• Abortion
• Philosophical Ethics
• Embryos and Fetuses
• Interests of Woman/Fetus/Father
• Newborns and Minors

After the publication of our article ‘After-birth abortion: why should the baby live?’ in the Journal of Medical Ethics,¹ we received hundreds of emails, most of which were very abusive or involved death threats. Also the media paid a lot of attention to our work, and for a few weeks we were in the eye of a media storm.

Many people suggested that we should have expected such heated reactions. But it is hard to foresee something that never happened before to such an extent after the publication of an academic paper, as even very controversial publications have not had such media coverage in the past. From now on, this sort of reaction will probably be more and more common because of the internet and the globalisation of information. However, we have been among the first bioethicists to experience such strong and immediate reaction from the general public, and therefore we could not possibly see it coming.

Our intention was to ask—and attempt to answer—questions arising from philosophical considerations about the moral status of newborns, compared with that of fetuses, and about the normative consequences of the answer. This is because we list among our professional duties that of following a logical path to its (extreme) consequences. In the case of our paper about after-birth abortion, the logical path is this: if we think that abortion is morally permissible under certain circumstances because fetuses lack certain properties, then, since newborns lack the same properties, we should also think that what we called ‘after-birth abortion’ is equally morally permissible under the same circumstances.

Rational agents make decisions on the basis of good reasons. All important decisions we make, such as deciding to do one job rather than another, to have children or not, or to have children at a certain time of our life rather than earlier or later, are (or at least should be, if we are talking of rational people) the result of hard thinking about principles informing our lives and consequences for ourselves and other people involved.

In general, the more that is at stake, the harder the thinking before acting is and should be. For example, termination of pregnancy is an important decision that is requested by women who typically have serious reasons for doing so: the fetus is affected by a severe abnormality that will make the quality of its life extremely poor; the pregnancy puts at risk a woman's health or even her life; the fetus is the result of a sexual abuse; the woman is incapable (for various reasons) of taking care of a child at that particular moment of her life; there are extreme economic difficulties or social conditions which are hardly compatible with having children, and so on2 ,3; in any case, reasons are usually deeper than the mere desire not to be pregnant, and they are hardly trivial.4 It is worth noting that many of these reasons can be present whether or not the fetus is healthy, and are held by many as morally acceptable regardless of whether the fetus is healthy. Women usually choose to have abortions only if they have serious reasons because what is at stake is extremely important—for example, bringing a new person into existence or not, the possibility of creating or enlarging a family, experiencing parenthood.

The thesis that fetuses and newborns share the same moral status is not new (especially, but not only, among Catholic and pro-life philosophers),5 ,6 as references in our article should have suggested also to those who are not acquainted with bioethics debates. Rather than saying anything new about this point, the aim of our article was to make explicit conclusions that, we think, were implicit in what others said before us.7–9 Specifically, we drew some conclusions in the light of socioeconomic circumstances families might be facing. If there are good reasons to think that such circumstances matter when decisions concern termination of a life before birth, then there are good reasons to think that these circumstances matter immediately after birth too.

Those who advocated the legitimacy of after-birth abortion (or infanticide) before us often confined their discussion to cases in which the newborn is disabled10 ,11; and, as we said in the first part of the article, disability is often held as a good justification for abortion. But a disability such as, for example, Down syndrome does not necessarily make the life of a person not worth living. There has been a lot of misunderstanding on this point. In our paper, we refer to studies showing that a person with Down syndrome can have a happy and worthwhile life. It might be more difficult for her/him to achieve certain goals than for a person without Down syndrome, of course, but the condition alone does not seem to make a life not worth living. Much depends on the social and economic situation of the family rather than on the disability itself. A disabled child who grows up in an adequate environment in which the family has the means to support her/him might have a life not worse, but better, than that of a healthy child who is brought up in an extremely poor or dangerous or hostile socioeconomic context. Nonetheless, such disabilities are usually held as valid justifications for abortion without further specification. This means that in assessing the permissibility of abortion the interests of the woman and of family members are—at least on some occasions—given priority over the expected quality of life of the potential child who is prevented from coming into existence. But since both fetuses and newborns lack the moral status of people (and we explain why we think they do in our paper), the same moral consideration of the quality of life of potential people should be consistently held when we talk about newborns.

The same considerations about socioeconomic context apply to discussion of the quality of life of actual people having to deal with a new baby. If the family is in very poor economic circumstances or in a very disadvantaged social situation, even a mild disability might have a negative effect on the life of its members in a very dramatic way. However, a family with adequate resources and assistance might not be severely affected by having a disabled child. But this key role played by social and economic circumstances means that the same consideration holds if we talk of children without disabilities. Such circumstances can affect the wellbeing of existing people (women, partners, already existing siblings) to the same extent as, or even more than, physical or mental disabilities of a new child. The relevance of social, psychological and economic circumstances explains why many agree that women who have an abortion even when the fetus is healthy are morally justified in doing so. Our article suggests that the same circumstances that justify terminating the life of fetuses without disabilities, an option about which there is ‘broad consensus’,8 also would justify terminating the life of newborns without disabilities. The difference is that a woman would probably be less likely to want to terminate the life of a newborn than that of a fetus, so the ‘same circumstances’ would rarely occur. Thus, of course, parents’ wishes and parents’ bonds with the newborns (as well as with fetuses) are part of the wellbeing to be preserved and of the relevant ‘circumstances’ (exactly as in cases of abortion).