Timothy F. Murphy

In ‘A consequentialist case for permitting conscientious objection in healthcare,’ Steve Clarke proposes a publicly available registry for people seeking certain medical procedures (eg, abortion) to which some clinicians object for moral reasons.1 The registry would list healthcare professionals (HCPs) available to perform those procedures, and patients could locate clinicians willing to help them and bypass the others. HCPs could also use the registry as an informational source for referrals, provided they are willing to make referrals. Clarke presents two chief virtues of this kind of registry. It would work to ensure that patients do not encounter HCPs unwilling to help them. It would also help protect HCPs from inquiries about services to which they have moral/religious objections and who may even object to making a referral for those services. Clarke presents this registry as a practical bypass of certain ethical conflicts, by keeping would-be disputants from ever encountering one another so far as possible. That done, medical ethics and the law could give wide berth to conscience exemptions for HCPs without moral worry about a lot of downstream effects, such as moral injuries to HCPs or deprivation of services to patients. Even so, no shortage of ethical questions attaches to such an informational registry. First, we can ask, ‘Whose moral responsibility is this registry?’ Clarke effectively treats the answer as self-evident, …

ABSTRACT In this essay the argument set forth by Michael Levin regarding the abnormality of homosexual behaviour is reviewed and criticized. Against his argument which holds that homosexual behaviour is abnormal because it constitutes an evolutionary aberration, I argue that Levin's and all similarly constructed arguments fail to show that evolutionary origins of sexual behaviour have any significant normative force. I contend that his notion of homosexuality is confused and that he fails to consider alternative methods of how homosexuality might have indeed served evolutionary adaptive purposes or been the result of surplus adaptations. I argue, too, that Levin's linking of unhappiness with homosexual behaviour is spurious and ill‐supported. Consequently, I reject Levin's claims that public policy ought to do what it can to minimize the incidence of such behaviour. I argue by contrast that if happiness is the end of public policy decisions, then society ought to take what measures it can to protect persons in respect of their homosexual behaviour and identities.

The motives and consequences of harvesting sperm from brain dead males for the purpose of effecting post mortem fatherhood are examined. I argue that sperm harvesting and post mortem fatherhood raise no harms of a magnitude that would justify forbidding the practice outright. Dead men are not obviously harmed by the practice; children need not be harmed by this kind of birth; and the practice enlarges rather than diminishes the reproductive choices of surviving partners. Certain ethical and legal issues nevertheless require attention. As a matter of consistency with other harvesting protocols, there ought to be a mechanism for respecting the wishes of men who when alive do not wish to become fathers post mortem. Mechanisms governing entitlement to harvest and use sperm will also be required. I note that the law is unlikely to recognize the paternity of children born from harvested sperm, though there may be reasons to recognize that paternity in some instances.

In Paid Sexual Encounters among Men: A Study in Ethics and Law, I make the case that paid sexual encounters among adult men are not necessarily immoral in themselves or in their effects. In making these arguments, I consider whether these sexual encounters are even morally distinct in kind from others, whether they involve harm to a degree that justifies presuming them as immoral, and whether they trade only on status equality and compromised consent. With extended reference to the way the idea of 'morality' has been relied on in U.S. Supreme Court cases, I also make the case that the state lacks the authority to criminalize these sexual encounters when they occur among adult men in private even if some people consider them immoral. On the contrary, I argue that the state should not intrude against the privacy of these relationships and that it owes them protection from hostile moralistic uses of the law, although some regulations that protect rights and limit harm are within the state's authority.

In ‘Towards an ethics of pronatalism in South Korea (and beyond),’ Lee argues that certain pronatalist policies and programmes enacted by the state presuppose and reinforce objectionable social norms, for example, pathologising people who deviate from the script of marriage and children and imposing disproportionate burdens on women.1 The argument suggests that instead of managing ‘symptoms’ (eg, individual motivations towards or against having children), the state should address their ‘aetiology’ (eg, domestic inequalities and environmental pollutants). However, even while progressing towards these goals, it remains an open question whether addressing them would work any better at boosting certain countries’ low birth rates or maintaining them in the long term. While Lee accepts that the “justifications for pronatalist incentives … are well founded,” she effectively undercuts the authority of the state to engage in them. For example, Lee only grudgingly accepts the “so-called ‘problem’ of fertility decline” as a concern in its own right. She treats the state’s efforts at boosting fertility rates as almost beside the point relative to “several serious issues,” namely the “variegated social and relational concerns” that constitute barriers to wanting …

Some commentators confer the right to children on those who gestate them because of the personal intimate relationship they say obtains in gestation.1 Benjamin Lange criticises two variants of that argument.2 He argues against the view that gestation creates a sui generis relationship that in its distinctiveness confers the right to the child on its gestator and the right of the child to its gestator. He also argues against the view that gestation involves a relationship whose dissolution necessarily causes morally significant harm. I do not dispute these lines of reasoning, but the analysis goes further than Lange indicates. The reasons that Lange deploy to reject the relationship involved in gestation as conferring any kind of proprietary right to children also undercut that relationship as a ground of a presumptive duty towards those children. In the first instance, Lange disputes the idea that gestation produces a non-instrumental good that both the gestator and child have an interest in maintaining. In part, he argues that this kind of relationship lacks the emotional complexity, intimacy and intensity that underwrite other kinds of relationships, namely the very qualities that constitute the value of those relationships. More tellingly, he says, there is no unambiguous evidence that …

Experience with electronic communication in ethics committees at two hospitals is reviewed and discussed. A listserver of ethics committee members transmitted a synopsis of the ethics consultation shortly after the consultation was initiated. Committee comments were sometimes incorporated into the recommendations. This input proved to be most useful in unusual cases where additional, diverse inputs were informative. Efforts to ensure confidentiality are vital to this approach. They include not naming the patient in the e-mail, requiring a password for access to the listserver, and possibly encryption. How this electronic communication process alters group interactions in ethics committees is a fruitful area for future investigation.

Abstractabstract:Birth certificates typically designate parents as "mothers" or "fathers," although some US states offer nongendered designations. The authors argue that gendered characterizations offer scant legal or moral value and that states should move to degender parental status on birth certificates but retain that information in registrations of birth. Registrations of birth identify the person giving birth to a child, when, and where, and they report demographic and health information useful for civic and public health purposes. Birth certificates typically report a child's name, sex, date and location of birth, and parentage so far as known. As documents establishing parents' standing in relation to children and vice versa, as well as age and presumptive citizenship, birth certificates add no legal or moral value by gendering parents. Gendering parents on birth certificates obliges the state to rely on exclusionary criteria of "mother" and "father." By contrast, degendering parental status withdraws the need for such criteria and confers benefits on people with transgender and nonbinary identities, as well as undercutting any problematic presumption that parents have responsibilities to their children qua mother or qua father.

Robinson argues that by certain threshold criteria, pregnant women qualify for a higher moral status by reason of their pregnancies. While her intention is to make this a status upgrade for women, we worry that it may result in a status downgrade for women as a class, by presupposing and reinforcing women’s value in relation to their reproductive labour. Historically, central to feminist analysis is resistance to reductive accounts of women in relation to their reproductivity. For example, de Beauvoir addressed men’s transcendence and contrasted it with women’s immanence, a status distinction possible because women are mired in expectations that they will marry, produce children and remain in the domestic realm; and for her part, Firestone argued that biological reproduction underlies women’s inferiority to men and that ‘The reproduction of the species by one sex for the benefit of both (should) be replaced by…artificial reproduction’1 2 Her concern was to liberate women from expectations of biological reproduction so their productive value in society is not reduced to their reproductive contributions. A formidable body of analysis in this same vein cautions against collapsing the value of women into their pregnancies, so much so that some commentators even distinguish ‘mothering’ from gestation.3 Robinson’s argument that pregnant women qualify at a higher threshold of personhood emphasises …

Abstract: This essay explores recent trends and major issues related to gay and lesbian philosophy in ethics (including issues concerning the morality of homosexuality, the natural function of sex, and outing and coming out); religion (covering past and present debates about the status of homosexuality and how biblical and qur'anic passages have been interpreted by both sides of the debate); the law (especially a discussion of the debates surrounding sodomy laws, same-sex marriage and its impact on transsexuals, and whether the law should be used to enforce morality); scientific research into the origins of homosexuality (including discussion of arguments against such research); and metaphysics (especially the question of whether homosexuality is socially constructed during particular times and in particular cultures, or whether sexual orientation is an essential trait cutting across times and cultures).

Some commentators maintain that gestational surrogates are not ‘mothers’ in a way capable of grounding a claim to motherhood. These commentators find that the practices that constitute motherhood do not extend to gestational surrogates. We argue that gestational surrogates should be construed as mothers of the children they bear, even if they fully intend to surrender those children at birth to the care of others. These women stand in a certain relationship to the expected children: they live in changed moral circumstances by reason of their pregnancy, and they engage in the practices said to define motherhood in the post‐birth context. By contrast, ovum donors and embryo donors are not similarly ‘mothers’ because they do not find themselves involved in these circumstances. Not all women involved in three‐parent in vitro fertilization qualify as mothers either. Given this analysis of mothering, we note that transmen who gestate children are engaged in mothering activity even if they otherwise function as a father to those children. By itself, this defence of the maternity of gestational surrogates does not confer moral title to the children they bear; gestation would not by itself override the contractual arrangements gestational surrogates have made regarding the disposition of their children. This interpretation of gestational surrogates as mothers does, however, undercut cultural understandings of these women as mere ‘vessels’, devoid of entitlement to respect as persons and parents. We also consider the meaning of mothering for ‘brain‐dead’ women kept alive to give birth and for the prospect of extracorporeal gestation.

According to an almost axiomatic standard in bioethics, moral commitment should ground parents’ relationship with their children, rather than biogenetic relatedness. This standard has been used lately to express skepticism about extending existing assisted reproductive treatments (ARTs) to same‐sex couples and to research into novel fertility interventions for those couples, but this skepticism is misplaced on several grounds. As a matter of access and equity, same‐sex couples seem presumptively entitled to genetic relatedness to their children as far as possible both in regard to existing ARTs and to novel ARTs under investigation. For those worried about the effects of trying to secure biogenetic relatedness for same‐sex couples, it may be noted that same‐sex couples will only ever be a fraction of the parents implicated in propping up “biologism,” as the expectation of biogenetic relatedness it is sometimes called. The cultural force of biologism would survive almost intact even if no same‐sex couples were ever to have genetically related children. It is therefore hard to see why same‐sex couples should forfeit aspirations to biogenetic relationships with their children or enjoy less subsidy for ARTs than the subsidy given to different‐sex couples. As matter of moral consistency, the full implications of the biologism critique have yet to be evaluated relative to different‐sex couples.

Abstract:Because the demand for intensive care unit (ICU) beds exceeds the supply in general, and because of the formidable costs of that level of care, clinicians face ethical issues when rationing this kind of care not only at the point of admission to the ICU, but also after the fact. Under what conditions—if any—may patients be denied admission to the ICU or removed after admission? One professional medical group has defended a rule of “first come, first served” in ICU admissions, and this approach has numerous moral considerations in its favor. We show, however, that admission to the ICU is not in and of itself guaranteed; we also show that as a matter of principle, it can be morally permissible to remove certain patients from the ICU, contrary to the idea that because they were admitted first, they are entitled to stay indefinitely through the point of recovery, death, or voluntary withdrawal. What remains necessary to help guide these kinds of decisions is the articulation of clear standards for discontinuing intensive care, and the articulation of these standards in a way consistent with not only fiduciary and legal duties that attach to clinical care but also with democratic decision making processes.