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After-Birth Abortion: Editorial Comment

28 Feb, 12 | by BMJ

Rev Prof Ken Boyd, Associate Editor, Journal of Medical Ethics, writes:

Coming up to me at a meeting the other day, an ethics colleague waved a paper at me. “Have you seen this ?”she asked,  “It’s unbelievable!” The paper was ‘After-birth abortion: why should the baby live?” by two philosophers writing from Australia, Alberto Giubilini and Francesca Minerva. Well yes, I agreed, I had seen it: in fact I had been the editor responsible for deciding that it should be published in the Journal of Medical Ethics; and no, I didn’t think it was unbelievable, since I know that arguing strongly for a position with which many people will disagree and some even find offensive, is something that philosophers are often willing, and may even feel they have a duty, to do, in order that their arguments may be tested in the crucible of debate with other philosophers who are equally willing to argue strongly against them. Of course for that debate to take place in the Journal of Medical Ethics, many of whose readers, doctors and health care workers as well as philosophers, may well disagree, perhaps strongly, with the paper’s  arguments,  we needed first to make sure that the paper, like any other submitted to the Journal, was of sufficient academic quality for us to publish; and the normal way in which we determine this is to invite academics in relevant disciplines to review the paper critically for us, so that we can eventually make an informed decision about whether or not to publish it, either in its original or (as in this case) a form revised in the light of the reviewers’ reports. Satisfied by the reviewers’ reports and my further editorial review that the paper was of sufficient academic quality to be published in the Journal of Medical Ethics, and being charged with making the decision as an Editor with no conflict of interest in the matter, since unlike my fellow-editors in the relatively small world of international academic medical ethics I have never met the authors, and indeed personally do not agree with the conclusions of their paper, I decided that it was appropriate to publish it in the interest of academic freedom of debate.  It has subsequently been suggested to me that people whose lives might have been ended by ‘after-birth abortion’ were this legal, might be deeply offended by this paper. If that is the case I am sorry, but I am also confident that many of these people are equally capable of mounting a robust academic reply to the paper which, again subject to peer-review, the Journal of Medical Ethics will be very willing to consider for publication.

(IB adds: the paper in question is here; Julian Savulescu defends publication in the next post down.  I’ll add relevant links, both pro and contra, as I find them.)

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  • Kvmc2

    Would you make a decision as editor to publish a paper recommending the killing of Jews in the interest of acdemic freedom. A paprer suggesting the killing of live humans has absolutely no place in a journal of medical ethics. Possibly one should start a journal of academic ethics in which we could suggest the murder of these authors as “non-persons” by virtue of their callous disregard for human life. There is absolutely no difference in killing the authors because they have inflicted “pschological suffering” on all actual humans who abhore the murder of children. I would be happy to “peer review” it.

  • Kevin Wight

    Wow, Godwin in the first comment; although an admittedly subtle application! Where better for a discussion on such a paper than a journal of medical ethics? I don't agree with the findings of the paper either, but I believe that the inclusion is more than satisfactorily justified in the comment. Your objection is valid, but your argument is pure whataboutery.

  • Neil Levy

    How can “an ethics colleague” think this argument is unbelievable? Is the standard of ethics so low that people can get jobs in the field without having encountered this argument? Never read Singer or Tooley, or the debate they sparked? Wow. That really *is* a scandal.

  • Neil Levy

    Actually the argument is worse than that; its circular. Imagine the same argument was run against the claim that is permissible to kill animals for meat. Or for that matter to kill wheat. Now suppose someone objects to the publication on the grounds that academic freedom can't justify publishing an argument for the permissibility of killing Jews. Why would the argument be bad? Because the moral status of wheat and jews is very dissimilar. So the argument can only be any good if it supposes that the moral status of newborns and jews is in fact very much the same. But what is at issue is whether newborns (like jews) have the rights of persons. So you can't suppose that they do in order to make your argument; that's circular.

  • Kevin Wight

    I see; there is a more-or-less a priori judgement made of the worth of the subject before the worth of the subject could begin to be ascertained using any available evidence. The conclusion has already been made.

  • Dr Alan Marsh

    It seems the academic standards of the Journal are very low indeed, if it is willing to publish arguments based not on ethics but extreme utilitarianism which would be illegal in virtually any modern society.

    The analogy which the argument foolishly attempts to set up between prenatal infanticide and postnatal infanticide is not only deeply repugnant to any moral form of ethics, it is so naive as to suggest that it is the work of children in a school debate, who have no knowledge of the long historical antecedents of infanticide and the ideologies with which it has always been associated.

  • apeel11

    This is exactly the point – this article is a political and economic argument masquerading a ethics. I am amazed the Editor allowed it to slip through.

    They even quote the idea that a person with Downes Syndrome may be better off being killed because society has to pay for their care in later life. This is an entirely politico-economic argument somehow claiming the life of a disabled person has a value over which society allows them to die. What is this value?

  • http://www.facebook.com/profile.php?id=729368150 Felipe Kohon

    To kill the authors of this completely out of mind stupidity should be a profilactic act to protect humanity against this  intelectual criminals that for sure forgot Hipocrates Juramentum

  • http://www.facebook.com/profile.php?id=729368150 Felipe Kohon

    did thisd octor read the Hipocratomise that all doctors one day sign?

  • http://www.facebook.com/profile.php?id=729368150 Felipe Kohon

    The unethic part of the ethic journal. what a counter sense

  • Goeze

    The problem is, you can't debate on human rights, they stand like axioms in mathematics in the beginning of every ethic discussion. Put aside axioms and mathematics will disappear, put aside human rights and there is no ethic discussion, only senseless reasoning.

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington Iain Brassington

    I'm not sure that that's true. Rights-talk is a fairly recent phenomeonom – post-war, really. If you'd tried to talk to Aristotle or Hobbes or Grotius or Hume or – most famously – Bentham – about human rights, they'd have been baffled. Yet they weren't involved in senseless reasoning.

  • apeel11

    I may not be an academic or an ethics expert however I am a 54 year old male  with Spina Bifida. When I was born my parents were told I would never walk, talk or live a useful life. In fact one of the Nurses actually suggested to my Mother if she went out of the Ward then the Nurse would turn  me face down and I would 'slip away;.

    When we get to medical ethics Doctors and Health Professionals always seem to think they can pontificate about where the line should be drawn. People such as myself are rarely if ever asked to make policy because of the negative image associated with disability. Somehow non disabled people are seen as 'experts' on disability.

    Imagine if people from ethnic minorities were never consulted out ethics affecting them? There would be an outcry. However disabled people are seen as a group of people you do things 'to' as opposed to 'for'.

    The logical extension of the authors arguments if applied to race would run as follows; if a black child were born to parents who wanted to give it up in a largely white society then it may be better if that child were killed. No sane person would now hold this view. 

    Millions of people died fighting these views in the Second World War where one of the most evil men the world has ever known also referred to disabled people as 'non persons'.

    I would never issue a death threat against the authors because that would be the easy way out for them. They have put down heinous views in writing and must now face the storm they have created. I would never accept an apology from them as it is clear we now have 'ethicists' who have lost their moral compass.

    This paper has no academic quality as it merely regurgitates previous views on this subject. Society has decided that disabled people have a legal protection from such views. I am actively pursuing the matter with the police to ask whether a disability hate crime has been committed by these authors. If any UK Health Professional came close to acting in accordance with the views expressed in this article they would be guilty of serious misconduct.

    As a footnote the disabled person born nearly 54 years ago who would never live a useful life is now happily married and project manages a £3M ICT Project. Yes your decision as Editor to publish this pseudo academic article has caused me profound, deep personal offence. The unfortunate thing is that the Far Right will use cant like the article you published to justify further hate crimes against disabled people. The idea that philosophy and the views expressed in the article appear in the same sentence staggers me.. 

    Andrew Peel
    contact details supplied on request 

  • Morgan-LynnGriggs Lamberth

    Thank you!

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington Iain Brassington

    Doesn't that amount to “I disagree with these people, therefore they should be killed”? That's a rather strange way to occupy the moral high ground.

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington Iain Brassington

    I wonder if you might be misreading the paper a little.  As I read it, the claim being advanced applied to any newborn, since no newborn is a person in the technical sense that philosophers often use the term.  The paper then suggests that disability is one of the reasons that might be advanced for thinking that the newborn ought not to live.

    But I think that there are two quite separate claims that need to be unpicked.  One has to do with the moral status of any and all newborn(s); the other has to do with whether congenital disability is morally relevant as a further fact about any given newborn.  And, obviously, there's a range of combinations in which these two questions might be answered.

    I think that the appeal to history misfires slightly, too.  A Nazi denying the personhood of a Jew simply on the grounds that he's a Jew would have made – to put it extremely charitably – a huge error.  However, the person/ non-person distinction that underpins the argument here is very different.  As such, the appeal seems to be – while understandable – a little shaky.

  • apeel11

    Typical reply from academia – shame you don't inhabit the same world as the rest of us.

  • Danny_Ross_4Eva

    although my uncle a peel would not make a death threat i would like to say if the so called and no doubt self proclaimed professor was in Manchester there is nothing more i would like than to let's say knock some sense in to his narrow minded skull who are we to decide if that was the case i think an article should be written on why shallow minded Nazi's should be shot when making such comments

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington Iain Brassington

    It's an attempt to engage with your claims in an intelligent way.  I'm not sure why my day-job should debar me from that.

  • Neil Levy

    Yes! When will doctors stop performing surgery, as the Hippocratic oath (which is what I assume you mean) requires? 

  • Aeron

    My thoughts exactly, Neil. An ethicist that hasn't encountered 'personhood theory' (for want of a better term)? Truly worrying.

  • Kevin Wight

    Hahahaha! Excellent. He's not the first person to make a smart reply and make himself look a moron on this issue.

  • Aeron

    Andrew,

    This paper is not about disability. It is a philosophical article about personhood and when a human might acquire it. This is a debate that has gone on for many years among ethicists. A single sperm or egg could be considered a potential person but unless you are going to suggest women who menstruate or men who masturbate are murderers then you must surely appreciate the ethical dilemma as to when human life becomes meaningful.

    Much of society may think that birth is the appropriate time to give the fetus full rights, and some ethicists advocate this, while others argue that this, in itself, is not reason enough. For instance, a newborn child has less capability or awareness of itself and its surroundings than an adult chimpanzee, and yet we do not generally afford chimps personhood status.

    It is unfortunate, though not surprising, that you have picked up on the disability angle within the paper. The authors, in my opinion, were just using this as an example as why parents might choose to abort after birth (call it infanticide if you like, it makes little difference to the argument).

    What I would say is that virtually all bioethicists I know (and as a student, I know quite a few) argue that a life, unless so intolerable that it would be cruel to bring to birth, is a life worth saving and nurturing. I can point you to dozens of academic papers that argue this point. And I am pretty sure, though I obviously cannot speak for them, that the authors of this paper would agree.

    So, at the sake of repeating myself, the paper was an ethical argument about personhood and when it might apply to humans. The authors might just have used the example of parents realising they had given birth to a gay baby (if a test was possible) and the gay community might have been outraged. The point is, if you look at the arguments, a newborn is not as important as an adult human, all things considered, and so the decision of the parents will always trump, even if we don't always agree with that decision.

  • apeel11

    These two philosophers need putting in the same category as Dr Joseph Mengele. They are expressing neo-Nazi propaganda which has no place in a reputable medical ethics journal.

    This is not some intellectual exercise; it is very dangerous cant in a world that is lurching to the right. The fact that other commenters even think that human rights are not absolutes is very worrying.

    My point is that it must be very nice to operate in a world where basic rights enshrined in law are somehow up for debate.

    There is no debate that Disabled People have Human Rights – and I really don't care if you and you colleagues want to debate it till the cows come home. People have died for these rights while academics waste oxygen debating whether they exist.

    There is a vast difference between withholding treatment and offering palliative care until say a young baby passes away. Actively intervening and killing a baby – and that is what these two are proposing even though they try and dress it up as 'post abortion' – is an act of murder pure and simple.

    All right thinking people in society must take a stand and say enough is enough. This article is not about medical ethics; it is about socio-political views on the cost disabled people impose on society. The measure of a civilization is how well it treats its most vulnerable members. This is why the vast majority of the World condemned the Nazis as uncivilized.

    So lets stop talking about 'philosophical definitions of people' and have the courage to do the right thing which is to condemn these views as 'unethical' and criminal.

    To do otherwise leads to a very slippery slope. The Editor and Peer Reviewers thought this was some kind of 'sterile debate' – well words have power and the words they put down have the power to fuel hatred of disabled people. On that basis alone I am actively campaigning to have all their funding withdrawn and get them sacked from their positions. Never again can we allow the mass genocide in the name of people being 'non persons'.

    I may not be able to do something about conflicts in the world but I am a seasoned disabled rights campaigner and can do something to stop these two people expressing such odious views again.

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington Iain Brassington

    I campaigning for people to lose their jobs the best response? Is that the way you normally respond to people with whom you disagree?

    I predict that this weekend has echoed to the sound of nib hitting paper as people begin to draft responses, rebuttals, and refinements of the paper. What weaknesses there are will be scrutinised and analysed; the paper will be fairly forensically picked apart. At the end of the process, we'll have an account of which bits of the argument are sound and where the mistakes are. And the arguments will move on.

    That's how debate works.

    This does not happen if the response is nothing more than threats to the livelihood of the authors. Threats don't address the paper and its claims, and so misjudge the target. All they do is send out a message that noone in future will be permitted the space to air controversial ideas; and the result of that is intellectual stagnation.

  • Roberto Fezzi

    I am 48 and I have three children.

    When I heard about this ethical (or better, dis-ethical) discussion I suffered a lot, because we know that when an argument can be discussed, some consequencies are possible.

    The real point is that if we open the discussion about the possibility that someone can decide if you can live or die, by law, also if only by hypothesis, we are doing the same path of nazism.

    That originates from the fact that moral law is not regarded as essential for the life: so we can argue that “a baby is not a baby before his birthday” and you can eradicate this cell cluster without any doubt. And you can proceed further without limits: neither the birth is a limit because this Person is not  self-conscious; further again we can decide to stop a life in case of a disease, when you are old and ill ….
    The -not secondary- question is: who will decide?

    To me it seems we are opening the doors to the eugenetic: then we can only remember that “the sleep of reason produces monsters”…….

    Roberto Fezzi
    Milan
    Italy

  • David Gillon

    “Then they came for the disabled, the so-called incurables, and I said nothing, because I was not disabled”
    (From an early version of Pastor Martin Niemoller’s prayer/poem on the Holocaust).

    The progression from the systematic murder of disabled people under Aktion T4 to the systematic murder of European Jews in the far better known Holocaust is an established historical precedent which makes the analogy used above perfectly valid. If A led to B, and we accept B is wrong, then can arguing for A be right? Godwin’s Law isn’t applicable when discussing disability and the right to life because the clearest historical precedent is Aktion T4. See http://www.latentexistence.me.uk/godwins-law-must-die/ for an explanation of why invoking Godwin’s Law is actively dangerous when disability rights are being discussed.

  • David Gillon

    Why are you so convinced it’s essential to be able to attack the rights of disabled people to be considered as equal? Do you understand why disabled people would find that threatening at a time when we are being attacked in the media on a daily basis and face abuse, assault and worse in the street?

    You say ‘that’s how debate works’, but how this debate works for us is me being attacked in the street on multiple occasions by complete strangers for no other reason than that I happen to be walking while disabled (it’s society’s new ‘driving while black’), or, worse, seeing friends with less ability to defend themselves than I have, reporting that this time it wasn’t me, but they who have been attacked. I know several people who have been advised by complete strangers that they should go to Switzerland and avail themselves of the facilities of Dignitas because as a disabled person their life is an affront to ‘normal’ people. Your arguments may move on, but we are the people who are left in fear of walking the street; your ‘debate’ is our hate crime.

  • hindman

    Using the example of a woman menstruating or a man losing his sperm being viewed as human life or personhood is a red herring. A person is created (or begun) with the UNION of egg and sperm, resulting in a completely unique DNA and must be killed to stop life.

  • David Gillon

     ‘A Nazi denying the personhood of a Jew simply on the grounds that he’s a
    Jew would have made – to put it extremely charitably – a huge error.
     However, the person/ non-person distinction that underpins the argument
    here is very different.’

    Is it? It seems to me the definition of non-personhood (a truly revolting conceit) is simply chosen to fit the author’s preconceptions of worth, which is precisely the process undertaken by the Nazis with regard to European Jews, Gypsies, and disabled people before them. The only ‘huge error’ at work here is the persistent attempt on the part of the ethics establishment to deny that disabled people have legitimate reasons to fear the consequences of these arguments, both historically, as seen in Aktion T4 and other eugenics programmes, and in contemporary society, with disability hate crime figures showing massive rises.

  • David Gillon

     ‘This paper is not about disability.’

    Yet every disabled person I know who has looked at it has seen it as directly applicable and been horrified by it. The paper specifically invokes disability as ample reason to justify killing a child. There is a deeply unpleasant history of people applying precisely this judgement, there have been a string of horrific torture-murders in which disability has been considered justification for the upmost depravity by the perpetrators (read Katharine Quarmby’s ‘Scapegoat’) and the disability hate crime figures are headed steadily skyward. When you say ‘this isn’t about disability’, might it not be an idea to ask an actual disabled person what they think? Speaking as a disabled person who is into double figures with incidents of abuse from people who think my disability legitimises them making me their punch bag, I have to tell you that this paper is very much about disabled people and the way that society devalues us. It’s perhaps a measure of that devaluation that it can happen in a paper on ethics, of all things, and not be noticed.

    And then again, considering the history of medical ethics and disability, maybe it isn’t so surprising at all.

  • David Gillon

    I'm sorry? You're the editor of a scientific journal covering a particularly esoteric area of philosophy, which has just argued that a disabled life is inherently a lesser life, and you are convinced there are 'many' disabled people capable of writing a counter-argument that will pass peer review? I doubt that we can find enough people in general capable of writing at that standard in this sub-speciality to meet most people's definition of 'many', never mind among disabled people. There is a deeply unpleasant double standard at play here: it is all right for ethical specialists to claim that our life is not worth living, but for us to have a right to reply we have to jump through your professional hoops?

    I might not have been a candidate for ‘after-birth abortion’, my disability being of adult onset, but I am far more than 'deeply offended' by this paper, and so to is every disabled person I know who has looked at it. A friend's label is perhaps most apt when she calls it 'terrifying'. If you and the authors had cared to glance beyond the ivory towers before publication then you might have realised that disabled people are living in a very frightening world in which hate crime rates are headed steadily higher, in which most of us have experienced those hate crimes directly, and in which many disabled people are scared to leave their houses because of the levels of hostility we face in the street, hate that is whipped up on a daily basis by the media. A paper that argues a disabled life is a lesser life that can be disposed of for the convenience of 'normal' people is not simply deeply offensive, but actively gives aid and comfort to those who persecute us by providing a justification of their views.

    The paper pours more petrol onto an already raging bonfire of hate, and I rather thought that avoiding that kind of thing was pretty much the entire point of ethics. It shouldn't need disabled people to come in here and force the ethicist community to look at the real-world effects of what you are proposing for us, but the oft-repeated pattern seems to be that every couple of years an ethicist will pop up to preach our lives aren't worth living, we suffer for it, and then ethicists as a whole close ranks and disclaim any responsibility for people implementing precisely the points they have been arguing for. When a pattern of denial repeats again and again, isn't it time to start wondering whether there might be something deeper and darker at work?

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington Iain Brassington

    I find the attacks you describe unthinkable (and would hope that everyone else does); I can't for the life of me imagine what might motivate them. But neither can I see how they're even in the same league as an academic paper (of whatever quality). What'm I missing?

  • David Gillon

    “I find the attacks you describe unthinkable (and would hope that everyone else does)”

    The attacks aren't 'unthinkable', they are the every day reality of disabled people, and they are the context against which Minerva and Giubilini's paper is written.

    “neither can I see how they're even in the same league as an academic paper”

    This paper, and others like it questioning the worth of disabled people, are first and foremost an attack on my worth and that of every other disabled person, as an equal member of society. They are just as much an act of discrimination, just as much an attack on me and people like me as those who abuse us in the street, because they all revolve around a viewpoint that disabled people are of less worth. If someone advanced that viewpoint to my face then I would be fully justified in labelling them a disablist bigot. So why does the venue make a difference? Aren't ethics and morality universal in application?  

    Here's a little academic exercise for you: go through the paper and everywhere it says that a disability makes a baby of less worth, substitute your own name for disability (or 'Gypsy', or 'Jewish' or 'gay'). Uncomfortable reading? Imagine how it feels for me. 

    “What'm I missing?”

    That if you demean me, or anyone else, for who we are, then it doesn't matter where you do it, it doesn't matter whether we are aware of it, the argument itself is an act of bigotry.

  • Dr Julie Barker

    I look forward to further publications of intellectual vigour that challenge the supposition put by the Australian authors. My response to them was as follows:

    Dear Francesca,

    I read your paper with interest and a growing horror. I had thought that you would go on to argue that on the basis of moral equality, a foetus, compared with an infant (or older but equally vulnerable older child or adult for that matter, who currently enjoy status as human beings who have rights and intrinsic value, abortion legislation and scrutiny should be re-examined. Currently in the UK, abortion legislation has been corrupted such that abortion on demand is a basic right and often a means of family planning, albeit not first line.

    Dr Julie Barker

    Mod Edit: On the assumption that you don’t really want your personal contact details on the web forever, I’m editing them out.

  • http://www.facebook.com/rythymsounds.beats Rythym Sounds Beats

     question: if these so called educated professor and philosophers where aborted by their parents then we would not have them destroying the morality of life.  they should kill their children first, and abort their grandchildren after birth,  ….they are evil, we kill and say we are civilized, it is discrimination, not free speech, today we have technology that in the past they hardly could imagine but we still use the crude methods of human sacrifice which had been a part of the early humans and till date. if kill an adult is killed it becomes a crime, well children are small adults with the same right to life. you call your selves educated, industrialized, civilized no you leader and educators are evil. you make laws to kill, you hide behind truth whereas you are far from truth you are what your  fathers where evil. history tells it all and we do not learn. how then can you be civilized, you only are civilized in killing,,,

    cephas

  • Perkinspatsy

    To Whom It May Concern:  I am in the health profession;and,have seen many things and many situations.For anyone who believes in GodJesus Christ(the only begotten son of God,and the Holy Spirit knows that there is only one God.That’s how you got here.You were a miracle of God.A baby being born in a miracle of God.Jesus was born of the Virgin Mary (the immaculant conception).God created you and He is the only one that “in charge” of taking the soul from the body.Not man.Jesus does not condone murder.If He did it would have not been in the ten commandments……these people will not inherit the Kingdom of Heaven  …. adulterers,liars,homosexuals and murderers.I’m entitle to my opinion and it is: God created Heaven and Earth verythig that breathes.If you want to be saved and go to Heaven and not be left behind to suffer the tribulation then time is of essence for you.We are living in the last days and trust me (a child of God0 anyone who participates and/or encourages this insanity will be judged by God.He will not show you mercy when you are being judged.So anyone can whitewash this all they want to but payday is coming.There is a Heaven and a Hell.Believe me you better get yourself right because Heaven has no place for these murderers.I call it what is is MURDER

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington Iain Brassington

    Psssst… The Immaculate Conception refers to Mary’s birth, not Jesus’. And it’s a dogma that was only adopted in 1854.

    As for the rest: evidence, please.

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