Both the diagnosis and medical treatment of gender dysphoria —particularly in children and adolescents—have been the subject of significant controversy in recent years. In this paper, we outline the means by which GD is diagnosed in children and adolescents, the currently available treatment options, and the bioethical issues these currently raise. In particular, we argue that the families and healthcare providers of children presenting with GD currently face two main ethical dilemmas in decision making regarding treatment: the pathway dilemma and (...) the consent dilemma. (shrink)

This article argues that a particular metaphysical model permeates cultural practices surrounding pregnancy: the foetal container model. Widespread uncritical reliance on this view of pregnancy has been highly detrimental to women's liberty and reproductive autonomy. In this article, I extend existing critiques of the medical treatment of pregnant women to the context of the burgeoning commercial surrogacy industry. In doing so, I aim to show that our philosophical analysis in both spheres is constrained by the presupposition that the foetus and (...) pregnant woman are metaphysically and ethically distinct entities. By exploring the similarities and differences between the expectations placed on pregnant women in these two spheres, I show that the foetal container model is not a homogeneous understanding of pregnancy applied consistently across contexts; rather, it has been used to justify various practices and attitudes toward pregnancy and pregnant women through different moral frameworks, in the service of different overarching aims. (shrink)

Gender dysphoria (GD) is marked by an incongruence between a person’s biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called “wait-and-see” approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of a “third pathway” for the (...) diagnosis and treatment of GD in youths. To make our case, we draw on a recent development in bioethics: the phenomenological approach. Scholars such as Slatman and Svenaeus have argued that the extent to which the body can (or should be) manipulated or reconstructed through medical intervention is not only determined by consideration of ethical frameworks and social and legal norms. Rather, we must also take account of patients’ personal experience of their body, the personal and social values associated with it, and their understanding of its situation in their life: their narrative identities. We apply this phenomenological approach to medicine and nursing to the diagnosis and treatment of GD in youth. In particular, we discuss Zahavi and Martiny’s conception of the phenomenological interview, in order to show that narrative techniques can assist in the process of gender identification and in the treatment of youth presenting with GD. We focus on two case studies that highlight the relevance of a narrative-based interview in relations between patients, HCPs, and family, to expose the influence of social ideologies on how young people presenting with GD experience their bodies and gender. (shrink)

Assisted reproduction often involves biological contributions by third parties such as egg/sperm donors, mitochondrial DNA donors, and surrogate mothers. However, these arrangements are also characterised by a biological relationship between the child and at least one intending parent. For example, one or both intending parents might use their own eggs/sperm in surrogacy, or an intending mother might conceive using donor sperm or gestate a donor embryo. What happens when this relationship is absent, as in the case of 'double‐donor surrogacy' arrangements (...) (DDS)? Here, a child is conceived using both donor eggs and sperm, carried by a surrogate, and raised by the commissioning parents. In this paper, I critically examine proposals to allow DDS in the United Kingdom, and the intentionalist justification for treating this practice distinctly (morally and legally speaking) from private adoption. I argue that the intentionalist approach cannot plausibly justify such a distinction and that other approaches to moral parenthood are also unlikely to succeed. (shrink)

Surrogacy and adoption are both family-making measures subject to extensive domestic and international regulation. In this nationally representative survey study (N = 1552), we explore public attitudes to various forms of surrogacy and adoption in the United Kingdom, in response to an early proposal to allow “double donor” surrogacy as part of the ongoing legal reform project. We sought to both gauge public moral support for adoption and surrogacy generally, the effect that prospective parents’ fertility had on this support, and (...) the extent to which the public would find equivalencies between “double donor” surrogacy (DDS) and planned private adoption (PPA) to be morally significant. Our findings indicate that whilst there is broad baseline support for all forms of adoption and surrogacy, this support increases significantly when one or both prospective parents are infertile. These findings also suggest that the language in which a family-making arrangement is characterized has a greater influence on moral support for the arrangement than practical features such as the biological relationship (or absence thereof) between one/both parents and the child. (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)

In their recent paper ‘Is pregnancy a disease?’, Anna Smajdor and Joona Räsänen argue in the affirmative, highlighting features shared by both pregnancy and paradigmatic diseases. In particular, they point to the harmful symptoms and side effects of pregnancy, and the provision of medical treatment to both pregnant patients and those aiming to avoid pregnancy. They consider both subjectivist and objectivist approaches taken by philosophers of health in defining disease, and point out that neither approach convincingly excludes pregnancy. Finally, they (...) present a normative case for treating pregnancy as a disease, suggesting that this attitude could promote preventive provision of contraception and abortion, and encourage respect for (and better treatment of) patients’ suffering during pregnancy. In this response, I challenge various parts of Smajdor and Räsänen’s argument, and cast doubt on the normative benefits of their approach. (shrink)

ABSTRACT Most existing literature on the ethics of full ectogenesis has proceeded under the presupposition that science will at some point produce sophisticated technologies for full‐term gestation (from embryo to infant) outside the human womb, delivering neonate health outcomes comparable with (or even superior to) biological gestation. However, the development of this technology—as opposed to the support systems currently being advanced—would require human subject experiments in embryo‐onwards development using ectogenic prototypes. Literature on ectogenic research ethics has so far focused on (...) ‘backwards’ development of partial ectogenesis: incubation and ectogestation technologies that would allow the support of earlier and earlier neonates and foetuses. However, little has been said about the ethics of ‘forwards’ development of (partial or full) ectogenesis, involving the development of embryos and foetuses in prototype environments. Such a prototype might allow us to produce a gestateling or live neonate from a human embryo, but with poorer expected development and health outcomes than from biological gestation; it might also produce only gestatelings (healthy or otherwise) before the technology was developed to a stage where full‐term gestation was achievable. This paper explicates some of the ethical issues that this raises for the development of ‘full’ ectogenesis, and presents prima facie reasons to consider this research problematic and therefore to require extensive further argument in its defence. (shrink)

In this paper, I explore the ways in which consideration of adolescent parents forces us to confront and question common presuppositions about parental rights. In particular, I argue that recognising the right of adolescent mothers not to be forcibly separated from their newborn children justifies rejecting the notion that parental rights are all acquired in the same manner and acquired as a ‘bundle’ of concomitant moral rights. I conclude that children and adolescents who conceive and give birth have some parental (...) rights concerning their newborn children – in particular, the right not to be forcibly separated from those children – even if they do not have the ‘full complement’ of parental rights as we generally characterise these. (shrink)

A number of countries and states prohibit surrogacy except in cases of “medical necessity” or for those with specific medical conditions. Healthcare providers in some countries have similar policies restricting the provision of clinical assistance in surrogacy. This paper argues that surrogacy is never medically necessary in any ordinary understanding of this term. The author aims to show first that surrogacy per se is a socio-legal intervention and not a medical one and, second, that the intervention in question does not (...) treat, prevent, or mitigate any actual or potential harm to health. Legal regulations and healthcare-provider policies of this kind therefore codify a fiction—one which both obscures the socio-legal motivations for surrogacy and inhibits critical examination of those motivations while mobilizing normative connotations of appeals to medical need. The persisting distinction, in law and in moral discourse, between “social” and “medical” surrogacy, is unjustified. (shrink)

Some National Health Service healthcare boards in the UK will approve a request for female sterilisation only if the patient first accepts a trial period of 1 year with an intrauterine device (IUD), a form of long-acting reversible contraception. In this article, I argue that this requirement is not justified by appeal to any of (or any combination of) promotion of informed consent, paternalistic concerns regarding patient regret in later life and health service budgetary considerations. Informed consent and patient autonomy (...) may be promoted by a mandatory waiting period, but the concomitant imposition of an IUD trial during this period cannot be justified on these grounds. As long as elective vasectomy is offered by the healthcare system, elective female sterilisation should be accessible under reasonably similar—even if not identical—conditions. (shrink)

Ashley’s response to our recent paper argues that a fuller appreciation of the available clinical data, of the rights of children to autonomy, and of the primary purpose of gender-affirming endocrine treatment supports the rejection of both the pathway and consent dilemmas for the treatment of gender dysphoria, as raised in this journal. In this response, we highlight certain misrepresentations of our argument, and defend our conclusions against Ashley’s main objections.

In this paper, I offer a critique of (actual and possible) causal theories of parenthood. I do not offer a competing account of who incurs parental obligations and why; rather, I aim to show that there are fundamental problems for any account of who acquires parental obligations and why by appeal to causal responsibility for a child’s existence. I outline and justify three criteria that any plausible causal account of parental obligation must meet, and demonstrate that attempting to fulfil all (...) three criteria simultaneously will give rise to one or both of two potentially insurmountable dilemmas. (shrink)

The economic crash of 2008 demonstrated the fragility of financial systems throughout the world; COVID-19, as the first pandemic in over a century to wreak global havoc, has demonstrated the fragility of healthcare systems. At the time of writing, the virus has been with us for a little over a year, and concerted vaccination efforts have begun. At the same time, several variants (some significantly more infectious than others) of SARS-CoV2, the virus that causes COVID-19, have emerged in different countries, (...) sparking a new wave of border closures and local lockdowns, and a new wave of debates over the right way for governments and individuals alike to respond to the pandemic. The response of governments around the world has been far from synchronised over the last year, but almost without exception, they have made significant efforts to reduce the public health impact of the pandemic – overall, the preservation of life and health has been prioritised at the cost of material and financial goods and other widely used metrics of socio-political success. In this chapter, I suggest that a taking a care ethics perspective allows us to elucidate the important place of caring duties and caring relationships in ethical evaluation of pandemic management strategies. Government action and public attitudes alike demonstrate that care – concern for the wellbeing of others – has had significant normative force in motivating decision-making and shaping ethical responses to COVID-19. (shrink)

This paper examines the legitimacy of retrospective parental rights-claims through the lens of so-called ‘thwarted father’ cases: men who are unaware of their progeny’s existence until the window for establishing legal parentage (and associated rights) has passed. In some famous cases of thwarted fathers, courts have found that an injustice has been done which must be rectified by awarding retrospective parental rights and custody to those men, even when their genetic child has already lived for some extended period with their (...) adoptive parents. In this paper, I critically examine Norvin Richards’ liberty-based defence of the parental rights of these fathers. He argues that the decision to overturn an adoption in a thwarted father case is justified if we agree that a man’s contribution of sperm was indeed the first act of a parenthood project that he should have had the liberty right to continue. Although Richards’ account might allow us to say that a thwarted father has been wronged, justice cannot demand that the situation be rectified through specific performance (as in cases when property is stolen and justice requires that it be returned). (shrink)

Discusses the ethics of family from a philosophical and practical perspective, engaging law, psychology, and sociology.

Our understanding of what it means to be a parent is shaped by our biological, social, legal, and moral concepts of parenthood. This book combines traditional philosophical methods with research in the broader social sciences and humanities to explore the dilemmas which challenge our understanding of parenthood today.