Saturday, 28 March 2015

Editors' Introduction The Philosophical Treatments of Miscarriage and Pregnancy Loss

Editors' Introduction Cahill 2015 Journal of Social Philosophy Wiley Online Library

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Editors' Introduction

  1. Ann J. Cahill,
  2. Kathryn J. Norlock and
  3. Byron J. Stoyles
Article first published online: 17 MAR 2015
DOI: 10.1111/josp.12083
Journal of Social Philosophy

Journal of Social Philosophy

Volume 46, Issue 1, pages 1–8, Spring 2015

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.
  1. 1
    The 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 Kate Parsons, “Feminist Reflections on Miscarriage, in Light of Abortion,” International Journal of Feminist Approaches to Bioethics 3, no. 1 (2010): 122; Carolyn McLeod, Self-Trust and Reproductive Autonomy (Cambridge, MA: MIT Press, 2002); Christopher Kaczor, “Moral Absolutism and Ectopic Pregnancy,” Journal of Medicine and Philosophy 26, no. 1 (2001): 61–74; Benjamin Hale, “Culpability and Blame After Pregnancy Loss,” Journal of Medical Ethics 33, no. 1 (2007): 2427. 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.
  2. 2
    McLeod, Self-Trust; Parsons, “Feminist Reflections on Miscarriage.”
  3. 3
    Rosalyn Diprose, Corporeal Generosity: On Giving with Nietzsche, Merleau-Ponty, and Levinas (Albany: State University of New York Press, 2002).
  4. 4
    Martha Nussbaum, Upheavals of Thought: The Intelligence of Emotions (Cambridge: Cambridge University Press, 2001).
  5. 5
    Christine Overall, Ethics and Human Reproduction: A Feminist Analysis (London: Allen & Unwin, 1987).
  6. 6
    The 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; Lynne M. Paltrow and Jean Flavin,”  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 See also “If Stillbirth Is Murder, Does Miscarriage Make Pregnant Women into Criminals?” by Sadhbh Walshe, The Guardian, March 26, 2014 (available at