In a recent article, Fiona Woollard draws attention to a number of problems, both theoretical and pragmatic, with current discourse around infant feeding. References both to the ‘benefits of breastfeeding’ and ‘harms of formula’ are problematic, since there is no obvious baseline of comparison against which to make these evaluations. Further, she highlights the pragmatic consequences of these linguistic choices. Saying that formula feeding harms babies, for instance, is likely to exacerbate feelings of guilt and shame felt by many mothers (...) who use formula, for various reasons. Since I agree with much that Woollard says, this response is mostly sympathetic, but I wish to draw attention to one point that is largely missing from her analysis. The pragmatic effect of an utterance depends significantly on who is speaking, to whom, and in what context. Thus, we might differentiate between what it is appropriate to say in a professional context, such as an academic journal, from what one might say in a policy document or to a new mother. While we should always be careful about the language that we use, we need not assume that the same language is appropriate in all contexts nor that equal care is always required. (shrink)

Health institutions recommend that young infants be exclusively breastfed on demand, and it is widely held that parents who can breastfeed have an obligation to do so. This has been challenged in recent philosophical work, especially by Fiona Woollard. Woollard’s work critically engages with two distinct views of parental obligation that might ground such an obligation—based on maximal benefit and avoidance of significant harm—to reject an obligation to breastfeed. While agreeing with Woollard’s substantive conclusion, this paper (drawing on philosophical discussion (...) of the ‘right to rear’) argues that there are several more moderate views of parental obligation which might also be thought to ground parental obligation. We first show that an obligation to breastfeed might result not from a general obligation to maximally benefit one’s child, but from what we call ‘choice-specific’ obligations to maximise benefit within particular activities. We then develop this idea through two views of parental obligation—the Dual Interest view, and the Best Custodian view—to ground an obligation to exclusively breastfeed on demand, before showing how both these more moderate views fail. (shrink)

Clarifying the meaning of ethical concepts is fundamental for medical ethics. Many of the best papers in the Journal of Medical Ethics have advanced our understanding of the limits and implications of ethical concepts. This issue includes a number of papers that give us reason to reflect on the use, implications and grounding of some important ethical concepts. The concepts we use are rarely neutral. For example, those arguing against assisted dying are more likely to use terms such as ‘euthanasia’ (...) or perhaps even ‘killing’, while those arguing in favour of it might opt for ‘aid in dying’ or ‘facilitated aid in dying’. Of course, these are different concepts and do not mean the same thing, but the different associations and implications of concepts can weaken or strengthen a position. Woollard analyses the way in which the terms used in public information and discussions about breastfeeding can be morally loaded and thereby cause guilt or detract from the effectiveness of public information.1 She argues that normative concepts such as ‘harm’ or ‘dangerous’ and slogans such as ‘breast is best’ can imply moral duties or criticism when it is unhelpful and inappropriate to do so. She does this by showing how concepts such as ‘harm’ and ‘risk’, …. (shrink)