Contraception

Conservative and liberal approaches to the problem of abortion are oversimplified and deeply flawed. Accepting that the moral status of the conceptus changes during gestation, the author advances a more nuanced perspective. Through applying a form of rules in practice utilitarianism within the context of overall population policy, he provides a compelling ethical and legal framework for regulating contraception and abortion practices.

The ethics of abortion considers whether abortion is immoral. Pro-choice philosophers think that it is not immoral, while pro-life philosophers think that it is. The axiology of abortion considers whether world would be better if the pro-choice or pro-life position is right. While much attention has been given to the ethics of abortion, there has been no attention given to the axiology of abortion. In this article, I seek to change that. I consider various arguments for thinking our world would (...) be better if the pro-choice position or the pro-life position is correct, ultimately concluding that it would be better if the pro-choice position is right. This is unfortunate, however, since there is no good reason to think the pro-choice position is correct. (shrink)

While the Value-Free Ideal of science has suffered compelling criticism, some advocates like Gregor Betz continue to argue that science policy advisors should avoid value judgments by hedging their hypotheses. This approach depends on a mistaken understanding of the relations between facts and values in regulatory science. My case study involves the morning-after pill Plan B and the “Drug Fact” that it “may” prevent implantation. I analyze the operative values, which I call zygote-centrism, responsible for this hedged drug label. Then, (...) I explain my twofold account of value-ladenness, involving the constitutive role of value judgments in science and the social function of facts as political tools. Because this drug fact is ineliminably value-laden in both senses, I conclude that hedged hypotheses are not necessarily value-free. (shrink)

Drucker's contribution succeeds as a handbook of contraceptive history, but I criticize her definition of contraception as too broad, and I argue that a narrower definition undermines her reproductive justice claims.

Several influential organisations have attempted to quantify the costs and benefits of expanding access to interventions-like contraceptives-that are expected to decrease the number of pregnancies. Such health economic evaluations can be invaluable to those making decisions about how to allocate scarce resources for health. Yet how the benefits should be measured depends on controversial value judgments. One such value judgment is found in recent analyses from the Disease Control Priority Network (DCPN) and the Study Group for the Global Investment Framework (...) for Women's and Children's Health. Noting the decrease in the number of pregnancies expected to result from providing access to family planning, DCPN and the Study Group claim that a substantial benefit of such interventions is averting the stillbirths and child deaths that would have resulted from those pregnancies. We argue that health economic analyses should not count such averted deaths as benefits in the same way as saved lives. First, by counting averted stillbirths and child deaths as a benefit but not counting as a cost the lives of babies who survive, DCPN and the Study Group implicitly commit themselves to antinatalism. Second, this method for calculating the benefits of family planning interventions implies that infertility treatments are harmful. Determining how potential people should be treated in health economic analyses will require grappling with population ethics. (shrink)

Much of the discussion surrounding the ethics of abortion has centered around the notion of personhood. This is because many philosophers hold that the morality of abortion is contingent on whether the fetus is a person - though, of course, some famous philosophers have rejected this thesis (e.g. Judith Thomson and Don Marquis). In this article, I construct a novel argument for the immorality of abortion based on the notion of impairment. This argument does not assume that the fetus is (...) a person - indeed, I concede (for the sake of argument) that the fetus is not a person - and hence the morality of abortion is not contingent on whether the fetus is a person. I finish by answering a plethora of objections to my argument, concluding that none of them are successful. (shrink)

In this article, I address what kinds of claims are of the right kind to ground conscientious refusals. Specifically, I investigate what conceptions of moral responsibility and moral wrongness can be permissibly presumed by conscientious objectors. I argue that we must permit HCPs to come to their own subjective conclusions about what they take to be morally wrong and what they take themselves to be morally responsible for. However, these subjective assessments of wrongness and responsibility must be constrained in several (...) important ways: they cannot involve empirical falsehoods, objectionably discriminatory attitudes, or unreasonable normative beliefs. I argue that the sources of these constraints are the basic epistemic, relational, and normative competencies needed to function as a minimally decent health-care professional. Finally, I consider practical implications for my framework, and argue that it shows us that the objection raised by the plaintiffs in Zubik v. Burwell is of the wrong sort. (shrink)

Sterilisation requests made by young, childfree adults are frequently denied by doctors, despite sterilisation being legally available to individuals over the age of 18. A commonly given reason for denied requests is that the patient will later regret their decision. In this paper I examine whether the possibility of future regret is a good reason for denying a sterilisation request. I argue that it is not and hence that decision-competent adults who have no desire to have children should have their (...) requests approved. It is a condition of being recognised as autonomous that a person ought to be permitted to make decisions that they might later regret, provided that their decision is justified at the time that it is made. There is also evidence to suggest that sterilisation requests made by men are more likely to be approved than requests made by women, even when age and number of children are factored in. This may indicate that attitudes toward sterilisation are influenced by gender discourses that define women in terms of reproduction and mothering. If this is the case, then it is unjustified and should be addressed. There is no good reason to judge people’s sterilisation requests differently in virtue of their gender. (shrink)

I will argue that physicians have an ethical obligation to justify their conscientious objection and the most reliable interpretation of the Polish legal framework claims that conscientious objection is permissible only when the justification shows the genuineness of the judgment of conscience that is not based on false beliefs and arises from a moral norm that has a high rank. I will demonstrate that the dogma accepted in the Polish doctrine that the reasons that lie behind conscientious objection in medicine (...) cannot be evaluated or controlled by anyone is based either on a mistaken interpretation of the Constitution or on the unreliable concept of conscience. I will refer to the legal regulations concerning military refusals that require from objectors to reveal and justify their views. Finally, I will demonstrate why conscientious objection under uncertainty does not deserve acceptance, because it is based on a specific version of the precautionary principle. (shrink)

Niektórzy twierdzą, że nawet jeśli ktoś nie wierzy, że embriony lub płody ludzkie mają jakiś szczególnie wyróżniony status moralny, to z ostrożności powinien traktować je tak, jak gdyby miały pełny status moralny. Pokażę, dlaczego takie rozumowanie jest niepoprawne.

„Skoro powszechnie przyjmuje się, że sumienie jest suwerenne, to nie wiadomo, po co lekarz miałby uzasadniać pisemnie swój światopogląd” – napisała Naczelna Izba Lekarska w skardze do Trybunału Konstytucyjnego. Trybunał tę część skargi oddalił w wyroku z 7 października 2015 r., ale stwierdził, że „Celem prowadzenia dokumentacji medycznej nie jest (…) utrwalanie na piśmie poglądów filozoficzno-prawnych lekarza”. Uznał też, że uzasadnienie „powinno mieć charakter medyczny, a nie służyć wyjaśnieniu światopoglądu lekarza, czy też wskazaniu zasady moralnej leżącej u podstaw jego zachowania”. (...) Podobną interpretację akceptuje wielu polskich prawników, twierdząc, że skoro sumienie czy światopogląd lekarza są „indywidualne”, „autonomiczne”, „suwerenne”, to merytoryczne powody odmowy wykonania świadczenia medycznego nie mogą podlegać jakiejkolwiek ocenie i kontroli. (shrink)

Some philosophers have argued for what I call the reason-giving requirement for conscientious refusal in reproductive healthcare. According to this requirement, healthcare practitioners who conscientiously object to administering standard forms of treatment must have arguments to back up their conscience, arguments that are purely public in character. I argue that such a requirement, though attractive in some ways, faces an overlooked epistemic problem: it is either too easy or too difficult to satisfy in standard cases. I close by briefly considering (...) whether a version of the reason-giving requirement can be salvaged despite this important difficulty. (shrink)

I argue that Malthus’s Essay on Population is more a treatise in applied ethics than the first treatise in demography. I argue also that, as an ethical work, it is a highly innovative one. The substitution of procreation for sex as the focus makes for a drastic change in the agenda. what had been basically lacking in the discussion up to Malthus’s time was a consideration of human beings’ own responsibility in the decision of procreating. This makes for a remarkable (...) change also in the approach, namely, the discussion becomes an examination of a well-identified issue, taking cause-effect relationships into account in order to assess possible lines of conduct in the light of some, widely shared and comparatively minimal, value judgements. This is more or less the approach of what is now called applied ethics, at least according to one of its accounts, or perhaps to the account shared by a vast majority of its practitioners. In a sense, both the subject matter, sexuality, was substituted with a more restricted issue, namely reproduction, and the traditional approach, moral doctrine, was substituted with a more modest approach, in Malthus’s own words, the “moral and political science”. Such a drastic transformation brought about a viable framework, for a discussion of ethical issues that were still unforeseen by Malthus, namely those having to do first with the technical feasibility of eugenics programs and secondly with the scientific discovery of genetics as a field of study but also of possible intervention. Malthus’s ethics had obviously enough nothing to say on those unforeseen issues in so far as it was meant to treat just the ‘quantitative’ dimension of procreation, that is, ‘how many’. Later discussions and controversies will arise around different dimensions, that is, not just ‘how many’ but also ‘how healthy, how strong, hoe empowered’, but what Malthus’s lesson could have taught and still can teach to partners defending opposite views in these controversies is that such issues may be framed in a way that possibly avoids unending controversy on incompatible ultimate principles once the strategy is turned upside down and a principle of responsibility becomes the overriding rule in the treatment of such ethical issues. -/- . (shrink)

Benatar’s central argument for antinatalism develops an asymmetry between the pain and pleasure in a potential life. I am going to present an alternative route to the antinatalist conclusion. I argue that duties require victims and that as a result there is no duty to create the pleasures contained within a prospective life but a duty not to create any of its sufferings. My argument can supplement Benatar’s, but it also enjoys some advantages: it achieves a better fit with our (...) intuitions; it does not require us to acknowledge that life is a harm, or that a world devoid of life is a good thing; and it is easy to see why it does not have any pro-mortalist implications. (shrink)

Emergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the right (...) of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists' moral or religious objections. (shrink)

This paper addresses the likely impact on women of being denied emergency contraception (EC) by pharmacists who conscientiously refuse to provide it. A common view—defended by Elizabeth Fenton and Loren Lomasky, among others—is that these refusals inconvenience rather than harm women so long as the women can easily get EC somewhere else nearby. I argue from a feminist perspective that the refusals harm women even when they can easily get EC somewhere else nearby.

Concerning abortion and infanticide, ethics has always seen to each one as quite puzzling an issue. The dilemma expectedly goes like this: “Are they morally good, permissible or acceptable, or are they not?” All three major approaches in ethics, viz. virtue ethics, deontology and consequentialism, have fervently exerted themselves in order to settle both. A virtue ethicist is expected to approach the issue wondering: “Is performing abortion and infanticide indicative of virtues, to wit of character traits that the virtuous agent (...) possesses?” A deontologist would bring the dilemma up for discussion asking: “Is conducting abortion and infanticide in accordance with some moral rule or principle?” To an act utilitarian, on the other hand, the same question would strike as: “Do abortion and infanticide promote the best consequences, to wit those in which happiness is maximized?” All three approaches have been applied to the subject matter ever since the classic era, sadly with no remarkable success and, most of the times, even without the slightest suspicion of the promised rigor. (shrink)