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Abortion

The subtle line between conscientious objection and sabotage

The Washington Post recently reported the news of a dozen of nurses from a New Jersey hospital who claimed the right not to assist a patient before and after an abortion.                                                                                                                                                                   Although conscience clauses are very common worldwide, they usually allow the health care personnel to refuse to perform abortions (or other morally controversial treatments) but not to refuse to assist a patient before and after the abortion. For this reason, the request put forward by the New Jersey nurses is particularly interesting.One of these nurses declared to the newspapers “I’m a nurse so I can help people, not help kill, and it just doesn’t seem right to me”. Now, it is hard to understand how someone who takes care of a woman who just had an abortion is somehow helping to kill. The care these nurses are refusing to provide involves feeding and washing the patient, maybe giving her pain killer drugs, but certainly not helping to kill, because the killing happens during the abortion, not before or after.

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Is a child a blessing?

By Charles Foster

Three years ago Ana Mejia bore a son, Bryan Santana. To her surprise he had no arms and only one leg. I should have been warned about this, she recently told a Florida court. It was negligent not to warn me. Had I been warned, I would have had an abortion. She asked the court for $9 million compensation. The jury gave her $4.5 million.

The disability rights lobby is predictably outraged. Why, they say, should it be presumed (as it clearly is), that a disabled person’s life isn’t worth living?

If that is Ana Mejia’s presumption, then (at least in relation to a child as relatively mildly disabled as Bryan) it is plainly reprehensible. I don’t know her motivation, but I doubt that she saw it that way. Many parents in her situation (and this is a very common issue in medico-legal practice) don’t make their decisions on the basis of their child’s quality of life at all. A much commoner thought is: ‘A disabled child will disrupt my own life. One of the purposes of pre-natal screening is to enable me to decline to bring into the world a child who does not fit with my ideas about how I should be living my life.’ I will call this thought the ‘pre-natal screening default thought’ (PNSD).Read More »Is a child a blessing?

Unpalatable Theories about Falling Crime

The US crime rate continues to fall. There is no consensus why this is so, but there are a range of diverse theories, ranging from gun control, higher incarceration rates, the collapse of the crack cocaine epidemic, and ‘zero tolerance’ policing. While the diverse theories are interesting, so too are the different reactions that the theories provoke. Despite the difficulties in objectively assessing the theories, all theories are not equal: some are particularly unpalatable.

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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?

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Abortion and Equality

During the year I’ve just spent in the US, several of the ethical issues commonly discussed in the media – gay marriage, assisted suicide, whether there should be universal health care, along with several others – have seemed to me largely unproblematic in themselves. The main issue in each case is how to deal politically… Read More »Abortion and Equality

What is the point of being a doctor when conscience overrules professional duties?

A new study recently published on the Journal of Medical Ethics and  reported by the newspapers explored the attitude towards conscientious objection of 733 medical students from four different UK medical schools (Cardiff University, King’s college London, Leeds University and St George’s University of London).The results of this survey are interesting and deserve to be introduced in details.When the students were asked if doctors should be entitled to object to any procedure for which they have a moral, cultural or religious disagreement, the 45.2% agreed doctors should be entitled to make conscientious objection, the 40.6% disagreed and the 14.2% was unsure.

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How are future generations different from potential persons?

A debate piece in the Swedish newspaper Dagens Nyheter by the philosophers Nicholas Espinoza and Martin Peterson (autotranslated version) on abortion rights has led to strong reactions in the Swedish blogosphere. The authors make two claims: First, that even people with liberal values can take issue with current abortion rights because it involves a goal conflict between the interests of present and future individuals in having their legitimate desires fulfilled. Second, that the binary view that things must be either allowed or banned is wrong, and that there exists a third domain where laws should take moral ambiguity or internal conflict into account. Their suggestion is that women who end up in situations in this third domain should neither be helped nor hindered by society, and should be allowed to end their pregnancies at clinics where the fee is proportional to their ability to pay. The short article seems tailored to anger holders of practically every view, although I suspect the authors mainly felt it was more of an interesting argument than a deliberate golden apple. Here is a small bite on the green half of the apple: is climate and abortion ethics comparable?

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Moralism and Reproduction: Ten Infringements of Liberty

One of the great success stories of British science in the last 30 years was the introduction of In Vitro Fertilisation by Steptoe and Edwards in 1978. They should have won the Nobel Prize. Around 3% of babies are now born after IVF. Testing of and experimentation on early human embryos offers great prospects for improving not only the health of the next generation but how well their lives go. Today, a wide variety of genes which cause or contribute significantly to disease can be tested. Soon, it will be possible to test for all the genes an embryo has and choose embryos which start life with the least prospects of disease and greatest range of talents, abilities and capacities. And IVF has allowed individuals and couples to have children in new ways, expanding procreative liberty. Experimentation on embryos is yielding important knowledge of human development and contributing to the development of regenerative medicine, or stem cell therapies.

Assisted reproduction, including embryo testing, and research involving the embryo has been controlled by the Human Fertlisation and Embryology Authority (HFEA). I recently wrote an evaluation of the performance of the HFEA. I argued that the HFEA was set up on the wrong premise: the embryo was said to have a special moral status. Regulation should be set up on the basis of preventing real, tangible and direct harm. Destroying some embryos but not others is not an example of preventing harm. Secondly, it has operated to enforce public morality, imposing moralism not preventing harm. This was kind of objectionable moralism that was employed by Lord Devlin to justify a ban on homosexuality. Thankfully, HLA famously disposed of that bad justification, at least in the case of homosexuality. Moralism, however, has been alive and well in the case of reproduction.Read More »Moralism and Reproduction: Ten Infringements of Liberty

Solving the Puzzle of the Moral Status of the Embryo and Fetus

In March 2006, 21 yo Cleveland man Christopher Challancin was driving home from a party with his 17 yo girlfriend, Jessica Karos. She was 4 months pregnant. They began to argue about her ability to care for their child. Challancin, who had been drinking, became angry. He began to weave high speed through traffic and crashed. Karos was left paralysed.  The baby died. Challancin was unhurt. Because he killed the baby, he was charged with homicide and sentenced to five years.

In 2005, Alison Miller and Todd Parrish sued their fertility clinic in Chicago. They had been having IVF treatment back in 2002 and stored 9 embryos. One of these was “mistakenly” discarded. The clinic apologised and offered the couple a free cycle of IVF. They sued for the “wrongful death” of their embryo.

Every year, about 100 000 fetuses are aborted. No one is charged over these deaths. Thousands of embryos are also destroyed. The law on IVF in England and Australia requires their destruction after a period of time, 5 to 10 years.

How can killing a fetus at once be homicide and yet no crime at all? How can the destruction of embryos be required by law and widely practised but also, in some places, the crime of wrongful death? How can one act – killing early human life – be both right and wrong? This is the puzzle of social practice involving early human life.

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Can Liberals Support a Ban on Sex Selection?

Australia essentially bans sex selection, except to prevent babies being born with serious sex-linked disorders. The National Health and Medical Research Councils also prohibits it in its guidelines.

A couple in the state of Victoria is currently appealing to the Victorian Civil and Administrative Tribunal to allow them to access IVF and to deliberately have a girl. The couple have had three boys naturally and lost a daughter soon after birth. They recently had IVF which resulted in a twin pregnancy. The twins were boys. They aborted the pregnancy.

I argued over 10 years ago there are no good reasons to oppose sex selection in countries like Australia.

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