Handout 1: Outline of Four Ethical Positions on the Status of the Embryo and Developing Fetus

(From Hope, T. and Savulescu, J. Medical Ethics and Law: the Core Curriculum.)

We will use the term “abortion” in the normal, but not the medical sense, to mean the intentional termination of pregnancy with the resulting death of the embryo or fetus. At the heart of much of the debate around abortion, embryo experimentation and in vitro fertilisation is the question of the moral status of the embryo and fetus. Is it wrong to kill human embryos and fetuses, and if it is, is that wrong significant enough to outweigh other goods?

Many different positions are taken on this issue. What is agreed by all is that there are very few justifications, if any, for killing a child or adult. Such killing is a serious wrong. The child (normally) develops from the fertilised egg. At what stage in the development of the human organism from egg to child does it become a significant wrong to kill the organism? Some answer this question through identifying a point in the developmental process when such killing passes from being morally unimportant (or almost so) to being morally extremely serious - on a par with the killing of a child. Others deny that there is a point at which there is a sudden large change in moral status. Instead, through the developmental period, the wrong of killing increases so that there has to be increasing justification for allowing an abortion. Whichever of these two positions is taken, grounds have to be given for why it is that the moral status is different at different times in development.

Four views on what is important in determining the moral status of the embryo

There are four main positions that have been taken on the issue of what determines the moral status of the embryo and fetus.

1. Identity as a human organism

According to this view there are essentially no good grounds for according a different moral status to the human being at different stages in its development. If it is wrong to kill the child then it would have been just as wrong to kill that child at any stage in its existence. The fundamental reason is that the embryo is the same entity - it has the same identity - as the child into which it develops.

Most supporters of this position put the moment at when the embryo attains full moral status as conception. Prior to conception neither the egg nor the sperm can be said to have the same identity as the later child. But once conception has taken place the organism that will be the child has come into existence.

Even if one holds this fundamental position there is a problem with claiming that the fertilised egg has the same identity as the later child. This is because of the phenomenon of twinning. Suppose the single celled fertilised egg A, divides into two cells B and C (which it normally does) and those two cells then split from one another to go on to form different complete human organisms. When did B and C begin to exist? By the rules of identity, if B and C each have the same identity as A then they would have the same identity as each other. This would lead to the absurd conclusion that identical twins have the same identity (are the same person) as each other. This argument leads to the conclusion that B and C did not come into existence until after A had divided. At least in the case of twins, therefore, each twin did not start to exist until twinning is complete. Some philosophers have used this example to argue that we cannot be said to exist until the potential for twinning is lost. It is thought that twinning ceases to be a possibility at about 14 days after conception. This, therefore, might be the point at which the embryo achieves full moral status according to those who believe that the key issue is identity as a human organism.

One variant on this view draws an analogy with an amoeba. When an amoeba divides it ceases to exist and is replaced by its own qualitatively identical daughter cells. No individual persists through these divisions. Only when cell differentiation starts to occur, and the different cells engage in co-ordinated activity, do the cells together constitute an individual that can be said to have the same identity as the later child. On this view, therefore, it is the time of first differentiation, rather than the last time of possible twinning, that constitutes the point when the moral status of the embryo changes.

2. The potential to be a person

There is another criterion that is normally taken to put the point of moral status at conception. This is the argument from potentiality. This argument goes as follows. It is wrong to kill a child. If you kill an embryo or fetus, at any stage, you are carrying out an act that will have the effect that the potential future child will not exist. You are in effect killing a potential child. This argument differs from the argument from human identity (above) in that it does not accord fetuses and embryos moral status for what they are but because of what they have the potential to become. According to the argument from human identity killing the fetus is wrong because you are killing something that has the right to live. According to the argument from potential, killing the fetus is wrong because it involves carrying out an act that will have the effect of preventing a future person from existing.

The argument from potentiality has two main problems. The first is that potential X's do not have the same rights as X's. A medical student (potential doctor) does not have the same rights as a doctor; nor a prince the same rights as a king. The second problem is that the argument is likely to prove too much. A single sperm about to be injected into an egg constitutes a potential person. But it seems absurd to object to the disposal of either the egg or the sperm on the grounds that they constitute a potential person. Furthermore each couple could give birth to many potential people. Contraception and sexual abstinence both prevent some of these potential persons from coming into existence. Are they therefore morally wrong?

Cloning raises new problems for the appeal to potentiality. Somatic cells, such as those that can be scraped from the inside of the cheek, have the potential to give rise to people through cloning. Such cells (indeed all somatic human cells) are potential people. It would be absurd to suggest that destroying such cells, and therefore destroying potential people, would be (a serious) wrong.

3. Identity as a person

The view that an embryo, from the point of conception, has the same moral status as a child, is sometimes called the right-to-life, or the pro-life position. The main alternative is the view that the moral status of an embryo depends on its properties, and not on its identity or potential. This view is often expressed as follows: it is very wrong to kill a person (in most situations), but a human embryo is not a person. A person is a human being that has certain characteristics. An embryo or fetus (or baby) is a moral entity at the point when it becomes a person. The important moral issue is therefore: what determines the stage during development when a human organism becomes a person?

Many different answers have been given to this question. Most proponents of this approach hold that being a person must involve some degree of consciousness. We, as persons, are conscious minds as well as physical bodies. Conscious life it is thought, or at least the perception of pain, starts at about 24 weeks. On most forms of this view, therefore, fetuses less than 24 weeks do not have moral status.

However, consciousness in the sense of feeling pain seems a rather minimal condition for being a person. Even quite primitive animals feel pain and yet we do not accord them anything like the status of human persons in terms of the morality of killing. Some philosophers have focussed on self-consciousness as the hallmark of being a person.

Tooley and Singer have argued that it is not morally wrong to kill human beings until those human beings have self-consciousness - an idea of themselves existing across time, with plans and hopes for the future. Human beings do not become self-conscious (it is believed) until some time in the first year of life. These philosophers argue that what is wrong with killing a self-conscious being is the frustration of those desires that the being has for its own future; its future-directed plans and goals. Beings that are not self-conscious have no such desires for their own futures.

Singer's position is closely related to the issue of the moral status of animals. He argues that those who hold a right-to-life position do not generally believe that killing non-human animals is wrong (or at least nothing like as wrong as killing a fetus). What is it, Singer asks, that distinguishes a human being from a non-human animal, such that the one has a strong right to life and the other does not? Singer argues that differences such as the number of chromosomes cannot by themselves ground such a moral difference. Neither can the fact that people look different from animals. The difference, he claims, that justifies treating humans differently from most (or all) other animals is that humans are self-conscious and have a conception of themselves as existing in time with plans and hopes for that self. It is wrong to frustrate these desires by killing that person.

Many philosophers who take the same general view reject Singer's particular criterion. Other candidates for the mental capacities that are important to being a person include rationality (the ability to reason) and the ability to form relationships. Some religious traditions confer moral status at the point when the soul enters the body (ensoulment). Various times, from conception to birth, have been proposed as the moment of ensoulment. The problem with this position is providing objective criteria for identifying that moment.

4. The value given to the human organism by others is crucial (conferred moral status)

Some have argued that moral status need not be based only on intrinsic properties of the entity (position 3 above), but that it can be conferred by others. Benn and Feinberg have argued that conferring moral status at birth can be justified in terms of the consequences for others and in terms of fostering concern, warmth and sympathy for others. Feinberg argues that it is because infants are so similar to persons that we should confer status on them in a symbolic way. Englehardt argues that at birth the infant takes on an important social role and that this justifies conferring moral status.

On all these closely related views, a strong prohibition on killing infants is justified both because those close to the infant care strongly for it, and because without such strong prohibition there is a danger that we will relax the strong prohibition on killing older babies and children. It is for these reasons that killing a human infant, or a child with severe learning difficulties, is morally more serious than killing an animal (such as an adult ape), even if the non-human animal possesses more of the morally important features of a person.

Problems with these four views

Each of the four views outlined above faces problems, which is why the issue of abortion remains so difficult.

The first position confers moral status on what is just one cell or a few cells. It implies that killing that cell (or that early embryo) is, from a moral point of view, the same as killing a ten-year-old child. Such a position faces particular difficulties when the reasons a woman has for wanting an abortion are very powerful – for example that she has become pregnant as a result of rape. This view also implies that taking post-coital contraception (such as the “morning after” pill) or using an intra-uterine contraceptive device amounts, morally, to murdering an adult. The second position faces the same difficulties as the first, and in addition the other problems outlined above.

If the first two positions appear to give too much moral protection to very early embryos, the third position may give too little protection to infants and people with severe learning difficulties. It also faces problems in justifying the particular feature, or group of features, that is taken to characterise a person.

The fourth position helps justify some of our intuitions about the moral importance of infants. However, to many it seems to justify these intuitions for the wrong reasons. It seems to suggest that we should not kill an infant on grounds such that the infant’s parents (and a few others) would be terribly upset. For many this is not the fundamental reason why we should not kill new-born children.

One view that is intuitively attractive to many people is that the moral status of the fetus develops as the fetus itself develops. On this view, it may be wrong to kill even an early fetus, but the degree of wrong would be very much less than killing a late fetus. Furthermore the grounds that would justify killing a fetus need to become stronger and stronger as the fetus develops. Parental convenience may be sufficient to justify the abortion of an early fetus, but it would need something much more significant to justify the abortion of an older fetus. Such a position is not easily compatible with either of the first two positions. However the third and fourth positions can readily be adapted to allow the idea that the concept of a person, whether based on internal criteria or conferred by others, or a mixture of both, can admit of degrees; and that therefore the wrong in killing a fetus can change through development.

Beyond the status of the embryo

Despite the wide range of quite different views on abortion considered above, they all share one assumption. This assumption is that, if the fetus had the same moral status as, say, a normal adult, then it would be (almost always) wrong for a woman to have an abortion, and (almost always) right for the state to prevent the woman from having an abortion. Thomson (1971) denies this assumption.

The case of the connected violinist

Imagine that you wake up one day with your circulatory system connected to another person. It transpires that you are connected to a famous violinist. This man has a fatal kidney condition. However, if he remains connected to your circulatory system, he will eventually be cured. You are the only person who can save his life. His fans have kidnapped you and connected you up. “But,” they say, “good news. It is only for nine months and then he will be fully recovered and you can be disconnected.”

Thomson argues that it would be highly laudable if you were to choose to remain connected to the violinist, and thus save his life, but you are not morally required to remain connected, even though the violinist has a right to life.

The assumption that the morality of abortion is determined by the issue of the moral status of the fetus is challenged by Thomson (1971).

The key point of this analogy is first, to suggest that carrying out an act that leads to the death of a person is not necessarily the same, morally, as killing that person; and second, that for a woman to have an abortion is an act that is not the same as killing. Thus the abortion debate should not depend exclusively on the issue of the moral status of the embryo.

Many feminists argue that a woman has a right to choose abortion on more general principles. Benschof (1985) claims that a right to choose abortion is grounded in a right to “privacy, autonomy and bodily integrity.” Petchesky (1985) argues that decisions about abortion should place more emphasis on the social situations that place women in a situation of seeking an abortion (see figure 1), and should give central emphasis to their own moral judgements. Warren (1991) argues that making abortion illegal fails to respect women’s rights to liberty, self-determination and freedom from bodily harm, since carrying a pregnancy is arduous and risky (see also Warren 1988, Purdy 1996, Holmes and Purdy 1992).

References

Thomson J J. 1971. A Defence of Abortion. Philosophy and Public Affairs, Princeton University Press. Reprinted in: Singer P (Ed), 1986. Applied Ethics. Oxford University Press. Oxford

Benschof J. 1985. Reasserting Women’s Rights. In: Late Aabortion and Technological Advances in Fetal Viability. Family Planning Perspectives. 17:160-4.

Petchesky R. 1985. Abortion and Women’s Choice. Northeastern University Press. Boston, USA.

Warren M A. 1991. Abortion. In: Singer P (Ed). A Companion to Ethics. Basil Blackwell. Oxford. pp 303-14 and 303.

Purdy L M. 1996. Reproducing Persons: Issues in Feminist Bioethics, Ithaca: Cornell University Press.

Holmes H B., Purdy L M. (Eds). 1992. Feminist Perspectives in Medical Ethics. Indiana University Press; Bloomington.

For further information on Termination of Pregnancy:

• the UK Clinical Ethics Network web site has a detailed discussion around these issues .
• Hope T, Savulescu J, and Hendrick J - Medical Ethics and Law : the Core Curriculum. Edinburgh: Churchill Livingstone, Elsevier Science, 2003. The main text book used for the University of Oxford Medical Ethics and Law course provides more details for both teachers and their students.
• Hope T - Medical Ethics; a Very Short Introduction. Oxford: Oxford University Press, 2004.
• Ashcroft A, Lucassen A, Parker M, Verkerk M, and Widdershoven G - Case Analysis in Clinical Ethics. Cambridge: Cambridge University Press, 2005.