An Opening Case
Jill has called and asked if you could meet her for dinner. You and Jill were good friends throughout your time at the university, but regrettably you haven’t seen much of her for the last three years. You both landed good jobs shortly after graduation, but yours was downtown, while her work was in the suburbs. You are both still unmarried, but like many twentysomethings, you have each enjoyed some responsible (at least in terms of consent, STDs, and birth control) sexual relationships in recent years.
Shortly after your salads arrive, Jill reports through tears that she is about seven weeks pregnant. Her pregnancy is the unintended result of contraceptive failure. While she likes the father, both had planned to stay single for several more years, and in any case, their relationship had not yet gone to the level of considering marriage. Neither of them was financially prepared to raise a child.
She wants your advice about whether she should terminate the pregnancy or carry it to term (placing the child up for adoption). The doctor who confirmed her pregnancy reported that both she and the fetus appear to be in good health, but she believes a pregnancy would ruin her chances for advancement at work in the near future. What do you encourage Jill to consider? How do your faith convictions shape your response?
When does life begin? When must it be supported? When can it be ended? Our next two topics—abortion and physician-assisted suicide—express the moral issues at stake surrounding the question of personhood. Ironically, debates about these issues have intensified because advances in medical technology have created new possibilities for the way we treat nascent life, severely diminished forms of life, and the terminally ill.
The subject of abortion has been particularly divisive in our society. At one extreme in this debate are those who maintain that the fetus is essentially just a clump of cells belonging to the woman, having no independent humanity of its own. On the opposite side are those who argue that the fetus is a human being, innocent and totally dependent, whose right to life must be protected against any and all claims of the pregnant woman to bodily autonomy and well-being. Proponents of this view often hold that the moral status of person should be attributed to the zygote or fertilized egg. From their perspective, the use of the birth control pill, IUDs, and the so-called morning after pill—because they may prevent implantation as well as fertilization—should be banned as abortifacient.
The first view absolutizes the right to life and the bodily integrity of the woman; the second view does the same for the fetus/embryo but most often the zygote. Each of these positions denies that there is a real moral problem between competing values. Between the advocates of these two positions stand those who seek a point of view more reflective of the potentially deep value conflict posed by some pregnancies. They recognize that banning abortion in effect mandates bodily forms of life support, which the law does not require, even of parents, in any other situation. For example, we don’t mandate that a father donate a lobe of his liver to his daughter with whom he is histocompatible because she desperately needs a transplant, even if we would want to support and encourage his doing so.
In order to gain a clearer picture of our present situation, a brief review of the legal history surrounding the current debate might be helpful. Originally abortion was governed by state laws in the United States, which uniformly prohibited it. In 1959, the American Law Institute proposed that abortion be legalized in cases where two physicians certified that an interruption of the pregnancy was required for the “physical or mental health” of the mother.
In the early 1970s, the legal struggle over the decision of some states to permit “abortion on demand” reached the US Supreme Court. The cases of Roe v. Wade and Doe v. Bolton marked an important turning point in the debate about abortion in the United States. In these decisions, the court struck down both the older, more restrictive legislation operative in thirty states and the more lenient legislation of sixteen other states. By a 7-2 vote, the court affirmed the right of a woman to have an abortion in the first trimester of her pregnancy; it also declared that the state’s interest in the health of the mother and in the potentiality of human life might lead it to regulate abortion procedures in the second trimester and to regulate and possibly proscribe abortion depending on the viability of the fetus. Even after the point of viability, however, abortion was to be permitted if the life or health of the mother was endangered by the pregnancy.
Justice Blackmun’s majority opinion based its decision on four supports: (1) it noted that historically there has been no consistent opposition to abortion, because of differing judgments concerning the time when the fetus developed into a person; (2) it observed that the late nineteenth-century laws establishing a clear pattern of opposition to abortion were frequently motivated by the danger of abortion to the health of the mother, a factor that has been altered by modern technology; (3) it determined that the rights of privacy guaranteed by the Fourteenth Amendment protect a woman’s decision to have an abortion in the first stage of pregnancy but do not eliminate state interest in later stages out of concern for the woman’s health and for the “potentiality of life”; and (4) it declared that the word “person” in the Fourteenth Amendment cannot be used to include the unborn.
Antiabortionists, having lost that judicial battle, turned to Congress in an effort to create legislation that would make abortion illegal. A “Human Life Amendment” to the Constitution never got out of the Senate, but other efforts to define life as beginning at conception continue to surface across the states. Congress has barred the use of federal Medicaid funds for abortion, except in cases of rape, incest, or a threat to the pregnant woman’s life (but not her health). In June 1992, the Supreme Court (Planned Parenthood of Southeastern Pennsylvania v. Casey) upheld Roe v. Wade and affirmed the right of a woman to have an abortion. However, this same decision did allow states to pass more restrictive legislation as long as such restrictions did not pose an “undue burden” on the woman. What constitutes an “undue burden” has now become a critical legal issue. In Gonzales v. Carhart, the Supreme Court upheld the Partial Birth Abortion Act of 2003. This federal law banned a specific type of late-term abortion, except when necessary to preserve the life (but not the health) of the pregnant woman. (NB: Only 1 percent of abortions occur at twenty-one weeks or later.) By 2011, six states had banned all abortions at the twentieth week of conception.
The first two articles in this chapter are by feminists: Beverly Wildung Harrison and Shirley Cloyes articulate a pro-choice stance, while Sidney Callahan voices a pro-life or antiabortion one. Harrison and Cloyes provide a historical perspective on the practice of abortion and the equation of any effort to control procreation with homicide. Antiabortion sentiment, although traditional, has not been universal. The article then makes two moral responses to the assertion that the fetus in early stages of development is a human person. They conclude their argument by considering the social-policy dimensions of abortion and suggest that patriarchal bias led to the prohibition of abortion.
Sidney Callahan provides a fascinating counterpoint in her article. She considers many of the same issues on a feminist basis and concludes that “women can never achieve the fulfillment of feminist goals in a society permissive toward abortion.” She advocates a more inclusive ideal of justice that does not exclude human life in its beginning stages. Concerning the injustice of taking the decision to abort out of women’s hands, Callahan suggests that justice may not be served when an interested party (and the more powerful party in this case) is able to decide on his or her own case when there is a conflict of interest. Rather than being simply the victim of a male-dominated society, women, Callahan argues, are in danger of assuming a male-dominated sexual ethic—a permissive, erotic view of sexuality and consequently a permissive attitude toward abortion. The results, according to Callahan, are already proving to be destructive of women’s best interests.
The next article in this chapter demonstrates how both scientific advances and medical practices can influence moral choices in the area of abortion. Science contributed to the development of chemical—that is, nonsurgical—methods of abortion that are effective at terminating a pregnancy up to its seventh week. In 2000, the FDA approved the use of such medications for early abortions. (Currently their use accounts for about 17 percent of the induced abortions in the United States.) Thomas Shannon suggests that the abortion debate hinges “on the underlying standing of the fetus.” Although he concludes it is difficult to argue that the pre-implantation embryo is a person, Shannon argues that it is living, possesses the human genome, and has a biological and developmental teleology that would lead it eventually to become a person.
Recent years have seen a decline in the rate of legal abortions in the United States. In 2008, 1.21 million abortions were performed, down from 1.31 million in 2000 (and from the all-time high of 1.61 in 1990). However, between 2005 and 2008, the long-term decline in abortions stalled. Many on both sides of the debate want to avoid such plateaus and steadily reduce abortions. It is clear that knowledge of contraception, and reliable, steady access, reduces the number of unplanned pregnancies and lowers abortion rates. Comparative study of health care systems around the world indicates that expanding health care coverage is a key factor to reducing abortions as well. The essay by Glen Stassen in this chapter provides us with an overview of “what actually works” in this regard.
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Much discussion of abortion betrays the heavy hand of misogyny, the hatred of women. We all have a responsibility to recognize this bias—sometimes subtle—when ancient negative attitudes toward women intrude into the abortion debate. It is morally incumbent on us to convert the Christian position to a teaching more respectful of women’s concrete history and experience. . . .
Although I am a Protestant, my own “moral theology”[1] has more in common with a Catholic approach than with much neo-orthodoxy ethics of my own tradition. I want to stress this at the outset because in what follows I am highly critical of the reigning Roman Catholic social teaching on procreation and abortion. I believe that on most other issues of social justice, the Catholic tradition is often more substantive, morally serious, and less imbued with the dominant economic ideology than the brand of Protestant theological ethics that claims biblical warrants for its moral norms. I am no biblicist; I believe that the human wisdom that informs our ethics derives not from using the Bible alone but from reflecting in a manner that earlier Catholic moral theologians referred to as consonant with “natural law.”[2] Unfortunately, however, all major strands of natural law reflection have been every bit as awful as Protestant biblicism on any matter involving human sexuality, including discussion of women’s nature and women’s divine vocation in relation to procreative power. And it is precisely because I recognize Catholic natural law tradition as having produced the most sophisticated type of moral reflection among Christians that I believe it must be challenged where it intersects negatively with women’s lives. . . . Given the brevity of this essay, I will address the theological, Christian historical, and moral theoretical problematics first and analyze the social policy dimensions of the abortion issue only at the end, even though optimum ethical methodology would reverse this procedure.
In the history of Christian theology, a central metaphor for understanding life, including human life, is as a gift of God. Creation itself has been interpreted primarily under this metaphor. It follows that in this creational context procreation itself took on special significance as the central image for the divine blessing of human life. The elevation of procreation as the central symbol of divine benevolence happened over time, however. It did not, for instance, typify the very early, primitive Christian community. The synoptic gospels provide ample evidence that procreation played no such metaphorical role in early Christianity.[3] In later Christian history, an emergent powerful antisexual bias within Christianity made asceticism the primary spiritual ideal, although this ideal usually stood in tension with procreative power as a second sacred expression of divine blessing, and procreation has since become all but synonymous among Christians with the theological theme of creation as divine gift. It is important to observe that Roman Catholic theology actually followed on and adapted to Protestant teaching on this point.[4] Only in the last century, with the recognition of the danger of dramatic population growth in a world of finite resources, has any question been raised about the appropriateness of this unqualified theological sacralization of procreation. . . .
The problem, then, is that Christian theology celebrates the power of human freedom to shape and determine the quality of human life except when the issue of procreative choice arises. Abortion is anathema, while widespread sterilization abuse goes unnoticed. The power of man to shape creation radically is never rejected. When one stops to consider the awesome power over nature that males take for granted and celebrate, including the power to alter the conditions of human life in myriad ways, the suspicion dawns that the near hysteria that prevails about the immorality of women’s right to choose abortion derives its force from the ancient power of misogyny rather than from any passion for the sacredness of human life. An index of the continuing misogyny in Christian tradition is male theologians’ refusal to recognize the full range of human power to shape creation in those matters that pertain to women’s power to affect the quality of our lives.
In contrast, a feminist theological approach recognizes that nothing is more urgent, in light of the changing circumstances of human beings on planet Earth, than to recognize that the entire natural-historical context of human procreative power has shifted.[5] We desperately need a desacralization of our biological power to reproduce[6] and at the same time a real concern for human dignity and the social conditions for personhood and the values of human relationship.[7] And note that desacralization does not mean complete devaluation of the worth of procreation. It means we must shift away from the notion that the central metaphors for divine blessing are expressed at the biological level to the recognition that our social relations bear the image of what is most holy. An excellent expression of this point comes from Marie Augusta Neal, a Roman Catholic feminist and a distinguished sociologist of religion:
As long as the central human need called for was continued motivation to propagate the race, it was essential that religious symbols idealize that process above all others. Given the vicissitudes of life in a hostile environment, women had to be encouraged to bear children and men to support them: childbearing was central to the struggle for existence. Today, however, the size of the base population, together with knowledge already accumulated about artificial insemination, sperm banking, cloning, make more certain a peopled world.
The more serious human problems now are who will live, who will die and who will decide.[8]
Between persons who oppose all abortions on moral grounds and those who believe abortion is sometimes or frequently morally justifiable, there is no difference of moral principle. Pro-choice advocates and antiabortion advocates share the ethical principle of respect for human life, which is probably why the debate is so acrimonious. I have already indicated that one major source of disagreement is the way in which the theological story is appropriated in relation to the changing circumstances of history. In addition, we should recognize that whenever strong moral disagreement is encountered, we simultaneously confront different readings of the history of a moral issue. The way we interpret the past is already laden with and shaped by our present sense of what the moral problem is.
For example, professional male Christian ethicists tend to assume that Christianity has an unbroken history of “all but absolute” prohibition of abortion and that the history of morality of abortion can best be traced by studying the teaching of the now best-remembered theologians. Looking at the matter this way, one can find numerous proof-texts to show that some of the “church fathers” condemned abortion and equated abortion with either homicide or murder.
Whenever a “leading” churchman equated abortion with homicide or murder, he also and simultaneously equated contraception with homicide or murder. This reflects not only male chauvinist biology but also the then almost phobic antisexual bias of the Christian tradition. Claims that one can separate abortion teaching into an ethic of killing, separate from an antisexual and antifemale ethic in the history of Christianity, do not withstand critical scrutiny.[9]
The history of Christian natural law ethics is totally conditioned by the equation of any effort to control procreation with homicide. However, this antisexual, antiabortion tradition is not universal, even among theologians and canon lawyers. On the subject of sexuality and its abuse, many well-known theologians had nothing to say; abortion was not even mentioned in most moral theology. An important, untold chapter in Christian history is the great struggle that took place in the medieval period when clerical celibacy came to be imposed and the rules of sexual behavior rigidified.
My thesis is that there is a relative disinterest in the question of abortion overall in Christian history. Occasionally, Christian theologians picked up the issue, especially when these theologians were state-related, that is, were articulating policy not only for the church but for political authority. Demographer Jean Meyer, himself a Catholic, insists that the Christian tradition took over “expansion by population growth” from the Roman Empire.[10] Christians opposed abortion strongly only when Christianity was closely identified with imperial state policy or when theologians were inveighing against women and any sexuality except that expressed in the reluctant service of procreation.
The Holy Crusade quality of present teaching on abortion is quite new in Christianity and is related to cultural shifts that are requiring the Christian tradition to choose sides in the present ideological struggle under pressure to rethink its entire attitude toward women and sexuality. My research has led me to the tentative conclusion that, in Protestant cultures, except where Protestantism is the “established religion,” merging church and state, one does not find a strong antiabortion theological-ethical teaching at all. At least in the United States, this is beyond historical debate.[11] . . .
In concluding this historical section, I must stress that if present efforts to criminalize abortion succeed, we will need a state apparatus of massive proportions to enforce compulsory childbearing. In addition, withdrawal of legal abortion will create one more massively profitable underworld economy in which the Mafia and other sections of quasi-legal capitalism may and will profitably invest. The radical right promises to get the state out of regulation of people’s lives, but what they really mean is that they will let economic activity go unrestrained. What their agenda signifies for the personal lives of women is quite another matter.
An adequate historical perspective on abortion recognizes the long struggle women have waged for some degree of control over fertility and their efforts to regain control of procreative power from patriarchal and state-imperial culture and institutions. Such a perspective also takes into account that more nearly adequate contraceptive methods and the existence of safe, surgical, elective abortion represent positive historic steps toward full human freedom and dignity for women. While the same gains in medical knowledge also open the way to new forms of sterilization abuse and to social pressures against some women’s use of their power of procreation, I know of no women who would choose to return to a state of lesser knowledge about these matters.
There has been an objective gain in the quality of women’s lives for those fortunate enough to have access to procreative choice. That millions upon millions of women as yet do not possess even the rudimentary conditions—moral or physical—for such choice is obvious. Our moral goal should be to struggle against those real barriers—poverty, racism, and antifemale cultural oppression—that prevent authentic choice from being a reality for every woman. In this process we will be able to minimize the need for abortions only insofar as we place the abortion debate in the real lived-world context of women’s lives.
The greatest strategic problem of pro-choice advocates is the widespread assumption that pro-lifers have a monopoly on the moral factors that ought to enter into decisions about abortion. Moral here is defined as that which makes for the self-respect and well-being of human persons and their environment. Moral legitimacy seems to adhere to their position in part because traditionalists have an array of religioethical terminology at their command that the sometimes more secular proponents of choice lack. But those who would displace women’s power of choice by the power of the state and/or the medical profession do not deserve the aura of moral sanctity. We must do our homework if we are to dispel this myth of moral superiority. A major way in which Christian moral theologians and moral philosophers contribute to this monopoly of moral sanctity is by equating fetal or prenatal life with human personhood in a simplistic way and by failing to acknowledge changes regarding this issue in the history of Christianity. . . .
In any case, there are two responses that must be made to the claim that the fetus in early stages of development is a human life, or more dubiously, a human person. . . . First, the historical struggle for women’s personhood is far from won, owing chiefly to the opposition of organized religious groups to full equality for women. Those who proclaim that a zygote at the moment of conception is a person worthy of citizenship continue to deny full social and political rights to women. Whatever one’s judgment about the moral status of the fetus, it cannot be argued that that assessment deserves greater moral standing in analysis than does the position of the pregnant woman. This matter of evaluating the meaning of prenatal life is where morally sensitive people’s judgments diverge. I cannot believe that any morally sensitive person would fail to value the woman’s full, existent life less than they value early fetal life. Most women can become pregnant and carry fetal life to term many, many times in their lifetimes. The distinctly human power is not our biologic capacity to bear children, but our power to actively love, nurture, care for one another and shape one another’s existence in cultural and social interaction.[12] To equate a biologic process with full normative humanity is crass biologic reductionism, and such reductionism is never practiced in religious ethics except where women’s lives and well-being are involved.
Second, even though prenatal life, as it moves toward biologic individuation of human form, has value, the equation of abortion with murder is dubious. And the equation of abortion with homicide—the taking of human life—should be carefully weighed. We should also remember that we live in a world where men extend other men wide moral range in relation to justifiable homicide. For example, the just-war tradition has legitimated widespread forms of killing in war, and Christian ethicists have often extended great latitude to rulers and those in power in making choices about killing human beings.[13] Would that such moralists extended equal benefit of a doubt to women facing life-crushing psychological and politicoeconomic pressures in the face of childbearing! Men, daily, make life-determining decisions concerning nuclear power or chemical use in the environment, for example, that affect the well-being of fetuses, and our society expresses no significant opposition, even when such decisions do widespread genetic damage. When we argue for the appropriateness of legal abortion, moral outrage arises.
The so-called pro-life position also gains support by invoking the general principle of respect for human life as foundational to its morality in a way that suggests that the pro-choice advocates are unprincipled. I have already noted that pro-choice advocates have every right to claim the same moral principle, and that this debate, like most debates that are morally acrimonious, is in no sense about basic moral principles. I do not believe there is any clear-cut conflict of principle in this very deep, very bitter controversy.
It needs to be stressed that we all have an absolute obligation to honor any moral principle that seems, after rational deliberation, to be sound. This is the one absolutism appropriate to ethics. There are often several moral principles relevant to a decision and many ways to relate a given principle to a decisional context. For most right-to-lifers only one principle has moral standing in this argument. Admitting only one principle to one’s process of moral reasoning means that a range of other moral values is slighted. Right-to-lifers are also moral absolutists in the sense that they admit only one possible meaning or application of the principle they invoke. Both these types of absolutism obscure moral debate and lead to less, not more, rational deliberation. The principle of respect for human life is one we should all honor, but we must also recognize that this principle often comes into conflict with other valid moral principles in the process of making real lived-world decisions. Understood in an adequate way, this principle can be restated to mean that we should treat what falls under a reasonable definition of human life as having sanctity or intrinsic moral value. But even when this is clear, other principles are needed to help us choose between two intrinsic values, in this case between the prenatal life and the pregnant woman’s life.
Another general moral principle from which we cannot exempt our actions is the principle of justice, or right relations between persons and between groups of persons and communities. Another relevant principle is respect for all that supports human life, namely, the natural environment. As any person knows who thinks deeply about morality, genuine moral conflicts, as often as not, are due not to ignoring moral principles but to the fact that different principles lead to conflicting implications for action or are selectively related to decisions. For example, we live in a time when the principle of justice for women, aimed at transforming the social relations that damage women’s lives, is historically urgent. For many of us this principle has greater moral urgency than the extension of the principle of respect for human life to include early fetal life, even though respect for fetal life is also a positive moral good. We should resist approaches to ethics that claim that one overriding principle always deserves to control morality. Clarification of principle, for that matter, is only a small part of moral reasoning. When we weigh moral principles and their potential application, we must also consider the implications of a given act for our present historical context and envision its long-term consequences. . . .
Two other concerns related to our efforts to make a strong moral case for women’s right to procreative choice need to be touched on. The first has to do with the problems our Christian tradition creates for any attempt to make clear why women’s right to control our bodies is an urgent and substantive moral claim. One of Christianity’s greatest weaknesses is its spiritualizing neglect of respect for the physical body and physical well-being. Tragically, women, more than men, are expected in Christian teaching never to honor their own well-being as a moral consideration. I want to stress, then, that we have no moral tradition in Christianity that starts with body-space, or body-right, as a basic condition of moral relations. (Judaism is far better in this regard, for it acknowledges that we all have a moral right to be concerned for our life and our survival.) Hence, many Christian ethicists simply do not get the point when we speak of women’s right to bodily integrity. They blithely denounce such reasons as women’s disguised self-indulgence or hysterical rhetoric.[14] . . .
Only when people see that they cannot prohibit safe, legal, elective surgical abortion without violating the conditions of well-being for the vast majority of women—especially those most socially vulnerable because of historic patterns of oppression—will the effort to impose a selective, abstract morality of the sanctity of human life on all of us cease. This is a moral battle par excellence, and whenever we forget that we make it harder to reach the group most important to the cause of procreative choice—those women who have never suffered from childbearing pressure, who have not yet put this issue into a larger historical context, and who reverence women’s historical commitment to childbearing. We will surely not reach them with pragmatic appeals to the taxpayer’s wallet! To be sure, we cannot let such women go unchallenged as they support ruling-class ideology that the state should control procreation. But they will not change their politics until they see that pro-choice is grounded in a deeper, tougher, more caring moral vision than the political option they now endorse.
Most people fail to understand that in ethics we need, provisionally, to separate our reflection on the morality of specific acts from questions about how we express our moral values within our social institutions and systems (that is, social policy). When we do this, the morality of abortion appears in a different light. Focusing attention away from the single act of abortion to the larger historical context thrusts into relief what “respect for human life” means in the pro-choice position. It also illuminates the common core of moral concern that unites pro-choice advocates to pro-lifers who have genuine concern for expanding the circle of who really counts as human in this society. Finally, placing abortion in a larger historical context enables proponents of pro-choice to clarify where we most differ from the pro-lifers, that is, in our total skepticism that a state-enforced antiabortion policy could ever have the intended “pro-life” consequence they claim.
We must always insist that the objective social conditions that make women and children already born highly vulnerable can only be worsened by a social policy of compulsory pregnancy. However one judges the moral quality of the individual act of abortion (and here, differences among us do exist that are morally justifiable), it is still necessary to distinguish between how one judges the act of abortion morally and what one believes a society-wide policy on abortion should be. We must not let those who have moral scruples against the personal act ignore the fact that a just social policy must also include active concern for enhancement of women’s well-being and, for that, policies that would in fact make abortions less necessary. To anathematize abortion when the social and material conditions for control of procreation do not exist is to blame the victim, not to address the deep dilemmas of female existence in this society. . . .
If we are to be a society genuinely concerned with enhancing women’s well-being and minimizing the necessity of abortions, thereby avoiding the danger over time of becoming an abortion culture,[15] what kind of a society must we become? It is here that the moral clarity of the feminist analysis becomes most obvious. How can we reduce the number of abortions due to contraceptive failure? By placing greater emphasis on medical research in this area, by requiring producers of contraceptives to behave more responsibly, and by developing patterns of institutional life that place as much emphasis on male responsibility for procreation and long-term care and nurturance of children as on female responsibility.
How can we reduce the number of abortions due to childish ignorance about sexuality among female children or adult women and our mates? By adopting a widespread program of sex education and by supporting institutional policies that teach male and female children alike that a girl is as fully capable as a boy of enjoying sex and that both must share moral responsibility for preventing pregnancy except when they have decided, as a deliberative moral act, to have a child.
How would we reduce the necessity of abortion due to sexual violence against women in and out of marriage? By challenging vicious male-generated myths that women exist primarily to meet the sexual needs of men, that women are, by nature, those who are really fulfilled only through our procreative powers. We would teach feminist history as the truthful history of the race, stressing that historic patterns of patriarchy were morally wrong and that a humane or moral society would be a fully nonsexist society.
Technological developments that may reduce the need for abortions are not entirely within our control, but the sociomoral ethos that makes abortion common is within our power to change. And we would begin to create such conditions by adopting a thoroughgoing feminist program for society. Nothing less, I submit, expresses genuine respect for human life.
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The abortion debate continues. In the latest and perhaps most crucial development, pro-life feminists are contesting pro-choice feminist claims that abortion rights are prerequisites for women’s full development and social equality. The outcome of this debate may be decisive for the culture as a whole. Pro-life feminists, like myself, argue on good feminist principles that women can never achieve the fulfillment of feminist goals in a society permissive toward abortion.
These new arguments over abortion take place within liberal political circles. This round of intense intra-feminist conflict has spiraled beyond earlier right-versus-left abortion debates, which focused on “tragic choices,” medical judgments, and legal compromises. Feminist theorists of the pro-choice position now put forth the demand for unrestricted abortion rights as a moral imperative and insist upon women’s right to complete reproductive freedom. They morally justify the present situation and current abortion practices. Thus it is all the more important that pro-life feminists articulate their different feminist perspective.
These opposing arguments can best be seen when presented in turn. Perhaps the most highly developed feminist arguments for the morality and legality of abortion can be found in Beverly Wildung Harrison’s Our Right to Choose (Beacon Press, 1983) and Rosalind Pollack Petchesky’s Abortion and Woman’s Choice (Longman, 1984). Obviously it is difficult to do justice to these complex arguments, which draw on diverse strands of philosophy and social theory and are often interwoven in pro-choice feminists’ own version of a “seamless garment.” Yet the fundamental feminist case for the morality of abortion, encompassing the views of Harrison and Petchesky, can be analyzed in terms of four central moral claims: (1) the moral right to control one’s own body; (2) the moral necessity of autonomy and choice in personal responsibility; (3) the moral claim for the contingent value of fetal life; (4) the moral right of women to true social equality.
Pro-choice feminism argues that a woman choosing an abortion is exercising a basic right of bodily integrity granted in our common law tradition. . . . This moral claim to abortion, according to the pro-choice feminists, is especially valid in an individualistic society in which women cannot count on medical care or social support in pregnancy, childbirth, or childrearing. A moral abortion decision is never made in a social vacuum, but in the real life society which exists here and now.
Beyond the claim for individual bodily integrity, the pro-choice feminists claim that to be a full adult morally, a woman must be able to make responsible life commitments. To plan, choose, and exercise personal responsibility, one must have control of reproduction. A woman must be able to make yes or no decisions about a specific pregnancy, according to her present situation, resources, prior commitments, and life plan. Only with such reproductive freedom can a woman have the moral autonomy necessary to make mature commitments, in the area of family, work, or education. . . .
Pro-choice feminist exponents like Harrison and Petchesky claim that the value of fetal life is contingent upon the woman’s free consent and subjective acceptance. The fetus must be invested with maternal valuing in order to become human. This process of “humanization” through personal consciousness and “sociality” can only be bestowed by the woman in whose body and psychosocial system a new life must mature. The meaning and value of fetal life are constructed by the woman; without this personal conferral there only exists a biological, physiological process. Thus fetal interests or fetal rights can never outweigh the woman’s prior interest and rights. If a woman does not consent to invest her pregnancy with meaning or value, then the merely biological process can be freely terminated. Prior to her own free choice and conscious investment, a woman cannot be described as a “mother” nor can a “child” be said to exist. . . .
Women have a moral right to full social equality. They should not be restricted or subordinated because of their sex. But this morally required equality cannot be realized without abortion’s certain control of reproduction. Female social equality depends upon being able to compete and participate as freely as males can in the structures of educational and economic life. If a woman cannot control when and how she will be pregnant or rear children, she is at a distinct disadvantage, especially in our male-dominated world.
Psychological equality and well-being is also at stake. Women must enjoy the basic right of a person to the free exercise of heterosexual intercourse and full sexual expression, separated from procreation. No less than males, women should be able to be sexually active without the constantly inhibiting fear of pregnancy. Abortion is necessary for women’s sexual fulfillment and the growth of uninhibited feminine self-confidence and ownership of their sexual powers. . . .
How does a pro-life feminist respond to these arguments? Pro-life feminists grant the good intentions of their pro-choice counterparts but protest that the pro-choice position is flawed, morally inadequate, and inconsistent with feminism’s basic demands for justice. Pro-life feminists champion a more encompassing moral ideal. They recognize the claims of fetal life and offer a different perspective on what is good for women. The feminist vision is expanded and refocused.
The moral right to control one’s own body does apply to cases of organ transplants, mastectomies, contraception, and sterilization; but it is not a conceptualization adequate for abortion. The abortion dilemma is caused by the fact that 266 days following a conception in one body, another body will emerge. One’s own body no longer exists as a single unit but is engendering another organism’s life. This dynamic passage from conception to birth is genetically ordered and universally found in the human species. Pregnancy is not like the growth of cancer or infestation by a biological parasite; it is the way every human being enters the world. Strained philosophical analogies fail to apply: having a baby is not like rescuing a drowning person, being hooked up to a famous violinist’s artificial life-support system, donating organs for transplant—or anything else.
As embryology and fetology advance, it becomes clear that human development is a continuum. Just as astronomers are studying the first three minutes in the genesis of the universe, so the first moments, days, and weeks at the beginning of human life are the subject of increasing scientific attention. While neonatology pushes the definition of viability ever earlier, ultrasound and fetology expand the concept of the patient in utero. Within such a continuous growth process, it is hard to defend logically any demarcation point after conception as the point at which an immature form of human life is so different from the day before or the day after, that it can be morally or legally discounted as a non-person. Even the moment of birth can hardly differentiate a nine-month fetus from a newborn. It is not surprising that those who countenance late abortions are logically led to endorse selective infanticide.
The same legal tradition which in our society guarantees the right to control one’s own body firmly recognizes the wrongfulness of harming other bodies, however immature, dependent, different looking, or powerless. The handicapped, the retarded, and newborns are legally protected from deliberate harm. Pro-life feminists reject the suppositions that would except the unborn from this protection.
After all, debates similar to those about the fetus were once conducted about feminine personhood. Just as women, or blacks, were considered too different, too underdeveloped, too “biological,” to have souls or to possess legal rights, so the fetus is now seen as “merely” biological life, subsidiary to a person. A woman was once viewed as incorporated into the “one flesh” of her husband’s person; she too was a form of bodily property. In all patriarchal unjust systems, lesser orders of human life are granted rights only when wanted, chosen, or invested with value by the powerful.
Fortunately, in the course of civilization there has been a gradual realization that justice demands the powerless and dependent be protected against the uses of power wielded unilaterally. No human can be treated as a means to an end without consent. The fetus is an immature, dependent form of human life which only needs time and protection to develop. Surely, immaturity and dependence are not crimes. . . .
It also seems a travesty of just procedures that a pregnant woman now, in effect, acts as sole judge of her own case, under the most stressful conditions. Yes, one can acknowledge that the pregnant woman will be subject to the potential burdens arising from a pregnancy, but it has never been thought right to have an interested party, especially the more powerful party, decide his or her own case when there may be a conflict of interest. If one considers the matter as a case of a powerful versus a powerless, silenced claimant, the pro-choice feminist argument can rightly be inverted: since hers is the body, hers the risk, and hers the greater burden, then how in fairness can a woman be the sole judge of the fetal right to life?
Human ambivalence, a bias toward self-interest, and emotional stress have always been recognized as endangering judgment. Freud declared that love and hate are so entwined that if instant thoughts could kill, we would all be dead in the bosom of our families. In the case of a woman’s involuntary pregnancy, a complex, long-term solution requiring effort and energy has to compete with the immediate solution offered by a morning’s visit to an abortion clinic. On the simple, perceptual plane, with imagination and thinking curtailed, the speed, ease, and privacy of abortion, combined with the small size of the embryo, tend to make early abortions seem less morally serious—even though speed, size, technical ease, and the private nature of an act have no moral standing. . . .
A distorted idea of morality overemphasizes individual autonomy and active choice. Morality has often been viewed too exclusively as a matter of human agency and decisive action. In moral behavior persons must explicitly choose and aggressively exert their wills to intervene in the natural and social environments. The human will dominates the body, overcomes the given, breaks out of the material limits of nature. Thus, if one does not choose to be pregnant or cannot rear a child, who must be given up for adoption, then better to abort the pregnancy. Willing, planning, choosing one’s moral commitments through the contracting of one’s individual resources becomes the premier model of moral responsibility.
But morality also consists of the good and worthy acceptance of the unexpected events that life presents. Responsiveness and response-ability to things unchosen are also instances of the highest human moral capacity. Morality is not confined to contracted agreements of isolated individuals. Yes, one is obligated by explicit contracts freely initiated, but human beings are also obligated by implicit compacts and involuntary relationships in which persons simply find themselves. To be embedded in a family, a neighborhood, a social system, brings moral obligations which were never entered into with informed consent.
Parent-child relationships are one instance of implicit moral obligations arising by virtue of our being part of the interdependent human community. A woman, involuntarily pregnant, has a moral obligation to the now-existing dependent fetus whether she explicitly consented to its existence or not. No pro-life feminist would dispute the forceful observations of pro-choice feminists about the extreme difficulties that bearing an unwanted child in our society can entail. But the stronger force of the fetal claim presses a woman to accept these burdens; the fetus possesses rights arising from its extreme need and the interdependency and unity of humankind. The woman’s moral obligation arises both from her status as a human being embedded in the interdependent human community and her unique life-giving female reproductive power. To follow the pro-choice feminist ideology of insistent individualistic autonomy and control is to betray a fundamental basis of the moral life.
The feminist pro-choice position which claims that the value of the fetus is contingent upon the pregnant woman’s bestowal—or willed, conscious “construction”—of humanhood is seriously flawed. The inadequacies of this position flow from the erroneous premises (1) that human value and rights can be granted by individual will; (2) that the individual woman’s consciousness can exist and operate in an a priori isolated fashion; and (3) that “mere” biological, genetic human life has little meaning. Pro-life feminism takes a very different stance to life and nature.
Human life from the beginning to the end of development has intrinsic value; which does not depend on meeting the selective criteria or tests set up by powerful others. A fundamental humanist assumption is at stake here. Either we are going to value embodied human life and humanity as a good thing, or take some variant of the nihilist position that assumes human life is just one more random occurrence in the universe such that each instance of human life must explicitly be justified to the universe to prove itself worthy to continue. When faced with a new life, or an involuntary pregnancy, there is a world of difference in whether one first asks, “Why continue?” or “Why not?” Where is the burden of proof going to rest? The concept of “compulsory pregnancy” is as distorted as labeling life “compulsory aging.”
In a sound moral tradition, human rights arise from human needs, and it is the very nature of a right, or valid claim upon another, that it cannot be denied, conditionally delayed, or rescinded by more powerful others at their behest. It seems fallacious to hold that in the case of the fetus it is the pregnant woman alone who gives or removes its right to life and human status solely through her subjective conscious investment or “humanization.” Surely no pregnant woman (or any other individual member of the species) has created her own human nature by an individually willed act of consciousness, nor for that matter been able to guarantee her own human rights. An individual woman and the unique individual embryonic life within her can only exist because of their participation in the genetic inheritance of the human species as a whole. Biological life should never be discounted. Membership in the species, or collective human family, is the basis for human solidarity, equality, and natural human rights.
Pro-life feminists and pro-choice feminists are totally agreed on the moral right of women to the full social equality so far denied them. The disagreement between them concerns the definition of the desired goal and the best means to get there. Permissive abortion laws do not bring women reproductive freedom, social equality, sexual fulfillment, or full personal development.
Pragmatic failures of a pro-choice feminist position combined with a lack of moral vision are, in fact, causing disaffection among young women. Middle-aged pro-choice feminists blamed the “big chill” on the general conservative backlash. But they should look rather to their own elitist acceptance of male models of sex and to the sad picture they present of women’s lives. Pitting women against their own offspring is not only morally offensive, it is psychologically and politically destructive. Women will never climb to equality and social empowerment over mounds of dead fetuses, numbering now in the millions. As long as most women choose to bear children, they stand to gain from the same constellation of attitudes and institutions that will also protect the fetus in the woman’s womb—and they stand to lose from the cultural assumptions that support permissive abortion. Despite temporary conflicts of interest, feminine and fetal liberation are ultimately one and the same cause.
Women’s rights and liberation are pragmatically linked to fetal right because to obtain true equality, women need (1) more social support and changes in the structure of society, and (2) increased self-confidence, self-expectations, and self-esteem. Society in general, and men in particular, have to provide women more support in rearing the next generation, or our devastating feminization of poverty will continue. But if a woman claims the right to decide by herself whether the fetus becomes a child or not, what does this do to paternal and communal responsibility? Why should men share responsibility for child support or childrearing if they cannot share in what is asserted to be the woman’s sole decision? Furthermore, if explicit intentions and consciously accepted contracts are necessary for moral obligations, why should men be held responsible for what they do not voluntarily choose to happen? By pro-choice reasoning, a man who does not want to have a child, or whose contraceptive fails, can be exempted from the responsibilities of fatherhood and child support. Traditionally, many men have been laggards in assuming parental responsibility and support for their children; ironically, ready abortion, often advocated as a response to male dereliction, legitimizes male irresponsibility and paves the way for even more male detachment and lack of commitment.
For that matter, why should the state provide a system of day-care or child support, or require workplaces to accommodate women’s maternity and the needs of childrearing? Permissive abortion, granted in the name of women’s privacy and reproductive freedom, ratifies the view that pregnancies and children are a woman’s private individual responsibility. More and more frequently, we hear some version of this old rationalization: if she refuses to get rid of it, it’s her problem. A child becomes a product of the individual woman’s freely chosen investment, a form of private property resulting from her own cost-benefit calculation. The larger community is relieved of moral responsibility.
With legal abortion freely available, a clear cultural message is given: conception and pregnancy are no longer serious moral matters. With abortion as an acceptable alternative, contraception is not as responsibly used; women take risks, often at the urging of male sexual partners. Repeat abortions increase, with all their psychological and medical repercussions. With more abortion there is more abortion. Behavior shapes thought as well as the other way round. One tends to justify morally what one has done; what becomes commonplace and institutionalized seems harmless. Habituation is a powerful psychological force. Psychologically it is also true that whatever is avoided becomes more threatening; in phobias it is the retreat from anxiety-producing events which reinforces future avoidance. Women begin to see themselves as too weak to cope with involuntary pregnancies. Finally, through the potency of social pressure and force of inertia, it becomes more and more difficult, in fact almost unthinkable, not to use abortion to solve problem pregnancies. Abortion becomes no longer a choice but a “necessity.”
But “necessity,” beyond the organic failure and death of the body, is a dynamic social construction open to interpretation. The thrust of present feminist pro-choice arguments can only increase the justifiable indications for “necessary” abortion; every unwanted fetal handicap becomes more and more unacceptable. Repeatedly assured that in the name of reproductive freedom, women have a right to specify which pregnancies and which children they will accept, women justify sex selection, and abort unwanted females. Female infanticide, after all, is probably as old a custom as the human species possesses. Indeed, all kinds of selection of the fit and the favored for the good of the family and the tribe have always existed. Selective extinction is no new program.
There are far better goals for feminists to pursue. Pro-life feminists seek to expand and deepen the more communitarian, maternal elements of feminism—and move society from its male-dominated course. First and foremost, women have to insist upon a different, woman-centered approach to sex and reproduction. While Margaret Mead stressed the “womb envy” of males in other societies, it has been more or less repressed in our own. In our male-dominated world, what men don’t do, doesn’t count. Pregnancy, childbirth, and nursing have been characterized as passive, debilitating, animal-like. The disease model of pregnancy and birth has been entrenched.
The female disease or impairment, with its attendant “female troubles,” naturally handicaps women in the “real” world of hunting, war, and the corporate fast track. Many pro-choice feminists, deliberately childless, adopt the male perspective when they cite the “basic injustice that women have to bear the babies,” instead of seeing the injustice in the fact that men cannot. Women’s biologically unique capacity and privilege has been denied, despised, and suppressed under male dominations; unfortunately, many women have fallen for the phallic fallacy. . . .
New feminist efforts to rethink the meaning of sexuality, femininity, and reproduction are all the more vital as new techniques for artificial reproduction, surrogate motherhood, and the like present a whole new set of dilemmas. In the long run, the very long run, the abortion debate may be merely the opening round in a series of far-reaching struggles over the role of human sexuality and the ethics of reproduction. Significant changes in the culture, both positive and negative in outcome, may begin as local storms of controversy. We may be at one of those vaguely realized thresholds when we had best come to full attention. What kind of people are we going to be? Pro-life feminists pursue a vision for their sisters, daughters, and granddaughters. Will their great-granddaughters be grateful?
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In the United States, the debate about abortion, the moral status of the fetus, and the use of fetal tissue and organs for various therapeutic interventions continues to rage. Within this debate, however, there seems to be some emerging consensus on issues of critical note. First, there is a growing recognition that fertilization is a process that takes about a day to complete rather than being a sharply defined moment. Thus the beginning of a particular human life is not as clearly demarcated as previously thought. Additionally there seems to be growing consensus around the fact that individuality—the inability of an organism to be divided into whole other organisms—comes after the process of restriction—which commits each cell to becoming a particular body part—occurs. There is about a two-week time period in which the pre-implantation embryo, while manifesting a unique genetic code, is not an individual for it can be divided either naturally into twins or triplets or artificially into individual cells each of which can become a whole other being. Third, there is a degree of consensus that while not necessarily a person in the full sense, the pre-implantation embryo is entitled to some measure of respect because it is living, shares the human genome, and has a strong potential (though not a present reality) for personhood.
Parallel to these developments, which provide some moral room for maneuvering, are others which seemingly want to take this moral inch and stretch it to the proverbial mile. Thus fetal cells are sought for therapeutic procedures, or fetuses for experimentation. Some have proposed the developments of embryos explicitly for the sake of research. Others have proposed fetuses as sources for organs. These and other social practices make contradictory contributions to the debate on fetal moral status. The small gains in moral coherence suggested above are in danger of being lost because of practices that seem to contradict any moral status the fetus may have. At present we have in our country a kind of undiagnosed and, therefore, untreated cultural schizophrenia with respect to fetal standing.
In this essay, then, I will examine four social contexts which contribute to these differing views of fetal status: the fetus in the context of developments in technology and medicine; fetal usefulness; the fetus in prenatal diagnosis; the fetus in the abortion debate. I will conclude that we must go beyond the procedural issues primarily related to the presence or absence of rights with which we typically resolve fetal standing. This in turn argues to some recognition of the moral status of the fetus in itself, independent of its uses or social or medical valuing.
The rapidly developing field of Artificial or Assisted Reproduction (AR) has had a profound, though unrecognized, impact on views of the pre-implantation embryo and the early fetus. In AR, this entity is the prize of a quest that begins with a desire for a child and ends in a laboratory at the cost of enormous psychological and physical strain and at least tens of thousands of dollars. The parents, as well as the health care providers, are heavily invested in this quest. The pre-implantation embryo is valued and clearly seen and experienced as a child-to-be.
Another medical basis for the valuing of the fetus is the growing practice of fetal surgery. While still experimental, surgeons can remove the fetus from the uterus, perform a surgical procedure, and replace the fetus in the uterus for the duration of the pregnancy. It is also possible to perform procedures on the fetus within the uterus. Again the perception conveyed is that the fetus not only has some degree of worth based on the willingness to intervene for therapeutic purposes, but can be a legitimate patient. But patients have rights, and so the question is: if the fetus is a legitimate patient, does it have rights? Then we need to consider the implications for abortion of the answer to this question.
A final medical and technical dimension that places the fetus in a different light is the amazing developments in the Newborn Intensive Care Units (NICU). These units have been in full operation for about two decades and the progress is simply stunning. Viability for premature newborns has shifted from about thirty weeks to somewhere around twenty-one to twenty-two weeks, depending on the technology available in the unit and the skill of the staff. The NICU functions essentially as an artificial uterus. But this progress comes at a high price. The average stay in such a unit can easily run into the hundreds of thousands of dollars. But NICUs are expanding, not contracting. Whether this will continue given constraints on health care financing is not clear, but presently such costs are considered worthwhile because of high survival rates of such mid-term fetuses.
Two related practices, which are not as prominent as they were several years ago, also speak to perceptions of fetal value. Criminal charges have been brought against women who used illegal drugs during pregnancy. Whether prosecution is a way of telling the larger community that “we are serious about drug abuse,” or whether it is a way of further victimizing women in desperate circumstances, the practice makes a strong statement about the value of the fetus. Moreover, there have been a number of well publicized instances of involuntary Caesarean sections performed on the basis of fetal well-being. While these cases seem to be diminishing, or at least not publicized if performed, the basis for such court-justified involuntary surgical procedures was fetal well-being, which again suggests a perception of fetal value.
Fetal tissue can be quite useful in various medical procedures. It is important in research which seeks to understand the process of fertilization, to discover the causes of developmental anomalies during early gestation, and for alleviating the symptoms of individuals with Parkinson’s Disease. A borderline case is the debate over the use of fetuses with anencephaly, an extremely severe brain trauma which results in very early death, as organ donors. In some cases organs were sought from infants already born, but in other cases there was discussion over whether to induce birth so the organs would be more useful.
Such practices see the pre-implantation embryo or fetus as valuable, but the value is seen in utilitarian terms, i.e., as a means to an end. That is, in practices such as fetal tissue transplantation, the pre-implantation embryo or fetus is not experienced as having some value in itself but as valuable because it is useful. It serves the needs or purposes of others such as physicians involved in research, patients who benefit through symptomatic relief of their disease, or the recipients of organ transplantation. Such practices suggest the fetus is an object at the disposal of others and that its value is derived from its instrumental utility. It is a means, rather than an end.
The last several decades have seen remarkable developments in the area of prenatal diagnosis. We have moved from amniocentesis which provides samples of fetal cells which can then be examined for genetic anomalies, to various visualization technologies, such as ultrasound and fetoscopy. These allow quite clear, occasionally technicolor, images of the fetus, both internally and externally. In the newly developed field of pre-implantation diagnosis, a cell or cells are taken from the pre-implantation embryo so its genetic profile can be ascertained before implantation. Such practices, with the exception of pre-implantation diagnosis, are standard obstetric care. Because these technologies are widely used and because of the practice of defensive medicine, one has to make a very active and firm decision not to utilize these diagnostic technologies.
The still definitive study of prenatal diagnosis by Barbara Katz Rothman, The Tentative Pregnancy, highlights the tensions raised by such technologies. On the one hand, if a pregnancy continues to the stage where prenatal diagnosis is recommended, it is clear that it is essentially a desired pregnancy, or at least has not been rejected by means of abortion. On the other hand, the fetus still must pass an acceptability test. It must have an acceptable genetic profile to continue to be valued and desired.
While I do not want to minimize, trivialize, or dismiss the genuine ethical dilemmas surrounding prenatal diagnosis and selective abortion, its practice does raise fundamental questions about the perception of the fetus. First, what is the problem the practice is to solve; whose problem is it: the woman’s, the couple’s, or the fetus’s? Second, how is the problem to be resolved? The practice of prenatal diagnosis seems to put the fetus in the category of being a patient because it is a diagnostic procedure. But, more often than not, the disease or the disposition to one has no cure. This leads to other problematic choices: abortion, avoiding future pregnancies, using artificial insemination with a donor for future pregnancies, having the child and letting the disease run its natural course with appropriate interventions. Whose interests should govern the selection of any of these alternatives—those of the fetus or child-to-be, the parents, the extended family, or society? And on what basis are these interests determined? Again how these questions are answered reveals much about the fetus’s standing.
The practice of abortion continues to be at the center of national politics, religious debate, and difficult individual decisions. While there is a decrease in the abortions performed annually, there are still over one million abortions per year performed in the United States. The majority of these are performed on women under 20 years of age. There have been numerous challenges to Roe v. Wade but its core claim of abortion’s being an issue of privacy and, therefore, constitutionally protected appears to be secure. While there has been some fraying at the edges of this right with respect to issues such as information presented, waiting periods, and parental notification, the core of Roe remains intact. Chemical abortions such as RU 486 could replace the surgical methods now used. These will make abortion totally private or hidden as part of routine obstetric care for the procedure will occur in a physician’s office and no one will know the reason for the visit. Abortion would no longer be the semi-public event it is now, which could significantly impact social, moral, and legal perspectives on abortion and fetal standing.
Finally, there is a point of conflict brought about by modern technology and the timing of abortion articulated in Roe which defined viability as the time when the state might assert an interest in regulating abortion. At the time of Roe, viability was about twenty-eight weeks but now, given technological developments, viability is around twenty-two to twenty-four weeks. Some hospitals and clinics are reluctant to perform mid-second trimester abortions because, depending on the method used, the fetus might be viable. Thus while an abortion at the gestational age of twenty-four weeks is legal, such a fetus is potentially viable. Technology has injected a note of tension between law, medicine, morality, social practice, and women’s choices.
Where does all of this leave us? If my analysis is correct, we have been engaging simultaneously in several practices that reveal a mixed picture of the fetus. Legally, we rely on a procedural analysis that tends to sideline the ethical issues and values which extend beyond privacy and freedom of choice. The procedural analysis focuses on the questions of individual rights, who has them, and which take priority. The limits of this practice are evident from the many legal battles over abortion as well as continued attempts to insert other moral issues into the debate. We need to come to terms with the underlying standing of the fetus—a standing which cannot be resolved by procedural appeals.
Two factors are crucial in reconsidering the moral status of the pre-implantation embryo or the fetus as we consider new medical and social practices which involve it.
First, few would dispute that the pre-implantation embryo is a living entity. It engages in cell division and metabolizes. True, it is dependent, but so are most other living creatures, including human infants. Second, this entity has the human genome. That is, it has a biological program from its DNA which ensures its development into a human being, not a horse or a tree. This outcome is neither a possibility nor a random occurrence. Given its DNA, we know what this organism will become.
On the one hand, these developmental directions are matters of biological fact. That is, if one presented a pre-implantation human embryo to a biologist or embryologist, he or she would make these observations: it is living, has the human genome, and has a development program. On the other hand, these factors raise, if not force, certain moral issues: the fact that this entity is living and shares in the human genome is a basis for differential treatment.
Second, there are some claims I think are extremely difficult to make about the pre-implantation embryo. It is arguably not an individual, for example, until the process of restriction is completed. That is, until the cells become restricted to becoming a particular part of the body and that part only, the pre-implantation embryo is divisible into parts, each of which can become a whole. After restriction, at around two weeks, the capacity of the cells to become any body part is “turned off” and the pre-implantation embryo becomes indivisible. Because the pre-implantation embryo is not an individual during this time, it cannot be a person for individuality is a necessary, though not sufficient, condition of being in that state. While the potential for personhood is inherent in the ongoing developmental process, this is not actualized and the pre-implantation embryo is not morally a person.
These two sets of observations leave us in a morally complicated position. It is difficult, if not impossible, to argue that the pre-implantation embryo is a person because it lacks individuality. Yet it is living, possesses the human genome, and has a biologically grounded, developmental teleology that eventuates in a person and only a person. The pre-implantation embryo thus has a value related to the value of human personhood—even though this is difficult to define precisely. However, this is not the value associated with actualized personhood. Nonetheless, these factors force us to move beyond primarily procedural considerations of the pre-implantation embryo and the fetus. Such moves make us, in my judgment, address the very difficult issue of the value of the pre-implantation embryo and fetus in itself and to consider that such a value might place constraints on its use.
Yet, because the value of the pre-implantation embryo is not that associated with personhood, there is also an opening for justifying its use in other settings. Does appropriate “respect for” and “protection of” the pre-implantation embryo necessarily preclude its use in research, for example? The critical issue is a balancing of the genuine value of the pre-implantation embryo against the actual benefits and significance of the research, considered as a means of contributing to the well-being of individuals whose personhood is established and not merely tentative. These and other dilemmas can be resolved only through painful, but honest, public debate which could eventuate in policies which balance the actual value of the pre-implantation embryo against the values to be achieved through an abortion or the potential benefits to be obtained by, for example, a research project or the use of such tissue in medical therapy to benefit another.
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Shirley Bogard was an impressive teenager in the Kentucky Baptist church where I was pastor. The church awarded her its scholarship for the most deserving teenager so she could train as a nurse. She was a devoted Christian, and she became a super-competent nurse.
Shirley, now Shirley Martin, became the nurse in Louisville and Jefferson County’s Teenage Parent Program (TAPP)—a middle school and high school for pregnant students. She hired my wife, Dot, who is also a nurse, to work with her, teaching the teenagers prenatal nutrition, healthy child-raising, and how not to get pregnant again. They worked in the ob/gyn clinic held in the school two days a week: The girls got regular medical examinations, without having to leave school and their studies.
A University of Louisville School of Medicine study reported that, surprisingly, unlike typical teenage mothers, TAPP’s teenagers produced healthy babies averaging normal birth weight. Premature babies are highly expensive when they require intensive care and are more likely to have learning problems and medical problems later in life. TAPP prevented that. It was enormously cost-effective.
And 99 percent of these girls chose not to have an abortion. By contrast, the official Centers for Disease Control and Prevention report for 1998—the year of the Louisville study—concludes that 75 percent of pregnant teenagers younger than fifteen years old, and 39.1 percent of teenagers fifteen to nineteen years old, terminated their pregnancies with abortions. The abortion ratio in TAPP, with girls twelve years old and up, was a remarkably low 1 percent. TAPP gave pregnant teenagers a way to continue school while taking care of their babies, and while building an economically viable future. The clear result was that they chose not to have abortions.
The school had a nursery, so the girls could attend school regularly without having to worry about who would care for their babies. They each worked one class period a day in the nursery, thus receiving expert instruction in care for babies. Two trusted social workers counseled the girls, helping them plan their futures, stay in school, and complete their diplomas. The girls had much lower dropout rates and much lower drug addiction and suicides than typical teenagers.
While the preferred goal, especially among teenagers, is prevention of unintended pregnancy, the Teenage Parent Program provides a striking example of how to reduce abortion rates:
But the catch is how to pay for a school like TAPP. The public school system paid for the usual education—English, math, history, etc. Medicaid and the State Maternal Health Division, supported by federal funding, paid for most of the ob/gyn clinic. Ominously, in 2002 federal funding for the ob/gyn services was canceled, and the state could not afford it alone. The ob/gyn program is no longer available to students without insurance or Medicaid, and no nurses are teaching any more.
The support that was provided by TAPP, in many ways, is echoed when the nation adequately provides programs such as SCHIP (health insurance for children), health insurance for all ages, child care assistance, as well as food stamps and WIC (Women, Infants, and Children).
In addition to Dot’s experience with TAPP, our family has another reason to know personally how crucial support for pregnant women and children is in preventing abortions. In the eighth week of Dot’s third pregnancy, she got rubella (German measles). Rubella in the first trimester of pregnancy is likely to be devastating for the baby’s heart, brain, sight, and hearing. But we did not have an abortion because we had hoped we could cope.
Our son David was born with a heart that failed in his first month; odds were against his survival. He did not speak, mumble, or chew until he was four and a half years old. He has brain damage. He is legally blind. But we had enormous support from church members, medical personnel, the Kentucky School for the Blind, and caring teachers, and we had medical insurance and a job. Now David translates theological books from German to English for leading publishers and for researchers.
That is why I worried enormously when the Bush administration cut back crucial supports for mothers and babies. I suspected it would increase abortions among those who did not have the kind of resources our family had. The government’s official reports for 2002—the first full year of the Bush administration—had not yet been published, but I found sixteen states that had reported. Based on these states, I published two articles predicting that although the number of annual abortions had declined significantly in the previous decade, the reductions would stall and abortions would actually increase in 2002. Some people attacked my findings harshly, claiming that when the complete data for 2002 was released, I would be proven wrong.
But the official government CDC report is now published. As I had predicted, the number of abortions did increase in 2002. And though the abortion rates for teenagers declined from the mid-1980s through 2000, they actually increased from 2001 through 2005. Though the abortion rate for all women was going down dramatically through 2000, it stalled at 15 per 1,000 from 2000 through 2005. And though the infant mortality rate had been steadily decreasing for six decades, it actually increased in 2002, for the first time ever. Furthermore, the economy is so devastated now in 2009 that more pregnant women may conclude they cannot afford a baby and thus choose to have an abortion.
The Obama administration is expanding health care insurance for children and is developing plans to provide access to health insurance for all of us, is working to get the economy revived, and is supporting programs to curb unintended pregnancy. If abortions reduced significantly during the Clinton years, stayed flat during the Bush years, and reduce significantly during the Obama years, what is a consistent pro-life person like me to conclude about which approach actually works to reduce abortion rates?