Violinists, Demandingness, and the Impairment Argument Against Abortion

The &#8216;impairment argument&#8217; against abortion developed by Perry Hendricks aims to derive the wrongness of abortion from the wrongness of causing foetal alcohol syndrome (FAS). Hendricks endorses an &#8216;impairment principle&#8217;, which states that, if it is wrong to inflict an impairment of a certain degree on an organism, then, ceteris paribus, it is also wrong to inflict a more severe impairment on that organism. Causing FAS is wrong in virtue of the impairment it inflicts. But abortion inflicts an even more severe impairment (death), and so, ceteris paribus, is also wrong. Notably, Hendricks thinks that this argument does not require the claim that the foetus is a person. Here, I respond to Hendricks by arguing that the ceteris paribus clause of the impairment principle is not met in ordinary cases of pregnancy. Carrying an unwanted pregnancy to term is much more burdensome than is refraining from excessive drinking for nine months. This provides a pro tanto justification for obtaining an abortion that does not apply to causing FAS. If the foetus is not a person, it seems fairly clear to me that this justification is strong enough to render abortion permissible. Hendricks is therefore incorrect in claiming that the impairment argument can go without claims concerning foetal personhood. If the foetus is a person, then whether burdensomeness justifies abortion depends on certain questions relating to Thomson&#8217;s famous violinist argument. I will not attempt to answer those. But anyone who is otherwise sympathetic to Thomson&#8217;s argument should not be moved by the impairment argument.


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CRUMMETT of its title, that 'even if the fetus is not a person, abortion is immoral'.
After all, the argument does not rely on any claims about foetal personhood. It instead relies on the claim that causing FAS is immoral, which will presumably be granted whatever one's views on foetal personhood.
I agree that causing FAS is ordinarily wrong. Furthermore, Hendricks' impairment principle seems plausible. Accordingly, I think the best bet for the pro-choice philosopher is to find some morally important difference between causing FAS in an ordinary case and obtaining an abortion, so that the ceteris paribus clause of the impairment principle is not satisfied. Here, I point out an important difference, which has not yet been entertained by either Hendricks or his critics. 3 I note that carrying an unwanted pregnancy to term is typically far more burdensome than is abstaining from excessive drinking for nine months, and argue that this is a morally important difference. If the foetus is not a person, then I suggest that this burdensomeness is sufficient moral justification for having an abortion. Hendricks' claim that the impairment argument against abortion can go without a commitment to foetal personhood therefore fails. If the foetus is a person, then whether this burdensomeness justifies having an abortion depends on how we answer certain questions related to Judith Jarvis Thomson's (1971) famous argument for abortion's permissibility. 4 I will not attempt to answer those questions here, except for one in Section 3 that is directly relevant to my argument. But I do claim that anyone who is otherwise sympathetic to something like Thomson's argument should not be moved by the impairment argument, even if the foetus is a person. The difference in burdensomeness provides an easy way of resisting the inference to the wrongness of abortion by way of the impairment argument.
In the next section, I explain the line of response to the impairment argument that I am defending. In Section 3, I explore whether the causing/allowing impairment distinction poses a problem for the argument of Section 2. In Section 4, I respond to a potential objection that asks about the mother's obligations in an odd scenario where refraining from drinking really would be as burdensome as an unwanted pregnancy.

| BURDENSOMENE SS , DRINKING AND ABORTION
Judith Jarvis Thomson famously asks us to consider the following scenario.
You wake up in the morning and find yourself back to back in bed with an unconscious violinist… He has been found to have a fatal kidney ailment, and the Society of Music Lovers has canvassed all the available medical records and found that you alone have the right blood type to help. Famously, many people agree that you are not obligated to remain plugged in. 6 And even philosophers who think I might be obligated to remain plugged into the violinist 7 will likely agree that, at least ordinarily, I would not be similarly obligated to remain plugged in if we replaced the violinist with a non-person organism (even if that organism will become a person later if I do stay plugged in). 8 So if the case is otherwise analogous to abortion, and if we accept that unplugging from the violinist is permissible, then abortion is also permissible; if we accept the even more common judgment about the permissibility of unplugging from a non-person organism, and the case is otherwise determines the demandingness of an action, and this will come up in Section 4. However, I take it that the intuitive idea is clear enough for now. It is a familiar thought that some actions-such as volunteering at a charity in my every spare moment-might be good, but are nonetheless supererogatory rather than required, precisely because they ask too much for them to be part of our moral duty. 9 Staying hooked up to the violinist for nine months is extremely burdensome for me, and this provides me with a fairly strong justification for unplugging. However, conditional on my bearing that cost, the further, marginal cost of putting the drinks off for an hour is trivial. Accordingly, though I can give a fairly strong justification for unplugging, I cannot give such a justification for drinking, given that I Of course, there is a disanalogy in that, in Parfit's case, there is apparently no reason to not save the stranger's other arm once you save one, whereas in Drinking while plugged in, there may be a small reason to go ahead and drink, if that is what you want to do. But of course, the reason in that case is small enough as to not matter much in comparison with the severe impairment one inflicts on the violinist. 12 So: by way of Hendricks' impairment principle, if it is wrong to cause FAS, then it is also wrong to procure an abortion, unless there is some relevant moral difference between the two. I suggest that this is an important moral difference: carrying an unwanted pregnancy to term is extremely burdensome, whereas refraining from excessive drinking for nine months is, by comparison, not very burdensome. What does this imply about the prospects for the impairment argument?
Suppose the foetus is a person. Return to Thomson's case. One way to resist Thomson's pro-choice conclusion is to reject the popular judgment about the violinist case and to say that I am obligated to stay plugged in after all. Another is to search for a disanalogy with the violinist case: perhaps it is different because, say, pregnancy usually results from a voluntary action on the part of the mother that she knew had some chance of resulting in pregnancy, or because abortion involves killing while unplugging merely involves letting die, or because the violinist is a stranger whereas the foetus is one's offspring.
Obviously, it is controversial whether these methods of resisting Thomson's argument succeed. 13 Apart from the killing/letting die objection, which I discuss in the next section, I will not attempt to evaluate whether they do. What I want to claim here is just that if one was otherwise sympathetic to Thomson's argument, one has little reason to worry about the impairment argument. The difference in burdensomeness provides an easy way of resisting the inference to the wrongness of abortion by way of the impairment argument. Now suppose that the foetus is not a person. In that case, my own inclination is to say that even if one or more of the objections to Thomson's argument do work on the supposition that the foetus is a person, they do not work on the supposition that it is not.
I think it really is pretty clear that a burden equivalent to an unwanted pregnancy would be too great for me to be obligated to bear it to keep a non-person organism alive, even if I am obligated to do so for the violinist. And I think the same is generally true even if I voluntarily did something that I knew had a small chance of creating this organism in a state of dependence on me, and so on. So, if the foetus is not a person, I think it is fairly clear that the burdensomeness of an unwanted pregnancy justifies an abortion.
But refraining from drinking is much less burdensome, and so does not justify causing FAS.

| C AUS ING AND ALLOWING IMPAIRMENT
There is another feature of Drinking while plugged in that might seem to make it worse than unplugging in Thomson's case. In Thomson's case, I allow the violinist to suffer a bad fate (by withdrawing support), but in Drinking while plugged in, I directly cause the violinist's impairment by drinking. One might think the latter is worse. I framed Drinking while plugged in as a case of causing impairment to make it analogous to drinking while pregnant, which also directly causes an impairment when it results in FAS. But it is also in this way more like abortion than Thomson's original case, since abortion generally does kill the foetus, rather than simply withdrawing support from its mother's body and allowing it to die. This mirrors a classic criticism of Thomson's violinist analogy: namely, that unplugging the violinist merely lets him die, while abortion directly kills the foetus, which is worse. 14 Of course, this would not show that the difference in demandingness is not a morally important difference between unplugging and drinking while plugged in. However, it might show that the difference is not as important as I claimed, if much of the difference between the cases is instead explained by the causing/ allowing impairment distinction. If much of the difference is explained by this distinction, and if abortion is ordinarily, in this respect, more like Drinking while plugged in than like unplugging, this might call into question whether the burdensomeness of carrying a pregnancy can justify procuring an abortion. This might seem especially compelling in light of the objection presented in the next section, which directly targets what I say about the significance of burdensomeness.
My response is that the causing/allowing impairment difference is not very morally important here, which can be seen by altering In this case, my drinking works, mechanically speaking, more like unplugging. It interferes with the medical equipment so that I fail to provide aid that would prevent an impairment, rather than directly causing an impairment myself. 15 However, it seems clear to me that drinking in the modified case is as, or almost as, wrong as in the ordinary Drinking while plugged in. So modifying the case introduces a disanalogy with drinking while pregnant. I now allow, rather than directly cause, the impairment. But this disanalogy does not seem to make a substantial moral difference. So the causing/allowing impairment distinction cannot be the main reason why drinking while plugged in is morally worse than unplugging the violinist, since the moral difference between the cases is about the same even if we eliminate the causing/allowing disanalogy. Of course, it does not follow that the causing/allowing harm distinction never makes a substantial moral difference, which might seem an implausible result. It may be that the relative unimportance of the distinction here is dependent upon special features of this case. 16 Whatever the reason, I take it as fairly clear that there is not a substantial moral difference between Drinking while plugged in and If we want to claim that drinking in the modified case still directly causes, rather than merely allows, an impairment, then I imagine we will have to say the same about unplugging the violinist, so that there is never any disanalogy to begin with. See Boonin,op. cit.,p. 195. …there is at least one method of abortion, hysterotomy, that is more plausibly described as a case of letting die rather than a case of killing. This puts the proponent of the impairment argument in an infelicitous position, if they claim that the main disanalogy between unplugging and Drinking while plugged in comes from the causing/allowing impairment distinction. For if the fact that one is causing the impairment in Drinking while plugged in is a very important difference between that and unplugging, then it will also be a very important difference between causing FAS and procuring an abortion via hysterotomy. The impairment argument then might not really an argument against abortion as such; it might instead just be an argument that any abortions need to be performed via a more dangerous and invasive procedure. 18 Further, Boonin argues at length that, if abortion via hysterotomy is permissible, then, given that other methods impose an additional cost on the mother and given certain other special features of the case, abortion via other methods that directly kill the foetus will be permissible, too. 19 If the impairment argument leaves abortion via hysterotomy untouched, then Boonin's line of reasoning may provide a way of resisting its conclusion even about other abortion cases.

| THE REL ATIVIT Y OF DEMAND ING NE SS
I have conducted this discussion on the assumption that an unwanted pregnancy is far more burdensome than refraining from excessive drinking for nine months. While this is no doubt true, it is not necessarily true. In light of this, someone might offer the following objection: You suggest that the greater demandingness of carrying an unwanted pregnancy to term, as opposed to refraining from drinking for nine months, is a morally important difference-one great enough to justify procuring an abortion, but not causing FAS.
But it is not necessarily true that refraining from drinking during pregnancy is more demanding. We can imagine, say, a severe alcoholic, or someone whose identity and leisure time are structured entirely around drinking fancy wines and craft beers, or around going to wild parties. Suppose the impact of temporarily giving up drinking on this person's ability to fulfil their desires and enjoy their life equals that typically involved in carrying an unwanted pregnancy to term. If the demandingness of pregnancy can justify inflicting the impairment of death, the demandingness of not drinking could, for this person, justify inflicting the lesser impairment of FAS. But it would be absurd and perverse to say that causing FAS is morally permissible as long as you are a severe enough alcoholic, or a dedicated enough wine snob or party animal.
There are at least six things to say about this objection.
The first is the least important. I never claimed that the difference in burdensomeness is the only morally relevant difference between abortion and causing FAS. In fact, I think it is not. So I am not committed to claiming that causing FAS would be permissible if avoiding it was sufficiently burdensome. However, I do want the account I have presented here to be able to stand on its own, without needing there to be other disanalogies in order to avoid implausible consequences. So I will not rely on this point in what follows.
Second: note that this is not a special problem for my account of the relative moral status of abortion and causing FAS, as long as we agree that burdensomeness sometimes means that we are not obligated to do certain things that we would otherwise be obligated to do. For instance, suppose we hold the common view that we are sometimes obligated to help others when we can achieve a very great benefit for little cost to ourselves, but that we are not obligated to devote every spare penny and moment to helping those in need, because of how demanding that would be. An objector could ask us to consider a rich person who is so greedy that giving away even a cent is extremely demanding for them, claim that the view commits us to saying that this person has no obligation to do so, and then claim that it is perverse to think that we are ordinarily required to do something for others, but not if we are greedy enough. Most readers will agree that there is some satisfactory response to this objection. Whatever that response, I as measured by desire satisfaction and hedonic level, is as great as that involved in carrying an unwanted pregnancy to term. It would not follow that refraining from alcohol was as demanding, in the morally relevant sense, for that individual.
Of course, it seems plausible that among the personal reasons we have are reasons to pursue enjoyment and the satisfaction of our desires, and to avoid misery and the frustration of our desires. And perhaps such reasons could always, in principle, outweigh any other reasons to object to the invasive and burdensome use of one's body by the violinist. So perhaps we can simply stipulate that for the individual in the example, the cost of giving up alcohol, as measured by desire satisfaction and hedonic level, would be much, much greater than the typical cost of carrying an unwanted pregnancy, measured the same way. This is fine, as far as it goes. But it will make some of the following points more powerful.
Fourth: the case we are being asked to imagine is highly unusual, and it is important to make sure that our intuitions are really being responsive to the highly unusual nature of the case. Carrying an unwanted pregnancy can be very burdensome, much more burdensome than giving up drinking for nine months would be for any ordinary person. 23 There is a risk that, in considering the case, we are really imagining what refraining from drinking would be like for, say, someone we know who is just really into parties, and thereby underrepresenting the burdensomeness that the objector stipulates is supposed to be involved. This is especially true if, in response to the previous point, we further stipulate that the cost to desire satisfaction and enjoyment is much, much greater than that typically involved in carrying an unwanted pregnancy. I think it is extremely difficult to imagine what a person for whom this was true would have to be like. Below, I will alter the imagined scenario in a way that I think makes it easier for our intuitions to be responsive in the right way.
Fifth, the case the objector is asking us to imagine involves other relevant considerations that make it disanalogous from the abortion case. Realistically, the severe alcoholic probably has decisive reasons to stop drinking anyway, even apart from the effect on the violinist. This may not be true of the party animal or wine snob. But their cases raise issues analogous to the classic 'problem of expensive tastes' from the distributive justice literature. The problem of expensive tastes is, roughly, the problem of when and to what extent the fact that one person needs more resources to enjoy the same level of well-being as other people can justify diverting extra resources to them. Such diversion sometimes seems justified and sometimes it does not. Suppose I have a chronic pain condition and need a special medicine to achieve an ordinary level of well-being. Suppose you are a dedicated coffee snob, despising normal drinks, and need Kona coffee imported from Hawaii to achieve an ordinary level of well-being.
The cost to me of not having the medicine is the same as the cost to you of not having the Kona coffee. Under normal conditions, it seems more justifiable for the government to spend extra money on me to provide the medicine than to spend extra money on you to provide the coffee, even if the medicine and coffee are equally expensive. The exact reasons why are controversial, but it is not too hard to identify clear-cut cases where diverting resources seems justifiable and where it does not. 24 The objection here raises an analogous problem: under what circumstances does the fact that an action is more demanding for one person excuse them from doing it, when doing it would be obligatory for an ordinary person? Again, the answer seems to be that they will be excused in some circumstances and not in others.
I think the cases of the wine snob or the party animal will, under realistic conditions, be circumstances where there is not much excusatory force. We would tell them that they needed to toughen up, to find ways of enjoying their lives that did not depend on alcohol. And I think this is part of why the objection, as I initially framed it, might seem compelling. Finally, point six: suppose we take the previous three lessons on board. We are confident that we really have described a case where refraining from alcohol is as burdensome as carrying an unwanted pregnancy, we are confident that we really are accounting for this fact in our intuitions, and we have constructed the case so as to avoid morally confounding factors. If we really do this, the conclusion that I am permitted to drink no longer seems like a counterexample to me. Suppose I am hooked up to the violinist in Thomson's case. However, in this variant, I have a rare, congenital, otherwise untreatable medical condition that is such that, if I do not occasionally drink some liquor, I will be stricken with excruciating and incapacitating fits of pain. (One can adjust the frequency and severity of these fits until the demandingness of not drinking for nine months seems comparable to that of carrying an unwanted pregnancy.) If I do drink, the violinist will develop an FAS-like impairment. Staying plugged in and drinking will nonetheless be better for him than unplugging and letting him die, which, we can suppose for purposes of argument, I would be permitted to do. For some reason I am unable to communicate with him about any of this-for instance, I cannot ask whether he would consent to my staying plugged in and drinking. I am willing to save his life, and I stay plugged in. Am I now also obligated to refrain from drinking at the cost of the incapacitating fits of excruciating pain? I doubt it. So: as far as the explanation of the difference between abortion and causing FAS that I have presented here goes, if refraining from drinking really was as burdensome as carrying an unwanted pregnancy, drinking might not be wrong. But once we account for all the difficulties involved in imagining a scenario like this, the implication is not a problem for the account. It is the intuitive result.

CO N FLI C T O F I NTE R E S T
The author declares no conflict of interest.