The Tiny Violinist
In which we look at a more plausible version of JJ Thomson's famous violinist argument.
fetus virtuoso by Bing Co-pilot Image Generator
Post-semester holiday greetings! I hope you are enjoying your holiday break. I had originally slated this post for November but opted to push it back. Admittedly its not the sort of post that lends itself to holidays, but really what in bioethics does?
Let me tell you a story involving abortion that had I known about it, I’d have definitely used it in the Practical Bioethics. In 2013, Marlise Munoz was at home when she suffered a pulmonary embolism (a bloodclot in the lungs) that resulted in her being brain dead—no higher brain functions—and breathing sustained by artificial respiration.
Marlise Munoz before her tragic accident
Munoz was a paramedic as was her husband and she had made it clear that she did not want to be kept alive on a ventilator. A real tragedy in the worst sense, but what made it a bioethics case is that Marlise was 14 weeks pregnant.
A Texas law required a pregnant woman to be kept alive on life-support if there was a good chance the fetus could be brought to viability and delivered via C-section. This applied even if the woman had an advanced directive.
If you’ve read or taught Practical Bioethics, you know we have a clear dilemma between our duty the mother’s stated wishes (autonomy) and the fetus’ interest in being brought to term (beneficence and non-maleficence). Some might argue there is also the interests of the husband. Erick Munoz argued it wasn’t right to keep his wife alive to be a incubator.
Now let me complicate this a bit. Let’s look a famous argument in favor of Abortion that touches on this case. In 1971 Judith Jarvis Thomson wrote an very influential argument defending abortion around the time of the oral arguments for Roe v. Wade.1
What made Thomson’s argument compelling was an analogy. Thomson compared bringing an unwanted fetus to term with waking up to find you’d been kidnapped and forced to use your kidneys to keep a famous violinist alive.
The director of the hospital now tells you, "Look, we're sorry the Society of Music Lovers did this to you—we would never have permitted it if we had known. But still, they did it, and the violinist is now plugged into you. To unplug you would be to kill him. But never mind, it's only for nine months. By then he will have recovered from his ailment, and can safely be unplugged from you." Is it morally incumbent on you to accede to this situation? No doubt it would be very nice of you if you did, a great kindness. But do you have to accede to it?
Thomson thinks intuitively that even though the violinist has rights to live, you would not have a duty to stay attached to the violinist till he is able to be removed from you.
Before Thomson, most abortion debates were centered around whether the fetus had the moral status of a person. (See chapter 9 of Practical Bioethics for a discussion of moral status). If the fetus was a person then abortion couldn’t be justified but since we didn’t have any definitive way of deciding personhood, abortion advocates could argue fetus’ didn’t have the characteristics of persons. Around and around it would go, with both sides arguing for a definition of personhood that would make their case.
What makes “An Argument for Abortion” significant was that Thomson stipulates for the sake of the argument, the fetus has full moral status. The fetus is as much a person as the famous violinist is. She then thinks intuitively, moral status doesn’t solve the issue. The fetus may have rights like the violinist but those rights don’t include a duty help the violinist survive until a kidney can be found.
Many people think waking up attached to a famous violinist works best as an analogy of a pregnancy from rape or incest. She has another analogy in the paper that seeks to justify abortion even if one is merely sexually active that is longer and more controversial that I’ll save for another post (See Chapter 9 of PB for the relevant text). Regardless, Munoz’s case is a less fanciful version of Thomson’s violinist analogy.
Munoz’s body is being used to keep a fetus alive until it is viable. The family does not want kill the baby, only unhook Marlise from life support—support that the baby needs. In a way, The Munoz’s baby is a sort of a tiny version of Thomson’s violinist.
As I said, had I known about it, I would have included this case as an exercise to apply Thomson’s article and the critique by Francis Beckwith. (As an aside, Practical Bioethics is the only bioethics textbook I know of that presents a critique of Thomson’s argument).
This argument gives a dilemma that is hard to dismiss by either side of the abortion debate. If we honor Marlise’s expressed wishes, we cause the death of her fetus. If we keep Marlise alive for the the next six weeks, we violate her expressed wishes and that of her immediate family. Then we do a c-section on a person in a permanent vegetative state to deliver a baby who may have already suffered irreversible damage and who has a less than 50% chance of living, even if completely healthy.2
I’ve left one detail from the story. the health of the fetus. (If you’ve been thinking as you read, “Well how healthy is the fetus” then you are developing good moral reasoning). In this case, the fetus was probably irreputably damaged by oxygen deprivation by the embolism.
According to court documents filed by Erick Munoz’s attorney, The baby had hydroencephalus (water on the brain) and heart problems. In addition at 22 weeks "Even at this early stage, the lower extremities are deformed to the extent that the gender cannot be determined."3
Most people I’ve talked to who are ambivalent about what to do, have an immediate response when this information is added. It’s as if, the damage to the fetus is the tipping point that justifies removing Marlise’s life-support and letting both die. This was the decision of the Texas court and on January 26th 2014 Marlise and the unborn baby they named “Nicole” after Marlise’s middle name.
It is interestingthat the fetal difficulties wouldn’t be enough for most already predisposed against abortion but combined with the vegetative state of the mother, it pushes intutions toward removing life-support even if it both mother and baby die.
Hopefully, if there is a second edition I can include a version of the Munoz case but I think I’ll leave out the damage to the fetus detail and let readers wrestle with a version where we don’t know the fetus will likely not survive. What do you think? Be sure and comment below.
https://rintintin.colorado.edu/~vancecd/phil215/Thomson.pdf
https://www.healthline.com/health/baby/premature-baby-survival-rate#24-weeks
https://web.archive.org/web/20140126063021/http://www.dallasnews.com/news/20140122-fetus-in-brain-dead-tarrant-woman-distinctly-abnormal-attorneys-say.ece