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Featured article
1
Centre for Applied Philosophy
and Public Ethics, Charles Sturt
University, Canberra, Australian
Capital Territory, Australia
2
Centre for Applied Philosophy
and Public Ethics, University of
Melbourne, Melbourne,
Victoria, Australia
Correspondence to
Dr Alberto Giubilini, Centre for
Applied Philosophy and Public
Ethics, Charles Sturt University,
Locked Bag 119, Kingston ACT
2604, Australia; agiubilini@
csu.edu.au.
Received 18 August 2012
Accepted 29 November 2012
To cite: Giubilini A,
Minerva F. J Med Ethics
2013;39:264–265.
264
Clarifications on the moral status of newborns
and the normative implications
Alberto Giubilini,1 Francesca Minerva2
ABSTRACT
In this paper we clarify some issues related to our
previous article ‘After-birth abortion: why should the
baby live?’.
After the publication of our article ‘After-birth
abortion: why should the baby live?’ in the Journal
of Medical Ethics,1 we received hundreds of emails,
most of which were very abusive or involved death
threats. Also the media paid a lot of attention to
our work, and for a few weeks we were in the eye
of a media storm.
Many people suggested that we should have
expected such heated reactions. But it is hard to
foresee something that never happened before to
such an extent after the publication of an academic
paper, as even very controversial publications have
not had such media coverage in the past. From now
on, this sort of reaction will probably be more and
more common because of the internet and the
globalisation of information. However, we have
been among the first bioethicists to experience such
strong and immediate reaction from the general
public, and therefore we could not possibly see
it coming.
Our intention was to ask—and attempt to
answer—questions arising from philosophical
considerations about the moral status of newborns,
compared with that of fetuses, and about the nor-
mative consequences of the answer. This is because
we list among our professional duties that of fol-
lowing a logical path to its (extreme) consequences.
In the case of our paper about after-birth abortion,
the logical path is this: if we think that abortion
is morally permissible under certain circumstances
because fetuses lack certain properties, then, since
newborns lack the same properties, we should also
think that what we called ‘after-birth abortion’
is equally morally permissible under the same
circumstances.
Rational agents make decisions on the basis of
good reasons. All important decisions we make,
such as deciding to do one job rather than another,
to have children or not, or to have children at a
certain time of our life rather than earlier or later,
are (or at least should be, if we are talking of
rational people) the result of hard thinking about
principles informing our lives and consequences for
ourselves and other people involved.
In general, the more that is at stake, the harder
the thinking before acting is and should be. For
example, termination of pregnancy is an important
decision that is requested by women who typically
have serious reasons for doing so: the fetus is
affected by a severe abnormality that will make the
Giubilini A, et al. J Med Ethics 2013;39:264–265. doi:10.1136/medethics-2012-101036
quality of its life extremely poor; the pregnancy
puts at risk a woman’s health or even her life; the
fetus is the result of a sexual abuse; the woman is
incapable (for various reasons) of taking care of a
child at that particular moment of her life; there
are extreme economic difficulties or social condi-
tions which are hardly compatible with having chil-
dren, and so on2 3; in any case, reasons are usually
deeper than the mere desire not to be pregnant,
and they are hardly trivial.4 It is worth noting that
many of these reasons can be present whether or
not the fetus is healthy, and are held by many as
morally acceptable regardless of whether the fetus
is healthy. Women usually choose to have abortions
only if they have serious reasons because what is at
stake is extremely important—for example, bring-
ing a new person into existence or not, the possibil-
ity of creating or enlarging a family, experiencing
parenthood.
The thesis that fetuses and newborns share the
same moral status is not new (especially, but not only,
among Catholic and pro-life philosophers),5 6 as
references in our article should have suggested also to
those who are not acquainted with bioethics debates.
Rather than saying anything new about this point,
the aim of our article was to make explicit conclu-
sions that, we think, were implicit in what others said
before us.7–9 Specifically, we drew some conclusions
in the light of socioeconomic circumstances families
might be facing. If there are good reasons to think
that such circumstances matter when decisions
concern termination of a life before birth, then there
are good reasons to think that these circumstances
matter immediately after birth too.
Those who advocated the legitimacy of after-
birth abortion (or infanticide) before us often con-
fined their discussion to cases in which the
newborn is disabled10 11; and, as we said in the
first part of the article, disability is often held as a
good justification for abortion. But a disability such
as, for example, Down syndrome does not neces-
sarily make the life of a person not worth living.
There has been a lot of misunderstanding on this
point. In our paper, we refer to studies showing
that a person with Down syndrome can have a
happy and worthwhile life. It might be more diffi-
cult for her/him to achieve certain goals than for a
person without Down syndrome, of course, but the
condition alone does not seem to make a life not
worth living. Much depends on the social and eco-
nomic situation of the family rather than on the
disability itself. A disabled child who grows up in
an adequate environment in which the family has
the means to support her/him might have a life not
worse, but better, than that of a healthy child who
is brought up in an extremely poor or dangerous or
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hostile socioeconomic context. Nonetheless, such disabilities are
usually held as valid justifications for abortion without further
specification. This means that in assessing the permissibility of
abortion the interests of the woman and of family members are
—at least on some occasions—given priority over the expected
quality of life of the potential child who is prevented from
coming into existence. But since both fetuses and newborns lack
the moral status of people (and we explain why we think they
do in our paper), the same moral consideration of the quality of
life of potential people should be consistently held when we
talk about newborns.
The same considerations about socioeconomic context apply
to discussion of the quality of life of actual people having to
deal with a new baby. If the family is in very poor economic cir-
cumstances or in a very disadvantaged social situation, even a
mild disability might have a negative effect on the life of its
members in a very dramatic way. However, a family with
adequate resources and assistance might not be severely affected
by having a disabled child. But this key role played by social and
economic circumstances means that the same consideration
holds if we talk of children without disabilities. Such circum-
stances can affect the wellbeing of existing people (women, part-
ners, already existing siblings) to the same extent as, or even
more than, physical or mental disabilities of a new child. The
relevance of social, psychological and economic circumstances
explains why many agree that women who have an abortion
even when the fetus is healthy are morally justified in doing so.
Our article suggests that the same circumstances that justify ter-
minating the life of fetuses without disabilities, an option about
which there is ‘broad consensus’,8 also would justify terminating
the life of newborns without disabilities. The difference is that a
woman would probably be less likely to want to terminate the
Giubilini A, et al. J Med Ethics 2013;39:264–265. doi:10.1136/medethics-2012-101036
Featured article
life of a newborn than that of a fetus, so the ‘same circum-
stances’ would rarely occur. Thus, of course, parents’ wishes
and parents’ bonds with the newborns (as well as with fetuses)
are part of the wellbeing to be preserved and of the relevant
‘circumstances’ (exactly as in cases of abortion).
Contributors The authors gave equal contribution.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.
REFERENCES
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3 Torres A, Forrest JD. Why do women have abortions? Fam Plan Perspect
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4 Bankole A, Singh S, Haas T. Reasons why women have induced abortions: evidence
from 27 countries. Int Fam Plan Perspect 1998;3:117–27.
5 Camosy C. Concern for our vulnerable prenatal and neonatal children: a brief reply
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practicalethics.ox.ac.uk/2012/03/concern-for-our-vulnerable-prenatal-and-neonatal-
children-a-brief-reply-to-giubilini-and-minerva/ (accessed 10 Jul 2012).
6 Devine PE. Abortion, contraception, infanticide. Philosophy 1983;226:513–20.
7 Tooley M. Abortion and infanticide. Philos Public Aff 1972;1:37–65.
8 McMahan J. Infanticide. Utilitas 2007;19:131–59.
9 Singer P. Practical ethics. 3rd edn. New York: Cambridge University Press, 2011:
151–154.
10 Harris J. Ethical problems in the management of some severely handicapped
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11 Kuhse H, Singer P. Should the baby live? The problem of handicapped infants.
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Clarifications on the moral status of

newborns and the normative implications
Alberto Giubilini and Francesca Minerva

J Med Ethics 2013 39: 264-265

doi: 10.1136/medethics-2012-101036

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