This is not an easy book to read. Nearly every sentence seems to have at least one endnote, often much longer than itself. These notes, however, do contain valuable documentation, and interrupting one's reading to look at them is eminently worthwhile. Helen Watt is addressing urgent moral issues in a highly competent way. Her argumentation is calm and persuasive. And she supplies some very disturbing facts about how pregnancy is treated in today's Western world.
The fundamental question in the ethics of pregnancy is whether what the pregnant woman carries is a second human being, and this is tackled in the first quarter of the book. In the Introduction Watt points out that pregnancy is not a pathological state like a boil, and, what may be less well known, the mother and foetus, unlike conjoined twins, do not have any bodily part in common: one part of the placenta is grown by the mother, the other by the foetus itself. In Chapter 1 Watt first argues briefly against dualistic views – that we ourselves are distinct subjects from our bodies, or else mere sequences of unowned experiences. Without going into the philosophies of Descartes and Hume she offers considerations a non‐philosopher might find plausible. She also criticises the idea that we come into existence out of foetuses or infants in the way embryos arise out of gametes. The next question is whether a human being, to be a human person, needs conscious desires. Some people reason that something is a person only if it has interests, and it has interests only if it has desires. Watt distinguishes between having an interest, and taking one. I have an interest if some occurrence can be good or bad for me. A human embryo is something for which it would be good to acquire the capacities of a human adult, and it has this interest from conception, (and not just, say, from the appearance of the primitive streak). If, Watt asks, the possibility of twins deprives a zygote of personhood, does the possibility of cloning do the same for adults? To the observation that a zygote does not look like a small human adult, she replies that it looks exactly like a very young human being. The argument of this chapter seems to me strong. Someone might agree, of course, that a young embryo is a young human person, but maintain that it is not wrong to kill some such persons. This possibility is considered in Chapters 2 and 3.
Chapter 2 opens with the question: how similar is the relation between a woman and a child in her womb to that between ordinary neighbours? Though injurious action is different from withholding help, withholding the help necessary for life even from a stranger – say a drowning child or a wounded man ‐ can amount to killing, and not only does a pregnant woman provide her child with the support necessary for life, but that support can be withdrawn only by positive violent action. A woman has a right not to be made pregnant, but a pregnant woman is already a parent, and Watt denies that she has a right to cease being a parent if that means preventing her child's survival. Watt meets the claim that a woman has the right to control what goes on in her body, by saying that if this is not simply an assertion that she has right to have an abortion it seems to give her a right to move her limbs as she pleases regardless of harm to other people.
Chapter 3 starts with surrogate motherhood. Besides noting the bizarre suggestion that a woman has the right to require others to make her a surrogate mother if she falls into a persistent vegetative state, Watt argues that a surrogate mother has a right to keep the child she carries, no matter what she may have promised in advance. Her most interesting argument here is not that the woman has supported the child in a unique fashion, but that acquiring parental rights is not simply a matter of choice. Being a parent is a role in the same way as being a sibling or a grandchild, and similarly depends on biology, in this case gestation, as well as freely entered contracts. Legislation that permits surrogacy has the effect, whether or not intended, of making the family less of a society intermediate between the state and the individuals, and more of an aggregate of individuals.
The chapter continues with cases where a pregnancy threatens the mother's life. This leads to discussion of intended and foreseen but unintended effects. Watt displays sure footwork in this marshy area, and she makes interesting comparisons with cases where the survival of one conjoined twin threatens the other.
In her fourth and last chapter Watt considers the significance for a pregnancy of ‘assisted reproductive technologies’, ARTs. While acknowledging that couples invoke these because they badly want a child, she contends that the commissioning processes, quality control and artificiality involved encourage a distant, critical attitude towards the resulting child: does it meet their specifications? She points out that couples, besides showing indifference to ‘superfluous embryos’, may authorise the ‘reduction’ of a multiple pregnancy by lethal injection of one foetus, and asks how the recipient of a donated egg can be more of a parent than a surrogate mother. I find these considerations more telling than the possibility (p. 114) that ARTs may cause people who see a pregnant woman to have false beliefs about the child's parentage. Watt holds, reasonably enough, that the best start for pregnancy is normal intercourse between husband and wife; and adds that it is also best for all concerned if the parents do not use contraception to limit their families, because if it fails they may fall back on abortion. This more controversial claim, however, occupies less than 0.5% of the book's text, and will not reduce the cogency of the rest for those unconvinced by it.
