After-birth abortion: why should the baby live? A disability perspective


Martin Sullivan

When I first heard reports of a couple of bioethicists promoting the idea of after-birth abortion I thought, “they’re at it again; coming up with more justifications for killing us; the b******s!”  Of course not all bioethicists hold to this position (as evidenced by the number who have since expressed outrage at the notion of after-birth abortion) but I find it profoundly alienating and quite sad that the only time the discipline or bioethicists themselves seem to show any interest in disability and disabled people is when they are arguing over when its OK to kill us. 

As a disabled person who knows his history, I can never separate these kinds of arguments from the situation which occurred  in Nazi Germany when over 200,000 disabled people – ‘useless eaters’ ‘life unworthy of life’ - were murdered in the Aktion T4 euthanasia programmes[i].  Justifications for after-birth abortion sound awfully like a reopening of that door, a rekindling of the Silent Holocaust; that is why my response is so personal, so visceral.  

Unfortunately, this after-birth abortion debate flows logically from the zeitgeist of consumer capitalism where the body is seen as a prime site of consumption and the neoliberal precepts of individual freedom and choice rule. In this environment ableism thrives.  Ableism promotes a particular kind of ‘able’ self and body as fully human. In light of that, any impairment or disability is seen as inherently negative and should be ameliorated, cured or eliminated[ii].  While Giubilini & Minerva’s argument is not entirely ableist insofar as they hold that after-birth abortion should apply to any abled or disabled infant who qualifies for abortion as a fetus, it begins with and builds upon ableist assumptions about children with ‘severe abnormalities’ whose lives are consequently judged as not worth living.

They begin by accepting that while it is easy and common for many in our contemporary society to conclude that living with severe abnormalities is not in the best interest of the child, it is hard to find definitive arguments supporting the case that such life is not worth living.  At this point an article of faith transmogrifies into scientific certainty as they assert that the potential of a child with Down syndrome can never equal that of a “normal’ child”.  Somewhat conveniently, their paper overlooks the question: potential for what?  Next, Giubilini and Minerva, somewhat incredulously, note that, despite this lack of potential, people with disability “are often reported to be happy.”  But these two important pieces of evidence – no definitive support for the “unworthy lives” thesis and severely impaired people reporting that they in fact have happy lives – are overridden by Giubilini and Minerva appealing to the “unbearable burden” thesis as justification for after-birth abortion.

The “unbearable burden” thesis states that a child with severe impairments will impose “unbearable” emotional and financial burden on the family and the financial costs of social provision on society as a whole.  Now the argument about the permissibility of after-birth abortion of such infants is justified on the basis of empirically verifiable claims about an infant’s financial impact on the family and broader society.  This marks an adroit shift – a claim that rests on assertion is suddenly presented as having a degree of ‘logic’ and legitimacy it does not warrant.  Also, somewhat conveniently, the burden thesis overlooks those parents who report that while not necessarily without struggle, their lives have been enriched by the child they refused to abort.

This is very much a ‘final solution’ which is not only abhorrent to me, but one which I find deeply ableist and difficult not to take personally.  I would argue that notions of “lives not worth living”, “potential” and “unbearable burden” are so context dependent, so deeply embedded in the social milieu, that it would be far more humane to address those variables before adopting a final solution. Ultimately, the solution lies in how much tax we are prepared pay in order to provide a just social wage which covers education, health and housing as well as a high enough welfare safety net so people don’t bruise themselves when they fall into it.   

To be fair, Giubilini and Minerva do spend some time in philosophical reflection on when a human becomes a person and at what point after-birth abortion is no longer permissible.  For someone who sees dignity and value in all human life, Giubilini and Minerva may as well be philosophising about how many angels can fit on the head of pin for all the good it will do in justifying after-birth abortion to me.

But I guess this is what many philosophers and bioethicists do: they engage in logic games and in this particular one they reduce themselves to playing the role of instrumental technocrats. It is a dangerous game they have begun playing because it is all theory about vulnerable lives and this is far too serious an issue to play with.

Undeniably, the most chilling aspect of this paper is its advocacy of after-birth abortion for those infants not wanted. Not-wanted!  As someone who lives with the shadow of the Silent Holocaust, these logic games are the opening gambit in a deadly game taking place in straitened times; times where it is quite possible the “unbearable burden” thesis may gain traction.  Under these conditions, no matter how repugnant, the bioethicists’ argument that after-birth abortion is permissible in cases where the potential life is deemed not worth living, too much of a burden or too expensive, may sound like commonsense. I cannot help thinking that it would not be too long before the justifications for a euthanasia programme for those ‘useless eaters’ began to be heard again.


Martin Sullivan, PhD, is a Senior Lecturer in disability studies and social policy at Massey University.

[i] Jones, D.A. (2012) Perils of pure logic, The Tablet, p.12, 17 March 2012

[ii] Campbell, F.K. (2009) Contours of Ableism. London: Palgrave Macmillan