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Twin pregnancy reduction is not an ‘all or nothing’ problem: a response to Räsänen
  1. Dunja Begović1,
  2. Elizabeth Chloe Romanis2,
  3. EJ Verweij3
  1. 1 Centre for Social Ethics and Policy, The University of Manchester, Manchester, UK
  2. 2 Gender and Law at Durham, Durham Law School, Durham University, Durham, UK
  3. 3 Department of Obstetrics and Gynaecology, Division of Foetal Therapy, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  1. Correspondence to Dunja Begović, Law, The University of Manchester, Manchester M13 9PL, UK; dunja.begovic{at}


In his paper, ‘Twin pregnancy, fetal reduction and the ‘all or nothing problem’, Räsänen sets out to apply Horton’s ‘all or nothing’ problem to the ethics of multifetal pregnancy reduction from a twin to a singleton pregnancy (2-to-1 MFPR). Horton’s problem involves the following scenario: imagine that two children are about to be crushed by a collapsing building. An observer would have three options: do nothing, save one child by allowing their arms to be crushed, or save both by allowing their arms to be crushed. Horton offers two intuitively plausible claims: (1) it is morally permissible not to save either child and (2) it is morally impermissible to save only one of the children, which taken together lead to the problematic conclusion that (3) if an observer does not save both children, then it is better to save neither than save only one. Räsänen applies this problem to the case of 2-to-1 MFPR, arguing ultimately that, in cases where there is no medical reason to reduce, the woman ought to bring both fetuses to term. We will argue that Räsänen does not provide adequate support for the claim, crucial to his argument, that aborting only one of the fetuses in a twin pregnancy is wrong, so the ‘all or nothing’ problem does not arise in this context. Furthermore, we argue that the scenario Räsänen presents is highly unrealistic because of the clinical realities of 2-to-1 MFPR, making his argument of limited use for real-life decision making in this area.

  • abortion
  • clinical ethics
  • embryos and fetuses
  • women

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  • Twitter @begovic_dunja, @ECRomanis, @JoanneVerweij

  • Contributors All three authors participated in researching, writing, editing and revising the manuscript. DB wrote the section on conceptual issues, ECR and EJTV wrote the section on clinical realities, ECR wrote the section on subjective decision making, and DB and ECR wrote the introduction and conclusion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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