Nathan Emmerich

The latest bioethical event of the on-going culture wars originates, somewhat unusually, in the UK, at least in so far as the Journal of Medical Ethics is a UK organ. The JME has in the past week published an article entitled “After-birth abortion: why should the baby live?” The author’s choice of term for the action they seek to consider is at best distasteful, at worst pointlessly misleading and obviously provocative. Seeking to describe the killing of newborn infants as ‘abortions’ is about as helpful as those who describe abortions as the murder of innocents or, in broader terms, as a genocide. Frankly at a time when a woman’s right to abortion services is being challenged across America and the UK the authors should question the ethics of using this terminology. 

Clearly this is an article designed to attract attention and, I think, one can question the sincerity with which it is offered on that basis alone. One could also question the motives of the JME in publishing it; certainly, as everyone has acknowledged, the article is not particularly original. This charge is, however, mitigated by the fact the handling editor was Rev Prof Ken Boyd (who offers his perspective here) someone who is obviously opposed to the point of view presented and is, in my view, unlikely to have approved the piece for the publicity alone. As the Editor in Chief of the JME Prof Savulescu defends his position here and further concerns over the controversy appear on the Guardian’s Comment is Free (another CiF point of view is here). I am in agreement that the intemperance of the response (understatement alert) exhibits a greater immorality than the article itself but equally no one should be surprised that it provoked such a response.

Regardless of the authors motivation this rather short article does present an argument that requires, if not exactly merits, a rebuttal.  This first challenge one might raise is that the authors assume that the reasons society finds acceptable for abortion are, in fact, moral justifications for abortion. Methodologically applied ethicists tend to overlook the possibility of moral pluralism, moral compromise or the possibility of true, irresolvable moral dilemmas. However these are often factors in the way in which we morally shape society. In the UK or, rather, Great Britain abortion was legalised not on the basis of women’s reproductive rights but as a response to the widespread problem of unsafe backstreet abortions. Indeed many involved with the bill would not have acknowledged that abortion was a moral practice. In America the legality of abortion is a matter of privacy and only extended to the first trimester of pregnancy. Thus when they talk of “pathologies [that] would constitute acceptable reasons for abortion” (p.1.) it is not clear what relevance and weight these might have when moves beyond the early stages of pregnancy into the later stages of gestation and, as the authors wish to consider, post-natally. In short the increasing limitations placed on abortion as the pregnancy progresses is, conveniently, ignored by the authors.

This is, perhaps, understandable, despite the venue of publication the authors are not overly interested in practical, social and cultural ethical questions but, rather, confine themselves to conceptual questions regarding ‘personhood’ and its philosophical moral status. Rather than being interested in the complex social ethics of abortion services they are interested in the abstract, i.e. simplified, morality of abortion. The authors deny that the foetus and the newborn are “’persons’ in the sense of ‘subject to a moral right to life’” (p.2). I dislike rights talk in moral philosophy. It seems to think that it can remain fully distinct from legal rights and, in my view, this is simply a misguided assumption. Since it is obvious that the Human Rights Act does extend to newborn babies they evidently do have this legal and moral right to life. Denying it is, simply, morally and legally pointless. Moral rights must be translated into legal rights and, in being so translated, the point at which human beings attract such rights must be defined, even if that definition, as is the case with placing it at birth, is somewhat arbitrary.

A greater challenge is their view that a ‘person’ is:

It is in virtue of this that human beings are supposed to have moral status. The authors do not state exactly this, they continue to equate ‘moral status’ with ‘right to life.’ However, let us restrict ourselves to considering whether a human being has moral status when he is capable of attributing value to his own existence or, to put it simply, when he acquires some minimal sense of self.

This would then seem to indicate that ‘personhood’ requires ‘subjectivity,’ something which is distinct from having phenomenological perceptions per se. Ants have phenomenological perceptions but they have no sense of self and are not, therefore, possessed of subjectivity, at least not in the sense in which I use it here. One could then be concerned with how such subjectivity comes about. This is, broadly, a psychological question and there are two theoretical perspectives one might take. First one can consider an ‘Piagetian’ perspective that understands subjectivity to be the result of broadly individual biological and cognitive development.* On the other hand one can take a Vygotskian perspective that suggests that subjectivity can only emerge in the context of social and cultural activity. Here individual cognitive development cannot be considered solely a matter of biology but a function of society, culture and supra-individual. Here subjectivity cannot be considered to emerge independently of intersubjectivity as our sense of self is intimately related to (and inseparable from) our sense of the other.

Thus, on the one hand we have the possibility that subjectivity, and therefore personhood and moral status, develops irrespective of human contact and on the other we have the possibility that (inter)subjectivity, and therefore personhood and moral status, can only occur through human interaction. I vastly prefer the latter account and I think there are good reasons for doing so. Furthermore I think this account indicates that human beings must be accorded moral and ethical importance in order for them to achieve any sense of (inter)subjectivity and therefore personhood and the kind of moral status the authors of this paper are concerned with.

If this is the case there are, I think, two ways one can go. The first would be to suggest that moral status is simply not a matter of personhood and that the article ‘After Birth Abortion’ can be considered a reductio ad absurdum of the idea that it is. If moral status and ‘personhood’ is not something attributable to newborn babies and it is therefore acceptable to kill them then this shows that premising moral status on personhood is a flawed perspective. Alternatively we might understand there to be an increasing degree of moral importance that pertains to the human organism, the human being and the human person. This would accord with the way in which abortion is increasingly restricted as the pregnancy progresses and with the varying degrees of moral and ethical concern we have with biomedical research on human blastocysts and foetuses. In fact we could remind ourselves of the moral and ethical complexity of human social and cultural life and address our deliberations at this rather than the impoverished individualist account apparently preferred by applied ethicists.

* I am doing some violence to Piaget’s actual views here but hopefully he will forgive me. 

[Edit: The authors reflect on the response to their article here. I am not sure I believe they had 'no idea' what the response might have been. I also wonder why the phrase '*After Birth* Abortion' was selected over, say, '*Post-Natal* Abortion' or '*Post* Birth Abortion.' Anyway, what is perhaps most interesting about this 'open letter' is that the authors do not think their article should be taken as an suggesting that 'After-Birth Abortion' should be made legal. It seems then they have a very restricted view regarding whether or not we should act on applied ethical conclusions. I find this strange, particularly given the venue of publication. In my view the JME is a venue for those interested in professional medical and bioethics to engage in reflection and debate regarding issues raised by modern healthcare and medical science. It might be predominantly philosophical but is it cannot be understood as a purely philosophical and academic journal.]