We are all the result of gestation: the process of becoming before birth. The very nature of human gestation, however, has shifted and will continue to shift as a result of technology. Uterus transplantation and ectogestation, and the novel modalities of gestation beyond sex and beyond bodies that they potentially make possible, raise unique conceptual problems that have received little attention. -/- Biotechnology, Gestation and the Law presents the first comprehensive ethico-legal analysis of the nature of (...) gestation and of technologies enabling gestation, offering a concept analysis grounded in ontology, phenomenology, politics, and law. The first three chapters develop a transdisciplinary approach for identifying and exploring the ethical issues raised by uterus transplantation and ectogestation. This addresses the ontological and legal confusion about what gestation is, how we should classify procreative technologies in relation to gestation, and why it is important to have precise classification. The remaining chapters use this framework to undertake a rigorous examination of pressing socio-legal implications of uterus transplantation and ectogestation: who has access to technologies enabling gestation and under what circumstances? Who is/are the parent/s when novel forms of gestation are used? How do these technologies disrupt our notions of reproductive biosex and are they tools of emancipation from gendered roles? This book, and the original conceptual lens it sets out, forges a new direction for legal and social reform directed at addressing the harms of constructed gendered procreative and parenting roles. In speculating about future possibilities, Elizabeth Chloe Romanis brings visibility to the oppressive propagation of biological essentialism that underpins the contemporary regulation of human procreation, and considers how to address this issue now and into the future. (shrink)

Some commentators maintain that gestational surrogates are not ‘mothers’ in a way capable of grounding a claim to motherhood. These commentators find that the practices that constitute motherhood do not extend to gestational surrogates. We argue that gestational surrogates should be construed as mothers of the children they bear, even if they fully intend to surrender those children at birth to the care of others. These women stand in a certain relationship to the expected children: they live in changed moral (...) circumstances by reason of their pregnancy, and they engage in the practices said to define motherhood in the post‐birth context. By contrast, ovum donors and embryo donors are not similarly ‘mothers’ because they do not find themselves involved in these circumstances. Not all women involved in three‐parent in vitro fertilization qualify as mothers either. Given this analysis of mothering, we note that transmen who gestate children are engaged in mothering activity even if they otherwise function as a father to those children. By itself, this defence of the maternity of gestational surrogates does not confer moral title to the children they bear; gestation would not by itself override the contractual arrangements gestational surrogates have made regarding the disposition of their children. This interpretation of gestational surrogates as mothers does, however, undercut cultural understandings of these women as mere ‘vessels’, devoid of entitlement to respect as persons and parents. We also consider the meaning of mothering for ‘brain‐dead’ women kept alive to give birth and for the prospect of extracorporeal gestation. (shrink)

Developments in uterus transplant put assisted gestation within meaningful range of clinical success for women with uterine infertility who want to gestate children. Should this kind of transplantation prove routine and effective for those women, would there be any morally significant reason why men or transgender women should not be eligible for the same opportunity for gestation? Getting to the point of safe and effective uterus transplantation for those parties would require a focused line of research, over and (...) above the study of uterus transplantation for non-transgender women. Some commentators object to the idea that the state has any duty to sponsor research of this kind. They would limit all publicly-funded fertility research to sex-typical ways of having children, which they construe as the basis of reproductive rights. This objection has no force against privately-funded research, of course, and in any case not all social expenditures are responses to ‘rights’ properly speaking. Another possible objection raised against gestation by transgender women is that it could alter the social meaning of sexed bodies. This line of argument fails, however, to substantiate a meaningful objection to gestation by transgender women because social meanings of sexed bodies do not remain constant and because the change in this case would not elicit social effects significant enough to justify closing off gestation to transgender women as a class. (shrink)

INVOcell is an in vivo fertilisation device marketed as an alternative to in vitro fertilisation treatment. In this paper, we explore the ethical implications that arise when this device is framed as a type or process of ‘gestation’. We anticipate several effects that may be of ethical interest: marketing in vivo fertilisation as being comparable to traditional gestation may be misleading and even harmful to its users, but on the other hand, it captures a potential need to acknowledge (...) and be more inclusive of those who wish to identify diverse reproductive experiences as gestative experiences. In light of these insights, we articulate the concept of ‘simulated gestation’ as a novel framework to explain, and potentially accommodate, the diverse ways in which assisted reproductive technologies are shaping people's ideas about—and desires for—gestation. (shrink)

Multiple gestations, or multifetal pregnancies,raise a number of significant policy questionsconcerning the well being of women and the wellbeing of the children fetuses might become.Important questions for feminists pertain notonly to multifetal pregnancy itself, but alsoto the medical interventions associated withthese pregnancies. In this paper, we addressthe questions of how many embryos should betransferred in assisted reproduction, how manyfetuses should remain in a multiple gestation,who should make these decisions, and the needto protect women from overexposure to exogenoushormones. Although we (...) focus on assistedreproduction in the United States, we believethat our suggestions are applicable to othercountries where the technology is comparable. (shrink)

The benefits of full ectogenesis, that is, the gestation of human fetuses outside the maternal womb, for women ground many contemporary authors’ arguments on the ethical desirability of this practice. In this paper, I present and assess two sets of arguments advanced in favour of ectogenesis: arguments stressing ectogenesis’ equality-promoting potential and arguments stressing its freedom-promoting potential. I argue that although successfully grounding a positive case for ectogenesis, these arguments have limitations in terms of their reach and scope. Concerning (...) their limited reach, I contend that ectogenesis will likely benefit a small subset of women and, arguably, not the group who most need to achieve equality and freedom. Concerning their limited scope, I contend that these defences do not pay sufficient attention to the context in which ectogenesis would be developed and that, as a result, they risk leaving the status quo unchanged. After providing examples of these limitations, I move to my proposal concerning the role of ectogenesis in promoting women’s equality and freedom. This proposal builds on Silvia Federici’s, Mariarosa Dalla Costa’s and Selma James’ readings of the international feminist campaign ‘Wages for Housework’. It maintains that the political perspective and provocation that ectogenesis can advance should be considered and defended. (shrink)

In law and common-sense morality, it is generally assumed that adults who meet a minimum threshold of parental competency have a presumptive right to parent their biological children. But what is the basis of this right? According to one prominent account, the right to parent one’s biological child is best understood as being grounded in an intimate relationship that develops between babies and their birth parents during the process of gestation. This paper identifies three major problems facing this view—the (...) explanatory, adjudicatory, and theoretical problems—and explains how an alternative autonomy-based account is capable of avoiding them. (shrink)

Parenting our biological children is a centrally important matter, but how, if it all, can it be justified? According to a contemporary influential line of thinking, the acquisition by parents of a moral right to parent their biological children should be grounded by appeal to the value of the intimate emotional relationship that gestation facilitates between a newborn and a gestational procreator. I evaluate two arguments in defence of this proposal and argue that both are unconvincing.

According to Chloe Romanis, it is worth distinguishing interventions such as surrogacy, uterus transplantation (UTx), and potentially artificial placenta technology, as falling under the genus assisted gestative technologies (AGTs) rather than the more general term assisted reproductive technologies (ARTs). The proposed genus of assisted gestative technologies is a helpful first step in the endeavour to distinguish between the different ethico-legal landscapes across various ‘assisted reproductive technologies.’ Yet, if assisted gestative technologies can be considered a genus of assisted reproductive technologies, we (...) might consider surrogacy, uterus transplantation (UTx), and artificial placenta technology their individual species. Between these various species of AGTs, I would argue, there remains enough ethico-legal diversity to warrant independent discussion about the descriptive and normative functions of each AGT and the relationship between gestation, genetic relatedness, and legal/moral parenthood. (shrink)

This article explores the controversial practice of transnational gestational surrogacy and poses a provocative question: Does it have to be exploitative? Various existing models of exploitation are considered and a novel exploitation-evaluation heuristic is introduced to assist in the analysis of the potentially exploitative dimensions/elements of complex health-related practices. On the basis of application of the heuristic, I conclude that transnational gestational surrogacy, as currently practiced in low-income country settings , is exploitative of surrogate women. Arising out of consideration of (...) the heuristic's exploitation conditions, a set of public education and enabled choice, enhanced protections, and empowerment reforms to transnational gestational surrogacy practice is proposed that, if incorporated into a national regulatory framework and actualized within a low income country, could possibly render such practice nonexploitative. (shrink)

In his article entitled ‘Moral parenthood: not gestational’, Benjamin Lange makes the following central and narrow claim: that moral parenthood cannot be defended fully based on an ‘emotional relationship’ facilitated by gestation.1 By ‘moral parenthood’, Lange appears to mean a moral right to parent the child. The ‘emotional relationship’ under scrutiny seems to be a form of intimate relationship during pregnancy involving an emotional attachment between the pregnant woman (or, in Lange’s terminology, the ‘gestational procreator’) and the newborn. In (...) other words, Lange critiques the view that a moral right to parent a child can be grounded in an emotional relationship, as developed during pregnancy, between the mother and child. Lange discusses the possible emotions of both of them, during pregnancy, and at the time of birth. He notes some problems in seeing this relationship as one that has sufficiently weighty moral importance: it is asymmetrical, for example, and the relationship is not obviously reciprocal. The central claim here is in fact quite easily convincing. It is quite right that emotions alone should not ground a moral right to parent a child. Lange accepts for example that ‘gestational procreators are usually highly emotionally invested in their pregnancy’ (p3),1 and this ‘usually’ …. (shrink)

Anna Smajdor’s proposal for “whole-body gestational donation” (WBGD) rests on a utilitarian analogy: if brain-dead individuals can donate organs, why not their reproductive capacity? This logic, however, triggers a visceral ethical disquiet—a phenomenological uncanniness—that exposes deeper tensions about bodily integrity, gender, and the ontology of death. To interrogate this disquiet, we must move beyond bioethical frameworks of autonomy and utility and ask, what does it mean to reduce a deceased woman’s body to a gestational tool? And how does this proposal (...) reconfigure the boundaries between life, death, and moral personhood? This paper intervenes in bioethical debates by reframing WBGD as not just a question of ethics but of ontology—a violation of the corpse’s ambiguous being and the maternal body’s intersubjective legacy. The paper weaves together perspectives from phenomenology, enactivism, Heideggerian existentialism, and Levinas’ ethics to critically engage with Anna Smajdor’s proposal of using brain-dead women as gestational surrogates. (shrink)

Common sense morality and legislations around the world ascribe normative relevance to biological connections between parents and children. Procreators who meet a modest standard of parental competence are believed to have a right to rear the children they brought into the world. I explore various attempts to justify this belief and find most of these attempts lacking. I distinguish between two kinds of biological connections between parents and children: the genetic link and the gestational link. I argue that the second (...) can better justify a right to rear. (shrink)

Developments in uterus transplant put assisted gestation within meaningful range of clinical success for women with uterine infertility who want to gestate children. Should this kind of transplantation prove routine and effective for those women, would there be any morally significant reason why men or transgender women should not be eligible for the same opportunity for gestation? Getting to the point of safe and effective uterus transplantation for those parties would require a focused line of research, over and (...) above the study of uterus transplantation for non-transgender women. Some commentators object to the idea that the state has any duty to sponsor research of this kind. They would limit all publicly-funded fertility research to sex-typical ways of having children, which they construe as the basis of reproductive rights. This objection has no force against privately-funded research, of course, and in any case not all social expenditures are responses to ‘rights’ properly speaking. Another possible objection raised against gestation by transgender women is that it could alter the social meaning of sexed bodies. This line of argument fails, however, to substantiate a meaningful objection to gestation by transgender women because social meanings of sexed bodies do not remain constant and because the change in this case would not elicit social effects significant enough to justify closing off gestation to transgender women as a class. (shrink)

In this short response, I agree with Cavaliere’s recent invitation to consider ectogenesis, the process of gestation occurring outside the body, as a political perspective and provocation to building a world in which reproductive and care labour are more justly distributed. But I argue that much of the literature Cavaliere addresses in which scholars argue that artificial wombs may produce greater gender equality has the limitation of taking a fixed, binary and biological approach to sex and gender. I argue (...) that in taking steps toward the possibility of more just practices of caregiving and family making, we must look first not to artificial womb technologies but to addressing the ways that contemporary legal and social practices that enforce essentialising, binary ways of thinking about reproductive bodies inhibit this goal. (shrink)

This book explores how and when biology emerged as a science in Germany. Beginning with the debate about organism between Georg Ernst Stahl and Gottfried Leibniz at the start of the eighteenth century, John Zammito traces the development of a new research program, culminating in 1800, in the formulation of developmental morphology. He shows how over the course of the century, naturalists undertook to transform some domains of natural history into a distinct branch of natural philosophy, which attempted not only (...) to describe but to explain the natural world and became, ultimately, the science of biology. (shrink)

The introduction of contraceptive technologies hasresulted in the separation of sex and procreation. Theintroduction of new reproductive technologies (mainlyIVF and embryo transfer) has led not only to theseparation of procreation and sex, but also to there-definition of the terms mother and family.For the purpose of this essay, I will distinguishbetween:1. the genetic mother – the donor of the egg;2. the gestational mother – she who bears and gives birth to the baby;3. the social mother – the woman who raises the (...) child.This essay will deal only with the form of gestationalsurrogacy in which the genetic parents intend to bethe social parents, and the surrogate mother has nogenetic relationship to the child she bears anddelivers. I will raise questions regarding medicalethical aspects of surrogacy and the obligation(s) ofthe physician(s) to the parties involved. I will arguethat the gestational surrogate is a womb to rent,that there is great similarity between gestationalcommercial surrogacy and organ transplant marketing.Furthermore, despite claims to freedom of choice andfree marketing, I will claim that gestationalsurrogacy is a form of prostitution and slavery,exploitation of the poor and needy by those who arebetter off. The right to be a parent, although notconstitutional, is intuitive and deeply rooted.However, the issue remains whether this rightoverrules all other rights, and at what price to theparties involved. I will finally raise the followingprovocative question to society: In the interim periodbetween today''s limited technology and tomorrow''sextra-corporeal gestation technology (ectogenesis),should utilizing females in PVS (persistent vehetativestate) for gestational surrogacy be sociallyacceptable/permissible – provided they have leftpermission in writing? (shrink)

Let me begin by thanking the Journal of Medical Ethics editors and the four commentators for taking time to read, reflect and offer thoughtful comments on my paper. The issues they raise warrant careful attention. Regrettably, I am only able to address some of their key concerns due to space constraints. In my paper, ‘Gestation, Equality and Freedom: Ectogenesis as a Political Perspective’, I outline two sets of critiques of liberal defences of ectogenesis and contend that these defences are (...) limited in their reach and scope. Building on Federici’s,1 and Dalla Costa’s and James’2 readings of the of the international feminist campaign ‘Wages for Housework’, I argue that the value of ectogenesis is to similarly advance a political perspective and a provocation. Framing ectogenesis in these terms enables to critically engage with the physical and social burdens of pregnancy, childbirth and childrearing, which all too often are borne by women. It also allows to demand for better medical and social services for mothers and women more generally, as well as better working and living conditions for these and other disadvantaged groups. Lisa Campo-Engelstein thoughtfully broadens my reading of liberal defences of ectogenesis and contextualises them within the history of ‘reproductive advancements and technologies’.3 She illustrates that …. (shrink)

In this article, we investigate the role of scientific and patient narratives on perceptions of the medical debate around gestational diabetes testing. Among medical scientists, we show that the narrative surrounding GDM testing affirms that future research and data will lead to medical consensus. We call this narrative trajectory the “deferred quest.” For patients, however, diagnosis and their subsequent discovery that biomedicine does not speak in one voice ruptures their trust in medical authority. This new distrust creates space for patients (...) to develop a Frankian quest narrative where they become the protagonist in their story. Additionally, across these different narratives, we observe how character is constructed and employed to negotiate trust. We conclude that healthcare providers should assess the narrative trajectory adopted by patients after diagnosis. Also, we suggest that providers acknowledge the lack of medical consensus to their patients. This veracity would foster women’s sense of trust in their provider as well as allow women to be active interlocutors in a debate that ultimately plays out in their deliberation about their body, pregnancy, and risk. (shrink)

Whole body gestational donation offers an alternative means of gestation for prospective parents who wish to have children but cannot, or prefer not to, gestate. It seems plausible that some people would be prepared to consider donating their whole bodies for gestational purposes just as some people donate parts of their bodies for organ donation. We already know that pregnancies can be successfully carried to term in brain-dead women. There is no obvious medical reason why initiating such pregnancies would (...) not be possible. In this paper, I explore the ethics of whole-body gestational donation. I consider a number of potential counter-arguments, including the fact that such donations are not life-saving and that they may reify the female reproductive body. I suggest if we are happy to accept organ donation in general, the issues raised by whole-body gestational donation are differences of degree rather than substantive new concerns. In addition, I identify some intriguing possibilities, including the use of male bodies–perhaps thereby circumventing some potential feminist objections. (shrink)

In the target article, Kirby (2014) explores conditions under which gestational surrogacy in developing countries (in this case India) may (or may not) be considered as exploitative. The author pro...

This paper argues that we ought to distinguish between ‘assisted’ gestation and ‘delegating’ gestation—and that the relevant difference does not depend on whether it is another human or technological system doing the work.1 In the philosophy of action, there is an important theoretical gap between S ‘helping A to φ’ and S ‘φ-ing on behalf of A’: the former is an instance of joint agency while the latter is an individual’s action. This matters because if the latter counts (...) as an intentional action, then only S is being said to have acted intentionally while, if the former is an intentional action, then both S and A have acted intentionally—which might have consequences for responsibility attributions, for example. To put it brutally, it is the difference between Belarus supporting Putin’s invasion and Belarus doing Putin’s dirty work—and you do not have to be a Russian mother to see that these two alternatives will have very different consequences. In another context, the economics of outsourcing is also built around the same theoretical distinction. But does this matter to gestation and reproduction? It does, argues this paper. Insisting on an ‘assisted’ reproduction framework2–8 reinforces patriarchal stereotypes and continues to put undue burdens on prospective mothers both by perpetuating the stereotype of women as needing help and also by implicating them in an action that might genuinely not be theirs. Delegation, on the other hand, empowers parents—who are in charge, rather than needing help. Furthermore, an action-theoretical delegation framework might be better placed to regulate and anticipate future technological developments, …. (shrink)

The case law surrounding surrogacy, in vitro fertilization, genetic donation, and legal parenthood is notoriously confused. Yet the issues involved in these cases are of fundamental importance to our most basic rights. To make matters worse, ongoing developments in technology continue to push the conceptual limits of both our legal and moral schemes. In this paper I argue that the concept of ‘parenthood’ is deeply ambiguous and attempt to carefully untangle the notion into two distinct concepts – one biological and (...) largely descriptive, and the other social and profoundly normative. I argue that the social notion of parenthood is a complex function of intentions, actions, and emotional states. It is a concept both defined and constrained by social norms. The biological notion of parenthood, for its part, cannot be understood in strictly genetic terms. I offer, instead, a more fleshed out view that treats biological parenthood as a family resemblance concept. Finally, I discuss the role of gestation in the context of a powerful feminist critique and argue that although gestation is a biological phenomenon, it is a mistake to think that its relevance is limited to biology. In fact, what is special about gestation, in the context of parenthood and obligation, is its distinctly social role. By shifting the discussion of gestation away from biology and toward the realm of the social, we can make better sense of the disputes that manifest themselves in the literature and in the law. (shrink)

This article aims to reflect on the process of gestation and to carry out a phenomenological analysis in the light of its fundamental affective conditions: pain and joy. For this, it is necessary to examine the mother-fetus relationship in terms of the division-fusion between the self and otherness. This will enable us to understand how this relationship takes shape after birth, particularly during lactation. To carry out this analysis, we consider the experiences of women who experience these processes. For (...) this reason, we turn to existential phenomenology and feminist phenomenology, since this perspective allows us to understand these experiences in the first person and to conceptualize sexual difference as a condition of possibility and a form of relationship. From this approach, relationships between men and women can be understood as a multiplicity of human bodies that, although different, are deeply interconnected. These bodies are composed of various layers and dimensions, such as sensibility, motility, materiality, affectivity and expressiveness, among others. This allows for a deeper understanding of embodied experience and its relational character. It is important to note that our analysis focuses on women who have explicitly chosen to conceive and become mothers, or who, at the very least, have accepted that this is the case. We understand that pregnancy is experienced differently depending on the circumstances in which it occurs. (shrink)

This article challenges a subtle critique of ectogenesis—what I call the “social coercion argument” (SCA). The SCA holds that if ectogenesis becomes a standard gestational option, those who prefer pregnancy might be pressured into adopting it, thereby infringing on their autonomy and reinforcing inequality. On this view, ectogenesis might not be a morally sound solution to gender inequality. I first analyze the SCA within the liberal framework that underpins it. While its descriptive claim—that future women who prefer pregnancy may face (...) pressure—may be valid, it cannot justify discounting the emancipatory potential of ectogenesis. I then examine some women’s preference for pregnancy over ectogenesis through feminist insights into adaptive preferences (APs). I argue that such preferences may be harmful and shaped by injustice, suggesting that gestational preferences are dynamic, and that addressing gender inequality requires strategies beyond cultural and social inclusivity. I conclude that the SCA’s core concern should be separated from the ethical evaluation of ectogenesis and addressed by continually “levelling up” choices. (shrink)

In an evolving global market of procreation, surrogacy is increasingly practiced and raises many ethical issues in terms of respect of the dignity of women, their bodily integrity and the consideration of the best interests and kinship of the unborn child. Faced with such ethical questions, the legal response in international law was tepid, while that of the States was fundamentally disparate, varying between systems of prohibition or legal framing of this practice and others that tolerate surrogacy but do not (...) regulate it. This article seeks to analyze the different ethical issues raised by surrogacy, then focuses on the various legal trends prohibiting or totally or partially authorizing this practice, and studying the legal treatment reserved by international law to this question. (shrink)

As Jhering pinpoints, the birth of a new right is always painful and as with human birth, it involves a certain amount of violence. It is fair to say that the birth of the recognition of the right to gestational surrogacy is not without its complications. Although the practice has been technically possible since the late seventies, only a minority of States have granted legal recognition. It has been argued that gestational surrogacy constitutes a prior right which States must institutionalize. (...) We will challenge this idea and then we will approach the issue from the perspective of narrative bioethics. It is this perspective, conceived in a certain way, which can not only shed more light but also push the boundaries to a greater extent than two of the most relevant methodologies in biomedical ethics, principlism and casuistry. (shrink)

Assisted conception can be distinguished from assisted gestation.1 These processes have tended to be grouped together under the generic term assisted reproductive technology in the bioethical literature. According to Chloe Romanis, however, it is worth distinguishing interventions such as surrogacy, uterus transplantation, and potentially artificial placenta technology, as falling under the genus assisted gestative technologies. This is because gestation carries unique ethico-legal implications as compared with conception. The proposed genus of assisted gestative technologies is a helpful first step (...) in the endeavour to distinguish between the different ethico-legal landscapes across various ‘assisted reproductive technologies.’ I am generally in favour of adopting AGT as a term which separates various forms of gestational services from other kinds of reproductive technologies. Yet, if assisted gestative technologies can be considered a genus of assisted reproductive technologies, we might consider surrogacy, UTx, and artificial placenta technology their individual species. Between these various species of AGTs, I would argue, there remains enough ethico-legal diversity to warrant independent discussion about the descriptive and normative functions of each AGT and the relationship between gestation, genetic relatedness and legal/moral parenthood. Chloe Romanis claims that legal and social issues about attribution of parenthood and the importance that might be placed on information about gestational origins affect all forms of AGTs.1 I take it ethical ambiguities arise because the relationship between who gestates, genetic relatedness to the prospective child, and claims to legal/moral parental responsibility can be disrupted or made ambivalent with the involvement of third-party support. For many of those who do not require reproductive assistance, the gestational labour, genetic relatedness and parental responsibility would traditionally …. (shrink)

This article defends the morality of heterologous embryo transfer (HET) against those who claim that HET is wrong because it makes a woman a mother through someone other than her spouse. I contrast genetic parenthood with gestation to show that gestation alone does not make someone a mother in the focal sense. Genetic parenthood gives rise to the full obligations of parenthood—i.e., makes someone a parent in the focal sense—because the child’s relationship to his genetic parents is (1) (...) permanent, (2) identity-defining, and (3) initially (at conception) the child’s closest human relationship. While the gestational relationship importantly influences the child’s identity, it lacks the unique closeness, permanence, and identity-defining nature that characterize the genetic parent-child relationship, and therefore gives rise only to temporary obligations akin to those of a foster parent. Recognizing these crucial differences between gestation and procreation helps to show that HET is not inherently immoral. (shrink)

In this short piece I discuss how thinking about medical care and gestation as intimate can give us new insights into experiences of illness and the wrongness of gestation mandates.

When the delivery of a baby at the edge of viability is imminent, gestational age is usually the primary indi­cator for resuscitation. However, four other variables—female sex, antenatal corticosteroid therapy, singleton birth, and increased birth weight—are also associated with better infant survival and neurologic outcome in intensive care, and the combination of all five variables provides a stronger prognostic tool. An ethical framework is provided here for use in determining whether proposed treatments are likely to defend the dignity and sanctity (...) of a fragile periviable life. The framework is based on the principle of ordinary/propor­tionate and extraordinary/disproportionate medical treatment. The author recommends using the most recent outcome data and this ethical framework together to make perinatal resuscitation decisions. Use of gestational age alone is insufficient and ethically immoral. National Catholic Bioethics Quarterly 14.3 : 429–439. (shrink)

Advances in reproductive medicine have provided new, and much needed, hope for millions of people struggling with infertility. Gestational surrogacy is one such development that has been gaining popularity with infertile couples, especially those unable to benefit from other reproductive procedures such as In Vitro Fertilization. For many Muslim couples, however, surrogacy remains a nonviable option. Islamic scholars have deemed the procedure incompatible with Islam and have prohibited its use. This paper examines the arguments presented for proscribing surrogacy arrangements in (...) Sunni Islam in particular. These include preservation of lineage, exclusion of third parties in reproduction, upholding the rights of the child, and protection from the negative effects of surrogacy arrangements. The rationales for banning surrogacy are subsequently refuted utilizing Islamic law “Sharia”, bioethics, and medical evidence. The paper also presents reasons for why surrogacy is not only consistent with Sunni Islamic teachings, but is also both ethically justified and medically necessary. Lastly, Islamic scholars are urged to take into account the arguments presented in this paper and reconsider their rulings on the permissibility of surrogacy. (shrink)

This paper analyzes the following question: What do women deserve, ethically speaking, when they agree to gestate a fetus on behalf of third parties? I argue for several claims. First, I argue that gestational motherhood’s moral significance has been misunderstood, an oversight I attribute to the focus in family ethics on the conditions of parenthood. Second, I use a less controversial version of James Rachels’s account of desert to argue that gestational mothers deserve a parent-like voice as well as significant (...) care and support, conclusions that have implications for commercial surrogacy. Finally, I argue that we should not make requests of others when fulfilling them will lead others to deserve goods we cannot reasonably expect them to receive, and I conclude based on this thesis, what I call the “strings attached thesis,” that pro-life arguments in support of prohibitions on abortion commit their proponents to policies which they may not be willing to support. (shrink)

The development of artificial womb technology is proceeding rapidly and will present important ethical and theological challenges for Christians. While there has been extensive secular discourse on artificial wombs in recent years, there has been little Christian engagement with this topic. There are broadly two primary uses of artificial womb technology—ectogestation as a form of enhanced neonatal care, where some of the gestation period takes place in an artificial womb, and ectogenesis, where the entire gestation period is within (...) an artificial womb. Ectogestation for the latter weeks or months of pregnancy could be possible within a decade or so, while ectogenesis for humans is far more speculative. Ectogestation is likely to significantly decrease maternal and neonatal morbidity and mortality, and so there is a strong case for supporting its development. Ectogenesis, however, may bring a number of challenges, including the commodification of children, and the pathologizing of pregnancy and childbirth. Its long-term effects on those who are created through this process are also unknown. In the event that it becomes ubiquitous, we may also find the central theological significance of pregnancy and birth diminished. The dilemma for Christians is that the development of ectogestation seems likely to normalise the use of artificial gestation, and, in time, pave the way for ectogenesis. (shrink)

Robinson offers the ‘superior personhood’ approach (SPA) to capture the value of gestation and ground justice for women/gestators.1 SPA holds that women/gestators are more than mere persons given the reality of pregnancy and the vital role women/gestators play in reproduction.1 In this commentary, I speak to some background context perhaps relevant to SPA, lay out areas of agreement with Robinson and then raise four worries about the approach. In my view, the devaluing of gestation and injustice for women/gestators (...) need rectifying, but SPA is not the way. It is difficult not to read Robinson’s piece through the lens of 2022’s Dobbs v. Jackson decision and the politics of abortion, with its focus on fetal status. This background offers a certain kind of sympathetic strategic/rhetorical reading of the motivation for SPA—one to which I found students and others with whom I discussed the piece quite open. Perhaps the goal here is to offer an ingenious defence of abortion rights: if women/gestators are more than one person, then the immorality of abortion cannot be easily grounded in claims about fetal personhood.2 However, Robinson downplays abortion, affirming only ‘my approach could support a wide range of positions on abortion’. This is curious. Is SPA compatible with significant restrictions on abortion? Assuming a realistic political context, this would involve mere persons (men/non-gestators) legislating how superior persons can …. (shrink)

Gestational surrogacy is ethically complex, generating very different responses in law and policy worldwide. This paper argues that contemporary surrogacy law and policy, across many jurisdictions, fail to give sufficient attention to the significance of the relationship between the child and the gestational surrogate. This failure risks repeating the mistakes of historical, discredited approaches to adoption and donor‐assisted conception. This paper argues that proper recognition of the significance of gestation must be an organising principle in surrogacy law and policy. (...) The paper begins by pointing to examples of surrogacy law and practice where the role of the gestator is unacceptably minimised, most notably the framing of the surrogate as a mere ‘carrier’. It goes on to examine the nature of gestation, including consideration of contemporary scholarship on the metaphysics of pregnancy and emerging work in epigenetics, and argues that current evidence supports the view that the gestational relationship must be taken more seriously than it currently is. The paper then draws analogies with parenthood in donor‐assisted conception and adoption to argue that approaches to parental status in novel family formations that fail to promote transparency and seek to deny the truth of familial relationships are doomed to fail. The paper concludes by suggesting some implications for law and policy that flow from placing sufficient emphasis on the gestational role. The overarching thesis of this paper is that gestational surrogacy is ethically permissible when these fundamental requirements are adhered to, and that surrogacy law should proceed on this basis. (shrink)

It is a pleasure to comment on Giulia Cavaliere’s ‘ Gestation, Equality and Freedom: Ectogenesis as a Political Perspective’ in what one might say is ‘enthusiastic disagreement’. The enthusiastic part is because the article is deserving of much praise for adding an important feminist and political theoretical perspective on ectogenesis. The disagreement may come more from disciplinary differences or disposition. As I understand her argument, Cavaliere intends to attack two common arguments in favour of research into ectogenesis—that is, (...) class='Hi'>gestation of a human fetus outside the womb—one that sounds in the potential of the technology to promote equality, the other that it has the potential to promote liberty. On the first her critique is that the risks and burdens of gestation for women are most pronounced for the worst off, but ectogenesis is unlikely to be used by them. On the second her critique is, i nter alia, that treating ‘ectogenesis as a means to address workplace inequalities calls for solutions that change the way society reproduces itself rather than a labour market …. (shrink)

As surrogacy grows, many states and countries are enacting or considering relevant regulations, while others oppose it. Ethical, legal and policy questions arise: how to balance the rights of various kinds of parents (e.g., heterosexual and same-sex couples and single individuals) against the rights and well-being of surrogates. Concerns include risks of exploitation, autonomy, benefits of enabling prospective parents to create loving families, and mitigating possible harms through regulations. Though a few instances of abuse have been reported in developing countries, (...) these do not appear to have occurred in developed countries, where robust regulations exist. The limited data available on surrogates in general (i.e., including traditional and non-commercial surrogacy) do not suggest exploitation or trafficking. In 2021, New York State enacted robust regulations allowing commercial surrogacy. Subsequent competing bills have sought to loosen or enhance certain restrictions. These regulations may be a model for commercial surrogacy regulations elsewhere, but certain ethical, legal and policy questions remain (e.g., where to draw the line to prevent trafficking). Additional data and exploration of these challenges are crucial. (shrink)

Surrogacy is an encouraging management for many childless couples and can hypothetically resolve many unbearable pain that they are confronted. Initially surrogacy treatment was frowned upon, however, surrogacy is more popularly accepted now a day. Though, surrogacy has not yet recognized by 199 country in the globe. Different country has different regulations on surrogacy. However, “there are some indication of the degree of divergence between official discourse and actual practice of surrogacy throughout world”. There are positive changes in attitude toward (...) surrogacy has been seen in some countries. This special issue of Bangladesh Journal of Bioethics has been organized on surrogacy to see the current thinking of surrogacy around the world and how people come out from the social, religious and political framework. (shrink)

In cultures where reproduction is highly medicalised, pregnancy is often understood in terms of foetal development and an anticipated baby. This is connected to a wider privileging of the ‘foetal subject’ in these settings, which has had implications for reproductive autonomy. In this article, I disrupt dominant understandings of pregnancy by engaging with qualitative accounts of gestational trophoblastic disease. This rare condition can entail experiences of pregnancy without foetal development, allowing for scholarly attention to the wider biological, affective and relational (...) constituents of this corporeal event. In this article, I pay particular attention to the ‘pregnancy hormone’ human chorionic gonadotropin (hCG), which in the context of gestational trophoblastic disease becomes a biomarker for disease. My research extends feminist science studies perspectives destabilising understandings of maternal and foetal bodies as bounded and distinct entities. The article de-centres foetal development as the most significant consequence of conception and enriches feminist discussions of reproductive politics. (shrink)

Ectogenesis technology would make it possible to support the complete gestational development of a human being outside the female body. Proponents argue that this technology offers a welcome opportunity to expand reproductive options for those unable or unwilling to gestate. However, by completely bypassing pregnancy, the use of ectogenesis prevents the formation of gestational family ties. Consequently, it has faced criticism for perpetuating a patriarchal view of the family that undermines the moral significance of gestation. The concern is that (...) the introduction of this technology might result in the loss of reproductive autonomy for those who desire to experience pregnancy, as they face pressures to opt for ectogenesis instead. Existing accounts of family values define parents' rights to rear a child, but they fail to establish a right to gestate that can protect an individual's interest in bearing a child. To provide a more comprehensive account of family values, I argue that pregnancy involves a unique quality of intimacy and can make distinct contributions to one's flourishing. Based on this premise, I defend a fundamental moral right to gestate that can help safeguard the option of pregnancy for those who desire it. In conclusion, I consider how a prospective gestator need not provide optimal conditions for fetal development in the way that ectogenesis promises in order for their choice of pregnancy to be justified. (shrink)

Anna Smajdor’s proposal of whole body gestational donation (WBGD) states that female patients diagnosed as brain-dead should be considered for use as gestational donors. In this response, Smajdor’s proposal is rejected on four different accounts: (a) the debated acceptability of surrogacy despite women's autonomy, (b) the harm to dead women ́s interests, (c) the interests of the descendants, and (d) the symbolic value of the body and interests of relatives. The first part argues that WBGD rests on a particular conception (...) of the instrumentalization of bodies that cannot be circumvented simply by the patient’s consent and relinquished autonomy. The second part argues the importance of avoiding any harm to dead women’s interests. The third part identifies the importance of the interest of the foetus in the light of Procreative-Beneficence principle that Smajdor overlooks. And finally, the fourth part considers the symbolic value of the human body and the interest of relatives. The main goal of this commentary is not to show that WBGD cannot be implemented; rather, it is to show that there are not any good arguments in favour of doing so. (shrink)

From Leibniz and Georg Ernst Stahl to Albrecht von Haller, Germans of the eighteenth century calved off an experimental physiology from medicine and made this research a centerpiece of their new model university, first under Haller at Göttingen, then under von Humboldt at Berlin. Haller made Göttingen the most important center for the advancement of Enlightenment science in Germany, but that is not where Johann Herder went looking for new ideas in psychology, turning instead to France, avidly studying Condillac and (...) Diderot, and meeting the latter in Paris in 1769. Herder wanted to use French psychology in his theory of how the history of art recapitulates the development of the senses. To work out his ideas he found it necessary to ignore Kant's careful distinction between life and matter. Kant made life an inexplicable boundary for mechanical explanation, though with Herder it became the key concept for interpreting nature. That all the forces in the physical world are held to express one organizing, integrating vital principle is what excited Goethe about Herder's work and provoked the Naturphilosophie that Schelling invented at this time in close collaboration with Goethe. (shrink)

It is now medically possible for a baby to have two biological mothers. A fertilized ovum from one woman can be implanted into a second woman for gestation in her uterus. In fact, there have been several such cases. The ova donor is the mother in the genetic sense: her genetic material,along with that of the sperm donor,appears in the developing baby. The uterine hostess is the birth mother: she gestates the fetus and gives birth to it. In essence, (...) the two female reproductive functions, genetic and gestational, can be and have been divided from each other. Our current conception of biological maternity has lagged behind these technological marvels and still assumes that both functions will be performed by the same woman. At a time when two "biological mothers" can and do make claims for the same child,each on the ground that she is the "true mother", it is crucial to examine our concepts of biological maternity and their relation to our social policies about maternity in these cases. In this paper I will argue that the best social and legal policy would involve a prima facie preference for the claims of the gestational mother over the claims of the genetic mother for custody of the child in a contest (if there is no question of parental unfitness on either side). That is, in any dispute, presumption should be in favor of the gestational mother. This argument is made independent of considerations about pre-birth and pre-conception contracts, because the issues raised about the roles of gestational and genetic maternity are substantial in themselves and have obvious implications about the acceptability of such contracts.Rather, I argue that a revision of our concept of biological maternity which emphasizes the importance of gestation and which would prefer the claims of the gestational over the genetic mother would have positive benefits for both women and newborns. (shrink)

This chapter analyses the surrogate motherhood case law of the European Court of Human Rights. A case law that focuses on the protection of everyone’s right to respect for private and family life (art. 8 ECHR). Usually the case decision is about the States’ refusal to recognise a birth certificate from a foreign country that has allowed a surrogacy agreement. Court’s decision does not recognize a right to become a father or a mother. And it does not usually declare the (...) right to respect for family or private life of the intended parents has been violated. The decision often states that the right to private life of the children has been violated. Children’s identity and inheritance rights should be protected and the State condemn. This case law leads to protecting children but it leaves little room for the States to oppose surrogacy, whitening the practice. (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. 1 In what follows, I seek to respond to some of the main points raised in each commentary. Cordeiro examines the implications of various forms of ectogestation for the gestational versus moral parenthood debate by contrasting it with in vivo (natural) gestation. 2 His analysis considers the gestating mother’s and biological father’s parenthood claims in (...) light of various outcomes and the burdens and harms ectogestation may impose on them and on the fetus and newborn. I think his analysis helps to illustrate that—even if gestation does not necessarily give rise to a non-instrumentally valuable good in the form of an intimate relationship—corresponding pro tanto claims to moral parenthood might be settled by appeal to harms of ectogestation itself or voluntaristic considerations. Murphy... (shrink)

In 2023, I published a paper discussing the theoretical possibility of bringing about pregnancies in brain dead women (or men): whole body gestational donation (WBGD) (Smajdor 2023). The purpose wa...

Many people – including many feminists – believe both of the following: (i) abortion is morally permissible regardless of the moral status of the fetus (at least for most of a pregnancy) and (ii) members of society have a shared, moral obligation to provide care for dependents. Yet it has been argued that the shared, moral obligation of members of society to care for dependents entails that women may be morally obligated to gestate unwanted fetuses. Central to this argument is (...) that fetal dependency is relevantly similar to (other) persons' dependency on care and that pregnancy itself is a kind of caregiving. We think this argument is erroneous and politically dangerous. To expose its faults, we engage in a philosophical analysis of pregnancy: how to understand it, how it differs from caregiving, how it is inherently risky, how fetal development is by its nature invasive, and why all this matters for the ethics and politics of abortion. (shrink)