Exploring the controversial debate about personhood, bodily rights, and the boundaries of medical ethics
What if everything we assume about the sanctity of newborn life is based on a philosophical oversight? In 2012, two philosophers from respected Australian universities published a paper that sent shockwaves through the medical and bioethics communities. Alberto Giubilini and Francesca Minerva made a startling argument in the Journal of Medical Ethics: the killing of healthy newborns, which they termed "after-birth abortion," could be morally permissible for the same reasons that justify abortion 1 .
Key Insight: Their thesis challenged fundamental assumptions about life, personhood, and morality, igniting a fierce debate that continues to reshape the boundaries of medical ethics and our understanding of what it means to be human.
This controversial proposition emerges from a branch of philosophy known as bioethics, which applies ethical reasoning to medical practice and biological research. Unlike traditional medical ethics that prioritizes individual patient welfare, some forms of bioethics embrace utilitarian principles that consider collective societal interests 1 . The newborn dilemma represents one of the most extreme applications of this philosophical framework, pushing us to examine where we draw the line on life and why.
When does life gain moral value and protection?
Cognitive capacity as the basis for moral rights
At the heart of the newborn debate lies a crucial distinction between biological human life and philosophical "personhood." Prominent philosophers like Michael Tooley and Peter Singer have argued that personhood, not mere biological humanity, grants beings a right to life 4 .
According to this view, persons are defined by specific psychological traits including:
Since newborns lack these advanced cognitive capacities, proponents argue they do not qualify as persons and therefore lack the same right to life as older humans 4 .
More recently, philosopher James G. Robinson has proposed an alternative explanation for why killing infants might be wrong, even if they lack personhood. He suggests that bodily rights rather than personhood might provide the moral foundation for protecting infants 4 .
This perspective offers a middle ground in the debate, acknowledging that birth marks a significant moral transition—not because the infant suddenly becomes a person, but because their body becomes physically separate and independent from the mother 4 .
"Birth represents a transition in physical independence, not necessarily a transition in moral status."
| Philosophical Framework | Key Criteria for Moral Protection | View on Newborns |
|---|---|---|
| Traditional Sanctity of Life | Biological humanity | Full moral worth from conception or birth |
| Personhood Theory | Cognitive capacities (self-awareness, rationality) | Not persons, therefore no full right to life |
| Bodily Rights Theory | Physical separation and bodily independence | Moral protection through bodily rights at birth |
While no laboratory experiment exists for this ethical debate, the 2012 paper "After-birth abortion: Why should the baby live?" serves as a crucial philosophical experiment that tests the logical consistency of our moral reasoning about life 1 .
Giubilini and Minerva employed a straightforward methodological approach: they applied the same reasoning used to justify abortion to newborns. Their process followed these steps:
Beings only have a right to life if they possess the capacity to value their own existence
Since neither fetuses nor newborns possess this capacity, neither has a strong right to life
If abortion is permissible because the fetus lacks personhood, then killing newborns should be permissible for the same reasons
The family's well-being and potential suffering determine whether ending a life is preferable 1
"Having a child can itself be an unbearable burden for the psychological health of the woman or for her already existing children, regardless of the condition of the fetus." 1
The authors specifically argued that adoption fails to resolve the psychological burden on the family in such cases.
| Supporting Arguments | Counterarguments |
|---|---|
| Moral consistency with abortion practices | Slippery slope toward devaluing vulnerable life |
| Reduction of family suffering | Alternative solutions exist (adoption, support) |
| Newborns lack self-awareness | Birth marks significant moral transition |
| Potential personhood is morally irrelevant | All human life has inherent dignity |
Rooted in the Hippocratic Oath, traditional medical ethics emphasizes:
This modern approach often focuses on:
Critics like author Wesley Smith have labeled this utilitarian approach a "culture of death" because it potentially supports not only infanticide but also euthanasia for the elderly and physician-assisted suicide 1 .
While the theoretical debate about healthy newborns continues, real-world neonatal medicine already faces difficult ethical decisions regarding severely ill infants. In neonatal intensive care units (NICUs), medical teams regularly encounter what specialists call the "gray zone"—situations where an infant's prognosis is uncertain, and it's unclear whether to continue aggressive treatment or transition to comfort care 3 .
This complex medical decision-making involves:
Unlike the theoretical proposal of "after-birth abortion" for healthy infants, actual neonatal end-of-life decisions typically involve infants with "severe deformations, very grave and severe medical syndromes" where life expectancy is limited and suffering is significant 2 .
| Concept | Definition | Application in NICUs |
|---|---|---|
| Gray Zone | Area of prognostic uncertainty where no clear "right" choice exists | Guides decisions about continuing or limiting treatments |
| Palliative Care | Active total care of body, mind, and spirit when cure isn't possible | Focuses on comfort and quality of remaining life |
| Therapeutic Alliance | Shared decision-making between medical team and family | Builds consensus on most ethical path forward |
| Best Interest Standard | Ethical obligation to choose what most benefits the child | Balances quality and length of life according to individual circumstances |
Navigating these complex questions requires specific conceptual tools from philosophy and ethics:
A framework for determining which beings have rights and deserve moral consideration, based on criteria like sentience, consciousness, or relationships 4 .
A method for evaluating whether accepting one practice might lead to accepting increasingly problematic ones, crucial in assessing potential consequences of changing ethical norms 1 .
An approach that evaluates ethical decisions based on their consequences and overall impact on well-being, often contrasting with rights-based approaches 1 .
A framework that applies key principles like autonomy, beneficence, non-maleficence, and justice to medical dilemmas, providing structure for complex decisions 3 .
The debate over newborn infants represents one of the most challenging frontiers in bioethics—a field continually reshaped by medical advancements and evolving social values. While the extreme position of "after-birth abortion" for healthy infants remains largely theoretical, it forces us to examine the consistency of our ethical reasoning and the foundations of our moral intuitions about life.
What makes this discussion particularly urgent is its connection to real-world policy decisions. Countries like Canada have seen their Medical Assistance in Dying (MAID) program expand significantly since 2016, with proposals emerging to extend euthanasia to severely ill newborns 2 . Meanwhile, the Netherlands already permits infant euthanasia under strict guidelines for cases of unbearable suffering 7 . These developments suggest that questions about the ethics of ending newborn lives are no longer purely academic but are becoming pressing policy concerns.
The newborn dilemma ultimately raises profound questions that extend beyond medicine into philosophy, law, and the foundations of society:
As science continues to push the boundaries of what's medically possible, these ethical questions will only become more pressing, reminding us that progress involves not just technical capability but moral wisdom as well.
References will be added here in the final publication.