Two to One

Today's New York Times Magazine has an excellent article about the growing practice of using abortion to reduce twin pregnancies to singletons. I'm (frankly) repulsed, but it's a challenge to explain why the practice is objectionable.  LINK


Faust said...

What you mean is "it's a challenge to explain why the practice is objectionable without implicating the practice of abortion generally.

This basic difficulty one of the main themes of the article:

Dr. Berkowitz asks: “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?”

In a society where the “termination of pregnancy” (in this context this favored phrase threatens to become an obvious misnomer, can we really say we are “terminating half a pregnancy?”) is viewed as a basic right of women (independent of the reasons for that termination), is there even room for discussion on this? Haven’t we (“we” on the “left”) already committed ourselves to a completely hands off approach?

Dr. Bloomfield explains her personal journey through this logic:

“I couldn’t have imagined reducing twins for nonmedical reasons,” she said, “but I had an amnio and would have had an abortion if I found out that one of the babies had an anomaly, even if it wasn’t life-threatening. I didn’t want to raise a handicapped child. Some people would call that selfish, but I wouldn’t. Parents who abort for an anomaly just don’t want that life for themselves, and it’s their prerogative to fashion their lives how they want. Is terminating two to one really any different morally?”

And the answer is of course no there isn’t. NOT if you are committed to the baseline logic of it’s the right of parents to “fashion their lives how they want.”

“Society,” however, remains uncertain about this chain of reasoning:

"Society judges reproductive choices based on the motives behind them. Though roughly half of Americans identify as “pro-choice” and half as “pro-life,” polls also show the distinction blurs depending on why the woman is aborting. If a woman is the victim of incest or rape, or if her health is threatened, far more people — including abortion opponents — understand her choice to end the pregnancy. Support falls off if a woman aborts for financial reasons and is lowest of all if she aborts because of the fetus’s sex."

The challenge to find a coherent framework that helps explain these various conflicting intuitions, of this field where we continuously contrast deontic “not treating our fetuses as means only” with utilitarian “how do we fashion the various lives that we want” has not been met, to my knowledge, by anyone working in this area of ethics to date.

Faust said...

Here is one example of such a difficulty as it relates to the article in question. In Thompson’s seminal paper on this general subject she maps out some logic that offers some defense against the notion that women are morally responsible for the various accidents that might plant seeds in fertile ground:

“…suppose it were like this: people-seeds drift about in the air like pollen, and if you open your windows, one may drift in and take root in your carpets or upholstery. You don't want children, so you fix up your windows with fine mesh screens, the very best you can buy. As can happen, however, and on very, very rare occasions does happen, one of the screens is defective, and a seed drifts in and takes root. Does the person-plant who now develops have a right to the use of your house? Surely not--despite the fact that you voluntarily opened your windows, you knowingly kept carpets and upholstered furniture, and you knew that screens were sometimes defective. Someone may argue that you are responsible for its rooting, that it does have a right to your house, because after all you could have lived out your life with bare floors and furniture, or with sealed windows and doors. But this won't do--for by the same token anyone can avoid a pregnancy due to rape by having a hysterectomy, or anyway by never leaving home without a (reliable!) army.”

Whatever the merits of Thomson’s argument here, in the present case of twin reduction, typically occurring after extensive IVF treatment, not only have the windows been opened, the fertilizer has been distributed, signs have been posted, and red carpets laid out. It is not as though multiples are a SURPRISE in the context of IVF fertilization. They are a flat out high probability.

To my mind, the most chilling line in this entire article is offered by Dr. Mark Evans. “Ethics, evolve with technology.” I think he’s right. Certainly that’s what Huxley foresaw.

Jean Kazez said...

I might cover this article in my course--yes, all the issues you mention are at the heart of it. We will have read Thomson by the point we discuss this, so we'll be able to discuss the people seeds. Yes, very relevant.

To disapprove in strongest terms, you'd want to make the case that someone is harmed if parents reducing two to one (in cases where there are no special medical reasons to do so).

You might say they harm the surviving child by depriving him of a twin sibling. (It's very cool to have a twin sibling, as I've seen with my twins.) If the parents keep a secret of the abortion, they can limit other harms, but the secrecy is perhaps (weezle word alert!) problematic. If they do tell the surviving child, then that child has to live with the thought--"Mom & Dad were willing to take a 50% of killing me!"

But .... when all is said and done, I think the issue isn't primarily harm to the survivor, but rather it seems like the character of people who would do this is problematic. How can a person be open, and in fact eager, to have one child, but horrified by two? A person like that seems too rigid--they're thinking of children too much as consumer products. I mean, if you order one new refrigerator, and they show up two, damn it, why should you have to put up with the second? Send it back! Only, kid #2 is a kid, not a refrigerator.

It's different if you're not open to even one kid--if in fact having one would turn your life up side down, as is the case with most people who have abortions.

Faust said...

I think something like what you suggest is a good start. So we find ourselves contrasting (at least) two pairings of [attitude towards having a child or children]/[consequences of having a child or children]:

1. Not open to any children/life would be turned up side down by having any children

2. Open to having one child/life would be turned up side down by having more than one child.

Now we may have the intuition that there is something odd about being open to only one child, and we can frame our imaginings in the worst possible light where they are "returning the refrigerator" instead of paying DOUBLE day care, DOUBLE college funds, DOUBLE the food and so forth, but the bottom line is that under our current moral frameworks on this subject (for those of us on the left anyway) there is no way to adjudicate between these positions.

Are we going to develop some set of criteria for "turns life upside down?" Some set of financial and or psychological tests that determine if the parents seeking twin reduction are really making "the proper decision?"

I simply don't see any positive set of criteria that one could come up with for managing twin reduction that would not ALSO impinge on the general BLANKET right of women to self-determine what they may do with their bodies prior to 24 weeks of pregnancy. We just don't get to comment on any aspect of the decision making process prior to that point in time. And if we do allow for such commentary, then we are admiting that perhaps the non-person status of fetuses is a bit more problematic than we might like to admit, that we really are constrained by the limitations of Thomson's argument (whatever they might be).

Jean Kazez said...

I would say we should generally allow for such commentary, and that it is an acceptable correlate that a fetus is not just any piece of tissue. Some reasons for abortion are very bad, some acceptable. That's not to say that there's a clear line between the two. For example, I don't mind being judgmental about someone who aborts because the timing wasn't quite right, if there is such a person. Such a person is willing to have a child, to be pregnant, to give birth, etc. Just wants all that three months later. There's a character problem there! It's different when someone doesn't want a child, pregnancy, birth, etc...because she's in highschool. All that would be horrible for the second person, but just inconvenient for the first. If we ought to have some regard for something well-on-the-way-to human, then some reasons for discarding are strong enough, others too weak.

In the case of reducing from two to one, there are the character issues, but also there's some question of harm--because the mother is depriving the survivor of a twin sibling and winds up with a secret that would be devastating if revealed. I don't see how you can treasure a child properly after willingly taking a 50/50 chance of killing her.

(Granted, I have twins, so the whole idea is extra disgusting to me, and I know that.)

Wayne said...

I think there are plenty of horrifying reasons for having twins... Not the least of which is the sheer fact that you have two infants. Taking care of a single infant is taxing on a couple, taking care of two at the same time would be more taxing (I doubt it would be doubling taxing though).

What would be doubling taxing would be the financial cost of having twins. Paying for two children to go to school at the same time would be taxing on most people's finances.

In the NYT article, the couple got pregnant using reproductive medicine... speaking from recent experience, that will cost a lot of money, if it isn't covered by your insurance provider. My wife and I had to abandon our treatment after just getting the bill for the preliminary labs. We hadn't taken that cost into consideration, and even though we budgeted $35k for treatment, we were priced out of it after one visit and 4 bills. So assuming that the couple spent $50-100K to have that child, thinking about college expenses should be a serious consideration. So having abortion to reduce to a singleton pregnancy would be very similar to a young couple having an abortion because they are not financially able to care for a single child.

Finally, in utero, twins get less room, and typically are less developed than a normal singleton pregnancy. So there might be health considerations for the children to desire a singleton pregnancy rather than twins.

Jean Kazez said...

Wayne, The first couple in that article had gobs of money. One of the odd things about them was that they already had school age children (plural!) yet had spent 6 years on every possible infertility treatment to have one more (with success at age 45). To have the abortion, they spent $6,500! So if the financial reason to go from two to one made sense (frown, I don't like it!), it didn't apply to them.

Re infertility treatment--yes, crazy expensive:-(

Faust said...

I suppose I should clarify my general interest here by noting that I am principally interested in the question of the legality of the various practices in question. It is one thing to "allow moral commentary" another to hook up a set of moral judgments to legislation intended to govern our social practices. I'm inclined to be very sympathetic to the "yuck" reaction, but after that I want to think about how that reaction hooks up to what should and should not be legally permissible.

In the article this seems to be "resolved" on a case by case basis by the various physicians deciding whether or not they can perform the procedures in good conscience. Some of them feel they can't, other feel essentially that it's "just like any other abortion." (That would be my reading of the Dr. Berkowitz comment quoted above).

So when I say things like "we can't allow further commentary if such and so" what I'm really trying to say is that the slippery slope here is quite slippery and any legal framework that legislated against twin reduction would be hard pressed not to slide into an outright abortion ban, or at least significantly more restrictive legislation that we have right now.

So what I'm looking for are the principles or set of principles that would allow a legal distinction between the two events, if such a distinction could be found. Or I suppose we could just leave it at "worthy of moral critique but not of outright legal prohibition."

Jean Kazez said...

I don't think I'd be for legally prohibiting twin-reduction, even though the whole idea bothers me. I think you're exactly right about a slippery slope being problematic. What's going on already seems like the only third-party response that could make sense--most doctors just won't perform this procedure.

Simon Rippon said...

I posted about this story over at Practical Ethics:

Jean Kazez said...

I read that, liked it, and actually posted a link at twitter. Great title! I'm actually going to teach that article in a class this semester--there's much to discuss and find puzzling.