Catherine Mills

Reproductive Autonomy as Self-Making: Procreative Liberty and the Practice of Ethical Subjectivity

In this article, I consider recent debates on the notion of procreative liberty, to argue that reproductive freedom can be understood as a form of positive freedom-that is, the freedom to make oneself according to various ethical and aesthetic principles or values. To make this argument, I draw on Michel Foucaults later work on ethics. Both adopting and adapting Foucaults notion of ethics as a practice of the self and of liberty, I argue that reproductive autonomy requires enactment to gain meaning within the life contexts of prospective parents. Thus, I propose a shift away from the standard negative model of freedom that sees it solely as a matter of noninterference or nonimpedance, a view advocated by major commentators such as John Harris and John Robertson. Instead, reproduction should be understood as a deeply personal project of self-making that integrates both negative and positive freedom.

Simply providing information: Negotiating the ethical dilemmas of obstetric ultrasound, prenatal testing and selective termination of pregnancy

Obstetric ultrasound is key to opposing ways of valuing foetuses, that is, both to the ascription of foetal personhood and to foetal selection and termination of pregnancy. Whilst ultrasound images are increasingly common within the public sphere there has been relatively little public discussion of its role in identifying actual or potential foetal anomaly and the consequences of this. This paper examines how professionals working with obstetric ultrasound encounter, navigate and make sense of the different uses of this technology. Professionals commonly delineate their work (as providing information) from women’s autonomous choices. Emphasising “women’s choice” can obscure consideration of different collective ways of valuing foetuses with anomalies. It can also deflect consideration of the fundamentally ambiguous information that ultrasound can produce. Distinguishing information from choice is underpinned by a questionable fact–value distinction. We describe alternate professional practices which involve questioning these binaries and foregrounding clinicians’ responsibilities for women’s current and future experience. Public discussion of ultrasound’s different roles in valuing foetuses would be enriched if the discourses and practices shaping professionals’ attempts to facilitate ethical decision-making were included for collective consideration.

Technology, embodiment and abortion

In August 2004, ABC Television screened the controversial documentary on abortion, ‘My Foetus’, directed by British filmmaker, Julia Black. 1 Black’s explicit question in making the documentary was whether one could ‘look at the facts’ of abortion and still be prochoice. The documentary did not provide a definitive answer to this question; Black herself stated her prochoice stance, but in the film she adopted a number of strategies used by anti-abortion campaigners to probe the ethical issues raised by abortion. Primarily, Black’s focus lay on the imagery of the fetus, a powerful tool in anti-abortion campaigns, and in particular, on the effect of ultrasound technologies that allow 3-D imaging of the fetus on our intuitions about the ethics of abortion. Indeed, Black suggests at one point that if anything is to lead her to take an anti-abortion position, it is this capacity to see the fetus, particularly as it is performing activities normally associated with babies, such as thumb sucking. The polemical force of such imaging technologies lies in the emotive effect that seeing the fetus induces, which, it is implicitly suggested, necessarily leads to the conclusion that abortion is immoral. In order to rebut this conclusion, standard accounts of the ethics of abortion, which for the most part focus on the dual problem and apparent conflict of rights and autonomy, have discounted the moral importance of this emotive response. Although recognizing that ultrasound imaging may have a strong emotive effect, within the dominant ethical frameworks there is no sense in which this effect ought to impact upon the rationalistic moral conclusions to be drawn about the permissibility or otherwise of abortion. That is, although such images may have a strong emotive effect, this effect is itself irrelevant to the moral conclusions that we should draw. Although there are good reasons to distrust the effect of emotion within moral reasoning, this approach nevertheless avoids a key issue here – that technologies such as ultrasonography may transform the relations that we bear to each other, including to the fetus, and hence the ethical responsibilities that take hold in that relationality. Further, this avoids a broader question of the impact of images on our ethical responses. While the affective impact of images is often deployed to great effect, not only in campaigns against abortion, but also in campaigns to enhance funding for aid and development agencies for instance, little has been said to explain why images have such an effect on our ethical intuitions and responses. Certainly, attention has focused on establishing whether particular images are morally good or bad, for instance in relation to pornography. But less has been said of the effect of images on our ethical responsiveness and the responsibilities that take hold from that. Regardless of arguments concerning viability and potentiality that dominate moral debates on abortion, one key effect of ultrasound technologies is to constitute the fetus as a human being, as a person. French philosopher Louis Althusser argued that ideologies work to ‘interpellate’ individuals into particular social positionings, where the process of interpellation entails being called or ‘hailed’ into being. 2 Althusser’s understanding of interpellation can help illuminate the effect of ultrasound technology, which does not simply represent the fetus, but has the effect of hailing the developing fetus into being as human, as a baby and as a son or daughter. Thus, the illusion of immediacy established by the technology – which is further reinforced by the apparent continuity in activities between the fetus and the newborn, the future child – operates to establish an emotive and social relation to the fetus that is dramatically different from that in effect without such access to the intra-uterine life of the fetus. Several important points follow from the interpellative capacity of ultrasonography, two of which I want to mention here. First, that the fetus is interpellated or hailed as human in ultrasonographic imaging implies that the category of the human is itself a social category and not merely a natural one. Judith Butler, the American feminist theorist famous for her critique of the apparent naturalness of gender categories, has recently made this claim, arguing that what counts as human is constituted as such through a process of ‘humanization’. 3–5 This process entails that being human requires fulfilling a usually implicit set of normative criteria that more or less effectively regulate the process of humanization. Butler argues that this regulation of the process of humanization also generates a particular susceptibility or vulnerability to violence, particularly for those beings who do not wholly satisfy the criteria of regulation. This point highlights the way in which the fetus itself is vulnerable to those criteria of humanization, a point that is particularly pertinent today given the ways in which technologies such as pre-implantation and prenatal genetic diagnosis allow a genetic perfectionism to be increasingly built into our conception of the Correspondence to: Catherine Mills, School of Philosophy, University of New South Wales, Sydney, NSW 2052, Australia. Email: catherine.mills@unsw.edu.au

The performativity of personhood

In debates on infanticide, including the recent defence of so-called ‘after-birth abortion’, philosophers generally treat the term ‘the person’ as descriptive, such that statements claiming that something is a person (or not) can be considered true or false, depending on the characteristics of that thing. This obscures important aspects of its usage. J L Austen identified a subset of speech acts as performative , in that they do things in their very declaration or utterance. They do not simply describe states of affairs or things, but perform the act they ostensibly describe. ‘I promise’ or ‘I apologise’ may be taken as paradigmatic. Performative speech acts are not judged according to their truth-value, but their …

Ambiguous encounters, uncertain foetuses: Women’s experiences of obstetric ultrasound

We examine pregnant women’s experiences with routinised obstetric ultrasound as entailed in their antenatal care during planned pregnancies. This paper highlights the ambiguity of ultrasound technology in the constitution of maternal–foetal connections. Our analysis focusses on Australian women’s experiences of the ontological, aesthetic and epistemological ambiguities afforded by ultrasound. We argue that these ambiguities offer possibilities for connecting to the foetus in ways that maintain a kind of unknowability; they afford an openness and ethical responsiveness irrespective of the future of the foetus. This suggests that elucidating women’s experience has implications for theorising ethics across maternal–foetal relations and, more specifically, for the ‘moral pioneering’ (Rapp, 2000) that reproductive technologies can demand of women. Moral pioneering cannot be reduced to moments or processes of decision-making; it must allow for greater recognition of the affective commitments entailed in and incited by ultrasound. Furthermore, focussing on experiences of the ambiguity of ultrasound allows for understanding the ways in which affectivity circulates across domains commonly understood as medical or social, public or private. In doing so, it contributes to undermining a series of tensions that currently shape feminist analysis of obstetric ultrasound, often at the expense of the experience of women.

Images and Emotion in Abortion Debates

Paul Lauritzen (2008) argues that bioethics ignores the role that images play in moral debates at its peril, a claim he makes by focusing on the ways that images have been mobilized in contestations of the moral status of the human fetus, such as debates on abortion. Arguing for greater recognition of the “complex interplay of words and images” (50) that goes beyond claims about “emotional manipulation” (50), Lauritzen claims that images can be understood as visually mediated arguments. As such, they can be assessed and rebutted on the basis of criteria that are similar to those deployed in regard to linguistic arguments, namely, factual accuracy and consistency. While I commend Lauritzen’s call for greater recognition of the visual within bioethics, these argumentative criteria indicate that he remains caught within the allure of language in attempting to address the role of images in ethics. Consequently, the particular force of the image is again occluded. I suggest instead, then, that taking the possibility of a “visual bioethics” seriously requires that more attention is paid to the emotive or affective impact of images on ethical intuitions. This will not only help to articulate the specific force of images, but may also help to explain why images of the human fetus have the significance that they do in abortion debates. While Lauritzen (2008) places emphasis on the interrelation of words and images, wherein texts and images can enliven each other, his analysis is ultimately unable to resist the pull of language. This is evident in the fact that much of the essay does not actually discuss the force of images so much as the rhetorical force of the narratives that frame them, whether it be the narrative of The Silent Scream (Several Sources Shelters 2007), or the captions of the Gary Trudeau cartoons that respond to it (Trudeau 1985). But, even at its

GENETIC SCREENING AND SELFHOOD

Recent years have seen the increasing development of a strong critique of bioethics by theorists more convinced by the presuppositions of phenomenology or poststructuralism than by those of liberal individualism. Two of the key claims frequently made in such critiques are, first, that traditional bioethics focuses on consciousness and will at the expense of embodiment and the experiential networks of obligation that embodiment entails, and, second, that the normative principles of traditional bioethics are not simply guidelines for acting but have a performative force such that they regulate and normalise the bodies at stake in biotechnical interventions requiring ethical mediation. Capturing both of these arguments, Adrian Mackenzie, for instance, writes that:

Normal Life: Liberal Eugenics, Value Pluralism and Normalisation

The development of technologies such as preimplantation genetic diagnosis, reproductive cloning, and genetic therapy and enhancement have prompted considerable public and scholarly concern about a return to the eugenic projects of the early twentieth century. But while there has been much disagreement on whether new genetic technologies are eugenic or not, with the implication being that their moral acceptability rests on this designation, some contributors to this debate have taken a different approach. They argue that while new genetic technologies may well be eugenic, they constitute a new form of ‘liberal’ or ‘laissez faire’ eugenics, which are morally distinct from the totalitarian eugenics of the twentieth century. The core idea driving the formulation of this notion is that even if genetic practices are considered eugenic, this is not necessarily an indication that they are morally indefensible, since a certain form of eugenic intervention may be compatible with the key moral principles of liberal democratic societies. In apparent opposition to the more familiar form of eugenics, it is argued that this form of eugenic intervention extends individual freedom in reproductive choices and insists upon state neutrality and value pluralism.

Liberal Eugenics, Human Enhancement and the Concept of the Normal

In this chapter, I examine the uses to which the concept of the normal is put in debates on liberal eugenics and human enhancement. I discuss three particular approaches to human nature and the normal: Jurgen Habermas’s emphasis on human nature as a normative concept that grounds the moral distinction between therapy and enhancement; the use of the ‘normal species function’ model of normality by Allen Buchanan and his co-authors; and finally, John Harris’s rejection of normality and consequent embrace of enhancement technologies. Following this, I draw on the work of Georges Canguilhem to outline a conception of the normal that would avoid the worries that hound Habermas’s normative account of human nature, while still allowing for a distinction between therapy and enhancement.

Reproducing Alterity: Ethical Subjectivity and Genetic Screening

To a large extent, reproductive decisions are decisions about who comes into the world. As the non-identity problem discussed in the previous chapter makes clear, this is true of more traditional forms of decision-making and contingencies such as when conception occurs. It is also true, and increasingly obvious, with decisions about preimplantation and prenatal screening. Rather than address issues of the obligations that parents may have to give birth to specific children – such as those with the best chance of the best life – in this chapter, I want to ask what the fundamental stakes are of decisions about who comes into the world, and how screening technologies may impact upon this decision.