Might stopping miscarriages be a very important cause area?
Recently I’ve been giving some more thought to abortions, given what’s happening with the Supreme Court in the U.S.
Entertain this crass analogy.
Let’s say that you have some ashes of a dead person. You’re 100% confident the person is dead. Throwing the ashes into the ocean is clearly ok. It’s not immoral.
Now let’s instead say that you have the body of someone lying in front of you. You’re 50% confident the person is dead. (i.e. you think there’s a good chance, 50%, that the person is alive) Then, it is your moral obligation to save that person.
Even if that probability reduced from 50% to 5%, as long as you had a certain confidence that the person is alive and rescue-able, you’d be obligated to immediately bring that person to the hospital, no matter how inconvenient that would be for you. (This is assuming that there’s only 1 person in front of you. You’re not a emergency responder that has to triage 100s of people.) Even if it took you 9 months to carry that person, it would not be admissible to throw that person into the ocean (you see where the analogy is going).
Okay, now, let’s naively say that I’m 50% confident that embryos are human. (~50% of people in the US are supposedly pro-life) Then, intentionally having an abortion is potentially an intentional killing of another human. Even if I were 5% confident that embryos are human, I’d be morally obligated to carry that pregnancy to term.
It would be immoral to have an abortion.
We can even take this a step further, past abortion and Roe v. Wade. Unintentional abortions, i.e. miscarriages, are also potentially the deaths of other humans.
“Miscarriages occur in at least 20 percent of pregnancies, many in the first twelve weeks.” There are cost-effective interventions to prevent miscarriages, such as providing folic acid, adequate maternal nutrition, education etc.
Thus, if we are purely utilitarian, then the highest priority item ought to be to stop unintentional abortions, as that would literally increase lives saved by 5x (1/0.2). Even if we set our prior at 50% of whether embryos are human, then still the highest priority ought to be to stop unintentional abortions. 50% times 20% of all pregnancies is 10% of all pregnancies, which is still a massive number.
That would be orders of magnitude greater than any other EA cause area.
Someone check my logic?
Might stopping miscarriages be a very important cause area, or are your priors much much lower?
Additionally, (regardless of legality, constitutionality or effectiveness of repealing Roe v. Wade), on purely moral grounds, if one has a 50% prior that something is human, doesn’t that mean that getting rid of it is immoral?
Thank you.
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Edit 1: Thanks to @Lark for pointing out that Toby Ord makes the reverse argument in his piece, The Scourge: Moral Implications of Natural Embryo Loss. Toby says that the implications of the above argument are so radical that it must imply that most people do not believe that embryos are human. As stated in the comments, I think this is flawed—it could also be the case that most people have not yet internalized the consequences of what they believe. As with most challenges that have afflicted us for long periods of time, miscarriages are so diffuse as to not have any particular advocacy group and therefore be not very politically tractable.
The original argument you’re reacting to is flawed, which carries over into your second one. To make both arguments clearer, we need to know the significance of an embryo being human, why this matters to utilitarians, and what sort of utilitarians you mean. Does an embryo being human mean it has the same moral status as an adult human? Does it mean it has a similar interest in continued living as an adult embryo does? Does it mean it is harmed by death—and if so, does this harm of death leave it worse off than if it were never conceived at all?
And what type of utilitarians do you have in mind? Total hedonic utilitarians presumably wouldn’t be that worried about miscarriages for the sake of the embryos themselves even if the embryos were human, had the same moral status as adult humans, and had an interest in continued existence. That’s because embryos are usually relatively replaceable and their deaths are usually less traumatic for others than the deaths of those who are already born.
As for the harm of death, total utilitarians care about intrinsic value of outcomes, and most philosophers of death don’t think of death as an intrinsic harm. This means that for a total utilitarian, if someone pops into existence, has a good fleeting moment of existence and then dies painlessly without anything else being affected, the only thing that counts is the good moment. We don’t count the death as something bad, or something worse than the being never existing in the first place. It would be better if the being lived longer and had more good experiences, but it’s not worth preventing an existence just to prevent a death.
Total hedonic utilitarians care about saving lives because that seems like an effective way to increase good. Stopping miscarriages does not seem like an effective way to do that.
But maybe you have other sorts of utilitarians in mind. There could be some utilitarians with certain person-affecting views, or who think of death as an intrinsic harm, who might be more worried about this. But even then it would be important for them what the moral status of embryos is and whether embryos have an interest in continued existence. I would expect them to think an interest in continued existence would require sentience at least, or a greater conscious awareness than we expect embryos to have.
Hey, thanks for answering my post. Means a lot, especially since you seem to be more familiar with philosophy than me.
“Total utilitarians care about intrinsic value of outcomes.”
- But a) death is painful b) death is the loss of future life c) parents grieve over miscarriages just as people grieve over the loss of a friend.
“Embryos must have an interest in continued existence.”
- Hm, but I argue this is a temporary state. Say I give that mother nutrition and I wait 9 months. That embryo now has an interest in continued existence. In a similar vein, suicidal people have no interest in continued existence. But if I give that suicidal person therapy and wait some time, that person now has an interest in continued existence.
It isn’t a temporary state if the embryo dies, though, so this seems to reduce back to a potentiality argument, if we’re using a standard based on sentience for moral status.
A suicidal person may have an interest in continued existence that is contingent on them becoming better off. They may rank outcomes as status quo < death < happiness.
Relevant:
Where Are the Pro-Life Utilitarians?
I think what you’re saying is basically right, and it’s an important topic to discuss further.
This is more of a technical point, but I don’t you need to worry about whether a miscarriage or abortion kills a human. Rather, you the relevant question is whether the being killed matters. (My own intuition isn’t very strong that beings very early in development matter morally a lot, but I recognize that many people have the opposite intuition and I’m a bit moved by arguments based on potential (like from Don Marquis), and I’m willing to assign a probability to their views being right given this.)
This post by Michael Huemer has some interesting and relevant numerical comparisons that include abortion and miscarriage. https://fakenous.net/?p=225
From time to time, I think about exploring this topic in greater depth, trying to understand the potential effects of different interventions (e.g., potential for new forms of birth control to reduce number of unintended fertilizations, potential for different kinds of interventions—like better economic support—to reduce the frequency of the choice of abortion, and I’m not sure what for miscarriage but you list some good ideas worth exploring), but I haven’t ever gotten further than adding to a notes file. If you or someone else reading this is interested in exploring this area further, I’d be interested in collaborating. The collaboration would help me find motivation.
Thanks for your post!
Thanks for the link. It’s good to get a sense of the scale of things. I hadn’t realized that induced abortions were such a large number.
The reason I wanted to use the “human” bit was that I think the argument about “potential” is flawed. If we care about depriving the future potential of something, then we would oppose girls education on the basis that it reduces fertility (i.e. potential human beings). See https://forum.effectivealtruism.org/posts/YSz8JsCi3u7fupWHX/is-ea-just-about-population-growth.
If we care only about human beings that are already in existence, (which I think is something that most people can agree on), what then matters is what counts as a human being.
In a more political vein, I personally am staunchly in the camp of increased birth control, though my views on abortion (as shown here) are tenuous at best. There are many birth control methods, such as IUDs, that dramatically decrease the chance of an unintended pregnancy (to near 0), yet the public decides to promote greater condom use for their ability to protect against STDs. Both are needed.
I think most people do care about future generations—if they didn’t, people probably wouldn’t worry very much about climate change, for example, as the vast majority of the costs are >100 years out. Equally I think most people would reject a trade that gave someone currently alive $1, in return for a baby being born into terrible pain in a year’s time. Longtermist EAs are outliers in how much they care about future generations, but I don’t think most people care literally zero.
Working on abortion or miscarriage probably wouldn’t even make sense if you didn’t care about future people, since the work you do now wouldn’t help fetuses or embryos that exist right now much. Any work you do would have to pay off in less than 9 months to have any value at all. That includes this post.
It could make sense on certain more complex person-affecting views or views that otherwise assign badness to death, so I would assume SaraAzubuike would adopt some such view.
My bad, I meant to say, “If we can all agree to care about human beings that are already in existence, what then matters is what counts as a human being.” The split between many EAs is just as you say—some care about future lives a lot; some don’t. However, I think what we all can agree upon is that humans that exist now are extremely important. Thus, what then matters is what counts as a human being.
Couldn’t stopping miscarriages potentially increase the mutational load within the population? Embryos that end in miscarriages may miscarry because they have genetic defects. The embryos that are saved will potentially still have those genetic defects, which will potentially lead to a lower quality of life.
I refer you to Toby’s piece, from Larks’s reply to this post.
Thanks for writing this. You might be interested in this post from Toby on miscarriage.
My main question is about the tractability. Increasing the legal restrictions on abortion is definitely possible—the US has some of the weakest legal protections for life in the world, lagging far behind much of Europe etc, so there is a lot of room for improvement—but is already a heavily contested issue which could reduce your ability to make an incremental difference to the law. My understanding is that CEA did some research into abortion but never published it; possibly this is why. You could alternatively try to reduce the social pressures that cause people to feel they need to abort.
Reducing miscarriages doesn’t have the same political opposition, but a lot of miscarriages are due to chromosomal defects, and I don’t think there is currently any medical solution to this. Maybe rolling out the sort of interventions you linked to to wider populations could be good—e.g. the UK is only recently adding folic acid to cereal, something the US did decades ago.
Hey, thanks for the reply. I had read Toby’s piece some time ago, but didn’t cite it because I couldn’t find it. Now editing the original. Overall, I think Toby’s article is very pertinent, but potentially wrong. The very fact that many people do not support the “Conclusion” implies that there is a prevailing problem with the way people perceive the consequences of what they actually believe.
Regarding your other points on tractability, I personally find quite strong evidence that contraception, rather than legal barriers to abortion are the way to improve this. (see prior point about IUDs, or vasectomies)