Keeping it in the family: reproduction beyond genetic parenthood.

Recent decades have seen the facilitation of unconventional or even extraordinary reproductive endeavours. Sperm has been harvested from dying or deceased men at the request of their wives; reproductive tissue has been surgically removed from children at the request of their parents; deceased adults' frozen embryos have been claimed by their parents, in order to create grandchildren; wombs have been transplanted from mothers to their daughters. What is needed for requests to be honoured by healthcare staff is that they align with widely shared expectations about what people's reproductive potential ought to be, what marital relationships ought to result in, and which kinds of ties are desirable between parents and children. Costly and invasive technologies are not considered excessive when they are used to support the building of appropriate families. However, deviations from dominant reproductive norms, even if technologically simple and convenient to the participants, are unlikely to receive support. In this paper, we offer examples of such deviations and explore their implications. If reproduction is important as a way of creating genetic relationships, should reproductive material in storage be offered to genetic relatives other than the people from whom it originated? And if parents are allowed to have reproductive material collected from their offspring, or even to use it to create babies, should offspring likewise be allowed to use their parents' reproductive material? We tackle these questions and suggest ways in which interests in genetic ties could be operationalised in a more coherent and less-invasive manner than they currently are.

If Marc is Suzanne's father, does it follow that Suzanne is Marc's child? An experimental philosophy study in reproductive ethics.

In this paper, we report the results from an experimental reproductive ethics study exploring questions about reproduction and parenthood. The main finding in our study is that, while we may assume that everyone understands these concepts and their relationship in the same way, this assumption may be unwarranted. For example, we may assume that if 'x is y's father', it follows that 'y is x's child'. However, the participants in our study did not necessarily agree that it does follow. This means, at the very least, that we need to make sure all parties in a debate have the same relationships in mind when talking about reproduction and parenthood. Moreover, it gives us reason to explore more carefully the conditions which support or undermine the connections between these concepts. This cannot come from purely theoretical reasoning, nor from empirical research alone, but from the alliance between the two.

Nothing if not family? Genetic ties beyond the parent/child dyad.

Internationally, there is considerable inconsistency in the recognition and regulation of children's genetic connections outside the family. In the context of gamete and embryo donation, challenges for regulation seem endless. In this paper, I review some of the paths that have been taken to manage children' being closely genetically related to people outside their families. I do so against the background of recognising the importance of children's interests as moral status holders. I look at recent qualitative research involving donor-conceived people and borrow their own words to make sense of a purported interest to know (of) their close genetic ties. I also review ways in which gamete donation may have facilitated new kinds of kinship, which are at the same time genetic and chosen. In short, in this paper, I explore what meaning there could be in genetic connections that is not about parenthood. Further, I argue that the focus on parenthood in previous work in this area may be detrimental to appreciating some of the goods that can be derived from close genetic connections.

Artificial gametes, the unnatural and the artefactual.

In debates on the ethics of artificial gametes, concepts of naturalness have been used in a number of different ways. Some have argued that the unnaturalness of artificial gametes means that it is unacceptable to use them in fertility treatments. Others have suggested that artificial gametes are no less natural than many other tissues or processes in common medical use. We suggest that establishing the naturalness or unnaturalness of artificial gametes is unlikely to provide easy answers as to the acceptability of using them in fertility medicine. However, we also suggest that we should be cautious about repudiating any relationship between nature and moral evaluation. The property of being natural or man-made may not per se tell us anything about an entity's moral status, but it has an important impact on the moral relationship between the creator and the created organism.

"I am Your Mother and Your Father!" In Vitro Derived Gametes and the Ethics of Solo Reproduction.

In this paper, we will discuss the prospect of human reproduction achieved with gametes originating from only one person. According to statements by a minority of scientists working on the generation of gametes in vitro, it may become possible to create eggs from men's non-reproductive cells and sperm from women's. This would enable, at least in principle, the creation of an embryo from cells obtained from only one individual: 'solo reproduction'. We will consider what might motivate people to reproduce in this way, and the implications that solo reproduction might have for ethics and policy. We suggest that such an innovation is unlikely to revolutionise reproduction and parenting. Indeed, in some respects it is less revolutionary than in vitro fertilisation as a whole. Furthermore, we show that solo reproduction with in vitro created gametes is not necessarily any more ethically problematic than gamete donation-and probably less so. Where appropriate, we draw parallels with the debate surrounding reproductive cloning. We note that solo reproduction may serve to perpetuate reductive geneticised accounts of reproduction, and that this may indeed be ethically questionable. However, in this it is not unique among other technologies of assisted reproduction, many of which focus on genetic transmission. It is for this reason that a ban on solo reproduction might be inconsistent with continuing to permit other kinds of reproduction that also bear the potential to strengthen attachment to a geneticised account of reproduction. Our claim is that there are at least as good reasons to pursue research towards enabling solo reproduction, and eventually to introduce solo reproduction as an option for fertility treatment, as there are to do so for other infertility related purposes.

Writers Blocked: On the Wrongs of Research Co-authorship and Some Possible Strategies for Improvement.

The various problems associated with co-authorship of research articles have attracted much attention in recent years. We believe that this (hopefully) growing awareness is a very welcome development. However, we will argue that the particular and increasing importance of authorship and the harmful implications of current practices of research authorship for junior researchers have not been emphasised enough. We will use the case of our own research area (bioethics) to illustrate some of the pitfalls of current publishing practices-in particular, the impact on the evaluation of one's work in the area of employment or funding. Even where there are explicit guidelines, they are often disregarded. This disregard, which is often exemplified through the inflation of co-authorship in some research areas, may seem benign to some of us; but it is not. Attribution of co-authorship for reasons other than merit in relation to the publication misrepresents the work towards that publication, and generates unfair competition. We make a case for increasing awareness, for transparency and for more explicit guidelines and regulation of research co-authorship within and across research areas. We examine some of the most sensitive areas of concern and their implications for researchers, particularly junior ones, and we suggest several strategies for future action.

Will artificial gametes end infertility?

In this paper we will look at the various ways in which infertility can be understood and at how need for reproductive therapies can be construed. We will do this against the background of research with artificial gametes (AGs). Having explored these questions we will attempt to establish the degree to which technologies such as AGs could expand the array of choices that people have to reproduce and/or become parents. Finally, we will examine whether and in what ways the most promising developments of such technologies are likely to bring about the "end of infertility".

Preserving children's fertility: two tales about children's right to an open future and the margins of parental obligations.

The sources, extent and margins of parental obligations in taking decisions regarding their children's medical care are subjects of ongoing debates. Balancing children's immediate welfare with keeping their future open is a delicate task. In this paper, we briefly present two examples of situations in which parents may be confronted with the choice of whether to authorise or demand non-therapeutic interventions on their children for the purpose of fertility preservation. The first example is that of children facing cancer treatment, and the second of children with Klinefelter syndrome. We argue that, whereas decisions of whether to preserve fertility may be prima facie within the limits of parental discretion, the right to an open future does not straightforwardly put parents under an obligation to take actions that would detect or relieve future infertility in their children-and indeed in some cases taking such actions is problematic.

Artificial gametes: perspectives of geneticists, ethicists and representatives of potential users.

Several threads of research towards developing artificial gametes are ongoing in a number of research labs worldwide. The development of a technology that could generate gametes in vitro has significant potential for human reproduction, and raises a lot of interest, as evidenced by the frequent and extensive media coverage of research in this area. We have asked researchers involved in work with artificial gametes, ethicists, and representatives of potential user groups, how they envisioned the use of artificial gametes in human reproduction. In the course of three focus groups, the participants commented on the various aspects involved. The two recurring themes were the strength of the claim of becoming a parent genetically, and the importance of responsible communication of science. The participants concurred that (a) the desire or need to have genetic offspring of one's own does not warrant the investment of research resources into these technologies, and that (b) given the minefield in terms of moral controversy and sensitivity that characterises the issues involved, how information is communicated and handled is of great importance.

Is it a boy or a girl? Who should (not) know children's sex and why?

In this paper, we present the case of a couple who refused to disclose the sex of their child to others, and some of the responses that this case prompted in the international media. We outline the ethical issues that this case raises, and we place it into the more general context of parental preferences regarding the gender (development) of their children and of the impact on children of parental choices in the matter. Based on current knowledge of gender identity development, we identify some of the potential pitfalls of such a course of action and we briefly present some alternative strategies that could be implemented in order to ensure more freedom of gender formation in children.

Person centred care and shared decision making: implications for ethics, public health and research.

This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective. This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective.

On triparenting. Is having three committed parents better than having only two?

Although research indicates that single parenting is not by itself worse for children than their being brought up by both their parents, there are reasons why it is better for children to have more than one committed parent. If having two committed parents is better, everything else being equal, than having just one, I argue that it might be even better for children to have three committed parents. There might, in addition, be further reasons why allowing triparenting would benefit children and adults, at least in some cases. Whether or not triparenting is on the whole preferable to bi- or monoparenting, it does have certain advantages (as well as shortcomings) which, at the very least, warrant its inclusion in debates over the sorts of family structures we should allow in our societies, and how many people should be accepted in them. This paper has the modest aim of scratching the surface of this wider topic by challenging the necessity of the max-two-parents framework.

Reproductive and parental autonomy: an argument for compulsory parental education.

In this paper we argue that comprehensive and systematic parental education has the potential to equip young adults with the necessary information for the responsible exercise of their autonomy in choices about reproduction and parenting. Education can allow young adults to acquire largely accurate beliefs about reproduction and parenting and about the implications of their reproductive and parental choices. Far from being a limitation of individual freedom, the acquisition of relevant information about reproduction and parenting and the acquisition of self-knowledge with respect to reproductive and parenting choices can help give shape to individual life plans. We make a case for compulsory parental education on the basis of the need to respect and enhance individual reproductive and parental autonomy within a culture that presents contradictory attitudes towards reproduction and where decisions about whether to become a parent are subject to significant pressure and scrutiny.

Sex is over-rated: on the right to reproduce.

In this article, I will show what is respected most in human reproduction and parenting is not a right to reproduce in the way in which this right is explicitly proposed. The only way in which people can become, and function as, parents without having to submit themselves to anyone else's judgements and decisions, is by having reproductive sex. Whatever one's intentions, social status, standard of living, income, etc., so long as assistance is not required, that person's reproductive decisions will not be interfered with in any way, at least not until neglect or abuse of their offspring becomes known. Moreover, none of the features that are said to back the right to reproduce (such as bodily integrity or personal autonomy) can justify one's unquestioned access to the relationship with another unable to consent (the child). This indicates that the discourse in terms of the right to reproduce as is currently used so as to justify non-interference with natural reproduction and parenting coupled with the regulation of assisted forms of reproduction and parenting, is at best self-deluding and that all it protects is people's freedom to have reproductive sex and handle the consequences.

Postmenopausal Motherhood Reloaded: Advanced Age and In Vitro Derived Gametes.

In this paper we look at the implications of an emerging technology for the case in favor of, or against, postmenopausal motherhood. Technologies such as in vitro derived gametes (sperm and eggs derived from nonreproductive cells) have the potential to influence the ways in which reproductive medicine is practiced, and are already bringing new dimensions to debates in this area. We explain what in vitro derived gametes are and how their development may impact on the case of postmenopausal motherhood. We briefly review some of the concerns that postmenopausal motherhood has raised-and the implications that the successful development, and use in reproduction, of artificial gametes might have for such concerns. The concerns addressed include arguments from nature, risks and efficacy, reduced energy of the mother, and maternal life expectancy. We also consider whether the use of in vitro derived gametes to facilitate postmenopausal motherhood would contribute to reinforcing a narrow, geneticized account of reproduction and a pro-reproductive culture that encourages women to produce genetically related offspring at all costs.

On a Romanian attempt to legislate on medically assisted human reproduction.

The paper presents and briefly analyses some of the provisions of a Romanian legislative proposal which arrived at the Presidency for ratification twice, in slightly different forms, and which was rejected twice: the first time at the Presidency in October 2004, and the second at the Constitutional Court in July 2005. The proposal was finally dropped in February 2006. My intention here is to point to some of the most problematic deficiencies of the legislative document in the hope that this may assist with future debates and regulations on assisted reproduction either in Romania or elsewhere. I have isolated the features to be discussed under two headings: (1) whose are the rights to reproduce, that the document claimed to 'acknowledge, regulate and guarantee' and (2) what is the status of the embryo, the child and the surrogate mother?

Postmenopausal motherhood: immoral, illegal? A case study.

The paper explores the ethics of post-menopausal motherhood by looking at the case of Adriana Iliescu, the oldest woman ever to have given birth (so far). To this end, I will approach the three most common objections brought against the mother and/or against the team of healthcare professionals who made it happen: the age of the mother, the fact that she is single, the appropriateness of her motivation and of that of the medical team.

Looking for the meaning of dignity in the Bioethics Convention and the Cloning Protocol.

This paper is focused on the analysis of two documents (the Council of Europe's Bioethics Convention and the Additional Cloning Protocol) inasmuch as they refer to the relationship between human dignity and human genetic engineering. After presenting the stipulations of the abovementioned documents, I will review various proposed meanings of human dignity and will try to identify which of these seem to be at the core of their underlying assumptions. Is the concept of dignity proposed in the two documents coherent? Is it morally legitimate? Is it, as some might assume, of Kantian origin? Does it have any philosophical roots?