The Complicated Ethics Of Twin Reduction

In one of the many special cases complicating the abortion debate, a number of parents are choosing to abort one fetus when they discover they’re carrying twins. This has created an ethical quagmire for parents and doctors alike.

In this Sunday’s New York Times Magazine, Ruth Padawer profiles a number of couples who chose “reduction to a singleton” in order to avoid overstretching their financial or emotional resources. An example:

Jenny’s decision to reduce twins to a single fetus was never really in doubt. The idea of managing two infants at this point in her life terrified her. She and her husband already had grade-school-age children, and she took pride in being a good mother. She felt that twins would soak up everything she had to give, leaving nothing for her older children. Even the twins would be robbed, because, at best, she could give each one only half of her attention and, she feared, only half of her love. Jenny desperately wanted another child, but not at the risk of becoming a second-rate parent.

Essentially, reduction to singleton involves terminating a wanted pregnancy, often one that began with expensive fertility treatments (which are more likely than natural means to produce multiple fetuses). And, although not all parents make the decision themselves, the process does involve choosing one twin over another. The result is a complicated moral calculus that every parent — and every doctor — seems to perform differently. One doctor Padawer spoke to doesn’t perform reductions to singleton anymore. Another does, because he feels health outcomes for single fetuses are significantly better than for twins. Parents who choose reduction seem to go through extended processes of justification and guilt — and many choose to tell no one about the procedure.

All this illustrates what bioethicist Josephine Johnston calls “the dark lining of that otherwise very silver cloud” of women’s increasing reproductive choices. She says,

[Y]ou make the choice of when to get pregnant, and so you feel really responsible for its consequences, like do you have enough money to do it well, and are you going to be able to provide your child with everything you think you ought to provide? In an environment where you can have so many choices, you own the outcome in a way that you wouldn’t have, had the choices not existed. If reduction didn’t exist, women wouldn’t worry that by not reducing, they’re at fault for making life more difficult for their existing kids. In an odd way, having more choices actually places a much greater burden on women, because we become the creators of our circumstance, whereas, before, we were the recipients of them.

Women and their families have more reproductive options than ever before, which means they have more opportunities than ever to feel bad about their decisions — and outsiders have more opportunities to judge them. The debate over the ethics of reduction to singleton isn’t easily solved, but it does illustrate one thing clearly: while control over family planning is an important right, it’s not always a privilege. And whatever we think about women’s individual reproductive decisions, we should remember that the existence of the technological means to carry them out doesn’t necessarily make them easier.