By Joona Räsänen

Many people believe abortion is morally permissible. Yet many of the same people also believe that if the woman is pregnant with healthy twins, it is morally wrong for her to abort only one of the fetuses. But since we should choose morally permissible acts instead of impermissible ones, it implies that the woman ought to abort both fetuses rather than just one. But this sounds very odd. Surely, any plausible moral theory should not encourage such a pro-death view where a person should take more rather than fewer lives.

This is just one instance of a more general problem which has become known in philosophy as the all or nothing problem, where by accepting some significant cost to yourself you could bring either a good outcome or an even better one.

In my recent article, Twin pregnancy, fetal reduction and the ‘all or nothing problem’ published in the Journal of Medical Ethics, I apply this problem in the context of abortion and consider possible ways to solve it. Like many philosophical problems, it divides people into camps where everyone thinks their solution is obviously the right one.

First, there are pro-lifers who think the solution to the problem lies in the belief that every abortion is immoral. If all abortions are wrong, then an abortion that kills just one of the twin fetuses is wrong as well. Nevertheless, many find it difficult to accept the pro-life position.

Then there are pro-choicers who think that a pregnant woman is the only person who should have any say in whether she will continue the pregnancy and how many fetuses – if any – she will gestate. We should just accept that she is morally entitled to abort one of her fetuses and gestate the other – if that is what she wants. However, if we follow this reasoning then we should also accept that a pregnant woman is also morally entitled to end any number of pregnancies at any stage of the pregnancy for any reason, however trivial. Yet, many people (even those who think the woman should always have a legal option to do so) think it is morally wrong, for instance, to end the life of a female fetus at the last stages of pregnancy because of its sex.

A plausible solution to the problem is to show that twin pregnancies are much riskier and more burdensome to the woman than single pregnancies, so gestating two fetuses is not really the same thing as gestating one. Therefore, we could keep the belief that there is something morally wrong in late-term sex-selective abortion but we could also think that reducing a twin pregnancy to a singleton is not wrong because it is done to reduce the risks for both the fetus and the mother – not because of some trivial preference.

However, it is not clear that reducing a twin pregnancy to a singleton actually reduces pregnancy risk and complications or burdens of the pregnancy. At least some recent studies suggest that while twin pregnancies are more difficult than singletons in many respects, aborting the other twin does not reduce the risks of the pregnancy – at least not to the same extent. Singleton pregnancies that started as twins are still difficult and risky for the fetus and the mother – aborting the other fetus does not change that.

My solution to the problem is that if a woman is pregnant with twins she is of course allowed to end the pregnancy since no-one, not even twins, is entitled to use someone else’s body to sustain their own life. But if the woman accepts the burdens and risks of the pregnancy and offers her body to be used by one of the fetuses, she should offer her body to be used by the other fetus as well. This is in line with Horton’s solution to the more general version of the problem.

It is not easy to accept this view because if the woman cannot or does not want to raise two children, it would imply that she should adopt out the other child rather than have it killed in the womb. Separating twins at birth seems morally disturbing, but perhaps not as disturbing as the other solutions to the problem.

Paper title: Twin pregnancy, fetal reduction and the ‘all or nothing problem’

Author: Joona Räsänen

Affiliations:

Department of Philosophy, Classics, History of Art and Ideas, University of Oslo, Norway

Faculty of Social Sciences, Tampere University, Finland

Competing interests: none