Examining the thorny moral problem of foetal reduction

Michael Cook*

It is a truth universally acknowledged that defending an opinion on abortion will make at least half of one’s readers unhappy. But Joona Räsänen, a Finnish bioethicist at the University of Oslo, defends an opinion on abortion in the Journal of Medical Ethics which is bound to make all of them unhappy.

He tackles the controversial question of foetal reduction: killing one or more foetuses in a multiple pregnancy. This may happen when one of them is diseased or has a birth defect or when the mother feels incapable of caring for more than one child. It often happens after IVF when a woman ends up with triplets or quadruplets – or even octuplets. Some doctors have refused to “reduce” the pregnancies because they regard it as immoral.

Räsänen points out that most people nowadays have two contradictory intuitions: that abortion is permissible and that killing one of two foetuses is not. This seems to imply that killing twin foetuses is moral while killing one is not – which seems counterintuitive.

He is not questioning a woman’s right to abortion. Abortion is always a woman’s decision, he says, but the woman still must face up to the ethical conundrum: save both, terminate one, or terminate both.

What is Räsänen’s proposal? It’s an unexpected blend of pro-life and pro-choice elements, which is bound to upset both:

So here is a suggestion: gestate both fetuses and give the other one for adoption. This conclusion might disturb some—it certainly disturbs me. I admit that separating twins raises their own set of ethical issues but it cannot possibly be worse for the child to become separated from her twin sibling than to have the sibling killed.

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