Reproductive Ethics

Using Ursula K. Le Guin’s The Left Hand of Darkness as an inspirational backdrop, a novel whose story unfolds on a genderless planet that nevertheless relies on reproductive sex for the sake of generativity, this paper tackles the sex/gender debate, its entanglements with procreation, and its consequences for transgender pregnancies. More specifically, I analyze three issues that pose barriers to thinking about a more inclusive reproductive ethics: state-sanctioned sterilization, non-reproductive futurism, and access to assisted reproductive technology.

ABSTRACT: If Savulescu’s (2001; 2009) controversial principle of Procreative Beneficence (PB) is correct, then an important implication is that couples should employ genetic tests for non-disease traits in selecting which child to bring into existence. Both defenders as well as some critics of this normative entailment of PB have typically accepted the comparatively less controversial claim about non-disease traits: that there are non-disease traits such that testing and selecting for them would in fact contribute to bringing about the child who is expected to have the best life. We challenge this less controversial claim, not by arguing deductively for its falsity, but by showing that Savulescu’s central argument for this presumably less controversial claim fails. Savulescu offers intelligence as the paradigm example of a testable non-disease trait such that testing and selecting for it would increase the likelihood that the child selected would be the one who is expected to have the best life (or at least as good a life as the others). We provide a series of arguments aimed at demonstrating that Savulescu’s argument from intelligence fails. If our arguments are successful, the upshot is not that PB is false, but more modestly, that the burden of proof remains squarely with Savulescu.

This paper draws the connection between the changes in the American perspectives on abortion in the second half of the twentieth century and shifts in the cultural, social and legal status of the society. The major change occurred in 1973, when it was ruled by the Supreme Court in Roe v. Wade that it was unconstitutional to restrict abortion by law for it violated a woman’s right to privacy. The law, however, left many special cases unaddressed, such as when a fetus becomes a person or when the government has the right to step in and claim protection over "human" life. The ambiguity of the laws left the debate over the legality of abortion open, and movements continued into the twenty-first century in attempt to both undo the ruling and to secure the reproductive rights of women. As perspectives are shaped by reproductive rights issues of the past, the issue continues into the twenty-first century with more unanswered questions.

An increasing number of bioethicists are raising concerns that young childless women requesting sterilisation as means of birth control are facing unfair obstacles. It is argued that these obstacles are inconsistent, paternalistic, that they reflect pronatalist bias and that men seem to face fewer obstacles. It is commonly recommended that physicians should change their approach to this type of patient. In contrast, I argue that physicians’ reluctance to eagerly follow an unusual request is understandable and that whatever obstacles result from this reluctance serve as a useful filter for women who are not seriously committed to their expressed requests for sterilisation. As women already disproportionally bear the birth control burden, less resistance that men might be getting in terms of voluntary sterilisation works to women’s advantage, providing a much needed balance. Societal attitudes towards women and motherhood should not be confused with individual physicians’ reasonable reluctance to jump at a serious elective procedure at fairly mild expression of interest.

The practice of egg freezing reached a new milestone in 2012, when the American Society for Reproductive Medicine removed its designation as “experimental”. Studies of the safety and efficacy of egg freezing led the ASRM to recommend egg freezing for patients facing infertility due to gonadotoxic therapies, but prompted continued caution against egg freezing when undertaken for nonmedical reasons. The European Society of Human Reproduction and Embryology has more explicitly supported nonmedical egg freezing. Ethical debate about nonmedical egg freezing raises many familiar issues, including the limits of individual autonomy when a medical technology is used for an elective reason. Concerns include commercial exploitation, pressure on women to use egg freezing, and the overall impact of egg freezing on sex inequality and professional norms. The ethical debate also calls for a more careful consideration of whether age-related fertility decline should count as a medical justification for fertility preservation. In lieu of broad consensus on these matters, this paper recommends honoring the principle of autonomy while insisting on better information about utilization and outcomes. Given the significant drop-off in success rates for women who attempt egg freezing when they are older than 38 years, full disclosure in the informed consent process must involve information about success rates by age-group. Much greater consistency and thoroughness in reporting would yield better and more generalizable data.

Abortion remains a highly contentious moral issue, with the debate usually framed as a battle between the fetus's right to life and the woman's right to choose. Often overlooked in this debate is the impact of the concurrent legalization of abortion and the development of new prenatal screening tests on the birth prevalence of many inherited diseases. Most proponents of abortion support abortion for fetuses with severe congenital diseases, but there has unfortunately been, in our opinion, too little debate over the moral appropriateness of abortion for much less severe congenital conditions such as Down's syndrome, deafness, and dwarfism. Due to scientific advances, we are looking at a future in which prenatal diagnosis will be safer and more accurate, raising the specter, and the concomitant ethical concerns, of wholesale abortions. Herein, we present a reframing of the abortion debate that better encompasses these conditions and offers a more nuanced position.

A new technique called Non-Invasive Prenatal Testing (NIPT) has been developed which can detect a range of genetic and chromosomal diseases as well as fetal sex earlier, more easily and more reliably. NIPT therefore potentially expands the market for sex determination and sex selective abortion. This paper argues that both practices should be prevented by not including fetal sex in prenatal test reports. This is because there is a discrepancy between what parents are concerned with (gender) and what the prenatal test can provide (sex). The paper first presents arguments which indicate a difference between sex and gender before presenting parental motivations for sex selection and sex determination to show that parents are not concerned with their child’s sex chromosomes, or even their genitalia, but the gender role that their child will espouse. That, however, is not something that a prenatal test can provide. We are thus left with a situation in which what parents are told and what they think they are being told are two different things. In other words, as the conflation of sex with gender is implicit in the disclosure of fetal sex, it may be more accurate to refer to it as misinformation. This misinformation promotes sexism via gender essentialism, which is neither in the interests of the future child or society.

Prominent critics and skeptics of genetic engineering have treated the ethical issue of human germline genetic modification (HGGM) as if it were still science fiction, like the artificially made Creature imagined in Mary Shelley’s 1818 novel Frankenstein. After surveying the history of making genetically modified (GM) children through three-person IVF since the late 1990s, I sketch a framework for a normative political theory of the rights of the GM children made from heritable biotechnological interventions in the human genome. In light of the history and trajectory of HGGM, the preeminent hard question is no longer “Should science genetically engineer children?” An equally difficult question is “What are the rights of the GM child?” The source of all speculative fiction, Frankenstein presciently addresses the latter question by having the Creature articulate a child’s fundamental and universal rights to both parental love and nondiscrimination, regardless of reproductive circumstances or genetic features.

Suppose that you are soon to be a parent and you learn that there are some simple measures that you can take to make sure that your child will be healthy. In particular, suppose that by following the doctor’s advice, you can prevent your child from having a disability, you can make your child immune from a number of dangerous diseases and you can even enhance its future intelligence. All that is required for this to happen is that you (or your partner) comply with lifestyle and dietary requirements. Do you and your partner have any moral reasons (or moral obligations) to follow the doctor’s advice? Would it make a difference if, instead of following some simple dietary requirements, you consented to genetic engineering to make sure that your child was free from disabilities, healthy and with above average intelligence? In this paper we develop a framework for dealing with these questions and we suggest some directions the answers might take.

Spay and neuter campaigns represent one of the more hopeful and friendly faces of animal advocacy to the public, and have been widely successful in convincing self-proclaimed animal lovers that sterilizing one’s animal companion should be a given. Typically non-threatening to the core, such campaigns feature smiling celebrity endorsements, or cute (if occasionally risqué) posters.  When serious, they appeal to the public’s sympathy for homeless animals and indignation toward irresponsible owners, whose failure to sterilize their animal companions perpetuates the unmanageable populations that ostensibly guarantee consistently overflowing shelters.  While spay and neuter campaigns may also invoke concern for the health and general well-being of one’s companion animal, consideration of the potentially sterilized animal himself is not typically emphasized. This is unsurprising, given the serious risks of mainstream sterilization methods.  Nevertheless, spay and neuter campaigns enjoy widespread success and support among the general public, companion animal caregivers, and animal activists alike. 
In this chapter I examine the tenability of that support, and the justifiability of preventing reproduction in companion animals more generally, from an animal rights framework that espouses relational obligations.  My proposal for how to interpret the duty of care in regard to reproduction centers on an analysis of the relationship between reproduction and flourishing for companion animals and humans. I conclude that good care for companion animals may be compatible with preventing them from reproducing. Preventative efforts are not, however, unconditionally acceptable; for one, they must not reinforce instrumentalizing attitudes and practices concerning companion animals.

The abortion rate in Cuba is staggering--in 2008, official records indicated that 60.7 abortions were performed for every 100 live births. Information gathered from news outlets, personal interviews, and available literature suggests that economic instability and liberal abortion legislation are the principal driving forces of this controversial trend.

This chapter is in two parts. First, I argue that transnational commercial contract pregnancy involves the exploitation of impoverished and often uneducated Indian women and that this exploitation is morally objectionable. It capitalizes on existing social, material, and political inequalities and reinforces morally unacceptable structural injustices, thereby harming Indian women, as individuals and as a group. Second, I argue that transnational commercial contract pregnancy in India harms the children born of this family-making strategy-a strategy that involves both the use of assisted reproductive technologies and adoption. Of particular concern are the damaging effects on identity formation. The offspring oflndian reproductive labourers are denied the benefits of access to genetic and personal information about biological parentage and kinship relations, and they are at risk of stigma associated with not knowing biological relatives, with being birthed by a woman who was exploited, and with being commodified.

Postmortem sperm retrieval (PMSR) is a procedure to procure sperm from a man who has been dead for a short period of time, or a man who has been declared dead by neurological criteria and is being kept alive artificially. Requests for PMSR are typically made by widows with the intention of using the sperm for artificial insemination in the future, but this is not always the case. This article examines requests for postmortem sperm retrieval from parents and family members. I will first overview the legal landscape and policies regarding PMSR internationally. Next, I will provide two clinical cases of requests for postmortem sperm retrieval from parents and family members which occurred at a major medical center in California, USA. I will then analyze the salient ethical features with particular emphasis on  California laws and Israel posthumous grandparenthood policies. Requests for postmortem sperm retrieval from parents, which will not necessarily result in posthumous grandparenthood, will become more frequent. This is a compelling reason for major hospitals to draft policies. I conclude with policy suggestions for this rarified request, which I believe will become routine in the future.

This paper analyzes the underlying tendencies and attitudes toward reproductive medicine borrowing the Nietzschean concepts of nihilism: “death of God” with secularization; “will to power” with reproductive liberty and technological power; and the race of “supermen” with transhumanism. Medical science has advanced in leaps and bounds. In some way, technical innovations have given us unprecedented power to manipulate the way we reproduce. The indiscriminant use of medical technology is backed by a warped notion of human freedom. With secularization in the West, freedom has taken on greater significance in society, but with a heavy emphasis on individual choices and rights. As technology joins forces with sexual liberty, it is not difficult to understand why the public accepts the latest novelty from the reproductive industry. As a result, many find Catholic teaching behind the times and incomprehensible, if not downright anti-scientific. In fact, this coupling of reproductive liberty (will) with reproductive technology (power) echoes the famous dictum “will to power” Nietzsche predicted would characterize post-modern societies. When liberty becomes absolute and technology unchecked, transhumanism is the logical outcome. As a response to these nihilistic tendencies, the paper will end with a critique drawing from theological insights.

CONTENTS
Preface i
Chapter I
The Story in Your Head: Tomoceuszkakatiti and Gyugyu 1
Chapter II
How Thought Experiments Move Us: The Samaritan and His Neighbours 16
Chapter III
What Makes a Thought Experiment? 34
Chapter IV
Thought Experiments in Practical Philosophy and Bioethics 75
Chapter V
The Experience Machine 93
Chapter VI
The Last Man Argument 129
Chapter VII
The Trolley Problem 158
Chapter VIII
The Violinist Analogy 213
Conclusion 246
Notes 248

The purpose of the research is to demonstrate how the practice of abortion in India involves state intervention in women’s personal lives. I demonstrate how significant contradictions arise in state practice towards women’s access to abortion. I discuss the implications of these contradictions for women. Moreover the sensitive issue of female feticide, which is the product of gender inequality, has been highlighted to show how this practice is culturally embedded and are generated indirectly by some of the state policies.
This research shows how abortions in India are often a breach of reproductive rights of women, and merely serve as a tool to address the concern about population explosion. Moreover the state has imposed the 1994 Pre Conception and Pre-natal Diagnostic Techniques Act to prohibit sex selective abortions from above, without bringing changes from below, which is making the law stringent implications ineffective.

With increased frequency, reproductive technologies are placing prospective parents in the position of choosing whether to bring a disabled child into the world. The most well-known objection to the act of “selecting against disability” is known as the Expressivist Argument. The argument claims that such acts express a negative or disrespectful message about disabled people and that one has a moral reason to avoid sending such messages. We have two primary aims in this essay. The first is to critically examine the standard Expressivist Argument, which we analyze in terms of the expression of ableist attitudes. We distinguish three interpretations of the argument and argue that each version faces serious objections. Our second aim is to articulate two distinct but closely related arguments that also pertain to expressed ableist attitudes. The Expressive Harms Argument maintains that there is a moral reason to avoid actions that give rise to the perception of ableist attitudes in cases where this is likely to have negative consequences for disabled people. The Ableist Motivation Argument speaks against selecting against disability in cases where one would be motivated by ableist attitudes. While these two arguments face various objections, we seek to establish that they are more promising than the most natural interpretations of the Expressivist Argument.

State regulation of reproductive practices secure the hetero- sexual infrastructure of kinship through means that include elitization, institutional hostility, and plain criminalization. This article draws on personal experiences of gay fathers through transnational gestational surrogacy in Spain to show the extent to which that is the case even in those contexts where some gay and lesbian kinship rights are available. Public and aca- demic debates on the possible regulation of gestational surro- gacy will be analyzed through the lens of Gayle Rubin’s intervention in the sex wars that divided feminism in the 1980s, with which contemporary anti-surrogacy movements show crucial genealogical links. In addition, in order to unearth some gendered assumptions on the ahistorical link between surrogacy and motherhood, the role of the gestational carrier will be read in relation to the figure of the “bad mother.”

In this paper, I reconsider David Benatar’s primary argument for anti-natalism—the asymmetry argument—and outline a three-step process for rejecting it. I begin in Part 2 by reconstructing the asymmetry argument into three main premises. I then turn in Parts 3-5 to explain how each of these premises is in fact false. Finally, I conclude in Part 6 by considering the relationship between the asymmetry argument and the quality of life argument in Benatar’s overall case for anti-natalism and argue that it is the latter argument that is actually doing the work. In this sense, the asymmetry argument is not only unsuccessful in generating Benatar’s anti-natalist conclusion, it is also unnecessary as well.

Preimplantation genetic diagnosis (PGD) is taken to mark the starting-point of a new phase in human reproduction, where the possibility of choosing children on genetic grounds without having to resort to dangerous or ethically controversial procedures (such as abortion) will gradually increase. Ethical and political issues actualised by this development are addressed.
The discussion touches upon issues regarding the moral status of embryos and gametes, the moral import of respecting individual autonomy and its implications for the requirement of informed consent in health-care, the connection between disease, disability and the value of life, the moral status of possible future people, and the connection between choosing children and eugenic policies of the past. Practical policy issues are addressed on the basis of this, as well as an empirical case-study of the introduction of PGD in Sweden.
The book ends up in a set of recommendations regarding the management of research on, introduction and routine use of pure selection, both within health care and from the point of view of society as a whole. It is argued that research on such procedures should be allowed and supported by society. However, tight restrictions regarding the clinical introduction of new procedures in this area is highly desirable. A rough model for implementing such restrictions is also presented. It is further asserted that, although reasons of economy and safety should limit the access to pure selection, society should not apply any explicit restrictions based on ideas regarding how different traits affect a person's quality of life. It is stressed that, in order to avoid a resurrection of eugenic policies of the past, the development in this field underlines the need for continued and strengthened public support to the sick, disabled and mentally retarded.

Keywords: assisted procreation, bioethics, embryo experimentation, eugenics, genetic testing, in vitro fertilisation, medical ethics, medical genetics, polar body biopsy, preconception diagnosis, preimplantation genetic diagnosis, prenatal diagnosis, public policy, reproductive medicine, research ethics, sex preselection.

Many people believe that the abortion debate will end when at some point in the future it will be possible for fetuses to develop completely outside the womb. Ectogenesis, as this technology is called, would make possible to reconcile pro-life and pro-choice positions. That is because it is commonly believed that there is no right to kill the fetus if it can be detached alive and gestated in an artificial womb. Recently Eric Mathison and Jeremy Davis defended this position, by arguing against three common arguments for a right to the death of the fetus. I claim that their arguments are mistaken. I argue that there is a right to the death of the fetus because gestating a fetus in an artificial womb when genetic parents refuse it violates their rights not to become a biological parent, their rights to genetic privacy and their property rights. The right to the death of the fetus, however, is not a woman's right but genetic parents' collective right which can be used only together.

Although Jainism has been largely absent from discourses in bioethics and religion, its rich account of life, nonviolence, and contextual ethical response has much to offer the discussion within and beyond the Jain community. In this essay, I explore three possible reasons for this discursive absence, followed by an analysis of medical treatment in the Jain tradition-from rare accommodations in canonical texts to increasing acceptance in the post-canonical period, up to the present. I argue that the nonviolent restraint required by the ideal of ahiṃsā is accompanied by applied tools of carefulness (apramatta) that enable the evolution of medicine. These applied tools are derived from the earliest canonical strata and offer a distinct contribution to current bioethical discourses, demanding a more robust account of: (1) pervasive life forms; (2) desires and aversions that motivate behavior; (3) direct and indirect modes of harm; and (4) efforts to reduce harm in one's given context. I conclude by examining these tools of carefulness briefly in light of contemporary Jain attitudes toward reproductive ethics, such as abortion and in vitro fertilization.

Introductory courses dealing with sex, gender and sexuality are usually quite biased, going as far as to deny the reality of biology. Drawing on the Catholic tradition (Aquinas), this article presents an accessible argument aimed at restoring deliberative balance in the classroom.

Commercial* surrogacy* is* a* challenging* contemporary* issue* that* raises* various* concerns*
because* it* commodifies* the* female* body* in* a* new* way.* It* is* now* becoming* increasingly*
common*for*couples*from*the*Global*North*to*seek*out*gestational*surrogates*in*the*Global*
South.* These* transnational* commercial* surrogacy* arrangements* raise* questions* about* the*
surrogates’*rights*to*bodily*integrity,*as*well*as*patient*rights*and*health*policy,*immigration*
and*citizenship,*race,*power,*gender,*consent,*and*agency*(Pande*2010,*Bailey*2011).*I*explore*
these* questions* in* greater* detail* by* reviewing* the* literature* on* the* rights* and* bioethics*
discourse* of* transnational* surrogacy* in* the* Indian* context.* I* also* examine* contemporary*
issues* concerning* the* intersectionality* of* transnational* commercial* surrogacy* from* a*
feminist* perspective,* especially* the* commodification* of* the* “othered”* reproductive* female*
body.

Noninvasive prenatal testing (NIPT), a new technology that uses cell-free fetal DNA in maternal plasma to detect fetal aneuploidies, is currently entering clinical practice. NIPT offers great clinical benefits as it is much more accurate than current
screening, allows earlier testing, and eliminates the risk of miscarriage associated with amniocentesis and chorionic villus
sampling (CVS). In the future, it may become accurate enough to replace invasive testing. To date, no attention has been given
in the literature to the role that earlier testing through NIPT might play in the context of religious traditions with particular
attitudes toward abortion, such as in Muslim communities. This article presents some Islamic views regarding fetal
development and abortion as well as some recent legislative developments surrounding abortion for fetal conditions, focusing
on Iran and Saudi Arabia. It then offers a discussion of possible implications of NIPT for Muslim communities, such as its
potential to allow access to diagnostic information before “ensoulment,” the point of fetal development at which the fetus is
bestowed the moral status of a human being. The possible impact of early access to information on the evolution of legislation
surrounding abortion for fetal conditions is also discussed. Finally, we suggest future research directions based on empirical
studies with women, partners, health professionals, and religious authorities in Muslim countries and in countries with a
Muslim majority in order to explore their preferences and attitudes regarding the future implementation of NIPT within those
communities.