Ji-Young Lee

Surrogacy and uterus transplantation (UTx) are current forms of assisted gestation. Support for UTx is often grounded on the basis that it would ethically and legally mitigate the moral issues associated with surrogacy. In this article, I problematize this narrative by highlighting the perspective of third parties to assisted gestation through the topics of incentivization and compensation. I demonstrate that the ethical, legal, and social idiosyncrasies associated with each technique make it the case that UTx does not easily resolve the shortcomings of surrogacy – and vice versa.

The current global mental health crisis needs action. Here we show, using empirical evidence of randomised controlled trials combined with Rose’s theoretical framework of preventive medicine and epidemiological principles, that the universal practice of kindness is a potentially effective grassroots public health promotion action that could propagate from the individual to the collective. Beyond effectiveness alone, we present medical ethics principles to show that the universal practice of kindness is also relatively costless, socially just, inherently consensual, empowering, and immediately available to, for and within every one of us. We argue that the need for structural changes and future research studies should not justify delaying the individual practice of kindness in our daily lives, since kindness is compatible with research, clinical practice and policy-making.

INVOcell is an in vivo fertilisation device marketed as an alternative to in vitro fertilisation treatment. In this paper, we explore the ethical implications that arise when this device is framed as a type or process of ‘gestation’. We anticipate several effects that may be of ethical interest: marketing in vivo fertilisation as being comparable to traditional gestation may be misleading and even harmful to its users, but on the other hand, it captures a potential need to acknowledge and be more inclusive of those who wish to identify diverse reproductive experiences as gestative experiences. In light of these insights, we articulate the concept of ‘simulated gestation’ as a novel framework to explain, and potentially accommodate, the diverse ways in which assisted reproductive technologies are shaping people's ideas about—and desires for—gestation.

To overcome certain challenges with surrogate decision-making traditionally understood, technological support tools have been proposed. One such proposal, as presented by Earp et al, is the development of a ‘Personalised Patient Preference Predictor’ (P4).1 This system would leverage patient-specific data to train a personalised large language model which could then—hopefully—accurately predict that patient’s treatment preferences. Using P4 would be compatible with respect for patient autonomy, at least on the substituted judgement standard, in which making the decision the incompetent person would have made if competent is a priority.2 Annoni, however, doubts that P4 can respect the autonomy of incapacitated patients. This is because ‘the satisfaction of individual treatment preferences is questionable whenever such preferences are not actual, explicit and specific.’2 His view is that merely satisfying a patient’s hypothetical preference is not sufficient to respect their autonomy. Instead, fulfilling respect for autonomy requires ‘explicit, first-person, actual and specific consent.’2 This is clearly not possible if the patient in question no longer has capacity. Thus, arguing for the use of P4 in such cases on the basis of respect for patient autonomy is moot; rather, Annoni claims, P4 can be justified on other grounds, such as the ‘honouring of a patient’s unique identity.’2 In my own view, there are two issues with Annoni’s argument. The first is his rationale that respect for autonomy requires the actual consent of the patient, against the possibility of generating hypothetical consent using tools like P4. While he is correct to point out the various …

I reflect herein on the diverse commentaries for my feature article, ‘Towards an ethics of pronatalism in South Korea (and beyond),’1 taking up each commentary in turn. Shandilya and Murphy claim that the state is “entitled to take measures to ensure economic and demographic sustainability,”2 contrary to my characterisation of state viewpoint neutrality. Pronatalist policies are, after all, one of many tools that the state might deploy to protect long-term economic and social stability. I don’t object to the view that the state may be entitled, in general, to take certain kinds of action on behalf of their citizens. However, childbirth is a special case in which the risks that would have to be imposed on a certain group (the childcarers and would-be gestators) to achieve this ‘greater good’ are rather high, especially if there are not so many citizens who are individually willing (or able) to undergo this process for the sake of that greater good. Promoting childbirth in a populace that is already hesitant about procreation (for whatever reason) would have negative implications for the negative rights of those citizens (to not be harmed). We have already witnessed the moral costs of such negative rights violations in the case of anti-natalist policies undertaken against a population (or certain groups of people) who do want children. Hence, I would maintain that efforts to address population dynamics, as a matter of imperfect duty, should rather focus on wider solutions that would improve the lives of everyone, rather than on fertility rates per se. Räsänen and Smajdor challenge my assumption that coercive pronatalism must obviously …

A global trend of institutionalised pronatalism situates low fertility as a site of demographic disaster – positioning primarily women’s bodies as both its cause and solution. In light of such demographic dread, assisted reproductive technologies (ART) may be utilized by pronatalist states as a strategy for fertility recovery, rather than as a benefit for individual aspiring parents. In other words, ARTs are at risk of being co-opted by nation-states for problematic demographic designs which do not advance emancipatory goals. The underlying issue of pronatalism, however, is not always explicitly acknowledged in feminist bioethics as a barrier to ethical ART usage. In my paper, I argue that it would be a mistake to assume ART can be used for emancipatory ends if we do not, at the same time, critically investigate its connections to institutionalised pronatalism.

East Asian countries such as South Korea have recently made headlines for experimenting with different methods to incentivise people to have (more) children, in a bid to reverse declining birth rates. Many such incentives—child benefits, cash bonuses, dating events, and so on—appear morally innocuous at first glance. I will demonstrate in this analysis, however, that they amount to stopgap measures which reveal fundamental shortcomings with the way various nation states are approaching the so-called ‘problem’ of fertility decline.

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.

Bio-heteronormative conceptions of the family have long reinforced a nuclear ideal of the family as a heterosexual marriage, with children who are the genetic progeny of that union. This ideal, however, has also long been resisted in light of recent social developments, exhibited through the increased incidence and acceptance of step-families, donor-conceived families, and so forth. Although to this end some might claim that the bio-heteronormative ideal is not necessary for a social unit to count as a family, a more systematic conceptualization of the family—the kind of family that matters morally—is relatively underexplored in the philosophical literature. This paper makes a start at developing and defending an account of the family that is normatively attractive and in line with the growing prevalence of non-conventional families and methods of family-formation. Our account, which we call a constitutive-affirmative model of the family, takes the family to be constituted by an ongoing process of relevant affective and affirmative relations between the putative family members.

Ugar and Malele write that generic machine learning (ML) technologies for mental health diagnosis would be challenging to implement in sub-Saharan Africa due to cultural specificities in how those conditions are diagnosed. For example, they say that in South Africa, the appearance of ‘schizophrenia’ might be understood as a type of spiritual possession, rather than a mental disorder caused by a brain dysfunction. Hence, a generic ML system is likely to ‘misdiagnose’ persons whose symptomatology matches that of schizophrenia in the South African context. The authors thus claim that ‘a generic or universal design cannot be effective given the heterogeneity of value judgements in defining what mental health disorders are in different contexts’.1 Should we take this to mean that ML systems ‘should not be designed with a generalised perception of mental disorders,’1 as the authors suggest? On the contrary, my view is that generic ML can be useful, with the caveat that issues of cultural sensitivity may engender translational challenges in various national and cultural contexts. Yet, if it can be demonstrated that a generic ML system can reliably and accurately pick up on shared symptomatologies across cultures despite what any individual or community might believe about their actual causes, this aspect is surely the function and value of diagnostic ML which we should take to matter. Cultural gaps in aetiological understandings of mental health conditions make it all the more important to advance generic ML as a calibrating diagnostic tool. In this commentary, therefore, I will endeavour to make a case for generic ML in mental healthcare. ### Aetiological (mis)understanding across cultures The fundamental complexity to which Ugar and Malele direct our attention is the fact that mental health conditions are attributed to variable causal explanations, rather than a …

Mere inability, which refers to what persons are naturally unable to do, is traditionally thought to be distinct from unfreedom, which is a social type of constraint. The advent of biomedical enhancement, however, challenges the idea that there is a clear division between mere inability and unfreedom. This is because bioenhancement makes it possible for some people’s mere inabilities to become matters of unfreedom. In this paper, I discuss several ways that this might occur: first, bioenhancement can exacerbate social pressures to enhance one’s abilities; second, people may face discrimination for not enhancing; third, the new abilities made possible due to bioenhancement may be accompanied by new inabilities for the enhanced and unenhanced; and finally, shifting values around abilities and inabilities due to bioenhancement may reinforce a pre-existing ableism about human abilities. As such, we must give careful consideration to these potential unfreedom-generating outcomes when it comes to our moral evaluations of bioenhancement.

In this article, I argue that various epistemic challenges associated with eating disorders (EDs) can negatively affect the care of already marginalized patient groups with various EDs. I will first outline deficiencies in our understanding of EDs—in research, healthcare settings, and beyond. I will then illustrate with examples cases where discriminatory misconceptions about what EDs are, the presentation and treatment of EDs, and who gets EDs, instantiate obstacles for the treatment of various ED patient groups.

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.

Should involuntarily childless people have the sameopportunities 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, wecritically 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.

An episiotomy is ‘an intrapartum procedure that involves an incision to enlarge the vaginal orifice,’1 and is primarily justified as a way to prevent higher degrees of perineal trauma or to facilitate a faster birth in cases of suspected fetal distress. Yet the effectiveness of episiotomies is controversial, and many professional bodies recommend against the routine use of episiotomies. In any case, unconsented episiotomies are alarmingly common, and some care providers in obstetric settings often fail to see consent as necessary in context. In their article, ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al reiterate that consent is necessary for episiotomies. They specify, further, that the antenatal period is crucial for exchanging information, establishing trust between the birthing subject and provider, and exploring the birthing subject’s—rather than the care provider’s—values and preferences regarding episiotomies. They recommend an individualised approach, which would enable birthing subjects to choose how and when they want to give consent. I applaud van der Pijl et al on their practicable recommendations regarding consent for episiotomies. This is certainly a step in the right direction where respect for birthing subjects’ bodily autonomy and integrity is concerned. Still, we must be reminded that consent alone is not coextensive with autonomy. The conditions for securing informed consent in healthcare does not guarantee that one’s decision is truly reflective of their values. After all, even valid consent does not rule out ‘normatively significant external influence’.2 Consent acquisition for obstetric procedures present no …

In this paper, I claim that live uterus donors ought to be considered for the possibility of compensation. I support my claim on the basis of comparable arguments which have already been applied to gamete donation, surrogacy, and other kinds of organ donation. However, I acknowledge that there are specificities associated with uterus donation, which make the issue of incentive and reward a harder ethical case relative to gamete donation, surrogacy, and other kinds of organ donation. Ultimately, I contend that while reimbursement for the costs incurred by live uterus donors should be treated as a necessary ethical minimum, how much further we ought to remunerate uterus donations remains an open question.

Because many involuntarily childless people have equal interests in benefitting from assisted reproductive technologies like in vitro fertilization as a mode of treatment, we have normative reasons to ensure inclusive access to such interventions for as many of these people as is reasonable and possible. However, the prevailing eligibility criterion for access to assisted reproductive technologies—'infertility'—is inadequate to serve the goal of inclusive access. This is because the prevailing frameworks of infertility, which include medical and social infertility, fail to precisely capture and unify the relevance of certain involuntarily childless experiences as warranting assisted reproductive technology (ART) treatment. I argue that the least we can do for those who have an interest in accessing ARTs is to conceptualize involuntarily childless experiences in dialogue with interactionist and ecological models of disability, to outline a unified and more inclusive eligibility criterion.

Individualistic traditions of autonomy have long been critiqued by feminists for their atomistic and asocial presentation of human agents. Relational approaches to autonomy were developed as an alternative to these views. Relational accounts generally capture a more socially informed picture of human agents, and aim to differentiate between social phenomena that are conducive to our agency versus those that pose a hindrance to our agency. In this article, I explore the various relational conceptualizations of autonomy profferred to date. I critically review some of the ongoing internal disputes within the relational autonomy literature, and conclude the article by taking stock of the value of relational autonomy despite these unresolved debates.

In this article, I critique the commonly accepted distinction between commercial and altruistic surrogacy arrangements. The moral legitimacy of surrogacy, I claim, does not hinge on whether it is paid (‘commercial’) or unpaid (‘altruistic’); rather, it is best determined by appraisal of virtue-abiding conditions constitutive of the surrogacy arrangement. I begin my article by problematising the prevailing commercial/altruistic distinction; next, I demonstrate that an assessment of the virtue-abiding or non-virtue-abiding features of a surrogacy is crucial to navigating questions about the moral legitimacy of surrogacy; in the final part, I reject other moral heuristics that might be proposed as alternatives to the commercial/altruistic dichotomy, and reiterate that a virtue-ethical framework is the most suitable way forward.

The common liberal understanding of reproductive autonomy – characterized by free choice and a principle of non-interference – serves as a useful way to analyse the normative appeal of having certain choices open to people in the reproductive realm, especially for issues like abortion rights. However, this liberal reading of reproductive autonomy only offers us a limited ethical understanding of what is at stake in many kinds of reproductive choices, particularly when it comes to different uses of reproductive technologies and third-party reproduction. This is because the liberal framework does not fully capture who benefits from which reproductive options, the extent of the risks and harms involved in various reproductive interventions, and the reasons for why people are driven to make certain reproductive choices.

According to Chloe Romanis, it is worth distinguishing interventions such as surrogacy, uterus transplantation (UTx), and potentially artificial placenta technology, as falling under the genus assisted gestative technologies (AGTs) rather than the more general term assisted reproductive technologies (ARTs). 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.’ Yet, if assisted gestative technologies can be considered a genus of assisted reproductive technologies, we might consider surrogacy, uterus transplantation (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.

This bioethics handbook offers concise, up-to-date, and easy to read chapters on a broad range of bioethical topics in the following categories: foundational concepts, theory and method, healthcare ethics, research ethics, public health, technology, and the environment. The volume provides a snapshot of current bioethics, taking into account current affairs and emerging new topics. Each chapter acknowledges and critically breaks down the historical developments of the subject and the most authoritative existing literature on respective topics, providing accessible and up-to-date philosophical analysis. As such, the chapters are designed to be attractive as primary or supplementary teaching material for university classes of the philosophical or bioethical variety, with clear demarcations and indicators for key terms, ideas, and arguments that should also facilitate productive note-taking and points for critical discussion for students. The handbook also serves as a one-stop starting resource for multi- and interdisciplinary researchers and practitioners who engage with bioethics in their work.

Ascribing autonomous status to agents is a valuable practice. As such, we ought to care about how we engage in practices of autonomy ascription. However, disagreement between first-personal experiences of an agent's autonomy and third-personal determinations of their autonomy presents challenges of ethical and epistemic concern. My view is that insights from a dialogical rather than nondialogical account of autonomy give us the resources to combat the challenges associated with autonomy ascription. I draw on Andrea Westlund's account of dialogical autonomy—on which autonomy requires a dialogical disposition to hold oneself answerable to external critical perspectives—to make my case.

Natalie Stoljar posits that those who have internalized oppressive norms lack normative competence, which requires true beliefs and critical reflection. A lack of normative competence makes agents nonautonomous, according to Stoljar. This framework is thereby meant to address what she calls the “feminist intuition”—the intuition that oppressive norms are incompatible with autonomy. On my view, however, Stoljar’s normative competence account of autonomy is subject to a worrying problem. Her account misattributes nonautonomy to those who perpetrate the oppression, making those who are oppressed and those who oppress count as equally nonautonomous. I argue that this is implausible and demonstrate in this paper that we can establish an asymmetry of autonomy between those who oppress others and those who are made the target of oppression.

Some have claimed that moral bioenhancement undermines freedom and authenticity – thereby making moral bioenhancement problematic or undesirable – whereas others have said that moral bioenhancement does not undermine freedom and authenticity – thereby salvaging its ethical permissibility. These debates are characterized by a couple of features. First, a positive relationship is assumed to hold between these agency-related concepts and the ethical permissibility of moral bioenhancement. Second, these debates are centered around individualistic conceptions of agency, like free choice and authenticity, which hail from an atomistic tradition of autonomy. My view is that emphasizing individualistic conceptions of autonomy do not provide particularly strong foundations on which to argue about the issue of the permissibility of moral bioenhancement. This is because individualistic autonomy is not the kind of agency-related consideration we ought to value. Instead, I propose that we investigate the relationship between moral bioenhancement and a more relational kind of autonomy. Focusing on this latter relationship, on my view, clarifies the potential for moral bioenhancement to support or enhance people’s autonomy.