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Editorial
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Editors' Introduction
Article first published online: 17 MAR 2015
DOI: 10.1111/josp.12083
© 2015 The Authors. Journal of Social Philosophy Published by Wiley Periodicals, Inc.
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Miscarriage
of pregnancy is widely experienced and seldom discussed. Because of the
surpassing silence on the subject, experiences of miscarriage may be
misunderstood, difficult to articulate, and isolating, and attitudes
toward miscarriage may be under-informed. Women are more likely to be
offered cultural information on what to expect when we are expecting,
than we are to be offered preparation for, or recognition of, the
unexpected. Philosophers can, and should, contribute to changing that by
promoting discourse on miscarriage as an experience which is
meaningful, and significant to self-understanding and social awareness,
and by providing a contextual realm in which related discussions of
pregnancy, fertility loss, and fetal death could take place. The
implications of reflections on the phenomenon of miscarriage for many
lines of inquiry turn out to be multifold. To date, unfortunately,
philosophers have not been central participants in theorizing about
miscarriage, pregnancy loss, or fetal death outside of the confines of
abortion debates.1
We
ought to be concerned about the risks of furthering the social and
academic silence surrounding phenomena that so many have experienced,
and that raise important questions regarding grief and loss, the social
construction of pregnancy, technological developments, social
recognition, and, to put it grandly, the nature of human life. As our
contributors observe, one reason at least for the silence on miscarriage
is obvious: addressing and conceptualizing the loss that is central to
some (and not all) experiences of miscarriage may risk undermining some
central principles of reproductive freedom. As feminist philosophers, we
are certainly sympathetic to such concerns. We suggest that the
riskiness of theorizing about miscarriage, and its implications for
applied philosophical arguments with respect to abortion, seem to us to
be compelling reasons why this issue is especially important to offer.
The practice of philosophical investigation includes the social
practices of cooperatively facing our reasons for ignoring some topics
while devoting attention to related issues. Existing accounts of meaning
in reproductive contexts—especially those put forward in debates
concerning abortion—tend to focus on the (moral) status of the fetus.
This is true even of relational accounts aimed at promoting reproductive
autonomy by highlighting the ways in which the fetus is inseparable
from the woman who carries it. It will probably not come as a surprise
that we hope this issue on miscarriage, pregnancy loss, and fetal death
accomplishes a shift this conversation, in the direction of pushing past
embryo-centric value judgments. In part this is because, to put it
bluntly, the miscarried embryo is not the one who has to live with the
experience.
The essays in this special
issue are a significant addition to the scarce literature on miscarriage
and fetal death. Contributions are from specialists in continental and
analytical philosophy, feminism, bioethics, theoretical and applied
ethics, social and political philosophy, social epistemology and
philosophy of language, narrative, aesthetics, popular culture, and
gender studies. As guest editors, we sought to offer a variety of
approaches to the topic, to further the understanding of miscarriage and
fetal death as important to many areas of philosophy, especially social
philosophy. We suggest that the unchosenness and invisibility of
miscarriage are central to its seeming irrelevance to social identities
and social norms of testimony, recognition, and ascription of
significance to experiences.
The first
several contributions to this volume focus on the phenomenon of
miscarriage and its meanings. In “‘The Event That Was Nothing’:
Miscarriage as a Liminal Event,” Alison Reiheld argues that miscarriage
is poorly understood and that people find it difficult to make sense of
the experience of miscarriage for the reason that it is a liminal
event—an event suspended in a space between socially recognized states.
Reiheld identifies four distinct, but related, dimensions along which
miscarriage is liminal: parenthood, procreation, death, and abortion. In
relation to parenthood, miscarriage halts the transition from not being
a parent to being a parent to the child that would have been born. In
relation to procreation as a result of a specific pregnancy, miscarriage
lies between having procreated and having not procreated. In relation
to death, it is not clear whether miscarriage involves the death of
someone or the loss of (potential) life given the lack of social
agreement about the status of embryos and fetuses. In relation to
abortion, miscarriage lies in the space between the social categories of
induced abortion and pregnancy. Reiheld argues that, as a result of its
liminality, miscarriage has been enrolled in social and moral debates
that are not really about miscarriage at all. These include debates
about the permissibility of abortion and debates about control over
pregnancy. By considering particular laws bearing on miscarriage,
Reiheld points to some of the dangers resulting from our failure to
separate miscarriage from the states between which it is suspended.
Reiheld's hope is that a better understanding of miscarriage's
liminality will help us respond in better ways to women who experience
miscarriage and avoid enrolling their experiences in debates that really
have little to do with miscarriage.
In
“Early Pregnancy Losses: Multiple Meanings and Moral Considerations,”
Amy Mullin draws on literature from a variety of disciplines to
highlight some of the complex and variable features of the ethical
terrain related to pregnancy loss. She then considers, specifically, the
moral significance of early pregnancy loss—that is, pregnancy loss that
occurs before the fetus is sentient and before the fetus is able to
survive outside of the womb. Mullin points to problems with arguments
that tie the moral status of the fetus to the question of whether the
fetus is a person. These include the argument, defended by many feminist
scholars, that the moral status of a fetus depends on the extent to
which other people, and especially pregnant women, construct their
fetuses as persons. Mullin proposes another way of understanding the
moral significance of early pregnancy loss. Specifically, she postulates
that the loss of embryos or early fetuses can be morally considerable
for the reason that embryos and early fetuses have the potential to
survive until infancy and to become members of the moral community (a
potential resting on both the features of the fetus itself and the plans
of the pregnant woman). If we accept this postulate, we are able to
understand miscarriage as a loss of a being that is morally considerable
without presupposing that every person will respond to pregnancy loss
in the same way and without abandoning respect for reproductive
autonomy.
In “Miscarriage and
Intercorporeality,” Ann J. Cahill develops a philosophical account of
pregnancy that allows the possibility of recognizing the suffering of
persons who experience miscarriage without undermining reproductive
rights. Cahill resists the relational model of pregnancy defended by
many feminist scholars and invoked in the accounts of miscarriage
defended by Carolyn McLeod and Kate Parsons.2
On a relational model, pregnancy is conceived of as a severable
relation between two distinct individuals where the pregnant woman can
attach moral and emotional significance to the relationship (and indeed
to the fetus) as though she were somehow outside of the relationship,
whereas the fetus cannot. While Cahill acknowledges that a relational
model of pregnancy has much to recommend it, she argues that this model
is problematic in so far as it rests on an individualism that precludes
recognition of the ways in which the lived, embodied experience of
pregnancy is transformative of the pregnant woman's subjectivity. Cahill
draws on Rosalyn Diprose's notion of corporeal generosity—the
prereflective openness to otherness and being given to others that
constitutes social relations—to account for pregnancy and miscarriage in
a manner that reflects the intersubjectivity, rather than mere
relationality, of these phenomena.3
Cahill holds it to be an ontological fact that identities are
constructed only through interaction with other embodied beings such
that the identity of any subject is tied to and implicated in the
identity of other bodies and identities. She argues that the identity
being constructed by the pregnant person as a pregnant person
(as an expectant parent, for instance) is inescapably intertwined with
the existence of the fetus. Miscarriage is, on this account,
disorienting and gives rise to many, often conflicting, emotions in so
far as it ends the transformative experience of pregnancy—often with
painful and sometimes long-lasting physical effects—and calls into
question the identity under construction.
In
her contribution, “Miscarriage and Person-Denying,” Lindsey Porter
considers one way in which reflecting on miscarriage and people's
reactions to miscarriage can inform debates about the moral status of
abortion. Specifically, she argues against person-denying arguments for
the moral permissibility of abortion—arguments aimed at establishing the
permissibility of abortion on the grounds that the fetus is not a
person and, thus, lacks moral status. Porter observes that grief is a
common response to miscarriage and suggests that grief following
miscarriage is evidence that some people experience miscarriage as the
loss of a loved one. She draws on Martha Nussbaum's account of grief to
argue that grief following miscarriage presupposes that the fetus is
something that should be given moral consideration—something with moral
status.4
Porter argues that, if the person-denying argument works, it works only
in the “strong form” in which it is understood that the fetus is
entirely outside of the sphere of moral concern. Thus, unless we dismiss
people who grieve following miscarriage as being mistaken about the
significance of their loss, something Porter is unwilling to do, we must
reject person-denying arguments. Along with other authors contributing
to this volume, Porter is very clear that her argument is not meant to
undermine reproductive autonomy. Even if we reject person-denying
arguments, the permissibility of abortion might be defended on other
grounds.
The next several contributions
focus on the ways in which experiences of miscarriage are shaped by
social scripts and narrative-sharing spaces (or lack of same). While
several authors contributing to this volume note with dismay the social
silence surrounding the phenomenon of pregnancy loss, Hilde Lindemann's
“Miscarriage and the Stories We Live By” reminds us of the relevance of
narrative even with regard to things rarely spoken of. She considers
that the stories by which people in English-speaking societies identify a
woman who is pregnant as an “expectant mother” commonly look forward
to, and converge on, the birth of the child. As such, it is easy to make
sense of who a woman is when she is pregnant and it is easy to respond
well to what the pregnant woman does to express who she is. In contrast,
it is often difficult to know how to respond well to a woman who has
miscarried. Lindemann argues that we do not lack stories by which to
make sense of miscarriage. Rather, she contends that the difficulty lies
in determining which stories help us respond well to people who
experience a miscarriage. Lindemann suggests one condition: the stories
we construct must reflect that miscarriage involves the loss of
something valuable to the pregnant woman, to the fetus, or both.
Recognizing that pregnancy is not purposeful in every respect, Lindemann
argues for an account of pregnancy that emphasizes the agency of the
pregnant woman—the creative activity that includes transforming
biological processes in purposeful and deliberate ways by caring for,
valuing, and giving meaning to (or otherwise coming to terms with) the
natural processes of pregnancy in addition to the social activity of
creating the stories that constitute the identity of the ‘child’ and the
identity of the pregnant woman as an expectant mother. Lindemann also
emphasizes the need to listen to the stories the woman is telling—her
stories may or may not represent her as having suffered a loss. Whatever
story we tell to make sense of miscarriage must represent the loss to
the fetus.
In “The Value of Pregnancy and
the Meaning of Pregnancy Loss,” Byron Stoyles considers the meaning and
value of pregnancy to conceptualize pregnancy loss and reactions to
pregnancy loss. Stoyles begins by reflecting on the different ways in
which philosophers engaged in debates about the moral and legal status
of abortion conceptualize the meaning of pregnancy. He argues that most
of the arguments found in the literature about abortion (including most
feminist arguments) are fetal-centric in the sense that they focus on
the status of the fetus to such an extent that the value and meaning of
pregnancy as something involving persons other than the fetus is mostly
ignored. Stoyles then builds on Hilde Lindemann's account of the value
and meaning of pregnancy by considering how value in pregnancy can
derive from both the activity Lindemann calls “calling the fetus into
personhood” (an idea she explains in her contribution to this volume)
and what he calls the activity of creating an identity as a parent.
Stoyles argues that the recognition of these related activities allow us
to make sense of common—albeit diverse and sometimes
conflicting—reactions to pregnancy loss including confusion about the
identity of the would-be parents and the fetus.
In
“Making Sense of Miscarriage Online,” Sarah Hardy and Rebecca Kukla
explore ways in which women who have experienced miscarriage give
narrative shape to their experiences online. Hardy and Kukla begin by
noting ways in which it is difficult to make sense of miscarriage
against the backdrop of medical institutions and practices in so far as
miscarriage is treated as medically significant (as most matters related
to pregnancy are), but also as something that happens mostly outside of
the medical context. Using examples from Facebook, discussion boards,
and blogs, Hardy and Kukla consider how women use online fora to
articulate the experience of miscarriage and to shape their narrative
identity outside of the medical context. They also consider ways in
which online fora provide opportunities for other people to give uptake
to women's responses to miscarriage by posting comments and stories
affirming women's responses to miscarriage as meaningful. In their
contribution, Hardy and Kukla point to a number of ways in which the
functional structure of different online spaces influence the kind and
quantity of content posted. Facebook, for example, allows each author
extensive control over the content of her own page whereas discussion
boards are inherently more conversational. Despite such differences,
Hardy and Kukla contend that the internet provides important social
tools for creating new kinds of collaborative interaction. Engaging
online, women can maintain their anonymity, create multiple (even
incompatible) narrative threads simultaneously, and otherwise make sense
of the experience of miscarriage in a more or less collaborative way.
The
last two contributions focus more explicitly on ethical questions
surrounding fetal death. In “Rethinking Abortion, Ectogenesis, and Fetal
Death,” Christine Overall proposes a revised understanding of abortion
and argues that pregnant women are entitled to choose abortion as this
is understood to include both ending the life of the fetus in utero
and the evacuation of the uterus. This view is a departure from
Overall's earlier view that pregnant women are entitled to choose
uterine evacuation but not to end the life of the fetus if it could
survive by means of ectogenesis (gestation within an artificial uterus).5
Overall outlines how she has changed her view after considering
objections to her earlier work. Specifically, the view Overall defends
in her contribution to this volume is aimed at rethinking abortion in a
way that is consistent with pregnant women's bodily autonomy and women's
right to not reproduce. The former reflects Overall's view that the
pregnant woman's relationship to the fetus determines what can be done
for or to it (on Overall's account, the fetus has no independent moral
status until it emerges from the woman's body) and respects that women's
bodily autonomy should include being entitled to determine what happens
not only to one's body but also to one's body parts and the products of
one's body (including the fetus). The latter respects that reproductive
autonomy should reflect a right not to reproduce and the reality that a
woman might want there to be no genetic offspring resulting from the
pregnancy that is ended. Though Overall argues for the right for the
pregnant woman to kill the fetus in utero, she opposes
“after-birth abortion” for the reason that, on her view, an infant does
not have the same moral status as a fetus. Since an infant is no longer
in the same relationship to the pregnant woman as a fetus, a woman's
entitlement to end the life of the fetus ends once it is removed from
her body. Overall goes on to consider moral questions and potential
problems related to the possibility of ectogenesis which she no longer
regards as part of the solution to debates related to abortion.
The
collection closes with Sarah Clark Miller's “The Moral Meanings of
Miscarriage,” in which she attends to the range of ethical challenges
presented by complex and varied responses to miscarriage. Miller
articulates the urgency of the need for a “perinatal ethics,” that is,
not just a prenatal bioethics which tends to be the focus of clinical
obstetrics literature, but a more robust ethical approach that addresses
the moral issues that arise before, during, and after pregnancy,
appreciative of the changes in a woman's identity over the course of the
arc of miscarriage experience. Miller contends that miscarriage exceeds
the standard categories of ethical analysis, involving the blending of
moral agent and moral patient in the same individual, the presence of
distinctive reactive attitudes along with social and political denial of
recognition that an event occurred at all, the moral standing of fetal
life, and the moral self-understanding of women who suffer pregnancy
loss. Miller concludes that, absent a better formulation of ethics
regarding miscarriage, we are in danger of neglecting the moral
considerability of women when we fail to attend to their moral emotions
regarding their pregnancy losses.
Even
these brief synopses indicate some fruitful and productive overlaps
among the diverse articles that comprise this volume. There is
controversy, for example, over the centrality of loss with regard to
miscarriage; Cahill rejects the narrative of loss, while Lindemann
argues that loss accrues to the fetus as well. The collected articles
draw important connections between miscarriage and elective abortion,
two phenomena that in common discourse are viewed as entirely distinct.
To the contrary, our authors (especially Overall, Stoyles, and Porter)
articulate important ways in which ways of thinking about abortion can
affect our understanding of miscarriage, and vice versa. Mullin and
Miller argue that paying philosophical attention to miscarriage should
and must transform our understanding of the ethics of pregnancy and
reproductive autonomy, and while Reiheld provides the most detailed
account of the liminality of miscarriage, several other articles address
its uncanny nature, the slippery in-betweenness that may contribute to
the social and intellectual silence that surrounds the topic. Finally,
almost every article in the collection mentions that silence, but Kukla
and Hardy describe the way that cyberspace not only provides an
opportunity for the sharing of narratives, but in fact shapes those
narratives in significant ways.
Yet
unexplored questions remain. Reiheld's contribution articulates some of
the ways that the liminality of miscarriage intersects with laws
regarding pregnancy to increase the vulnerability of pregnant bodies;
yet even more attention is needed to the various ways in which
miscarriage has been criminalized, leading to the incarceration of women
who have experienced pregnancy loss.6
There is more to be said too about the experience of the partners (of
all sexes) of pregnant persons who have experienced miscarriage. What
philosophical meanings can be found in an embodied experience that
happens to another that has potentially transformative effects on the
partner's own (perhaps embodied) subjectivity? Finally, the intriguing
parallels between miscarriage and elective abortion need further
exploration. How might recognizing the similarities between these
phenomena (without ignoring their important differences) assist in
reframing the political discourse on reproductive autonomy?
These
questions and, we are sure, many others, would benefit from further
attention. Thus it is our hope that this volume is merely the beginning
of a long-standing, vigorous philosophical exploration of these common,
yet all too frequently ignored, experiences.
The
editors would like to express their gratitude to the Kenneth Mark Drain
Chair in Ethics at Trent University Trust for funds to make this issue
open access in entirety.
Notes
- 1The literature on miscarriage and pregnancy loss is more robust in fields including medicine, nursing, anthropology, and psychology, but some sustained work on miscarriage has been done by a handful of notable philosophers; see , “Feminist Reflections on Miscarriage, in Light of Abortion,” International Journal of Feminist Approaches to Bioethics 3, no. 1 (2010): 1–22; , Self-Trust and Reproductive Autonomy (Cambridge, MA: MIT Press, 2002); , “Moral Absolutism and Ectopic Pregnancy,” Journal of Medicine and Philosophy 26, no. 1 (2001): 61–74; , “Culpability and Blame After Pregnancy Loss,” Journal of Medical Ethics 33, no. 1 (2007): 24–27. Anthropologist Linda Layne is perhaps the most well-known and frequently cited author of work centrally focused on miscarriage and pregnancy loss; her work Motherhood Lost: A Feminist Account of Pregnancy Loss in America (New York: Routledge, 2002) is cited by many of our authors, as is environmental sociologist Myra Hird, whose article, “Vacant Wombs: Feminist Challenges to Psychoanalytic Theories of Childless Women,” Feminist Review 75, no. 1 (2003): 5–19 was an especially welcome discovery to the editors when we began this project.
- 2McLeod, Self-Trust; Parsons, “Feminist Reflections on Miscarriage.”
- 3, Corporeal Generosity: On Giving with Nietzsche, Merleau-Ponty, and Levinas (Albany: State University of New York Press, 2002).
- 4, Upheavals of Thought: The Intelligence of Emotions (Cambridge: Cambridge University Press, 2001).
- 5, Ethics and Human Reproduction: A Feminist Analysis (London: Allen & Unwin, 1987).
- 6The criminalization of miscarriage and pregnancy loss is a growing problem which philosophers havenot yet attended to excellently. See, for example, “Outcry in America as Pregnant Women WhoLose Babies Face Murder Charges,” The Guardian, June 24, 2011 (available at http://www.theguardian.com/world/2011/jun/24/america-pregnant-women-murder-charges); and ,” Arrests of and Forced Interventions on Pregnant Women in the United States, 1973–2005: Implications for Women's Legal Status and Public Health,” Journal of Health Politics, Policy and Law 38, no. 2 (2013). Lynne Paltrow also co-authored the webzine article, “Keep Mothers Out of Jail: Vote ‘No’ on Colorado's ‘Personhood’ Measure,” with Cristina Aguilar (available at http://rhrealitycheck.org/article/2014/10/07/keep-mothers-jail-vote-colorados-personhood-measure/). See also “If Stillbirth Is Murder, Does Miscarriage Make Pregnant Women into Criminals?” by Sadhbh Walshe, The Guardian, March 26, 2014 (available at http://www.theguardian.com/commentisfree/2014/mar/26/stillbirth-murder-miscarriage-pregnant-women-criminals).
