"Ethical Boundaries" in Multiple Pregnancies

A recent article in the New York Times Magazine discussed the issue of reductions in cases of multiple pregnancies (twins, triplets, etc.) This has become an issue because of the high incidence of such pregnancies when in vitro fertilization is performed - a process necessitating the implantation of multiple eggs into the uterus of the recipient. Physicians seem to have no difficulty in agreeing to reduce a resultant quadruplet or triplet pregnancy to a twin pregnancy, but ethical issues have arisen when the mother expresses the desire to reduce twins to a "singleton." In the past twin pregnancies carried an increased risk to a normal outcome, but this is no longer the case.

Many physicians perfectly willing to perform a routine choice abortion are not amenable to reduce below twins in cases of in vitro pregnancies. One obstetrician was quoted as saying that reduction to singletons "crosses the line between doing a procedure for a medical indication versus one for a social indication." Apparently a standard singleton abortion for a "social indication" is somehow different. Another, after consultation with his staff, similarly decided against such reductions because of the lack of medical justification. One could conclude that such lack of justification is immaterial when considering a routine choice abortion

Isn't it interesting, in our world of "choice," that how a fetus is regarded is dependent on the conditions of his existence. A physician who would readily abort a product of a normal conception, is not willing to abort the product of an in vitro conception because, as one obstetrician put it: "We were in the business to improve pregnancy outcomes" and reductions of twin in-vitro pregnancies "didn't fit the criteria."

Somehow an abortion intended to reduce a twin to a singleton in an in vitro pregnancy is said to bring on a new "ethical boundary." Is there really an ethical boundary between a woman choosing to abort a single normal pregnancy and a woman choosing to abort one of a normal twin pregnancy conceived in vitro?

It is altogether possible that with future medical advances, triplets, or perhaps even quadruplets could have an outcome no different from that of a singleton or a twin. What then?

When the medical indications disappear, will the physicians quoted above refuse to reduce four to two or three to two if it be solely for "social reasons?"

It seems to me that the choice to abort either belongs to the woman, or it does not. It is black or white - there can be no gray. A woman choosing to abort or reduce a twin pregnancy, or a triplet pregnancy should be regarded no differently from one choosing a routine abortion of a single pregnancy, no matter the manner of conception. The existence of a product of conception is being terminated in both cases. Why should it make any difference whether it be one, or two, or three, or four, or what the style of conception was?

The so-called ethical boundary can not be conditional on the "style" of conception or on the number of fetuses contained in the uterus. The ethical boundary, if it exists at all, must continue to lie between "pro-choice" and "pro-life."