Jason Lee

Uterus transplantation (UTx) is an experimental surgery likely to face the issue of organ shortage. In my article, I explore how this issue might be addressed by changing the prevailing practices around live uterus donor recruitment. Currently, women with children – often the mothers of recipients – tend to be overrepresented as donors. Yet, other potentially eligible groups who may have an interest in providing their uterus – such as transgender men, or cisgender women who do not wish to gestate or to have children – tend to be excluded as potential donors. Moving forward, I recommend that donor inclusion criteria for UTx be broadened to be more inclusive of these latter groups.

Natalie Stoljar posits that purely procedural theories of autonomy are unable to explain the ‘feminist intuition’, which is the idea that the internalization of false and oppressive norms are incompatible with autonomy. She claims instead that an account based on ‘normative competence’ – which requires true beliefs and critical reflection – can explain why oppressive norms should be excluded as legitimate decision-making inputs. On my view, however, the normative competence approach is subject to a worrying problem. While Stoljar's view successfully problematizes the internalization of oppression, her view misattributes non-autonomy also to those who perpetrate the oppression. I suggest that this is implausible, arguing instead that we can establish an asymmetry of autonomy between those who oppress others and those who are made target of oppression.

The growing demand for uterus transplantation (UTx) invites continued philosophical evaluation of the function of UTx (and what constitutes its ‘success’), as well as the recipient eligibility for UTx. Currently, UTx caters to partnered, cisgender women of childbearing age looking to get pregnant and give birth to a biogenetically related child. The medical justification for this—the treatment of uterine infertility—explains the primacy of this practice. However, this dominant conceptualization of UTx does not necessarily capture the diverse needs for which both cis- and transgender women might take interest in UTx that are not strictly procreative, such as bodily integrity and gender identity reasons. In this paper, I argue that non-procreative motivations for uterus acquisition ought to be taken seriously as a matter of non-discrimination and consistency.

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 …

Japan has one of the highest numbers of high-cost medical devices installed relative to its population. While evaluations of the distribution of these devices traditionally involve simple population-based assessments, an indicator that includes the demand of these devices would more accurately reflect the situation. The purpose of this study was to develop an indicator of the supply–demand balance of such devices, using examples of magnetic resonance imaging scanners (MRI) and extracorporeal shockwave lithotripters (ESWL), and to investigate the relationship between this indicator, personnel distribution statuses and operating statuses at the prefectural level. Using data from nation-wide surveys and claims data from 16 hospitals, we developed an indicator based on the ratio of the supplied number of device units to the number of device units in demand for MRI and ESWL. The latter value was based on patient volume and utilization proportion. Correlation analyses were conducted between the supply–demand balances of these devices, personal distribution and operating statuses. Comparisons between our indicator and conventional population-based indicators revealed that 15% and 30% of prefectures were at risk of underestimating the availability of MRI and ESWL, respectively. The numbers of specialist personnel/device units showed significant, negative correlations with our indicators in both devices. Utilization-based analyses of health care resource placement and utilization status provide a more accurate indication than simple population-based assessments, and can assist decision makers in reviewing gaps between health policy and management. Such an indicator therefore has the potential to be a tool in helping to improve the efficiency of the allocation and placement of such devices.

Should involuntarily childless people have the same opportunities to access parenthood as those who are not involuntarily childless? In the context of assisted reproductive technologies, affirmative answers to this question are often cashed out in terms of positive rights, including rights to third-party reproduction. In this paper, we critically explore the scope and extent to which any such right would hold up morally. Ultimately, we argue for a departure away from positive parental rights. Instead, we argue that the state has an imperfect duty to benefit involuntarily childless people in relation to their parental aspirations.