Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-17T23:24:30.147Z Has data issue: false hasContentIssue false
  • English
  • Français

Selective Reduction: “A Soft Cover for Hard Choices” or Another Name for Abortion?

Published online by Cambridge University Press:  01 January 2021

Radhika Rao
Get access Rights & Permissions [Opens in a new window]

Extract

Selective reduction, also known as multifetal pregnancy reduction (MFPR), is the practice of terminating one or more fetuses to reduce a multiple pregnancy, e.g., from quadruplets to twins or a singleton. Selective reduction and abortion both involve the destruction of fetal life, but they are classified by different designations to underscore the notion that they are regarded as fundamentally different medical procedures: the two are performed using distinct techniques by different types of physicians, upon women under very different circumstances, in order to further dramatically different objectives. For these reasons, the two procedures appear to call for a distinct moral calculus, and they have traditionally evoked contradictory reactions from society — sympathetic responses towards selective reduction, which is perceived as a difficult but “responsible” choice vs. stigmatizing or even punitive approaches towards abortion, which is deemed an immoral action.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 43 , Issue 2 , Summer 2015 , pp. 196 - 205
Copyright
Copyright © American Society of Law, Medicine and Ethics 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

See Madeira, Jody, unpublished personal interviews, manuscript on file with author (suggesting that a significant fraction of women interviewed who considered selective reduction regard the procedure as fundamentally different from abortion).Google Scholar
Mundy, L., “Too Much to Carry?” Washington Post Magazine, Sunday May 20, 2007.Google Scholar
Armstrong, T. F., “What Is the Difference between Selective Reduction and Abortion?” Yahoo! Health, available at <http://voices.yahoo.com/what-difference-between-selectivereduction-12077534.html> (last visited July 29, 2014).+(last+visited+July+29,+2014).>Google Scholar
See Mundy, , supra note 2.Google Scholar
Daar, J. F., “Selective Reduction of Multiple Pregnancy: Lifeboat Ethics in the Womb,” U.C. Davis Law Review 25 (Summer 1992): 773–843, at 783.Google Scholar
Id.Google Scholar
See Padawer, R., “The Two-Minus-One Pregnancy,” NY Times Magazine, August 10, 2011.Google Scholar
Abortion has been constructed differently in other countries. In Columbia, for example, abortion is conceptualized as an issue of women's health, whereas in China, abortion may be viewed as a method of population control. See Rao, R., Abortion Rights, in Global Perspectives on Constitutional Law, Amar, V. D. Tushnet, M. V., eds. (New York: Oxford University Press, 2009).Google Scholar
See Abrams, P., “The Bad Mother: Stigma, Abortion, and Surrogacy,” Journal of Law, Medicine & Ethics 43, no. 2 (2015): 179–191.CrossRefGoogle Scholar
See, e.g., Stenberg v. Carhart (opinion of Kennedy, J., dissenting) (subtly disparaging physicians who perform abortions by repeatedly referring to them as “abortionists,” and arguing that “the majority views the procedures from the perspective of the abortionist, rather than from the perspective of a society shocked when confronted with a new method of ending human life”).Google Scholar
See Bernstein, E., “Disclosures Two Ways,” Journal of Law, Medicine & Ethics 43, no. 2 (2015): 245–254.CrossRefGoogle Scholar
Jones, R. Finer, L. Singh, S., Characteristics of U.S. Abortion Patients, 2008 (May 2010), Guttmacher Institute, available at <http://www.guttmacher.org/pubs/US-Abortion-Patients.pdf> (last visited April 22, 2015) (last visited April 22, 2015).Google Scholar
See Spar, D. L., “Fertility Industry Is a Wild West,” New York Times, September 13, 2011. But see Daar, J., “Federalizing Embryo Transfers: Taming the Wild West of Reproductive Medicine?” Columbia Journal of Gender & Law 23, no. 2 (2012): 257–325 (disputing characterization of ART as the “wild west” of reproductive medicine, and contending that this is an urban myth).Google Scholar
See Spar, D. L., The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception (Boston: Harvard Business Review Press, 2006).Google Scholar
See Madeira, J. L., “Conceiving of Products and the Products of Conception: Reflections on Commodification, Consumption, ART, and Abortion,” Journal of Law, Medicine & Ethics 43, no. 2 (2015): 293–306 (describing the tension between those who envision themselves as “patients” within the medical model and those who see themselves as “consumers” within the market model).Google Scholar
See Padawer, , supra note 7.Google Scholar
Id.Google Scholar
See Britt, D. W. Evans, W. J. Mehta, S. S. Evans, M. I., “Framing the Decision: Determinants of How Women Considering Multifetal Pregnancy Reduction as a Pregnancy-Management Strategy Frame Their Moral Dilemma,” Fetal Diagnosis & Therapy 19, no. 3 (2004): 232–240.CrossRefGoogle Scholar
The role of doctors as moral gatekeepers policing entry to selective reduction is reminiscent of “the doctor's dilemma” in historically policing entry to abortion. See Swanson, K. W., “The Doctor's Dilemma: Paternalism in the Medicolegal History of Assisted Reproduction and Abortion,” Journal of Law, Medicine & Ethics 43, no. 2 (2015): 312–325 (describing the “doctor's dilemma,” which is about exercising medical paternalism to promote the best interests of patients in the face of legal regulation while at the same time avoiding the pitfalls of unregulated consumerism).CrossRefGoogle Scholar
Evans, M. I., “The Truth about Multiple Births,” Newsweek, July 1, 2010.Google Scholar
Evans, M. I. Fletcher, J. C. et al., “Selective First-Trimester Termination in Octuplet and Quadruplet Pregnancies: Clinical and Ethical Issues,” Obstetrics and Gynecology 71, no. 3 (March 1988): 289–296.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Evans, M. I. Kaufman, M. I. Urban, A. J. Britt, D. W. Fletcher, J. C., “Fetal Reduction from Twins to a Singleton: A Reasonable Consideration?” Obstetrics & Gynecology 104, no. 1 (July 2004): 102–109.CrossRefGoogle Scholar
Evans, M. I. Britt, D. W., “Multifetal Pregnancy Reduction: Evolution of the Ethical Arguments,” Seminars in Reproductive Medicine 28, no. 4 (2010): 295–302.CrossRefGoogle Scholar
See, e.g., Rovner, J., “Partial-Birth Abortion: Separating Fact from Spin,” NPR, February 21, 2006 (explaining that the phrase “partial-birth abortion” was coined by the National Right to Life Committee in 1995 in order to foster opposition to abortion). See also Stenberg v. Carhart, at footnote 16 (opinion of Thomas, J., dissenting) (conceding that “the statutory term “partial birth abortion” may express a political or moral judgment,” but arguing that the choice to use a technical term instead may also be normative).Google Scholar
See Gonzales v. Carhart (upholding federal law prohibiting “partial-birth abortion”).Google Scholar
Berkowitz, R. L. Lynch, L., “Selective Reduction: An Unfortunate Misnomer,” Obstetrics & Gynecology 75, no. 5 (1990): 873–874.Google Scholar
Id., at 874.Google Scholar
Id., at 873.Google Scholar
Evans, M. et al., “Selective Termination: Clinical Experience and Residual Risks,” American Journal of Obstetrics & Gynecology 162, no. 6 (1990): 1568–1572.Google Scholar
Id., at 1575.Google Scholar
Id.Google Scholar
Id., at 1574.Google Scholar
See Evans, et al., supra note 28.Google Scholar
See Evans, Fletcher, et al., supra note 21.Google Scholar
127 S.Ct. 1610 (2007).Google Scholar
See Suter, S. M., “The “Repugnance” Lens of Gonzales v. Carhart and Other Theories of Reproductive Rights: Evaluating Advanced Reproductive Technologies,” George Washington Law Review 76, no. 6 (2008): 1514–1598.Google Scholar
See Rao, R., “Equal Liberty: Assisted Reproductive Technology and Reproductive Equality,” George Washington Law Review 76, no. 6 (2008): 1457–1489, at 1469.Google Scholar
Rao, R., “Reconceiving Privacy: Relationships and Reproductive Technology,” UCLA Law Review 45, no. 4 (1998): 1077–1123, at 1114.Google Scholar
See Padawer, , supra note 7.Google Scholar
Id.Google Scholar
See Mundy, , supra note 2.Google Scholar
See Cahn, N. Carbone, J., Red Families v. Blue Families: Legal Polarization and the Creation of Culture (New York: Oxford University Press, 2010).Google Scholar
See Mundy, , supra note 2.Google Scholar
See Padawer, , supra note 7.Google Scholar
See Americans United for Life, Women's Right to Know Act: Model Legislation & Policy Guide for the 2013 Legislative Year (2013), available at <http://www.aul.org/wp-content/uploads/2012/11/WRTK-Informed-Consent-2013-LG.pdf> (last visited April 22, 2015). (last visited April 22, 2015).' href=https://scholar.google.com/scholar?q=See+Americans+United+for+Life,+Women's+Right+to+Know+Act:+Model+Legislation+&+Policy+Guide+for+the+2013+Legislative+Year+(2013),+available+at++(last+visited+April+22,+2015).>Google Scholar
See Robertson, J., “Is Selective Reduction Covered by State Abortion Law?” April 10, 2013, available at <https://blogs.law.harvard.edu/billofhealth/2013/04/10/john-robertsonabortion-law-online-abortion-and-reproductive-technology-symposium> (last visited April 22, 2015).+(last+visited+April+22,+2015).>Google Scholar
See R.R.S. Neb. Section 71–6901.Google Scholar
See R.R.S. Neb. Section 44–1615.01 and 1999 Attorney General Opinion No. 5.Google Scholar
See Utah Code Ann. Section 76-7-301(1)(a)(ii).Google Scholar
See Section 188.015 R.S. Mo.Google Scholar
See Wyo. Stat. Section 35-6-101.Google Scholar
See, e.g., Spar, supra note 14.Google Scholar
See Evans, , supra note 20.Google Scholar
Of course, stark disparities in the treatment of those who engage in essentially equivalent acts are pervasive in our society. See, e.g., Goodwin, M., “Prosecuting the Womb,” George Washington Law Review 76, no. 6 (2008): 1657–1746 (arguing that prayers and sympathy are offered to women who endanger fetal life and health through the use of ART, whereas criminal punishments are administered to pregnant women who use illegal drugs).Google Scholar
See Rao, , Equal Liberty, supra note 43 (arguing that “[l]ines drawn based upon the status of the persons involved would likely be unconstitutional, whereas lines drawn to differentiate between different acts would likely be constitutional”).Google Scholar
See NeJaime, D., “Marriage Equality and the New Parenthood,” Harvard Law Review (forthcoming 2016) (depicting the ways in which the movement for marriage equality was enabled by significant shifts in the law's understanding of parenthood, which stem in part from the use of assisted reproductive technologies).Google Scholar
Of course, there is always the risk of a contrary result: Drawing attention to selective reduction may actually enhance negative attitudes towards assisted reproduction.Google Scholar