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Twin pregnancy reduction is not an ‘all or nothing’ problem: a response to Räsänen

Begovic, Dunja; Romanis, Elizabeth Chloe; Joanne Verweij, E

Twin pregnancy reduction is not an ‘all or nothing’ problem: a response to Räsänen Thumbnail


Dunja Begovic

E Joanne Verweij


In his paper, ‘Twin pregnancy, fetal reduction and the ‘all or nothing problem’, Räsänen sets out to apply Horton’s ‘all or nothing’ problem to the ethics of multifetal pregnancy reduction from a twin to a singleton pregnancy (2-to-1 MFPR). Horton’s problem involves the following scenario: imagine that two children are about to be crushed by a collapsing building. An observer would have three options: do nothing, save one child by allowing their arms to be crushed, or save both by allowing their arms to be crushed. Horton offers two intuitively plausible claims: (1) it is morally permissible not to save either child and (2) it is morally impermissible to save only one of the children, which taken together lead to the problematic conclusion that (3) if an observer does not save both children, then it is better to save neither than save only one. Räsänen applies this problem to the case of 2-to-1 MFPR, arguing ultimately that, in cases where there is no medical reason to reduce, the woman ought to bring both fetuses to term. We will argue that Räsänen does not provide adequate support for the claim, crucial to his argument, that aborting only one of the fetuses in a twin pregnancy is wrong, so the ‘all or nothing’ problem does not arise in this context. Furthermore, we argue that the scenario Räsänen presents is highly unrealistic because of the clinical realities of 2-to-1 MFPR, making his argument of limited use for real-life decision making in this area.


Begovic, D., Romanis, E. C., & Joanne Verweij, E. (2021). Twin pregnancy reduction is not an ‘all or nothing’ problem: a response to Räsänen. Journal of Medical Ethics,

Journal Article Type Article
Acceptance Date May 14, 2021
Online Publication Date Jun 28, 2021
Publication Date 2021
Deposit Date May 20, 2021
Publicly Available Date Oct 26, 2021
Journal Journal of Medical Ethics
Print ISSN 0306-6800
Electronic ISSN 1473-4257
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed


Accepted Journal Article (229 Kb)

Copyright Statement
This article has been accepted for publication in Journal of Medical Ethics, 2021 following<br /> peer review, and the Version of Record can be accessed online at

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