s well-being. Together these represent the various means by which scholars aim to defend access to sex selection for social reasons as a legitimate (...) procreative choice. In response, I contend that these justifications are flawed and often inconsistent and therefore fail to vindicate the practice. (shrink)

Human reproductive cloning provides the possibility of genetically related children for persons for whom present technologies are ineffective. I argue that the desire for genetically related children is not, by itself, a sufficient reason to engage in human reproductive cloning. I show this by arguing that the value underlying the desire for genetically related children implies a tension between the parent and the future child. This tension stems from an instance of a deprivation and violates a general principle of reasons (...) for deprivation. Alternative considerations, such as a right to procreative autonomy, do not appear helpful in making the case for human reproductive cloning merely on the basis of the desire for genetically related children. (shrink)

Recently a child’s right to a father was invoked to justify the prevention of single women from obtaining access to IVF. This article explores the conceptual and normative issues about the nature of the right and its conflict with a woman’s right to procreative autonomy. The discussion relates the conceptual issues to those raised in the context of ‘wrongful life’ tort cases. It concludes that the right to be born with a father, although conceptually sound, does not justify (...) the restriction on the procreative right of single women. (shrink)

In liberal societies, we generally admit the principle of Procreative Liberty (PL) that, though usually defended with no explicit reference to Mill’s Harm Principle (HP), is perfectly coherent with it. It comprises several liberties, such as the liberty to decide when, how many times, with whom and if to procreate at all. On the other hand, we talk about the principle of Parental Autonomy (PA) or Parental Liberty: the parents have the right to raise their children and to (...) make all decisions concerning them free from governmental intervention. Whatever the scope defended for this right, we usually admit that it has more limits than PL. The reason is clear enough: there is a third party involved, the child, and, according to Mill’s HP, the society can rightfully intervene. Though traditionally procreative and parental rights have been considered as independent rights, and though PL and PA have been defended on different basis, in this paper I want to argue that some proposed extensions of PL are best considered as cases of PA. (shrink)

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

In the first part of my paper, drawing on the works by David Heyd, I argue that, in the choices related to procreation, an autonomous decision of the woman involved should play the key role. In the relation between a healthcare professional, on the one hand, and a pregnant patient, or a patient who intends to become pregnant, on the other – the former is ethically obliged to provide proper help in the decision-making process that should nevertheless be founded on (...) the ethical ideal of a morally good person. The decision should also be informed by the conception of a morally good person endorsed by the woman . In the second part of my paper, I refer to the conception of the sanctity of human life, developed by Ronald Dworkin, to claim that, in a complex medical model, the tendency to equate the fetus with bodily organs should be curtailed as far as the relation between the pregnant woman and the fetus is concerned. The idea of the sanctity of life also serves as the ground on which what I call a ‘procreation epic’ is based. The suggested epic, viewed as a general philosophical framework for the healthcare and reproductive medicine policy, is considered relevant to democratic societies. (shrink)

The spectacular progress in assisted reproduction technology that has been witnessed for the past thirty years resulted in emerging new ethical dilemmas as well as the revision of some perennial ones. The paper aims at a feminist approach to oocyte and spare embryo donation for research. First, referring to different concepts of autonomy and informed consent, we discuss whether the decision to donate oocyte/embryo can truly be an autonomous choice of a female patient. Secondly, we argue the commonly adopted (...) language of gift is misleading and that calling for altruism could put female patients at risk of exploitation. Finally, we point out that the presence of gender stereotypes in the procreative area casts doubt whether even a more robust notion of informed consent manages to overcome this risk. (shrink)

The scope of noninvasive prenatal testing (NIPT) could expand in the future to include detailed analysis of the fetal genome. This will allow for the testing for virtually any trait with a genetic contribution, including “non-medical” traits. Here we discuss the potential use of NIPT for these traits. We outline a scenario which highlights possible inconsistencies with ethical decision-making. We then discuss the case against permitting these uses. The objections include practical problems; increasing inequities; increasing the burden of choice; negative (...) impacts on the child, family, and society; and issues with implementation. We then outline the case for permitting the use of NIPT for these traits. These include arguments for reproductive liberty and autonomy; questioning the labeling of traits as “non-medical”; and the principle of procreative beneficence. This summary of the case for and against can serve as a basis for the development of a consistent and coherent ethical framework. (shrink)

The scope of noninvasive prenatal testing (NIPT) could expand in the future to include detailed analysis of the fetal genome. This will allow for the testing for virtually any trait with a genetic contribution, including “non-medical” traits. Here we discuss the potential use of NIPT for these traits. We outline a scenario which highlights possible inconsistencies with ethical decision-making. We then discuss the case against permitting these uses. The objections include practical problems; increasing inequities; increasing the burden of choice; negative (...) impacts on the child, family, and society; and issues with implementation. We then outline the case for permitting the use of NIPT for these traits. These include arguments for reproductive liberty and autonomy; questioning the labeling of traits as “non-medical”; and the principle of procreative beneficence. This summary of the case for and against can serve as a basis for the development of a consistent and coherent ethical framework. (shrink)

Anna Smajdor’s proposal of whole body gestational donation (WBGD) states that female patients diagnosed as brain-dead should be considered for use as gestational donors. In this response, Smajdor’s proposal is rejected on four different accounts: (a) the debated acceptability of surrogacy despite women's autonomy, (b) the harm to dead women ́s interests, (c) the interests of the descendants, and (d) the symbolic value of the body and interests of relatives. The first part argues that WBGD rests on a particular (...) conception of the instrumentalization of bodies that cannot be circumvented simply by the patient’s consent and relinquished autonomy. The second part argues the importance of avoiding any harm to dead women’s interests. The third part identifies the importance of the interest of the foetus in the light of Procreative-Beneficence principle that Smajdor overlooks. And finally, the fourth part considers the symbolic value of the human body and the interest of relatives. The main goal of this commentary is not to show that WBGD cannot be implemented; rather, it is to show that there are not any good arguments in favour of doing so. (shrink)

The cultural imagery of women is deeply ingrained in our consciousness. So deeply, in fact, that feminists see this as a fundamental threat to female autonomy because it enshrines procreative heterosexuality as well as the relations of domination and subordination between men and women. Diana Meyers' book is about this cultural imagery - and how, once it is internalized, it shapes perception, reflection, judgement, and desire. These intergral images have a deep impact not only on the individual psyche, (...) but also on the social, political, and cultural syntax of society as a whole. Meyer's argues for the necessity of crafting a dissident, empowering, and 'emancipatory counter-imagery' for women. Rigorous, well written, and accessible, the reach of Gender in the mirror is arguably catholic, and addresses the interests or readers across an impressive range of intellectual disciplines. (shrink)

Julian Savulescu argues for two principles of reproductive ethics: reproductive autonomy and procreative beneficence, where the principle of procreative beneficence is conceptualised in terms of a duty to have the child, of the possible children that could be had, who will have the best opportunity of the best life. Were it to be accepted, this principle would have significant implications for the ethics of reproductive choice and, in particular, for the use of prenatal testing and other reproductive (...) technologies for the avoidance of disability, and for enhancement. In this paper, it is argued that this principle should be rejected, and it is concluded that while potential parents do have important obligations in relation to the foreseeable lives of their future children, these obligations are not best captured in terms of a duty to have the child with the best opportunity of the best life. (shrink)

Recent cases in the United States and Australia have catapulted surrogacy into the forefront of debates and public policy regarding new procreative technologies, even though gestating and birthing a baby for another woman does not necessarily involve artificial insemination or in vitro fertilization. Feminists have condemned commercial surrogacy because it borders on baby selling and exploits women. Similar criticism has appeared in the mass media, but these forums, as well as the medical profession, have considered noncommercial surrogacy as more (...) acceptable because of the absence of monetary exchange. Using two cases of surrogacy, this article argues that the distinction between commercial and altruistic surrogacy is socially constructed rather than based on self-evident or intrinsic differences. Both types of surrogacy involve the application of pervasive gender norms specifying that women's motivations to have children should be based on emotion, selflessness, and caring, not on self-interest, financial incentives, or pragmatism. Applying these norms renders commercial surrogacy deviant, but altruistic arrangements more acceptable. However, the article's central argument is that both types of agreement can entail exploitation, the denial of the birth mother's rights, and the severe reduction of her autonomy. (shrink)

Reproductive freedom plays a pivotal role in debates on the ethics of procreation. This moral principle protects people’s interests in procreative matters and allows them discretion over whether to have children, the number of children they have and, to a certain extent, the type of children they have. Reproductive freedom’s theoretical and political emphasis on people’s autonomy and well-being is grounded in an individual-centred framework for discussing the ethics of procreation. It protects procreators’ interests and significantly reduces the (...) permissible grounds for interference by third parties. In this article I show that procreative decisions have far-reaching effects on the composition and size of the population. The upshot of considering these effects allows for the appreciation of the inadequacy of a framework that solely considers individual (i.e. procreators’) interests to discuss the ethics of procreation. To address such inadequacy, I assess costs and benefits of past and present proposals to reflect on procreation in such a way as to consider its far-reaching effects. I conclude by arguing that reproductive freedom should be defended as an imperfect but instrumentally necessary tool. This framing would enable those participating in debates on the ethics of procreative decisions to work towards an ethical framework that accounts for the cumulative effects of these decisions. (shrink)

The book analyses moral and legal problems of assisted reproduction providing a pluralistic approach which combines principles of procreative beneficence, procreative nonmaleficence, reproductive autonomy and rationality with the meaning and nature of the parent-child relationship as the main criterion of moral assessment.

The article concerns the claim of a handicapped child for having come into the world in a harmed state, called the wrongful life claim. The article first presents an analysis of the legal construction of a claim, which has to do with such aspects as the subject of the relationship of restitution and the legal conditions for restitution, including the problem of the legal protection of the good of the child, the cause and effect relationship, and the harm. The conclusion (...) of the analysis is that on the basis of current Polish law the wrongful life claim would be rejected as unfounded. After carrying out a legal analysis the article also considers problems of a philosophical nature to which the above claim gives rise, such as the problem of nonexistence, the problem of the right not to have been conceived and not to have been born, the problem of measuring the value of a human life, and the problem of procreative freedom and autonomy. At the end the author presents the ethical and social aspects of the claim, such as the promotion of a proeugenic and proabortion attitude, the stigmatization of handicapped children, discrimination on the basis of health, the change of the standard of medical services, and the issue of social care. These analyses lead to the conclusion of the necessity of establishing legal regulations that exclude the possibility of these kinds of claims. At the same time she postulates the strengthening of parental awareness and responsibility and the creation of appropriate legal and social structures to support handicapped children and their families. (shrink)

Surrogacy is one of the desired reproductive technologies for family formation, yet surrogate mothers are subjected to unethical treatments and unbalanced power relations in India. Such treatment obscures women’s free decision-making and can be detrimental to their maternal self. Recently, the Surrogacy Act, 2021, has received the President’s approval to regulate surrogacy practices by limiting them for the altruistic motives which have again provoked the burning debates regarding reproductive technologies, women’s emancipation and procreative labour. The paper thus explores women’s (...) agency, maternal freedom and surrogate arrangements in Indian society. The complexity of the implementation of the law, vulnerability of surrogate labour, woman’s bodily autonomy and reproductive choices have been analysed. This has been done through comprehensive feminist discussions on motherhood experience in terms of enforced vs. voluntary to find the way to protect women’s freedom and subjectivity in the task of ‘mothering as empowerment’. (shrink)

Preimplantation genetic diagnosis allows the detection of genetic abnormalities in embryos produced through in vitro fertilization. Current funding models in Australia provide governmental subsidies for couples undergoing IVF, but do not extend to PGD. There are strong reasons for publicly funding PGD that follow from the moral principles of autonomy, beneficence and justice for both parents and children. We examine the objections to our proposal, specifically concerns regarding designer babies and the harm of disabled individuals, and show why these (...) are substantially outweighed by arguments for subsidizing PGD. We argue that an acceptance of PGD is aligned with present attitudes towards procreative decision making and IVF use, and that it should therefore receive government funding. (shrink)

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

Introduction Cholbi, Michael (et al.) Pages 1-10 -/- Assisted Dying and the Proper Role of Patient Autonomy Bullock, Emma C. Pages 11-25 -/- Preventing Assistance to Die: Assessing Indirect Paternalism Regarding Voluntary Active Euthanasia and Assisted Suicide Schramme, Thomas Pages 27-40 -/- Autonomy, Interests, Justice and Active Medical Euthanasia Savulescu, Julian Pages 41-58 -/- Mental Illness, Lack of Autonomy, and Physician-Assisted Death Varelius, Jukka Pages 59-77 -/- Euthanasia for Mental Suffering Raus, Kasper (et al.) Pages 79-96 -/- (...) Assisted Dying for Individuals with Dementia: Challenges for Translating Ethical Positions into Law Downie, Jocelyn (et al.) Pages 97-123 -/- Clinical Ethics Consultation and Physician Assisted Suicide Adams, David M. Pages 125-147 -/- License to Kill: A New Model for Excusing Medically Assisted Dying? Huxtable, Richard (et al.) Pages 149-168 -/- Medically Enabled Suicides Cholbi, Michael Pages 169-184 -/- Saving Lives with Assisted Suicide and Euthanasia: Organ Donation After Assisted Dying Shaw, David M. Pages 185-192 -/- Implanted Medical Devices and End-of-Life Decisions Gill, Michael B. Pages 193-215 -/- Everyday Attitudes About Euthanasia and the Slippery Slope Argument Feltz, Adam Pages 217-237 -/- “You Got Me Into This…”: Procreative Responsibility and Its Implications for Suicide and Euthanasia Weinberg, Rivka Pages 239-252 . (shrink)

This Article considers the moral and legal status of practices that aim to modify traits in human offspring. As advancements in reproductive biotechnology give parents greater power to shape the genetic constitution of their children, an emerging school of legal scholars has ushered in a privatized paradigm of genetic control. Commentators defend a constitutionally protected right to prenatal engineering by appeal to the significance of procreative liberty and the promise of producing future generations who are more likely to have (...) their lives go well. This 'new eugenics,' however, confronts us with ethical challenges that neither liberal arguments about autonomy, fairness, and consent, nor utilitarian arguments about preferences, happiness, and equality, are able to capture. I begin by analyzing the Supreme Court's modern substantive due process jurisprudence, as it bears on recent advancements and controversies in genetic science. After developing a doctrinal framework that could support an asserted right to genetic engineering, I draw on empirical research in behavioral psychology to examine the influence of eugenic norms on egalitarian attitudes and institutions. I predict that if parents become accustomed to choosing the genes of their children, it would be radically more difficult to give an influential account for why the successful should adopt a charitable posture toward those who are less fortunate. I argue that by shifting control over offspring DNA from chance to choice, enhancement will inflate a sense of individual entitlement for social and economic outcomes. I conclude that increasing willingness to prevent the birth of abnormal children distracts attention from institutions that fail to accommodate the limitations of imperfect people. Some may reply that producing people who better fit the roles society chooses to reward need not deter us from providing for people whose abilities fail to meet the demands of modern society. However, this reply misses the way that changes in reproductive practices can bring about changes in the way that we understand our identities and relationships. Eugenic solutions to social problems such as poverty, crime, and unemployment reshape the challenge of genetic disadvantage so that it is no longer one we address through collective measures such as public education, social services, and income redistribution, and instead becomes one for individual parents to prevent through donor screening, embryo discard, or selective abortion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Women on the Global Market: Irigaray and the Democratic StateNicole Fermon (bio)Best known for her subtle interrogation of philosophy and psychoanalysis, Luce Irigaray clearly also conducts a dialogue with the political, proposing that women’s erasure from culture and society invalidates all economies, sexual or political. Because woman has disappeared both figuratively and literally from society [see Sen, “More Than 100 Million Women Are Missing”], Irigaray conceives the contemporary ethical (...) project as a recall to difference rather than equality, to difference between women and men—that is, sexual difference. She characterizes relations between men and women as market relations in which women are commodities, objects, but never subjects of exchange, objects to men but not to themselves: women do not belong to themselves but exist “to keep relationships among men running smoothly” [TS 192]. Women under these conditions require imaginative ways to reconfigure the self, to subvert the melancholy and regression of masculinist economies and envisage a future in which women would not be ashamed of the feminine, would experience it as a positivity worth emulating.Irigaray contends that after the gains of egalitarian politics are carefully examined, the inclusion of women in the political arena has failed to take into account women’s distinct and different position from men, and from each other, as well as perpetuating the fiction of the “neutral” citizen, the ahistorical individual citizen of the nation-state. It is that fiction Irigaray dispels in her critique of liberal democratic politics and its creation, “citizens who are neuter in regard to familial singularity, its laws, and necessary sexual difference” [SG 112] in order to benefit the State and its laws. The subject is male; the citizen is neuter. Who is the female citizen in contemporary society? What is the ethical elaboration of the contractual relations between women and men, and between sexed individuals and the community? How do women imagine a distinct set of rights and responsibilities based on self-definition and autonomy, given the particular strictures of contemporary politics—that is, the market-driven, antidemocratic nature of the current economic national and global forces? Irigaray suggests that “the return of women to collective work, to public places, to social relations, demands linguistic mutations” and profound transformations, an embodied imagination with force and agency in civil life [TD 65].Irigaray warns that if civil and political participation is construed in overly narrow terms, if focus is on economic or judicial “circuits” alone, we overlook the symbolic organization of power—women risk losing “everything without even being acknowledged” [TD 56]. Instead an interval of recognition can expand the political to include the concerns and activities of real women, lest silence imply consent to sexual neutrality, or more likely, to women’s obliteration under men’s interests and concerns. Women’s insistence on self-definition and wage labor, on love and justly remunerated work, [End Page 120] testifies to the obduracy of women’s difference, one that is not likely to disappear. The patriarchal family is still the legal norm, even when certain exceptions are made, while enduring questions regarding women’s health and children’s physical welfare as priorities beyond market considerations are consigned to legislative obfuscation, still a political afterthought. Instead, in the US the liberal state removes the slender welfare net specific to women and children, Aid to Families with Dependent Children, and fails to provide medical coverage to those who are among the most vulnerable of its citizens. Women without access to the legal protection of sex-neutral citizenship, poor working women without language (the money for an effective “mouthpiece” to represent their distress in a court of law), are further disempowered by liberal politics’ insistence on sexual neutrality—that is, on repression or amnesia regarding the lived experiences of women.Sexual difference is key to any project of self-definition by women. Irigaray insists on the sexual nature of this self-definition, not solely for its obvious procreative necessity, but because the natural world is a source of renewal and fecundity which requires attentive interrogation and respect [SG 15]. This rebirth seems alien to the structure of male politics, which instead seem to provoke disasters (Bhopal, Chernobyl, or the current runaway... (shrink)

Philosophical defenses of parents’ rights typically appeal to the interests of parents, the interests of children, or some combination of these. Here I propose that at least in the case of biological, non-adoptive parents, these rights have a different normative basis: namely, these rights should be accorded to biological parents because of the compensatory duties such parents owe their children by virtue of having brought them into existence. Inspried by Seana Shiffrin, I argue that procreation inevitably encumbers the wills of (...) children in otherwise morally objectionable ways. Such subjection generates duties to compensate children, even if the child’s life is on balance a benefit to her. The right to procreate is thus conditioned on prospective parent’s willingness to compensate for the harms of procreation. And because parents bear such compensatory duties, they must be accorded permissions (i.e., rights) to fulfill these duties. These rights include familiar exclusionary rights to promote children’s welfare, etc. Moreover, because subjecting children to harms or the risks thereof violates their autonomy, parental duties (and rights) include the provision of education and other goods that enable their subsequent autonomy as adults. Grounding parental rights in compensatory procreative duties avoids problems associated with appeals to the interests of children (e.g., that these interests do not seem to generate exclusive parental rights) or to the interests of parents (e.g., that these interests do not appear strong enough to permit the creation of a new, vulnerable human individual). (shrink)