Cutting God in Half

Philosophy

In order to solve the problem of the monstrous acts that an all-powerful, all-knowing God would daily be performing, we need to sever the God of Power from the God of Value.  The former is the underlying dynamic unity in the physical universe, eternal, omnipresent, all-powerful, but an It, and thus not capable of knowing what It does.  It can be forgiven the terrible things It does.  The latter is what is of most value associated with our human world - or the world of sentient life more generally.  Having performed this surgical operation on God, the problem then becomes: How can we put the two halves of God together again?  How can our human world, imbued with experiential qualities, consciousness, free will meaning and value, exist and best flourish, embedded as it is in the physical universe?  This is our fundamental problem - philosophical, intellectual and practical.  It is our fundamental religious problem.

Cutting God in Half Nicholas Maxwell Published in Philosophy Now Issue 35, March/April 2002, pp. 22-25. There is an urgent need to cut God in half. To make such a pronouncement, these days, is a risky business. One risks having a fatwa declared against one. Or one risks being arrested under some new David Blunkett law about causing offence to the religious. So, let me explain as quickly as I can what I mean by this outrageous pronouncement, in the hope that this will keep such disasters at bay. Consider the thesis: The ultimate reality is God, a Being who created the world and everything in it, a Being who is all-powerful, all-knowing, and all-loving, the source of all value, a Being who cares, profoundly, for the salvation of our souls. This is, I take it, a central tenet of Christianity, Judaism and Islam. It is not upheld by all religions; it is not, for example, a part of Buddhism. But it is believed to be true by millions, possibly billions, of people alive today. Many more pay lip service to the doctrine. Its influence is felt in many contexts: educational, political, legal, ceremonial. It even has a certain impact on war and terrorism. Given all this, the thesis deserves to be taken seriously intellectually. We need to ask: What would it be to treat this doctrine in an intellectually responsible fashion, with a measure of intellectual honesty? This question has especial relevance to education. For in so far as there are religious schools which take the thesis seriously, educational authorities responsible for educational standards need to be sure that these schools treat the God-doctrine in an educationally responsible way, in a way that promotes education rather than mere indoctrination. But we can only know what it means for a school to treat the God-doctrine in an educationally responsible way if we know what it means to treat it in an intellectually responsible way. In what follows I spell out a few elementary steps that need to be taken if one is to uphold the God-thesis with a modicum of intellectual honesty. These are steps that all theistic religions need to take if they are to avoid charges of dogmatism, charlatanism, disreputably and immorally misleading the public. The first step towards intellectual honesty that one needs to take is to note that this creed, like other substantial theses about the nature of things, needs to be treated as a conjecture, a hypothesis, which may, or may not, be true. Two points deserve to be noted about this first, minimal step. First, even here, many religious traditions paralyse rational thought by making it a sin to doubt the existence of God. The sin, of course, is to make doubt a sin. Second, it is important that one does not exaggerate the power of reason, and claim that, in order to be rational, a belief must be proven or justified. As Karl Popper tirelessly argued, even our best scientific theories cannot be verified or justified; they remain, for ever, conjectures which, at best, can be empirically falsified. The result of giving exaggerated powers to reason is that it becomes reasonable to hold that reason has its limits, and all sorts of beliefs, including 2 religious ones, are beyond the scope of reason, defy reason, and are legitimately held as articles of irrational faith. Interpret the powers of reason more modestly, as helping us to choose, fallibly, between rival conjectures, and no thesis, not even a religious one concerning the existence of God, lies beyond the reach of reason. The next step, then, is to ask: Are there good grounds for preferring the God conjecture to rival conjectures such as, for example, that no such Being as God exists? What problems does the God-thesis solve, what phenomena does it explain? Can it be refuted? There can be no doubt at all that the conjecture that an all-powerful, all-knowing, all-loving God exists does solve problems, and does make many things intelligible. The dreadful, apparently unsolvable problem of death is solved at a stroke: such a God would arrange for us to survive death. The dreadful problem of the unspeakable suffering of this world, the awful waste of human potential, the numbing injustice of human life: all this will be put right after death, if an all-powerful, all-knowing, all-loving God exists. And if such a God exists, we have an immediate explanation for the fact that our environment, here on earth seems, in many ways (if not in all ways) especially designed to nourish us and support our existence. We can even understand why the universe is knowable to us, by means of science: God created both the universe, and human beings; being benevolent, He would naturally arrange things in such a way that there is a sufficient match between the nature of the universe and the nature of our minds for us to be able to improve our knowledge of the universe. God explains why science works. How Can God's Evil Deeds be Excused? But there is a dreadful snag. If God is all-knowing and all-powerful, then God must be knowingly in charge of natural phenomena, in particular those natural phenomena that cause human suffering and death as a result of earthquakes, drought, disease, accident. Even when people torture and kill other people, God is always a co-torturer and co-murderer, in that He decides the knife will not, at the last minute, turn into rubber, the bullet will not evaporate before it hits its target, the virus will not die or become abruptly harmless. Day after day, hour after hour, God knowingly tortures and murders innocent children (children dying of painful diseases) to put the point at its most emotionally inflammatory, but correctly. The obvious conclusion to draw is that the hypothesis that an all-powerful, all-knowing, allloving God exists is refuted by the most elementary tragic facts of human existence. This conclusion is inescapable once one child has suffered and died as a result of injury or disease - suffered and died as a result of the knowing actions of God (if He exists). A loving God would take care of His children in at least as humane a fashion as, let us say, a petty thief. No run-ofthe-mill petty thief would torture his child to death over a period of days or months, a commonplace action for God (if He exists). God tortures and murders billions of people; indeed none of us escapes. Nothing can excuse God for killing one child, let alone all of humanity, one after the other. And yet, over the centuries theologians, instead of emphasizing that the God conjecture is decisively refuted, have instead struggled to invent excuses for God's criminal acts. The excuses are dreadful, utterly immoral and hopeless, and yet they continue to be taken seriously today. "God must allow us to suffer and die, because he must allow us our freedom" runs one 3 excuse. So, should we equally demand of human parents that if their child runs onto the road in front of an incoming lorry, they should not interfere, so that the child may have his freedom? "God is unknowable, and we human beings cannot know why God performs these monstrous acts" runs another. But nothing can excuse God murdering a child slowly and agonizingly by means of cancer, let us say. People living in the Soviet Union under Stalin are on record as endlessly excusing the frightful crimes of Stalin; these excuses are morally and intellectually dreadful (however excusable in the circumstances): how can any excuse, whatever it might be, be any better for God's far more dreadful crimes? "God lets us suffer so that we may grow spiritually" runs a third excuse. Are child molesters to be excused on similar grounds? Can we be so sure that suffering ennobles? Would not this argument imply that we do a person a favour if we hurt him? "It is not God who does these dreadful things, but the Devil". If God is allpowerful and all-knowing, God has the power to stop the Devil; if He decides not to, then He is in part responsible for what goes on. "People suffer and die because of the sins of their ancestors." What an appallingly immoral argument! "God does not murder people; he acts as a surgeon, causing pain in order to cure: those who die live on in Heaven (at least those who deserve it do)." But a surgeon who caused unspeakable pain in a patient over weeks or months, without adequate explanation, and without anaesthetics, would be struck off the medical register, and would doubtless be prosecuted for assault to an extreme degree: even if God does cause us to suffer so that we may be released into the after-life, this might mean that God does not murder, but it does not remotely excuse His actions. (On these grounds, no true believer could be accused of murder either, of course!) Religious communities should hang their heads in shame at producing such appalling, immoral arguments. Taking such arguments seriously, even if only to set about refuting them, is in itself to take part in a corporate dance of insanity. Why, why has humanity, or so much of humanity, allowed itself to be so bamboozled? Because the need for God is so potent, the fear of His non-existence so terrible. God's criminality is excused for the same reason, essentially, that Stalin's criminality was excused: the consequences of acknowledging that the crimes are real are too dreadful to contemplate. And this is backed up, in both cases, by a system of "education" which prompts one to believe that it is not God's (or Stalin's) criminality that is at issue, but one's own any hint of a suspicion that God (or Stalin) is a monster instantly demonstrating one's own dreadful disposition for sin. How justified God (or Stalin) would be in punishing such suspicion, and how merciful God (or Stalin) so often proves to be in not bringing down instant punishment on those who so sin. Granted that the conjecture that an all-powerful, all-knowing, all-loving God exists has been refuted, what do we put in its place? This is the really important question! In order to answer it, the first point we need to note is that, as we have discovered that God in the orthodox sense does not, and cannot exist, we need to be more open-minded about what sort of entity God may be. The question of whether God exists or not can always be converted into a question, not about God's existence, but rather about what sort of entity God is. If we mean something very specific and highly problematic by "God", then it is all too likely that God, in this sense, does not exist. But if we mean something highly unspecific and unproblematic by "God", it becomes much more likely that "God", in this sense, does exist. One way of posing the question is: What is the nature of that Entity which (a) preserves as much as possible about 4 what is best in the orthodox notion of God, and (b) exists? Reformulated in this way, the question becomes, not "Does God exist?", but rather "What is the nature of God?" where God, in this sense, exists by definition as it were. The next step, in answering the above question, is to track down what it is in the orthodox conception of "God" that we have been discussing that makes it so impossible for "God" in this sense, to exist. We then need to broaden our conception of "God" appropriately, so that "God", in this sense, becomes at least a viable possibility, the "God"-thesis a viable conjecture. It is not difficult to track down what it is about the orthodox conception of God that creates the difficulties we have been considering. These all come from the supposition that God is both all-powerful, and all-loving. This is what we need, of course, an all-powerful being who is also all-loving, so that everything that is most precious in existence will be effectively, lovingly taken care of. But in our world, this leads to the awful consequences that we have been considering. One possibility, of course, is that God, far from being loving, is thoroughly evil. But this does not seem to do justice to all the wonderful things that there are in existence. What is so confusing is that life is such a mixture of joy and horror, the extraordinary, the prosaic and the unspeakable. Perhaps God is confused, schizophrenic even, a dreadful mixture of love and hate? But this does not seem to do justice to the majesty of the universe, its intricate splendour. Could this have been created by a neurotic? One might take the thing further, by postulating two equally powerful gods, God and the Devil, one good, the other evil, locked in terrible combat, humanity somehow the field of battle. But if this really were the case, there would be, one feels, more disruptive explosions in the natural world, as the two cosmic Beings fought out their mighty, eternal battle. Another possibility, of course, is that God is all-loving, but lacks power. He sees the terrible things that go on, but is powerless to intervene. It is a version of this hypothesis that I wish to defend. As it stands, however, it is incomplete: nothing is said about the nature of that which does have power, which is the cause of natural phenomena, and thus the cause of so much of our suffering. Dissecting the Deity Here is how, in my view, the problem is to be solved. God must be cut in two. (At last I come to the proposition with which I began.) The God of power must be severed from the God of love, the God that is the source of all value. Or, if it seems just a little too brutal, too grandiose, to speak of cutting God in half, let us say, rather, that we need to cut the concept of God in half a much more modest surgical deed. The God of cosmic power is utterly impersonal. It is that impersonal something, whatever It may be, that exists everywhere, eternally and unchanging, throughout all phenomena, and determines (perhaps probabilistically) the way phenomena unfold. It is what theoretical physics seeks to discover. It is Einstein's "God", eternal, omnipresent, all-powerful, but utterly impersonal, an It, not a conscious Being. It is that physical property of the fundamental physical 5 entity, the fundamental physical field or whatever, that determines the way in which that which changes does change. It is what corresponds physically to the true unified theory of everything that physicists seek to discover. It is this cosmic It that is responsible for all our suffering. And precisely because It is an It, incapable of knowing and feeling, It can be forgiven the terrible things that It does. If It knew that the laws of nature, working themselves out as usual, meant, in this particular case, horrible suffering and death from cancer for this child, agonizing burns for this person, burial in rubble for that person, the It would at once bend a law of nature here and there, so that these ghastly tragedies can be avoided. But this cosmic It has no mind, no understanding, no awareness: it goes blindly on Its way, incapable of knowing anything, and therefore can be forgiven. But what of the other half of the traditional God, the God of value? This, I suggest, is what is best in us. It is that potentially or actually aware and loving self within us that sees, feels, knows and understands, at least partially, and either does intervene to prevent disaster, or is powerless to do so. The God of value is the soul of humanity, embedded in the physical universe, striving to protect, to care for, to love, but all too often, alas, powerless to prevent human suffering. (More generally, the God of value is that which is of most value, actually and potentially, in sentient life.) What is usually characterized as belief in science and humanism is actually what emerges as a result of a rational evolution of belief in God. The scientific view of the universe, and the humanistic faith that it is individual human beings that are of supreme value in existence amount, when taken together, to a profoundly religious view, one which does not have the awful intellectual and moral defects of orthodox Theism (whether Christian, Judaic or Islamic). Science + Humanism only denies the existence of God, in a thoroughly disreputable sense of "God"; granted a somewhat more reputable sense of "God", Science + Humanism is a passionate affirmation of the existence of God. But if this religious view solves problems that haunt orthodox Theism, it does so at the expense of creating an immense new problem. Having chopped God into two, into the God of Cosmic Power and the God of Cosmic Value, we are at once confronted by the problem: How are the two halves to be put together again? How is it possible for the God of Cosmic Value to exist embedded in the God of Cosmic Power the physically comprehensible universe? How can we understand our human world, embedded as it is within the physical universe, in such a way that justice is done to both the richness, meaning and value of human life on the one hand, and what modern science tells us about the physical universe on the other hand? This final formulation of the problem (created by cutting God in half) ought, in my view, to be regarded as the most general and fundamental problem confronting humanity. It is a philosophical problem indeed, the fundamental problem of philosophy: How is it possible for our human world, imbued with sensory qualities, consciousness, free will, art, science, and much else of value, to exist embedded in the physical universe? (This embraces, as subordinate issues, the mind-body problem, the problem of free will, problems of knowledge, of perception, of the philosophy of science, of biology and evolution, even problems of moral and political philosophy, problems of language, culture, history, abstract entities, time, space and causation.) The above is also a fundamental problem of knowledge and understanding much more 6 generally: How precisely do features of our human world, such as perceptual qualities, consciousness, and life more generally, fit into the physical universe? The problem can also be regarded as a fundamental problem of living, of action: How can we help what is of value in existence, actually and potentially, to flourish? What do we need to do, as individuals, so that what is of value to us may flourish? And what do we need to do, collectively, socially and politically, so that what is of value to people everywhere, to humanity, may flourish? The problem of fitting the God-of-value into the God-of-cosmic-power (the underlying unified It of the physical universe) is not only a conceptual problem, a problem of knowledge and understanding; it is also a practical problem, the most general, fundamental practical problem that there is: to help the God-of-value, what is of most value in us, to exist in the physical universe in ways that are less painful and constrained, more exuberant and joyful, more just, peaceful and noble, than at present. Once we recognize that the God-of-value is what is of most value, actually and potentially, in us, it becomes our most profound religious obligation to help what is of value in us to flourish in the real world. The outcome of treating the initial God-thesis with a modicum of intellectual honesty is that we are led straight to the most fundamental problems of knowledge, understanding and living that there are. Education in religious schools, in all schools, should explore these issues. Children deserve to hear, and to take part in debating, the arguments for and against steps of the kind I have indicated in this article. Anything less is dangerously close to indoctrination rather than real education. But, it may be asked, where are the textbooks for such an education? Let me conclude by recommending five relevant titles. Is Science Neurotic? (Imperial College Press, 2004). The Human World in the Physical Universe: Consciousness, Free Will and Evolution (Rowman and Littlefield, 2001). From Knowledge to Wisdom (Blackwell, 1984). The Comprehensibility of the Universe (Oxford University Press, 1998). What's Wrong With Science? (Bran's Head Books, 1976). I must however declare an interest. I am the author.


Philosophy

The recent spectacular progress in assisted reproductive technologies (ARTs) has resulted in new ethical dilemmas. Though women occupy a central role in the reproductive process, within the ART paradigm, the importance accorded to the embryo commonly surpasses that given to the mother. This commentary questions the increasing tendency to position the embryonic subject in an antagonistic relation with the mother. I examine how the motherâs reproductive autonomy is compromised in relation to that of her embryo and argue in favour of doing away with the subject-object dyad between them, particularly in the contexts of surrogacy and abortion. I also engage with the Surrogacy (Regulation) Bill, 2016. A critical discussion of the privacy judgment passed by the Supreme Court of India helps examine how personal autonomy of the body and mind extends to include the reproductive autonomy of women as well.

Indian Journal of Medical Ethics Vol III No 2 April-June 2018 [ 113 ] perspective. In: Arda, v. Rispler-Chaim (eds). Islam and Bioethics. b. Ankara University Turkey; 2012. 29. murray T. The Worth of a Child. berkeley: University of California press; 1996:1–214. 30. nelson J. parental obligations and the ethics of surrogacy: A causal perspective. Public Affairs Quarterly. 1991;5:49–61. 31. matrimonial Causes Act. Cap m7, Laws of the Federation of nigeria, 2004. 32. brake E, millum J. parenthood and procreation. In: Edward n (ed). The Stanford Encyclopedia of Philosophy; 2016 [cited 2016 sep 26]. Available from: http://plato.stanford.edu/archives/fall2016/entries/parenthood/ 33. hamilton b, mcmanus b. Infertility treatment markets: The effects of competition and policy. Unpublished Manuscript, Olin School of Business, Washington University, St. Louis, 2005. 34. sherwin s. Feminist ethics and in vitro fertilization. Canadian Journal of Philiosophy. 1987;10(1):74–103. 35. warnock Committee, Report of the Committee of Inquiry into Human Fertilization and Embryology, Cmnd 9314, 1985, London: hmsO (the warnock Report). 36. meribe v Egwu.(1976) 1 ALL nLR 266. 37. status of Children Act, 1974, Act 8602 of 1974, amended Jan 1, 2015. section 10C. Available from: http://www.legislation.vic.gov.au/domino/ web_notes/LDms/LTObject_store/ltobjst9.nsf/DDE300b846EED9C7 CA257616000A3571/1ECD00FACECAC2A8CA257DbD007A3C7F/$FI LE/74-8602aa040%20authorised.pdf 38. swain mE. Oocyte donation: legal aspects. In: Third-Party Reproduction. 2014: springer new York. (pp. 31-39). 39. human Fertilisation and Embryology Act, 1990. Available from https:// www.legislation.gov.uk/ukpga/1990/37 Invisible women in reproductive technologies: Critical reflections PIYALI MITRA Author: Piyali Mitra (email@example.com), ph.D student, Department of philosophy, University of Calcutta, 1, Reformatory street, Alipore, Kolkata -700 027, InDIA To cite: mitra p. Invisible women in reproductive technologies: Critical reflections. Indian J Med Ethics. 2018 Apr-Jun;3(2) ns:113-9. DOI:10.20529/ IJmE.2018.031 manuscript Editor: Rakhi ghoshal ©Indian Journal of Medical Ethics 2018 Abstract The recent spectacular progress in assisted reproductive technologies (ARTs) has resulted in new ethical dilemmas. Though women occupy a central role in the reproductive process, within the ART paradigm, the importance accorded to the embryo commonly surpasses that given to the mother. This commentary questions the increasing tendency to position the embryonic subject in an antagonistic relation with the mother. I examine how the mother's reproductive autonomy is compromised in relation to that of her embryo and argue in favour of doing away with the subject-object dyad between them, particularly in the contexts of surrogacy and abortion. I also engage with the Surrogacy (Regulation) Bill, 2016. A critical discussion of the privacy judgment passed by the Supreme Court of India helps examine how personal autonomy of the body and mind extends to include the reproductive autonomy of women as well. Introduction "Putravati Bhava" – may you be blessed with progeny – is traditionally an extremely coveted blessing for a woman. progeny is highly prized for most and childlessness appears to be a curse for couples. The essence of female autonomy, particularly in male-dominated societies, lies in women's ability to control their own fertility, and reproductive autonomy provides women with a model for personal autonomy. however, the different reproductive technologies that abound in the contemporary world tend to scale women down to secondary positions, or even, at times erase them. The question may arise as to whether the increasing subjectification of the embryo reduces women to the position of an antagonist. In the first part of this commentary I examine whether the alleged "primacy" of the embryo has in any way contributed to the marginalisation/erasure of women. while discussing the subject-object dichotomy between the embryo and the mother, the commentary moves from the concept of motherhood to a theorisation of maternal subjectivity. It does not deny the potential of childbearing as a meaningful activity but denies that childbearing is a necessary part of women's nature. There are many women who are not able-bodied and lack the capacity to get pregnant and give birth naturally. If motherhood is viewed as synonymous with womanhood, would women who are infertile, homosexual, or not able to get pregnant naturally, not be considered women? They are women as well, though in a developing context such as India, infertility is commonly viewed as some sort of disability (1: p 117). The situation of infertile women in India is aggravated by their being negatively limited in their social and political participation (1: pp 113,117-119). Infertility may result from delayed pregnancy, sexually transmitted infections, or abortions conducted in unhygienic conditions (2: p 165). Advancements in medical science have made it possible for clinics providing assisted reproductive services, ie, the ART clinics, to promote their services as offering a chance to negotiate infertility. India has more than 1000 in-vitro fertilisation (IvF) clinics offering a range of services including surrogacy (3). Despite the debates and the recommended ban on commercial gestational surrogacy, the demand for surrogacy has scarcely waned; and yet sections of society continue to consider it a taboo (4). This commentary examines how reproductive autonomy and privacy get compromised for women in India; it critically reflects on the abortion and surrogacy debates, especially in the light of the recent verdict on privacy passed by the supreme Court of India on August 24, 2017. Indian Journal of Medical Ethics Vol III No 2 April-June 2018 [ 114 ] The mother and her embryo: a subject-object dyad new reproductive technologies are rarely controlled by those who seek them. women are urged to believe that their lives would be incomplete if they do not have children. such a framework reduces mothers to objects. The mother as a woman, an agent in her own right, remains largely absent in such discourses; further, the subjective meaning a woman gives to the lived experience of mothering a child gets overshadowed. within the praxis imagined by the ARTs, women are increasingly objectified. ARTs involve privately contracting a biogenetically curated pregnancy using IvF. The aspect of a woman's choice is sidelined. women have to undergo painful hormonal stimulation; the egg retrieval process involves risk to women's health. The rights and safety of women are now more at stake. with ARTs they are reduced to commodified means to solve the infertility problem. This tendency to objectify women gets aggravated when we accord higher value to the embryo as a subject at the cost of objectifying the gestating woman. This leads to the woman being represented as an interchangeable object rather than a unique subject. Does default maternal subjectivity lie in the process and act of a woman becoming a mother? One may say that mothers are subjects in the sense that they have experience – of gestating, giving birth, breastfeeding, mothering, where each experience is both unique and also dovetails into another, overdetermining each other. but to be a subject one must not only have experience or live through experience, but also one must author the meaning of that experience and be able to exercise autonomy in the process, regenerate new meanings that are adapted to one's own situation and history. Others would argue that motherhood connotes a natural state or condition which functions as an empty category into which the needs of the embryo, ie, the future child, can be placed. while talking of maternal subjectivity, stone points out that, mothers are often not properly recognised as subjects by others around them. Indeed, mothers often experience the transition to motherhood in terms of just this loss of recognition (5: p 2). with pregnancy a woman, who has been formerly viewed as an agent of her own life and been treated by others as a centre of agency, is suddenly perceived as largely subservient to the embryo she is nurturing. Thus, with pregnancy, women begin to lose control of their lives; they feel that in entering the realm of the maternal body they have fallen into a formless realm that excludes meaning and autonomy. mothers do strive to regain subjectivity where it has been compromised, but this cannot be the usual kind of subjectivity grounded on separation from the maternal body. It can only be subjectivity of a new kind, arising from their place in maternal body relations. In fact, institutionalised "regard" for human embryos has been captured in various forms in laws around the world, adversely impacting gestating mothers. Ethical policies have been motivated by a belief in the innate sanctity or value of the life of human embryos which extend to prevent the destruction of the embryo through a range of measures (6: p 71). These laws completely override women's decision making. The choices of women – whether to use the embryo (especially when pre-implanted) for one's own pregnancy, or donate it for the reproductive use of another woman, or freeze it for future use, or donate it for research purposes, or destroy it – are not prioritised within such a framework. when we accord a moral status to the pre-implanted human embryo, there is an overall acceptance that it is an entity of social and ethical significance from conception onwards and its inception into human life. This idea implies that embryos are of abstract significance to society at large, rather than of specific importance to the woman undertaking infertility treatment. The importance of the embryo is concentrated in its potential for life rather than its representation of the myriad potentialities and desires to the mother herself (both in potentiality and actuality). There is a general tendency to represent women as wombs and child bearing operators, instead of composite persons (7: p 240). Feminist theorists began to query the romanticised version of self-effacing motherhood (8). The painful maternal experiences of ambivalence have remained under-explored. During pregnancy, a woman contains at least two beings within her body; however, women are absorbed by a sense of the "otherness" besides her own self existing in the maternal body. whether interpreted as mystical "communion" or nightmarish exploitation, the reciprocal exchange through the placenta which transfers nutrients in one direction and waste-products in the other, continues as a physiologically intimate and integral process. with advancing pregnancy, the uncontrollable nature of the "other" occupying the maternal body becomes increasingly evident. Far from an idyllic "communion", pregnancy is often accompanied by a sense of invasion from a parasite sapping the resources of the host body (8: p 9). It becomes an ethical imperative to shift the subjectivity from the "embryo" to the "mother". Karpin suggests that a feminist regulatory response might be initiated by challenging the primacy of the disembodied embryo – disembodied because the embryo hovers between having a materiality in terms of mass and weight, and a simultaneous lack of personhood. Indeed, it would challenge both its physical detachment from the female body and its social detachment from the parental relation. The next step would be the replacement of the "phantasmic preominitional [sic] embryo with an alternate phantasm: that of the not yet pregnant pregnant woman." within the ambit of the feminist regulatory response, the "not yet pregnant" pregnant woman would be accorded legislative visibility and centrality, not the embryo (9: p 621). millbank proposes a relational sense of the embryo that centres the woman and values the "intensely personal and infinitely variable" meaning to her. This framework of relational sense of the embryo centering the woman not only allows us to consider a woman's decision making concerning her embryo as part of a broader political and social context, but also accepts that this experience incorporates an individualised, fluid and variable sense of kinship and belonging, in which the embryo may but not necessarily be regarded as part (6: pp 85-86). Indian Journal of Medical Ethics Vol III No 2 April-June 2018 [ 115 ] Technological advancements in the sphere of health, especially women's health, have come to (re)shape conventional scripts of sexuality, pregnancy, childbirth and parenting. but these advancements have not led to the recognition of women's choice and agency. In India, having a genetic child is of fundamental importance in upholding the validity of the institution of the family. Thus, ARTs began to play a vital role in addressing such concerns, in order to preserve caste and community as they enable people across the board to have genetically related children. ARTs provide technological solutions to produce a child that bears the genetic imprint of oneself. not having one's own genetic child is a social impediment, for genes are one of the ways families are made (10: p 2). Families are assumed to be an essential social unit and support for people. Families preserve and perpetuate caste and community through maintaining the genetic lineage of heterosexual couples (11). Commissioning couples availing of an IvF service may express a preference for a surrogate belonging to a particular caste or religious community (12: p 6). Thus, ARTs have a big role in the preservation of caste and community. Infertile married Indian women are stigmatised by the socio-cultural normative framework of society. For these women then, resorting to ARTs in order to realise their desire for motherhood becomes the only viable option to "cure" their infertility. but there is need for more research and dialogue on ethical issues related to women's health and bodies with regard to invasive ARTs and surrogacy. The following sections address how the question of women's autonomy was debated in the issues on abortion and surrogacy in India. ARTs in India The Indian Council of medical Research (ICmR) developed research guidelines for the development of testing reproductive technologies (13,14). The ICmR recognises that women should have equal right to participate in research and should not be deprived arbitrarily of the opportunity to benefit from research; however, sometimes women's autonomy is compromised because researchers have to abide by the requirements of local cultural practices in order not to disturb the harmony in the household or community (13: sec. 6.4, p 60). A key aspect of reproductive autonomy is reproductive rights, which include the right to make sexual and reproductive decisions, as recognised by the 1994 United nation International Conference on population and Development (15). These rights include contraceptive rights, the right to undergo legal and safe abortion, the right to make decisions pertaining to reproduction free of coercion, discrimination and violence. The Indian perspective on reproductive rights takes account of several inequalities and contradictions in society. In 2009, the supreme Court recognised women's reproductive autonomy as a fundamental right, stating that "There is no doubt that a woman's right to make reproductive choices is also a dimension of 'personal liberty' as understood under Article 21." (16) needless to say, reproductive rights extend to surrogacy as well. surrogacy is a complex issue which raises multiple ethical and legal issues including definitions of parenthood and custody of children. surrogacy may be commercial or altruistic in nature. In India commercial surrogacy was legalised in 2002 and soon acquired an internal market as several foreign couples came to India to commission surrogacy at costs much lower than in their own countries. The debate on commercial surrogacy was sparked off in India by a controversial case in 2008 (17,18), where the Indian judiciary had to resolve legal issues relating to the "statelessness" of children born via surrogacy. Over time, numerous cases of abandonment of babies, exploitation of surrogates and egg donors, and non-payment of promised monetary compensation were reported (19). It has been argued that surrogacy depersonalises reproduction (20: p 2). There is social stigma and ostracism attached to surrogacy in India's social structure (21: p 975, 4: p 1). The socially conservative culture of India treats the surrogate mother as a disposable object. Despite this, commercial surrogacy in India has moved far beyond myth (3). The factors conducive to commercial surrogacy in India such as comparatively lower costs, availability of a large pool of women ready to become surrogates, and lack of regulation have consequently turned India, until recently, into the most sought-after destination for reproductive tourism and womb renting (4). based on the recommendations of the Law Commission of India, the Union Cabinet approved the surrogacy (Regulation) bill in 2016 (22). The bill had been introduced to prevent commercialisation of surrogacy, prohibit potential exploitation of surrogate mothers and of children born through surrogacy. however, the bill questions the reproductive rights of women. The right to life enshrines the right to reproductive autonomy, inclusive of the right to procreation as an exclusive right, free of the state's interference. The decision on the mode of parenthood should lie with an individual and not with the state. The bill hinges on the paternalistic imperative to protect the surrogate against exploitation, as seen in commercial surrogacy, and to permit surrogacy only involving a "near relative" and for altruistic reasons. It proposes to bring in the greatest utility for the greatest number of women, but surprisingly the bill has disregarded the ethical issue of whether "altruism" within patriarchal familial contexts can be free of coercion, given the social premium placed on motherhood. besides this, it recommended conditional surrogacy to married Indian couples, disqualifying others on the basis of nationality, marital status, sexual orientation or age – decisions which do not appear to pass the test of equality as described under Article 14 of the Indian Constitution (23), or of being a reasonable classification, satisfying the very objective it seeks to achieve. The bill severely limits the autonomy of potential surrogates with stringent conditions and requirements of eligibility certificates. The parliamentary standing Committee Report (2017) on the surrogacy (Regulation) bill reckoned that coercing a married couple to come out in the open about their infertility breaches privacy, especially given the stigma often attached Indian Journal of Medical Ethics Vol III No 2 April-June 2018 [ 116 ] to infertility (3). The Report raises similar concerns regarding the surrogates whose identity would be disclosed and privacy compromised. The bill had also left unanswered the question of ensuring protection of health of the surrogate mother; it prohibited homosexual couples from opting for surrogacy services because the Indian state does not recognise homosexual persons as legal citizens. while the Delhi high Court ruled down Article 377 of the IpC in 2009, granting samesex relationships a legal status, the supreme Court of India set aside the high Court's ruling in 2013 (24). by limiting surrogacy only to those physically incapable of maintaining a pregnancy, so-called "socially infertile" women are disqualified under the 2016 bill. The use of reproductive technologies and surrogacy arrangements needs to be regulated. The law should promote transparency by incorporating the principle of accountability. Ethical practices should be encouraged. There is definitely a need for regulation. but the blanket restriction proposed in the 2016 surrogacy bill is akin to capping a volcano. while there is a need for regulation, we cannot wish away the advances in medical science and the subsequent impact on surrogacy. we need to have a legislation which, while dealing with the problems associated with surrogacy does not interfere with the reproductive rights and freedom of choice of women. The use of biomedical technologies enables a simultaneous focus on women's bodies as sources of both reproductive power and value, and away from their bodies exclusively as vessels for the "vansh" or progeny for their families. Future research ought to highlight the inequalities and ethical complexities both in national and transnational reproductive transfers. Abortion and reproductive autonomy The attitude of the Indian judiciary to the right to reproductive choice is garnered from decisions that handled issues concerning abortion in controversial situations. The question that has been posed before Indian courts most often is whether abortion without spousal consent amounts to cruelty, which is recognised as a reason for divorce in India (25: p. 85). The Indian judiciary's attitude expressed a complete disregard of the woman's right to privacy, and her right to make independent reproductive choices (26). but on 24 August, 2017, there was a historic judgment (27) which specifically recognised the constitutional right of women to make reproductive choices as a part of personal liberty under Article 21 of the Indian Constitution. The bench recognised privacy as an inalienable right, based on values such as dignity that underlies all our fundamental rights, and it categorically located privacy in the individual. while the judges phrased their conceptions of privacy differently, the bench held in common that privacy encompasses personal autonomy concerning body and mind and making choices, as well as informational privacy. The draft of the national policy for women (2016) aims to protect the rights of women adopting reproductive technologies (28). In the puttaswamy judgment (27), the bench reiterated the position adopted by the three-judge bench in the suchita srivastava case (16) which upheld that reproductive rights include the woman's right to privacy, dignity and bodily integrity. The suchita srivastava case arose in the context of the medical Termination of pregnancy Act (1971) (mTp Act) (29); this Act governs abortions in India. The mTp Act permits abortion where the continuance of the pregnancy will cause "grave injury to mental or physical health." The Act recognises the anguish caused by the "grave injury to mental health" in pregnancy as a consequence of the failure of contraception. strangely enough, the anguish caused by a pregnancy applies only to married women and does not recognise the anguish caused to an unmarried woman by an unwanted pregnancy. It reveals that "the Act was motivated not by libertarian ideals but by the need to promote abortion as a family planning tool" (26: p. 77). Further, the mTp Act does not leave the decision to abort with the woman. section 3 of the Act states that only registered medical practitioners can terminate a woman's pregnancy provided that the doctor believes in good faith that continuing the pregnancy would be a risk to the woman's life or that the child would be born with serious physical or mental abnormalities. If the woman has been pregnant for 12 weeks, the permission of one medical practitioner is required, and if the pregnancy extends between 12 and 20 weeks, the permission of two medical practitioners is mandatory. The Act was not envisaged as a tool for women to control their reproductive choices. The Act grants veto power to a third person, viz the medical practitioner. Thus, abortion laws in India reflect that policy makers consider abortion a tool for controlling population growth, rather than an expression of women's right to control their bodies. It has met with opposition over the years for its restrictive nature and for not being able to accommodate the growing technological advancements in medicine1. The privacy judgment significantly bolsters calls for reform, paving ways for sections 3 and 5 of the mTp Act to be contested. section 5 of the Act is applicable in the case of termination of pregnancy beyond 20 weeks, where the doctors believe that abortion is an immediate requirement in order to save the woman's life. In 2017, the sC clarified that abortion at 24 weeks is legal in the case of anencephaly, which is a fatal foetal impairment that also puts the mother's life at risk, stating that her rights to bodily integrity and reproductive autonomy allow her to "preserve her own life against the avoidable danger to it" (30). The law recognises only medical reasons and risks to allow abortion, delegitimising all other reasons for a woman to seek abortion. A woman is coerced to carry a pregnancy to full term unless it poses a grave risk to her life, even if other grounds of physical and mental anomalies in the foetus are satisfied as per section 3. so, sections 3 and 5 evidently infringe women's rights to make reproductive choices which the bench affirmed as part of the right to privacy. The law hardly leaves room for non-medical concerns over the economic burden of child-rearing, effects on career, or Indian Journal of Medical Ethics Vol III No 2 April-June 2018 [ 117 ] other personal reasons. In fact, the Act turns a blind eye to the plight of married women who are forced to conceive and carry the pregnancy to term against their will. This is grounded in the reason that the marital rape of women older than 15 years does not legally amount to rape2. It is to be noted that fundamental rights are placed under limitations by the state, but these limitations need to pass tests outlined in constitutional jurisprudence. The bench affirmed that any curb on privacy will be tested according to the fundamental rights which it infringes and the established jurisprudence on those rights. The bench distinctly focused on Article 21, which guarantees the fundamental right to life and personal liberty, and entails a "just, reasonable, and fair" test (31), that is, any law curbing Article 21 must be "just, reasonable, and fair" to remain constitutionally valid. The mTp (Amendment) bill 2014 (32) seeks to broaden the reproductive rights under the Act. most importantly for privacy concerns, the bill allows abortion on the "request" of a woman up to 12 weeks of pregnancy without having to justify the woman's needs. The Abortion Assessments project also revealed that doctors in public sector hospitals sometimes refuse to perform abortions unless women undergo sterilisation concurrently (33). Through section 2(d), the bill aims to improve access to abortion by giving access to "registered healthcare providers." section 5A of the bill mandates that no registered healthcare provider shall disclose the name and other details of the woman about to undergo abortion. however, the amended bill may not satisfactorily address all privacy concerns with the Act's restrictions on abortions. It is to be noted that though the newly amended mTp bill (32) permits abortion beyond 12 weeks at the request of the woman, yet women still have to prove that it was an unplanned pregnancy or that contraceptive measures have failed, which still considerably restricts their power to exercise their reproductive choice in this issue. The state does not merely have a negative duty not to infringe privacy, but also has the positive obligation to uphold reproductive autonomy and take steps to sustain an individual's privacy as held in the puttaswamy judgment (27). Apart from the privacy judgment, in the 2016 case of High Court on its Own Motion v State of Maharashtra (34), the bombay high Court ruled in favour of improving the access of women prisoners to abortion and strongly affirmed women's rights to abortion as a part of the fundamental right conforming to the right to live with dignity under Article 21 of the Indian Constitution. The judgment recognises that unwanted pregnancies are disproportionately cumbersome to the woman and to force her to carry a pregnancy to term represents a violation of the woman's bodily integrity and aggravates her mental trauma thus being harmful to her mental health condition. Even when the judiciary does give access to abortion beyond 20 weeks, the fact that women have to move the court highlights a further restriction on their access to safe and legal abortions, thus hindering their reproductive autonomy. In a country where 9 to 20% of maternal deaths occur due to unsafe abortions (35) there is an urgent requirement to align the provisions of the mTp Act with these judgments. From the above decisions, it appears as if the supreme Court supports reproductive autonomy, but when it comes to abortion, women are not given any real control, though the most recent supreme Court and bombay high Court decisions (27, 34) may be an indication of progress. The court applies the protection of privacy to those rights it deems implicit in the concept of ordered liberty, fundamentally affecting a person, or so significant that they need to continue to be inviolable. In fact, the right to privacy has spawned discussions on the right to integrity of one's personality, and the right to "selfhood" (36: p. 330). A woman's security in her own body is fundamental to her intellectual, psychological development. but this security of women again gets compromised with the implementation of reproductive technologies, especially in surrogacy. The privacy judgment did not explicitly refer to surrogacy, but it affirmed existing jurisprudence on privacy, which has considered personal decisions about birth and babies as being part of reproductive autonomy (37). Conclusion: issues that need to be resolved A brief examination of the legislative viewpoint in the country, with regard to the right of reproductive autonomy of women, reveals its notion of deep-rooted patriarchy. social change is the most difficult but also the most crucial element of overcoming the influence of biologism and pronatalism on patients' reproductive autonomy. The framework for our collective convictions and ideologies needs to be more accommodating and sensitive towards the condition of women. These social changes may help to challenge the assumptions that all women want children, that biological connections are better than social connections and moreover, that those who fail to meet the pronatalist or biologistic stereotypes are deficient in some ways. Undoubtedly, personal, medical and social contexts in which these technologies are delivered would have a far-reaching effect on the extent to which these reproductive options may challenge or support the autonomy of both individual women and women as a group. Reproductive autonomy is a basic right. women see this as necessary because pregnancy and child rearing are for all practical purposes, the sole responsibility of women. women should therefore have the right to choose when and under what circumstances they will bring a child into the world, for women should be able to control what happens to their bodies and lives. The right to safe and legal abortion is also an essential right of self-determination. The privacy judgment has rekindled the debate around abortion. The judgment enabled the restoring of the reproductive autonomy of women and providing impetus to the better amendment of the long pending mTp (Amendment) bill. This will help in reducing the social pressure and stigma attached to procurement of abortion. It needs to be understood that not every woman Indian Journal of Medical Ethics Vol III No 2 April-June 2018 [ 118 ] wants to abort the foetus. however, the choice must be free of coercion so that she may decide her future course of action concerning her pregnancy. The autonomy of the individual is conditioned by the individual's relationship with the rest of society. Those relationships may and do often pose questions to autonomy and free choice. The overarching presence of state and nonstate actors regulates aspects of social existence which bear upon the freedom of the individual. In India women continue to experience significant obstacles in their full enjoyment of reproductive rights including denial of women's decisionmaking authority. For long, reproductive health-based laws and policies in India have failed to take a women's rightsbased approach; instead they have focused on demographic targets, such as population control, while also implicitly or explicitly undermining women's reproductive autonomy through discriminatory provisions such as spousal consent requirements for access to reproductive health services. The issue of spousal consent involves a balancing of the woman's right to privacy and personal autonomy and the spouse's interests in the life of the unborn child. Finally, the goal of reproductive research is not only to respect the autonomy of women, but also to expand reproductive freedom. To this end, there must be more equal participation in medical research by women and members of minority groups. modern technology and gender relations are deeply intertwined; therefore, a feminist critique of philosophies of technology in the context of a feminist understanding of infertility brought women together to evaluate this matter. I believe that as rational beings and informed and competent decision-makers, women are strongly placed to decide what is beneficial for them. we should leave women to decide whether the reproductive technologies enrich and enlarge our lives as women or whether in accepting and abetting these technologies we are forcing ourselves in serving to accept a misogynist ideal of freedom. If there be any coercive element behind these reproductive interventions, then we should try and eliminate the coercive element, not the technologies. Acknowledgements: Thanks to Professor Priyambada Sarkar, Department of Philosophy, Calcutta University, and to the Government of West Bengal for providing financial assistance under the Swami Vivekananda Merit Cum Means Scheme. Conflict of interest: None declared Notes 1 One specific advance that requires mention here relates to the detection of cardiac anomalies only after 22 weeks of pregnancy. The national Commission for women (nCw) recommended that the Union health ministry extend the time limit from 20 to 24 weeks, acknowledging the present developments in medical diagnostic technologies, in addition to the social scenario. The mTp Amendment bill of 2014 also changed the time limit from 20 to 24 weeks in keeping with the recommendation of the nCw. 2 In light of the privacy judgment, a two-judge sC bench recently read down the exception for marital rape and held that forced sex with all minor wives and not just wives under 15 years, would constitute rape. The larger exception for marital rape is expected to be debated further. References 1. shah K, batzer F. Infertility in the developing world: The combined role for feminists and disability rights. International Journal of Feminist Approaches to Bioethics. 2010; 3(2):109-25. doi: 10.2979/fab.2010.3.2.109 2. gomez vR, Unisa s. Surrogacy from a reproductive rights perspective: the case of India. Autrepart. 2014; 70:165-183. doi:10.3917/autr.070.0185 3. Department-Related parliamentary standing Committee on health and Family welfare. One hundred second Report on The surrogacy (Regulation) bill, 2016. new Delhi: Rajya sabha secretariat; 2017. Report no. 102. [cited 2018 mar 06] Available from: http://www.prsindia.org/ uploads/media/surrogacy/surrogacy%20(Regulation)%20bill,%20 2016.pdf [published in gazette of India Extraordinary part II section 2, november 21, 2016.] 4. Arvidsson A, vauquline p, Johnsdotter s, Essen b. surrogate motherpraiseworthy or stigmatized: a qualitative study on perceptions of surrogacy in Assam, India. Global Health Action. 2017; 10(1): 1-10. [cited 2018 march 06] Available from https://doi.org/10.1080/16549716.2017 .1328890 5. stone A. Feminism, Psychoanalysis, and Maternal Subjectivity. new York: Routledge; 2012. p.2. 6. millbank J. Reflecting the 'human nature' of IvF embryos: disappearing women in ethics, law, and fertility practice. J Law Biosc. 2016; 70-93; doi:10.1093/jlb/lsw058. [cited 2017 nov 10]. Available from https:// papers.ssrn.com/sol3/papers.cfm?abstract_id=2876369 7. gupta JA, Richters A. Embodied subjects and fragmented objects: women's bodies, assisted reproduction technologies and the right to self-determination. Bioethical Inquiry. 2008; 5: 239-49. 8. Raphael-Leff J. healthy maternal ambivalence. Studies in the Maternal. 2010; 2(1); doi: 10.16995/sim.97 [cited 2018 February 2]. Available from https://www.mamsie.bbk.ac.uk/articles/abstract/10.16995/sim.97/ 9. Karpin IA. The uncanny embryos: legal limits to the human and reproduction without women. Sydney Law Review. 2006; 28(4): 599-623. 10. shah C. Regulate technology, not lives: a critique of the draft ART (Regulation) bill. Indian J Med Ethics. 2009; 6(1):32-5 [cited 2018 mar 13]. Available from: http://ijme.in/articles/regulate-technology-not-lives-acritique-of-the-draft-art-regulation-bill/?galley=html 11. The baby market: gendered implications of assisted reproductive technologies and the surrogacy industry in India. Gender and Economic Policy Discussion Forum. 03 August, 2017, Forum-XXIII, briefing note:24, Institute of social studies Trust/heinrich böll stiftung. [cited 2018 march 06] Available from https://in.boell.org/sites/default/files/ uploads/2013/10/gender_brouchure_xxii_02_may_2017.pdf 12. sama Resource group for women and health. Surrogacy Information Brief. sAmA-Resource group for women and health, India. 2014 [cited 2018 march 07] Available from http://india.unfpa.org/sites/default/ files/pub-pdf/surrogacyInfobrief-1.pdf 13. national Ethical guidelines for biomedical and health Research Involving human participants. new Delhi: Indian Council of medical Research; 2017. [cited 2017 november 15]. Available from http://www. icmr.nic.in/guidelines/ICmR_Ethical_guidelines_2017.pdf 14. national guidelines for stem Cell Research. new Delhi: Indian Council of medical Research & Department of biotechnology; 2017. 15. program of Action adopted at the International Conference on population Development. Cairo: UnpF; 1994 sep [cited 2018 mar 14]. Available from: https://www.unfpa.org/sites/default/files/pub-pdf/ programme_of_action_web%20EngLIsh.pdf 16. Suchita Srivastava & Anr v Chandigarh Administration, (2009) 11 s.C.C. 409. Available from: https://www.reproductiverights.org/sites/crr. civicactions.net/files/documents/Reproductive-Rights-Indian-Courtsweb.pdf 17. Baby Manji Yamada v. Union of India and Anr [2008] InsC 1656. Available from: https://indiankanoon.org/doc/854968/ 18. Commercial surrogacy and Fertility Tourism in India: The Case of baby manji: The Kenan Institute for Ethics at Duke University. [cited 2018 mar 15]. Available from: https://web.duke.edu/kenanethics/Casestudies/ babymanji.pdf 19. ghosh A, Khaitan n A. womb of one's own: privacy and reproductive rights. Econ pol wkly. 2017; 52(42-43). 20. Lewis s. International solidarity in reproductive justice: surrogacy and gender-inclusive polymaterialism. Gender, Place & Culture: A Journal of Feminist Geography. 1-21 [cited 2018 march 11] Available from https:// 1. supreme Court of India. Common Cause v Union of India (2018): SCC OnLine, sC, 208. [cited 2018 mar 10] Available from: http://supremecourtofindia.nic.in/supremecourt/2005/9123/9123_2005_Judgement_09mar-2018.pdf Indian Journal of Medical Ethics Vol III No 2 April-June 2018 [ 119 ] doi.org/10.1080/0966369X.2018.1425286 21. pande A. Commercial surrogacy in India: manufacturing a perfect mother-worker. Culture and Society. 2010; 35(4): 969-992. 22. Department of health Research. The surrogacy (Regulation) bill, 2016. new Delhi: ministry of health and welfare, government of India; 2016. bill no. 257. 23. Constitution of India. Amended up to 2006. Available from: https:// www.india.gov.in/my-government/constitution-india/constitutionindia-full-text 24. venkatesan J. supreme Court sets aside Delhi hC verdict decriminalising gay sex. The Hindu. 2013 Dec 11. Available from: http://www.thehindu. com/news/national/supreme-court-sets-aside-delhi-hc-verdictdecriminalising-gay-sex/article5446939.ece 25. bhattacharyya R. Draft surrogacy (Regulation) bill 2016: Rhetoric or surrogate-centric? Space and Culture, India. 2016; 4(2): 9-21; doi: http:// dx.doi.org/10.20896/saci.v4i2.219 26. george sR. Reproductive rights: a comparative study of constitutional jurisprudence, judicial attitudes and state policies in India and the U.s. Student Bar Review. 2006; 18(1): 69-92. 27. Justice K S Puttaswamy v Union of India wp(C) no.494/2012. Available from: https://indiankanoon.org/doc/91938676/ 28. ministry of women and Child Development. Draft national policy of women, 2016. new Delhi: mwCD; 2016 [cited 2018 march 13]. Available from: http://wcd.nic.in/sites/default/files/draft%20national%20 policy%20for%20women%202016_0.pdf 29. medical Termination of pregnancy Act, 1971. no.34 of 1971 [10th August, 1971]. Available from: http://www.health.mp.gov.in/acts/ mtp%20Act.pdf 30. Meera Santosh Pal & Others v Union of India & Others, (2017) w.p. (C) no. 17. Available from: http://www.advocatekhoj.com/library/judgments/ announcement.php 31. Maneka Gandhi v Union of India [1978] AIR 597, 1978 sCR (2) 621. Available from: https://indiankanoon.org/doc/1766147/ 32. ministry of health and Family welfare (Department of health and Family welfare). medical Termination of pregnancy Amendment bill. government of India 2014 October 29 [cited 2018 mar 13] Available from: http://www.prsindia.org/uploads/media/draft/Draft%20 medical%20Termination%20of%20pregnancy%20Amendment%20 bill%202014.pdf 33. Duggal R, Ramachandran v. The abortion assessment project –India: Key findings and recommendations. Reprod Health Matters. 2004; 12(24) suppl: 122-9. 21. 34. High Court on its Own Motion v State of Maharashtra, wp (CRL) no. 1/2016, maharashtra h.C. Reproductive Rights in Indian CourtsFundamental and human Rights in India-Centre for Reproductive Rights. Available from: https://www.reproductiverights.org/sites/crr.civicactions.net/ files/documents/RR-Indian-Courts-web.pdf 35. sebastian mp, Khan mE, sebastian D. Unintended pregnancy and abortion in India: Country profile report with focus on Bihar, Madhya Pradesh and Orissa. new Delhi: population Council; 2017 [cited 2017 nov 10] Available from https://www.popcouncil.org/uploads/pdfs/2014sTEpUp_ IndiaCountryprofile.pdf. 36. neff CL. woman, womb, and bodily integrity. Yale Journal of Law & Feminism. 1990; 3(2): 327-53. 37. B K Parthasarathi v Government of Andhra Pradesh [2000] ALD 199, Ap, 1. Available from: https://indiankanoon.org/doc/708608/ ARTs and the problematic conceptualisation of declining reproduction ANINDITA MAJUMDAR Author: Anindita Majumdar (firstname.lastname@example.com), Assistant professor of sociology, Department of Liberal Arts, Indian Institute of Technology, hyderabad, InDIA To cite: majumdar A. ARTs and the problematic conceptualisation of declining reproduction. Indian J Med Ethics. 2018 Apr-Jun; 3(2) ns:119-24. DOI: 10.20529/IJmE.2018.032 manuscript Editor: Rakhi ghoshal © Indian Journal of Medical Ethics 2018 Abstract The routinisation of assisted reproduction in India has led to its proliferation and the easy identification of infertility. However, clinical and popular discourse tends to focus primarily on age-related deficiencies in reproduction. Here, both the "dangers" of declining reproduction as well as the facilitation of delayed reproduction are areas of focus and eulogisation. Bringing together the diverse elements of the medico-social conversation, the aim of this commentary is to examine the ways in which the ARTs are used to make sense of declining reproduction. Background In its representation in academic literature and in life, ageing is seen as a state of decline and debilitation. Its physical markers are associated with regression and a slowing down of the "normal" body. In the process, more often than not, ageing has conceptually also been compared to a pathological, diseased state of being. This is especially so in relation to women's bodies, where the idea of ageing within biomedicine is associated with progressive reproductive decline (1,2). This conceptualisation of ageing and its association with reproduction is the most provocative in contemporary medical practice and ideology. In this commentary, I discuss how ageing and aged bodies become signifiers of failed and resurrected reproduction. This is particularly evident in the case of assisted reproduction through the use of technologies such as in-vitro fertilisation (IvF) and/or intracystoplasmic sperm injection (ICsI), besides other assisted reproductive technologies (ARTs) that are becoming popular in the "curing of infertility" as an emerging health problem. The paradoxical position that ARTs occupy within the socio-medical discourse on infertility is seen in the ways in which the failure of the technology to "cure" is often projected on to issues of age (3), just as the technology promises to alleviate the obstacles of age in seeking infertility treatment. however, the recent public fear of the ticking "biological clock", especially with regard to working women in their 30s with no children and the associated fanfare surrounding the birth of children to 70-year-old women through IvF (4) has led to questions regarding how infertility and ARTs are marking ageing and reproduction in India.


The big lie

Philosophy

People wonder about the cause of poverty when scarcity is the natural state of things. Why? Because we are âdesignedâ (metaphorically) to survive and reproduce our genes as much as possible. Not to discover reality. Not to enjoy. This is why evolution has selected in us the fear of death and the belief in that life is always worth living. We are âprogrammedâ to make our life as long as possible, at any cost.

          âThe Big Lieâ was published in The Antinatalism Magazine, vol. 1, September, 2017. Jiwoon Hwang, Ed. Paperback Kindle Edition

The big lie BY MANU HERRÁN "A powerful piece." -David Pearce People wonder about the cause of poverty when scarcity is the natural state of things. Why? Because we are "designed" (metaphorically) to survive and reproduce our genes as much as possible. Not to discover reality. Not to enjoy. This is why evolution has selected in us the fear of death and the belief in that life is always worth living. We are "programmed" to make our life as long as possible, at any cost. "The Big Lie" was published in The Antinatalism Magazine, vol. 1, September, 2017. Jiwoon Hwang, Ed. Paperback Kindle Edition For me, "life" has always been synonymous with "happiness". I grew up in a large family and have always associated the noise of family gatherings with the happiest moments. My relationship with animals, and in particular dogs and cats, has always been about joy, laughter and games. Pain has always been a test, surpassable, that made me stronger. Death was something that happened to others, while I was endowed with a transcendent perspective on existence. But, as I discovered later, it was a rather aesthetic transcendent perspective on existence. Everything I believed about life was wrong. Or rather, it was totally true, but only a tiny part of reality: It was true only for me and a small group of lucky people like me. I remember as a child sometimes finding myself having disturbing thoughts, a trace of suspicion that everything around me might be a fragile decoration that hid a terrible truth on the other side. "I am a member of the privileged species in the privileged moment in the privileged place. Others are not so lucky." Over time I have realized to what extent I am an extraordinarily fortunate being. I belong to the dominant privileged species (the human species). I was born at the time of the greatest prosperity and guarantee of rights in all known history. And if this were not enough, I was born in the middle-upper class of a relatively quiet and safe country. In short, I am a member of the privileged species, in a privileged moment, in a privileged place. The others have not been so lucky. The fact of being privileged and basically relating to other privileged beings has made me think, for most of my life, that this was normal. But the truth is that we humans, in general, suffer a lot. Of course, we use our intelligence and other resources within our reach to suffer as little as possible, but we can't always avoid suffering. In the Second World War, 75 million people died in very painful circumstances. More than 300 million people in the world suffer from depression and more than 800,000 commit suicide each year. "The problem is not to die. Everyone dies. The problem is having a miserable life or a terrifying death." Surely animals in nature usually suffer more than humans. Only one in five lion cubs reaches two years of age. And they do not die with palliative care, analgesics and anesthetics, but from hunger, thirst, diseases, or being devoured or attacked by other animals. The mortality rate of lions may seem high, but on the contrary: most species have a reproduction strategy known as "r" (r-selection) in which many descendants are generated, each of which has a very low probability of survival. Animals on industrial farms have no better luck. We boil live lobsters and crabs before eating them. Nearly one million chickens and turkeys are boiled alive as well each year in U.S. slaughterhouses, often because fast-moving lines fail to kill the birds before they are dropped into scalding water (2013 estimate). I insist on stressing the suffering because the problem is not to die. Everybody dies. The problem is having a miserable life, or a terrifying death. Among disappeared detainees, executed, tortured and political prisoners, the number of victims of the Pinochet dictatorship exceeded 40,000 people. More than 4,000 people were tortured in the Basque Country in the last 50 years, according to a report. Since the coup in Egypt, 60,000 people have been arrested and many tortured. More than 11,000 children have died in the civil war in Syria and hundreds have been executed or tortured. Figures of tens of thousands or hundreds of thousands of people suffered from Inquisition in some way or another. About 50,000 patients die each year in Spain with avoidable suffering, because they do not have access to palliative care. Every day more than 2,000 children around the world die in painful accidents. In only one year and only in the European Union, 252 million pigs were sacrificed. 77% of these pigs were castrated without anesthesia. During one year, 140,000 experiments are carried out on non-human animals in Spain in which the animal dies or suffers great damage. These are just some examples. Although I have not lived any of them, I can imagine what these atrocities are like and I am convinced that I do not want to experience them at all, nor do I want anyone to have to go through them. I would not risk living their lives. If I were offered to live any of those lives, I would, of course, reject it. Not only that: in fact, I would refuse to live any life that was not mine, unless it was a better life. So, if it were possible and offered it to me, I would refuse to be reincarnated at random. With the information I have, I consider that I have no interest in living a random life as a sentient being, whether animal or human. I would not take that risk. So what's the point of bringing new lives into existence and putting them at risk of experiencing some of those horrible experiences? It would only be a good idea to do so if we could reasonably assure their happiness. This way of posing the problem seeks impartiality in the form of what is known as "the veil of ignorance", although the name is confusing to me and I think it's more appropriate to call it "veiled egoism" or "blind egoism". "Evolution has designed us to believe that life is worth living and is more important than avoiding suffering. We are designed to survive, not to enjoy." Some may argue that most lives, both human and animal, are worthwhile, since most of them do not commit suicide. But there are very specific reasons why we should not commit suicide, even if this was the most rational option. In the first place, committing suicide is not easy. Technically, it is very difficult to do without suffering, so trying to commit suicide can make the situation even worse. On the other hand, for many it may be inconceivable. They simply do not raise the possibility. In addition, the very state of suffering can cloud reason and impede suicide. Suicide can be a desperate but rational act. Those who commit suicide consider that their life is not worth it or that it is unbearable. If animals do not do it massively, I think it's because suicide is complex, difficult (in the physical and in the mental sense). And for many humans, in my opinion, the same thing happens. At a deep level, I believe there is no significant difference between the reasons why non-human animals whose future lives are expected to be negative do not commit suicide, and the reasons why most humans do not do so in similar circumstances. The reason is the same: we were not designed (metaphorically) to enjoy, but for the survival of our genes. Evolution has not created us with a good ability to commit suicide. Moreover, evolution produces the bias of believing that life is worthwhile, no matter what happens. We are designed to survive, not to enjoy. This is the great deception that evolution has caused in us: evolution has designed us to believe that life is worth living, and that living is more important than avoiding suffering. Evolution has even designed us to have the feeling that there is more enjoyment than suffering. People wonder about the cause of poverty, when scarcity is the natural state of things. Misery is the normal thing: for what it is necessary to inquire is about prosperity. Sadly, there is a lack of symmetry between enjoyment and suffering. As Eduardo Mendoza said in the mouth of one of his novel characters (I quote from memory because I do not find the literal quotation, but the idea is faithful): it is frustrating to see how a stroke of good luck is not enough to make up for a lifetime of discomfort and misery; and yet a setback of fortune can ruin a lifetime of happiness in a minute. I know that these ideas can be extravagant or depressing, but unfortunately, I think they reflect reality better than the usual belief that life is wonderful and that everything will be fine. Although talking about these issues can be sad, reflecting and being prepared can avoid great suffering in the future, for ourselves and for other loved ones, and even for others we will never know. Perhaps reading and being interested in avoiding intense suffering is the best decision you can make in your entire life. Expect the best, but be prepared for the worst. Do you want to be happy? We all want to be happy. And happiness is not a matter of years. A short life can be happy while a long life can be miserable. A short and happy life will always be preferable to a long and miserable life although, as I said, we are programmed to make our life as long as possible, at any cost. This is the deception to which evolution subjects us, but which I think we can and must get rid of. "Happiness is not a matter of years. A short and happy life is always preferable to a long and miserable life." I do not intend to encourage the idea of ending indiscriminately the lives of others or one's own life, nor do I advocate the idea of the "button of the destruction of the universe", although an empty world would be better. Even if lives have a clearly negative net worth, and deaths would be without suffering, there are many reasons why it's a bad idea to try to finish lives systematically. With "ending lives systematically" I mean lives of a large group of individuals: those who fulfill certain characteristics, for example, belonging to one, several or all sentient species, perhaps also human, so that individuals are considered statistically, and not individually. It is not a good idea. What I intend to do fundamentally is to promote the idea that suffering is very relevant, and that ending extreme suffering is the most relevant of all. We need to stop extreme suffering, but not in any way. What are the reasons why it is a bad idea to try to systematically terminate lives whose future net worth is predictably very negative? There is a first group of motives that I consider to be intuitive, related to the respect for individual freedom, or to seek the convergence of different value systems, as well as the indecision to do something that may be totally contrary to our most basic impulses (for example, our most basic impulses of survival or empathy). Another second group of motives would be practical, such as avoiding social alarm, and generally avoiding a greater evil -such a mistake that leads to disasters-, or that is, simply, technically or politically difficult to do, if not impossible. There is a third group of motives, perhaps unintuitive but logical, based on the consequences of our actions. On the one hand and on a "shortterm" basis, humanity is demonstrating its ability to end all suffering as it is demonstrating its ability to end all forms of life, for example with nuclear war. But to do so, humanity must exist. In particular, the voluntary human extinction movement would be one of the worst possible ideas in this sense, as it would leave the rest of sentient animal species in a world full of suffering. On the other hand, and in the "long term", the disappearance of all sentient life would only delay the problem, since foreseeably evolution would open up again, creating new sentient beings in an endless cycle. This is, in my opinion, the definitive argument against the "button of the destruction of the universe", and is the reason why it is interesting that humanity continues to exist in general, and effective altruists in particular: someone has to take care to ensure to avoid future suffering, somehow building an earthly paradise. Why do I say that ending extreme suffering is the most relevant of all? As explained by the Organisation for the Prevention of Intense Suffering: "Suffering is rarely if ever a good thing in itself, even though it can lead to personal growth and sometimes allow us to appreciate happiness that follows it even more. But the intense suffering of torture or certain chronic diseases can make life literally unbearable. This suffering, which cries out to be relieved, is on a whole different level, and it makes minor forms of suffering pale in comparison. There is nothing else that has greater urgency than preventing or relieving the intense suffering of sentient beings." That is why I defend euthanasia, assisted suicide and palliative care whenever there is intense suffering that does not lead to a greater good. We are all going to die and if we find ourselves in an irreparable situation, it does not make any sense to extend our lives by a few weeks or months, not even a few years, if this is going to add much suffering to our lives. It will always be better to live a little shorter life, but with less suffering. For the same reason, I also call for responsibility on the issue of reproduction. Bringing new lives into the world without being able to ensure that they will be happy, not just these children, but the children of their children and so on, does not seem like a good idea. Acknowledgments I would like to thank reviewers for their insightful comments on the paper, as these comments led me to an improvement of the work: Imma Six, Raúl Mella, Patri Pérez, Jonathan Leighton and Octavio Muciño.