From a perspective where embryos are moral patients, I think preventing otherwise healthy
embryos from failing to implant or otherwise make it to term looks pretty promising, especially since these are generally wanted pregnancies. A few years ago I took some time with a med student thinking through some options:
Reduce pelvic inflammatory disease. This causes uterine scarring, which leads to implantation failure, and the main causes are STIs like gonorrhea and chlamydia. Cervical cancer is also an issue, and we do have the HPV vaccine for this. These are already bad things weâd like to prevent, but this raises the stakes a lot.
Decrease the C-section rate. Abdominal surgery is another thing that gives uterine scarring. The US C-section rate is much higher than the rest of the world, for reasons that seem to be more about how we allocate medical providers and less about peopleâs health, and there are already good options here like providing doulas for anyone who wants one. C-sections are worse than other abdominal surgeries from this perspective because the embryo can implant into the surgical scar, which gives you an ectopic pregnancy and generally requires an abortion to save the life of the mother. Appendectomies might be another good candidate here, because outside the US people have way fewer of them. Though some of that is that different health systems respond differently to appendicitis: it recurs about 20% of the time, so different places have made different calls about whether removing it the first time it happens is worth it.
Come up with better detection methods for fibroids. These are benign tumors in the uterus that grow with estrogen, and compete with the fetus for space. This is more of a problem later in the pregnancy when space is tighter. This one might make sense if you donât think embryos matter but do think second or third trimester fetuses matter. This also disproportionately affects black mothers, so it may be underfunded.
Encourage people to switch to methods of birth control that prevent ovulation or fertilization instead of implantation. For example, estrogen over progesterone. This one is the odd one out, in that itâs one where youâre not just more highly prioritizing something people already think would be good. IUDs, for example, are really good in many ways, but they work by preventing implantation. This is at least less tractable socially than the others, because youâd get a huge fight.
The first three medical interventions you pointed out would have been excellent for me to include in this postâs Community Actions section, as the possible moral patienthood of embryos would indeed update their significance. Thanks for bringing them to my attention.
On the fourth, I agree, with the following caveats:
In the case that embryos have moral patienthood and we hold non-person-affecting /â deprivationist views, there shouldnât be much difference between preventing fertilization and preventing implantation, because the outcome in terms of (adjusted) life years is the same.
Replaceability seems to become a much more compelling objection at that stage. If a couple is trying for a baby and an embryo fails to implant, they likely wonât even notice and will keep trying until they get one.
If a couple is trying for a baby and an embryo fails to implant, they likely wonât even notice and will keep trying until they get one.
I think this doesnât belong as a caveat on #4, but instead as an objection to the whole idea of trying to reduce implantation failures? In #4 weâre talking about people who are trying to avoid pregnancy, not people trying for one.
In the case that embryos have moral patienthood and we hold non-person-affecting /â deprivationist views, there shouldnât be much difference between preventing fertilization and preventing implantation, because the outcome in terms of (adjusted) life years is the same.
I think thatâs not right? Preventing fertilization does not cause any deaths, and my understanding of your argument here is that it is relies on abortion causing moral patients to die?
Otherwise, interventions that increased how many babies people wanted to have would be roughly interchangeable with interventions that decrease abortions.
Your understanding is right, but itâs not the only reason why it seems to me that abortion may be wrong. I sketch out the generalization in the âIncreasing the Amount of Near-Term Future Peopleâ section, but itâs probably not sufficiently explicit. Many of the arguments for why abortion may be wrong generalize to arguments for why preventing a future person from coming into being is wrong:
If abortion is wrong because we shouldnât hold person-affecting views (i.e. we should care about possible people, and fetuses are possible people, even if they might not be considered living persons), then any action which prevents a future person from coming into being is similarly wrong, as weâre violating the preferences they counterfactually would have had.
If abortion is wrong because of deprivationism (i.e. it prevents the (adjusted) life years of the child from being lived), then any action which prevents a future person from coming into being and living out their (adjusted) life years is wrong.
Richard Chappell sketches the implications of these views quite well here. It seems to me that he generally holds these views, but includes a factor to strongly discount the value of adding a future person versus saving a life now. This enables him to believe abortion is morally OK (since his discount factor applies), but longtermism is still an imperative (since heavily discounting 10^whatever possible future people still means theyâre extremely important in aggregate).
Otherwise, interventions that increased how many babies people wanted to have would be roughly interchangeable with interventions that decrease abortions.
Under non-person-affecting/âdeprivationist views, I would argue that thatâs correct.
Under non-person-affecting/âdeprivationist views, I would argue that thatâs correct.
If you think thatâs correct, then my (very rough) guess is that promoting having children gives more future lives for the amount of time/âresources than voluntary abortion reduction. For example, there are lots of âdonât have kids for climate change reasonsâ arguments going around that are pretty misguided, and not much effort on countering them. There are also policies that would likely lead to more kids, like making childcare cheaper.
But then if what you care about is maximizing the number of future people, trying to increase near term births is probably not what gives the most impact: reducing existential risk is. (Happy to argue more for this if you like.)
I think voluntary abortion reduction is just one of many ways to increase the amount of near-term future people. The postâs âIn Our Personal Livesâ section includes the suggestions you gave and more, which I agree are arguably more effective than voluntary abortion reduction in accomplishing that goal. I also agree with you that reducing x-risk is (probably) much more important than directly increasing the amount of near-term future people, and I think far more EA resources should be devoted to the former than the latter.
So why did I care enough about voluntary abortion reduction to write this post?
I do believe that adding one future person is close to as good as saving a life, so it still seems to me that when measured against other concerns which occupy the minds of the general public, voluntary abortion reduction is very important indeed, especially given abortionâs staggering scale.
I think bringing up ideas which provoke conversations and challenge preconceptions within the community is good for its own sake.
This concern is more debatable, but Iâm personally deeply receptive to the idea that our values should cause us to make mini-interventions in our personal lives. Being a vegan is a drop in the bucket of animal suffering, but making a real change in a personal life in response to my moral principles is very important to me. With apologies to those who disagree, I think about voluntarily choosing to not have abortions in the exact same way.
Being a vegan is a drop in the bucket of animal suffering, but making a real change in a personal life in response to my moral principles is very important to me. With apologies to those who disagree, I think about voluntarily choosing to not have abortions in the exact same way.
Changing our personal lives in response to a view that itâs very good for more people to exist (and with approximate indifference between ending the lives of fetuses and something that prevents those lives from ever starting) doesnât seem like it primarily would give avoiding abortion (typically using birth control, non-impregnatable sex, or abstinence) to avoiding starting pregnancies). Instead, it would primarily push towards having kids earlier in life and having a large number of them, no?
I think maybe a goal of maximizing how many kids you have is doing all the work here? Almost all of the cases I can think of where someone who is trying to have as many kids as possible would have an abortion if not for a no-voluntary-abortion goal (risk to life of mother, accidental pregnancy early enough in life that it would limit ability to have more other kids later, prenatal test shows serious issues, etc) are cases where I think your reasoning above would lead to having the abortion and then going on to have more other kids.
Youâre making the understandable assumption given your familyâs history in EA that I too am a saint, and that does run into the conclusion you gave. Most likely, Iâll marry someone whoâd also like to have many children, and weâll have as many children as we agree to. However, if thereâs a happy accident, Iâd prefer to keep that happy accident. If there were a happy accident who for whatever reason we werenât able to support, we should give up for adoption rather than abort.
From a perspective where embryos are moral patients, I think preventing otherwise healthy embryos from failing to implant or otherwise make it to term looks pretty promising, especially since these are generally wanted pregnancies. A few years ago I took some time with a med student thinking through some options:
Reduce pelvic inflammatory disease. This causes uterine scarring, which leads to implantation failure, and the main causes are STIs like gonorrhea and chlamydia. Cervical cancer is also an issue, and we do have the HPV vaccine for this. These are already bad things weâd like to prevent, but this raises the stakes a lot.
Decrease the C-section rate. Abdominal surgery is another thing that gives uterine scarring. The US C-section rate is much higher than the rest of the world, for reasons that seem to be more about how we allocate medical providers and less about peopleâs health, and there are already good options here like providing doulas for anyone who wants one. C-sections are worse than other abdominal surgeries from this perspective because the embryo can implant into the surgical scar, which gives you an ectopic pregnancy and generally requires an abortion to save the life of the mother. Appendectomies might be another good candidate here, because outside the US people have way fewer of them. Though some of that is that different health systems respond differently to appendicitis: it recurs about 20% of the time, so different places have made different calls about whether removing it the first time it happens is worth it.
Come up with better detection methods for fibroids. These are benign tumors in the uterus that grow with estrogen, and compete with the fetus for space. This is more of a problem later in the pregnancy when space is tighter. This one might make sense if you donât think embryos matter but do think second or third trimester fetuses matter. This also disproportionately affects black mothers, so it may be underfunded.
Encourage people to switch to methods of birth control that prevent ovulation or fertilization instead of implantation. For example, estrogen over progesterone. This one is the odd one out, in that itâs one where youâre not just more highly prioritizing something people already think would be good. IUDs, for example, are really good in many ways, but they work by preventing implantation. This is at least less tractable socially than the others, because youâd get a huge fight.
Hi Jeff, thanks for your comment!
The first three medical interventions you pointed out would have been excellent for me to include in this postâs Community Actions section, as the possible moral patienthood of embryos would indeed update their significance. Thanks for bringing them to my attention.
On the fourth, I agree, with the following caveats:
In the case that embryos have moral patienthood and we hold non-person-affecting /â deprivationist views, there shouldnât be much difference between preventing fertilization and preventing implantation, because the outcome in terms of (adjusted) life years is the same.
Replaceability seems to become a much more compelling objection at that stage. If a couple is trying for a baby and an embryo fails to implant, they likely wonât even notice and will keep trying until they get one.
I think this doesnât belong as a caveat on #4, but instead as an objection to the whole idea of trying to reduce implantation failures? In #4 weâre talking about people who are trying to avoid pregnancy, not people trying for one.
Yep, youâre right about that! Itâs a greater caveat than I pointed out.
I think thatâs not right? Preventing fertilization does not cause any deaths, and my understanding of your argument here is that it is relies on abortion causing moral patients to die?
Otherwise, interventions that increased how many babies people wanted to have would be roughly interchangeable with interventions that decrease abortions.
Your understanding is right, but itâs not the only reason why it seems to me that abortion may be wrong. I sketch out the generalization in the âIncreasing the Amount of Near-Term Future Peopleâ section, but itâs probably not sufficiently explicit. Many of the arguments for why abortion may be wrong generalize to arguments for why preventing a future person from coming into being is wrong:
If abortion is wrong because we shouldnât hold person-affecting views (i.e. we should care about possible people, and fetuses are possible people, even if they might not be considered living persons), then any action which prevents a future person from coming into being is similarly wrong, as weâre violating the preferences they counterfactually would have had.
If abortion is wrong because of deprivationism (i.e. it prevents the (adjusted) life years of the child from being lived), then any action which prevents a future person from coming into being and living out their (adjusted) life years is wrong.
Richard Chappell sketches the implications of these views quite well here. It seems to me that he generally holds these views, but includes a factor to strongly discount the value of adding a future person versus saving a life now. This enables him to believe abortion is morally OK (since his discount factor applies), but longtermism is still an imperative (since heavily discounting 10^whatever possible future people still means theyâre extremely important in aggregate).
Under non-person-affecting/âdeprivationist views, I would argue that thatâs correct.
If you think thatâs correct, then my (very rough) guess is that promoting having children gives more future lives for the amount of time/âresources than voluntary abortion reduction. For example, there are lots of âdonât have kids for climate change reasonsâ arguments going around that are pretty misguided, and not much effort on countering them. There are also policies that would likely lead to more kids, like making childcare cheaper.
But then if what you care about is maximizing the number of future people, trying to increase near term births is probably not what gives the most impact: reducing existential risk is. (Happy to argue more for this if you like.)
I donât think we actually disagree :)
I think voluntary abortion reduction is just one of many ways to increase the amount of near-term future people. The postâs âIn Our Personal Livesâ section includes the suggestions you gave and more, which I agree are arguably more effective than voluntary abortion reduction in accomplishing that goal. I also agree with you that reducing x-risk is (probably) much more important than directly increasing the amount of near-term future people, and I think far more EA resources should be devoted to the former than the latter.
So why did I care enough about voluntary abortion reduction to write this post?
I do believe that adding one future person is close to as good as saving a life, so it still seems to me that when measured against other concerns which occupy the minds of the general public, voluntary abortion reduction is very important indeed, especially given abortionâs staggering scale.
I think bringing up ideas which provoke conversations and challenge preconceptions within the community is good for its own sake.
This concern is more debatable, but Iâm personally deeply receptive to the idea that our values should cause us to make mini-interventions in our personal lives. Being a vegan is a drop in the bucket of animal suffering, but making a real change in a personal life in response to my moral principles is very important to me. With apologies to those who disagree, I think about voluntarily choosing to not have abortions in the exact same way.
Changing our personal lives in response to a view that itâs very good for more people to exist (and with approximate indifference between ending the lives of fetuses and something that prevents those lives from ever starting) doesnât seem like it primarily would give avoiding abortion (typically using birth control, non-impregnatable sex, or abstinence) to avoiding starting pregnancies). Instead, it would primarily push towards having kids earlier in life and having a large number of them, no?
I think it should push towards both of those values, and I plan on fulfilling both ;)
Thanks for clarifying!
I think maybe a goal of maximizing how many kids you have is doing all the work here? Almost all of the cases I can think of where someone who is trying to have as many kids as possible would have an abortion if not for a no-voluntary-abortion goal (risk to life of mother, accidental pregnancy early enough in life that it would limit ability to have more other kids later, prenatal test shows serious issues, etc) are cases where I think your reasoning above would lead to having the abortion and then going on to have more other kids.
Youâre making the understandable assumption given your familyâs history in EA that I too am a saint, and that does run into the conclusion you gave. Most likely, Iâll marry someone whoâd also like to have many children, and weâll have as many children as we agree to. However, if thereâs a happy accident, Iâd prefer to keep that happy accident. If there were a happy accident who for whatever reason we werenât able to support, we should give up for adoption rather than abort.
@Ariel Simnegar air pollutionâs another significant factor in pregnancy loss:
https://ââwww.thelancet.com/ââjournals/ââlanplh/ââarticle/ââPIIS2542-5196(20)30268-0/ââfulltext