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The procreation asymmetry is a widely held view in ethics, claiming that one should make existing people happy but has no reason to make happy people. Here, I shall present a new objection demonstrating from modest premises that one has a reason to take a sequence of actions that simply creates a happy person; yet this judgment in combination with plausible principles about sequences of actions entails that one has some reason to simply create a happy person. Additionally, I will argue that one's reasons to create a happy person are quite strong.

The considerations presented here cover one aspect of the use of AI algorithms in the process of establishing phenotypic similarity between a cell donor or embryo donors and those interested in parenthood and the child. The Infertility Treatment Act does not expressly exclude the use of AI algorithms, which may help to achieve the goal of phenotypic similarity but may, contrary to the intention of the legislature, serve to disclose the data of a person or persons to whom the Act, by design, provides anonymity. The authors analyse the acceptability of using images of donor reproductive cells and the use of AI algorithms to establish phenotypic similarity. Both benefits and potential risks remain under consideration.

Recently, childfree people have been foregrounded in mainstream media. More than seven percent of Western women choose to remain childfree and this figure is increasing. Being childfree challenges the ‘procreation imperative’ residing at the center of our hetero-normative understandings, occupying an uneasy position in relation to—simultaneously—traditional academic ideologies and prevalent social norms. After all, as Adi Avivi recognizes, if a woman is not a mother, the patriarchal social order is in danger. This collection engages with these (mis)perceptions about childfree people: in media representations, demographics, historical documents, and both psychological and philosophical models. Foundational pieces from established experts on the childfree choice--Rhonny Dam, Laurie Lisle, Christopher Clausen, and Berenice Fisher--appear alongside both activist manifestos and original scholarly work, comprehensively brought together. Academics and activists in various disciplines and movements also riff on the childfree life: its implications, its challenges, its conversations, and its agency—all in relation to its inevitability in the 21st century. Childfree across the Disciplines unequivocally takes a stance supporting the subversive potential of the childfree choice, allowing readers to understand childfreedom as a sense of continuing potential in who—or what—a person can become.

ObjectivesShared decision-making (SDM) is increasingly emphasized in the treatment of systemic lupus erythematosus (SLE). Although SDM has been linked to quality of life (QoL) in various diseases, its direct and quantitative relationship with QoL in SLE remains unclear. This study aimed to investigate the longitudinal relationship between SDM and QoL in a multicenter cohort of patients with SLE.MethodsPatients aged 20 years or older diagnosed with SLE according to the 1997 revised American College of Rheumatology criteria were included. The association between baseline scores on the SDM-Q-9, an indicator of SDM, and one-year changes in scores on the LupusPRO, a QoL measure for patients with SLE, was examined using multiple regression analysis. Additionally, we evaluated the association between SDM changes and QoL, both overall and across the four groups, categorized by baseline SDM levels and SDM changes.ResultsA total of 436 patients were included in this analysis. Higher baseline SDM-Q-9 scores were associated with a 0.16-point improvement (95% confidence interval [CI]: 0.071–0.24, p = 0.001) in non-health-related QoL, particularly in the satisfaction with care domain (0.36-point improvement, 95% CI: 0.14–0.58, p = 0.003). For health-related QoL, SDM-Q-9 scores improved the procreation domain by 0.13 points (95% CI: 0.033–0.22, p = 0.01). Longitudinal changes in SDM over one year did not substantially alter these associations.ConclusionsHigher SDM levels in patients with SLE may enhance their QoL. Sustained high SDM appears to be more influential than short-term improvements.

This paper offers a unified explanation for the procreation asymmetry and the non-identity thesis – two of the most intractable puzzles in population ethics. According to the procreation asymmetry, there are moral reasons not to create lives that are not worth living but no moral reasons to create lives that are worth living. I explain the procreation asymmetry by arguing that there are moral reasons to prevent the bad, but no moral reasons to promote the good. Various explanations for the procreation asymmetry have failed to explain the non-identity thesis: if one could create a person with a good life or a different person with a better life, one has a moral reason to create the better life. I argue that reflections on the misfortune of unfulfilled potential allow us to circumvent the non-identity problem.

Research Framework: The concept of personal origins is constantly evolving as the ways in which families are formed diversify. In France, parents who have recourse to sperm donation are now encouraged to pass on to their child the circumstances of their birth. These narratives are particularly important for single mothers: they are supposed to give the donor a part in the family history, without compensating for the absence of a second parent.Objectives: This article aims to analyze how narratives about origins – in this case about donors – are constructed by single mothers.Methodology: As part of a doctoral thesis, eighteen biographical interviews were carried out with single women who had become mothers through sperm donation, both abroad and in France. These interviews were complemented by the analysis of an online group, which was a productive field of investigation for observing family intimacies.Results: Revealing one’s history gives rise to a variety of practices and narrative strategies, based on a moral norm of dual responsibility for single mothers. Investigating these narratives reveals the place assigned to the donor. He embodies a symbolic figure in family history, that is unrelated to kinship or filiation. His place is constructed in a feminine group that includes other single mothers, and is then negotiated with the close family. Furthermore, these narratives are materialized through the creation of various supports (books, images, films, etc.), testifying to single mothers’ desire to assert their family model.Conclusion: The creation of the origin story is part of the narrative work of single mothers, aimed at their children and their relatives, and contributes to family memory.Contribution: This article contributes to a better understanding of the experience of single mothers, and more generally of the place given to a donor in the history of families born of donation.

Endometriosis and infertility are associated clinically. Medical and surgical treatments for endometriosis have different effects on a woman's chances of conception, either spontaneously or via assisted reproductive technologies (ART). Medical treatments for endometriosis are contraceptive. Data, mostly uncontrolled, indicate that surgery at any stage of endometriosis enhances the chances of natural conception. Criteria for non-removal of endometriomas are: bilateral cysts, history of past surgery, and altered ovarian reserve. Fears that surgery can alter ovarian function that is already compromised sparked a rule of no surgery before ART. Exceptions to this guidance are pain, hydrosalpinges, and very large endometriomas. Medical treatment—eg, 3–6 months of gonadotropin-releasing hormone analogues—improves the outcome of ART. When age, ovarian reserve, and male and tubal status permit, surgery should be considered immediately so that time is dedicated to attempts to conceive naturally. In other cases, the preference is for administration of gonadotropin-releasing hormone analogues before ART, and no surgery beforehand. The strategy of early surgery, however, seems counterintuitive because of beliefs that milder non-surgical options should be offered first and surgery last (only if initial treatment attempts fail). Weighing up the relative advantages of surgery, medical treatment and ART are the foundations for a global approach to infertility associated with endometriosis.

In this paper, I propose a refined version of Seana Shiffrin’s consent argument for anti-natalism and argue that longtermism is best justified not through the traditional consequentialist approach, but from an anti-natalist perspective. I first reformulate Shiffrin’s consent argument, which claims that having children is pro tanto morally problematic because the unconsented harm the child will suffer could not be justified by the benefits they will enjoy, by including what I call the to better accommodate various criticisms. Based on this iteration of anti-natalism, I argue that future generations should not be seen as far away strangers who are merely anonymous bearers of well-being, but rather as collective victims of the wrongful acts of procreation. As a result, anti-natalism provides us with a rational ground to put a key moral priority on improving the future, not only as restitution to future generations for the unconsented harm imposed on them, but also as part of a long-term effort to nullify the anti-natalist criticism, since the consent argument would no longer apply if our society eventually becomes so utopian that the positive aspects of the average person’s life vastly outweigh its negative aspects.

Tumor necrosis factor-alpha (TNF-α) is a multifunctional Th1 cytokine and one of the most important inflammatory cytokines. In pregnancy, TNF-α influences hormone synthesis, placental architecture, and embryonic development. It was also shown that increased levels of TNF-α are associated with pregnancy loss and preeclampsia. Increased TNF-α levels in complicated pregnancy draw attention to trophoblast biology, especially migratory activity, syncytialisation, and endocrine function. Additionally, elevated TNF-α levels may affect the maternal-fetal relationship by altering the secretory profile of placental immunomodulatory factors, which in turn affects maternal immune cells. There is growing evidence that metabolic/pro-inflammatory cytokines can program early placental functions and growth in the first trimester of pregnancy. Furthermore, early pregnancy placenta has a direct impact on fetal development and maternal immune system diseases that release inflammatory (e.g., TNF-α) and immunomodulatory factors, such as chronic inflammatory rheumatic, gastroenterological, or dermatological diseases, and may result in an abnormal release of cytokines and chemokines in syncytiotrophoblasts. Pregnancy poses a challenge in the treatment of chronic disease in patients who plan to have children. The activity of the disease, the impact of pregnancy on the course of the disease, and the safety of pharmacotherapy, including anti-rheumatic agents, in pregnancy should be considered.

Cryopreservation of eggs or ovarian tissue to preserve fertility for patients with cancer has been studied since 1994 with R G Gosden's paper describing restoration of fertility in oophorectomised sheep, and for decades previously by others in smaller mammals. Clinically this approach has shown great success. Many healthy children have been born from eggs cryopreserved with the Kuwayama egg vitrification technique for non-medical (social) indications, but until now very few patients with cancer have achieved pregnancy with cryopreserved eggs. Often, oncologists do not wish to delay cancer treatment while the patient goes through multiple ovarian stimulation cycles to retrieve eggs, and the patient can only start using the oocytes after full recovery from cancer. Ovarian stimulation and egg retrieval is not a barrier for patients without cancer who wish to delay childbearing, which makes oocyte cryopreservation increasingly popular to overcome an age-related decline in fertility. Cryopreservation of ovarian tissue is an option if egg cryopreservation is ruled out. More than 37 babies have been born so far with cryopreserved ovarian tissue in patients with cancer who have had a complete return of hormonal function, and fertility to baseline. Both egg and ovarian tissue cryopreservation might be ready for application to the preservation of fertility not only in patients with cancer but also in countering the increasing incidence of age-related decline in female fertility.