The ethics of ectogenesis-aided foetal treatment.

In this paper, we aim to stimulate ethical debate about the morally relevant connection between ectogenesis and the foetus as a potential beneficiary of treatment. Ectogenesis could facilitate foetal interventions by treating the foetus independently of the pregnant woman and provide easier access to the foetus if interventions are required. The moral relevance hereof derives from the observation that, together with other developments in genetic technology and prenatal treatment, this may catalyse the allocation of a patient status to the foetus. The topic of foetal medicine is of growing interest to clinicians, and it also deserves due attention from an ethical perspective. To the extent that these developments contribute to the allocation of a patient status to the foetus (and to its respective interests for medical treatment), normative questions arise about how moral responsibilities towards foetal interests should be balanced against the interests of the pregnant woman. We conclude that, even if ectogenesis could facilitate foetal therapy, it is important to remain sensitive to the fact that it would not circumvent the key ethical concerns that come with in utero foetal treatment and that it may even exacerbate potential conflicts between directive treatment recommendations and the pregnant woman's autonomous decision to the contrary.

Two Cases of Pregnancy Following Uterine Transplant: An Ethical Analysis.

Uterine factor infertility (UFI) affects 1-5% of women of reproductive age, and uterus transplantation is the only option available to these women for carrying a pregnancy. The ethical analysis of uterus transplantation focuses on the value and experience of pregnancy in recipients; to date, however, no personal experiences with pregnancy after uterus transplantation have been published. The authors share the stories of two of our uterus transplant recipients, obtained through semi-structured, in-person interviews. The interview questions focused on the recipients' experiences during pregnancy. We report the cases as the interwoven narratives of the two women's pregnancies and their perceptions of the value of gestation.

Gravidez decorrente de violência sexual: revisão sistemática da literatura / Pregnancy resulting from sexual violence: systematic review of the literature / El embarazo resultante de la violencia sexual: revisión sistemática de la literatura

Este estudo teve como objetivo geral mapear os estudos existentes sobre o desfecho da gestação de mulheres que engravidaram como resultado de violência sexual e descrever quais aspectos são ressaltados nos artigos em relação a essas experiências de desfecho. Foi realizada uma Revisão Sistemática de Literatura nas bases de dados IndexPsi, PePSIC, SciELO e Lilacs, a partir da combinação de 11 descritores e processo rigoroso de análise, selecionando-se 30 artigos ao final. A análise destes mostrou que as experiências de gravidez decorrente de estupro revelam uma diversidade de vivências, que, embora não possíveis de serem generalizadas, apontam para aspectos comuns tanto no que se refere à interrupção (vínculo com a violência, repúdio à gravidez e temor de dano social ou psicológico à criança) quanto à continuidade (relação de apego e vínculo com o bebê, crenças religiosas)

This study consists of a Systematic Literature Review (SLR). Aimed to map the existing studies on the outcome of pregnancy in women who become pregnant as a result of sexual violence, and describe which aspects are highlighted in articles regarding these experiences outcome. Research was conducted on the basis of IndexPsi, PePSIC, SciELO and Lilacs from the combination of eleven descriptors and rigorous analysis, selecting 30 items that comprised the corpus of work. Analysis of these articles showed that pregnancy resulting from rape experiments reveal a variety of experiences, which although it is not possible to generalize, point to commonalities regarding both the interruption (bond with violence, rejection of pregnancy and fear of social or psychological damage to the child) and continuity (attachment and bonding with the baby, religious beliefs)

Este estudio tuvo como objetivo general mapear los estudios existentes sobre el resultado del embarazo en las mujeres que quedaron embarazadas como consecuencia de la violencia sexual y describir cuales aspectos se destaca en los artículos sobre estas experiencias de resultado. Se llevó a cabo una Revisión Sistemática de Literatura (RSL) en las bases de datos IndexPsi, PePSIC, SciELO y Lilacs, a partir de la combinación de once descriptores y riguroso proceso de análisis, con la selección de 30 artículos al final. El análisis de los mismos mostró que las experiencias de embarazo decurrentes de violación revelan una diversidad de vivencias, que aunque no es posible generalizar a punto en común, tanto en lo relativo a la interrupción (vínculo con la violencia, el rechazo del embarazo y el temor de daño social o psicológico al niño) cuanto a la continuidad (relación de apego y el vínculo con el bebé, creencias religiosas)

Consulta de ética sobre el zika: orientación ética sobre cuestiones clave planteadas por el brote

En este documento se presenta la orientación que resultó de la Consulta de ética sobre el zika convocada por la Organización Panamericana de la Salud (OPS) para abordar los temas que los países afectados habían previamente identificado como los desafíos éticos más importantes en el contexto del brote del virus del Zika. Se explican los deberes éticos en los ámbitos de la atención de salud, las actividades de salud pública y la investigación. Con respecto a la atención de salud, se destaca el derecho moral de las mujeres a elegir entre todas las opciones reproductivas relevantes. Respetar la capacidad de las mujeres de elegir va de la mano del deber ético de apoyarlas y proteger su salud. Ofrecerles toda la información de una manera honesta y transparente es un deber ético transversal de los prestadores de salud, los ministerios de salud y los gobiernos. Asimismo, se resalta la importancia en todos los ámbitos del deber ético de hacer investigación y luego compartir los datos y los resultados de las investigaciones para hacer posible respuestas inmediatas a la emergencia de salud, así como el imperativo de promover la investigación y la vigilancia. Dado que el brote del virus del Zika es un problema de salud mundial, la solidaridad debe guiar la colaboración entre los países en la atención de salud, el avance de la salud pública y realización de investigaciones.

Mars ain't the kind of place to raise your kid: ethical implications of pregnancy on missions to colonize other planets.

The colonization of a new planet will inevitably bring about new bioethical issues. One is the possibility of pregnancy during the mission. During the journey to the target planet or moon, and for the first couple of years before a colony has been established and the colony has been accommodated for children, a pregnancy would jeopardize the safety of the crew and the wellbeing of the child. The principal concern with a pregnancy during an interplanetary mission is that it could put the entire crew in danger. Resources such as air, food, and medical supplies will be limited and calculated to keep the crew members alive. We explore the bioethical concerns of near-future space travel.

Ethical aspects of creating human-nonhuman chimeras capable of human gamete production and human pregnancy.

In this paper I explore some of the moral issues that could emerge from the creation of human-nonhuman chimeras (HNH-chimeras) capable of human gamete production and human pregnancy. First I explore whether there is a cogent argument against the creation of HNH-chimeras that could produce human gametes. I conclude that so far there is none, and that in fact there is at least one good moral reason for producing such types of creatures. Afterwards I explore some of the moral problems that could emerge from the fact that a HNH-chimera could become pregnant with a human conceptus. I focus on two sets of problems: problems that would arise by virtue of the fact that a human is gestated by a nonhuman creature, and problems that would emerge from the fact that such pregnancies could affect the health of the HNH-chimera.

Assisted Gestation and Transgender Women.

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.

Silences and moral narratives: infanticide as reproductive disruption.

Infanticide is a widespread practice, yet few ethnographic and theoretical works examine this. Drawing on ethnographic research conducted in the Indian Himalayas, I argue that infanticide is a form of reproductive disruption that elicits both public moral judgments and private silences. In this Himalayan context, the stigmas of abortion and premarital sex prevent community acknowledgement of infanticide and baby abandonment. Unmarried women hide their pregnancies, deliver and abandon their babies, and later are rushed to the hospital with postdelivery complications. While biomedical doctors deal with the debris of infanticide (postpartum hemorrhage), there is no formal accounting of the practice. I argue that by regarding infanticide as a form of reproductive disruption, we can open up women's narratives of pain and suffering that are silenced because of moral repugnance.

Beyond altruistic and commercial contract motherhood: the professional model.

It has become common to distinguish between altruistic and commercial contract motherhood (or 'surrogacy'). Altruistic arrangements are based on the 'gift relationship': a woman is motivated by altruism to have a baby for an infertile couple, who are free to reciprocate as they see fit. By contrast, in commercial arrangements both parties are motivated by personal gain to enter a legally enforceable agreement, which stipulates that the contract mother or 'surrogate' is to bear a child for the intending parents in exchange for a fee. She is required to undergo medical examinations and to refrain from behaviour that could harm the foetus. The intending parents are the child's legal parents from the outset. The parties to the contract can, but are not expected to, maintain contact after the transaction is completed. We argue that contract motherhood should not be organized according to the norms of the gift relationship, and that contract mothers should be compensated for their labour. However, we accept that there are good reasons for rejecting the commercial model as a suitable framework for contract pregnancy, and argue, instead, in favour of viewing it as a profession.

Abortion and regret.

The article considers three theses about postabortion regret which seek to illustrate its pertinence to reasoning about abortion, and which are often deployed, either explicitly or implicitly, to dissuade women out of that reproductive choice. The first is that postabortion regret renders an abortion morally unjustified. The second is that that a relatively high incidence of postabortion regret-compared with a lower incidence of postnatal regret in the relevant comparator field-is good evidence for the moral impermissibility of abortion choice. The third is that high rates of postabortion regret suggest that abortion is not the most prudent or welfare-maximising choice for the woman concerned. All three theses argue for the compellingness of knowledge about postabortion regret in moral and practical reasoning about abortion, especially from the pregnant woman's point of view. This article argues that all three theses are flawed. In particular, it seeks to remind readers that feelings of regret directed at past decisions are often decoupled from the fact of the matter about their moral or rational justification. Moreover, certain features of reproductive decisions in particular make regret an especially unsuitable yardstick for actual justification in this context, and even less epistemically reliable as evidence for a lack of justification than it may be in other fields of decision-making. The implication is that rates of postabortion regret, even if they can be presumed to be higher than rates of postnatal regret, are not as pertinent to moral and practical reasoning about abortion as is sometimes suggested.

Pregnancy as a harm?

Michigan's Appellate Court ruled in 2004 that a pregnancy that resulted from a rape should be considered a bodily injury for sentencing purposes. Interestingly, all three possible outcomes of a pregnancy-abortion, miscarriage, or childbirth-are considered to bring with them significant and substantial physical, psychological, and emotional changes. While the immediate impact of the ruling in People v. Cathey affected only the guilty individual, there are larger implications for this ruling beyond just sentencing guidelines. The ruling can be considered a step forward in prosecuting rapists, but possibly at the expense of reimagining the female body. This article considers the Cathey ruling itself, the potential benefits and consequences of this understanding on feminist discourse, and, crucially, the impact of this decision on abortion discussions. The central question that emerges is, can we both consider pregnancy a harm and believe that this harm is not always wrong-making?

Is it "every man's right to have babies if he wants them"? Male pregnancy and the limits of reproductive liberty.

Since the 1980s, a number of medical researchers have suggested that in the future it might be possible for men to become pregnant. Given the role played by the right to reproductive liberty in other debates about reproductive technologies, it will be extremely difficult to deny that this right extends to include male pregnancy. However, this constitutes a reductio ad absurdum of the idea of reproductive liberty. One therefore would be well advised to look again at the extent of this purported right in other contexts in which it is deployed.