Fetal Reduction in a Multiple Pregnancy: the Case of Identical Twins

Written by Elizabeth Crisp and Roger Crisp

When a woman aborts a single fetus, that abortion can be a morally troubling experience for her. What about a situation in which a woman is pregnant with more than one fetus, perhaps identical twins, and wishes to abort just one of them – that is, engage in what is sometimes called ‘fetal reduction’ in a ‘multiple pregnancy’?Women involved in multiple pregnancies have often sought to become pregnant, while those seeking a singleton abortion may not. Here we wish to consider the rightness and wrongness of the abortions independently of the woman’s prior intentions.

Some have seen special difficulties in cases of fetal reduction, and apparently such abortions are more likely to be kept secret by the woman. Fetal reduction is said to involve ‘lifeboat ethics’ — that is, a choice between who is to be ‘saved’ and who not — and to be equivalent to ‘playing God’. Further, it is sometimes alleged that the surviving twin may experience feelings of vulnerability, guilt, and loss, and the mother will be constantly distressed by the surviving twins’ ‘reminding’ her of what she has chosen.

In our view, the mother has no reason to be especially distressed, since, other things being equal, fetal reduction is ethically equivalent to a standard singleton abortion. To the extent that fetal reduction involves playing God, so does a singleton abortion. It is true that fetal reduction may involve a choice about which fetus is to survive, but singleton abortion involves a choice about whether or not a fetus is to survive, and these choices seem to be on a moral par.

How might the actual selection be made in a case involving identical twins? It could be a purely medical matter, with the less healthy fetus, or the one easier to remove, being selected. Otherwise it may be random, left to the surgeon, or decided by the toss of a coin. Again, this procedure seems to lack moral importance. Consider two beneficial actions. In the first, I benefit person A. In the second, I benefit either person B or person C, the beneficiary being selected by a coin-toss. These actions seem of equivalent moral worth. Or consider two harmful actions. In the first, I punch person D. In the second, I punch either person E or person F, the victim being selected by a coin-toss. Again, given that all else is equal, these actions seem morally equivalent. (In the case of the harmful action, someone, perhaps imagining the agent taking sadistic pleasure in tossing the coin, might think the second action displays a worse character. But this need not make the actionitself morally worse. And of course in this example we are imagining the two actions as performed by the same person.)

It is true that the mother and the surviving child may experience particular feelings of distress that would not arise in the case of singleton abortions, and this does seem to us a morally relevant feature. But given the weight of other relevant factors, we believe that in nearly every case this particular consideration is unlikely to be decisive, though it should of course be taken into account by the mother when she is making her choice about whether or not to engage in selective reduction.

(With thanks, as often, to Brian Earp for insightful comments and advice.)

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