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.

Is pregnancy a disease? A normative approach.

In this paper, we identify some key features of what makes something a disease, and consider whether these apply to pregnancy. We argue that there are some compelling grounds for regarding pregnancy as a disease. Like a disease, pregnancy affects the health of the pregnant person, causing a range of symptoms from discomfort to death. Like a disease, pregnancy can be treated medically. Like a disease, pregnancy is caused by a pathogen, an external organism invading the host's body. Like a disease, the risk of getting pregnant can be reduced by using prophylactic measures. We address the question of whether the 'normality' of pregnancy, its current necessity for human survival, or the value often attached to it are reasons to reject the view that pregnancy is a disease. We point out that applying theories of disease to the case of pregnancy, can in many cases illuminate inconsistencies and problems within these theories. Finally, we show that it is difficult to find one theory of disease that captures all paradigm cases of diseases, while convincingly excluding pregnancy. We conclude that there are both normative and pragmatic reasons to consider pregnancy a disease.

The Ethics of Cellular Reprogramming.

Louise Brown's birth in 1978 heralded a new era not just in reproductive technology, but in the relationship between science, cells, and society. For the first time, human embryos could be created, selected, studied, manipulated, frozen, altered, or destroyed, outside the human body. But with this possibility came a plethora of ethical questions. Is it acceptable to destroy a human embryo for the purpose of research? Or to create an embryo with the specific purpose of destroying it for research? In an attempt to construct ethical and legal frameworks for the new era of cellular reprogramming, legislators and ethicists have tried to distinguish between different kinds of biological entity. We treat cells differently depending on whether they are human or animal, somatic cells or gametes, and on whether they are embryos or not. But this approach to the ethics of cellular reprogramming is doomed to failure for the simple reason that cellular reprogramming in itself destroys the distinctions that the law requires to function. In this article, we explore the historical trajectory of cellular reprogramming and its relationship with ethics and society. We suggest that the early hype of embryo research has not obviously fulfilled expectations, but since new avenues of research are continuously opening, it is hard to say definitely that these promises have been broken. We explore the forthcoming challenges posed by the creation of DNA from scratch in the laboratory, and the implications of this for understandings of identity, privacy, and reproduction. We conclude that while ethics used to seek answers in biological facts, this is no longer possible, and a new approach is required.

Reification and assent in research involving those who lack capacity.

In applied ethics, and in medical treatment and research, the question of how we should treat others is a central problem. In this paper, I address the ethical role of assent in research involving human beings who lack capacity. I start by thinking about why consent is ethically important, and consider what happens when consent is not possible. Drawing on the work of the German philosopher Honneth, I discuss the concept of reification-a phenomenon that manifests itself when we fail to observe or respond to our fellow humans' need for recognition. I suggest that assent is a way of responding to this moral need for recognition, which exists independently of cognitive capacity. I will look at the circumstances in which consent cannot be obtained from human beings, and ask whether some of the same ethically important considerations that underpin the need for consent might be achieved through seeking assent. I discuss the ways in which this might be beneficial for researchers, for prospective research participants and for society at large.

Whole body gestational donation.

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.

The complex case of Ellie Anderson.

Ellie Anderson had always known that she wanted to have children. Her mother, Louise, was aware of this wish. Ellie was designated male at birth, but according to news sources, identified as a girl from the age of three. She was hoping to undergo gender reassignment surgery at 18, but died unexpectedly at only 16, leaving Louise grappling not only with the grief of losing her daughter, but with a complex legal problem. Ellie had had her sperm frozen before starting hormone treatment, specifically so that she would retain the chance of becoming a parent after her gender reassignment. Ellie had considered what might happen to the sperm if she died and was adamant that her children should be brought into the world. She made her mother promise to ensure that this would happen. But according to UK law, Ellie's mother has no legal right to retain her sperm, or to use it to fulfil Ellie's wishes. In this paper, we raise several key ethical questions on this case, namely: does a refusal to bring Ellie's children into the world wrong her posthumously? Is Ellie's mother morally entitled to use her daughter's sperm as Ellie wished? Should the fact that Ellie was a minor at the time of her death or the fact that she was transgendered undermine her wish to have children? Can Ellie become a parent posthumously? We consider how these complex ethical questions could be approached.

Why bother the public? A critique of Leslie Cannold's empirical research on ectogenesis.

Can discussion with members of the public show philosophers where they have gone wrong? Leslie Cannold argues that it can in her 1995 paper 'Women, Ectogenesis and Ethical Theory', which investigates the ways in which women reason about abortion and ectogenesis (the gestation of foetuses in artificial wombs). In her study, Cannold interviewed female non-philosophers. She divided her participants into separate 'pro-life' and 'pro-choice' groups and asked them to consider whether the availability of ectogenesis would change their views about the morality of dealing with an unwanted pregnancy. The women in Cannold's study gave responses that did not map onto the dominant tropes in the philosophical literature. Yet Cannold did not attempt to reason with her participants, and her engagement with the philosophical literature is oddly limited, focussing only on the pro-choice perspective. In this paper, I explore the question of whether Cannold is correct that philosophers' reasoning about abortion is lacking in some way. I suggest that there are alternative conclusions to be drawn from the data she gathered and that a critical approach is necessary when attempting to undertake philosophy informed by empirical data.

An alternative to sexual reproduction: artificial gametes and their implications for society.

INTRODUCTION: Artificial gametes (AGs) are cells that have been 'reprogrammed' to function as sperm or eggs. Such cells may in the future enable people who cannot produce gametes, to have genetically-related offspring. In this paper, I consider the prospect of AGs in the context of declining birthrates and postponed parenthood across the Western world. SOURCES OF DATA: The data quoted in this paper is gathered from a range of sources, encompassing both scientific, demographic and philosophical work. AREAS OF AGREEMENT: Fertility decline in Western democracies is a widely recognised phenomenon, and postponement of parenthood is regarded as a significant contributing factor in this phenomenon. AREAS OF CONTROVERSY: It is not clear at what point, if ever, AGs might come into clinical use. There is dispute as to what is the best approach to declining fertility rates in developed countries. GROWING POINTS: Technologically-assisted reproduction is becoming a more common phenomenon as fertility rates fall and maternal age increases. AGs could offer new ways in which to prolong fertility. AREAS TIMELY FOR DEVELOPING RESEARCH: More research into the development of AGs is required. There is a need for close analysis of the possible causes of declining fertility and the ways in which societies might respond to these challenges.

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.

Institute of Medical Ethics Guidelines for confirmation of appointment, promotion and recognition of UK bioethics and medical ethics researchers.

This document is designed to give guidance on assessing researchers in bioethics/medical ethics. It is intended to assist members of selection, confirmation and promotion committees, who are required to assess those conducting bioethics research when they are not from a similar disciplinary background. It does not attempt to give guidance on the quality of bioethics research, as this is a matter for peer assessment. Rather it aims to give an indication of the type, scope and amount of research that is the expected in this field. It does not cover the assessment of other activities such as teaching, policy work, clinical ethics consultation and so on, but these will be mentioned for additional context. Although it mentions the UK's Research Excellence Framework (REF), it is not intended to be a detailed analysis of the place of bioethics in the REF.

"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.

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.

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".

Perimortem gamete retrieval: should we worry about consent?

Perimortem gamete retrieval has been a possibility for several decades. It involves the surgical extraction of gametes which can then be cryo-preserved and stored for future use. Usually, the request for perimortem gamete retrieval is made by the patient's partner after the patient himself, or herself, has lost the capacity to consent for the procedure. Perimortem gamete retrieval allows for the partner of a dead patient to pursue jointly held reproductive aspiration long after their loved one's death. But how can we know if the dying patient would have consented to gamete retrieval? In the UK, consent is a legal necessity for storing or using gametes-but this is not always enforced. Moreover, although the issues related to posthumous reproduction have been discussed at length in the literature, few commentators have addressed the specific question of retrieval. Gamete retrieval is an invasive and sensitive operation; as with any other intervention performed on the bodies of dead or dying patients, the nature and justification for this procedure needs to be carefully considered. In particular, it is important to question the idea that consent for such an intervention can be inferred solely from a person's known wishes or plans concerning reproduction.

How useful is the concept of the 'harm threshold' in reproductive ethics and law?

In his book Reasons and Persons, Derek Parfit suggests that people are not harmed by being conceived with a disease or disability if they could not have existed without suffering that particular condition. He nevertheless contends that entities can be harmed if the suffering they experience is sufficiently severe. By implication, there is a threshold which divides harmful from non-harmful conceptions. The assumption that such a threshold exists has come to play a part in UK policy making. I argue that Parfit's distinction between harmful and non-harmful conceptions is untenable. Drawing on Kant's refutation of the ontological argument for God's existence, I suggest that the act of creation cannot be identical with the act of harming-nor indeed of benefiting-however great the offspring's suffering may be. I suggest that Parfit is right that bringing children into existence does not usually harm them, but I argue that this must be applied to all conceptions, since Parfit cannot show how the harm threshold can be operationalised. If we think certain conceptions are unethical or should be illegal, this must be on other grounds than that the child is harmed by them. I show that a Millian approach in this context fails to exemplify the empirical and epistemological advantages which are commonly associated with it, and that harm-based legislation would need to be based on broader harm considerations than those relating to the child who is conceived.