Please read The Two-Minus-One Pregnancy, a New York Times article by Ruth Padawer, before reading my commentary below. It is an excellent, thought-provoking article and my post is incomplete without it. All quotations below are from the above mentioned article.
The Situation
In vitro fertilization and fertility drugs greatly increase the chances of a multiple pregnancy. Carrying multiples (especially more than three), increases the health risks for both mother and babies. The accepted solution is “reduction,” eliminating some of the fetuses to increase the likelihood of health for the mother and surviving child(ren).
“The procedure, which is usually performed around Week 12 of a pregnancy, involves a fatal injection of potassium chloride into the fetal chest. The dead fetus shrivels over time and remains in the womb until delivery.”
Reductions used to only be done in pregnancies of triplets or higher, reducing the number remaining to twins. But recently, more women are pushing to have their twin pregnancies reduced to a “singleton.” Most doctors agree there is little to no medical justification for such reductions; they are done simply for the preference of the mother. While some doctors are willing to do these two-to-one reductions, many refuse.
The article examines the issue in depth. It offers the perspective of several mothers who chose to reduce, one mother who didn’t want twins but kept them both, a father, doctors both for and against the procedure including some who have changed views, and experts in fertility treatment, social and clinical psychology, bioethics, and philosophy. (If you haven’t yet, please read the article.)
The Problem
Some doctors will only reduce twins if there is a significant medical complication. Many won’t do it at all. Even many supporters of abortion rights are uncomfortable with two-to-one reductions. Why?
It would seem to revolve around the reason for the choice. One might assume that most seeking elective abortions never intended to get pregnant in the first place. It’s assumed these women had no choice in the matter, or that pregnancy was an unintended, unforeseen consequence of their actions.
Women seeking pregnancy reductions are a different matter entirely. These women wanted to get pregnant. Fertility treatments cost thousands of dollars, often involve years of trying and can be physically and emotionally strenuous. Women invest a lot to get pregnant with fertility treatments. The likelihood of multiples is high and is well known. Women make the choice to undergo the treatments, knowing that a pregnancy of twins or more is a very real possibility. They choose this and then want to eliminate some of the children they worked so hard to produce. To many, this course is blatantly irresponsible and therefore, morally wrong.
“Society judges reproductive choices based on the motives behind them…Think about the common reaction to a woman who aborts because contraception failed versus a woman (and her partner) who took no precaution at all…Likewise, people may judge two-to-one reductions more harshly because the fertility treatment that yielded the pregnancy significantly increased the chance of multiples. “People may think, You brought this about yourself, so you should be willing to take some of the risk,” Steinbock says.
The Endless Gray Area
Though Berkowitz insists that there is no clear medical benefit to reducing below twins, he will do it at a patient’s request. “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?”
“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.”
Indeed, what is the difference between a reduction and an elective abortion? According to Merriam Webster’s Dictionary, abortion is defined as the termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus. So? Reduction is abortion. There is no difference, technically speaking.
What about morally speaking? Legally, a woman can abort in the U.S. for any reason. Polls show that many who identify as pro-choice prefer abortion only be an option under certain circumstances. It seems that many feel the same way about reductions. This is OK if (fill in the blank) but it’s really not OK if… We get bogged down in what-if scenarios, complex nuances and endless gray areas. Trying to make specific hard and fast rules becomes a nightmare. Frustrated, people conclude that we can never legislate morality and despite personal beliefs, we must be pro-choice.
“As science allows us to intervene more than ever at the beginning and the end of life, it outruns our ability to reach a new moral equilibrium. We still have to work out just how far we’re willing to go to construct the lives we want.”
The Real Question
If we want any answers, we must step back and look at the fundamental question. What is at stake here? When life begins is the only relevant question. If the embryo or fetus is not alive, then the debate is silly. Who cares what reasons the mother has for her decision? It’s her body, it’s her life, it’s rightfully her choice. If the embryo or fetus is alive, the debate is absurd and terrifying. What reason is good enough to justify the killing of an innocent, helpless person?
I contend that life begins at fertilization. This is a reasonable statement that is supported by science. For a very thorough explanation of life’s beginning, read this page on medical testimony and this one on prenatal development.
If science is correct that life begins at fertilization, then every abortion at any stage for any reason takes a human life. The same is true of reduction, whether two-to-one or any other reduction of a pregnancy. Can this ever be justified?
The only argument worth considering is the argument for health. If the life of the baby will end the life of the mother, it is quite a quandary. In the case of higher numbered reductions (reducing quintuplets or quadruplets, for example), the act may increase the likelihood of life or health for both the mother and the surviving children. Is this then justified? Most would agree it’s a tragic situation to begin with, if we find ourselves having to choose one life over another. The best possible solution would be to avoid the situation in the first place.
Since it’s known that fertility drugs and in vitro fertilization significantly increase the chance of multiples, and it’s known that having multiples increases medical risks, isn’t it logical to conclude that such drastic measures are morally irresponsible? Even if a fertility specialist only fertilizes one egg in vitro and only inserts that one resulting embryo into the woman’s uterus, there is a high risk that the embryo will fail to implant. In other words, it’s quite likely that the baby will die. That’s why in vitro fertilization so often leads to multiples: they insert several embryos, hoping that at least one of them will “take.” All those who don’t implant are lost without a thought and considered collateral damage. If unwanted “extras” implant, they may be killed by reduction. Often, “extras” are produced in vitro but never inserted into the woman if they aren’t needed. These extra embryos are discarded or used for embryonic stem cell research. In other words, all the unneeded living humans are killed.
How did we get to the point where any of this became acceptable?
Defining Persons and Non-Persons
When faced with the evidence, honest people usually concede that “some sort” of life does begin developing at fertilization. The next argument is that while a zygote, embryo or fetus is alive, it is not yet a person and therefore does not deserve human rights.
How do we define whether a living human being is a human person worthy of rights? We’ve tried to do it many times before, with horrific consequences.
America defined Blacks as non-persons to justify slavery. In the Three-Fifths Compromise, a slave was defined as three-fifths of a person, obviously not for any rational reasons, but for political reasons of power and money. Even after abolition, Jim Crow laws ensured Blacks could not have the same rights as other people. We defined Native Americans as non-persons to force them off their land. Women were thought of as non-persons to keep them from voting and to keep them out of the workforce. A woman was considered her parents’ property until she married and became her husband’s property. If we say a human isn’t a person, we can justify horrible treatment and even killing them for our own personal gain.
Unborn babies are treated as people when society considers them “wanted.” Every alcoholic beverage and cigarette pack is required to carry a Surgeon General’s warning about the risk of use during pregnancy – this is risk to the unborn baby and not to the mother. Women can be prosecuted for child abuse if caught using illegal drugs while pregnant. A person who kills a pregnant woman can be charged with double homicide in some states.
If we’re honest, these issues aren’t about when life begins. They aren’t about when personhood begins. They are about the fact that we are more powerful than another group of people, and that group of people is in the way of what we want: absolute control over life.
America’s selfish demand for limitless choice has driven us to treat our fellow humans, even our own children, as yet another product to be bought, sold, or thrown away as we please.
“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, choosing an egg donor, having the embryo placed in me — 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.” -Woman identified as “Jenny” in the article
We must recognize that human life has intrinsic value, regardless of perceived usefulness or inconvenience to others. We must recognize that all humans are persons equally deserving rights. We must recognize that if people are weaker, vulnerable, or unable to speak for themselves, it is our moral obligation to defend their rights. These are universal values of human decency that we should all hold, regardless of our religion, philosophy or political leaning.
Great post. I read about 3/4 of the original article and then skimmed and read the conclusion, but it is very fascinating. The quote that jumped off the page for me was when Evans said that “Ethics … evolve with technology.” Wow. I see this same trend in cyber crime. The first time someone stole money from a bank via a computer network, his defense was that no law prevented him from doing so. To address this, every state and the federal government have now passed laws specifically dealing with cyber crime. But the fact remained: the criminal committed theft from a financial institution. No new laws were really needed (for the most part). Re-evaluating ethics in light of new technology is a dangerous trend. I fear we are closer to eugenics than people realize (not to mention the fact that Margaret Sanger, the founder of Planned Parenthood, was de facto intending to eugenically annihilate low-income minorities, see http://odayfam.com/the-racist-foundations-of-planned-parenthood). Great post; this new abortion trend of reducing multiple fetuses to a singleton is alarming.
Irrespective of the various euphemisms that are often used, interventions are a result of fears and value systems. In India abortions are overwhelmingly more common when the fetus is a female but the official reason remains the health of the mother rather than the worthlessness of the fetus.
If a woman happens to be carrying twins of different sexes, she knows that at about three months her body will give her son a testosterone bath but that her daughter’s brain will also react. Should intervention be performed to reduce it to a singleton? Is convenience of the parents a proper factor to be considered.
We used to impose motherhood irrespective of desires, now we offer more options but still consider a refusal to select such options as a measure of character. We question what the law should be but we also question whether the law should be invading the home, the bedroom and the woman’s body..
If medical care costs and child care costs were not so notoriously excessive would we have fewer of these issues to deal with.
Fleastiff,
Money is a strong motivating factor for a lot of people. But women using in vitro have already chosen exorbitant costs for the procedure. If they’re willing to pay for the risk, they should be willing to pay for the result. I’m sure you agree in such cases it is exactly the opposite of anyone “imposing motherhood” on the woman; she has very intentionally imposed motherhood on herself.
In regards to money, it is also true that being anti-abortion is only a part of what it means to be truly pro-life. I just got back from a conference in Washington that featured several workshops and speakers on how we can be providing resources to those in need. There is a growing number of people who sponsor or work at pregnancy resource centers, maternity homes, and organizations that provide free or reduced cost medical care and child care. One example is Students for Life of America’s “Pregnant on Campus Initiative.” (http://pregnantoncampus.studentsforlife.org/) This program’s aim is to create and promote resources on college campuses for pregnant and parenting students. Assistance funds, special on-campus housing, bathrooms with diaper decks and nursing areas, and day care services are some of the resources they want to make available.The group Feminists for Life (http://www.feministsforlife.org/) also has a college outreach as well as demanding better resources for pregnant women who want to maintain their careers. There’s still much to be done, but there are ways to find resources if money is the issue. It’s funny to call a view pro-choice if the single solution offered is abortion – where’s the choice in that?
When you say we used to “impose motherhood irrespective of desires,” I picture the government rounding up women and impregnating them against their will. I realize that rape is a horrible reality for some women, but less than 1% of all abortions are done because of rape or incest. The vast majority willingly chose to have sex knowing that sex often naturally results in pregnancy. By their actions, they’ve “imposed motherhood” on themselves. And while being pregnant for nine months can be uncomfortable, no one is trying to “impose motherhood” for a period longer than that. It is possible for a pregnant woman to arrange for adoption and, if she wants, to interview potential adoptive parents and select the ones she deems most worthy. Her baby can be adopted the day of birth, her motherhood period effectively ended, and she can go about her life as she wishes.
We can agree that the law should stay out of the bedroom. The government shouldn’t tell people whether or not they may have sex. But it’s reasonable that when we give people choices, we hold them responsible for the outcome of those choices. Of course we should offer what help we can to deal with the outcome. But when the proposed solution to the problem involves killing a human who had no say in the initial decision to cause the problem, the government should have the right and responsibility to say no, you just can’t do that.
You hit at the heart of it with fears and value systems. We need to provide better resources to alleviate fears. At the same time, we need to promote self-control, responsibility and rational decision making so fewer people find themselves in situations they didn’t plan for and don’t want. Values influence laws and laws in turn influence values. It will not be enough to change laws to prohibit things like reductions and abortions. Only when we change the entire value system of our country will we see positive results. Right now, our value system is limitless choice without consequences. Take a look at things like our national debt and our war problems to see how well actions without consequences are working out for us.