Joona Räsänen

Ectogestation and the Future of Reproductive Rights explores the profound ethical, legal, and social implications of artificial womb technology. It brings together leading scholars in bioethics to critically examine the transformative potential of ectogestation for reproduction, gestation, and abortion. In the wake of the Dobbs v. Jackson decision, questions regarding ectogestation have been elevated beyond mere philosophical curiosity. This volume addresses the heightened relevance of ectogestation for reproductive ethics, emphasizing its implications for bodily autonomy, fetal viability, and the future of abortion debates. The book is divided into four thematic sections: the use of ectogestation in clinical settings, questions regarding the pregnant person and gestational justice, the meaning of "birth" in relation to the biological entity gestating in an artificial womb, and how the advent of ectogestation might impact abortion rights in the future. Furthermore, this volume interrogates the intersections of gender, autonomy, and justice, offering fresh perspectives on the societal and philosophical challenges posed by this emerging technology. By engaging with cutting-edge arguments, this volume will provoke further discussion on reproductive rights in a rapidly evolving technological landscape. This volume is essential reading for scholars and advanced students working in philosophy, bioethics, sociology, medicine, medical humanities, and legal philosophy.

Many people think that producing online pornography, such as creating sexual content at OnlyFans, is permissible. Many of the same people also think that creating deepfake pornography without or against the consent of the person is wrong. I argue that accepting online sex work is inconsistent with judging pornographic deepfakes as worse than non-pornographic deepfakes. This claim resembles similarity with a broader problem in sexual ethics raised by David Benatar. I apply Benatar’s argument in the context of online sexual activities to highlight the ethical issues recent technological developments raise. I do this neither as a case against the permissibility of online sex work nor as a defense of pornographic deep fakes. The purpose is to point out the inconsistency. One could avoid the problem by extending or limiting the range of permissible sexual practices online. But if I am right, we cannot both accept OnlyFans and condemn non-consensual pornographic deep fakes.

Scholars in philosophy of medicine and bioethics have recently turned their attention to transformative experiences: experiences that teach something new that one could not have known before having the experience, while simultaneously changing one as a person. Sanne Elisa van der Marck recently argued, drawing on the work of Fiona Woollard, that the subjective experience of pregnancy should be included in moral debates on abortion, since pregnancy is a transformative experience. Van der Marck implicitly suggested that such a view strengthens autonomy-based pro-choice abortion arguments because only pregnant people have crucial knowledge of what it is like to be pregnant. However, as I will show, the upshot of her argument is that it undermines the autonomy-based pro-choice arguments. This is because if pregnancy is a transformative experience, then it becomes increasingly difficult to give informed consent for abortion, since only by going through pregnancy would one gain the knowledge of ‘what it is like’ that is necessary to make the rational choice of having the abortion in the first place. Thus, her argument has a counterintuitive conclusion—it limits rather than reinforces reproductive autonomy.

Ryan and Savulescu recently offered an ethical analysis of the use of semaglutide-based weight-loss drugs such as Ozempic. In this response, we continue the discussion and argue that their framework insufficiently addresses structural inequalities and the broader political context of obesity treatment. Positioning pharmaceutical drugs as a solution to socially produced health problems narrows moral decision-making, causing structural approaches to appear less urgent and less important. We criticise the individualistic conception of autonomy commonly invoked to justify pharmaceutical choice, arguing that a proper definition of autonomy requires attention to social contexts—stigma, discrimination and economic inequality—that shape treatment decisions. We call for a broader ethical framework—one that interrogates structural injustices and reimagines health interventions beyond individual treatment—asking: is the problem our bodies or unregulated markets and environments that produce ill health in them?

Lee argues that pronatalist policies in countries suffering from declining birth rates, such as South Korea, are ethically flawed.1 The ‘soft’ pronatalist policies Lee describes aim at persuading citizens to reproduce. For Lee, coercive pronatalist policies are so obviously unacceptable as not to merit consideration. However, we suggest that this is an issue that requires further analysis. When ethicists regard certain possibilities as not worth debating, we miss opportunities to examine the basis for our convictions. In short, it behoves us now and again to challenge our convictions, especially if they seem inconsistent in relation to other views we hold. By comparing coercive pronatalism with enforced military conscription, we can notice some inconsistencies. South Korea—which Lee discusses in her paper—enforces military service, as do Austria, Switzerland, Ukraine and Finland to name a few. Many countries that do not currently conscript citizens retain the right to do so during wartime. Conscription is an example of coercive state intervention which, even if not widely endorsed, rarely generates outrage or even attention from ethicists.2 For those who accept that coercive conscription could in principle be justified, it is not easy to show why coercive pronatalism must be rejected without argument. Indeed, many of those who are alarmed about declining birth rates …

In the article “The Past 110 Years: Historical Data on the Underrepresentation of Women in Philosophy Journals,” Hassoun et al. claim that there is a connection between triple anonymous review and the proportion of women authors in interdisciplinary journals. However, the sample size of interdisciplinary journals using triple-blind review practice in the analysis is 1. In addition, the sole interdisciplinary journal claimed to be triple-blind, the Journal of Medical Ethics, is not and has not been triple-blind. The finding that interdisciplinary journals publish the greatest proportion of women authorship when practicing triple anonymous review is thus unwarranted.

This chapter provides a philosophical overview of different approaches to age and aging. I challenge the belief that our age is always determined by the amount of time we have existed: chronology. I propose there are different views on age and aging. Biological age, which can be estimated based on epigenetics, might be more useful and important concept than chronological age. I suggest that sometimes some people should be allowed to change their legal age to reduce the harms that come from unjust assumptions related to old age. Changing legal age could also be used to fight ageism, discrimination based on age.

We recently suggested that there are both pragmatic and normative reasons to classify pregnancy as a disease. Several scholars argued against our claims. In this response, we defend the disease view of pregnancy against their criticism. We claim that the dysfunctional account of disease that some of our critics rely on has some counterintuitive results. Furthermore, we claim that our critics assume what needs to be argued that the primary function of our sexual organs is to reproduce. Since only a small percentage of sexual intercourse leads to pregnancy, it is far from obvious that reproduction is the primary biological function of our sexual organs. We also claim that while taking pregnancy itself as a reference class could avoid the conclusion that pregnancy is a disease, the strategy is problematic since it renders the Boorsean approach to disease and health circular and effectively deprives it of any utility in determining whether a particular phenomenon is a disease or not.

In 1975, The New England Journal of Medicine published James Rachels' article 'Active and Passive Euthanasia'. The argumentative method that Rachels introduced, the Bare Difference Argument (also known as the Contrast Strategy), became one of the most widely used tools in ethical reasoning. The argument, however, fails to show active euthanasia being morally permissible. It fails because Rachels takes the intuitions from the case where letting die is morally impermissible and applies the intuitions to cases where letting die is morally permissible. While it is possible to create thought-experiments that are more analogous to euthanasia, in this respect, than Rachels' cases, they too are disanalogous to euthanasia with some of the relevant features. Creating the perfect analogy, however, would be a mistake too. Such a case would be too analogous; people would simply be divided on what kind of moral intuitions they would have. The problem thus highlights a methodological limit in philosophical bioethics and raises questions related to the roles of philosophical ethicists in the context of assisted dying.

Andrea Bidoli argues that ectogestation could be seen as an emancipatory intervention for women. Specifically, she claims that ectogestation would create unique conditions to reevaluate one’s reproductive preference, address certain specific negative social implications of gestation and childbirth, and that it is unfair to hold ectogestation to a higher standard than other innovations such as modern contraceptives and non-medical egg freezing. In this commentary, I claim that Bidoli—like so many others—unjustly bypasses men and their reproductive desires. For a long time, the discussion of the ethics of ectogenesis has focused on women and their reproductive liberation. However, since in many countries, an increasing number of men in reproductive age face difficulties in finding a partner and lack access to other forms of assisted reproduction, it is men who need ectogestation the most.

Employers sometimes use personality tests in hiring or specifically look for candidates with certain personality traits such as being social, outgoing, active, and extraverted. Therefore, they hire based on personality, specifically extraversion in part at least. The question arises whether this practice is morally permissible. We argue that, in a range of cases, it is not. The common belief is that, generally, it is not permissible to hire based on sex or race, and the wrongness of such hiring practices is based on two widely accepted principles: the Relevance Principle and the Fairness Principle. The Relevance Principle states that hiring should be based on what is relevant to job performance, while the Fairness Principle states that hiring should be based on features that individuals can control. Since hiring based on sex or race violates these principles, it is wrong. However, we argue that, in a range of cases, hiring based on extraversion also violates these principles, and assuming the validity of the Relevance and the Fairness Principles, it follows that personality discrimination is morally wrong in those cases.

Herjeet Kaur Marway recently proposed the Principle of Procreative Justice, which says that reproducers have a strong moral obligation to avoid completing race and colour injustices through their selection choices. In this article, we analyze this principle and argue, appealing to a series of counterexamples, that some of the implications of Marway's Principle of Procreative Justice are difficult to accept. This casts doubt on whether the principle should be adopted. Also, we show that there are some more principled worries regarding Marway's idea of a strong pro tanto duty not to complete injustices through one's procreative choices. Nonetheless, we believe Marway's arguments point in the right general direction regarding duties and structural injustice. Thus, in the final part, we suggest a positive proposal on how it would be possible to respond to the cases we raise. More specifically, we explore the suggestion that agents have a pro tanto duty to participate in eliminating structural injustice. Importantly, this duty can be satisfied, not only in procreation choices but in multiple ways.

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.