This week’s practical philosophy seminar discussed personhood-based arguments for the resuscitation of extremely premature infants (EPIs). These notes focus less on discussion/paper specifics and more on what I learned about the topic as a whole during the discussion and afterward.

As an aside, this was the last session for the year and I’m pretty sad about it! But also very excited for them to restart in January. Aside from learning so much already, I’ve met some really great and welcoming people through these seminars, and gotten to practice my Swedish.

Now, on to the notes!

Extremely Premature Infants at Uppsala’s Akademiska Sjukhuset

Uppsala’s Akademiska sjukhuset is the only hospital in Sweden where resuscitation is attempted on EPIs without any input from parents being sought. Technically someone could have a legal abortion at Week 21 or a premature birth at Week 22, and at Week 22 the infant would always be given resuscitation attempts. This blanket policy may be morally questionable.

Personhood-based aguments for resuscitation of EPIs

Two main definitions of personhood were discussed: biological view and psychological view.

Biological view and its implications

• Fetal personhood: If a fetus is granted personhood due to its biological status, does that undermine abortion permissibility?
  • Counterpoint: Bodily autonomy of the mother might override the fetus’s rights. Personhood need not be the only factor taken into consideration.
  • Another thought that came up is that it may be perfectly morally reasonable for parents to elect an abortion and for hospital staff to then use whatever technology is available, if any, to begin life-saving measures. They don’t necessarily need to contradict each other.
• Resuscitation timelines: There is nothing saying that a fetus becomes a person at week 22 specifically. Why not week 21, 20, 19, etc? So the biological view suggests resuscitation should likely start earlier than week 22. This poses challenges, as it contradicts current practices and raises questions about stillbirth classifications.
• Technological advancements: As medical technology improves, resuscitation may become feasible earlier, pushing the limits of current ethical frameworks.

With biological view - why do we pick week 22 specifically and not before? A fetus could ostencibly be a “person” before week 22, so personhood alone can’t really be the sole deciding factor.

Psychological view and identity questions

• Continuity and identity: Psychological continuity as a basis for personhood is contested.
• Non-human persons: The biological view must account for entities like gods or even non-human animals who may have similar mental capacity as a fetus at week 22.
• Phases of existence: Personhood might represent a phase in the life of a human organism, with pre- and post-person states.

With psychological view focusing on memory, consciousness, self-awarenes, ability to reason, an arguent can be made that the fetus achieves ‘personhood’ after week 22, and possibly even after normally-timed birth. At which point personhood argument becomes invalid for resuscitation at week 22.

Is personhood even relevant in the decision?

Or rather, is it the most relevant factor?

• Additional factors: Other considerations, such as the capacity to feel pain, potential for becoming a person, impact on parents’ lives, available systemic resources, etc., may influence decisions.
• Personhood skepticism: Personhood as a concept may not be the determining factor, and its role in resuscitation needs further exploration.

Passive euthanasia and resuscitation analogy

• Comparison to abortion: A stronger analogy for resuscitation decisions might be passive euthanasia rather than abortion.
• Invasiveness and outcomes: Resuscitation can be invasive, with mixed outcomes. This might justify a presumption against resuscitation in some cases, akin to passive euthanasia decisions.

Potential personhood and ideal types

• Ideal types: Moral rights could be based on an “ideal type” of a human being rather than personhood.
• Potential: The fetus’s potential to become a person might grant it moral status, comparable to that of similarly sophisticated non-human animals.

Abortion-resuscitation policy contradictions

Different hospital policies allow for abortion and resuscitation under seemingly contradictory circumstances. This highlights potential arbitrariness in drawing ethical lines at specific gestational ages.

Early stages of development and organism status

• Defining an organism: Questions remain about when a fetus transitions into an organism. Early development is complex, and dividing lines between embryos, fetuses, and infants can seem arbitrary philosophically even if they have somewhat set timing definitions in medical field.
• Identity over time: Medical terminology complicates discussions of identity, but potential personhood may warrant consideration.

Conclusion

Personhood-based arguments for resuscitation of EPIs struggle to justify overriding parental will, or even other overriding factors. Personhood seems to be a commonly brought-up topic in debates of resuscitation of extremely premature infants, but seems to offer a pretty weak foundation. The debate must also address the intersection of personhood, parental rights, evolving medical technologies, conscousness, and other potential considerations. Not to say this means EPIs should never be given life-saving measures, only that personhood may not be the best argument to base the action on.