Obligations to the Fetus

20 Responses to “Obligations to the Fetus”

1. Lara Says:
   July 16th, 2006 at 12:19 AM

   Thorny: should a doctor be allowed to knowingly prescribe these drugs to a pregnant woman, if she makes an informed request? In the USA and Australia, a case like that (brought by the kid or on the kid’s behalf) would generally be considered utterly indefensible, no?

2. Richard Says:
   July 16th, 2006 at 3:44 AM

   I’m all in favour of aborting defective fetuses. But handicapping a child who would otherwise have been perfectly healthy is, I think, quite plainly morally bad. It makes no difference whether you cause the harm before or after they’re born. The eventual person is equally harmed either way.

   It’s just bad reasoning to deny this on the basis that “A life with them is still better than nothing at all.” That it’s better for the disabled child to be born than not shows that the birth doesn’t harm them. But who ever claimed otherwise? The alleged harm is in the pre-birth causing of the handicap. Clearly a life with the handicap is NOT better than a life without the handicap. When we consider these as the relevant alternatives, it is clear that causing the handicap is a harm to the resulting child.

   I think it’s pretty obvious that we can have a moral obligation not to lessen the quality of life of future generations. Environmentalists are surely right about that much. It would be grievously immoral to litter the world with radioactive waste, even if slow decay rates meant that it didn’t harm any presently existing person, but only future generations. Their interests must still be taken into account, assuming that they will actually exist at a future time.

   Abortion is fine because there is no such actual person who will exist in the future. If you abort the fetus, that’s it. No future person to worry about. But if you attach a time-bomb to a fetus, let it grow into a person and then *BOOM* make it explode, then dude, that’s plainly immoral. The cases you discuss involve drugs rather than gunpowder, but the principle is the same. Though the fetus does not, the child it will grow into certainly does have real, actual, interests, and your actions now can harm them — i.e. make their lives go worse than they otherwise would have.

   You argue: “We do not blame parents of children with accidentally-acquired birth defects, even when those parents deliberately choose not to abort that fetus.”

   But this is because of the non-identity problem. These parents had no choice to keep this child healthy. At best, they could abort it and reconceive a new child. (I think that would be morally preferable, actually, for reasons explained in the linked post. But it isn’t better for the aborted child. So the alternative choice does not harm them.)

   Now, it simply isn’t true that the choice to cause an otherwise healthy child to become handicapped is “essentially the same” as choosing to bear an already defective fetus rather than aborting it. One displays a lack of moral discernment in conflating the two.

   (Perhaps if the choice is exclusively between aborting a healthy fetus or else causing a defect and bringing it to term, then your equivalence would hold. But that is not the sort of case under discussion. There is also the choice to bring the child to term without handicapping them. In light of this alternative, it’s okay to abort the fetus so that the potential child never lives at all. But it is NOT okay to harm the child unnecessarily, so that they live a far worse life than they otherwise could have.)

3. Pejar Says:
   July 16th, 2006 at 9:04 AM

   Hmm, I’ve got to disagree with you on this one, KTK. Paradoxical as it may seem, I think that it is pretty clear that causing birth defects through deliberate or careless behavious when pregnant is much worse ethically than having an abortion.

   An early term foetus has no interests, and I maintain that a late term foetus has some but fewer than a full person, which are overridden by the mother’s rights to dignity and autonomy. However, once she makes the choice to continue the pregnancy, I don’t see anything wrong with that imposing new moral constraints on her. This does not violate her autonomy as she still has the opt-out clause of abortion.

   So why should these obligations arise? Because the effect of the actions very much will be felt by a person, albeit later on. It is like kicking someone such that internal damage only causes pain and death a year on. The delay does not matter. A person quite foreseeably felt the effects, so it is wrong. The fact that in the birth defects case the ‘victim’ was not yet a person does not matter. The effects will harm a person, albeit with delayed action.

   Now you say that We all could have had better lives. We are not victims solely because we did not. This is true. But if the reason that we did not is someone else’s deliberate and careless action then we clearly are victims, and it surely cannot matter that the actions in question occured a long time ago. Say I was to set a deadly trap for someone who was at that point not born, or even not conceived. On their 16th birthday the trap springs, killing them. Surely that must have been a wrong action, even though when it was done the victim was not yet a person?

4. Richard Says:
   July 17th, 2006 at 1:26 AM

   By the way, I’ve written up an expanded version of my above comment, here. (No worries if you’re too busy to continue the discussion in any depth, but if you could spare just a moment, I would be curious to hear at least whether you agree or disagree with my counterarguments. Cheers.)

5. Kevin T. Keith Says:
   July 17th, 2006 at 12:44 PM

   Lara:

   This would certainly be actionable if the doctor did not inform the woman of the likely consequences, since it’s assumed that any pregnant patient wants to avoid birth defects as far as possible. And most drugs that represent a risk of birth defects are either unavailable or severely restricted for that reason (this is the reasoning behind the bizarre restrictions in the US on Accutane); using such a drug in pregnancy would then be an “off-lable” use that would make it harder to defend. But I don’t know what the grounds would be for pursuing the doctor if the patient were fully informed and chose to take a drug that put the fetus at risk after considering and balancing her options and personal values. (I don’t know enough about the medical probabilities to predict such a situation, but if, hypothetically, the best drug to treat hypertension also caused birth defects, and the woman was a risk from hypertension during her pregnancy, it would seem perfectly reasonable to give her that drug and accept the risk to the fetus, because there was no better way to minimize the risk to her.)

   Richard:

   the birth doesn’t harm them. But who ever claimed otherwise? The alleged harm is in the pre-birth causing of the handicap.

   Actually, “wrongful birth” was a common complaint in cases of severe birth defect. It has never been recognized by the courts for the reason I give – birth is not a harm unless your life is so bad you would literally be better off dead. But pre-birth harms cannot be recognized either, because there is “no one there” to be harmed at that stage. If the “harm” occurs before birth, or at least relatively early in pregnancy, who is being harmed?

   It’s certainly true that you can do things at one point in time that turn out bad for someone at some later point in time. That by itself does not establish that you are morally in the wrong for doing those things – even for doing them gratuitously, with no compensating moral good in the balance. This is the familiar philosophical problem of “harm to future generations” that you note – do we have obligations to people who don’t even exist yet? The most commonly-accepted answer is that it makes no sense to talk as if we do. (Some people have attempted to claim that we owe general obligations to the future – not to specific people – as an offshoot of our obligations to other human beings generally. Since we do owe something to others, and we know there will be others who are affected by our actions, we owe something to them. But those obligations then turn out to be the broad ones that affect society as a whole – preserving the environment, maintaining a stable social order, and so forth – not particular things that affect particular people.) Simply put, we don’t owe anything in particular to “no one in particular”, that is, to people who don’t exist; among the things we don’t owe to non-existent people is that they have the best possible situation if we later cause them to exist.

   Arguing otherwise – that it’s immoral to do anything to bring to birth a child with foreseeable birth defects – would suggest that it’s immoral to do anything that is suboptimal for a future child. Among other things, it would immoral for people who carry genetic defects to have children at all (if we think those defects are undesirable – see below). It may be that they cannot prevent passing those defects on, but they could certainly choose not to have children, so in that sense doing so is deliberately creating a birth defect. If anything you do that foreseeably results in a suboptimal future for your child is wrong, simply having children – unless you could guarantee them the best of everything at every stage of life – would be wrong. Most people would reject that conclusion.

   So, both because there is no person present to be harmed before conception or before the fetus reaches the stage of moral personhood, and because it is not immoral to have children with birth defects anyway, and because life itself cannot be a harm no matter what kind of life it is (better than death, at least), there is literally no harm done in imparting a birth defect to a fetus.

   It would certainly be a kind of gross indifference to the fate of your own children to deliberately do something that would cause birth defects if you could avoid it. And we might wonder if a person who would do such a thing is a fit parent – if they might not later do something to neglect or harm the child. But that’s not to say it would be immoral to do that (cause birth defects prior to full development, that is) – again, for the reasons given above. To put that another way, there are lots of much-more-realistic scenarios by which parents not only can, but do, condemn their conceived future children to terrible lives: by bearing children in extreme poverty, by bearing more children than they can care for, by bearing children facing almost certain malnutrition, or violence, or starvation, or infant mortality. Any of these may create a much worse life than a distorted limb or limited intelligence – but we rightly do not regard it as immoral to bear children under these circumstances, even though doing so may very well be, essentially, a deliberate decision to doom those children to stunted lives. (There is a difference between an impoverished woman bearing children she cannot give a good life, and an affluent woman bearing children she decides not to give a better life than she does, but that is a difference that makes no difference to the children – the only ones whose moral interests are putatively at stake.)

   Finally, recognize that these hypothetical scenarios are very unrealistic. Most women go to tremendous lengths to give their offspring every advantage, beginning in utero. The scenario of the woman who deliberately creates birth defects in her fetus for no reason at all is surely entirely fictional, or restricted to psychotics. But there are women who have to make tradeoffs between their own interests and their future children’s – women whose health can only be preserved by a potential risk to the fetus, or who cannot manage to give their fetus an absolute optimum gestation without surrendering important personal or health interests of their own. These women’s rights must still be respected – as well as their ability to make decisions for themselves and their future children. Treating every woman as a presumed psychotic, by negating her own interests entirely as soon as a single sperm hits its target, is unnecessary, unrealistic, and immoral.

   Clearly a life with the handicap is NOT better than a life without the handicap.

   This actually complicates the matter a great deal, to your disadvantage.

   It is far from obvious that any handicap, including fairly severe ones, creates a life worse than a life without it. This point has been a major focus of the “disability activism” movement, and they have a strong argument in its favor. Many deaf parents argue heatedly that deafness itself is not a disability – that society’s refusal to acknowledge and accomodate people without hearing is the real cause of any “handicap” it creates – and there is no reason to avoid having deaf children. (Many decidedly prefer it.) To them, it is simply false that deafness – a condition that most hearing people would consider a great loss if they suffered it – is anything to be avoided, or that a life with deafness is worse than a life without it. Similar arguments can be made for many other “handicaps”. At best, you can factually state that certain conditions limit chances or opportunities in life – but that by itself may not be a “handicap”, and most such conditions are not “disabilities”, but rather the natural role of the genetic/social dice that we all must take.

   [More later.]

6. Brooklynite Says:
   July 17th, 2006 at 2:17 PM

   So, both because there is no person present to be harmed before conception or before the fetus reaches the stage of moral personhood, and because it is not immoral to have children with birth defects anyway, and because life itself cannot be a harm no matter what kind of life it is (better than death, at least), there is literally no harm done in imparting a birth defect to a fetus.

   Nope. I can’t go for it. Let’s say a woman is working in an factory in which chemicals that can cause birth defects are being used. She becomes pregnant, and goes to her boss and asks whether it’s safe for her to continue to work there. He says it is, knowing it isn’t, and her subsequent exposure causes a serious disability in her child.

   She hasn’t been harmed by her boss’s action? Her child hasn’t been harmed? Of course they have. I’ll come back to the case of the woman later, if you like, but let me tackle the case of the child now.

   What it boils down to, I guess, is that it’s not clear to me why “there is no person present to be harmed” is relevant in this context. If the child, years later, confronts the boss with his disability, and says “you did this to me,” would any of us disagree? How could the boss respond? “No, I didn’t do this to you — don’t you understand? I did it to the non-person human being that later turned into you.” That’s no kind of answer.

   I agree with you that fetuses, at least in the early stages of pregnancy, are not moral persons. But their status — call it “incipient personhood,” perhaps — has no obvious analogy in other non-person entities, and it’s not intuitively obvious to me that such a status carries no moral weight.

7. Kevin T. Keith Says:
   July 17th, 2006 at 6:06 PM

   Brooklynite:

   Consider a woman who encounters toxins on the job and miscarries, or has an abortion. (Assume she herself is not affected.) Is there no harm? If she merely decides not to have children because of the increased risk they face, is there no harm?

   Of course there is a harm, but the harm is to her – by way of the frustration of her plans or hopes, and by way of the interference with her control of the course of her own life. She can be harmed by way of the impact on her reproductive freedom whether or not the exposure affects the development of a fetus.

   To look at this from a different perspective, there is an obvious intuitive appeal to holding people responsible for harms to fetuses that have deleterious affects on the lives of the eventual children they become – especially when we consider historical cases of that kind, and how horrible they can be. But there is both theoretical and intuitive good sense to locating moral goods and harms in the moral persons they affect. If “nothing in this world is good or bad but thinking makes it so”, then nothing is good or bad except to someone capable of experiencing it. Believing otherwise leads us to bizarre muddles, such as that an injury to a fetus is a harm if the fetus is born and suffers from that injury, but is not a harm if the woman carrying the fetus aborts it first – or, worse, that an IVF embryo is “harmed” by not being gestated, as if the mere fact that it exists gives it not only moral interests it is utterly incapable of recognizing or appreciating, but a positive moral right to have someone donate their body to its succor. But these muddles resolve if we perceive non-persons as not the subject of moral goods or harms. Other persons may have an interest in their fate, and those persons are harmed if the embryos are damaged, but that harm flows from the violation of those other persons’ interests, not the embryo’s. (Thus the “parents” of an IVF embryo have a grave cause of complaint if someone carelessly destroys an embryo they intended to gestate, but are perfectly free to discard the unused ones if they choose, and a woman has a cause of complaint if she is injured and suffers a miscarriage, but also has a right to abortion.)

8. Brooklynite Says:
   July 17th, 2006 at 9:25 PM

   If “nothing in this world is good or bad but thinking makes it so”, then nothing is good or bad except to someone capable of experiencing it.

   But why, as a matter of principle, insist that the person who experiences the harm be extant at the time the harm is perpetrated, rather than at the time its effects are felt? If someone kills my father when I am in utero, hasn’t that person harmed me by depriving me of a father? (Imagine that my father has been sent overseas immediately after impregnating my mother, on a planned two-year assignment. Does it make moral sense to say that I have been harmed if he is murdered ten months into the trip, but not if he is murdered seven months in?)

   Believing otherwise leads us to bizarre muddles, such as that an injury to a fetus is a harm if the fetus is born and suffers from that injury, but is not a harm if the woman carrying the fetus aborts it first

   Maybe. I’d say “moral quandries” rather than “bizarre muddles,” though.

   I don’t subscribe to your belief that abortion is a morally uncomplicated issue. In the first weeks, or even months, of a pregnancy, it is. But as birth approaches, I see things getting more muddled. Some situations are inherently muddled, and this may be one of them.

   or, worse, that an IVF embryo is “harmed” by not being gestated, as if the mere fact that it exists gives it [...] moral interests it is utterly incapable of recognizing or appreciating

   I think it’s possible to separate out the moral status of an embryo from the moral claims a person can make on the basis of events that transpired while that person was embryonic. If one does so, much — though not all — of this muddle disappears.

   Going back to the murder of the absent father: Let’s say that I myself am killed in an unrelated accident the day after my father’s murder, before my mother has learned of the murder or affected by it in any way. In such a circumstance, it seems to make sense to say that I have not been harmed by the murder at all, which in turn seems to imply that the harm can be located not at the time of the murder but at the time at which its effects are felt.

   If we frame it this way, then perhaps the fetus that is aborted because of its mother’s exposure to toxic chemicals is never harmed, because it never attains personhood. Likewise the IVF embryo.

9. tgirsch Says:
   July 17th, 2006 at 9:57 PM

   No, sir, I don’t like it. This one doesn’t even smell right. Taken to its extreme, you’re essentially making the moral argument that a pregnant woman, even one who intends to carry the pregnancy to term and give birth, has no obligations whatsoever to the fetus she’s carrying. And I simply cannot accept this, even being staunchly pro-choice.

   Frankly, intent matters, as far as I’m concerned. Just as it’s eminently responsible to abort a fetus with serious defects, it’s equally irresponsible (and, I contend, immoral) to willfully and unnecessarily subject a fetus that serious risk of defects and/or harm if you intend to guide that fetus into life.

   If that’s not the argument you’re making, then I think you need to rephrase. But unless I’m grossly misreading your argument, you see no moral difference between a pregnant woman who takes excellent care of herself (and, by extension, her fetus) throughout the pregnancy, and one who drinks and smokes and abuses drugs during that time. That looks, feels, and smells wrong.

   The non-moral-personhood of the fetus is indeed an incredibly important factor in determining the morality of various actions during pregnancy (including abortion), but I think it’s a mistake to argue that it’s the only relevant factor. And I think this thread is an excellent illustration of that.

10. tgirsch Says:
    July 17th, 2006 at 10:04 PM

    Just to clarify on the above, what I’d argue is that if a pregnant woman wishes to continue to smoke and drink and abuse drugs, she has every right to do so, but if she makes these choices, she has a moral responsibility not to carry her fetus to term, because of the potential for harm to the future moral person.

    And I like the drink/smoke/drug scenario better because it’s a fairly realistic one.

    Now in the question that Serge poses, it’s muddier. Suppose a pregnant woman really wants to have a child, but has severe allergies that can only be effectively treated with chemicals that put the fetus at risk. In that scenario, I’m not willing to say that the woman is morally obligated to choose between keeping the fetus and taking the treatment. That’s the kind of choice she’d have to make for herself (no one can make it for her). I will say, though, that if she takes the treatment and serious defects do show up in the fetus, aborting is probably the right thing to do.

11. Richard Says:
    July 17th, 2006 at 10:43 PM

    “Arguing otherwise – that it’s immoral to do anything to bring to birth a child with foreseeable birth defects – would suggest that it’s immoral to do anything that is suboptimal for a future child.”

    Huh? My claim is merely that causing damage to pre-person bodily materials is harmful to the eventual person, in just the same way as causing damage to their body after it attained personhood would be. That has no implications whatsoever regarding “optimality”. No-one thinks that every single little harm is immoral. (They’re prima facie bad, of course, but might be outweighed by other values like autonomy. It depends how serious the harm is.)

    “Among other things, it would immoral for people who carry genetic defects to have children at all”

    No, re-read my previous comment (or, better, my blog post). I explain there the difference between giving birth and causing defects. In this case, the parents do not cause a defect to a person who could have otherwise lived healthily. The choice is between living with a defect or not living at all. That’s COMPLETELY DIFFERENT from the choice between living with a defect or living without a defect. This same confusion comes into your irrelevant discussion of giving birth into poverty, etc.

    As for being “unrealistic”, I certainly don’t think child abuse is widespread. But it obviously can happen, and it’s just as obviously a bad thing when it does. (I also think it’s pretty plainly PC nonsense that disabilities aren’t bad for you. Or should we allow parents to gratuitously amputate their children’s limbs on a whim?)

12. Lara Says:
    July 17th, 2006 at 10:52 PM

    ” If “nothing in this world is good or bad but thinking makes it so”, then nothing is good or bad except to someone capable of experiencing it.”

    You may have escaped some of what you’re calling ‘bizarre muddles’ by proposing this, but you’ve created new ones in the process. Extending your argument to its bloodiest edge, it would seem that raping someone under general anaesthetic would be a perfectly fine thing to do.

13. Lara Says:
    July 17th, 2006 at 11:00 PM

    KTK: “if, hypothetically, the best drug to treat hypertension also caused birth defects, and the woman was a risk from hypertension during her pregnancy, it would seem perfectly reasonable to give her that drug and accept the risk to the fetus, because there was no better way to minimize the risk to her.”

    You’ve switched things about here, enough to completely change the complexion of the argument. Doctors and mothers routinely weigh up health risks to mother vs health risks to fetus with impunity (bearing in mind I’m mostly familiar with the rather more sensible Australian system here, not the warped bizarrities of certain USAn areas where so-called “fetal rights” might be seen by some to trump a mother’s right to continue living.)

    Hypertension may carry significant risks of maternal stroke, eclampsia, placental abruption, fetal loss, and so on, life-threatening risks; in these cases, the mother’s risk is readily considered more important and immediate than risks to the eventual child.

    Let’s go back to Accutane for a moment …

14. Pejar Says:
    July 18th, 2006 at 1:39 PM

    KTK:

    Woah woah woah.

    do we have obligations to people who don’t even exist yet? The most commonly-accepted answer is that it makes no sense to talk as if we do.

    That is bizarre, because I can see absolutely no merit in that. Let’s say that a childless woman has her dead father’s signet ring, and plans to give it to her firstborn son on his 16th birthday. Another, hearing of her plans, poisons the ring to kill whoever wears it. As expected, the woman has a son eventually, who one day wears the ring. Are you seriously saying that the man has done nothing wrong??? Similarly, say someone sets a bomb in their house to detonate in 150 years’ time. Clearly it will not hurt anyone in existence, so can you be saying that setting the bomb was morally neutral?

    Obviously, examples are far-fetched. But surely just the fact that your philosophy would make traps set for those who are not yet conceived completely fine must send a chill down your spine? It flies counter to all our intuitions. Sure, the harm must be to someone with interests at the time it has its effect, but it need not be initiated during the victim’s lifetime to be wrong.

15. Richard Says:
    July 19th, 2006 at 12:16 AM

    “Sure, the harm must be to someone with interests at the time it has its effect”

    I’m not sure what work the “at the time it has its effect” clause is doing here. All that matters is that the harm must be to someone with interests. The harming event, including all the direct causal “effects”, can occur at earlier times (i.e. with no time-delayed action involved), and nevertheless harm a later person. Consider my wooden statues example: the physical damage is done before the person exists.

    So if by “effects” you mean the event of physical damage, then your claim is false. That event can occur earlier. But perhaps you instead mean the event of having the person “receive” the harm (i.e. “being harmed”, now, by the earlier damage).

    I’m not convinced that harms are the kinds of things which can be temporally located in this way. I explain this in the post linked above. The metaphor of moral harm as a kind of physical “transmission” (from the originating actor to the victim who “receives” it) is potentially misleading. It probably arises from conflating moral harm with physical damage. While of course related, the two should be kept distinct. Otherwise you end up with KTK’s confusions about how harm could “time travel”, etc. Again, my post on ‘the temporal acrobatics of harm‘ clears all that up. (There I explain how, once we ditch the transmission metaphor, there’s nothing particularly mysterious about the possibility of cross-temporal relations of harm. An event E at one time can unproblematically stand in the relation of “E makes X’s life go worse than it otherwise would have” to a person X who exists at a different time. And that’s all that “harm” is.)

16. tgirsch Says:
    July 19th, 2006 at 2:10 PM

    As a side note, I think KTK is learning that if he wants comments, just write controversial posts about abortion and fetal ethics all the time.

    Still waiting for some responses, by the way. I think some folks (myself not included) have made some excellent points here.

17. Kevin T. Keith Says:
    July 19th, 2006 at 8:18 PM

    Yes, there is some excellent stuff here, and on Pejar’s and Richard’s blogs.

    I admit the force of these counterexamples. Certainly you can do harm to people by way of acts that take affect only later – such as the time bomb. And the step from that to the conclusion you can do harm to people who do not exist at all, or as persons at the time of your act seems clear as well. It seems very clear that we can’t allow people to set harmful acts in motion simply because they have a long time horizon.

    But I harbor the intuition that a moral obligation must be an obligation to somebody, and that makes it hard to assign such obligations when the person in question does not exist, or may not ever exist.

    Unfortunately, this is piling up faster than I can respond to it all, and, as I say, I also admit I have to re-think my position somewhat.I was probably hasty in at least some of what I said before.

    Thanks very much for all the input; I’ll try to do it justice, but need to regroup a bit.

18. Richard Says:
    July 19th, 2006 at 10:18 PM

    Let me add: thanks for starting such a stimulating discussion!

19. Pejar Says:
    July 20th, 2006 at 9:37 AM

    I definitely agree that this is an interesting discussion, and I think there’s something particular about it has put it a step above the normal pro-life v. pro-choice shouting matches. That is that the debate about causing birth defects has basically been within the pro-choice side. While pro-lifers (like Serge) have quite admirably explained why they think that being anti-birth defects must mean anti-abortion, in essence the pro-life view is obvious here, and the debate is from the starting point that abortion is acceptable.

    Now of course there needs to be the fundamental abortion debate, but I’m glad that that those of us on the pro-choice side can debate each other about related issues to try to develop our ethical views. It helps to keep us consistent and honest and to learn to stay civil in such debates.

    I can’t help being curious – does the pro-life community have these kind of internal debates too?

20. Daniel Says:
    August 4th, 2007 at 12:03 PM

    I have to say, that I could not agree with you in 100% regarding Obligations to the Fetus, but it’s just my opinion, which could be wrong

Leave a Reply

Logged in as . Logout »