This chapter explores the WHO 2022 Abortion Care Guideline and some of the debates it engendered through the lens of narrative medicine, as reconceptualised and extended in this book. Rather than treating the guideline as a neutral technical document, the chapter approaches it as a value-laden story narrated by a powerful institution (WHO) about the highly contested topic of abortion care. It examines how the WHO narrative constructs authority, assigns roles (narrators, protagonists, antagonists), selectively highlights certain types of evidence and values, and is informed by specific assumptions about evidence, morality, and care. It further contextualises this story within the broader set of narratives advanced by the guideline’s supporters as well as its opponents in order to develop a nuanced understanding of how global health policies come to be imbued with moral authority or, alternatively, contested as ‘ideological stories’, with far-reaching consequences for global reproductive health governance. Analysing the WHO abortion guideline and its reception through a narrative lens uncovers a struggle between competing storylines – each with its own narrator claiming authority, its own cast of protagonists and antagonists, its curated evidence and value set, and its sense of past and future. These narratives construct very different social realities around abortion care, which in turn shape policy discourse and outcomes.

Privileges are generally disfavored as impeding the truth. But in this chapter, I propose a novel way to think of privilege altogether: privilege as a means of resistance, a tool to oppose unjust systems and laws. Current privilege scholarship essentially assumes faith in the adversarial legal system and the interest in soliciting, collecting, and admitting all available evidence. This assumption implicitly accepts that the adversarial system is valid, and the substantive law that privilege limits is also valid. However, if we question the legitimacy of the adversarial system and the substantive laws it upholds, the cost-benefit analysis shifts. Privilege could serve as an instrument of resistance by prioritizing the preservation of relationships over the legal system’s pursuit of truth.

‘Contemporary Irish Popular Fiction’ considers a genre of writing sometimes characterised as ‘chick-lit’ (a disputed term), women’s fiction (equally problematical), or popular women’s fiction, which now constitutes one of the largest and fastest-growing genres of Irish writing. Beginning with the emergence of Maeve Binchy as an internationally successful novelist in the 1990s, a succession of Irish writers – Patricia Scanlan, Cecelia Ahern, Sinéad Moriarty, Marian Keyes, Emer McLysaght, and Sarah Breen – have produced work that has not only been hugely popular with readers, but which has also addressed key issues in contemporary Irish society, including abortion, divorce, gender roles, aging, and housing. It is demonstrated that the familiar tropes and situations deployed in novels in this genre allow scope to address these issues. Ultimately, it is argued, this genre of popular fiction has been among the most successful in addressing the changing nature of Irish society.

Chapter 11 looks at some of the legal and ethical dimensions of two high-profile situations: abortion and voluntary assisted dying. These situations are often discussed together because they concern the limit of human vulnerability (in death) and the limit of human freedom and autonomy (in determining who can legitimately kill). This chapter considers some of the main ethical arguments for and against abortion and voluntary assisted dying, and sets out the relevant legal frameworks for nurses. In recent years, voluntary assisted dying laws have been introduced in all Australian states and the Australian Capital Territory, but not yet the Northern Territory, although legislation is being prepared. While nurses often have a special interest in the morality of abortion and voluntary assisted dying, the nurse’s role is clearly prescribed by law, and failure to act within the law can result in criminal charges of assault or even manslaughter.

This chapter examines intensifying state-led attacks on LGBTQ people and reproductive rights in the United States through the lens of patriarchal authoritarianism. It connects the rise of the worldwide anti-gender movement with the historic exploitation of preexisting patriarchal power disparities by fascist and authoritarian regimes. It exposes the retrenchment towards state control over reproductive, bodily, and sexual autonomy as a tangible marker of a nation’s transition towards patriarchal authoritarianism and a time-tested fascistic tool. Patriarchy can be wielded as a fascistic tool and help facilitate a slide into authoritarianism by expanding social control and narrowing acceptable expressions of individuality, dignity, and freedom. Patriarchy excludes women from the public sphere while also exerting control throughout the private sphere of the family. Patriarchal authoritarianism further reinscribes patriarchy by exerting state control over reproduction, sexuality, and the family. Restricting opportunities for women and narrowing avenues for gender and sexual expression support the consolidation of power by limiting individuality and nonconformity.

This chapter shifts addresses the advocacy agenda of the LGBTQ rights movement, specifically the pivotal role played by the US Supreme Court. In less than two decades, the Court recognized the right to engage in same-sex sex, mandated recognition of same-sex marriage, and interpreted Title VII of the 1964 Civil Rights Act to include discrimination on the basis of transgender status and sexual orientation as prohibited forms of sex discrimination. These developments fundamentally altered the legal lives of LGBTQ people. However, systemic efforts to undermine the integrity of the courts threaten these victories and the lives built around them. This chapter concludes that the current dominant interpretive approach of the US Supreme Court, known as originalism, is overly restrictive and arguably an expression of restorative nostalgia that prevents the Court from fulfilling its duty as a constitutionally mandated check against tyranny. An independent judiciary can serve as a powerful bulwark against democratic decline; however, courts can also provide a powerful legal veneer for otherwise patently autocratic policies. Democracy scholars refer to this as autocratic legalism. The increasing specter of autocratic legalism in the Unites States threatens to diminish the role of the Court as a tool for democratic self-defense.

This chapter explores the use of restorative nostalgic political propaganda by antidemocratic forces to pursue a myth of a “golden age” and reinstate policies built on racism, homophobia, transphobia, and misogyny. Although conservative political figures in the US have long capitalized on the allure of restorative nostalgia to delegitimize progressive social and political reforms, today’s populist MAGA movement is different in both kind and degree. In a quest to “make America great again,” the MAGA movement aims to turn the clock back on decades of social justice gains by villainizing the social progress and expansion of rights that have made many of our lives possible. This chapter explains the historic use of restorative nostalgic propaganda by fascist regimes to blame modernity and the expansion of civil and political rights for the loss of a “great mythic past” defined by simplicity and prosperity. Under this view, individuals who advocate for progressive reforms are demonized and branded as enemies of the state. Restorative nostalgic political propaganda demands the exclusion and erasure of nonconforming individuals to restore the “simple life” and regain national glory.

This chapter examines how state neutrality can be assessed by reference to the provision of certain information, with a particular focus on information provided through prenatal testing programmes. The information that parents receive about prenatal tests and procedures, and about disability, can be powerfully influential, and can shape the choices that are made. The chapter reviews a number of reasons why the provision of information might not reflect a neutral position: the information might be overly negative about disability, for example, and there is a risk that women will be blamed for any choice that they make. Although it must be acknowledged that it is not possible to have an entirely neutral framework, the chapter compares and evaluates different options that are thought to support autonomy. The chapter also considers nudge theory in order to critically assess both the state’s intention and some limits to individual choice. Although many of these limits are ones that the state cannot entirely avoid, it is important to consider how they put the parents in a particularly vulnerable position, where there is a risk of manipulation.

This chapter addresses a number of foundational issues in relation to the position of the modern liberal state and the use of techniques and procedures that can prevent the birth of a disabled child. It begins by explaining why the traditional approach to the ethics of selective reproduction is insufficient as it usually sidelines or minimises the role of the state, following on from a common assumption that the state is neutral. It then considers the meaning of a liberal commitment to neutrality, so that we can analyse and question this common assumption. Among other things, the chapter claims that the relevance of the role of the state is not limited to the use of coercive measures, and that we should focus on state intention. Although neutrality can be a matter of degree, and while there are different interpretations of a neutral state intention, the chapter suggests that the position of the state can be assessed by reference to certain central liberal commitments. In particular, the chapter examines the importance of individual choice as an essential commitment of the modern liberal state, and considers what choice should be available to prospective parents.

While Chapter 1 was focused on the importance of reproductive choice for the modern liberal state, this chapter examines whether a liberal commitment to neutrality would require that the state place certain constraints on choice, for the benefit of the future child. The chapter begins by considering a hypothetical scenario put forward by Bruce Ackerman, where decisions are made by a Master Geneticist according to a liberal commitment to neutrality, and then analyses arguments made by proponents of liberal eugenics. In so doing, it scrutinises a number of complexities surrounding a state concern for the interests of the future child. A first set of complexities relates to the nonidentity problem, given that it is not clear that a liberal state should be concerned with the interests of a hypothetical replacement child. A second set of complexities relates to the gendered impact of the state’s concern for the child, and to the risks involved for women’s bodily integrity and equality.

This chapter analyses the law in two areas that relate to prenatal selection, with the aim of critically evaluating what ‘messages’ the law might express about disabled lives, and about the state’s position: first, the law on abortion on the grounds of disability under the Abortion Act 1967, and second the law in the United Kingdom on preimplantation genetic testing (PGT). In the first case, it is argued that the disability ground in the law on abortion is not primarily protecting reproductive autonomy, but rather reflects a negative view about the value of disabled lives. In the second case, it is argued that the identification of approved conditions for PGT does not reflect a neutral approach to the definition of disability, and that the legal regime includes elements of state coercion. The chapter also examines a third area which does not relate to prenatal selection, but which might shed light on the state’s position about the latter: court decisions about the treatment of very ill infants. Here, there are reasons to think that interpretations of the best interests of the child do not, in fact, necessarily only take into account the interests of the child.

Discussions of the family and sexual orientation, the topics of Chapters 8 and 9, would not be complete without a consideration and review of contraception and birth control. Most married and unmarried sexually active women and men in the United States and in the countries of the developed world endeavor to limit their family size and/or to control the timing and spacing of their births.

St. Thomas and Thomists hold that the ground for having basic rights (including the right to life) is being a person. And a person can be defined as: an individual substance of a rational nature. This chapter sets out and defends this position, including its application to the beginning of human life, issues at the end of life, and capital punishment and killing in war. I argue that St. Thomas’s principles for determining when human life begins are correct, and that when applied to the embryological facts known today, show that human beings begin at fertilization. I set out St. Thomas’s position on capital punishment (where he holds that a human being can lose his inherent dignity) and discuss both criticisms and defenses of this position by later Thomists, indicating the centrality for this issue of the notions of dignity, the common good, and punishment.

Gender inequality in India arises from widespread societal attitudes that prioritize the economic and social status of men and, as a result, favour investment in male children. Policy actions have resulted in significant improvements in women’s educational attainment and political representation, but there has been only limited progress in women’s labour force participation, in rates of domestic violence and rape, and in the abatement of trends in the selective abortion of girls. Attitudes pertaining to the status of women also show limited improvement.