Ethical Issues in Gestational Surrogacy

The introduction of contraceptive technologies hasresulted in the separation of sex and procreation. Theintroduction of new reproductive technologies (mainlyIVF and embryo transfer) has led not only to theseparation of procreation and sex, but also to there-definition of the terms mother and family.For the purpose of this essay, I will distinguishbetween:1. the genetic mother – the donor of the egg;2. the gestational mother – she who bears and gives birth to the baby;3. the social mother – the woman who raises the child.This essay will deal only with the form of gestationalsurrogacy in which the genetic parents intend to bethe social parents, and the surrogate mother has nogenetic relationship to the child she bears anddelivers. I will raise questions regarding medicalethical aspects of surrogacy and the obligation(s) ofthe physician(s) to the parties involved. I will arguethat the gestational surrogate is “a womb to rent,”that there is great similarity between gestationalcommercial surrogacy and organ transplant marketing.Furthermore, despite claims to freedom of choice andfree marketing, I will claim that gestationalsurrogacy is a form of prostitution and slavery,exploitation of the poor and needy by those who arebetter off. The right to be a parent, although notconstitutional, is intuitive and deeply rooted.However, the issue remains whether this rightoverrules all other rights, and at what price to theparties involved. I will finally raise the followingprovocative question to society: In the interim periodbetween today's limited technology and tomorrow'sextra-corporeal gestation technology (ectogenesis),should utilizing females in PVS (persistent vehetativestate) for gestational surrogacy be sociallyacceptable/permissible – provided they have leftpermission in writing?     

Liberalism and the Privatised Family: The Legacy of Rousseau

This article argues that the intellectual legacy of Rousseau is at the root of the failure of 20th century egalitarian theorists such as Rawls and Dworkin to engage intellectually with feminist theorists working within the liberal tradition. Through an extended critique of Rousseau’s delineation of the relationship between liberal citizenship and the private family, it argues that the failure of such liberal theorists to take gender hierarchy seriously is a consequence of their attempt to place the private family outside the sphere not only of politics, but also of justice.     

The Duty to Eradicate Global Poverty: Positive or Negative?

In World Poverty and Human Rights, Thomas Pogge argues that the global rich have a duty to eradicate severe poverty in the world. The novelty of Pogges approach is to present this demand as stemming from basic commands which are negative rather than positive in nature: the global rich have an obligation to eradicate the radical poverty of the global poor not because of a norm of beneficence asking them to help those in need when they can at little cost to themselves, but because of their having violated a principle of justice not to unduly harm others by imposing on them a coercive global order that makes their access to the objects of their human right to subsistence insecure. In this paper, I claim that although Pogge is right in arguing that negative duties are crucial in an account of global justice, he is wrong in saying that they are the only ones that are crucial. Harming the global poor by causing their poverty provides a sufficient but not a necessary condition for the global rich to have a duty of justice to assist them. After engaging in a critical analysis of Pogges argument, I conclude by suggesting the need for a robust conception of cosmopolitan solidarity that includes positive duties of assistance which are not mere duties of charity, but enforceable ones of justice.     

The Role of Apparent Constraints in Normative Reasoning: a Methodological Statement and Application to Global Justice

The assumptions that are made about the features of the world that are relatively changeable by agents and those that are not (constraints) play a central role in determining normative conclusions. In this way, normative reasoning is deeply dependent on accounts of the empirical world. Successful normative reasoning must avoid the naturalization of constraints and seek to attribute correctly to agents what is and is not in their power to change. Recent discourse on global justice has often come to unjustified conclusions about agents obligations due to a narrow view of what is changeable and by whom.I would like to thank for their helpful comments Christian Barry, Rudiger Bittner, Darrel Moellendorf and Thomas Pogge.     

Welfare and Wealth, Poverty and Justice in Today’s World

This article argues that there is no sound basis for thinking that we have a general and strong duty to rectify disparities of wealth around the world, apart from the special case where some become wealthy by theft or fraud. The nearest thing we have to a rational morality for all has to be built on the interests of all, and they include substantial freedoms, but not substantial entitlements to others assistance. It is also pointed out that the situation of the worlds poor is not that of victims of disasters, but simply of less-developed technology, which can be repaired by full and free trade relations with others. The true savior of the worlds poor is the businessman, not the missionary. What we do need to do is strike down barriers to commerce, rather than requisition aid.     

Identity and moral responsibility of healthcare organizations

In this paper the moral responsibility of a Healthcare Organization (HCO) is conceived as an inextricable aspect of the identity of the HCO. We attempt to show that by exploring this relation a more profound insight in moral responsibility can be gained. Referring to Charles Taylor we explore the meaning of the concept of identity. It consists of three interdependent dimensions: a moral, a dialogical, and a narrative one. In section two we develop some additional arguments to apply his concept of personal identity to organizations. The final section works out the relationship of three dimensions of identity to some actual issues in contemporary HCOs: the tension between care and justice, the importance of dialogues about the diversity of goods, and the relevance of becoming familiar with the life-story of the HCO. Identity of an HCO is established and developed in commitments to and identification with certain goods that are central for a HCO. However, many of these goods are interwoven with everyday practices and policies. Therefore, moral responsibility asks for articulation of goods that often stay implicit and should not be reduced to a merely procedural approach. However difficult this articulation may be, if it is not tried at all HCOs run the risk of drifting away from their very identity as healthcare institutions: to offer care to patients and to do this in accordance with demands of social justice.     

Welfare,Justice, and Pareto Efficiency

In economic analysis, it is usually assumed that each individuals well-being (mental welfare) depends on her or his own resources (material welfare). A typology is provided of the ways in which one persons well-being may depend on the material resources of other persons. When such dependencies are taken into account, standard Paretian analysis of welfare needs to be modified. Pareto efficiency on the level of material resources need not coincide with Pareto efficiency on the level of well-being. A change in economic conditions that is Pareto efficient in the standard sense, i.e., with respect to material resources, may nevertheless sacrifice one persons well-being to that of another. It is shown that under plausible assumptions, Pareto efficiency on the level of well-being may require the reduction of inequality on the level of material resources.     

Body dissatisfaction in married women: the role of spousal influence and marital communication patterns

Family factors and the media have been established as determinants of body satisfaction, yet little research has looked at the contribution of spousal influence in body dissatisfaction. Marital quality and satisfaction can be a protective factor in the health of women, while high rates of criticism have been associated with poorer health outcomes. The present study investigated the relationship between perceptions of family and spousal factors and body dissatisfaction in married women. Additionally, the impact of marital communication was investigated. Seventy-seven married women completed self-report questionnaires assessing familial body-focused comments, spousal evaluation of a wife’s body, marital communication patterns, and body dissatisfaction. After controlling for weight status, women’s perceptions of familial body-focused comments and spousal evaluation emerged as significant predictors of body dissatisfaction. It was also found that more destructive communication patterns moderated the effect of perceived spousal evaluation on body dissatisfaction. This study provides some context for understanding the impact of specific influences on women’s body dissatisfaction.     

Inequalities in Health and Intergenerational Equity

In the popular folklore three-score-years-and-ten is treated as a fair innings for people, and thereby serves as an informal reference point for judgements about distributive justice within a community. But length of life alone is an insufficient basis for such judgements - a person's health-related quality-of-life also needs to be taken into account. If one of the objectives of public policy is to reduce inequalities in lifetime health, it will be demonstrated that this is very likely to require systematic discrimination against the older members of a community. The notion of community solidatity will also be tested, because a decision will need to be made as to whether the same fair innings applies to all members of the community, or whether some are entitled to more than others. The strength of the fair innings principle is that it brings these issues to the fore in a systematic way which should ais their resolition in a practical context.     

Justice and Game Advantage in Sporting Games

This paper is a case study of what Jon Elster calls "local justice"; particular schemes of justice which, on a relatively autonomous basis, are designed and implemented by institutions and practices to meet particular preferences and goals. The paper suggests an interpretation of the role of justice in sporting games. First, a framework for examinations of schemes of local justice is suggested. Second, norms are suggested that express the requirements that have to be met in order to consider a sporting game as just. The discussion shows that sports are characterized by a particular blend of meritocratic justice in which goods and burdens are distributed according to performance, and a non-meritocratic distribution through which goods and burdens arise as matters of chance. The essay concludes by arguing that the optimal blend of meritocratic justice and chance results in the realization of not merely fair sporting games, but of exciting and good games as well.