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Edith Flores

Phil323Z
May 5, 2014
The Policy for Choice
In Two-Minus-One, by Ruth Padawer, the morality o !ro"#hoi#e !aradi$ms
ittin$ into multietal !re$nan#y redu#tions is thorou$hly dis#ussed throu$h the eyes o
se%eral !roessionals and !atients in their irst"hand e&!erien#es' (hrou$h these
e&!erien#es, the %iew!oints o these indi%iduals e&!ressed %arious stan#es on the
!er!etual !ro"#hoi#e debate' )hen dis#ussin$ the issue o redu#in$ !re$nan#ies rom si&
or se%en etuses down to two etuses there is not mu#h debate made one whether the
!ro#edure is ethi#al' (his is mainly due to the de#ision ty!i#ally bein$ eli#ited by the
ris*s !resent to both the mother and #hild' (he debate demandin$ o#us is the redu#tion
rom twins to sin$letons where it then is analy+ed throu$h a dierent #riti#ism'
(he !ainul irony !resent here is that many women who be#ome !re$nant and are
re,uestin$ the !ro#edure to redu#e the number o etuses they #arry rom two to one
usually $o to $reat len$ths to be#ome !re$nant in the irst !la#e' -e#ause a !re$nan#y
holdin$ two etuses has si$nii#antly less ris*s than that o a !re$nan#y o three or more
the ethi#al dilemma is brou$ht into the e,uation' (he standin$ le$islation that #urrently
allows or le$al abortions in the .nited /tates as !ro%idin$ a #hoi#e or women to either
*ee! or abort the etus should ind the same moral ar$ument or the multietal !re$nan#y
redu#tion issue' In this re$ard the #hoi#e is u! to the indi%idual as it di#tates the uture o
their own lie as !ut by Padawer, 0the underlyin$ !remise is the same1 this is not what I
want or my lie'2
-y !ro%idin$ an indi%idual with the !ower to de#ide what ha!!ens in their own
lie #ertain !redi#aments rise to the sura#e' Many would belie%e that doin$ what it ta*es
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to ma*e the best o a $i%en situation with the betterment o one3s lie as the o#al !oint
be$s the #on#ern o what 4ustiies the measures ta*en' In The Prince, by 5i##ol6
Ma#hia%elli, it is dis#ussed that 0the end 4ustiies the means'2 In this #onte&t, true %irtue,
as deined by Ma#hia%elli, is the assertion o ta*in$ a#tion or the betterment o the
indi%idual or $rou! that is in%ol%ed re$ardless o the !otentially #onse,uential la#* o
morality' In this #ase the !ersons in%ol%ed are the mother and the #hild, whose saety the
do#tors #arryin$ out the !ro#edure are endorsed with and res!onsible or' 7##ordin$ to
Ma#hia%ellian belies the healthy out#ome o the mother as well as the #hild are enou$h
4ustii#ation to %indi#ate the termination o an unortunate etus' 8ealth, bein$ a
moti%ation that #an mobili+e !atients to ma*e this de#ision, is a #om!ellin$
rationali+ation or the o!eration, but not the only one'
)hen e&!lorin$ the a%enues o moti%ation that all in ali$nment with the !remise
o Padawer3s lie"di#tatin$ de#ision, one will #ome a#ross a multitude o e&!lanations' (o
a##urately de!i#t this line o thou$ht the %iews o 9r' Mar* E%ans, one o the irst do#tors
to #arry out this ty!e o !ro#edure, it is ne#essary to address his !ubli#ations that de!lore
the de#ision or redu#tion' E,ually as im!ortant is his swit#h o%er the line some years
later to deendin$ those who do de#ide to under$o the redu#tion !ro#edure' In his irst
!ubli#ations on the matter, as mentioned in Padawer3s wor*, E%ans des#ribed that the two
to one etal redu#tion !ro#edure 0#rosses the line between doin$ a !ro#edure or a
medi#al indi#ation %ersus one or a so#ial indi#ation'2 :learly when this #hoi#e is made
with so#ial indi#ations in mind %oid o medi#al ris*s, ne$ati%e 4ud$ment is easily !assed
on the moral #hara#ter o the indi%idual who is ha%in$ the redu#tion' (hese sentiments
are e#hoed as well by -onnie /teinbo#* who is on the ethi#s #ommittee o the 7meri#an
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/o#iety or Re!rodu#ti%e Medi#ine' -oth o these !roessionals, E%ans and /teinbo#*,
brin$ u! the to!i# o ethi#s in the !ro#edure, thou$h in dierent li$hts'
E%ans, !rior to his !ubli#ations o 2004 to"date, hi$hli$hts the anti!athy
surroundin$ those who ma*e the de#ision or redu#tion out o so#ial indi#ations and
ur$ed others in his ield to not be#ome 0te#hni#ians to our !atients3 desires'2 Followin$
his 2004 !ubli#ation, E%ans im!lores those who ha%e the #hoi#e o the redu#tion
!ro#edure due to reasons other than medi#al to #onsider !ossible im!a#tin$ a#tors that
#an inluen#e their de#ision' Many o these in#lude the a$e o the !atient, who ty!i#ally is
in their 40s and 50s, the im!a#t the #hild will ha%e on their li%es when it rea#hes
adoles#en#e and the inan#ial #onsiderations o uture #olle$e tuitions' /teinbo#* then
!oints out the im!a#t that 4ud$ment has u!on the de#ision o the !atient, !arti#ularly the
se#re#y o their de#ision' (he se#re#y that many !atients o multietal !re$nan#y
redu#tion !ro#edures ha%e with whom they entrust with the *nowled$e says ,uite a bit'
7lthou$h the !a!er thus ar has been buildin$ an ar$ument or the su!!ort o !ro"
#hoi#e le$islation and !oli#ies, underlyin$ so#ial !ra#ti#es and %iews must be ade,uately
e&!lored' Padawer e&!lains that 0do#tors who !erorm the !ro#edure, aware o the
sti$ma, tell !atients to be #autious about re%ealin$ their de#ision'2 (he se#re#y that is
#ommon amon$ many women who under$o su#h an o!eration ha%e a $ood reason to
*ee! this inormation to themsel%es as the bi$otry and sti$ma that is dire#ted towards this
ty!e o de#ision #an seriously ee#t their so#ial and !roessional li%es' (he le%el o
se#re#y also im!lies shame' ;uilt #an !ro%ide a stron$ deterrent to #arryin$ out the
!ro#edure but be#ause many women still ollow throu$h with it and !ro#eed to eel $uilt
and shame thereater there are other %ariables that are !la$uin$ their thou$hts'
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(he !oint that Padawer !re%iously made in the e&tensi%e len$ths in whi#h inertile
!atients $o to be#ome !re$nant and then re,uestin$ to $o throu$h a redu#tion !ro#edure
is in #on4un#tion with 9onna /teinber$3s o!inion on the matter' 7s !ut by /teinber$,
0they3%e !aid a lot o money and !ut their bodies throu$h tremendous stress, and they3%e
$otten what they wanted < and now they3re $oin$ to redu#e= >utsiders thin*, 8ow is that
!ossible= 7nd that3s also where the !atients3 $uilt #omes rom'2 Padawer also e&!ressed
her #on#erns that the !arents are not the only ones who #an eel $uilt on the matter or the
de#isions made' 0E%en i !arents wor* hard to #on#eal it, the #hild may dis#o%er the ull
story o his or her ori$ins, and we don3t *now what eelin$s o $uilt or %ulnerability or
loss this dis#o%ery mi$ht summon,2 in Padawer3s words on the !ossible tri#*le"down
ee#ts' (his brin$s the burden o these #hoi#es into !ers!e#ti%e, in a$reement with the
%iew o ?ose!hine ?ohnston' 7s she !oints out, 0you ma*e the #hoi#e o when to $et
!re$nant, and so you eel really res!onsible or its #onse,uen#es, li*e do you ha%e
enou$h money to do it well, and are you $oin$ to be able to !ro%ide your #hild with
e%erythin$ you thin* you ou$ht to !ro%ide=2 (he !ressure that this !la#es on the !atient
#an be o%erwhelmin$ly in#om!arable to someone on the outside and at irst $lan#e one
would most li*ely say that the more #hoi#es the better, as it $i%es the indi%idual more
inluen#e o%er their own ate and asso#iated out#omes' 7s ?ohnston e&#ellently
arti#ulates, 0#hoi#es are not always as liberatin$ and em!owerin$ as we ho!e they will
be'2 7nother unortunate side ae#t is the !er#e!tion that others may ha%e o the !atient
when this !er#e!tion inluen#es said !atients3 de#isions'
)hen so#ial indi#ators #ome into !lay in this #onte&t, there are se%eral !aradi$ms
throu$h whi#h one #an %iew the issue' (ou#hin$ ba#* on /teinbo#*, the moti%e behind
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the a#tual !ro#edure 0#han$es our 4ud$ment o the moral #hara#ter o the indi%idual
ma*in$ the abortion de#ision'2 Fear also sti!ulates rom Padawer3s e&!ression o a
0se#ond"rate !arent2 in how !atients are araid o not bein$ able to !ro%ide an ade,uate
amount o attention and #ommitment to their #hildren i there are too many o them'
/heena Iyen$ar, a so#ial !sy#holo$ist at :olombia -usiness /#hool, brin$s to li$ht the
7meri#an assum!tion o #ontrol and the ear o not ha%in$ it' 7s she !uts it, 0the story
u!on whi#h the 7meri#an dream de!ends is the story o limitless #hoi#e' (his narrati%e
!romises so mu#h1 reedom, ha!!iness, su##ess'2 7le&is de (o#,ue%ille also e&em!liies
an e&#ellent assessment o this 07meri#an dream'2 -e#ause !eo!le, in his eyes, are the
true so%erei$ns and ha%e the will and ri$ht to ma*e de#isions or themsel%es, this so#iety
subse,uently #reates an air o 7meri#an e&#e!tionalism' Peo!le rule here li*e the deity
does the uni%erse, and thus #ontain the #a!a#ity or ma*in$ de#isions li*e multietal
!re$nan#y redu#tion' -ut in order to ully en4oy those three !illars o bein$, #hoi#es be$
the im!erati%e o whi#h a!!roa#h they are #omin$ rom' ?ean"?a#,ues Rousseau !ro%ides
an e&am!le o su#h an e&amination'
Rousseau3s san#tity o the authenti# sel is de!endent u!on the #onsiderations o
other !eo!le3s o!inions in #omin$ to a #on#lusi%e de#ision' 7mour !ro!re is the !remise
in whi#h one #onstru#ts their sel identity throu$h the eyes o others, and thus resultin$ in
the loss o the authenti# sel' -y Rousseau3s deinition, there must not be a de#idin$
inluen#e #omin$ rom other !eo!le3s o!inions and a#tions must be ta*en or the interest
o the indi%idual by the indi%idual' In laymen3s terms, the !atient must only ta*e into
#onsideration their own ate and their own o!inion when ma*in$ a de#ision or multietal
!re$nan#y redu#tion and not those o others' (hrou$h the !aradi$m o Rousseau, modern
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man3s thralldom to his own needs deri%es rom the so#ietal ills that a #ommunity will
im!ose u!on the indi%idual to rea#t out o the boostin$ o sel"esteem and the eradi#ation
o de!ression' :ou!lin$ Rousseau3s authenti# sel is the /o#ial :ontra#t that he
ormulates' In this #ontra#t, so%erei$nty is an inalienable ri$ht, and the !eo!le are the true
so%erei$ns' (his eli#its a ri$ht o #hoi#e or the mother when addressin$ abortion and
multietal !re$nan#y redu#tion'
Fallin$ ba#* on E%ans, ethi#s and ethi#al !ra#ti#es do #han$e o%er time' 9r' Mar*
E%ans !ro%ides an e&#ellent e&am!le o this sin#e he was a role model or his #ollea$ues'
7ter !ublishin$ multi!le wor*s on !ro%in$ the !ra#ti#e o redu#in$ !re$nan#ies rom
two to one to be unethi#al, in 2004 !ubli#ly announ#e the re%ersal o his stan#e on the
matter, as e&!ressed earlier' (he si$nii#an#e in this mo%e is the e%olution o ethi#al
understandin$' 0Ethi#s,2 E%ans said, 0e%ol%e with te#hnolo$y'2 8is meanin$ behind this
is the te#hnolo$i#al ad%an#es made in the medi#al ield, rom understandin$ the
!re%iously unseen ris*s o twin !re$nan#ies to the ma#hinery used in ultrasounds and
other materials needed or the !ro#edure, were transormin$ the way !eo!le saw the
issue' 7s this transormation be$ins to settle in, as stated by Iyen$ar, 0we are in the midst
o a #hoi#e re%olution ri$ht now, where we3re tryin$ to i$ure out where the ethi#al
boundaries should be'2 7nd with the reassessment o these ethi#al boundaries #omes a
newound understandin$ or what ethi#al re!er#ussions #an be seen rom the same
#hoi#es !re%iously seen in a tone o disdain'
)ith the !ro$ression o the ethi#al #hara#teristi#s asso#iated with multietal
!re$nan#y redu#tion, es!e#ially within national and state le$islation, #omes the
!ro$ression o rele%ant lawul reorms' (he .nited /tates o 7meri#a is !redominantly
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seen by its #iti+ens as the land o reedom and liberty' Fo#usin$ 4ust on liberty at the
moment, Immanuel Aant #ontributes e&#ellent insi$ht' In the eyes o Aant, the deinition
o liberty !ertains to the obedien#e o 4ust le$islation' In order to #on#e!tuali+e the
!rominen#e o le$islation that is 4ust, there must e&ist the absen#e o natural authority and
natural #riteria to rule' Meanin$, no one #an obtain a biolo$i#al !redis!osition to im!ose
le$islation that di#tates the liberties and reedoms o others' (o build o this, Aant !uts
o#us on the obedien#e o rational laws that indi%iduals $i%e to themsel%es' Biberty, by
this deinition and by that o Aant3s, is the so#ial #ontra#t that when one #reates a law that
same !erson also must obey them, ma*in$ them uni%ersally a!!li#able' -e#ause there is
already an o%erwhelmin$ le$al status in the .nited /tates !ertainin$ to the abortion o a
sin$leton, so should there be the same status ailiated with multietal !re$nan#y
redu#tion, e%en those in the two to one #ate$ory'
(he 7utonomy o a !erson is another as!e#t o Aant3s !hiloso!hy on the reedom
o #hoi#e' 8e also is used as a stron$ su!!orter o the autonomy o women in /usan
Feldman3s How Kantian Ethics Should Treat Pregnancy and Abortion' /he ar$ues that
Aant would su!!ort the #hoi#e a woman has in de#idin$ to under$o an abortion' Aant
belie%es that the irst !remise o an institutional establishment is human reedom 0and
that indi%idual reedom, or autonomy, is a ne#essary !resu!!osition o human morality2
C/#hult+ and (annenbaum, 2004D' 7s translated rom Aant3s Metaphysics of Morals, 0the
will o a rational bein$ #an be a will o its own only under the Idea o reedom, and
thereore rom a !ra#ti#al !oint o %iew su#h a will must be as#ribed to all rational
bein$s'2 (his su$$ests that a mother, in this #ir#umstan#e and a#tin$ rationally or the
amelioration o both the mother and #hild, should be $i%en this reedom o #hoi#e out o
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ne#essity in order or her to ma*e a rational #hoi#e and ,ualiy or the #lassii#ation o a
rational bein$'
Re#a!!in$ on the %iews o the %arious !roessionals mentioned in this analysis,
all a$reed u!on the im!ortan#e o redu#in$ the health ris*s o both the mother and #hild
throu$h multietal !re$nan#y redu#tion rom si&, and u!wards, down to two' In the !ast
many had shown uneasiness and e%en #ontem!t towards ta*in$ it down to a sin$leton
rom a twin !re$nan#y' Mu#h o that distaste was due to the e&!erien#e that many
!hysi#ians were ha%in$ when #ondu#tin$ the !ro#edure' 7##ordin$ to Padawer, 0as
o!!osed to an abortion, multietal !re$nan#y redu#tion is done throu$h ultrasound
ma*in$ the !ro#edure %isually e&!li#it'2 (his uneasiness, undoubtedly, is not without 4ust
#ause, but the ethi#al ar$ument behind it is %oid and null while abortion #lini#s stay o!en
around the .nited /tates'
Res#alin$ the ethi#al ar$ument !resented by the amous thin*ers mentioned,
Ma#hia%elli, Rousseau, (o#,ue%ille and Aant, a !ro"#hoi#e !oli#y is most a!!ro!riate or
this issue' (he #hoi#e or a woman to under$o multietal !re$nan#y redu#tion should ta*e
the orm as a sel"satisyin$ and sel"ulillin$ res!onsibility %oid o other !eo!le3s
inluen#e or o!inion' (his #hoi#e is unmista*ably intertwined with the ate o the !atient,
as well as the #hild, and the ,uality o lie they will en4oy thereater as a result' (ou#hin$
ba#* on the Ma#hia%ellian %alues !resented earlier in the #onte&t o morality, the
relationshi! between !oliti#s, or institutional !oli#ies, and ethi#s is none&istent and
thereore they should not rele#t a sense o moral orientation' Inerrin$ u!on Aant3s
deinition o liberty, the !oli#ies that are institutionali+ed must show a la#* o bias a#ross
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the s!e#trum o abortions, in#ludin$ those where additional etuses remain inside the
womb'
)ith !eo!le bein$ the true so%erei$ns, in the eyes o (o#,ue%ille, they then hold
the !ower to di#tate their own utures and the betterment o their li%es throu$h their
#hoi#es, su#h as the ability to redu#e the number o etuses in a !re$nan#y' Ma*in$ this
#hoi#e with the health and wellbein$ o the mother and the #hild in mind introdu#es
sele#ti%e de#ision"ma*in$' (he sele#ti%eness behind it should in#lude only the o!inions
and #on#erns o those dire#tly in%ol%ed and not di#tated by the subse,uent 4ud$ments o
other !eo!le not ae#ted by the !ro#edure or multietal !re$nan#y redu#tion' (his line
o thou$ht, thou$h su!!orted by the authenti# sel !resented in the amour !ro!re deined
by Rousseau, should %ery mu#h be the !remise or more de#isions made today' 5ot to
say !eo!le should only a#t sel"interested with no one else in #onsideration, but #hoi#es
li*e this should ind their moti%ations within the indi%idual in%ol%ed and not those ready
to !ass 4ud$ment u!on them'
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Works Cited
1' Aant, Immanuel, and Bewis )hite -e#*' Kant selections' 5ew Hor*1
Ma#millan I, 1GFF'
2' JAantian ethi#s " )i*i!edia, the ree en#y#lo!edia'J '
htt!1KKen'wi*i!edia'or$Kwi*iKAantianLethi#s Ca##essed 7!ril E, 2014D'
3' Ma#hia%elli, 5i##olo, and 9a%id )ootton' The prince' Indiana!olis1 8a#*ett
Pub' :o', 1GG5'
4' Padawer, Ruth' J(he (wo"Minus">ne Pre$nan#y'J '
htt!1KKwww'nytimes'#omK2011K0FK14Kma$a+ineKthe"two"minus"one"
!re$nan#y'html=!a$ewantedMallNLrM0 Ca##essed 7!ril E, 2014D'
5' Rousseau, ?ean, and 9onald 7' :ress' On the social contract' Indiana!olis1
8a#*ett Pub' :o', 1GFE'
@' (annenbaum, 9onald ;', and 9a%id 7' /#hult+' !n"entors of ideas an
introduction to western political philosophy' 5ew Hor*1 /t' MartinOs Press,
1GGF'
E' (o#,ue%ille, 7le&is de, and /te!hen 9' ;rant' #e$ocracy in A$erica'
Indiana!olis, Ind'1 8a#*ett Pub', 2000'
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