Bruce P. Blackshaw

In his recent article Perry Hendricks presents what he calls the impairment argument to show that abortion is immoral. To do so, he argues that to give a fetus fetal alcohol syndrome is immoral. Because killing the fetus impairs it more than giving it fetal alcohol syndrome, Hendricks concludes that killing the fetus must also be immoral. Here, I claim that killing a fetus does not impair it in the way that giving it fetal alcohol syndrome does. By examining the reason why giving a fetus this condition is wrong, I conclude that the same reasoning, on common pro‐choice accounts, does not apply to killing the fetus. Accordingly, Hendricks's argument does not succeed in showing abortion is immoral.

William Simkulet has recently criticised Colgrove et al ’s defence against what they have called inconsistency arguments—arguments that claim opponents of abortion act in ways inconsistent with their underlying beliefs about human fetuses. Colgrove et al presented three objections to inconsistency arguments, which Simkulet argues are unconvincing. Further, he maintains that OAs who hold that the fetus is a person at conception fail to act on important issues such as the plight of frozen embryos, poverty and spontaneous abortion. Thus, they are morally negligent. In response, we argue that Simkulet has targeted a very narrow group of OAs, and so his criticisms are inapplicable to most OAs. We then explain why his responses to each of Colgrove et al’s objections do not succeed, even for this restricted group. Finally, we note that Simkulet fails to provide evidence for his claims regarding OAs’ supposed failures to act, and we show that OAs veritably do invest resources into these important issues. We conclude that Colgrove et al ’s reasons for rejecting inconsistency arguments remain intact.

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.

Eric Vogelstein has defended Don Marquis’ ‘future-like-ours’ argument for the immorality of abortion against what is known as the Identity Objection, which contends that for a fetus to have a future like ours, it must be numerically identical to an entity like us that possesses valuable experiences some time in the future. On psychological accounts of personal identity, there is no identity relationship between the fetus and the entity with valuable experiences that it will become. Vogelstein maintains that a non‐sentient fetus nonetheless has a future like ours because it is numerically identical with a future organism that has a mind that bears valuable experiences. Skott Brill, drawing on Jeff McMahan’s embodied mind account, denies that human organisms directly have experiences, claiming that they only have experiences derivatively by virtue of their thinking part, and the loss of a future like ours is not transferred to the organism. I show that on McMahan’s account, a strong case can be made for the organism having experiences directly, and the subject having these experiences derivatively. This negates Brill’s reasoning, although it does imply that non-sentient fetuses do not have a future like ours in quite the same way as we do. I conclude this is not problematic for Marquis’ argument

Perry Hendricks has recently presented the impairment argument for the immorality of abortion, to which I responded and he has now replied. The argument is based on the premise that impairing a fetus with fetal alcohol syndrome is immoral, and on the principle that if impairing an organism is immoral, impairing it to a higher degree is also—the impairment principle. If abortion impairs a fetus to a higher degree, then this principle entails abortion is immoral. In my reply, I argued that abortion does not impair an organism in the way fetal alcohol syndrome does, and showed that interest theorists can avoid the argument. Hendricks has responded to my criticisms by demonstrating how abortion does impair an organism. In this reply, I acknowledge Hendricks’ point, but proceed to criticise the application of the impairment principle to abortion, showing that it is invalid if we accept his explanation for why inflicting fetal alcohol syndrome is immoral. I also argue that counter-examples show the impairment principle itself to be dubitable, concluding that the impairment argument remains unpersuasive.

The substance view is an account of personhood that regards all human beings as possessing instrinsic value and moral status equivalent to that of an adult human being. Consequently, substance view proponents typically regard abortion as impermissible in most circumstances. The substance view, however, has difficulty accounting for certain intuitions regarding the badness of death for embryos and fetuses, and the wrongness of killing them. Jeff McMahan’s time-relative interest account is designed to cater for such intuitions, and so I present a proposal for strengthening the substance view by incorporating McMahan’s account – the Dual-Aspect Account of the morality of killing. I show that it resolves some important issues for the substance view while preserving its central premise of moral equality for all human beings. I then compare the Dual-Aspect Account with McMahan’s Two-Tiered Account of the morality of killing, which he derives from his time-relative interest account.

To determine when the life of a human organism begins, Mark T. Brown has developed the somatic integration definition of life. Derived from diagnostic criteria for human death, Brown’s account requires the presence of a life‐regulation internal control system for an entity to be considered a living organism. According to Brown, the earliest point at which a developing human could satisfy this requirement is at the beginning of the fetal stage, and so the embryo is not regarded as a living human organism. This, Brown claims, has significant bioethical implications for both abortion and embryo experimentation. Here, we dispute the cogency of Brown’s derivation. Diagnostic criteria for death are used to determine when an organism irreversibly ceases functioning as an integrated whole, and may vary significantly depending on how developed the organism is. Brown’s definition is derived from a specific definition of death applicable to postnatal human beings, which is insufficient for generating a general definition for human organismal life. We have also examined the bioethical implications of Brown’s view, and have concluded that they are not as significant as he believes. Whether the embryo is classified as a human organism is of peripheral interest—a far more morally relevant question is whether the embryo is a biological individual with an identity that is capable of persisting during development.

According to the psychological account of personal identity, our identity is based on the continuity of psychological connections, and so we do not begin to exist until these are possible, some months after conception. This entails the psychological account faces a challenge from the non-identity problem—our intuition that someone cannot be harmed by actions that are responsible for their existence, even if these actions seem clearly to cause them harm. It is usually discussed with regard to preconception harms, but in the context of the psychological account, it is also applicable to prenatal harms. Inflicting prenatal injury is widely thought to be morally impermissible, but if the injury is identity-determining on the psychological account, then no-one seems to be harmed—rather, the injury is responsible for bringing them into existence. Here, I argue that identity-determining injuries can routinely occur on the psychological account, and that this undermines the account. I assess Nicola Williams’ proposal to salvage the account based on a trans-world account of personal identity, and show that it is unsuccessful. I then show that Jeff McMahan’s embodied mind account of personal identity is also susceptible. I conclude that identity-determining prenatal injuries pose a significant challenge for the psychological account and its variants, and provide a reason for supporting alternative accounts that fix personal identity at conception.

One of the most influential philosophical arguments in favour of the permissibility of abortion is Judith Jarvis Thomson’s violinist analogy, presented in ‘A Defense of Abortion’. Its appeal for pro-choice advocates lies in Thomson’s granting that the fetus is a person with equivalent moral status to any other human being, and yet demonstrating—to those who accept her reasoning—that abortion is still permissible. In her argument, Thomson draws heavily on the parable of the Good Samaritan, arguing that gestating a fetus in some circumstances is what she calls a Good Samaritan act, and claiming that we are not morally required to be Good Samaritans. Here, I argue that Thomson has subverted the parable to justify an action that is the antithesis of its meaning. I contend that Christians are required to be Good Samaritans, and explain that for Christians, this entails abortion is impermissible in all circumstances. Further, I argue that the parable shows the fetus is our neighbour in need of our mercy and assistance, and consequently Christians should be actively involved in helping to ensure the unborn are protected, whether they are fetuses in danger of induced abortion or miscarriage, or surplus frozen embryos.

Background:Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants.Objective:This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures.Research Design:This is a survey of the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts.Participants and Research Context:No research participants were part of this analysis.Ethical Considerations:This article offers a conceptual analysis and recommendations only.Findings:The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress.Discussion:Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants.Conclusion:This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations.

Benjamin Zolf, in his recent paper ‘No conscientious objection without normative justification: Against conscientious objection in medicine’, attempts to establish that in order to rule out arbitrary conscientious objections, a reasonability constraint is necessary. This, he contends, requires normative justification, and the subjective beliefs that ground conscientious objections cannot easily be judged by normative criteria. Zolf shows that the alternative of using extrinsic criteria, such as requiring that unjustified harm must not be caused, are likewise grounded on normative criteria. He concludes that conscientious objection is therefore untenable. Here, I present an alternative account, based on the value we are willing to place on conscientious objection as an expression of freedom of conscience and religion. Using an extrinsic criterion such as harm, we can make a judgement of what degree of harm should be tolerated as the cost of permitting conscientious objection. A normative criterion for judging individual claims is therefore not required.

William Simkulet has recently criticised Colgrove et al’s defence against what they have called inconsistency arguments—arguments that claim opponents of abortion (OAs) act in ways inconsistent with their underlying beliefs about human fetuses (eg, that human fetuses are persons at conception). Colgrove et al presented three objections to inconsistency arguments, which Simkulet argues are unconvincing. Further, he maintains that OAs who hold that the fetus is a person at conception fail to act on important issues such as the plight of frozen embryos, poverty and spontaneous abortion. Thus, they are morally negligent. In response, we argue that Simkulet has targeted a very narrow group of OAs, and so his criticisms are inapplicable to most OAs. We then explain why his responses to each of Colgrove et al’s objections do not succeed, even for this restricted group. Finally, we note that Simkulet fails to provide evidence for his claims regarding OAs’ supposed failures to act, and we show that OAs veritably do invest resources into these important issues. We conclude that Colgrove et al’s reasons for rejecting inconsistency arguments (en masse) remain intact.

Arguments that claim opponents of abortion are inconsistent in some manner are becoming increasingly prevalent both in academic and public discourse. For example, it is common to claim that they spend considerable time and resources to oppose induced abortion, but show little concern regarding the far greater numbers of naturally occurring intrauterine deaths (miscarriages). Critics argue that if abortion opponents took their beliefs about the value of embryos and fetuses seriously, they would invest more time and resources combating these naturally occurring deaths than those caused by induced abortion. The implication is that abortion opponents do not take their beliefs about embryos and fetuses seriously—and so why should anyone else? These “inconsistency arguments”, as we have called them, have considerable intuitive appeal: showing that someone is living inconsistently or holding beliefs that seem prima facie inconsistent seems to many to undermine those beliefs. However, upon closer examination, these arguments become less convincing. In short, we show that the inconsistency arguments we are aware of are severely flawed, and so, if critics wish to continue their criticism, they should abandon inconsistency arguments in favor of other styles of argument. We will proceed in four stages. First, we describe the basic form of inconsistency arguments against abortion opponents. Second, we outline specific instances of the inconsistency argument that have been advanced. Third, we outline specific responses to these arguments, noting ways in which responses also conform to set patterns. Finally, we assess the debate and suggest how it might progress in productive ways.

Kyle van Oosterum and Emma Curran have recently argued that the impairment argument against abortion is weak and accomplishes little. They also claim that impairment fails to explain what makes giving a child fetal alcohol syndrome (FAS) immoral, which is an important premise of the argument. Here, I explain that the impairment argument is not as weak as they believe. Further, I argue that impairment offers a superior explanation for what makes giving a child FAS immoral than their proposal based on creative beneficence.

The impairment argument claims that abortion is immoral, because it results in a greater impairment to a fetus than other actions that are clearly immoral, such as inflicting fetal alcohol syndrome. Alex Gillham argues that the argument requires clarification of the meaning of greater impairment. He proposes two definitions, and points out the difficulties with each. In response, I argue that while the impairment argument’s definition of greater impairment is narrow in scope, it is sufficient for its intended purpose. Broadening its scope to more controversial comparisons of impairment is likely to undermine the intuitive appeal of the impairment principle that the argument is based upon.