Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin pregnancy. I argue (...) that in the case of a twin pregnancy, there are two intuitively plausible claims: abortion is morally permissible, and it is morally wrong to abort just one of the fetuses. But since we should choose morally permissible acts rather than impermissible ones, the two claims lead to another highly implausible claim: the woman ought to abort both fetuses rather than only one. Yet, this does not seem right. A plausible moral theory cannot advocate such a pro-death view. Or can it? I suggest ways to solve this problem and draw implications for each solution. There are no data in this work. (shrink)

In this paper, we explore how the prospect of artificial placenta technology (nearing clinical trials in human subjects) should encourage further consideration of the loss experienced by individuals when their pregnancy ends unexpectedly. Discussions of pregnancy loss are intertwined with procreative loss, whereby the gestated entity has died when the pregnancy ends. However, we demonstrate how pregnancy loss can and does exist separate to procreative loss in circumstances where the gestated entity survives the premature ending of the pregnancy. In outlining (...) the value that can be attached to pregnancy beyond fetal-centric narratives, we illustrate how pregnancy loss, separate to procreative loss, can be experienced. This loss has already been recognised among parents who have experienced an unexpected early ending of their pregnancy, resulting in their child being cared for in neonatal intensive care unit. Artificial placentas, however, may exacerbate these feelings and make pregnancy loss (without procreative loss) more visible. We argue that pregnancy is an embodied state in which gestation is facilitated by the body but gestation itself should be recognised as a process—and one that could be separable from pregnancy. In demarcating the two, we explore the different ways in which pregnancy loss can be understood. Our objective in this paper goes beyond contributing to our philosophical understanding of pregnancy towards practical-orientated conclusions regarding the care pathways surrounding the artificial placenta. We make recommendations including the need for counselling and careful consideration of the language used when an artificial placenta is used. (shrink)

Sometimes it is not us but those to whom we stand in special relations that face transformative choices: our friends, family or beloved. A focus upon first-personal rational choice and agency has left crucial ethical questions regarding what we owe to those who face transformative choices largely unexplored. In this paper I ask: under what conditions, if any, is it morally permissible to interfere to try to prevent another from making a transformative choice? Some seemingly plausible answers to this question (...) fail precisely because they concern transformative experiences. I argue that we have a distinctive moral right to revelatory autonomy grounded in the value of autonomous self-making. If this right is outweighed then, I argue, interfering to prevent another making a transformative choice is permissible. This conditional answer lays the groundwork for a promising ethics of transformative experience. (shrink)

Sometimes it is not us but those to whom we stand in special relations that face transformative choices: our friends, family, or beloved. A focus upon first-personal rational choice and agency has left crucial ethical questions regarding what we owe to those who face transformative choices largely unexplored. In this paper, I ask: under what conditions, if any, is it morally permissible to interfere with to try to prevent another from making a transformative choice? Some seemingly plausible answers to this (...) question fail precisely because they concern transformative experiences. I argue that we have a distinctive moral right to revelatory autonomy grounded in the value of autonomous self-making. If this right is outweighed then, I argue, interfering to prevent another making a transformative choice is permissible. This conditional answer lays the groundwork for a promising ethics of transformative experience. (shrink)

In recent years, an old challenge to informed consent has been rediscovered: the challenge of ignorance. Several authors argue that due to the presence of irreducible ignorance in certain treatments, giving informed consent to these treatments is not possible. The present paper examines in what ways ignorance is believed to prevent informed consent and which treatments are affected by that. At this, it becomes clear that if the challenge of ignorance truly holds, it poses a major problem to informed consent. (...) The paper argues, however, that from both an empirical and a theoretical point of view, it is not convincing that ignorance prevents informed consent. Still, it seems important that the presence of irreducible ignorance is openly discussed during the informed consent process. (shrink)

Pregnancy has a profound impact on individuals’ lives, yet the subjective experience is often absent from the discourse on reproductive rights and ethics. Although pregnancy is an epistemically transformative experience, phenomenology can help us describe common structures in the many different subjective experiences of pregnancy. Doing so shows us that the effects of pregnancy go beyond the physical symptoms; they invade the experience of the self and the world and transform identity. If someone wants to formulate an argument against abortion, (...) they will have to include the existential impact of pregnancy. In this paper I will further explore the impact of pregnancy through a phenomenological analysis of birth and birthmothers and show that the existential impact of pregnancy does not cease to exist after birth. Giving birth fundamentally changes the world of the pregnant person and leads to irreversible changes in identity. Their world will never return to the way it was before pregnancy. Arguments against abortion would have to take these existential implications into account as well. Finally, I will argue that a similar argument will also become relevant in the discourse on ectogenesis. (shrink)

Lange argues that the gestationalist approach to moral parenthood fails due to its implausible reliance on a ‘valuable intimate personal relationship between newborn and gestational procreator’ at birth.1 However, his dismissal of the moral significance of the maternal–fetal connection depends largely on inappropriate analogies to other forms of relationship. Further, Lange targets a very specific framing of the gestationalist view, overlooking the significance that many gestationalist accounts grant to maternal interests and experiences. Finally—perhaps due to this asymmetric focus—the version of (...) the Harm Argument with which he engages also fails to recognise as morally significant the harm of forced separation for parents (and especially gestational mothers). When investigating the purported value of the maternal–newborn relationship, Lange argues (plausibly) that the newborn’s experiences are so limited as to cast doubt on the non-instrumental value of this relationship for the newborn, and on the likelihood of harm to the newborn as a result of the interruption of this relationship. However, Lange grants little significance to the gestational mother’s experience of this relationship or her affect towards the fetus/newborn. He does not engage with literature on the epistemically transformative experience of pregnancy,2 nor, strikingly, does he discuss the possible significance of maternal love at birth. In fact, his paper mentions …. (shrink)

I ask what is required for pregnant trans and gender diverse (TGD) people to receive trustworthy reproductive healthcare which supports their autonomy. My focus is on wanted pregnancies. I understand interpersonal trust as a positive attitude towards the competence and motivation or commitment of a person trusted in a particular role, such as a healthcare professional, and autonomy as self-governance shaped by what one cares about. I conceive of autonomy as relational and potentially enhanced or damaged by social interactions. I (...) argue that mainstream bioethical conceptions of autonomy can accommodate my claims about how the autonomy of pregnant TGD persons can be diminished or supported, especially in relation to trust. I argue that support for the autonomy of pregnant TGD persons requires acknowledgement and understanding of their gender identity and when it is not relevant to their healthcare. My discussion has implications for whether morality requires us to affirm trans identities and what this means in healthcare. I conclude with remarks about what else we can learn by centering the experiences of pregnant TGD persons. (shrink)

Is genuine self‐creation – understood as self‐directed value‐acquisition – possible? Many philosophers think not. I disagree. I explain why a recent attempt to solve the problem fails and use it to motivate an alternative proposal: indirect evaluative voluntarism. Indirect evaluative voluntarism is not only well‐suited to explaining how self‐creation is possible; it also unifies two important aspects of our doxastic lives, viz. responsibility for the acquisition of both evaluative and non‐evaluative beliefs.

Having a child is one of the highest-carbon decisions made by affluent individuals. Does this uncomfortable fact mean they should limit biological family size? This salient question also forces attention to two key issues. One is just how demanding individual climate justice duties are. The other is the danger of ‘ivory tower’ reasoning by privileged philosophers. On some topics, it is imperative carefully to integrate philosophical discussion with sociological and psychological research. Assuming individual climate justice duties include cutting one's carbon (...) impact, the discussion goes as follows. Should affluent couples and individuals have no biological children, because of the carbon cost? Not unless emissions-cutting duties are extremely demanding, or we make dangerous, generalised socio-psychological assumptions. Is there any individual duty to consider carbon impact when determining family size? Yes, because individual emissions-cutting duties are more than trivially demanding. Should all duty-bearers ‘stop at’ some fixed maximum number of biological kids? Not unless that number is one and we are prepared to accept very demanding individual emissions-cutting duties and make problematic sociological assumptions. Finally, the article outlines three further individual duties following from the ‘uncomfortable fact’: to raise good climate citizens, become activists, and cut the family carbon footprint. (shrink)

An important strand in the debate on abortion focuses on the moral status of fetuses. Knowledge of the moral value of fetuses is needed to assess fetuses’ moral status. As Errol Lord argues, acquaintance plays a key role in moral and aesthetic knowledge. Many pregnant persons have acquaintance with their fetus that provides privileged access to knowledge about that fetus’ moral value. This knowledge is (a) very difficult to acquire without being pregnant and (b) relevant for assessing the moral status (...) of fetuses. This has implications for public debate on abortion and the research methods of philosophers working on abortion. (shrink)

Since the late 2000s trans pregnancy has received increasing public and academic attention, and stories of the ‘pregnant man’ have become a media staple. Existing research has critiqued such spectacularization and the supposed tension between maleness, masculinity, and pregnancy that underpins it. Extending that work, this article draws on interview data from an international study of trans reproductive practices and analyzes participants' experiences of being, and expecting themselves to be, perceived in public space not as spectacularly ‘pregnant men’, but as (...) fat men. As a starting point we take the experience of one participant whose heavily pregnant participation in a five-kilometer race prompted the question: ‘Why is the chubby guy running?’ Using Judith Butler's concept of the cultural intelligibility of gender, we ask why the question asked was not: ‘Why is the pregnant guy running?’ We further consider the degree to which pregnant trans people manage their unintelligibility within the matrix of pregnancy, fatness, and trans/gender and how this reveals the limits of gender intelligibility itself. (shrink)

Background Prenatal genetic testing, in particular non-invasive prenatal testing (NIPT), as well as screening for risks associated with pregnancy, and counseling, play pivotal roles in reproductive healthcare, offering valuable information about the health of the fetus to expectant parents. This study aims to delve into the perspectives and experiences of women considering genetic testing and screening during pregnancy, focusing on their decision-making processes and the implications for informed consent. Methods A nationwide qualitative study was conducted in Switzerland, involving in-depth interviews (...) with women who were 1 to 2 years post-partum, covered by basic compulsory Swiss insurance, including women with a migration background. Thematic analysis was employed to identify key themes and patterns in the data. Results The findings underscore the significance of effective communication during prenatal counseling, suggesting that healthcare providers could not only convey technical information but also support women in their decision-making processes. Women need comprehensive information about genetic testing and its implications, as well as the reasons for screening during pregnancy, as there might be a need to bridge knowledge gaps and clarify misconceptions. Furthermore, the study highlights the multifaceted nature of decision-making, with women considering factors such as uncertainty, values, emotional responses, and societal support systems. The concept of acceptance emerged as a crucial theme, with some women expressing their readiness to love and accept their child, regardless of genetic anomalies or disabilities. Conclusion This study offers valuable insights into the perspectives and needs of women regarding prenatal genetic testing, screening, and counseling in Switzerland. It underscores the importance of enhancing the clinical interaction and informed consent process by providing comprehensive information, addressing misconceptions, and supporting women in decision-making about pregnancy management and the management of the child’s health, following prenatal genetic testing, including NIPT. These findings can inform healthcare providers and policymakers in improving the quality of prenatal counseling, ensuring informed consent, and supporting women in making well-informed and meaningful decisions about genetic testing, and on the use of screening during pregnancy. (shrink)

Katie Watson describes her article in this special issue as “a call to bioethicists to recognize the ways we may have undervalued the moral status of women in our analytic frameworks, and to delibe...