Gulzaar Barn

Infertility and involuntary childlessness are often accompanied by psychological distress. Such distress exhibits gendered patterns: women typically experience greater infertility-related suffering, including while they undergo procedures like IVF, and when such procedures fail. Early feminist critics of reproductive technologies sought to locate and address this suffering in the totality of women’s experience under patriarchy. Contemporarily, a liberal approach to this issue emphasizes the importance of an individual’s reproductive autonomy to engage in infertility procedures as they see fit. In this paper, I suggest that a hidden assumption within this liberal argument, serving as an operant justification for the development and provision of assisted reproductive technologies (ARTs), is that ARTs promote welfare, or well-being, through the alleviation of infertility-related distress. I explore whether ARTs do appropriately attend to welfare and so meet this justificatory aim. I suggest that IVF, where it is not successful, that is, in the vast majority of cases, does not serve to promote well-being. A comprehensive picture of welfare requires examining the social context in which infertility-related distress operates and in which well-being is thus compromised. Such considerations are essential to forming a holistic picture of well-being and in assessing whether ARTs can meet their welfarist aims.

UK Biobank is a major biomedical database and research resource, holding the genetic, health, and lifestyle information of half a million adult volunteers. Its datasets are accessible to approved researchers from academic, charity, government, and commercial organisations for health-related research in the public interest. Drawing upon a range of approved projects and the downstream applications of this research, I suggest that UK Biobank datasets have been processed towards ends that are inimical to its stated aims, breaking the terms of consent under which its participants entered the study. First, I provide an overview of the broad consent model employed by UK Biobank in recruiting participants and using their data. The consent documents and participant information leaflets used exhibit information failures in their framing of health-research in terms of disease and treatment, obscuring the full range of lawful uses of participants’ data. Beyond this, certain approved uses of UK Biobank data, including studies by insurance companies and direct-to-consumer genetic testing companies, arguably fall outside UK Biobank’s stated aims altogether. Moreover, UK Biobank has not adequately safeguarded against “dual use” issues. Tracking the trajectory of research outputs that used biobank data, I suggest that approved uses of biobank datasets have gone on to have objectionable further applications that are not in the public interest. Such applications include the development of polygenic scores that seek to predict “intelligence” for use in commercial embryo screening services. Such tools are rife with risk of harm and are being deployed without sufficient public deliberation or oversight.

Abstract‘Moral bioenhancement’ refers to the use of pharmaceuticals and other direct brain interventions to enhance ‘moral’ traits such as ‘empathy,’ and alter any ‘morally problematic’ dispositions, such as ‘aggression.’ This is believed to result in improved moral responses. In a recent paper, Tom Douglas considers whether medical interventions of this sort could be “provided as part of the criminal justice system’s response to the commission of crime, and for the purposes of facilitating rehabilitation (Douglas in Journal of Ethics 18(2): 101–122, 2014).” He suggests that they could “at least in some cases, permissibly be provided without valid consent (Douglas in Journal of Ethics 18(2): 101–122, 2014)” as a form of rehabilitative punishment. He argues for this conclusion by ‘parity of reasoning,’ starting from the currently accepted practice of non-consensual incarceration. His argument appears to be dependent on the successful defence of the following two claims: (1) that non-consensual incarceration is a morally justifiable practice, and (2) that there is no meaningful distinction between the forcible imposition of this practice, and the forcible imposition of medical interventions on prisoners. From both claims, he deduces (3): if non-consensual incarceration is morally justifiable, so is the non-consensual imposition of medical correctives, in some cases. In this paper, I begin by suggesting that the basic argument behind the Parity Claim (2) results in a reductio ad absurdum, whereby any practice that is sufficiently similar to incarceration in the ways Douglas presents, would also be considered permissible. This appears to be an unpalatable conclusion, casting doubt on the soundness of a key premise. Douglas appears to offer no means of deciding which practices are sufficiently similar to incarceration in terms of harm and threat to agency, and of the practices that I will present, which do seem to be, it does not seem that he could rule them out in any principled way. Next I turn to dispute claim (1) relating to the purported justifiability of incarceration on rehabilitative grounds. If successful, this attack causes a break in reasoning from the justifiability of incarceration, to the justifiability of medical interventions (2). Medical interventions would then require an alternative, independent justification, through outlining the ways in which they are conducive to a particular aim of punishment, without relying on the justifiability of incarceration. This argument has not been provided, and I suggest that attempts to do so may run into difficulty. I untangle and make explicit the various assumptions made in Douglas’ contention that medical interventions “might be thought conducive to rehabilitation in some offenders,” locating my critique in the wider debate on the causes of crime. Finally, I seek to challenge the normative weight of the Parity Claim (2), arguing that to show that two practices are comparable in some sense is not sufficient to show that both are equally as permissible (3). Other social purposes must be considered, leading me to suggest that the forcible imposition medical correctives falls beyond the appropriate remit of the criminal justice system.

‘Moral bioenhancement’ refers to the use of pharmaceuticals and other direct brain interventions to enhance ‘moral’ traits such as ‘empathy,’ and alter any ‘morally problematic’ dispositions, such as ‘aggression.’ This is believed to result in improved moral responses. In a recent paper, Tom Douglas considers whether medical interventions of this sort could be “provided as part of the criminal justice system’s response to the commission of crime, and for the purposes of facilitating rehabilitation : 101–122, 2014).” He suggests that they could “at least in some cases, permissibly be provided without valid consent : 101–122, 2014)” as a form of rehabilitative punishment. He argues for this conclusion by ‘parity of reasoning,’ starting from the currently accepted practice of non-consensual incarceration. His argument appears to be dependent on the successful defence of the following two claims: that non-consensual incarceration is a morally justifiable practice, and that there is no meaningful distinction between the forcible imposition of this practice, and the forcible imposition of medical interventions on prisoners. From both claims, he deduces : if non-consensual incarceration is morally justifiable, so is the non-consensual imposition of medical correctives, in some cases. In this paper, I begin by suggesting that the basic argument behind the Parity Claim results in a reductio ad absurdum, whereby any practice that is sufficiently similar to incarceration in the ways Douglas presents, would also be considered permissible. This appears to be an unpalatable conclusion, casting doubt on the soundness of a key premise. Douglas appears to offer no means of deciding which practices are sufficiently similar to incarceration in terms of harm and threat to agency, and of the practices that I will present, which do seem to be, it does not seem that he could rule them out in any principled way. Next I turn to dispute claim relating to the purported justifiability of incarceration on rehabilitative grounds. If successful, this attack causes a break in reasoning from the justifiability of incarceration, to the justifiability of medical interventions. Medical interventions would then require an alternative, independent justification, through outlining the ways in which they are conducive to a particular aim of punishment, without relying on the justifiability of incarceration. This argument has not been provided, and I suggest that attempts to do so may run into difficulty. I untangle and make explicit the various assumptions made in Douglas’ contention that medical interventions “might be thought conducive to rehabilitation in some offenders,” locating my critique in the wider debate on the causes of crime. Finally, I seek to challenge the normative weight of the Parity Claim, arguing that to show that two practices are comparable in some sense is not sufficient to show that both are equally as permissible. Other social purposes must be considered, leading me to suggest that the forcible imposition medical correctives falls beyond the appropriate remit of the criminal justice system.

The human uterine transplant (UTx) is being developed as a procedure to alleviate absolute uterine factor infertility (AUFI). In light of recent UTx advances in India, I suggest that key ethical concerns would emerge if this procedure were to become established as part of India’s liberalised assisted reproduction industry. On evidence‐based projections, UTx would be likely to harm vulnerable populations in two key ways. Firstly, I suggest that a commercial model for uteri procurement is primed to develop due to various structural factors that facilitated the boom in commercial surrogacy remaining in place, despite commercial surrogacy having been outlawed. I outline ways in which Indian commercial surrogacy arrangements exhibited exploitation and suggest that a commercial UTx model would be similarly exploitative, with many background features of exploitative surrogacy remaining constant. The second way in which the development of UTx in India might pose harm is through the difficulty in obtaining proper informed consent, even under altruistic arrangements. I argue that structural factors, including a cultural deference to doctors, lack of medical understanding displayed by vulnerable populations, and a privatised healthcare system with little regulatory oversight, would render it difficult to obtain proper informed consent from living donors. Further, factors peculiar to UTx, such as its experimental nature, and the unknown and novel risks and harms it poses, heighten this difficulty. Accordingly, UTx in India would be unlikely to meet the Montreal criteria for the ethical feasibility of uterine transplantation and should thus raise ethical alarm.