Since 2000, 11 human uterine transplantation procedures (UTx) have been performed across Europe and Asia. Five of these have, to date, resulted in pregnancy and four live births have now been recorded. The most significant obstacles to the availability of UTx are presently scientific and technical, relating to the safety and efficacy of the procedure itself. However, if and when such obstacles are overcome, the most likely barriers to its availability will be social and financial in nature, relating in particular (...) to the ability and willingness of patients, insurers or the state to pay. Thus, publicly funded healthcare systems such as the UK9s National Health Service (NHS) will eventually have to decide whether UTx should be funded. With this in mind, we seek to provide an answer to the question of whether there exist any compelling reasons for the state not to fund UTx. The paper proceeds as follows. It assumes, at least for the sake of argument, that UTx will become sufficiently safe and cost-effective to be a candidate for funding and then asks, given that, what objections to funding there might be. Three main arguments are considered and ultimately rejected as providing insufficient reason to withhold funding for UTx. The first two are broad in their scope and offer an opportunity to reflect on wider issues about funding for infertility treatment in general. The third is narrower in scope and could, in certain forms, apply to UTx but not other assisted reproductive technologies (ARTs). The first argument suggests that UTx should not be publicly funded because doing so would be inconsistent with governments’ obligations to prevent climate change and environmental pollution. The second claims that UTx does not treat a disorder and is not medically necessary. Finally, the third asserts that funding for UTx should be denied because of the availability of alternatives such as adoption and surrogacy. (shrink)

In this article, I argue that God is authoritative over us because he is our divine, causal parent. As our causal parent, God has duties to relate to us, but he can only fulfill those duties if he has the practical authority to give us commands aimed at our sanctification. From ought-implies-can reasoning, I conclude that God has that authority. After I make this argument, I show how the view has significant advantages over extant arguments for divine authority and can (...) help solve other significant problems in philosophy of religion. (shrink)

The institution of the family and its importance have recently received considerable attention from political theorists. Leading views maintain that the institution’s justification is grounded, at least in part, in the non-instrumental value of the parent-child relationship itself. Such views face the challenge of identifying a specific good in the parent-child relationship that can account for how adults acquire parental rights over a particular child—as opposed to general parental rights, which need not warrant a claim to parent one’s biological progeny. (...) I develop a view that meets this challenge. This Project View identifies the pursuit of a parental project as a distinctive non-instrumentally valuable good that provides a justification for the family and whose pursuit is necessary and sufficient for the acquisition of parental rights. This view grounds moral parenthood in a normative relation as opposed to a biological one, supports polyadic forms of parenting, and provides plausible guidance in cases of assisted reproduction. (shrink)

I defend two collapsing or reductionist arguments against Weak Pro-Natalism (WPN), the view that procreation is generally merely permissible. In particular, I argue that WPN collapses into Strong Pro-Natalism (SPN), the view that procreation is generally obligatory. Because SPN conflicts with the dominant view that procreation is never obligatory, demonstrating that WPN collapses into or entails SPN establishes epistemic parity (at least as concerns reproductive liberty) between WPN and Anti-Natalism (AN), the view that procreation is always impermissible. First, I distinguish (...) between two moral goods: the good of procreation itself and the good of procreative potential. Second, I contend that the average moral agent is obligated to assist needy children via adoption, fostering, or other financial or interpersonal support. Third, I present the first collapsing argument: If an agent’s justification for not assisting needy children is preservation of their resources (financial or interpersonal) for their actual future offspring, that justification is preserved only if they eventually and actually procreate. Thus, their eventual procreation is morally obligatory, and SPN follows. Fourth, I present the second collapsing argument, which assumes procreative potential as the relevant good: If an agent’s justification for not assisting needy children is preservation of their resources for their potential future offspring, that justification holds only if (a) the objective or subjective valuation of the opportunity is of the relevant type and valence to justify not assisting needy children and (b) the agent sincerely values the opportunity. Fifth, I argue that (a) is unsatisfied and that while (b) is satisfied in most cases, it entails that most agents are obligated to desire or be behaviorally disposed to pursue procreation for themselves (i.e., SPN). Thus, I conclude that both actual procreation and procreative potential are either insufficient justifications for not assisting needy children or that they entail obligatory pro-reproductive attitudes or behaviors. (shrink)

David Benatar has argued both for anti-natalism and for a certain pessimism about life's meaning. In this paper, I propose that these positions are expressions of a deeply impersonal philosophical temperament. This is not a problem on its own; we all have our philosophical instincts. The problem is that this particular temperament, I argue, leads Benatar astray, since it prevents him from answering a question that any moral philosopher must answer. This is the question of rational authority, which requires the (...) moral philosopher to say why existing human agents have strong practical reasons to comply with the philosopher's dictates. A purely impersonal ethical system can never do this, and this is why Benatar has no answer to this question. (shrink)

It is widely assumed that there is value in the biological tie between parent and child. An implication of this is that adoption is often considered a less desirable alternative to procreation. This paper offers a philosophical defence of adoptive parenthood as a valuable and authentic form of parenthood. While previous defences have suggested that society’s valorisation of the biological tie is unjustified, I argue herein that the conception of the biological tie that features in the normative discourse on parenthood (...) is too narrowly genocentric. Against this genocentric conception, recent work in the philosophy of biology has emphasised the roles of joint determination, dynamic construction, and extended inheritance in development, which I suggest can substantiate a more inclusive conception of the biological tie. Accordingly, I propose that adoptive parents form a rich variety of biological ties with their children, some of which are as heritable and formative as genetic relatedness. (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)

People who are involuntarily childless need to use assisted reproductive technologies if they want to have a genetically related child. Yet, from an ethical point of view it is unclear to what extent assistance to satisfy this specific desire should be warranted. We first show that the subjectively felt harm due to the inability to satisfy this reproductive desire does not in itself entail the normative conclusion that it has to be met. In response, we evaluate the alternative view according (...) to which the satisfaction of this desire is regarded as a way to meet one’s presumed intermediate need for parenthood. This view presupposes that parenthood is one of those general categories of experiences and activities that contribute an irreplaceable value to people’s lives, but the central difficulty is to find those characteristics that mark out parenthood as an irreplaceable constituent of a valuable life. We go on to argue, however, that even if one assumes that parenthood is such an irreplaceable constituent that makes life more valuable, this does not necessarily entail a moral duty to satisfy the desire for genetic parenthood. We conclude that there is a pro tanto obligation to help people conceive a genetically related child (if this is what they prefer), but that this can be outweighed by other moral considerations, such as safety and justice concerns. (shrink)

Many environmental philosophers have argued that there is an obligation for individuals to reduce their individual carbon footprints. However, few of them have addressed whether this obligation would entail a corresponding duty to limit one’s family size. In this paper, I examine several reasons that one might view procreative acts as an exception to a more general duty to reduce one’s individual greenhouse gas emissions. I conclude that none of these reasons are convincing. Thus, if there is an obligation to (...) reduce one’s unnecessary greenhouse gas emissions, then people should also limit the size of their families when they have the means to do so. (shrink)

This paper comes out of a panel honoring the work of Anne Donchin (1940-2014), which took place at the 2016 Congress of the International Network on Feminist Approaches to Bioethics (FAB) in Edinburgh. My general aim is to highlight the contributions Anne made to feminist bioethics, and to feminist reproductive ethics in particular. My more specific aim, however, is to have a kind of conversation with Anne, through her work, about whether reproductive justice could demand insurance coverage for in vitro (...) fertilization. I quote liberally from Anne’s work for this purpose, but also to shower the reader with her words, reminding those of us who knew her well what a wonderful colleague she was. (shrink)

Many philosophers believe that the relationship between a parent and a child is objectively valuable, but few believe that there is any objective value in first creating a child in order to parent her. But if it is indeed true that all of the objective value of procreative-parenting comes from parenting, then it is hard to see how procreative-parenting can overcome two particularly pressing philosophical challenges. A first challenge is to show that it is morally permissible for prospective parents to (...) procreate given that adoption takes us much closer to both environmental and social justice. A second challenge is to show that it is morally permissible for biological parents to parent their biological child given that other prospective parents are willing and able to do a much better job at furthering the child's interests. In this essay, I argue that there is value in procreative-parenting, and that this value is of sufficient magnitude so as to block both the case against procreation and the case in favour of child re-distribution. (shrink)

In February 2016, the Institute of Medicine released a report, commissioned by the United States Food and Drug Administration, on the ethical and social‐policy implications of so‐called three‐parent in vitro fertilization. The IOM endorses commencement of clinical trials on three‐parent IVF, subject to some initial limitations. Also called mitochondrial replacement or transfer, three‐parent IVF is an intervention comprising two distinct procedures in which the genetic materials of three people—the DNA of the father and mother and the mitochondrial DNA of an (...) egg donor—can be used to create a child. Three‐parent IVF would enable a woman with mitochondrial disease to have a genetically related child without transmitting the disease to the child. The possibility for three‐parent children has prompted criticism from many corners. Critics have pointed to ethical issues including safety concerns and risks to children, genetic and germline engineering concerns, the potential exploitation of the third‐parent egg donor, donor anonymity and privacy, and objections to creating babies with three parents, which undermines natural and traditional conceptions of procreation. Additionally, developing the technology would involve experimenting on, manipulating, and disposing of embryos. Although the IOM report considers the ethical concerns about the value of the three‐parent IVF technology, the IOM failed to give due attention to an important objection to the development of this technology: three‐parent IVF lacks the social value necessary to make investment of public resources in it ethical.Unlike the other concerns, this objection is not based on conservativism about new reproductive technologies or default favoritism of the status quo. I argue that the technology does not meet a plausible social value standard to render public research investment into its development ethical. Proponents of three‐parent IVF make inaccurate and exaggerated claims that it will eradicate mitochondrial disease and save lives. Were these claims true, proponents would have a strong case for the social value of the technology. But three‐parent IVF alone will not eradicate mitochondrial disease, and it will not save lives. Rather, it can create healthy lives. As I discuss, the moral distinction is crucial. Most importantly, investment in three‐parent IVF comes at the opportunity cost of researching treatment for mitochondrial disease that would benefit actual, living disease sufferers. (shrink)

The use of genome embryo editing tools in reproduction is often touted as a way to ensure the birth of healthy and genetically related children. Many would agree that this is a worthy goal. The purpose of this paper is to argue that, if we are concerned with justice, accepting such goal as morally appropriate commits one to rejecting the development of embryo editing for reproductive purposes. This is so because safer and more effective means exist that can allow many (...) more prospective parents to achieve the same valued goal and that offer additional benefits. (shrink)

Around the world, millions of children are in need of parental care. In response to this global crisis, some philosophers defend a moral duty for prospective parents to adopt children rather than procreate. Challenges to the duty focus almost exclusively on parents’ desires to have biological children. However, reasons deriving primarily from one’s membership in a social group that favour procreation over adoption or oppose transracial adoptions are largely overlooked. In this dissertation, I examine whether group-based reasons could justifiably override (...) a duty to adopt for prospective parents who are members of racially oppressed groups. I ultimately argue that group-based interests cannot outweigh the needs of existing children for parental care, and thus provide further support for the duty to adopt. My thesis is divided into four chapters. In Chapter 1, I introduce a duty to adopt and argue that it is resilient against a series of proposed defeating conditions and foundational challenges. In Chapter 2, I develop three group-based reasons in favour of procreation that challenge the duty: reparative justice, racial solidarity, and cultural preservation. In Chapter 3, I argue that these reasons do not definitively support procreation over adoption and, instead, seem to favour adopting children either within or outside one’s racial group. I then identify remaining challenges to the duty that take issue with transracial adoptions and place a high value on children’s belonging in same-race families or in their communities of origin. In Chapter 4, I argue that the needs of individual children to receive timely parental care should not be compromised by groups’ interests and that children’s relationships with their communities of origin can be maintained in transracial or extra-communal adoptive placements. (shrink)

Informed consent is a central concept for empirical and theoretical research concerning pregnancy management decisions and is often taken to be one of the more fundamental goals of the profession of genetic counseling. Tellingly, this concept has been seen by disability communities as salutary, despite longstanding critiques made by disability activists, advocates, and scholars concerning practices involved in genetic counseling more generally. In this chapter, we show that the widespread faith in informed consent is misleading and can be detrimental to (...) the practice of genetic counseling as guided by concerns of justice and equity. We proceed in two steps. First, we explain how informed consent is flawed as a practical concept. Second, we show how the inadequacy of informed consent illuminates the animating core of disability critiques of genetic counseling: the issue of ableism. We argue that the problem of ableism cannot be solved with informed consent because it is not merely a problem of information, but also of epistemic schemas. We suggest that what we call critically informed consent is better suited to move genetic counseling from being aware of the problem of ableism to becoming actively anti-ableist. (shrink)

The use of reproductive techniques and the eventual reproductive negligence from the provider of reproductive services gave rise to situations in which the intended parents are deprived of raising a child genetically connected to them. Courts have been dealing with cases of those for years, but have systemically denied claimants compensation, failing to recognise as damage the loss of genetic connection. In 2017, for the first time, the Singapore High Court provided compensation for that damage, labelled “loss of genetic affinity”. (...) This paper will argue that the damage in question is the loss of genetic connection and results from a violation of reproductive rights because a key element of reproductive rights is to have children with whom we keep a genetic bond and raise them. The paper will explain why the arguments classically argued against such compensation are unfounded and it will argue for a compensation covering both patrimonial and non-patrimonial damages. (shrink)

Assessing what counts as infertility has practical implications: access to (state-funded) fertility treatment is usually premised on meeting the criteria that constitute the chosen definition of infertility. In this paper, I argue that we should adopt the expression “involuntary childlessness” to discuss the normative dimensions of people’s inability to conceive. Once this conceptualization is adopted, it becomes clear that there exists a mismatch between those who experience involuntary childlessness and those that are currently able to access fertility treatment. My concern (...) in this article is explaining why such a mismatch deserves attention and what reasons can be advanced to justify addressing it. My case rests on a three-part argument: that there are good reasons to address the suffering associated with involuntary childlessness; that people would decide to insure against it; and that involuntary childlessness is characterized by a prima facie exceptional kind of desire. (shrink)

Abstract:Research into the development of stem cell-derived (SCD) gametes in humans, otherwise known asin vitrogametogenesis (IVG), is largely motivated by reproductive aims. Especially, the goal of establishing genetic parenthood by means of SCD-gametes is considered an important aim. However, like other applications in the field of assisted reproduction, this technology evokes worries about the possibility of creating so-called ‘designer babies.’ In this paper, we investigate various ways in which SCD-gametes could be used to create such preference-matched offspring, and what this (...) would mean for the acceptability of IVG, if it is premised that it is morally problematic to ‘design’ offspring. We argue that IVG might facilitate the creation of preference-matched offspring, but conclude that this should not undermine the moral acceptability of IVG altogether—even if one concedes the premise that creating ‘designer babies’ is morally problematic. In the light of this, we also point at a possible inconsistency for a position that condemns the creation of ‘designer offspring,’ while accepting the various endeavors to have genetically related offspring. (shrink)

Assisted reproduction using donor gametes is a procedure that allows those who are unable to produce their own gametes to achieve gestational parenthood. Where conception is achieved using donor sperm, the child lacks a genetic link to the intended father. Where it is achieved using a donor egg, the child lacks a genetic link to the intended mother. To address this lack of genetic kinship, some fertility clinics engage in the practice of matching the ethnicity of the gamete donor to (...) that of the recipient parent. The intended result is for the child to have the phenotypic characteristics of the recipient parents. This paper examines the philosophical and ethical problems raised by the policy of ethnic matching in gamete donation. I consider arguments for the provision of ethnic matching based on maximising physical resemblance and fostering ethnic identity development. I then consider an argument against ethnic matching based on the charge of racialism. I conclude that while the practice of ethnic matching in gamete donation could promote positive ethnic identity development in donor-conceived children from historically subjugated ethnic minorities, it also risks endorsing the problematic societal attitudes and assumptions regarding ethnicity that enabled such subjugation in the first place. (shrink)

I am grateful to James Cordeiro, Timothy Murphy, Heloise Robinson and Teresa Baron for their perceptive and stimulating comments on my article in this journal. In what follows, I seek to respond to some of the main points raised in each commentary.

The institution of the family and its importance have recently received considerable attention from political theorists. Leading views maintain that the institution's justification is grounded, at least in part, in the non-instrumental value of the parent–child relationship itself. Such views face the challenge of identifying a specific good in the parent–child relationship that can account for how adults acquire parental rights over a particular child – as opposed to general parental rights, which need not warrant a claim to parent one's (...) biological progeny. I develop a view that meets this challenge. This Project View identifies the pursuit of a parental project as a distinctive non-instrumentally valuable good that provides a justification for the family and whose pursuit is necessary and sufficient for the acquisition of parental rights. This view grounds moral parenthood in a normative relation as opposed to a biological one, supports polyadic forms of parenting, and provides plausible guidance in cases of assisted reproduction. (shrink)

Following the Second Summit on Human Gene Editing in Hong Kong in 2018, where the birth of two girls with germline genome editing was revealed, the need for a responsible pathway to the clinical application of human germline genome editing has been repeatedly emphasised. This paper aims to contribute to the ongoing discussion on research ethics issues in germline genome editing by exploring key issues related to the initial applications of CRISPR in reproductive medicine. Following an overview of the current (...) discussion on bringing germline genome editing into clinical practice, we outline the specific challenges associated with such interventions and the features that distinguish them from conventional clinical testing of new medical treatments. We then review proposed ethical requirements for initial heritable genome editing, such as the absence of reasonable alternatives, the existence of sufficient and reliable preclinical data, appropriate informed consent, requirements related to safety, and long-term follow-up. (shrink)

I defend two collapsing or reductionist arguments against weak pro-natalism (WPN), the view that procreation is generally merely permissible. In particular, I argue that WPN collapses into strong pro-natalism (SPN), the view that procreation is generally obligatory. Because SPN conflicts with the dominant view that procreation is never obligatory, demonstrating that WPN collapses into or entails SPN establishes epistemic parity (at least as concerns reproductive liberty) between WPN and anti-natalism (AN), the view that procreation is always impermissible. First, I distinguish (...) between two moral goods: the good of procreation itself and the good of procreative potential. Second, I contend that the average moral agent is obligated to assist needy children via adoption, fostering, or other financial or interpersonal support. Third, I present the first collapsing argument: if an agent’s justification for not assisting needy children is preservation of their resources (financial or interpersonal) for their actual future offspring, that justification is preserved only if they eventually and actually procreate. Thus, their eventual procreation is morally obligatory and SPN follows. Fourth, I present the second collapsing argument, which assumes procreative potential as the relevant good: if an agent’s justification for not assisting needy children is preservation of their resources for their potential future offspring, that justification holds only if (a) the objective or subjective valuation of the opportunity is of the relevant type and valence to justify not assisting needy children and (b) the agent sincerely values the opportunity. Fifth, I argue that (a) is unsatisfied and that while (b) is satisfied in most cases, it entails that most agents are obligated to desire or be behaviourally disposed to pursue procreation for themselves (i.e., SPN). Thus, I conclude that both actual procreation and procreative potential are either insufficient justifications for not assisting needy children or that they entail obligatory pro-reproductive attitudes or behaviours. (shrink)

In the past, the Hague Conference on Private International Law has shaped how people can become the legal parents of children born in countries other than their own. It did so by creating the 1993 Hague Convention on Intercountry Adoption. It is now interested in developing a convention on international contract pregnancy. We discuss in this commentary what such a convention would have to include for it to be ethically consistent with the Convention on Adoption.

This paper calls for the development of a method of ectogestation as an emancipatory intervention for women. I argue that ectogestation would have a dual social benefit: first, by providing a gestational alternative to pregnancy, it would create unique conditions to reevaluate one’s reproductive preferences—which, for women, always include gestational considerations—and to satisfy a potential preference not to gestate. Enabling the satisfaction of such a preference is particularly valuable due to the pressures women face to embrace pregnancy as central to (...) their identity, while at the same time being penalised by it. Second, ectogestation would address certain specific negative social implications of gestation and childbirth, which cannot be avoided through social measures as they are caused by the corporeal nature of these phenomena. Finally, I argue that it is unfair to hold ectogestation to a higher standard than other innovations such as modern contraceptives and non-medical egg freezing. (shrink)