Might stopping miscarriages be a very important cause area?

SaraAzubuike

Might stopping miscarriages be a very important cause area?

SaraAzubuike

2 min readDec 5, 2021

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jasonk

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!

SaraAzubuike

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.

Larks

If we care only about human beings that are already in existence, (which I think is something that most people can agree on)

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.

Michael St Jules 🔸

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.

SaraAzubuike

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.

Larks

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.

SaraAzubuike

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.

"The argument then, is as follows. The embryo has the same moral status as an adult human (the Claim). Medical studies show that more than 60% of all people are killed by spontaneous abortion (a biological fact). Therefore, spontaneous abortion is one of the most serious problems facing humanity, and we must do our utmost to investigate ways of preventing this death—even if this is to the detriment of other pressing issues (the Conclusion). I do not expect many people to accept the Conclusion." [my addition: but perhaps they should?]

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)

Rhyss

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.

SaraAzubuike

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.

Michael St Jules 🔸

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.

Denkenberger🔸

Relevant:

Where Are the Pro-Life Utilitarians?

Question Mark

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.

SaraAzubuike

I refer you to Toby's piece, from Larks's reply to this post.

However, while many cases of spontaneous abortion do indeed result from chromosomal defects, this is not enough to undermine the main argument in this article. There are several reasons for this. First, it is important to note that some chromosomal defects are non-fatal, such as Down syn- drome (which involves three copies of chromosome 21). We rightly value people with Down syndrome and so, if the Claim is correct, we should also value and protect embryos with similar chromosomal abnormalities. Secondly, we may well be able to make great progress in curing chromosomal diseases through gene therapy or a similar technique. This would be difficult, but if the Claim is correct, then it would also be of overwhelming importance. For comparison, it is clearly very difficult to find a cure for cancer and we cannot be certain that a cure is even possible. However, because it is so critically important, there is still a moral imperative to continue the research. Thirdly, we may be able to use tech- niques such as sperm sorting to avoid some of the chromo- somal defects occurring in the first place. While this would not save pre-existing lives, it could prevent a vast amount of embryo death and may be technically easier than fixing an existing defect.

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