Selective Reduction of Multiple Pregnancy: Lifeboat Ethics in the Womb

Abstract

Selective reduction of multiple pregnancy is a medical procedure used during the first trimester to reduce a multifetal pregnancy to produce a twin or singleton birth. The technique is used increasingly to manage multiple pregnancies that result from fertility treatment, including ovulation induction and IVF. This article explores the medical, legal, and ethical aspect of selective reduction, acknowledging throughout the relationship between this treatment for multifetal pregnancy and abortion. Following an update of the medical literature in Part I, Part II focuses on the intent of the parties participating in selective reduction and abortion. A woman undergoing a "traditional" abortion intends that her entire pregnancy will be terminated: that following successful completion of the procedure she will no longer be pregnant. In contrast, a woman undergoing selective reduction intends that her pregnancy will not be terminated, but rather will be enhanced by creating a better environment for her fetus(es) to develop. The difference in intent so separates these two procedures as to render them wholly distinguishable. This distinction should be maintained in the policy-making and political arenas that swirl around the abortion issue. To allow selective reduction to be swallowed up in the abortion debate would be to bury it in the political process much the way other seemingly abortion-related technologies have been buried.

Part III of this Article looks at the ethical and moral dilemmas raised by selective reduction. At issue is a basic question pondered over time by moral philosophers and others: Is it ever right to do harm to one just to benefit another. American jurisprudence has often prided itself on protecting the individual from being invaded and hurt by another, reasoning that in a free society, every individual has a right to bodily security. This principle comes sharply into focus when one person asks another to submit to an intrusion of extraction of her body for the sake of the other. Generally, our jurisprudence has denied requests from those in need of rescue, in the form of medical treatment or otherwise, from gaining forced access into another's bodily integrity. Do our hard-wrought concepts on jurisprudence, including the mandate against forced rescue and the duty to do no harm to others, make us bristle at the thought of selective reduction. While these areas of the law serve as relevant analogies, in the end selective reduction must be viewed as the unique scenario that it is -- a lifeboat in the womb in which some must die for the others to live.