Human uterus transplantation is currently under investigation as a treatment for uterine infertility. Without a uterus transplant, the options available to women with uterine infertility are adoption or surrogacy; only the latter has the potential for a genetically related child. UTx will offer recipients the chance of having their own pregnancy. This procedure occurs at the intersection of two ethically contentious areas: assisted reproductive technologies and organ transplantation. In relation to organ transplantation, UTx lies with composite tissue transplants such as (...) face and limb grafts, and shares some of the ethical concerns raised by these non-life saving procedures. In relation to ART, UTx represents one more avenue by which a woman may seek to meet her reproductive goals, and as with other ART procedures, raises questions about the limits of reproductive autonomy. This paper explores the ethical issues raised by UTx with a focus on the potential gap between women's desires and aspirations about pregnancy and the likely functional outcomes of successful UTx. (shrink)

ABSTRACT Many people now believe that human reproductive cloning – once sufficiently safe and effective – should be permitted on the grounds that it will allow the otherwise infertile to have children that are biologically closely related to them. However, though it is widely believed that the possession of a close genetic link to our children is morally significant and valuable, we argue that such a view is erroneous. Moreover, the claim that the genetic link is valuable is pernicious; it (...) tends to give rise to highly undesirable consequences, and therefore should be combated rather than pandered to. The emphasis on the genetic is unwarranted and unfortunate; rather than giving us moral reason to support reproductive cloning in the case of infertility, the fact that cloning requests are likely to be motivated by the genetic argument gives us reason to oppose its availability. (shrink)

As the price of pharmaceuticals and biologicals rises so does the number of patients who cannot afford them. In this article, we argue that physicians have a moral duty to help patients access affordable medicines. We offer three grounds to support our argument: (i) the aim of prescribing is to improve health and well-being which can only be realized with secure access to treatment; (ii) there is no morally significant difference between medicines being unavailable and medicines being unaffordable, so the (...) steps physicians are willing to take in the first case should extend to the second; and (iii) as the primary stakeholder with a duty to put the individual patient’s interests first, the medical professional has a duty to address cost-barriers to patient care. In articulating this duty, we take account of important epistemic and control conditions that must be met for the attribution of this duty to be justified. (shrink)

Not all forms of human fragility or vulnerability are unavoidable. Sometimes we knowingly and intentionally impose conditions of vulnerability on others; and sometimes we knowingly and intentionally enter into and assume conditions of vulnerability for ourselves. In this article, I propose a presently overlooked basis on which one might evaluate whether the imposition or assumption of vulnerability is acceptable, and on which one might ground a significant class of vulnerability-related obligations. Distinct from existing accounts of the importance of promoting autonomy (...) in conditions of vulnerability, this article offers a preliminary exploration of the nature, role, and importance of resilience promotion, its relationship to autonomy promotion, and its prospects for improving human wellbeing in autonomy inhibiting conditions. (shrink)

This paper urges reconsideration of analyses of the alternatives to reproductive uterus transplantation (UTx). I focus here specifically on the adoption alternative. Importantly, my purpose is not to oppose UTx provision. Rather, it is to propose ways in which ethical analysis and provision of UTx can potentially accommodate the concerns discussed here. I argue that the adoption alternative to UTx is too readily dismissed, and that this is a dismissal with significant moral costs. I suggest that the radical nature of (...) UTx as a form of assisted reproduction calls for an equivalently radical socio‐moral agenda for reform and transformation of adoption law, policy and practice, as well as of the norms that prevail within our presently strongly bio‐normative reproductive context. In doing so I widen the ethical frame of responsible provision of assisted reproduction to encompass not just obligations towards donors and recipient, but also our broader social responsibilities to ensure that we are doing our best to meet the significant needs of some of the most vulnerable members of our society. (shrink)

OBJECTIVES: This article presents an original definition of surgical innovation and a practical tool for identifying planned innovations. These will support the responsible introduction of surgical innovations. BACKGROUND: Frameworks developed for the safer introduction of surgical innovations rely upon identifying cases of innovation; oversight cannot occur unless innovations are identified. However, there is no consensus among surgeons about which interventions they consider innovative; existing definitions are vague and impractical. METHODS: Using conceptual analysis, this article synthesizes findings from relevant literature, and (...) from qualitative research with surgeons, to develop an original definition of surgical innovation and a tool for prospectively identifying planned surgical innovations. The tool has been developed in light of feedback from health care professionals, surgeons, and policy makers. RESULTS: This definition of innovation distinguishes between variations, introduction of established interventions, and innovations in surgical techniques or use of devices. It can be applied easily and consistently, is sensitive to the key features of innovation, is prospective, and focuses on features relevant to safety and evaluation. The accompanying tool is deliberately broad so that appropriate supports may, if necessary, be provided each time that a surgeon does something "new". CONCLUSIONS: The definition presented in this article overcomes a number of practical challenges. The definition and tool will be of value in supporting responsible surgical innovation, in particular, through the prospective identification of planned innovations. (shrink)

Attempts to explain the intuitive wrongfulness in alleged ‘wrongful life’ cases commonly do so by attributing harmful wrongdoing to the procreators in question. Such an approach identifies the resulting child as having been, in some sense, culpably harmed by their coming into existence. By contrast, and enlarging on work elsewhere, this paper explores the relevance of procreative motivation, rather than harm, for determining the morality of procreative conduct. I begin by reviewing the main objection to the harm-based approach, which arises (...) out of Derek Parfit's analysis of the non-identity problem and its implications for preconception cases. Most attempts to avoid the non-identity objection adopt either an impersonal harm approach or draw on some version of a metaphysical modal counterpart theory to defend a person-affecting harm account. But here I develop an alternative view. The proposed account construes the wrongness in the considered cases as ‘evil’ rather than harm, and the type of evil in question as being of a non-grievance, welfare-connected, collective kind. Understanding the wrongness in this way offers a basis for the view that it matters morally why we procreate, and not just whether or how we do so. (shrink)

Human uterus transplantation (UTx)—the most radical and experimental of all current forms of assisted reproduction—gives rise to a range of complex ethical questions, including those related to individual safety, risk, and informed consent. I have argued elsewhere that the wider social impacts and implications of UTx provision must form part of a comprehensive ethical analysis. My socio‐moral critique of UTx provision has been responded to with a number of defences of possible public funding of UTx. In this paper I examine (...) a select number of those defences. These include: that UTx provision would address harms and needs that already exist and as such have priority; that UTx provision is fully compatible with the needed reform of the procreative context in which it would be offered; that UTx provision would not necessarily involve legitimation or endorsement of what are widely agreed to be problematic pronatalist or geneticist norms; and that UTx provision is required as a matter of justice and consistency with other practices. Importantly, defenders are not proposing a ceteris paribus justification of UTx provision; nor do my responses to their arguments represent a comprehensive opposition to UTx. Rather, my more limited purpose here is to show that whatever other defences may be given of publicly funded UTx provision, those considered here do not ultimately succeed and therefore do not allay the concerns underpinning the original socio‐moral critique. (shrink)

Successful innovative ‘leaps’ in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification (...) as ‘research’, with all of the attendant methodological and ethical obligations—of planning, regulation, monitoring, reporting, and publication—associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical ‘research’, where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients. (shrink)

Advances in reproductive technologies – in particular in genetic screening and selection – have occasioned renewed interest in the moral justifiability of the reasons that motivate the decision to have a child. The capacity to select for desired blood and tissue compatibilities has led to the much discussed 'saviour sibling' cases in which parents seek to 'have one child to save another'. Heightened interest in procreative reasons is to be welcomed, since it prompts a more general philosophical interrogation of the (...) grounds for moral appraisal of reasons-to-parent, and of the extent to which such reasons are relevant to the moral assessment of procreation itself. I start by rejecting the idea that we can use a distinction between 'other-regarding' and 'future-child-regarding' reasons as a basis on which to distinguish good from bad procreative reasons. I then offer and evaluate three potential grounds for elucidating and establishing a relationship between procreative motivation and the rightness/wrongness of procreative conduct: the predictiveness, the verdictiveness, and the expressiveness of procreative reasons. (shrink)

Increasing philosophical attention has recently focused on questions of the nature of vulnerability, and of the implications of recognizing and responding to vulnerability in human agents and subjects. Within that field of interest, explorations and analyses of the specific vulnerability of children have raised many interesting questions regarding the nature of childhood and the vulnerability-responsive obligations of parents. By contrast, there has been no philosophical recognition or discussion of parental vulnerability within the parent-child relationship. In this paper I seek to (...) address that theoretical gap, exploring the distinct ways in which parents are vulnerable qua parents, as well as some of the normative implications that follow from a recognition of that vulnerability. These implications include claims of a vulnerability-based foundation for extensive parental authority over children, and the significant role of expanded social structures and mechanisms to more adequately support the parenting of our children. (shrink)

It has been suggested that there is a troubling antagonism between the potential goods afforded for parents in the parent–child relationship, and the goods of childhood. Indeed, the problem appears deep: on one way of framing it the problem is not merely that realisation of the goods of parenting for parents is incompatible with realisation of the goods of childhood for children; it is that realisation of the parental goods of parenting is dependent on precisely what it is that makes (...) childhood bad for children, namely their dependency and vulnerability.In this paper I consider this supposed ‘vulnerability paradox’, as I will refer to it. I argue for a re-assessment and revaluation of the vulnerability in the parent–child relationship by developing an account of the crucial role that vulnerability plays in underpinning and facilitating what is a core – but as yet unrecognised – good of that relationship for both parents and children: namely what I call the good of ‘mutual reflexive co-constitution’ that the relationship enables. (shrink)

Edited by Lisa Cassidy and Mianna Lotz, Philosophies of Adoption: Perspectives and Reflections explores contemporary philosophical analysis of adoption, providing insight into new and underexplored topics in the field. Three scholarly developments are central to the emerging philosophical discourse on adoption explored in this volume: a problematizing of the adoption triangle or "triad", a critique of the so-called “bio-normative family", and an attention to specific issues in transracial and First Nations adoption. The book’s contributors expand on all three of these (...) areas by addressing a range of questions—How does being adopted shape self-knowledge and identity? What challenges arise at the intersection of race and adoption? What can be learned about epistemic justice, identity, and belonging from transracial adoption? What are the narratives told about adoption?—to show how current conditions and lived adoptee experiences give new shape, meaning, and importance to philosophical thinking about adoption. Showcasing a diversity of styles and standpoints, and organized into three core themes—situating adoption, knowing adoption, and telling adoption—this book grapples with the adoption experience, historical and recent developments in adoption practice, and emerging directions in philosophical scholarship. (shrink)

In this paper I suggest a number of reasons for concluding that Australia's existing Plant Intellectual Property system is incompatible with the provision of adequate protection of ownership of indigenous peoples' traditional plant knowledge.