Is Half an Abortion Worse than a Whole One?

Last week, the New York Times Magazine included an interesting article about abortion by Ruth Padawer. It provoked not a little angst and soul-searching among members of the pro-choice community, as well as some exultant pronouncements from anti-abortionists highlighting supposed inconsistencies in the pro-choice position.

The Times article profiled a number of women who chose to “reduce” their twin pregnancies to a single fetus, recounting the emotions and ethical issues grappled with by women, their partners, and the doctors who perform (or refuse to perform) this type of selective abortion. The procedure, which according to Padawer is “usually performed aound Week 12 of pregnancy”, involves the doctor selecting under an ultrasound scan a healthy fetus whose chest is lethally injected.  It shrivels in the womb, whilst its twin is carried to term. In the cases in question, the procedure is not performed for medical reasons, but because the woman has chosen for social reasons to carry only one child to term. Although reductions arose historically as a procedure that was medically indicated – reducing risky quint, quad or triplet pregnancies to twins that had a much better chance of survival – most practitioners have not recognized reduction below twins as having an adequate medical justification. Some practitioners consequently refuse to perform the procedure, but others perform it willingly. As Dr. Richard Berkowitz explained: “In a society where women can terminate a single pregnancy for any reason – financial, social, emotional – if we have a way to reduce a twin pregnancy with very little risk, isn’t it legitimate to offer that service to women with twins who want to reduce to a singleton?”  Dr. Berkowitz’s question is a good one, as is the main question that Padawer raises: “What is it about terminating half a twin pregnancy that seems more controversial than reducing triplets to twins or aborting a single fetus? After all, the math’s the same either way: one fewer fetus.”

So what is it that makes “terminating half a twin pregnancy” seem more controversial than aborting a single fetus? Does our  almost universal uneasiness about it show a fundamental inconsistency in pro-choice thinking, or is there a consistent pro-choice position that pays sufficient respect both to a woman’s presumed right to choose, and to our uneasy intuitive reactions to twin reduction?

In reflecting on these questions, it is worth considering what kind of specific reasons parents might have for pursuing twin reduction. “Jenny” was quoted in the Times article:

“Things would have been different if we were 15 years younger or if we hadn’t had children already or if we were more financially secure … If I had conceived these twins naturally, I wouldn’t have reduced this pregnancy, because you feel like if there’s a natural order, then you don’t want to disturb it. But we created this child in such an artificial manner — in a test tube … and somehow, making a decision about how many to carry seemed to be just another choice. The pregnancy was all so consumerish to begin with, and this became yet another thing we could control.”

Padawer adds that, “Jenny’s decision to reduce twins to a single fetus was never really in doubt. The idea of managing two infants at this point in her life terrified her … She felt that twins would soak up everything she had to give, leaving nothing for her older children. Even the twins would be robbed, because, at best, she could give each one only half of her attention and, she feared, only half of her love. Jenny desperately wanted another child, but not at the risk of becoming a second-rate parent.”

There is plenty to dispute about Jenny’s characterization of her reasons for seeking twin reduction. No doubt none are in a stronger position to dispute her claims than the many successful mothers of multiples who would rightly bristle at the suggestion that there has been anything “second-rate” about their parenting because of their necessarily divided attention. In addition to this, Jenny draws an odd connection between the rightness of her decision to pursue reduction and the fact that her pregnancy was not “natural”. Together with her rigid focus on providing not less than a certain amount of financial and emotional resources for each of her children, this suggests that she was aiming to produce a kind of “designer” family. But it is probably impossible to exert the degree of control over one’s family that Jenny seems to aspire to. Jenny might well be advised to revise her attitudes and learn to live with less control rather than trying to exert more, on the grounds that her hopes are likely to be thwarted and lead only to disappointment and hardship both for herself and, potentially, for her children as well.

It is considerations of this kind that make us unlikely to sympathize with Jenny’s decision to bring one of her twins but not the other to term. If Jenny’s reasons are typical of those women who choose twin reduction – as we (perhaps unjustifiably) may imagine they are – they make us unlikely to sympathize with the decisions of any of those who would choose twin reduction. Moreover, we may think that a fetus is not just a clump of any old cells, and that it deserves some degree of respect and deference in virtue of being a potential human person (even if not the full rights of an actual person). If so, we will probably conclude that Jenny’s mistaken assessment of her reasons led her to do something morally wrong in having an abortion. We may then worry that twin reduction can never be justified.

Yet we need not conclude from this that abortion is always and everywhere wrong, nor that it should be banned, nor even that the procedure of twin reduction specifically should be banned. To take an analogy: In standing up for the principle of freedom of expression, we endorse the principle that everyone should have a legal right to say what they will; in doing so we need not, of course, morally endorse the saying of everthing that is in fact said. We stand up for free expression not because we believe that every act of expression it permits is good or valuable or morally permissible, but because every alternative to that legal principle would be worse. Similarly, in the case of abortion, we can remain stalwart in our endorsement (perhaps limited by stage of pregnancy) of a woman’s legal right to choose and a doctor’s right to assist based on whichever reasons she sees fit, because we may reasonably think that every alternative principle would be worse. On those grounds we need not and should not morally endorse every woman’s decision, for whatever reasons, to have an abortion. The questions of which abortions are right and of which principles for regulating abortions are right are separate questions, and neither pro-choice nor anti-abortion partisans should confuse them.

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8 Responses to Is Half an Abortion Worse than a Whole One?

  • Lachlan de Crespigny says:

    The author has made a number of questionable assumptions.

    First, it is not clear how, by reading a newspaper article, he can reasonably decide that ‘we will probably conclude that Jenny’s mistaken assessment of her reasons led her to do something morally wrong in having an abortion’. Would we?

    I suspect that many people would feel compassion for Jenny. At 45 years old she is expecting twins and ‘the idea of managing two infants at this point in her life terrified her’. She already has ‘grade-school-age children’. She is clearly in turmoil. Who would not be daunted in her situation?

    And her concerns are valid. Families with a multiple birth are more likely to separate or divorce than other families (http://www.tamba.org.uk/Document.Doc?id=268). They also have lower average incomes. The authors note that the study’s results tend to understate the disadvantage faced by such families given their age and marital status.

    I also suspect that many people would find the author’s suggestion that she ‘might well be advised to revise her attitudes and learn to live with less control’ patronizing to say the least.

    The assumption that there is ‘almost universal uneasiness’ about multifetal reduction is unsupported. In my experience of practice in prenatal testing, this is untrue. I am also unaware of any statistics to support such a claim.

    For many people, whether individuals perceive particular abortions as right or wrong often comes down to whether the situation in question involves a loved one or a stranger.

    In a recent survey of Australian attitudes to abortion (http://blog.practicalethics.ox.ac.uk/2010/07/survey-on-community-attitudes-on-early-and-late-abortion/#more-127), 48% of respondents indicated that abortion should be unlawful in all circumstances in the third trimester. But in contrast, when given contextualized questions and asked to think specifically about a situation which involved them or a woman close to them, their views on abortion weren’t as harsh. In fact, 61% of respondents indicated that a doctor should not face professional sanctions for performing a termination after 24 weeks’ gestation for a woman close to them when there is evidence that the baby may be mentally impaired.

    Finally, in the conclusion, the author assumes that there can be effective, fair laws that dictate for all women when abortion is ‘right’ and ‘wrong’. Attempts to reasonably classify abortions, and multifetal reductions, as ‘right’ or ‘wrong’ inevitably are misguided, resulting in inappropriate or arbitrary limitations.

    Women considering terminations need support, not judgment.

    • Simon Rippon says:

      It is not clear how, by reading a newspaper article, [the author] can reasonably decide that ‘we will probably conclude that Jenny’s mistaken assessment of her reasons led her to do something morally wrong in having an abortion’. Would we?

      I suspect that many people would feel compassion for Jenny.

      The “we” in my sentence was restricted to people who share a particular (though I think a very common) belief that I described about the appropriate treatment of fetuses. I also researched people’s reactions to the newspaper article by looking at posts and comments on pro-choice oriented blogs. Go and read the links I provided and tell me how many people feel that Jenny’s decision was morally right (instead of changing the subject by talking about whether they “feel compassion”).

      And her concerns are valid. Families with a multiple birth are more likely to separate or divorce than other families (http://www.tamba.org.uk/Document.Doc?id=268). They also have lower average incomes.

      The report you cite stated a less-than-5% increase in the divorce rate compared to families with singletons – hardly a tectonic shift. And includes lots of noisy data in this context, because the above post was specifically about twin reduction, not reduction of multiples in general. It also strikes me as unlikely that the profiled family – that just underwent and paid for six years’ fertility treatment in the US, even though they already had children, were among those buckling under huge financial pressure. Another woman was quoted in the article as having spent $6,500 just on the reduction operation itself.

      I also suspect that many people would find the author’s suggestion that she ‘might well be advised to revise her attitudes and learn to live with less control’ patronizing to say the least.

      To say the least, this is just ad hominem name-calling. Any judgment of the form ‘S shouldn’t have done what he/she did’ where the subject would disagree can be decried as “patronizing” by the subject, or by a third party. Must we always withhold judgment, for fear that someone will accuse us? Or should we, rather, tell each other stories and discuss the ethics of them, in the hope that we might learn something?

      The assumption that there is ‘almost universal uneasiness’ about multifetal reduction is unsupported.

      Again, my post was about twin reduction only. And the claim of widespread uneasiness about it is supported by the intuitions of myself, those I’ve spoken to on the subject, and the majority of commentators I came across in the pro-choice blogosphere. The reader may disagree – in which case, (s)he may see no need to explain away an apparent tension between maintaining a pro-choice stance and uneasiness about twin reduction. My post is not aimed at that reader.

      Finally, in the conclusion, the author assumes that there can be effective, fair laws that dictate for all women when abortion is ‘right’ and ‘wrong’.

      I’m sorry, but I can’t make sense of this reading of my conclusion. I would reject the above claim.

      Women considering terminations need support, not judgment.

      And I would have it no other way! I am, after all, not sending “Jenny” nasty letters, or preaching at her in the street. I am merely responding in public to a story that she chose to share with a newspaper. And if you read my conclusion correctly, you would see that I defend her right to make her own decision about her abortion. I hope you don’t also think that the need to “support” women considering termination also puts all stories about such matters beyond the pale for ethical discussion, reflection and honest critique.

  • Michelle Hutchinson says:

    Thanks for a very interesting post Simon!
    I’m unconvinced that the example given provides support for the intuition that twin reduction is worse than single abortion. It seems to me that what makes us feel Jenny’s conduct to be objectionable, and what you were picking up on, is the strange way she phrased her reasoning, rather than the invalidity of general kinds of reasons in favour of a reduction. Her talk of consumer choice might give the impression she’s trying to design the perfect family with exactly the right amount of support for each child, and being objectionably exact or calculating. But fundamentally her contention is that she doesn’t have the financial and emotional resources available to raise the ‘marginal’ child. This is the same reasoning which we think is justifiable in the case of single abortion, so why shouldn’t it be in the case of twin reduction? Maybe we think that a couple prepared to take on the responsibility of one child are more likely to be financially and emotionally able to take on a second, than a childless couple are to take on one. But twin reductions are much rarer than ordinary abortions, so we still don’t seem justified in claiming that where they do happen, they’re less justified than ordinary abortions, unless we think it’s virtually always the case that the strains put on a family from a second child are much less than those from a first. That strikes me as implausible. It seems more likely to me that the intuition against twin reductions simply arises from the fact that they are less common than single abortions, and that both are something we naturally disapprove of, but we’ve grown accustomed to single abortions.

  • SMcQ says:

    I'd agree with Michelle that the 'almost universal uneasiness' about twin reduction stems more from the rarity of such cases, and our unfamiliarity with them, than any real difference in the moral dimensions between twin reduction and any other form of abortion. I'd suggest that the majority of people have imagined themselves in the position of having to make a decision about whether to abort an unwanted pregnancy, considering and reflecting on the arguments for and against termination, and have thus moved beyond having a simple gut reaction to the scenario. The twin reduction scenario is less familiar, and so we fall back on that gut reaction; it just *seems* wrong. Looking at some of the objections commenters have made in the linked posts, it's this gut reaction that is underpinning opposition, especially from those who have had twins or are themselves twins. I'm concerned that such arguments come from the same uneasy place as those from disability rights advocates who suggest that choices to abort disabled foetuses reflect badly on their own lives; they're rooted too deeply in personal circumstances, and reflex moves to defend our own choices against perceived attack. We mustn't forget that at the core of the right to choose lies respect for every woman's capacity and right to assess her own circumstances and make decisions accordingly.

  • Simon Rippon says:

    Thanks Michelle and SMcQ, your comments are interesting and have certainly got me wondering – even if I can't in the end bring myself to agree with you. As Michelle says, it might be "the strange way Jenny phrased her reasoning" rather than the inadequacy of the reasons for twin reduction in general, that makes us react negatively to the story. But of course we think about moral hypotheticals and moral principles in terms of stories and pieces of concrete reasoning just like the one the case of Jenny offers. As I indicated in the post, I do remain open to the idea that there might be excelllent reasons for having a twin reduction in some cases. I've just yet to hear the story that convinces me that there are, and my reaction, like that of other people, is inevitably based on the few cases I've read about. As for Michelle's claim about the marginal resource demands of a second child, I don't think my claim about the inadequacy of Jenny's reasons rests on the claim that these are much smaller than those of a first child, but only on the fact that if someone didn't happen to *want* children, that would be an adequate reason for the vast majority of singleton abortions, irrespective of whether they have adequate resources for raising them. It's hard to imagine that upper middle class people in the developed world, like Jenny, really don't have *adequate* resources for bringing up more than one child. And it's hard to imagine someone whose desires are instrinsically to *really want* one child (enough to pursue fertility treatment), but intrinsically to really want *not* two children, even though I suppose if that could occur, it would be a justifying reason for twin reduction.
    As for SMcQ's suggestion, also echoing Michelle, that we might be reacting with a negative gut reaction just because of unfamiliarity, that might well be right I suppose. But I don't find in myself any negative gut reaction to medically indicated reductions (such as cases of quadruplet reduction), so I doubt this is a good diagnosis of my own unease with cases like Jenny's. Also, one might wonder why the mere arithmetic of the case – aborting one of a pair of twins rather than a singleton – should loom so large that it makes us feel suddenly unfamiliar with the scenario. After all, cases of anencephalic fetuses (growing without a large part of the brain) are unusual, and at some point unfamiliar to all of us – but once introduced, we are not generally strongly tempted to judge that the women in these cases are doing anything wrong.

  • Robert Test says:

    Thank you Simon Rippon for an interesting post. Your comments seem to be spot on. Because your replies to some of the comments are so carefully constructed and focus on important distinctions I thought I would toss out a comment to see what you (and others) think.

    I think you make all the essential distinctions but not quite explicitly enough–at least not for my simple literal mind.

    I realize that your focus is on the reactions of people about someone aborting one fetus of a pair of twin fetuses and that your focus is not on the morality of abortion itself.

    But, it is only because some people view abortion itself as morally equivalent to murder that anyone would find this event (the abortion of one of a pair of twin fetuses) as worthy of comment. I think a clear understanding of the arguments supporting abortion rights shows that the idea of aborting one of pair of twin fetuses is not worthy of our attention. The reaction to it is merely the result of inattention to salient features of the basic arguments.

    There are two basic SORTS of arguments used to show that abortion is not morally equivalent to murder..

    The first sort of argument shows (or attempts to show) that the fetus does not have any moral standing so that killing does not violate any norms associated with killing human beings who have rights including a right to life. The conclusion of the argument is that abortion is not morally equivalent to murder.

    The second sort of argument shows (or attempts to show) that even if a fetus has a right to life, the rights of the woman outweigh those rights sufficiently to conclude that abortion is not morally wrong and not morally equivalent to murder.

    It is only if we ignore the first sort of argument that we would think there might be something wrong with aborting one of a pair of twin fetuses. If the fetus is not a person and has no rights then it logically follows that abortion of one of the twin fetuses is not morally wrong.

    It seems to be assumed that if the fetus has a right to life then the woman must have a "GOOD REASON" to abort a pregnancy — a reason strong enough to overcome the fetus' right to life.

    There are strong arguments for the view that merely a desire to end the pregnancy is strong enough to overcome the rights of the fetus. I won't go into these arguments in detail. But it depends on the premise, that no person has a right to use my body to maintain his life if it is contrary to my desires.

    I might refuse to let a close friend of mine use my body simply because I find it inconvenient. My reasons may be utterly frivolous. As a result of my refusal him use my body my friend dies. But, my refusal does not amount to murder — my action is not morally equivalent to murder.

    There might be every reason to think I am awful person and that my actions were immoral in many different ways. No matter. Whatever I did it was not murder and it was not morally equivalent to murder.

    Suppose I had promised my friend to I would let him use my body. It doesn’t matter. Morality does not support the premise that every promise and contract is absolute and inviolable.

    I have every right to change my mind and that's sufficient to void a contract concerning the use of my body. Imagine I had promised you one of my kidneys to save your life. Up to the very moment of surgery to remove it I have the right to back out. It might be despicable of me to change my mind at the last moment but if it is immoral to back out and if the consequence of my act is that you die, my action is still not morally equivalent to murder.

    You compare abortion to free speech. We may reject the message on moral grounds, but defend the right to free expression.

    I might reject someone's defense of homosexual marriage rights but defend their right to speak in favor of it. This doesn't quite seem to capture the salient points.

    I might think her opinion about homosexual marriage is mistaken, I might think that homosexual marriage is morally wrong, but I'm not sure I could claim that she is morally culpable (assuming normal intellectual diligence in forming her opinions)for believing as she believes.

    I suggest another sort of analogy.

    Suppose I am wealthy and plan to spend a few thousand dollars on a trip to Bermuda when, instead, I could give the money to agencies feeding starving people in Somalia. I might be morally callous to spend that much money on a vacation but morality does not require me to give my money to those who need it more than I.

    The suggestion here is that there are degrees of moral fallibility.

    I could rent a billboard proclaiming my plans to go to Bermuda and making fun of the idea of giving my money to help starving people. This would be even more repugnant. Instead of a vacation to Bermuda I might spend it on something else or merely leave it in the bank.

    But I'm still not helping starving Somalians. But I’m not committing murder nor are my actions morally equivalent to murder.

    The point is that you might find serious fault with my actions without concluding that the act, although repellent, reaches the level of being immoral and certainly doesn't reach the level of being morally equivalent to murder.

    The concept of aborting one of a pair of twin fetuses does nothing to clarify the morality of abortion.

    • Simon Jm says:

      Robert you still interested to run with this topic?

    • Simon Rippon says:

      Hi Robert, thanks for your comments. I disagree with you on several points, but I'll just focus on a couple.
      First, in drawing attention to the principle of free speech, I wasn't saying just that we hold this principle even while we disagree with the *opinions* of others, but rather that we hold this principle even while we disagree with the *speech acts* of others. We know it can be wrong to say some things even when they are true, for example because saying them would be hurtful and unnecessary. By defending the principle of free speech, I defend your legal right to say even these hurtful things. But I certainly do not thereby morally endorse your saying them.
      Another point at which I disagree with you is with your all-or-nothing approach to rights and duties related to abortion (which actually I think is quite common, and is part of what leads to the confusion that my post tried to remedy). I don't think "abortion is morally equivalent ot murder", but I still think the abortion of one of a pair of twin fetuses is liekly to be morally questionable, in many cases. You wrote: "If the fetus is not a person and has no rights then it logically follows that abortion of one of the twin fetuses is not morally wrong." There are a couple of problems here. One is that you draw together the claims "not a person" and "has no rights". It's not clear to me that the one entails the other: human fetuses, perhaps babies, and many animals might not be persons, but they might still have rights. The second is that even if fetuses have no rights, then still nothing logically follows about the wrongness of abortion. Compare "the grand canyon has no rights, therefore it logically follows that roofing it over and turning it into a giant WalMart would not be morally wrong", or (if you are skeptical about animal rights) "a cat has no rights, therefore it logically follows that setting fire to it is not morally wrong", or "a person's dead body is no longer a person, therefore it logically follows that using it for sexual satisfaction is not morally wrong." We might have moral duties of respect for human fetuses (especially more fully developed ones) even if they are not persons, and even if they have no rights. And these duties of respect might demand (among other things) that we don't kill them for frivolous or trivial reasons.

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