Moral, legal, and health considerations surrounding selective reduction do not diminish the happiness in vitro fertilization (IVF) has brought in the form of over 2 million live births since the world’s first test-tube baby, Louise Brown, in 1978.[1] However, at what cost is this happiness? Must some fetuses be sacrificed to achieve those millions of happy, healthy births? Bentham teaches that all decisions we make are for the purpose of maximizing pleasure and minimizing pain. This principle of utility states that a “right” action is one that results in the greatest amount of happiness and least amount of pain that can be achieved. When multiple entities are involved, the greatest happiness that can be achieved – or sum total of happiness – for the greatest number of people is the ideal.[2] [3] In order to achieve this ideal, some believe that selective reduction maximizes utility with regard to the sum total of what is best for the health, survivability, and/or quality of life for both the mother and unborn fetus(es).
Classical utilitarians (act utilitarians) represent this concept as a sum total of maximum happiness among all involved and would agree that if it is necessary to sacrifice one or some for the happiness of all, then so be it.[4] [5] Thus, a rule utilitarian – just like a steadfast selective reduction or abortion opponent – would not agree that happiness and well-being should occur at the expense of sacrificing any fetuses to achieve healthy births.[6] It is likely that these people will never be convinced of the utility of selective reduction. On the contrary, selective reduction opponents who adopt the negative utilitarian view[7] can likely be convinced of the utility of selective reduction in that harm should be minimized whenever possible, including when carrying a multiple pregnancy to term would result in harm to the mother and/or fetus. Similarly, these are usually the abortion opponents who would consider abortion if the life of the mother were at risk or in the case of rape in which physical, psychological, and/or emotional harm have been inflicted upon the mother.
Unfortunately, the “sum total of happiness” utilitarian result is not necessarily fair. Fairness implies that the rights of all parties involved are honored and respected. However, it seems that with selective reduction a mother’s right to terminate the life of the fetus is greater than that of the right of the fetus to live. Since fairness is compromised, it is highly likely that the rights of one or more parties may be compromised, as well, for the sake of achieving a utility.
Dorkina Myrick, MD, PhD, MPP, is a physician-scientist and pathologist trained at the National Institutes of Health. Dr. Myrick also previously served as a Senior Health Policy Advisor on the United States Senate. She obtained her Master of Public Policy degree at the University of Oxford in Oxford, England. Dr. Myrick is currently a JD candidate at the Boston University School of Law.
References:
[1] Evans, Mark et al. “Fetal Reduction: 25 Years’ Experience.” Fetal Diagnosis and Therapy. 35:69-82. 2014. Online: https://www.karger.com/Article/Pdf/357974.
[2] An Introduction to the Principles of Morals and Legislation. Bentham, Jeremy. 1789.
[3] Id.
[4] “The History of Utilitarianism: 2. The Classical Approach.” Stanford Encyclopedia of Philosophy. http://plato.stanford.edu/entries/utilitarianism-history/#ClaApp. First published Fri Mar 27, 2009; substantive revision Mon Sep 22, 2014
[5]Eggleston, Ben. “Chapter 6 – Act Utilitarianism.” The Cambridge Companion to Utilitarianism. Cambridge University Press. eds. Ben Eggleston and Dale Miller. pp.125-145. February 2014.
[6] Miller, Dale. “Chapter 7 – Rule Utilitarianism.” The Cambridge Companion to Utilitarianism. Cambridge University Press. eds. Ben Eggleston and Dale Miller. pp.146-165. February 2014.
[7] H. B. Acton and J. W. N. Watkins. “Symposium: Negative Utilitarianism.” Proceedings of the Aristotelian Society, Supplementary Volumes. Vol. 37 (1963), pp. 83-114
Reflections and Analysis in Law, Policy and Medicine 