Introduction

Like all clinicians, reproductive healthcare providers face specialty-specific ethical questions. However, the first editor of this book, Dr. Julie Chor (JC), an obstetrician-gynecologist who also completed a Complex Family Planning Fellowship, has never found an ethics text that is tailored to the needs of practicing clinicians, students, and trainees in reproductive healthcare. This is an unfortunate gap in the literature because whether reproductive health providers come from obstetrics and gynecology, family medicine, pediatrics, or another field, they all must be able to identify and analyze complex ethical issues that lie at the crossroads of patient decision-making, scientific advancement, political controversy, government regulation, and profound moral considerations in the context of continually evolving medical, legal, and societal factors. To fill this gap, Dr. Chor invited co-editor Professor Katie Watson (KW), a bioethics professor and lawyer who focuses on reproductive ethics, to partner in creating the text that she has always longed to use but has never found while practicing and teaching in this complex milieu....

Why Reproductive Justice Matters to Reproductive Ethics

This chapter addresses the historical and current attempts by physicians and legislators to regulate the reproduction of Black, Latina, and Indigenous women, with a particular focus on Black women. It connects the contemporary language promoting long-acting reversible contraception for “risky” populations to past policies coercing Black, Latina, and Indigenous women to use contraception and undergo sterilization. At the same time, these efforts to regulate the reproduction of women of color coincide with a rising number of abortion restrictions and lack of access to abortion and safe motherhood, which affect women of color disproportionately. Black women bear a disproportionate burden of the staggering and rising maternal mortality rate in the United States. These topics are often omitted from discussions about reproductive ethics, and social justice is often neglected as a major ethical principle. Approaching the reproductive freedom of women of color from a reproductive justice perspective, therefore, offers an important way to expand our understanding of reproductive ethics.

Reproductive Ethics in Clinical Practice

Reproductive healthcare professionals in fields such as obstetrics and gynecology, family medicine, and pediatrics routinely face unique ethical issues at the crossroads of patient decision-making, scientific advancement, political controversy, legal regulation, and profound moral considerations. This book is a carefully curated compilation of essays written by leading experts in the fields of medicine, ethics, law, and the social sciences who address key issues at the forefront of reproductive ethics. It is organized into three main sections: Preventing Pregnancy and Birth (Contraception and Abortion Ethics), Initiating Pregnancy (Assisted Reproduction Ethics), and Managing Pregnancy and Delivery (Obstetric Ethics). Each section begins with a short introduction by the editors, providing an overview of this area of reproductive ethics and contextualizing the essays that follow. Two features make the book appealing and useful to practicing clinicians as well as students and trainees: the short length of the essays and the practical yet exciting topics they cover (e.g., issues around race, religion, abortion, violations of confidentiality, conflicts of interest, legal liability, maternal choices that risk future children’s health, and reproductive practice in Europe and developing nations). The collection provides clinicians at all levels of training with frameworks within which to approach challenging encounters.

Bioethics and Jainism: From Ahiṃsā to an Applied Ethics of Carefulness

Although Jainism has been largely absent from discourses in bioethics and religion, its rich account of life, nonviolence, and contextual ethical response has much to offer the discussion within and beyond the Jain community. In this essay, I explore three possible reasons for this discursive absence, followed by an analysis of medical treatment in the Jain tradition—from rare accommodations in canonical texts to increasing acceptance in the post-canonical period, up to the present. I argue that the nonviolent restraint required by the ideal of ahiṃsā is accompanied by applied tools of carefulness (apramatta) that enable the evolution of medicine. These applied tools are derived from the earliest canonical strata and offer a distinct contribution to current bioethical discourses, demanding a more robust account of: (1) pervasive life forms; (2) desires and motivations; (3) direct and indirect modes of harm; and (4) efforts to reduce harm in one’s given context. I conclude by examining these tools of carefulness briefly in light of contemporary Jain attitudes toward reproductive ethics, such as abortion and in vitro fertilization.

Whose Ethics? Making Reproductive Ethics More Inclusive and Just

As the field of assisted-reproductive technology progresses, bioethicists continue to debate whether and how the availability of this technology creates new moral duties for parents-to-be. It is rare for these debates to seriously engage with questions related to race and class. Camisha Russell asks us to move race from the margins to the center of our discussions of reproductive ethics. She argues that this shift can work as a kind of corrective that will lead to better theory. In this paper, I build on Russell’s work by considering two proposals related to prenatal genetic diagnosis [PGD] that received a lot of attention and debate—Julian Savulescu and Guy Kahane’s argument in favor of a “principle of procreative beneficence” and Janet Malak and Judith Daar’s argument in favor of a legal duty, in certain cases, to use PGD. My analysis of each of these arguments shows how a lack of diverse viewpoints leads to bad theory. I end the paper by showing how including a diversity of perspectives shifts our focus from rights to justice.