In recent years, multifetal pregnancy reduction (MFPR) has increasingly been a subject of debate in Norway. The intensity of this debate reached a tentative maximum when the Legislation Department delivered their interpretative statement, Section 2 - Interpretation of the Abortion Act, in 2016 in response to a request from the Ministry of Health (2014) that the Legislation Department consider whether the Abortion Act allows for MFPR of healthy fetuses in multiple pregnancies. The Legislation Department concluded that the current abortion legislation [as of 2016] allows for MFPR subject to the constraints that the law otherwise stipulates. The debate has not subsided, and during autumn 2018 it was further intensified in connection with the Norwegian Christian Democratic "crossroads" policy and signals from the Conservatives to consider removing section 2.3c and to forbid MFPR. Many of the arguments in the MFPR debate are seemingly similar to arguments put forward in the general abortion debate, and an analysis to ascertain what distinguishes MFPR from other abortions has yet to be conducted. The aim of this article is, therefore, to examine whether there is a moral distinction between abortion and MFPR of healthy fetuses. We will cover the typical arguments emerging in the debate in Norway and exemplify them with scholarly articles from the literature. We have dubbed the most important arguments against MFPR that we have identified the harm argument, the slippery-slope argument, the intention argument, the grief argument, the long-term psychological effects for the woman argument, and the sorting argument. We conclude that these arguments do not measure up in terms of demonstrating a morally relevant difference between MFPR of healthy fetuses and other abortions. Our conclusion is, therefore — despite what several discussants seem to think — that there is no morally relevant difference between the two. Therefore, on the same conditions as we allow for abortions, we should also allow MFPR. Keywords: abortion, ethics, medical ethics, MFPR, selective MFPR

This study indicates an association between psychiatric illnesses and suicide in later life, history of suicidal behaviour, poor physical health and functional status and poor social circumstances. Conclusions: There are significant differences in the area off mental health and the behaviour of elderly women compared with younger subjects and between women and men. The preliminary study revealed that in most of cases, there was an association of major affective illness, substance uses disorder, severe physical illness with functional limitations, moderate and severe pain and little social support. living in a foreign community. First steps and initiatives involving multidisciplinary approaches have shown that women in migration need specific attention in psychiatric services as well as specific training is necessary for the providers of such services. Several case descriptions illustrating typical lifespan problems and examples of integrative tram-cultural work in the Psychiatric Outpatient Department of Basle, Switzerland will be shown. Yet there is need for further investigations as well as need for innovative service development and especially for an increase of women therapists to involve themselves into such topics. The prevention of depression-most common mental illness in late life-must address the educational program in primary care to enhance knowledge regarding the treatment of mental illnesses and recognise despair and suicidal ideation. The depression is often under-diagnosed and under-treated. Clinicians should use the newer antidepressants and community care to decrease the suicidal risk in elderly.

De siste årene har fosterreduksjon i økende grad vært gjenstand for debatt i Norge, og intensiteten nådde et foreløpig maksimum da Lovavdelingen leverte tolknings-uttalelsen § 2 - Tolkning av abortloven i 2016 som svar på at Helse- og omsorgs-departementet (i 2014) ba Lovavdelingen om å vurdere hvorvidt Lov om svangers-kapsavbrudd åpner for fosterreduksjon av friske fostre ved flerlings-vangerskap. Lovavdelingen konkluderte med at abortloven åpner for fosterreduksjon ved flerlingsvangerskap innenfor de rammene som loven ellers oppstiller. Debatten har ikke stilnet, og utover høsten 2018 ble den ytterligere tilspisset i forbindelse med KrFs veivalg og signaler fra Høyre om å vurdere å fjerne § 2.3c, samt å forby fosterreduksjon. Mange av argumentene i fosterreduksjonsdebatten fremstår tilsynelatende like de argumentene som verserer i abortdebatten, og det mangler en analyse av hva som stiller seg annerledes ved fosterreduksjon. Målet med denne artikkelen er følgelig å undersøke hvorvidt det finnes en moralsk relevant forskjell mellom abort og fosterreduksjon av friske fostre. Vi tar for oss typiske argumenter fra den norske debatten, og belyser dem med fagartikler fra forskningslitteraturen. De mest sentrale argumentene mot fosterreduksjon har vi identifisert som skadeargumentet, skråplansargumentet, intensjonsargumentet, sorgargumentet, psykologiske langtids-effekter for kvinnen og sorteringsargumentet. Vi kommer frem til at motargumentene ikke holder mål hva gjelder å påvise en moralsk relevant forskjell mellom abort og fosterreduksjon av friske fostre. Konklusjonen vår er derfor at det – på tross av hva flere debattanter synes å mene - ikke finnes en moralsk relevant forskjell mellom de to. Når vi derfor tillater abort, så bør vi også tillate fosterreduksjon. Nøkkelord: Abort, etikk, fosterreduksjon, medisinsk etikk, selektiv fosterreduksjon   English summary: Abortion and multifetal pregnancy reduction: An ethical comparison  During recent years, multifetal pregnancy reduction has increasingly been subject to debate in Norway, and this debate reached an apex when the Legislation Department delivered the interpretation statement § 2 - Interpretation of the Abortion Act in 2016 in response to the Ministry of Health and Care Services, who had (in 2014) requested the Legislation Department to assess whether the Abortion Act allowed for multifetal pregnancy reductions of healthy fetuses. The Legislation Department concluded that the Abortion Act does regulate and permit multifetal pregnancy reductions within the framework that the law otherwise stipulates. The debate has not subsided, and in the autumn of 2018, it was further intensified in connection with the Norwegian Christian Democratic Party´s (KrF) "crossroads choice" and the signals from the Norwegian Conservative Party that they would consider reverting the Abortion Act’s section 2.3c [regulating second trimester abortions due to fetal anomalies], as well as a ban on multifetal pregnancy reduction. Many of the arguments in the multifetal pregnancy reduction debate appear very similar to the arguments pending in the general abortion debate, and an analysis of what makes multifetal pregnancy reduction significantly different from abortion is wanting. The aim of this article is, accordingly, to investigate to what extent there is a morally relevant distinction between abortion and multifetal pregnancy reduction of healthy fetuses. We take on board typical arguments from the Norwegian debate and consider them in light of the scholarly literature. We have identified the most central arguments against multifetal pregnancy reduction as the harm argument, the slippery slope argument, the intent argument, the grief argument, the regret argument (concerning long-term psychological effects for the woman), and the sorting argument. We argue that these counter-arguments do not succeed in establishing a morally relevant difference between abortion and multifetal pregnancy reduction of healthy fetuses. Our conclusion is, therefore – that despite what is often held – there is no morally significant difference between the two. Therefore, when we allow abortion, we should also allow multifetal pregnancy reductions. Keywords: Abortion, ethics, fetal reduction, medical ethics, multifetal pregnancy reduction