Abstract
One of the most morally vexing issues to have arisen in reproductive medicine recently is that of selective termination. In this procedure, the number of fetuses in a multiple pregnancy is reduced for sound medical reasons.1 In vitro fertilization (henceforth IVF), followed by the transfer to and subsequent implantation of embryos in the wall of the uterus, as well as the use of fertility drugs, may lead to multiple gestations. These pose significant risks both to the fetuses and to the woman carrying them.2
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Notes and References
See Brahams, Diana (1987) Assisted reproduction and selective reduction of pregnancy, Lancet, 1409; (1988) Selective fetal reduction (review article), Lancet, 773; Evans, Mark I., et al. (1988) Selective first-trimester termination in octuplet and quadruplet pregnancies: clinical and ethical issues, Obst. Gynecol. 71, 3, 289-296; Berkowitz, Richard, et al. (1988) Selective reduction of multifetal pregnancies in the first trimester, N. Engl. J. Med. 118(16), 10431047. Cf. Hobbins, John (1988) Selective termination—a perinatal necessity? N. Engl. J. Med. 318(16), 1063.
Indeed, the risks of transferring multiple embryos that implant in the uterine wall have been significant enough to cause discontinuation of the practice in Australia of transferring more than three embryos. I thank Peter Singer and Nancy Davis for bringing this to my attention.
My concern with numbers of lives in situations of moral conflict owes much to three papers: Taurek, John M. (1977) Should the numbers count?, Philos. Public Affairs 6, 293-316; Parfit, Derek (1978) Innumerate ethics, Philos. Public Affairs 7, 285-310; and Sanders, John T. (1988) Why the numbers should sometimes count, Philos. Public Affairs 17, 3-14.
This figure indicates an increase in the rate of success from that of the 10% given by Singer, Peter and Dawson, Karen (1988) IVF technology and the argument from potential, Philos. Public Affairs 17, 87-104.
Implantation can occur only when the embryo is at the blastocyst stage. See Wolf, Don P. (ed.) In Vitro Fertilization and Embryo Transfer: A Manual of Basic Techniques, Plenum, New York, Chs. 1, 9, 11, 19. Also, Singer and Dawson.
Noted by Benson, Ralph (1983) in Handbook of Obstetrics and Gynecology, 8th ed., Lange Medical Publications, Los Altos, CA, p. 281. Berkowitz et al. offer a rationale for saving two fetuses in these cases, p. 1045.
Cited in Benson, pp. 255-258. Also, Kempke, C. Henry, et al. (1984) Current Pediatric Diagnosis and Treatment, 7th ed., Lange Medical Publications, Los Altos, CA, p. 65.
Dan Brock offers a very helpful overview of all relevant aspects of this issue in (1993) Quality of life measures in health care and medical ethics, in The Quality of Life, (Nussbaum, Martha C. and Sen, Amartya, eds.), Clarendon, Oxford, pp. 95-132.
For an account of virtue theory and its pertinence to biomedical ethics, see Hursthouse, Rosalind (1991) Virtue theory and abortion, Philos. Public Affairs 20, 223-246. The sanctity of life principle is formulated and defended by Ramsey, Paul (1978) in Ethics at the Edges of Life, Yale University Press, New Haven, pp. 191 ff., and by the Sacred Congregation for the Doctrine of the Faith (1980) Declaration on Euthanasia, Vatican City, p. 7. See also Keyserlingk, Edward W. (1979) Sanctity of Life or Quality of Life in the Context of Ethics, Medicine and Law. Study written for the Law Reform Commission of Canada, Law Reform Commission, Ottawa, pp. 9-47. Kuhse, Helga (1987) offers a critique of SLP in The Sanctity of Life Doctrine in Medicine, Clarendon, Oxford. Also germane to the issue under discussion in this chapter is Kuhse and Singer's (1985) Should the Baby Live?: The Problem of Handicapped Infants,Oxford University Press, Oxford.
Kant, Immanuel (1990) Groundwork of the Metaphysics of Morals (1785) (Beck, L. W., trans.) 2nd ed., Macmillan, New York, p. 429. References are to standard Prussian Academy pagination. See also Critique of Practical Reason (1788) (Beck, L. W., trans.) (1965), Bobbs-Merrill, Indianapolis, pp. 87, 131.
See Warren, Mary Anne (1978) Do potential people have moral rights? in Obligations to Future Generations (Sikora, R. I. and Barry, Brian eds.), Temple University Press, Philadelphia, pp. 1430; and (1973) On the moral and legal status of abortion, The Monist 57, 43-60. Also, Sumner, L. W. (1981) Abortion and Moral Theory, Princeton University Press, Princeton, NJ, pp. 143154; Feinberg, Joel (1984) (on birth and prenatal harm), Harm
Others, Oxford University Press, Oxford, pp. 95-104; and Thomson, Judith Jarvis (1986) A defense of abortion; rights and deaths, in Rights,Restitution, and Risk, Harvard University Press, Cambridge, MA, pp. 1-32.
Death and the value of life, (1988) Ethics 99, 54.
See Carter, W. R. (1980) Once and future people. Am. Philos. Quart. 17, 61-66, and (1982) Do zygotes become people? Mind 91, 77-95. Also, Quinn, Warren (1984) Abortion: identity and loss. Philos. Public Affairs 13, 24-54.
Narveson, Jan discusses the problem of trying to make such comparisons in "Future people and us," in Sikora and Barry, p. 48. Parfit elaborates the problem further (1986) in Reasons and Persons, Clarendon, Oxford, pp. 487-490.
I take utilitarianism to be a species of the theory of consequentialism, according to which the rightness or wrongness of actions are determined solely on the basis of their consequences.
The classical concept of utilitarianism is formulated by Mill, John Stuart (1979) in Utilitarianism (Sher, George, ed.), Hackett, Indianapolis, Ch. II. See also Sidgwick, Henry (1907) The Methods of Ethics, Macmillan, London. For discussion of the average concept of utilitarianism, see Parfit, Reasons and Persons, Part Four; Sumner, Ch. 5; and Rawls, John (1971) A Theory ofJustice, Harvard Belknap Press, Cambridge, MA, pp. 161-175.
0f course, there is at least one important difference. Whereas the main concern of SLP is not consequences but the intrinsic value of life, on the total and average versions of utilitarianism it is only consequences that matter. SLP rests on deontological rather than consequentialist principles and therefore takes the right to be prior to the good.
Berkowitz et al. "In pregnancies with multiple gestations, adverse outcome is directly proportional to the number of fetuses in the uterus, primarily because of an increased disposition to premature delivery." p. 1043.
For discussion of the principles of nonmaleficence, beneficence, and autonomy, see Beauchamp, Tom L. and Childress, James F. (1989) Principles of Biomedical Ethics, 3rd ed., Oxford University Press, Oxford, Chs. 3-5. The extent to which these principles figure in the mother's choices in a single pregnancy is examined by Mattingly, Susan S. (1992) The maternal-fetal dyad: exploring the two-patient obstetric model. Hastings Ctr. Rep. 22, 13-18.
See Feinberg, Joel (1987) Wrongful life and the counterfactual element in harming, in Philosophy and the Law (Coleman, Jules and Paul, Ellen Frankel, eds.), Blackwell, Oxford, pp. 145-178. Also,Steinbock, Bonnie (1986) Wrongful life. Hastings Cent. Rep. 15, 17.
Heyd, David (1992) makes this same point in Genethics: Moral Issues in the Creation of People, University of California Press, Berkeley, pp. 21-38. Here Heyd critiques Feinberg's views on wrongful life. John Harris offers further insightful analysis of this problem in (1992) Wonderwoman and Superman: The Ethics of Human Biotechnology, Oxford University Press, Oxford, pp. 79-97.
Groundwork of the Metaphysics of Morals, pp. 417, 428, 431. Also (1964) The Doctrine of Virtue (1797) (Gregor, Mary, trans.), University of Pennsylvania Press, Philadelphia, p. 452.
The Doctrine of Virtue, p. 451, and Critique of Practical Reason, pp. 110,111. See also Donagan, Alan (1977) The Theory of Morality, University of Chicago Press, Chicago, pp 85,86; and Cummiskey, David (1990) Kantian consequentialism. Ethics 100, pp. 586-615.
Groundwork of the Metaphysics of Morals, p. 421; The Doctrine of Virtue, p. 389; and Cummiskey, p. 607.
Harm to Others, pp. 147,148.
An ancestor of this chapter was presented at a conference on applied ethics at the University of British Columbia in June 1990, where I benefited from comments by Peter Singer. I am also grateful to Nancy Davis and, especially, Lainie Friedman Ross, for many helpful criticisms and suggestions on earlier drafts.
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Glannon, W. (1996). The Morality of Selective Termination. In: Humber, J.M., Almeder, R.F. (eds) Reproduction, Technology, and Rights. Biomedical Ethics Reviews. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-450-4_6
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