Twin pregnancy, fetal reduction and the 'all or nothing problem’

Abstract

Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin pregnancy. I argue that in the case of a twin pregnancy, there are two intuitively plausible claims: (1) abortion is morally permissible, and (2) it is morally wrong to abort just one of the fetuses. But since we should choose morally permissible acts rather than impermissible ones, the two claims lead to another highly implausible claim: the woman ought to abort both fetuses rather than only one. Yet, this does not seem right. A plausible moral theory cannot advocate such a pro-death view. Or can it? I suggest ways to solve this problem and draw implications for each solution.

Twin pregnancy reduction is not an ‘all or nothing’ problem: a response to Räsänen

“…Räsänen also modifies Thomson's famous violinist case [7] to argue that, if a person decides to stay attached to the violinist to save his life, and another violinist is added, "whom you could save at a marginal extra cost, then, it seems, you have an obligation to save the other one as well." [3] Neither of these arguments, however, provide independent justification for premise (2), since (as we have shown) they are based on an overly narrow understanding of the right to abortion, as well as the empirically inaccurate assumption that the burden of gestating twins is no greater than a singleton pregnancy. Räsänen concludes that, as the argument from bodily autonomy is (allegedly) not convincing, the only way out of the problem is to reject the assumption that the sacrifice involved in gestating two fetuses is not much greater than in gestating one.…”

“…Moreover, Räsänen observes that 2-to-1 MFPR may be undertaken because it is usual practice in IVF treatment 'to transfer two or more embryos to achieve pregnancy but it also results in a high increase of multiple pregnancies.' [3] However, single embryo transfer (eSET) is becoming increasingly common.…”

“…Taken together, they lead to a counterintuitive conclusion: that it is morally preferable for a pregnant woman considering 2-to-1 MFPR for 'social' reasons to abort both fetuses rather than just one. [3] Räsänen considers whether this counterintuitive conclusion can be avoided by rejecting either of the premises, ultimately concluding that the problem remains, and that therefore the morally best thing to do in such a case might be to keep both fetuses and give one child up for adoption after birth. In this paper we show that there are good reasons, both theoretical and empirical, that the premises Räsänen presents are not plausible, and therefore the all-ornothing problem does not actually occur in this context.…”

Ethics of fetal reduction: a reply to my critics

“…The problem I raised is the following. 1 Suppose a woman is pregnant with healthy twins. She has three choices:…”

Abortion and the veil of ignorance: a response to Minehan

“…Thomson has her critics 2-3 and defenders [4][5] and the discussion continues with further criticism 6 and new thought experiments in different context. 7 In a recent JME paper, 8 Matthew John Minehan argues that from the position of ignorance it is rational to oppose abortions and demand that a woman remains attached to the fetus. To make his case, Minehan cleverly asks his readers to imagine that one morning you are back to back in bed with another person.…”