Abortion, Infanticide and Allowing Babies To Die, 40 Years On
Abortion, Infanticide and Allowing Babies To Die, 40 Years On
Abortion, Infanticide and Allowing Babies To Die, 40 Years On
com
Editorial
Editorial
perhaps a little longer, because Jodie’s Another medical practice and example these five have contributed to this issue.
heart will eventually fail.7 of selective non-treatment that results in McMahan argues that the permissibility
the death of patients is the withholding of of infanticide in some circumstances is not
The High Court authorised surgical
life-sustaining medical treatment. Recent only implied by certain theories, but by
separation, knowing that this would kill
articles10 11 and newspaper coverage12 beliefs that are widely held and difficult to
Mary. The legal justification for this is
draw attention to the practice of not reject.22 Michael Tooley’s book is entitled
striking.
feeding severely disabled newborns. Abortion and infanticide. Peter Singer
Mary may have a right to life, but she has Arguably, this is morally equivalent to wrote a book in 1985 with Helga Kuhse
little right to be alive. She is alive because infanticide which, if it occurred outside of called Should the baby live?
and only because, to put it bluntly, but medical practice, might be referred to as Over the last 40 years, there has been
nonetheless accurately, she sucks the life- ‘starving a baby to death’ for this reason. an active debate on the ethics of killing or
blood of Jodie and she sucks the life- If a mother neglected to feed her disabled allowing severely ill or disabled newborns
blood out of Jodie. She will survive only baby, she would usually be guilty of a to die. Jonathan Glover’s landmark
so long as Jodie survives. Jodie will not criminal act. The medical practices of Causing death and saving lives notes that
survive long because constitutionally she
‘allowing newborns to die’ are the topics ‘Dr Francis Crick (the Nobel Laureate
will not be able to cope. Mary’s parasitic
living will be the cause of Jodie’s ceasing
of ongoing ethical debate but are a part of who discovered DNA with Jim Watson in
to live. If Jodie could speak, she would common medical practice and have been 1956) once proposed a two-day period
surely protest, ‘Stop it, Mary, you’re for several decades.2 4 13 Discussions of for detecting abnormalities, after which
killing me’. Mary would have no answer infanticide should be contextualised in infanticide would not be permissible’.22
to that. Into my scales of fairness and those practices that end life, which society Such debates are a continuation of very
justice between the children goes the fact already accepts, even if they are euphemis- ancient theological and philosophical
that nobody but the doctors can help tically redescribed. debates on abortion, on whether there is a
Jodie. Mary is beyond help. There is a vigorous body of literature moral difference between the effects of
on whether acts resulting in death (active acts and omissions, on ‘ordinary and
Hence I am in no doubt at all that the
scales come down heavily in Jodie’s euthanasia) are morally equivalent to extraordinary means’ and on ‘double
favour. The best interests of the twins is omissions resulting in death (passive effect’—whether there is a moral differ-
to give the chance of life to the child euthanasia). Some philosophers have ence between the effects of actions that
whose actual bodily condition is capable argued that there is no moral difference,14 are intentional and those that are merely
of accepting the chance to her advantage while others continue to dispute this. foreseen, but not intended.
even if that has to be at the cost of the Philippa Foot famously argued that to fail In the case of abortion, termination of
sacrifice of the life which is so unnatur- to send a food parcel to a starving child is pregnancy is now permissible in many
ally supported. I am wholly satisfied that not morally equivalent to sending a poi- countries not only for severe disability but
the least detrimental choice, balancing
soned food parcel.15 This is a long- also for reasons of maternal welfare (or
the interests of Mary against Jodie and
standing debate but does not need to be other reasons). Giubilini and Minerva
Jodie against Mary, is to permit the
operation to be performed.8 resolved to recognise that human beings’ extend the long-running debate on
(including infants’) lives are intentionally infanticide to ask: if abortion is permis-
This was, in my view, the correct judge- shortened in our society. For even if omis- sible both for social as well as medical
ment and separation was in the interests sions were morally different from actions, reasons, why is infanticide permissible
of Jodie, much more so than it was and so withholding life-sustaining treat- only for medical reasons (assuming that
against the interests of Mary. But it is also ment morally different from killing, the selective non-treatment is a form of
my view that it is a convenient fiction to withdrawing of medical treatment is an infanticide)? They ask: what is the moral
describe Mary as a parasite using Jodie’s intentional action,4 16 though this is difference between a fetus and a neonate?
body as a ‘life-support machine,’ as neo- denied by some.6 7 Withdrawing medical As McMahan points out in this issue,
natal surgeon Adrian Bianchi reportedly treatment might be like a person acting to there is at least a 4-month period during
said.9 intercept a food parcel sent to a starving which a human being could be either a
Conjoined twins arise when a single child, intentionally causing the death of fetus or an infant, depending on whether
embryo fails to completely divide into that child. It is an intentional act that delivery has yet taken place.23 Giubilini
identical twins. Both Mary and Jodie knowingly causes the death of the child. and Minerva point out that both have
arose from the same single embryo. Even if we can ignore omissions resulting similar capacities and if one is permissible,
Neither has a greater claim on the shared in death, it is important to ethically evalu- why not the other? The presence of
organs. Thus, it is my own view that it is ate the practice of the withdrawal of disease or disability should not make a
not ‘accurate’ to describe Mary as killing medical treatment that results in death. difference to moral status, so if infanticide
Jodie. They were both dying because their The ethical discussion of infanticide is permissible for medical reasons, why is
anatomy and physiology, as it happened dates back several thousand years. At least it not permissible for social reasons?
to develop, could not support both of 100 articles have been published on Their extension of the existing debate
their lives. The common artery no more infanticide in the Journal of Medical about infanticide from medical indications
belonged to Jodie than to Mary. There Ethics over its rather shorter history, with to social indications is relatively novel.
were two brains, and so two minds, articles both for and many against it. I personally don’t agree with the authors’
sharing vital parts. Mary was killed, sub- Some of the world’s most famous living conclusion. (One obvious difference
jected to infanticide, to save Jodie. Of philosophers have written about its merits between early abortion and infanticide is
course, Lord Justice Ward did not accept and justification over the last 40 years, that infanticide involves killing a human
this view, seeing one twin, Mary, as an including Michael Tooley,17 Jonathan being who could be adopted or cared for
aggressor against whom her sister needed Glover,18 Peter Singer,13 19 Jeff by people other than the mother. Indeed,
to be protected by the Court. McMahan5 20 and John Harris.21 Four of I have previously argued on this basis that
Editorial
we should encourage the donation of controversial and important topic by pro- 7 In Re A (Children) (Conjoined Twins: Surgical
excess frozen embryos produced by IVF viding a range of arguments from a Separation) [2001] Fam. 147, 155.
8 In Re A (Children) (Conjoined Twins: Surgical
to non-genetically related parents rather variety of perspectives. We have tried to Separation) [2001] Fam. 147, 197.
than discarding them.24) The important be as inclusive as possible and provided a 9 Boseley S. Law Decided Fate of Mary and Jodie. The
debate is rather about the nature, permis- double issue to include as many as pos- Guardian, 5 Feb 2002. http://www.guardian.co.uk/uk/
sibility and limits of euthanasia in society. sible of the submissions we received. 2002/feb/05/sarahboseley (accessed 4 Feb 2013).
10 Hellmann J, Williams C, Ives-Baine L, et al.
But their arguments—based on the similar Infanticide is an important issue and
Withdrawal of artificial nutrition and hydration in the
moral status of the fetus and neonate— one worthy of scholarly attention because Neonatal Intensive Care Unit: parental perspectives.
call for rebuttal. (Of course their argu- it touches on an area of concern that few Arch Dis Child Fetal Neonatal Ed 2013;98(1):F21–5.
ment can cut both ways—I understand societies have had the courage to tackle 11 Anonymous. How it feels to withdraw feeding from
that one relatively common response honestly and openly: euthanasia. We hope newborn babies. Br Med J 2012;345:e7319.
12 Reid S, Caldwell S. Now sick babies go on death
amongst the online community was to that the papers in this issue will stimulate pathway: Doctor’s haunting testimony reveals how
assume the paper was written from a ethical reflection on practices of euthan- children are put on end-of-life plan. Mail Online,
pro-life perspective as a reductio ad absur- asia that are occurring and its proper justi- 28 Nov 2012. http://www.dailymail.co.uk/news/
dum of the permissibility of abortion.) fication and limits. article-2240075/Now-sick-babies-death-pathway-
Doctors-haunting-testimony-reveals-children-
Giubilini and Minerva’s paper was
Contributors Thanks to Ingmar Persson, Jeff end-life-plan.html (accessed 4 Feb 2013).
handled by Associate Editor Professor 13 Kuhse H, Singer P. Should the baby live? The
McMahan, Peter Singer, Raanan Gillon, Guy Kahane,
Ken Boyd, a distinguished theologian and Imogen Goold, Tom Douglas and Dominic Wilkinson. problem of handicapped infants. Oxford: Oxford
medical ethicist with over 10 years editor- University Press, 1985.
Competing interests None. 14 Rachels J. Active and passive euthanasia. N Engl J
ial experience with the Journal. It was
Provenance and peer review Commissioned; Med 1975;292:78–8.
scrutinised by three peer reviewers and 15 Glover J. Causing death and saving lives.
internally peer reviewed.
revised in light of their comments. The Harmondsworth: Penguin, 1977: 93.
To cite Savulescu J. J Med Ethics 2013;39:257–259.
Journal neither publishes nor declines to 16 Persson I, Savulescu J. McMahan on the withdrawal
publish articles because of the controver- Received 4 February 2013 of life-prolonging aid. Philosophical Books
sial nature of their conclusion; rather, edi- Accepted 26 February 2013 2005;46:11–22.
17 Tooley M. Abortion and infanticide. Philos Public Aff
torial decisions are made on the basis of J Med Ethics 2013;39:257–259.
1972;2:37–65.
the quality of the argument. If an argu- doi:10.1136/medethics-2013-101404
18 Glover J. Causing death and saving lives.
ment were based on clearly mistaken Harmondsworth: Penguin, 1977.
premises or obvious failings in logic, then REFERENCES 19 Singer P. Practical ethics. Cambridge: Cambridge
1 Giubilini A, Minerva F. After-birth abortion: why University Press, 1979.
we would expect the review process to should the baby live? J Med Ethics 2013;39:261–3. 20 McMahan J. Infanticide. Utilitas 2007;19:131–59.
detect it and require its correction or 2 Verhagen AAE. The Groningen Protocol for newborn 21 Harris J. Ethical problems in the management of
reject the paper. But in this case, there has euthanasia; which way did the slippery slope tilt?. some severely handicapped children. J Med Ethics
been a long and ongoing debate on the J Med Ethics 2013;39:293–5. 1981;7:117–24.
3 Verhagen AAE, Janvier A, Leuthner SR, et al. 22 Glover J. Causing death and saving lives.
moral status of early human life—includ- Categorizing neonatal deaths: a cross-cultural study Harmondsworth: Penguin, 1977;168.
ing neonates—and many protagonists in in the United States, Canada, and The Netherlands. 23 McMahan J. Infanticide and moral consistency.
this debate have taken the same premises J Pediatr 2010;156:33–7. J Med Ethics 2013;39:273–80.
seriously, or even endorsed them, and 4 Young R. Medically assisted death. Cambridge: 24 Fuscaldo G, Savulescu J. Spare embryos: 3000 reasons
Cambridge University Press, 2007. to rethink the significance of genetic relatedness.
have made similar logical inferences.
5 McMahan J. The ethics of killing. Oxford: Oxford Reprod Biomed Online 2005;10:164–8.
The Journal aims in this issue to University Press, 2002.
promote further and more extensive 6 Kamm F. Morality, mortality. Oxford: Oxford
rational debate concerning this University Press, 1996: vol. II.
These include:
References This article cites 10 articles, 4 of which you can access for free at:
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Notes