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  1. My opinion on controversial paper published about infanticide

    Dear Editor,

    I am writting to express my opinion about the controversial paper published about infanticide. The term after-birth abortion, as admitted by the authors of the paper, "After-birth abortion; why should the baby live?" is an oxymoron and not acceptable medical terminology and because of this fact I believe it should not be published in this manner. Furthermore, the moral argument made to define an "actual person" vs. a non-person is based on a narrow non-standard definition of the meaning of the word "person", which is distorted. The standard definition of person according to the Oxford dictionary is "a human being regarded as an individual", which does not include

    The point I am making is that standard terminology, nomenclature and definitions must be applied in science and medicine to achieve comparable results. Scientific publications must be free of confounding or at minimum point out flaws that need to be futher investigated. If you hold the authors to this standard the paper is without merrit because it is founded on the premise that a newborn is not a person. Standard medical and scientific nomenclature absolutely includes newborns as persons and thus this is not an area where some research is needed to clarify the subject, it is an essence.

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  2. Response to After-birth abortion: why should the baby live?

    Dear Editor,

    I read with interest and some perturbation Dr Francesca Minerva's article in the BMJ http://jme.bmj.com/content/early/2012/03/01/medethics- 2011-100411.full advocating the admissibility of killing newborns in certain circumstances. In particular her arguments that (a) certain classes of people may be described as "non persons" and (b) because they are non persons they may be killed. I believe she has committed here a couple of basic logical fallacies (see http://en.wikipedia.org/wiki/List_of_fallacies and http://www.theskepticsguide.org/resources/logicalfallacies.aspx ). Her first proposition, that certain classes of humans are non persons, commits the informal logical fallacy of begging the question (she simply asserts they are non persons, without any physical, chemical, biochemical or psychometric evidence).She also commits the formal fallacy of affirming the consequent (because we kill unborn people, and some societies kill convicted murderers, these classes of people are non persons). I note she does not deny any of these are HUMAN. The killing of ones opponent in war is legal, even according to international treaty (The Geneva Convention). That doesn't make the oppositions' soldiers "non persons". "Justifiable Homicide" to defend one's person against an assailant is legal, does that make the assailant a "non person"? I think not. Few people appear to believe convicted murderers are "non persons"-they are persons who have committed a serious crime for which the state prescribes a punishment.Indeed if they were a non person killing another eg a tiger in the zoo, the tiger wouldn't be killed, just have its cage made more secure to prevent a repeat! The second proposition that certain classes of humans may be considered "non persons" is a semantic argument. Merriam Websters online dictionary gives the following definition: per*son noun \?p?r-s?n\ 1 : human, individual --sometimes used in combination especially by those who prefer to avoid man in compounds applicable to both sexes <chairperson> <spokesperson>

    As you can see the dictionary sees no distinction between the word person, individual or human, in describing a member of Homo Sapiens! It does not follow logically that a "non person" may be killed when one feels like it because that "non person" is inconvenient. (This is the informal logical fallacy known as "non sequiteur" where the conclusion doesnt follow the premise). A dog is not a "person". You may not kill my dog, and the killing is punishable by law. A feral dog ,or even my dog, however, may be legally killed but only if certain circumstances apply. For example a farmer may legally shoot it if the dog is threatening his sheep. But it's still a dog, it doesn't become a "non dog" just because the farmer is allowed to kill it!

    I must confess a personal involvement in this issue of the existence of "non persons" and the use of the term to justify killing. It has a long history, including the Polynesian cannibals. The Solomon Islanders word for their tribe is translatable as "human" and their word for other tribes is translatable as "non human" so under their rules before European's colonization it was permissible to eat a non human but not a human (someone from their own tribe). The height of this argument was the NAZIs in Germany, who used a similar argument to justify killing certain classes of people who their philosophy led them to believe were the cause of perceived difficulties. My personal involvement is three great uncles who perished in the NAZI concentration camps. This line of reasoning is similar to that popular position which loosely states that the world is full of problems, The problems are caused by some people and not others, therefore if we get rid of those causing the problems we will get rid of the problems. The NAZIs, the Communists and others have tried this to devastating effect throughout the 20th Century- and failed in their aims, because the argument is fallacious (spot the many logical fallacies in it!). As GK Chesterton responded to a Times article in the 1920's asking to describe what's wrong with the world, he famously wrote in "Dear Sir, what's wrong with the world? I am. GK." We are all flawed, no one is perfect, and attempts to solve our problems by punishing others are doomed to failure.

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  3. Singering from the same hymn sheet... [CORRECTED VERSION]

    Dear Editor,

    When the media storm over Alberto Giubilini and Francesca Minerva's article broke out a few weeks ago, I was reminded forcefully of the public protests that dogged the philosopher Peter Singer's public appearances in Germany in the late 1980s and early 1990s.

    This should perhaps be unsurprising, given Giubilini and Minerva's philosophical debt to Singer and his colleague Helga Kuhse - which they acknowledged in their article's citation of Kuhse and Singer's charmingly titled 1985 book Should the Baby Live? The Problem of Handicapped Infants.

    In Minerva's case, the debt to Singer is likely to be personal as well as professional, as they are colleagues at the Centre for Applied Philosophy and Public Ethics at the University of Melbourne, where Singer is Laureate Professor (though his main professorship is at Princeton).

    I point this out because for philosophers acquainted with the topic there was little, if anything, novel about Giubilini and Minerva's suggestion that the practice of abortion be extended to include newborns. The main novelty, rather, was the coining of the term "after-birth abortion" as a synonym for infanticide.

    And there was certainly nothing new about the crude utilitarian thinking underpinning their proposal. The authors skipped over this pretty lightly, commenting in passing that the lives of children with severe abnormalities "can be expected to be not worth living". Says who? Other than the authors and their philosophical godparents Singer and Kuhse, that is?

    Giubilini and Minerva's proposal has been described as shocking. And it is, on a number of levels. One of which, I would argue, is that the thinking that led them to advocate infanticide has been thoroughly discredited several times over.

    In which connection, permit me to cite a couple of articles that I found more or less conclusive on this subject, both of which date from the early 1990s.

    In his paper "The Euthanasia Debate in Germany - What's the Fuss?" in the Journal of Applied Philosophy (Vol 11, No 2, 1994: 213-224), Hans- Johann Glock notes that the protesters who had confronted Singer at his university speaking engagements included representatives of the disabled rights lobby, the political left, and the religious right. On the issue of freedom of expression, Glock defends Singer's right to advance his views in public - the right to a platform - concluding that it was illegitimate for his disabled opponents to attempt to silence him, as he did not deny their right to live. But he also concludes that it was legitimate for them to protest against Singer, as he had denied that some of their lives are worth living, in disregard of their own preferences.

    In perhaps the most telling passage, Glock takes aim at Singer's utilitarian assumptions, arguing that:

    "In my view it is fundamentally immoral to permit killing innocent human beings for the sake of maximising overall utility. When, e.g., haemophiliac infants are rejected by their parents, our obligation to protect their life is not dependent on whether they can conveniently be taken care of. The moral thing to do is never to knock off the baby, but to create the necessary facilities."

    Attacking the utilitarian notion that the sole aim of our actions should be to maximise happiness or preferences, Glock further notes that:

    "In our case, creating these facilities would be called for even if the overall utility of society were diminished. Indeed, Singer's conclusions, along with those of other radical utilitarians, help to show that utilitarianism simply does not express the moral point of view."

    The previous year, Glock's then colleague at the University of Reading, David S Oderberg, had written on "The Singer Controversy" in the September 1993 issue of Quadrant. In a devastating closing passage, he argues as follows:

    "Singer is right to say he is not advocating hatred of the disabled. No, his position is a touch more extreme. Why should restrictions only be placed on those who are 'trying to inflame emotions'? A speaker can quite coolly, calmly and bloodlessly advocate murder without trying to inflame emotions. And while he might offer reasons, this does not make his position reasoned. No advocacy of evil can be reasoned. On the contrary, the advocacy of evil must be opposed, no matter from whose lips it comes."

    Warming to this theme, Oderberg concludes his article thus:

    "The cover of the second edition of the best-selling Practical Ethics has a full-length photograph of Peter Singer against what I presume is the Melbourne skyline at night. The clear implication is that the discipline of practical ethics is to be identified with Peter Singer: he is the face of practical ethics. He says his views "have the potential to contribute to the development of a better world". Perhaps if Singer's views continue to be implemented, the world will indeed be better - for those of us left alive to enjoy it."

    Two decades on, Singer certainly appears to be enjoying himself. By dint of his book sales and general prominence in the field, he has been showered with a range of honours and invited to serve on government committees. For any student of ethics, there is no doubting his influence. That's why Giubilini and Minerva's paper matters: this isn't a purely seminar room debate, but one that could potentially affect public policy. Otherwise, one might ask, why bother having a journal of medical ethics in the first place?

    Part of philosophy's unique charm is that it doesn't progress in the same way that other disciplines do. It is quite possible for something Plato wrote two and a half thousand years ago to resonate in contemporary discourse. All the same, more than a quarter of a century on from the publication of Should the Baby Live? it is depressing to find Singer's disciples still peddling the same grim stuff. The only change appears to be one of emphasis: moving now to the question of "Why should the baby live?" Perhaps they next article they put out could be entitled "It's my baby and I'll kill it if I want to"?

    Something the furore over Giubilini and Minerva's paper has underlined for me is that any ethical theory worth the name should be able to answer such deceptively simple questions as "Why is murder wrong?" The answers will differ, but anything has to be preferable to falsely redefining the concept of a person in a way that purports to legitimise infanticide.

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  4. Six propositions on end-of-life decisions in neonatology

    Dear Editor,

    My letter is a response in six propositions to Giubilini and Minerva, After-birth abortion: Why should the baby live?1

    1. We as a society have the privilege, the pleasure and the moral (and in some countries, legal) obligation to help, protect, take care of and provide for the weak and the defenseless. This makes our lives worth living. Progress and civilization are brought about and maintained through a constant struggle against the oppression of the vulnerable and a continual assertion of the value of solidarity over self-interest.

    2. Every human being is a person: the two terms are coextensive. Extremely premature babies, severely defective newborns and babies with major brain damage are persons, because the attribute of personhood does not depend on moral agency or on cognitive capacities. Denying to some the right to life by arguing that they are not persons is merely playing with words.

    3. Every person has rights and interests, that may or may not coincide with those of family members or other members of society. In some situations, taking care of the child is a source of major practical and emotional difficulties for the parent(s). That does not make killing morally acceptable. Rather, it entitles the parent(s) to emotional and practical support. Supporting a few ten thousand people with a disability is not a serious practical and economical burden to developed countries of several millions: what is needed is a cultural change. While decisions that impact on the health and life plans of the parents cannot be made without them, their rights and interests are not the sole factor in the decision-making process.

    4. The right to life is not a duty to live. If the condition of the person deteriorates unacceptably, if there is unbearable suffering without prospects of improvement and the suffering cannot be relieved in any medically responsible manner, the life of the person should not be (further) extended artificially. It is one thing to treat a vulnerable human being, it is quite another to tread on his or her physical integrity and personal dignity by using him or her as a subject for uncontrolled medical experimentation. Primum non nocere (“first, do not harm”) is the fundamental ethical imperative guiding the medical profession. It is for this reason that life-prolonging ventilation is sometimes withdrawn from babies with Sarnat 3 asphyxia who are born in a coma and do not display any sign of improvement.

    5. It follows from point 4 that ending the lives of healthy babies, or of babies with Down syndrome, is never morally permissible. No person can be killed for the mere benefit of others.

    6. Abortion (from ab- “amiss” + oriri “appear, be born, arise”) takes place before birth. Killing newborns is not abortion. “When philosophers cannot change the world, they change the words” to fit their moral theories.

    Additionally, I would like to point out that the following statement is factually incorrect: “in fact no more than a few days would be necessary for doctors to detect any abnormality in the child”.

    Related Articles http://jme.bmj.com/content/35/6/369.short http://jme.bmj.com/content/36/6/336.short http://jme.bmj.com/content/37/1/29.short

    Reference

    1. A Giubilini, F Minerva. After-birth abortion: why should the baby live? J Med Ethics 2012; 0: 201110041 (Law, ethics and medicine)

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  5. After- birth abortion and infanticide: the controversy lingers on

    Dear Editor,

    Being a neonatalogist for over thirty years, I read with great interest the recent article on after-birth abortion published by your esteemed journal. Actually I find the term confusing. Medically speaking, abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a foetus or embryo prior to viability. I would presume that the author refers the term to infanticide ie. intentional killing of infants who are babies less than one year old.

    I am aware that a number of prominent western medical ethicists had discussed in depth on the rationale of infanticide, especially handicapped babies and they concluded that the practice is morally acceptable. However, I find that their ethical discussion unconvincing and unacceptable. In my humble view, newborn babies and infants are independent human beings and their human rights and dignity have to be fully respected.

    In their article, the authors have mentioned that many parents would choose to have an abortion if they find out that their foetus is affected by Treacher Collins Syndrome. I can assure them that it is not the case, especially in the eastern culture, as babies with TCS are mentally normal and can grow up to be useful members of the community.

    I wish to point out that infanticide, or so called after-birth abortion, is totally different from withhold/withdraw life support for sick babies and infants. The Royal College of Paediatricians and Child Health and Hong Kong Hospital Authority have respectively published useful guidelines on the indications etc.

    I hope this short communication can promote further discussion and dialogue on this controversial subject.

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  6. Re:After-birth abortion: why should the baby live? An Answer

    Dear Editor,

    Who are you?

    The proposal of the so-called post-birth abortion, in the article by Giubilini and Minerva, is astonishing but not surprising. As the journal editor pointed out, this issue has been largely discussed in the past, after it was formally advocated for the first time by Prof. Michael Tooley in 1972.

    The option of killing the human fetus has been part of medical practice in most western countries over the past decades. As we agree with the authors that no substantial difference is present in the individual before and after birth, we recognize that killing babies 'after birth' only increases the total number of individuals being eliminated, but not the matter at stake. The authors are well aware of this, and conclude that since abortion is commonly permitted, even infanticide should be.

    Our question for the authors is, who would be entitled to decree the death of an infant or any individual who 'might be an unbearable burden on the family and on society' (line 1, page 2) or is anybody at all entitled to make such a decision?

    No one of us decided to be born, when to be born and where to be born, it happened in a specific time in history, in a precise geographical place, and in a family we did not choose. We are indeed confronted with an unavoidable question, who decided of our existence and who called us to existence? The fact of our own birth and our own life brings about, whether we like it or not, that we are not 'in charge' of our life and even less of the life of others. Life is given to us.

    A famous Italian writer, Cesare Pavese, notes in his diary, after he had obtained the most highly prized Italian literary award, "You also have the gift of fertility. You are the master of yourself, of your fate ... yet all that will come to an end. This profound joy of yours, this glow of super-abundance, is made of things you did not take into account. It was given to you. By whom? Whom should you thank? Whom will you curse when it all disappears?" (*)

    The 'I', the human being, is that level of nature in which nature becomes aware of 'being made' and of 'not being made by itself', therefore this existential observation implies the presence of a mysterious relationship, what people historically call 'god'.

    Thus, we hold that each individual has an untouchable value exactly in virtue of this mysterious relationship and no one, whether the person itself, the family and nevertheless the physician is entitled to end their life.

    Moreover, we argue that, since medicine was started in human history in order to heal illnesses, alleviate suffering and comfort patients, the answer to a present or future disability or to parents' anxiety should not be death but solidarity.

    We propose that any patient, whether aware or unaware, capable or incapable, young or old, potentially disable or chronically ill, even when is incurable, holds an unconditional value and therefore should be object of profound respect and care.

    (*) Cesare Pavese, The Burning Brand: Diaries 1935-1950, translated by A.E. Murch (New York: Walker & Company, 1961:345).

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  7. A human being's right to live is a moral axiom

    Dear Editor,

    A human being's right to live is a moral axiom. If logical reasoning gives different result, it means that there is something wrong with the reasoning or with the assumptions. Both reasons apply here. To give some example:

    It is not enough to be a human being to have a right to live; human being has to be able to assign value to their life. If this assumption is true, we can kill all children up to the age of about five, most of mentally ill, all Alzheimer sufferers, most dementia sufferers, all with suicidal thoughts, all unconscious and all who are currently asleep (they can't assign any value to their life at the moment of sleep, they will be able to do this later - exactly like newborns, who will be perfectly capable of assigning value to their life few years later).

    "Or a person might be 'harmed' if something were done to her at the stage of fetus which affects for the worse her quality of life as a person (eg, her mother took drugs during pregnancy), even if she is not aware of it. However, in such cases we are talking about a person who is at least in the condition to value the different situation she would have found herself in if she had not been harmed." - Killing newborn definitely affects quality of their life. And the only thing that causes that they are not in the condition to value this, is this particular act of killing.

    If there is no harm, when there is no person to be harmed, we can kill anybody - after killing there is no person to be harmed, just like in case of post-natal abortion.

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  8. Re:Awkward Truths Should Make People Re-evaluate Routine Practice

    Dear Editor,

    The problem I have with this reply is that it reduces a human being to a dollar value, which flies in the face of any real ethics, moral or otherwise.

    A society should not have: "If you don't want it, kill it", as the basis for its value system.

    It is a product of the "Me Syndrome" society in which we have lived ever since the introduction of the contraceptive pill in 1961, which has also diminished any kind of sexual or moral responsibility, and done major damage to the Age Pyramid.

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  9. After-birth abortion: why should the baby live? An Answer

    Dear Editor,

    Abstract. The logic expressed by Giubilini and Minerva in their work is beyond reproach: it is impossible to make a distinction between a fetus and a neonate from the philosophical point of view, and this is, precisely, the reason why many oppose abortion. According to the authors, infanticide should be permissible “for both social as well as medical reasons”. They refer to the official definition of WHO “A state of complete physical, mental and social wellbeing”. In the dispute opened by the authors we are dealing with the relation between might and right. The fetus and the newborn represent the weak part in a situation of conflict of interest. Conflict of interest that, according to Giubilini and Minerva can be resolved through an act of violence.

    According to Julian Savulescu, Editor of the Journal of Medical Ethics “Giubilini and Minerva extend the long running debate on infanticide to ask: if abortion is permissible both for social as well as medical reasons, why is infanticide permissible only for medical reasons? What is the moral difference between a fetus and a neonate that justifies this difference? Both have similar capacities and if one is permissible, why not the other?” 1

    The logic expressed in the above reference is beyond reproach: it is almost impossible to make a distinction between a fetus and a neonate from the philosophical point of view, and this is the reason why many oppose abortion. 2

    The point we need to focus on is the reasons why abortion, as well as infanticide, should be permissible. Giubilini and Minerva claim it in a very simple sentence “for both social as well as medical reasons”. 3

    They refer to the official definition arising from WHO “A state of complete physical, mental and social wellbeing”.

    “The absence of disease and disability” was the previous pragmatic definition of Health that was discarded in order to bring about a utopian dream that is draining the finances of the States of the entire western world.

    The change of Health definition was brought about during the reign of Brock Chisholm as Director General of WHO (1948-1953) and, according to James Larson, changing definition was necessary to make a paradigm shift from a spiritual to a social orientation. 4

    “Absence of disease and disability” is a Health’s definition that can, hardly, be interpreted in a spiritual sense. Apparently the shift took the wrong direction.

    Besides the philosophical arguments, the economic one is also at stake according to Giubilini and Minerva:

    “The alleged right of individuals (such as fetuses and newborns) to develop their potentiality, which someone defends, is over-ridden by the interests of actual people (parents, family, society) to pursue their own well-being because, as we have just argued, merely potential people cannot be harmed by not being brought into existence Actual people’s well-being could be threatened by the new (even if healthy) child requiring energy, money and care which the family might happen to be in short supply of.” 3

    Helping the families with economic problems could also represent a way out if the only problem to keep the baby is of economic nature.

    Finally, it seems that, in this dispute, we are dealing with the relation between might and right. Either the fetus in the womb, or the newborn infant, are the weak part in a situation of conflict of interest (since, probably, the interest of the fetus is to be born and the one of child to live).

    As Sigmund Freud reminds us: “conflict of interest are resolved, in principle, by the recourse to violence. It is the same in the animal kingdom, from which man cannot claim exclusion” (http://sometimesagreatnotion.tumblr.com/post/367233982/the-einstein-freud-correspondence-1931-1932)

    Therefore we may conclude that, in the case of abortion and infanticide, violence is the rule to be applied, since human beings are part of the animal kingdom, a position that Giubilini and Minerva probably agree upon.

    References

    1. Why Did the Journal Publish an Article Defending Infanticide? J Med Ethics. 2012 Feb 23.

    2. Hare RM. A Kantian approach to abortion. In: Hare RM, ed. Essays on Bioethics. New York: Oxford University Press 1993:168e84.

    3. After-birth abortion: why should the baby live? J Med Ethics 2012 Feb 23.

    4. James Larson The World Health Organization's Definition of Health: Social versus Spiritual Health (Social Indicators Research 38:181-192 1996 Kluver Academic Publishers. Printed in the Netherlands.

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  10. Re:A response to 'After-birth abortion: why should the baby live?

    Dear Editor,

    Alberto Giubilini and Francesca Minerva (1) in their article titled "After the Birth Abortion: Why Should the baby live?" argues that killing a human newborn would be desirable if the birth goes against the interests, material and "moral" of the mother or the family.

    This thesis is based on three arguments:
    1) Killing the newborn would be better than adoption for the mother.
    2) Both fetus and newborns do not have the same moral status of person
    3) The fact that both are potential persons is moral irrilevant.

    At these arguments we made three objections:
    1) Killing the newborn could lead the mother to the possibility of developing psychiatric disorders

    2) Fetus and newborns are two different conditions

    3) The consequence of second point is that abortion and killing newborn are ethical dissimilars

    Adoption versus "post-natal abortion"

    "Post partum abortion" would be better than adoption. The advantage of "post-natal abortion" would be that it is irreversible: in adoption natural mothers could suffer because they could continue to dream the return of their child. This type of dream should be interpreted as meaning that it would indicate "the reluctance to accept the reality of loss." More correctly according to the psychiatric setting, we might suppose that the suffering might result from an inability of the mother to become completely affectless.
    It is obviously that it's not the real child that she is dreaming, but the interior child that alludes to her affective dimension. The irreversible loss of this personal element could mean mental illness accompanied by a feeling of absolute incurability. This could lead the mother to the possibility of developing psychiatric disorders. The psychiatric aspects of "post-natal abortion" is the most relevant. It is clear that we are faced with the provocative thesis of the utilitaristic bioethics which often, denying any intrinsic value to human life, has supported extremist theses far from common sense, denying those who are the real feelings and expectations and reactions of real people.
    In the current bioethical debate come back the arguments of the logic of what Horkeimer had once called "instrumental rationality (2). Kantian reason who had assumed that the man should always be the goal and not the means to achieve the purposes, it was exactly reversed into its opposite.
    The reason turned out to be unable to found and support a universal ethics from the perspective of Enlightenment ideologues, had become only an instrument for the pursuit of practical and utilitarian aim: it opened the way for what will be the post-modern thought. It abandons any pretense of seeking the truth about man and denies that there are no values accepted by all human beings. The right to life, as natural law shared by most cultures, reeling under the ax of critical enlightenment universalism.

    Fetus and newborns are two different conditions

    Why compare abortion with infanticide would not be morally reprehensible crimes? Simply because perpetrated against non-reflective consciousness or biographical provided as at the time had also supported the bioethicist Tooley.
    Perhaps Aristotle was right when he asserted that the child and the woman as irrational, are not human beings?
    Perhaps Freud was right when he said that the newborn baby is completely narcisistic, that is incapable of any relationship with the world and quite comparable to a schizophrenic in his autistic withdrawal(3)? Without consciousness of itself as subjectivity and autonomous center of the agent's actions do not exist, even for Giubilini, the "person". "Abortion post-partum" as exercised on a subject that does not yet exist would be not morally relevant but desirable as a producer of "benefits" for those who practiced it.
    The concept of "potential" to which Gibellini dedicated this year another paper conceives the process of becoming a person as a succession of a series of stages interconnected with each other in which each phase is a potential component of the whole. The development from fertilization would be a dimensional continuum toward the goal of an rational and social identity.
    Gibellini and Minerva take no account, or systematically misunderstand the acquisitions of modern medicine and particularly the neonatal and psychiatric research.
    The embryo does not have any chance of surviving outside the womb and the fetus only from 24 weeks acquires a "capacity to react" that is fundamental for the independent living.
    The birth is conceived by most advanced psychiatry and neonatology research as a transformative event that as a break of continuity between fetal and newborn.
    According to Lagercrantz if we assume that awakefulness is required for mental activity "(...) the are indication that fetus is never awake and conscious"(4). On the contrary the normal newborn is usually awake in the first 2 hours after birth. The awakening of the newborn is due to activation of the cerebral cortex which makes it possible for psychic reality emerging from the biological substrate: this is the result of environmental stimulation especially of the light that activates the brain substance in the immediate aftermath of the travail (5-7). These physiological findings strongly support the theory of the psychiatrist Massimo Fagioli according to whom the thought begins at the birth (5).
    Even if the newborn not futfill the criteria of being conscious as defined for the adult human he reaches for, neonatologists, a minimal level of consciousness considereted as unreflective and present oriented (4): this is consistent with the idea of mental activity made up of drives and fancy.

    Abortion and killing newborn are ethical dissimilars

    Following the experimental data of neonatology and clinical data of psychiatry fetus and newborn are two different conditions.
    So we can argue that we cannot compare abortion pre e post partum not only from the biological point of view but an ethical . The first one, conceptualized and legalized before 23-24th weeks abortion in most Western societies, interested a biological entity: it has eventually the "possibility", only in the future, if its natural development is uninterrupted, to be born. After 23-24th weeks the fetus reaches the capacity to react to the light so it has the "potentiality" of developing immediately , if it comes out of the womb, thought and imagination. According to the common sense and knowledge of medical science abort post partum is a infanticide because newborn is a human being in relation with the world around him.
    The form and content of thought at birth, mostly unreflective and unconscious is the original matrix from which develops the future personality: it is the deeper ethical and psychological sense and value of human existence.
    It can be concluded that the considerations and ethical arguments can not be separated from knowledge derived from the survey on embryological development and neurophysiology: the only way bioethics can be truly free from ideological prejudices and religious.

    References

    1. Giublini A, Minerva F. After-birth abortion: why should the baby live? J Med Ethics 2012. doi:10.2236/medethics-2011-100411

    2. Horkheimer M. Eclipse of reason, Continuum publishing company, New York, 1974.

    3. S. Freud, Inhibition, symptoms and anxiety, Hoghart Press, London, 1936.

    4. Lagercrantz H. Development of consciousness: fetal, neonatal and maternal interactions, in Fetal and Neonatal Neurology and Neurosurgery, edited by Levene M. and Chervenak F. Elservier 2009:25-26.

    5. Fagioli M. The disappearance fantasy and the death instinct. In: Fagioli M, editor. Death instinct and knowledge. L'asino d'oro: Roma 1971:41-50.

    6. Sernagor E, Young C, Eglen SJ. Developmental modulation of retinal wave dynamics: shedding light on the GABA saga. J Neurosci 2003;23:7621-7629.

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  11. Consistency Required

    Dear Editor,

    Proposing the murder of infants as an acceptable solution to the problem of unwanted burdens to society opens the door to the socially acceptable murder of all adult members of society who are burdensome and/or have no quality of life. ....As determined by others; not themselves, of course.

    We must ask:

    Should more people in prison be killed because they add no value to society and have become a burden and have a low quality of life?

    Should all the mentally ill members of society who are a drain on the socialized medical pocketbook, contribute little or nothing to society, and are not experiencing quality of life--should they be murdered?

    Should people who have AIDS be killed because their quality of life is only going to get worse and they are going to be a huge expense to insurance companies and experience emotional and physical pain that only gets worse?

    Should we murder injured veterans who are both physically and psychologically damaged, since they can no longer contribute very much to society, and are sometimes depressed and not experiencing a high level of satisfaction with their lives?

    Should people who are in foreclosure/and or a certain amount of unmanageable debt be killed because they have no quality of life, are not contributing anything to society, are not enjoying their lives, are sometimes a burden, and are hurting those to whom they owe money?

    Should we just go ahead and murder all people who live below the poverty level so that we no longer have to pay them their welfare checks and provide them with all kinds of government assistance? Because if we stopped assisting them, they might become even more miserable, and then they definitely would not have a quality of life, in addition to being burdens to society.

    Who gets to decide what the definition of "quality of life" is, anyway?

    To be consistent with this mentality of destroying worthless life and allowing all others to live, we need to allow an infant to prove his/her own worth. He/she should be given the chance to grow up and prove himself/herself before being murdered. We need to wait until people are adults before we decide whether or not they have a quality of life and deserve death.

    What this also means is that babies should be allowed to live, both in utero AND as a newborn. Currently, many fetuses and some newborns are being denied the right to grow up long enough to decide whether or not they enjoy their own lives or have a quality of life.

    If we carried this ugly mentality to its logical conclusion, we might find that we would be murdering more adults than infants.

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  12. Slippery Slope Slipped Upon

    Thank you, thank you, thank you, Drs. Giubilini and Minerva! Your paper illustrates what I have been saying for a long time: if you accept the idea that fetuses are not persons, then you have to accept that neither are babies, and you must admit the ethical (in this system) permissiveness of baby killing. I applaud the authors' honesty in also admitting that there can be no bright line defining a point in time, of the life of a baby, when killing would be prohibited. After all, some people never do grow up, and thus one could argue for post-birth abortion at practically any age.

    But the authors do not go far enough. I posit a parallel argument: the moral equivalence of fetuses and the elderly. Everyone dies eventually; at some point in every life comes a time span from the last meaningful "aims but also well-developed plans" until the moment of death. This interval might typically be occupied with such recognized meaningless activities as TV-game-show-watching or medical coma. Often people in this time period are "an unbearable burden on the family and on society as a whole." Clearly, under the author's reasoning, it is ethical to kill these no-longer-effective human beings as well.

    I'm not being sarcastic. I'm being brutally logical. If one accepts the rationale of abortion in the first place, there can be no drawing the line at such silly boundaries as birth and death. Ultimately the State can use such reasoning to kill anyone, any time.

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  13. Accepting Infanticide

    Dear Editor,

    The Medical Ethicists that see nothing wrong with killing an "unwanted child" after birth, quite possibly lack some scientific education. the child in the womb or fully delivered at term is not "potential person". It is an "actual person" (to use their childish description). In their mind there is a moral status to actual persons and no obligation to so-called potential persons, so we may kill newborns with no punishment.
    Many disagree including States that have laws protecting babies from outright murder, or manslaughter, abuse. Parents can even sue someone who causes a road accident injuring or killing a baby-born or unborn. A couple of years ago their argument to kill at will might have had some serious adherents. But we know positively that if a sperm fertilizes an ova, we get a baby. It makes no difference if it is grown in a petri dish and tranferred to a womb or even wanted. It is a real person, human being, someone's daughter or son.

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  14. Defining a person is morally crucial

    Dear Editor,

    I do applaud the author for her boldness and intellectual consistency. If there were no clear standard for morality and truth, then it is logical that the progression from abortion to infanticide would be the next step.

    The author's claim to the truth of these three statements is, however, in dispute.

    (1) both fetuses and newborns do not have the same moral status as actual persons, (1a) Both pre-birth babies and newborns do have the same moral status as adult persons.

    (2) the fact that both are potential persons is morally irrelevant (2a) This statement is astonishing. The claim that they are potential persons is crucial to the author's argument, not irrelevant. In fact, they are both persons. The 'potential' became reality when the sperm entered the egg and a zygote was formed.

    (3) adoption is not always in the best interest of actual people, (3a) There may be cases when adoption is difficult, but it is certainly morally superior to infanticide. Furthermore, judging 'best interest' with a slippery and intangible standard is not wise.

    The standard for morality and truth can be observed first-hand through the complexity and inherent design of the human form, even before birth, or observing the intricate design throughout all of nature.

    The standard for morality and truth can also be observed in words that our creator God has left for us. Certainly these references to children in the womb provide a moral foundation for their right to life: Jer 1:5, Exod 21:22-23, Ps 51:5, Ps 139, Luke 1:41-44.

    The moral argument swings on whether or not the pre-born child or newborn is a 'person', implying value. If all truth is relative to the speaker, then even such a person could later be deemed to have less value. If there is objective truth that applies to everyone, then every person has objective worth whether we believe it or not.

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  15. After birth abortion

    Dear Editor,

    I find this article disturbing on so many levels it is hard to know where to begin. Firstly I cannot fathom why it is deepened even acceptable to have such a discussion. Are the authors presumptuous enough to think they can play God? When EXACTLY does a baby become a baby and a real human rather than a potential one?
    One week?
    Two weeks?
    A month?
    A year?

    Maybe as autism is not usually diagnosed untill 12-18 months we should hang on till then just incase we wish to get rid of this life?
    I am quite sure any disabled person would be I sensed at this article as would anyone with a religious belief.
    Having given birth to 11 'potiential' humans I can categorically state they are not potential humans at all! They are babies with emotions and feelings and demand as such respect.
    I wonder if intact the authors have ever held their own precious newborn in their arms . Would you have ever then considered ending its life ?

    One of my children suffered hypoplastic left heart syndrome. I continued the pregnancy and was so grateful for the 3 days we had with him. He was not a potential human he was a human and I am so grateful the medical staff treated himas such. I am so grateful for the time we had with him.
    I would not wish the agnony of watching your e child die on anyone, let alone giving them the choice when they are in such a fragile state. I am so glad the wonderful staff on ICU treated him as a person and respected him. May I suggest the authors visit an ICU and suggest thier proposals to the parents watching their babies battle for life !

    This is not liberal, it's a moral, regressive and sickens me to the core.
    It is intelligence and inflated opinions loosing sight of morality at a disturbingly high level!

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  16. Where there is no love...

    Dear Editor,

    2003 had a baby with Patau's syndrome. Because of previous professional interest in the care of mothers and babies with a variety of complex medical problems and 'lethal conditions', I was greatly helped by the peace and love I had heard these mothers express, when I too passed through the medically difficult pregnancy, perinatal care and death of our daughter.
    A year later we were told about a website (livingwithtrisomy13.org) and were cheered to see the love stories of families living with children like our daughter. Professionals caring for mothers of babies with disabilities must accept that there is another view, even if they do not understand it: that these babies can give and receive love.

    Your article reads like a court proceeding in which all possible evidence against the baby living was taken into account, but there was no advocate for the baby. Economic, social or psychological circumstances, burdensomeness, `life not worth living` and presumed suffering of the child are all thrown in against the baby, and even the possibility of someone else adopting the child is rejected. In addition, your use of the term non-person, which may be seen by some as courageous, is offensive, and has no foundation in international human rights conventions.

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  17. Newborns, really?

    Dear Editor,

    This article is so shameful. Newborn babies feel, breathe, bleed, and learn. Once a baby is born, (I believe the moment it is conceived but that is a different discussion), it is a person with rights. Who are you or their parents to take away their opportunity to make a contribution to the world? No one took away this author's opportunities in life by killing them the moment after birth. No, no one had the right, no one even thought about it. Once you were here that was it. Also, there are plenty of people who would love to adopt a baby(disabled or not) and what right do you have to suggest that opportunity should be destroyed? Babies are such innocent creatures that have the potential to become anything if given some encouragement let alone a chance to survive. Trying to "play God" is a dangerous road and I don't recommend it for anyone.

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  18. The fetus and the newborn, what is the difference.

    Dear Editor,

    A fetus is a parasite incapable of living without the help of it's host. The host is one specific organism. If the host dies while the fetus is reliant on the it, the fetus dies. If the host is endangered by the presence of the parasite, or if the parasite is unwanted, the host rids itself of the parasite.

    A newborn exists on it's own. It is not part of another organism. The newborn is not limited in who can assist it while it completes it's growth to maturity. Thus a newborn is not a parasite. It is allowed to live, and cannot be aborted.

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  19. What about the dad?

    Dear Editor,

    Once the child is born, a father could take over all care of the child starting with bottle-feeding. In the scenarios presented, couldn't the father bring unlawful death suits against the mother and doctor if he were not informed and did not consent?

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  20. Re:Awkward Truths Should Make People Re-evaluate Routine Practice

    Dear editor,

    No Truth is awkward. If there is awkwardness it is the fact that people can see people through the eyes of nazi doctors who saw people as objects.

    There is no price tag on any human being. We are not commodities or objects to eliminate whenever you find an awkward logical reason.

    In the old Rome, men could kill his son before he became man.

    In some tribes of Africa you can kill your child before you give him/her a name.

    Using brains without heart is pointless. If we create 'intelligent' but 'heartless' machines, these machines, based on your awkward logic will find you worthless to live. Think about it.

    Blessings,

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  21. Definition of terms

    Dear Editor,

    Much of the argument that is presented depends on the definition of terms, with the most important being how the authors define what a person is. The definition used is certainly convenient for the paper, yet may not be the most commonly accepted definition.

    Statements such as, "Merely being human is not in itself a reason for ascribing someone a right to life" are dubious and highly debated. Studies show the number of people disagreeing with the authors arguments continue to grow. Many would boldly reject their assertion as outrages on its face.

    The authors use very weak premises and poor definition of its terms to "support" their contention. Poor use of logic in such an important issue. It is sad to see this poor use of reasoning to support terminating a human life.

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  22. Can Moral Value Be Quantified?

    Dear Editor,

    I have a concern regarding the need to explicitly explain the assumptions underlining the logical arguments made in the paper or to provide a proof. The authors state as fact "The moral status of an infant is equivalent to that of a fetus, that is, neither can be considered a 'person' in a morally relevant sense." and "The moral status of an infant is equivalent to that of a fetus in the sense that both lack those properties that justify the attribution of a right to life to an individual." This is stated without proof. I argue that the moral status of a fetus and newborn are both a matter of opinion rather than fact. In other words neither can be quantified or proven. As a matter of opinion, neither value can be quantitatively used to make mathematical or logical arguments except with acceptance of a presumption. In this case the conclusions would only be true to adherents of the same presumption (in this case moral beliefs). In this situation it would seem the correct course would have been to either prove with certainty that an intrinsic moral value can in fact be assigned (and was correctly assigned to both fetus and newborn) or to clearly state that the assignment made by the authors was based on a premise (belief) accepted (at least for arguments sake) by the authors; one that may not be universally held. It would also seem appropriate to state that the conclusions would also only apply if the underlying premise is accepted. As written, the abstract and conclusion seem to suggest that the findings are intrinsic rather than dependent on a belief system or underlying assumptions.
    It is my contention that another set of authors with exactly the same set of facts, but a different belief system might reach entirely different conclusions. Unless this can be refuted, the article should have clearly indicated this. I contend that the primary conclusion of the paper is belief rather than fact dependent.

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  23. Adoption as a solution

    Dear Editor,

    I appreciate your solution of adoption, however, I disagree with the subsequent argument against it. Perhaps you are not familiar with an open adoption (which is quite common today)? A birthparent places the child in adoption, she does not "give the child up" as you stated (to say that is very poor etiquette in the adoption world). We adopted our son; all parties involved couldn't be happier and he is loved not only by us, but by his birthfamily as well and has a wonderful relationship with both. I think the solution would be to significantly lower the fees for adoption and improve the entire adoption process, and then happiness could prevail for all!

    I appreciate your solution of adoption, however, I disagree with the subsequent argument against it.

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  24. Competing interests and infanticide

    Dear Editor,

    Suppose I accept Singer's views on newborns and their interests. Suppose I also think Singer and Kuhse are right to conclude that newborns with conditions that will make their lives a living hell ought to be euthanised. This view is controversial enough.

    The conclusion of Guiblinii and Minerava, however, is that even a modest interest on a parent's part in not being a parent can tip the calculus of interests in favour of the infanticide of an otherwise healthy newborn because the score line is, in effect, 1 to nil. Parents have preferences about how the future should go: newborns don't.

    I think this conclusion is mistaken and the mistake arises from a failure to take account of all the interests that are relevant. First let us consider the interest that we all have in the virtue of benevolence among members of the medical profession. This virtue requires putting the interests of one's patient first. Now, let us suppose that we both agree that the newborn doesn't have interests in the way that persons do. But that does nothing to change the fact that doctors and nurses relate to newborns largely as if they were persons with interests: after the birth, the obstetrician acts as if she now has two patients. And in this respect medical professionals do not differ significantly from most of the rest of humanity. Can they be trained to distinguish homo sapiens with interests from those without? Can this be done in a way that is compatible with the virtue of benevolence as it has been cultivated through centuries of medical tradition? Are the interests of the parents in the non-existence of a newborn biologically related to them so strong that we really want to try and find out? I submit that the interest of one or both parents in not being a parent is plausibly trumped by the interest that the entire community has in traditions that we know *reliably* promote the virtue of benevolence.

    I could continue to enumerate other interests that have been overlooked -- the interests of would-be adoptive parents, the interests of doctors and nurses in not killing a healthy infant, the interests of the public at large in not living in a community where healthy infants are killed. All these interests would, I submit, withstand reflective scrutiny and so are not mere whims but considered interests.

    At no point in this paper do the authors lay out a normative theory of their own. If the reader has to guess, I think that this paper argues within the framework of preference utilitarianism. If that's right, then the problem with the paper is not that it is taken wrongly by non-academic readers as a contribution to a policy debate. Rather, the problem is that it is not a very plausible application of preference utilitarianism because it ignores so many of the preferences that are relevant to the case at hand. Now, you may reply that all these interests are quite contingent. We could imagine cases in which they didn't obtain, and so on. Quite true! But that just shows that preference utilitarianism divorced from the real world of actual preferences is almost infinitely pliable and thus distinctly uninteresting.

    Nobody, however, should be threatened for putting an implausible argument and I deplore the abuse that has been visited upon the authors as a result of publishing this paper. On the other hand, it is not bold and innovative to publish a paper that challenges widespread beliefs on the basis of an argument that is implausible. In this respect I think the authors have been ill-served by the editor and referees for JME.

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  25. Re:Awkward Truths Should Make People Re-evaluate Routine Practice

    Dear Editor,

    Prayer After Birth (Acknowledgements and Apologies to Louis MacNeice).

    I am now born: please hear me, Let not the debt collectors, Or the rights protectors, Or the seditious insurrectors come near me.

    I am now born, comfort me, Else I fear that the human-folk may: With clever lies debase me, With bad science un-race me, And with strong drugs erase me.

    I am now born: please bestow me, Among the dancing grass, babbling brooks, Swaying trees and singing rooks, Undiminished bright light of grace and truth, To restore me.

    I am now born, with lullabies lull me, With warm cuddles mull me, With deep love sustain me, and, With silence, not gainsay me.

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  26. Infanticide and termination - an inexorable progression of logic

    Dear Editor,

    There is an inevitability about the logic that proceeds from a violation of the Hippocratic oath to allow termination of a foetus' life in strictly limited circumstances, to widespread abortion on demand, to the toleration of selective termination for no grounds other than that of sex, to justifying infanticide. It is the logic, if the term may be so wrenched, of the denial of the Divine commands.

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  27. A Modest Proposal

    Dear Editor,

    Let me offer Swift congratulations to Mr. Giubilini and Ms. Minerva for offering A Modest Proposal for Preventing the Children of Poor People From Being a Burden on Their Parents or Country, and for Making Them Beneficial to the Publick (sic).

    Two quibbles: First, it's really a thoughtless waste to just dispose of the remains. If an unenlightened and religiously superstitious public is not yet ready to use this unwanted meat for personal consumption, there is no reason it couldn't be sold to packers who could process it for dog and/or cat food.

    Second, why stop with infants? For instance, as the progeny of a former penal colony, Australians - while certainly "human beings and potential persons" - are surely not "subject of a moral right to life." If I thought about it a little further, I imagine I could come up with numerous examples of human beings that don't have the same right to life as I have!

    While it is, admittedly, hard to exactly determine when a subject starts or ceases to be a "person," I am so happy to see that someone in the ethical field has finally stated the obvious, viz., there is no difference between aborting a fetus and killing an infant.

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  28. Can after-birth abortion do harm?

    Dear Editor,

    Giubilini and Minderva's paper suffers from an inordinately one-sided perspective on the beginning of personhood. There is no consensus on the exact timing and nature of the beginning of personhood. It has been and will continue to be the subject of discussion and debate in science and philosophy. By contrast, the authors' assertions suggest a settled account of personhood. This account forms the basis of their premise that both fetuses and newborns do not have the same moral status as that of actual persons: "Both lack the properties that justify the attribution of a right to life to an individual." In particular, "all individuals who are not in the condition of attributing any value to their own existence are not persons." This leads to perhaps the most controversial statement in the paper: "If the death of a newborn is not wrongful to her on the grounds that she cannot have formed any aim that she is prevented from accomplishing then it should also be permissible to practice an after- birth abortion on a healthy newborn, given that she has not formed any aim yet." This implies that no harm can be done to newborns as "actual persons." They cannot experience the harm because "a newborn can hardly be said to have aims." As such, a newborn does not qualify as a person. Besides the fact that there are many aimless full grown men and women without "well-developed plans" - the authors' implied definition of "aims" - who we nevertheless characterize as persons, the paper completely ignores newborns' aims to survive, feel secure and content. Newborns meet these aims by calling attention to themselves (e.g., crying) until their parent or surrogate provides them with food, warmth, shelter, an embrace.

    The paper also endorses a teleological view of decision-making on the part of persons involved in decisions about after-birth abortion which is both narrow and unrealistic. It is narrow because a woman's decision- making is reduced to a presumably rational calculus of benefits and harms from after-birth abortion that impact her, her partner, and society. As an economist, I subscribe to the position that expected consequences lie at the root of most of our decisions. However, certain decisions we take appear to be independent of their consequences. These decisions could be habitual, for example, or for moral reasons other than the consequences of our actions. The authors' conception of decision-making is unrealistic in that they appear to presuppose certainty in calculations of benefits and harms that accrue to decision-makers and society. We may expect our actions to have definite consequences, such as clear benefits and harms to us, to society. However, invariably a large degree of uncertainty is involved in decision-making of any kind. First, this is a result of imperfect and probabilistic information with which to make a decision. To illustrate, the two prenatal tests cited - the ones for Treacher-Collins and Down's syndrome, respectively - are subject to error, as are clinical diagnoses of newborns for that matter. Second, even if the choices we make are based on 100% accurate information, we are never in a position of being able to fully anticipate our subjective response to the consequences of our actions, whether in the form of relief, regret, remorse, coping. Contrary to the authors' claims that with after-birth abortion "neither an actual nor a future person can be harmed, which means that there is no harm at all," harm can be done to persons, namely the ones doing the harming.

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  29. Re:A response to 'After-birth abortion: why should the baby live?

    Dear Editor,

    The troubling part of considering who is human under what criteria and thus deserves the protections of the law is that it is the service of disqualifying another group historically accorded that status and those protections.

    Perhaps instead of multiplying exclusions from humanity, we should reconsider the entire re-classification enterprise ethically.

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  30. Re:A response to 'After-birth abortion: why should the baby live?

    Dear Editor,

    It is crucial that as both citizens and professionals we distinguish between the argument of Guibilini and Mineras article(1) and the reaction to its publication. It is possible to argue, as some have, that this merely restates rather baldly what has been argued implicitly (and in some cases explicitly) in varying cases. The argument thus is a kind of "slippery slope" exemplar rather than a new and radical position. And, too, one may note, as others have, that infanticide as presented here would in most western countries probably be illegal.

    More troubling by far has been the public reaction to this article, and the journal. It has never been the task of the editors to censor articles based on political or ethical perspective. With others, I have benefited from the willingness of JME editors to engage uncommon and unusual positions. And further, the editors are typically at pains to provide an arena for response to articles.

    To criticize the journal and its editors is to criticize the ability of us all to argue points of view, and as importantly, to argue different points of law, medicine and ethics.

    Without commenting on the thrust of the argument (one I reject) I hope others will see this as an editorial exemplar of providing us all a wide arena of argument and reflection. The editors should be congratulated on this, not condemned.

    References

    1. Giublini A, Minerva F. After-birth abortion: why should the baby live? J Med Ethics 2012. doi:10.2236/medethics-2011-100411

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  31. A Modest Proposal

    Dear Editor,

    Giubilini and Minerva [1] argue that infanticide, which they call 'after-birth abortion' is ethically equivalent to abortion. This has been argued on similar grounds elsewhere, most notably in the work of Tooley [2], and has found some support among those who object to abortion on moral grounds.

    In this response, I wish to focus not on the argument itself but on the novel claims made in the concluding paragraph:

    'Second, we do not claim that after-birth abortions are good alternatives to abortion. Abortions at an early stage are the best [sic] option, for both psychological and physical reasons. However, if a disease has not been detected during the pregnancy, if something went wrong during the delivery, or if economical, social or psychological circumstances change such that taking care of the offspring becomes an unbearable burden on someone, then people should be given the chance of not being forced to do something they cannot afford.'

    The final sentence makes a claim that if there is 'disease' in the neonate that was undetected antepartum, or if any of several other conditions is fulfilled, then 'people' should be 'given the chance' of 'not being forced to do something', i.e. they should not be forced to raise a child. In the context of the paper, the implication is that they should perform, or cause others to perform, an 'after-birth abortion'. Since undetected disease, poverty, and psychological problems are practically inevitable, the authors advocate that people should be 'given the chance' of performing infanticide. How, then, are they to be given this chance? Presumably by removing some obstacle to infanticide that is currently in place. The most obvious obstacle to infanticide in Britain is the law, which would indeed need to be changed in order to give would-be after-birth abortionists their chance.

    The problem with this proposal is that it is not justified by the argument that precedes it. I am a dog owner. Suppose I construct a philosophical argument that my dog is morally a person (he displays 'aims', and can experience harm). If my dog is a person, and I am his owner, then it ought to be permissible for a human person to have an owner. Therefore, in conclusion, I propose we should remove any obstacles to owning humans, by legalizing slavery. I do not advance such a proposal, but were I to do so people might well think I would be better employed as a medical ethicist.

    References

    1. Giublini A, Minerva F. After-birth abortion: why should the baby live? J Med Ethics 2012. doi:10.2236/medethics-2011-100411

    2. Tooley M, 'Abortion and infanticide', in: Bioethics: An Anthology (ed. Kuhse H and Singer P) Wiley-Blackwell, Malden MA 2006: 25-39.

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  32. Re:A response to 'After-birth abortion: why should the baby live?

    Dear Editor,

    I would like to comment on "After-birth Abortion: Why Should the Baby Live" (Giublini and Minerva, 2012)(1), in which the authors propose that newborns do not have sufficient self-awareness to have a moral right to life and suggest that 'after-birth abortion' (infanticide) should be allowable under the same circumstances as abortion.

    The claim concerning neonatal self-awareness refers to, and largely reflects, a paper by Tooley (1972)(2) in which the author does not consider a neonate to have an intrinsic right to life simply due to its own existence, its species, nor its potential to become an adult human. The author argues that a kitten has no moral right to life, and that the same argument can be applied to the human neonate, who has no more continuing sense of self than a kitten:

    "This is obviously a matter for detailed psychological investigation, but everyday observation makes it perfectly clear, I believe, that a newborn baby does not possess the concept of a continuing self, any more than a newborn kitten possesses such a concept. If so, infanticide during a time interval shortly after birth must be morally acceptable."

    The argument is limited in its scope; at no point does the author consider that the killing of kittens might be morally wrong, nor does he allow that there may be any substantial difference between a kitten and a human neonate. The Tooley paper is 'of its time', with political leanings and anecdotal reasoning, without reference to scientific data on human infant development. The paper and its conclusions do not belong either culturally or scientifically in the twenty-first century - yet this paper forms the essence of the Giublini and Minerva argument.

    These days, the more salient argument and that addressed by Giublini and Minerva, is whether the human neonate is fundamentally different not just from kittens but from foetuses that can legally be subject to abortion (in the UK, up to 24 weeks' gestation, which until recent years reflected the ex-utero viability of the foetus). What is the moral difference between the two? How do we pinpoint the time at which a foetus or baby becomes a 'person'?

    From recent studies on infant development, Rochat states that while the human newborn may not have developed adult levels of self-perception and conceptual awareness(3), nevertheless, the newborn both experiences feelings(3,4), the precursor to self-awareness, and is in a phase of explosive development(3).

    These two factors, coupled with inter-individual variation, suggest that it is inappropriate to try and estimate a precise 'date' at which a baby develops a sense of continuing self, which in itself is an arguable benchmark for determining the right to live. Excluding the issue of euthanasia for terminally ill or deeply suffering newborns(5), which is a separate issue concerning whether death is the kindest option for the child, in the absence of reliable and unanimously accepted criteria for defining the right to live, the only safe option for a moral society is to assume the baseline position that all humans have every right to live.

    This does not mean that abortion should be illegal, it merely suggests that abortion is not always the result of a moral decision in relation to the foetus alone. There are strong arguments supporting the legalisation or continued legality of abortion, in this world, at this time. One key argument for legalisation of abortion is to reduce the maternal morbidity and mortality associated with illegal, backstreet abortions - an issue which continues in many countries today(6). The legalisation of abortion in such instances reflects a pragmatic decision to protect the mothers, and reflects the clinical preference for losing one life rather than two. As such it is a pragmatic solution to a real problem, rather than solely a measure of the relative humanity of a foetus. We do not live in a distant utopia where all mothers are supported and cared for, with adequate food, housing, healthcare and emotional support. In this world, pregnant women can be faced with severe practical or emotional difficulties, e.g. due to illness, poverty, rape, or social factors, and sometimes seek abortion irrespective of legality or risk. Legalisation allows those abortions to be conducted by medical staff in the appropriate clinical setting, where the women can be treated relatively safely during what is often a challenging time for them.

    Giublini and Minerva do not discuss the effects of abortion(7) or filicide(8,9) on parents, even though research has shown both to incur long-term psychological consequences for the mother, and could be expected to affect others.

    Regarding alternatives, Giublini and Minerva do not discuss the many potential support mechanisms, such as social support and counselling, that can be made available to struggling families, with the exception of adoption which is described in outdated terms (omitting to mention modern day open adoptions(10)), and dismissed on cursory grounds. Rather than using the legality of abortion as an argument for killing newborns, a moral argument might suggest focusing on practical or emotional assistance for families struggling to cope with pregnancy or parenthood.

    Lastly, the authors omitted to mention the deep and sustained joy that a baby can bring to both family and community, as he or she journeys towards a sense of continuing self.

    References

    1. Giubilini A, Minerva F. J Med Ethics (2012). After-birth abortion: why should the baby live? doi:10.1136/medethics-2011-100411 http://jme.bmj.com/content/early/2012/03/01/medethics-2011-100411.full

    2. Tooley M. Abortion and Infanticide. Philosophy and Public Affairs, 1972;2: No. 1. http://rci.rutgers.edu/~tripmcc/phil/cmsi/csmi- abortion/tooley-abortionandinfanticide.pdf

    3. Rochat P. The self as phenotype. Conscious Cogn. 2011;20(1):109-19. Epub 2010 Dec 8. (abstr.) http://www.ncbi.nlm.nih.gov/pubmed/21145260

    4. Rochat P. Five levels of self-awareness as they unfold early in life. Consciousness and Cognition 2003;12:717-731. http://www.psychology.emory.edu/cognition/rochat/lab/5%20levels%20of%20self -awareness.pdf

    5. Verhagen E, Sauer PJ. The Groningen Protocol -- Euthanasia in Severely Ill Newborns. N Engl J Med 2005;352:959-962 http://www.nejm.org/doi/full/10.1056/NEJMp058026

    6. Grimes DA, Benson J, Singh S, et al. Unsafe abortion: the preventable pandemic. The Lancet, 2006; 368(9550):1908-1919. doi:10.1016/S0140- 6736(06)69481-6 http://www.lancet.com/journals/lancet/article/PIIS0140- 6736(06)69481-6/abstract Full text: http://www.who.int/reproductivehealth/publications/general/lancet_4.pdf

    7. Casey PR. [Psychological effects of abortion]. Servir 1998;46(1):5. http://www.ncbi.nlm.nih.gov/pubmed/9653372

    8. Stanton, J. and Simpson, A.I.F. The aftermath: aspects of recovery described by perpetrators of maternal filicide committed in the context of severe mental illness. Behavioral Sciences & the Law 2006;24:103-112. doi: 10.1002/bsl.688 http://www.ncbi.nlm.nih.gov/pubmed/16491479

    9. Putkonen H, AmonS, et al. Filicide in Austria and Finland - A register-based study on all filicide cases in Austria and Finland 1995- 2005 BMC Psychiatry 2009;9:74. http://www.biomedcentral.com/content/pdf/1471-244X-9-74.pdf

    10. Grotevant HD, McRoy RG, Elde CL, Fravel DL. Adoptive family system dynamics: variations by level of openness in the adoption. Fam Process 1994;33(2):125-46. http://www.ncbi.nlm.nih.gov/pubmed/7925924

    Conflict of Interest:

    None declared

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  33. The fallacious argument of 'After-birth abortion: why should the baby live?'

    by Martin Rhonheimer

    Dear Editor,

    Alberto Giubilini and Francesca Minerva (1) argue on the basis of a well known fallacy: they consider "being a person" merely as a property of an individual belonging to the human species, a property, moreover, which only develops over time. But as many have demonstrated, this is erroneous. (2) Personhood is not a property of beings of the human species but belongs to what a being of the species homo sapiens essentially is. However, human persons do have, and only develop over time, properties and behaviors characteristic for persons, like thinking, wishing, speaking, laughing etc. The fact that they are able to develop these properties over time precisely shows that they already are person, because only human persons can develop the properties characteristic for human persons (horses or cats instead develop the properties typical for horses and cats; of course, already a horse-fetus actually is a horse, it is not only a "potential horse"). In brief: human beings are essentially, that is, by their very nature, persons, even though they develop the properties characteristic for human persons only over time.

    A "potential person" is something that is not yet a person, but in some way can become one. A stone is not a potential person. Nor is a sperm cell or an egg cell, considered in themselves; considered together, however, as possibly fused, they are a potential person (or rather: "they are potentially a person"). A fetus, on the other hand, is not a potential person, because it already is a person. It is, however, a person "in potential," that is, on the basis of his actually being a person, he possesses precisely that potentiality to develop personal prop?er?ties (to "actualize" them), that is, those properties that can belong only to persons (even if they have not yet developed any of these properties). But even a ten-year-old child is still a "person in potential" in this sense, even if he has developed many, but precisely not all, of these properties. In fact, every person is always in some way a "person in potential," given that no one has developed all of the possibilities of a person.

    "Potential" and "potentially" are in fact extremely ambiguous terms. At times they deal with a concept of possibility (including logical); at other times of a real capacity. Human gametes are potential persons because, as distinct from other types of cells, it is possible that they, when fused, can become a person (the fusion itself is based on a contingent event, external to this possibility; neither of the gametes possesses entirely in itself the capacity to develop the properties of a person). A fetus, on the other hand, is a "person in potential" because a fetus is capable of developing to the point of becoming an adult person (and this is not only possible, but certain, on the basis of what a human fetus is; only external contingent events can impede this development). In this latter sense, then, every person (including adults) is, in some respect, a "person in potential."

    The being-a-person of the fetus, therefore, is a present fact, and in no way merely potential. It is not the being-a-person that is potential, but personal behavior. Only a being who is already actually a person can demonstrate a potential for personal behavior, so as to eventually develop actual personal behavior. So we can restate the basic principle that only beings who ontologically or essentially already are persons can also develop the properties of persons! "Being a person" is not a property of a human being, but is part of its very nature as a being belongig to the species homo sapiens. (3)

    This is the fundamental truth Alberto Giubilini and Francesca Minerva are completely disregarding, following therewith authors like Peter Singer, Michael Tooley, Helga Kuhse and many others. However, repeating once and again that human embryos and fetuses and newborn children are "potential persons" does not make this improper way of speaking truer. It remains a fallacy. Human fetuses and newborn children definitely are not "potential persons", but actual persons and they therefore possess the inherent capacity of developing over time, precisely on the grounds of what they essentially already are, all the properties and types of behavior characteristic for human persons. This is why they possess human dignity and a right to life equal to all other human beings.

    References

    (1) After-birth abortion: why should the baby live? Retrieved 1 March, 2012 from http://jme.bmj.com/content/early/2012/02/22/medethics- 2011-100411.

    (2) Cf. e.g. Martin Rhonheimer, Ethics of Procreation and the Defense of Human Life (Washington D.C.: CUA Press, 2010), 179-227; Stephen Schwarz, The Moral Question of Abortion (Chicago: Loyola University Press, 1990); Christopher Kaczor, The Ethics of Abortion (New York and London: Routledge, 2011).

    (3) See my above quoted: Ethics of Procreation and the Defense of Human Life, 203-204.

    Conflict of Interest:

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  34. A response to 'After-birth abortion: why should the baby live?

    A response to 'After-birth abortion: why should the baby live?' (David Pohlmann, Ph.D.)

    Dear Editor,

    When I began to read this article published in the Journal of Medical Ethics, I initially thought the authors were writing somewhat tongue-in- cheek. My intrigue turned to dismay when I realized that they were actually arguing that killing newborn babies is morally justifiable. Law would call post-birth abortion murder, infanticide, or possibly euthanasia, but the authors argue that such an act should not be referred to as infanticide, claiming it to be morally equal to abortion; and reject the term euthanasia because they are not necessarily interested in the well-being of the baby concerned. They argue that "the moral status of [a newborn] is comparable with that of a fetus" , hence the use of the term after-birth abortion.

    One of the things that the authors have done, in my view, is to draw attention to societal double-standards wherein many (in the 1st world) are happy to use embryos for spare parts, abort fetuses and kill criminals but draw the line at terminating the lives of newborns. But from my vantage point in doing so, the authors simply strengthen the argument against all of these evils rather than justifying their argued position for post-birth abortion. If anything, they draw attention to some of the inept reasons proposed for abortion in the first place. It is 'a nonsense' to argue that just because something is societal practice, that those actions are moral. And just because those in the Netherlands have been allowed, by the Groningen Protocol (2002), to euthanize infants in certain situations, doesn't make this practice something for the rest of the world to emulate.

    The authors accept that there are some arguments brought to bear by people who would oppose abortion. They admit that "people with Down's syndrome, as well as people affected by many other severe disabilities, are often reported to be happy." , but gloss over this as if it is not important to their argument proposing that some such people should die at birth. While not rejecting the truth of such reports of happiness in life, the authors simply regard this evidence as immaterial to their argument. When the authors state that "It might be maintained that 'even allowing for the more optimistic assessments of the potential of Down's syndrome children, this potential cannot be said to be equal to that of a normal child'" , they are allowing tyranny of the bell curve to guide their proposed behavior. After all, the concept of 'normal' is a statistical function of central tendency and in itself simply a statement of what is, not a means of proposing what should be. If we retrospectively implemented these kinds of ideas, the world would have been robbed of people like Helen Keller, Andrea Bocelli and Nick Vujicic simply because someone decided they weren't normal.

    It seems to this reader that the foundation of the authors' thesis is their definition of person-hood. This definition runs something like this: That (1) an individual may only have the status of 'person' if they are able to attribute "to [their] own existence some (at least) basic value such that being deprived of this existence represents a loss to [them]." ; therefore (2) a human being is not necessarily a person; and hence (3) some non-human animals may be persons. From this they argue that certain individuals (such as fetuses and new-born babies) are not persons, and hence lack the rights of persons, including the right to live. They also make a dangerous extrapolation in their delineation between potential persons (such as the aforementioned) and actual persons. The authors argue that the moral status of 'non-persons' (as persons of value) "depends on the particular value the woman projects on them" when a termination takes place, and argue that a similar projection should be acceptable "...when a newborn becomes a burden to its family." . The authors assert that "since non-persons have no moral rights to life, there are no reasons for banning after-birth abortions" . Even if one were to take the softer line in calling newborn babies potential persons, they maintain that "the interests of actual people over-ride the interest of merely potential people" . This delineation between potential and actual people or persons and non-persons smacks of the once wide-spread and now largely refuted field of eugenics , of which Nazi Germany was the best known exponent. Do we, as a society, really want to travel back down that road?

    Surely value as persons is something that all humans are born with? The UN's Universal Declaration of Human Rights declares that "All human beings are born free and equal in dignity and rights" . The US declaration of Independence claimed that "all men (sic) are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness." Buddhism would teach that "we should abstain from taking a life which we ourselves cannot give and we should not harm other sentient beings." . Humanism "(a) affirm[s] life rather than [denies] it; (b) seek[s] to elicit the possibilities of life, not flee from them; and (c) endeavor[s] to establish the conditions of a satisfactory life for all, not merely for the few." From my own Christian perspective, we humans have a responsibility to defend the weak including helpless children, welcoming them into this world, not killing them, because they have been attributed innate worth and value by their creator.

    The authors state that "in order for a harm to occur, it is necessary that someone is in the condition of experiencing that harm." , but they have proposed harm to these children as they purport to stealing their very future, and therefore all future experiences, good and bad, would be dissolved by those doctors, neurologists and psychologists informing the decisions of parents . It puts an enormous burden on the moral or ethical judgements of those, in whose power it is, to 'abort' newborn babies. The authors' thesis calls on such professionals to assume the role of 'god' by determining which humans have value and which ones don't-I personally wouldn't want that job! If, as Churchill is attested to have said, it is true that 'you measure the degree of civilisation of a society by how it treats its weakest members' what kind of society are the authors of this article proposing?

    References

    1. Giubilini, A and Minerva, F. (2012). After-birth abortion: why should the baby live? Retrieved 1 March, 2012 from http://jme.bmj.com/content/early/2012/02/22/medethics-2011-100411.full, para 9

    2. ibid,para 6

    3. ibid,para 7

    4. ibid,para 7

    5. Nick Vujicic, Retrieved 1 March, 2012 from http://en.wikipedia.org/wiki/Nick_Vujicic

    6. Giubilini & Minerva, 2012, para 13

    7. Giubilini & Minerva, 2012, para 16

    8. Ibid, para 21

    9. Ibid, para 20

    10. Eugenics, Retrieved 1 March, 2012 from http://en.wikipedia.org/wiki/Eugenics

    11. Universal Declaration of Human Rights, Retrieved 1 March, 2012 from http://www.un.org/en/documents/udhr/, para 9

    12. The Declaration of Independence, Retrieved 1 March, 2012 from http://www.usconstitution.net/declar.html, para 3

    13. The Noble Eightfold Path - The Middle Way, Retrieved 1 March, 2012 from http://www.budsas.org/ebud/whatbudbeliev/78.htm para 11

    14. Humanist Manifesto I, Retrieved 1 March, 2012 from http://www.americanhumanist.org/Who_We_Are/About_Humanism/Humanist_Manifesto_I, para 18

    15. Ps 82:3; Matt 18:2-10

    16. Giubilini & Minerva, 2012, para 18

    17. Ibid, para 26

    Conflict of Interest:

    None declared

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  35. Awkward Truths Should Make People Re-evaluate Routine Practice

    Dear Editor,

    Giubilini and Minerva (1) make an interesting contribution to the literature on ethics. The public outcry against this proposal is unsurprising, but clearly misses the point. Currently a vast amount of money is spent on antenatal screening to identify foetuses with Down's syndrome so they can be destroyed before birth. Complex networks of midwives, ultrasonographers and laboratories are necessary to operate this search and destroy policy, but even then some affected babies are born. Furthermore, many women with unaffected babies endure the stress of being told that a screening test is positive and that further diagnostic testing is necessary. The sheer effort being applied in this area makes one think of the helicopter attack sequence from 'Apocalypse Now' and the effort that was taken to destroy a tiny native village. Are Down's syndrome babies so dangerous that they must be hunted to extinction?

    One could suggest that post-natal abortion merely returns society to the mores of earlier eras of civilisation, such as the Spartan practice of exposure on hillsides, or Nazi eugenics (2). The fact that such a prospect is considered unpleasant is however no reason not to consider the implications of a post natal abortion policy. A post-natal solution to Downs syndrome (and other potential screened 'diseases') would make economic sense because all of the money that is currently being spent on screening could be redirected to other areas of healthcare where adults who have developed and therefore become 'people' could benefit.

    However, instead of taking the hysterical option and shouting down the proposal, could the alternative lesson of Giubilini and Minerva's paper be that although antenatal and postnatal screening are technically little different, people would rather see large amounts of money spent on antenatal diagnosis / treatment / termination because it is much less psychologically difficult to casually destroy a small number of cells that do not yet look human than to wait until an identifiable 'baby' has been born.

    It is said that hard cases make hard law, but often the way to make people think about the truth of what they do is to extrapolate to an absurdist position. Perhaps the controversy raised by Giubilini and Minerva will make people evaluate the things that are already happening around them.

    References

    1. Giublini A, Minerva F. After-birth abortion: why should the baby live? J Med Ethics 2012. doi:10.2236/medethics-2011-100411

    2. Reynolds TM. The ethics of antenatal screening: Lessons from Canute. Clin Biochem Rev 2009;30:187-96.

    Conflict of Interest:

    None declared

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