Intrinsic and extrinsic qualities
I first want to pause a little over the claim that there is no ‘intrinsic’ difference between neonates and full-term fetuses. In the service of declaring birth morally insignificant, discussants typically emphasize the biological comparability of the late-term fetus and neonate. But this claim alone is liable to be exaggerated or simplified. In fact, many significant biological and behavioural state changes are triggered at birth. These include a number of biological adaptations which need to take place to enable a newborn to breathe in air for the first time. One such adaptation is the clearing of fluid from the lungs to allow them to inflate and draw in breath. Other significant adaptations include changes in the circulatory system, the activation of new enzyme systems, the digestive system, and the release of hormones to regulate temperature outside of the womb—to name just a few. In an explanation of the transition from intrauterine to extrauterine life, Noah Hillman et al describe that transition as ‘the most complex adaptation that occurs in human experience’^ Birth is a dramatic biological event.
Upon emergence into the world, a new baby also exhibits radical behavioural state transitions, most notably: crying for the first time; heightened wakefulness and reactivity, and increased responsiveness to environmental stimuli like noise, light, and touch.    Some experiments have documented the capacity for neonates to imitate other people’s facial expressions as early as forty-two minutes after birth, which is taken to indicate a primitive form of self-consciousness.27
It is simply false to claim, then, as some do, that the late fetus and the newborn share all of their properties except for their respective locations in the womb and in the world. Birth triggers this very same catalogue of changes in viable preterm neonates regardless of gestational age, although some of the developments will of course be stunted if the human being is too premature. Viable preterm infants undergo the same biological adaptations necessary for extrauterine life upon expulsion from the womb as do full-term ones. They too cry and breathe, and engage in limited inter-subjective interactions, such as responding to touch and sound.28
Is it so obvious that these kinds of physiological and behavioural state changes could not be intrinsic changes? Of course, this all depends on what exactly is meant by ‘intrinsic’. If ‘intrinsic’ is taken to be merely interchangeable with ‘morally significant’, then sceptics about the significance of birth would presumably argue that birth does not mark an intrinsic change because it does not occasion any of the developments in cognition or consciousness which they take to be the only features relevant to moral status. It is important to be watchful here of the potential for such accounts to smuggle in a psychological capacities-based view of personhood’s constitutive properties under the cover of the intrinsic-extrinsic distinction. It cannot be a foregone conclusion that intrinsic properties are only ever mental ones. This is what anyone committed to a psychological capacities account of moral status must establish independently. Thus, one cannot deploy the intrinsic—extrinsic distinction against the birth threshold before one explains what, on one’s accounting, makes a feature intrinsic or extrinsic, and why the features one picks out as intrinsic are the only morally relevant ones. Unless we are sure that biological, relational, or location-based properties could never be morally significant, the intrinsic-extrinsic distinction will not entail a powerful a dismissal of the birth threshold. I have, of course, already endorsed the account which grounds the concept of a person in core psychological and emotional capacities. But this is not, to my mind, inconsistent with attributing some moral significance to birth—the kind of significance that might explain and defend identifying the threshold of personhood status with the birth event, given that such a threshold must be stipulated. For this, we need only be convinced that birth is in some way morally salient, enough that we might justify preferring it over other potentially reasonable entry points.
What does it mean to say, then, that the changes occasioned by birth are merely extrinsic? Some may want to dismiss them as such for the sole reason that they are precipitated by an event. But it is clearly not true that morally significant ‘intrinsic’ changes cannot be brought about by other changes in the world. That rendering of the intrinsic-extrinsic distinction could not possibly be correct. This can be shown by harnessing an example considered in the previous chapter, of a Superdog who, as a result of being subjected to intensive treatment, has acquired the cognitive capacities of a normal adult human being. It is not right to suggest that because the change in the dog’s capacities depends on the circumstantial (or ‘extrinsic’) fact of having been selected for conditioning treatment, it is thereby not an intrinsic change. Clearly, intrinsic changes supervene in all sorts of ways on extrinsic ones.
The fact of having been born can certainly be extrinsic in a way, since it can depend on circumstantial factors not having to do with the nature of the early human being, including any of the circumstances that trigger labour. Nevertheless, the usual causal factor triggering birth is the maturity of the fetus, which is an intrinsic feature so far as an individual’s biological traits can count as intrinsic. The reply to this by those who are sceptical about the moral significance of birth is likely
Development 55, in which the authors note that ‘well before term age’, newborns in face-to-face interactions responded to ‘motherese’ (baby talk) with ‘increased visual attention’ and to tactile stimulation with ‘increased signs of distress and/or avoidance’ (at 66).
to be that the kinds of changes occasioned by birth—adaption to the extrauterine environment, and the beginning of interaction and intersubjectivity—are simply irrelevant to moral status, biological or not. Even if it is true that intrinsic properties often depend on extrinsic ones, or that some intrinsic changes invariably take place at birth, the defender of the birth threshold must still show that these changes are intrinsic in the sense of being morally significant, not just in the sense of being internal to the individual rather than circumstantial. This is exactly what anyone who thinks that birth is utterly morally arbitrary believes cannot be shown. None of these changes, it will be argued, has anything to with what it means to be a person and to possess strong moral rights.
But it is not true that birth is irrelevant to the possession of those traits that constitute personhood status on the capacities-based view. For one, entrance into the extrauterine world is a necessary precondition for any of the higher cognitive abilities constitutive of fully realized personhood on those accounts. Some psychologists have even suggested that it is a basic precondition for consciousness itself.
While it does not possess anything like the spectrum of cognitive capacities paradigmatic of personhood, the neonate’s emergence into the world introduces it to a mass of content for mental processing: the sights, smells, sounds, and feel of the world. The psychologist Stuart Derbyshire contends that exposure to this content is essential for developing conscious experience, memory, and emotion.29 Considering this relationship between exposure to content and mental states in the context of the fetal pain debate, he writes:
Before infants can think about objects or events, or experience sensations and emotion, the contents of thought must have an independent existence in their mind. This is something that is achieved through continued brain development in conjunction with discoveries made in action and in patterns of mutual adjustment and interactions with a caregiver ...
When a primary caregiver points to a spot on the body and asks ‘does that hurt?’ he or she is providing content and enabling an internal discrimination and with it experience. This type of interaction provides content and symbols that allow infants to locate and anchor emotions and sensations. It is in this way that infants can arrive at a particular state of being in their own mind. 
One of Derbyshire’s main claims is that the content of the world provides the essential material for conscious thought and experience. In the womb, the fetus is cut-off from this content. Cocooned in the uterine environment, it lacks the stuff of both conscious experience and, Derbyshire argues, sensory reaction. Emergence into the world thus brings with it the objects of thought and experience. This new exposure to content is reflected in the neonate’s mental state immediately after birth, when it experiences a period of intensely heightened alertness, interacting with and processing the world and everything in it.31
This is sharply contrasted by the ‘sleepier’ states of fetuses of the same or later gestational age.32 As Derbyshire explains further, only when being presented with content can young infants begin to develop representational memory (what he calls, the ‘building blocks of consciousness’) by ‘tagging’ as ‘something’ ‘all the objects, emotions, and sensations that appear or are felt’, enabling, among other things, the subjective experience of pain—the ‘ow!’ reflex.    Like other mental processes, Derbyshire’s conclusion is that the subjective experience of pain depends on the post-birth environment that makes all experiential discrimination possible.
According to some, then, emergence into the world marks the beginning of a human’s exposure to the objects of mental experience and enables the discriminations necessary for conscious self-awareness and the basic understanding of where we end and everything else begins. It could be argued that embodiment in the world is a precondition for another capacity central to our concept of a person: the capacity for individual agency. Embodied presence in the world is integral to becoming an agent within it. Joseph Raz has argued that only through engagement with the world can human beings learn how to act so as to produce effects.34 Through lived experience, we come to understand how to manipulate our environment so as to become a force within it. We learn this by testing our skills, learning how to calculate risk, and ‘assessing what is likely or unlikely to happen in the normal course of events’.35 As Raz elaborates, learning how to perform even the most basic of actions requires a certain amount of understanding the world as it is:
Unless I can trust the chair to carry my weight, the ground not to give way when I move across it, the plate on the table not to be stuck to the table when I reach for it, and to maintain rigidity and balance when I hold it, and so on, I cannot perform even the simplest act.36
Raz explains that learning how to perform actions is often concurrent with the acting itself; we learn how to affect our environment simply through doing so, and we learn how and when to exercise our skills through trial and error. Ultimately, it is only this kind of engagement with the world that enables persons to act at all, and hence mould their personal identity. Consequently, Raz suggests, someone who never engages with the world and only ever performs mental acts (who might be, for instance, kept alive through intravenous feeding)—who is, in other words, utterly passive—would live what seems to us to be a ‘stunted and pointless’ life. Raz seems to suggest that such a person would not be an agent at all, able to carve out a life narrative for himself. For this, one must be capable of doing things in the world.
If engagement with the world is inextricably bound up with our becoming agents, it seems that emergence into that world, far from being a mere change of location, marks the beginning of the early human being’s path to agency. Although a neonate is hardly an agent, birth is when it begins the concurrent process of understanding the world and learning how to act within it. This is so because it marks the very beginning of a human being’s exposure to the world in which she must learn how to act.
If agency in the world and conscious experience (including, especially, awareness of oneself as an individual subject) are important constitutive features of person- hood, birth is a watershed development in the life of the early human being. It may be objected, however, that birth is still only a precondition for such capabilities. It is not typically thought that neonates are, by virtue of having just been born, in greater possession of these capabilities than are late-term fetuses. While it may now exist in the essential context for developing conscious awareness and learning how to be an agent, a baby seconds after birth is not, at that moment, more of an agent or a subject of consciousness than a fetus seconds prior to birth. Because of this, it could be argued that birth is still a morally arbitrary threshold for full moral status.
However, following on from my argument above, this objection fails to properly apprehend what counts as a good reason to stipulate the legal threshold of personhood at birth, and what sort of arbitrariness that stipulation needs to avoid. I have already pointed out that any stipulated threshold for fully realized person- hood will be arbitrary to the extent that nothing metaphysically transformative will have taken place directly on either side of the threshold. This arbitrariness is unavoidable. We have seen, however, that resolution through stipulation is a principled reason in itself, and that there is a moral interest for specifying personhood as all-or-nothing past a minimum threshold. Assuming, then, that birth is within the range of acceptable minimum thresholds for personhood, we only need reason to regard it as an especially significant development for the moral status of the early human being, such as could explain and defend choosing it over other acceptable thresholds.
-  Noah H Hillman, Suhas G Kallapur, and Alan H Jobe, ‘Physiology ofTransition from Intrauterineto Extrauterine Life’ (2012) 39 Clinics in Perinatology 769, 769.
-  26 Lynna Littleton and Joan Engebretson, Maternity Nursing Care (Thomson 2005) 757.
-  Jose Luis Bermudez, ‘The Moral Significance of Birth’ (1996) 106 Ethics 378, 398. See also, ANMelttzoff and MK Moore, ‘Imitation of Facial and Manual Gestures by Human Neonates’ (1977) 198Science 75, and AN Meltzoff and MK Moore, ‘Newborn Infants Imitate Adult Facial Gestures’ (1983)54 Child Development 702. In the process of challenging the view that a change in ‘spatial position’is all that birth amounts to for the new human being, Jose Bermudez drew attention to a series ofexperiments revealing that the ability to imitate facial expressions such as tongue protrusion obtainedextremely quickly after birth, at an average age of thirty-two hours, and a lower limit of only forty-twominutes post-birth. Bermudez argues that the capacity for facial imitation requires at least a primitiveunderstanding of the difference between self and other, a rudimentary form of self-consciousness thatfull-term fetuses do not possess (see also Achas Burin, ‘Beyond Pragmatism: Defending the Bright-Lineof Birth’ (2014) 22 Medical Law Review 494, 500—504).
-  See: Colm PF O’Donnell and others, ‘Crying and Breathing by Extremely Preterm InfantsImmediately After Birth’ (2010) 157 The Journal of Pediatrics 846, and Carol O Eckerman andothers, ‘Premature Newborns as Social Partners Before Term Age’ (1994) 17 Infant Behaviour and
-  Stuart Derbyshire, ‘Can Fetuses Feel Pain?’ (2006) 332 British Medical Journal 909.
-  ibid 911. 3i ibid 910. 32 ibid.
-  ibid 911. 34 Joseph Raz, ‘Being in the World’ (2010) 23 Ratio 433.
-  35 Joseph Raz, ‘Agency and Luck’ in Ulrike Heuer and Gerald Lang (eds), Luck, Value, and
-  Commitment: Themes From the Ethics of Bernard Williams (Oxford University Press 2012) http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1487552, 15 (last accessed 15 October 2016).
-  Raz (n 34) 439.
-  See also Burin (n 27) 507, where she writes: ‘We want to influence or affect the world in oureveryday lives, and we do this by interpreting it and acting in it. There is a constant dyad between itand us.’