Revisiting the "after-birth abortion" controversy

In late February last year, two Italian academics working at Monash University in Australia flicked a match into a highly combustible pile of old abortion debates, caricatures of pointy-headed academics, news-hungry journalists and recycled Go-Home-Peter-Singer posters.
The controversy continued for weeks. The authors, Alberto Giubilini and Francesca Minerva, received hundreds of emails, some of them containing death threats. They were denounced in the United States Congress.
Their article in the UK-based Journal of Medical Ethics was “After-birth abortion: why should the baby live?” It wasn’t a very original argument for the morality of infanticide – philosophers Peter Singer and Michael Tooley had made the same point decades ago – but the arresting title tossed even more petrol on the blaze. The authors contended that the reasons which justify abortion are sufficient also to justify killing a child up for an unspecified time after birth.
This month the JME, a redoubt of utilitarian ethics, responded to the crisis with a special issue containing 31 commentaries from a range of ethicists, some of whom have argued for years that infanticide can be a moral action; others who believe that even suggesting it is a vile stain on academic integrity.
We asked bioethicist Shimon Glick, of the Jakobovits Center for Jewish Medical Ethics in Israel, to comment on the controversy.

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MercatorNet: The concept of the “slippery slope” is ridiculed by many bioethicists. Is is something real? Shimon Glick: In my opinion the "slippery slope" is very real, in spite of the various bioethicists who seem to deny its existence. It is a fact of human nature, not confined to the field of bioethics. In the criminal world we have the teenager who starts with minor pilfering, and progresses to much more serious crimes, which he would never have considered at the start.
In the field of bioethics there has been a steady "progression" from removal of the respirator from the Quinlan girl, to which the physicians objected, to almost universal acceptance of withdrawing even food and liquids from individuals in a vegetative state, to active euthanasia.
In the field of active euthanasia at the onset I remember Dr Pieter Admiraal , one of the earliest Dutch advocates of this procedure, telling us at a special meeting on end-of-life of all the precautions taken to see that the process is initiated voluntarily by an adult competent patient etc.
Two years later at a follow-up meeting, Dr Norman Fost, a paediatrician ethicist, asked Admiraal what was the youngest age at which euthanasia was performed. When Admiral said "two years old" an audible gasp was heard from the gathered ethicists.
The physician who was featured in the Dutch film, Death on Request, to illustrate the ideal way the procedure was carried out, was convicted in the Netherlands several years later for killing a patient in violation of many of the touted precautions.
Finally I once participated in a panel with a Dutch physician who was asked by my colleague, how it felt to kill a patient. He replied, "The first time it was difficult".
But the slippery slope could not be verbalized any better than did Giubilini and  Minerva that since we already permit abortion in late pregnancy and since the newborn has no more right to life than the fetus we should be able to carry out "post-birth abortion" MercatorNet: Is the publication of a proposal for "after-birth abortion" really analogous to the behaviour of Nazi physicians? Shimon Glick: I have always refrained from comparing almost any act in the field of bioethics to Nazi behavior, because the latter is almost sui generis, so far beyond the pale, that it is almost obscene to make the comparison.
But when one begins to propose the possibility of killing a perfectly normal infant because he/she may create problems for the family, one comes too close to the murder of the thousands of Aryans in Germany who were declared a burden to society. I feel certain that the authors Giubilini and Minerva are far from Nazi physicians, but unfortunately the principle they adopt comes dangerously close. MercatorNet: What has changed in the bioethical climate since the 1960s? Shimon Glick: In a conference some quarter of a century ago on the marginalization of religion in bioethics Daniel Callahan described the major change in the field was one of secularization. Ramsey, Jakobovits and their like were clergymen, and to a large extent they launched the field.
In my days in medical school (I graduated in New York in 1955) medical ethics did not appear in the curriculum of most American medical schools, except for the five Catholic ones. With the secularization of the field one must seek new bases for ethics, a very serious undertaking, and not an easy or obvious one. If one bases one’s ethics purely on biology and on utilitarianism one can go very far astray from the classic values of ethics and of medicine and in the wrong direction.  MercatorNet: The touchstone of morality is said to be autonomous decision-making when touch decisions have to be taken in hospitals. Do you think that there are any problems with this? Shimon Glick: The contribution of the concept of autonomy to the practice of medicine is a valuable and positive one. It empowers the patient and prevents the overbearing arrogance of the physician. It certainly is essential in today's society where medical information is available to all, and autonomy is a cherished value in everyday life. Should it be unlimited in medicine? I believe there is room for some exceptions, which I have described in a 1997 article of mine in the New England Journal of Medicine, “Unlimited human autonomy-a cultural bias”, in which I describe the unique clause in Israel's patients' rights law.
A similar episode of violation of autonomy is described in a 1999 article by Dr Atul Gawande's articles in the  New Yorker magazine. MercatorNet: You argue that society should maintain “the incommensurate and unique value assigned to human life, even if the religious roots are weakened”. How can you argue that in a pluralist society? Shimon Glick: I believe that abandoning the traditional incommensurate and unique value assigned to human life has the potential of disastrous consequences, as witnessed in the past century's experiences with both fascism and communism. It will also wreak havoc with the trust which patients have had in physicians over the centuries. MercatorNet: We seem to have lost a sense of the sacred in the modern world. Is that something we need to recover? Shimon Glick: The answer is a definite Yes, as I insisted in an article of mine “Humanistic medicine in a modern age” in a 1981 issue of the New England Journal of Medicine.   Shimon Glick is a world authority on Jewish medical ethics. He teaches at the Jakobovits Center for Jewish Medical Ethics, at Ben-Gurion University of the Negev, in Israel. He published a comment on the "after-birth abortion" article in the Israel Medical Association Journal last year. 


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