Abortion and Maternal-Fetal Conflicts Abortion: The Ethical Issue

Presuppositions of intelligent debate and awareness of the various sorts of reasons that may be given for having an abortion a basic acquaintence with the biological development of the human fetus Normative & Philosophical Issues Moral question: When, if ever, is abortion morally permissable? Social-political question: Under what circumstances, if any, should abortion be legally allowed?

Reasons for Abortion

A nonexhaustive list 1. to save the mother's life: "In certain extreme cases, if the fetus is allowed to develop normally and come to term, the pregnant woman will die." 2. to preserve the mother's health physical or mental 3. cases in which the pregnancy will produce an impaired child certainly or probably 4. cases in which the pregnancy is the result of rape or incest 5. cases where the pregnant woman is unmarried: to avoid the social stigma of illegitimacy for the child shame for the woman 6. cases where having (another) child will impose an unbearable financial burden on the woman or family 7. cases where having another child will interfere with the happiness of the woman or family Discussion cases 1-3 -- being undertaken of medical reasons -- are commonly deemed therapeutic case 4 is sometimes also -- less justifiably -- deemed "therapeutic" "Perhaps it is presumed that pregancies resulting from rape or incest are traumatic and thus a threat to mental health" (433) "Alternately, perhaps calling such an abortion `therapeutic' is just a way of indicating that it is thought justifiable" case 7 is probably the most common & includes almost endless possibilities (bit of a catch all category) woman's desire for a professional career couples desire not to take have (additional) children

Biological Development of a Human Fetus

Notable Stages Conception a male germ cell (the spermatazoon) carrying 23 chromosomes from the father a female germ cell (the ovum) carrying 23 chromosomes from the mother unite to form a single cell zygote which embodies a full human genome of 23 pairsor chromosomes Implantation: 0-2 wks. the single-cell zygote begins a process of cellular division the resultant multicell zygote continues to grow as it proceeds through the fallopian tube upon reaching the uterus the zygote undergoes gradual implantation at the uterine wall until it's fully implanted, approximately 2 weeks after conception when fully implanted, the zygote is deemed an embryo Embryonic development: 2-8 wks. organ systems and other human characteristics begin to noticably develop brain waves can be detected around the end of the sixth week at the end of the eighth week, the embryo is deem a fetus (though the word "fetus" is commonly used to designate the unborn child whatever its stage of development) Fetal development: 9-36 wks. (following dates calculated not from conception but from the date of the woman's last mentstruation) quickening: wk.12-16: the point at which the woman is able to feel the movements of the fetus viability: wk. 24: the point at which the fetus is capable of surviving outside the womb trimestesters months 1-3: first trimester months 4-6: second trimester months 7-9: third trimester Abortion techniques at various states First trimester (through wk. 12) formerly was done by dilation and curettage (D&C) which involves strecthing (dilation) of the cervix to allow insertion of a surgical instrument (a curette) scraping of the uterine walls with this instrument (curretage) now commonly performed by uterine aspiration (aka vacuum aspiration) a tube connected to a suction pump is inserted into the uterus and the fetus is sucked -- or vacuumed -- out Later stages (after wk. 12) dilation and evacuation (D&E): early stages of the second trimester

a forcepts is used to dismember the fetus within the uterus the fetal remains are withdrawn through the cervix induction techniques induce premature labor: saline induction a common type a saline solution is introduced into the amnioutic cavity which induces labor, thereby expelling the fetus prostoglandin induction: employs these hormonelike substances to induce abortion hysterotomy: in essence a mineratureceasarian-section a major surgical procedure seldom used in the U.S. The Ethical Question: When -- if ever -- is abortion morally permissable? Up to what stage of fetal development, if any? For what reasons, if any? Three (sets of) views Conservative: abortion is never morally acceptable (some allow acception to save the life of the mother) Liberal: abortion is always ethically acceptable at any stage for whatever (standard) reason Moderate views hold either abortion is permissable to a certain stage of fetal development, but not later abortion is permissable for certain reasons but not others (among the standard ones)

The Conservative View and the Liberal View

The moral status of the fetus is a pivotal issue in these discussions full moral status is that due to fully developed human beings, mentally competent adults like us assigning the fetus full moral status entails it has a right to life on a par with the rights of a normal human being no (significant) moral status assigning the fetus no moral status entails that it has no rights worth talking about and no significant right to life partial moral status rights -- including perhaps rights to life -- worth talking about but not to the full extent that a normal human being has Liberal vs. Conservative deductions (from their takes on the moral status of the fetus) extreme liberal position since the fetus has no moral standing it has no more right to life than a piece of tissue, such as an appendix and "aborition is no more morally objectionable than an appendectomy" (p. 429) extreme conservative position since the fetus has full moral standing

it has as much a right to life as anyone else -- including the mother abortion -- "except perhaps to save the life of a pregnant woman" -- is murder and "as morally objectionable as any other murder" Drawing the line: determining moral status Frequently posed question: "At what point in the continuous development does the fetus become human?" In the moral sense, i.e., a sense in which human implies full moral status and nonhuman implies lack of moral status Standard Conservative Approach The fetus becomes human at the moment of conception Supporting argument from the continuity of development conception is the only point at which the line can nonarbitrariliy be drawn quickening is not a morally significant dividing line not even birth: it's the same organism whether it's in or outside of the womb the zygote is endowed with a full -- and unique -- human genome that undergoes a continuous and gradual development from the moment of conception through birth and beyond Standard Liberal Approach The fetus remains nonhuman even in the later stages of development. Supporting argument Biological vs. moral humanity distinguished human organism: any organism with a human genome a person: a rational and self-conscious being Mary Anne Warren's argument (this volume) The fetus is not a person & the fetus is so far from possessing the crucial elements of personhood that it cannot be said to have a significant right to life Objection & Reply Objection: This same line of argument would justify infanticide Reply: no it wouldn't because newborns "are so very close to being persons" because the mother's overriding rights cease at birth The presumption argument: an nonstandard conservative approach We don't know for certain whether the fetus is a person on not.

So there's a chance -- for all we know -- that abortion kills a person. And it's not morally permissable to take that chance, just as suppose you were considering setting off an explosion in a mine it would be morally wrong to go ahead with the blast if you thought, possibly, that someone was still in the mine The potential person argument though not fully a person, yet, the fetus is a potential person potential persons are entitled to the same rights as fully developed ones (Warren argues against this) Don Marquis argument from the wrongness of killing (akin to the potential personhood argument) Killing a person is wrong because it deprives them of future satisfactions -- a future Killing a fetus, similarly, deprives the fetus (or the person they would become) of just such a future So it's morally wrong to kill a fetus for the same reason it's morally wrong to kill a person. Marquis stops short of the standard conservative claim of no exceptions except, possibly, to save the life of the mother, e.g., would perhaps allow abortions for severely impaired fetuses with dismal future prospects

Moderate Views According to the moderate position, Abortion is only a prima facie moral wrong, and thus prohibitions against it may be overridden by stronger moral considerations. (Womans duties to herself, to her family, and to the society) .

ABORTION IS PERMISSIBLE PROVIDED THAT: [Werner, 1979]

It is procured during pre- sentience (before the fetus has the capacity to feel) Post- sentience Self- defense (e.g. where the life or health of the mother would be at risk if the pregnancy was allowed to continue) Unavoidability (e.g. where abortion cannot be avoided, such as in the case of ectopic pregnancy or accidental injury).

[Bolton, 1983]

Since fetuses are not undisputed persons, they do not have the same rights not to be killed as do actual undisputed persons.

Hence, in the case of life- threatening pregnancy, at least, a womans right to life overrides that of the fetus. The bottom line of Boltons position is that abortion is morally permitted in some situations, and might even be morally required in others, and it is not morally permitted in some other types of situations. Another moderate argument raised in defense of abortion is that, A woman is under no moral obligation to bring a pregnancy to term, particularly in instances: Where the pregnancy has been forced upon her (as in cases of rape.) Where the pregnancy has not resulted from a voluntary and informed choice (as in cases involving contraceptive failure or ignorance).

[Judith Jarvis Thomson]

Even if it is conceded that a fetus is a person, this still does not place an obligation on a woman to carry it to full term. This is because morality does not generally require individuals to make large sacrifices to keep another alive. Thus, if pregnancy requires a woman to make a large sacrificeand one that she is not willing to makeit is morally permissible for her to terminate the pregnancy. ADOPTION OPTION Many view the adoption option as a respectable way out of the abortion dilemma. Thomson rejects the adoption option, arguing that it can be devastating on mothers, much more on adopted children, who may grow up wondering who they are and spending a lifetime searching for their unknown biological parents.

ABORTION and the Moral Rights of Women, Fetuses, and Fathers

CONSERVATIVE LIBERAL (never allowed) (allowed on demand) THREE POSITIONS ON ABORTION

MODERATE (sometimes allowed)

In considering these three positions on abortion, it can be seen that the abortion issue rests on two key points: (1) The moral status of the fetus (2) The moral rights of pregnant women to control their bodies and their lives (also referred to as reproductive autonomy) In defense of pro- abortionists position, that in order for a fetus to be a person it must satisfy the moral criteria of personhood. North American philosopher, Mary Anne Warren (1973), argued that for an entity to be a person, it must satisfy a number of criteria: (1) Sentience- the capacity to have conscious experiences, usually including the capacity to experience pain and pleasure. (2) Emotionality- the capacity to feel happy, sad, angry, loving, etc. (3) Reason- the capacity to solve new and relatively complex problems (4) The capacity to communicate by whatever means (5) Self- awareness- having a concept of oneself,as an individual and as a member of a social group (6) Moral agency- the capacity to regulate ones own actions through moral principles or ideals. Warren points out that an entity need not have all of these attributes to be a person. She suggests that in order to demonstrate that a fetus is not a person, all that is required is to claim that a fetus has none of the above six characteristics of personhood. For some, the personhood argument does little to settle to settle the abortion question. Even if it true that a person is not a person, it nevertheless has the potential to become one, and therefore it has rights. Thus abortion is still wrong on the grounds of the potentiality of the fetus. [Glover]

It is hard to see how this potential argument can come to any more than saying that abortion is wrong because a person who would have existed in the future will not exist if an abortion is performed. If we take the potentiality argument to its logical extreme, we are committed to accepting that contraception, the wasteful ejaculation of sperm, menstruation, and celibacy are also morally wrong, since these too will result in future persons being prevented from existing.

The main unresolved question is: Can a potential (fetus) person be meaningfully said to have actual rights and, if so, can these rights meaningfully override the existing rights of actual (mother) persons? The crux of the dilemma posed here is whether the more immediate and actual rights of the pregnant woman should be recognized before the more remote and potential needs of the fetus, or vice versa. One answer is that, given our understanding of the nature of moral rights and correlative duties, there is something logically and linguistically odd in ascribing rights to fetuses (non- persons), particularly during pre- sentient stage. If we were to accept that non- sentient fetuses have moral rights, we would be committed absurdly, to accepting that all sorts of other nonsentient things have moral rightsincluding human toenails, strands of hair, or pieces of skin.

WHICH FETAL/ MATERNAL RIGHTS ARE LIKELY TO CONFLICT? (1) The fetus and the mothers common claim to a right to life. n This is particularly in cases where the mothers life would almost certainly be lost if the pregnancy were allowed to continue. n In the case of life- threatening pregnancies, it seems reasonable to conclude that the pregnant womans right to life has the weightier claim. (2) The mother right to have control over her body and lifes circumstances vs. the fetus right to life. n It might be claimed that the inconveniencies and other psychological, physical or social ills caused by an unwanted pregnancy are still not enough to justify killing the fetus and violating its right to life. n The demand not to kill the fetus becomes even more persuasive when it is considered that there are alternatives available:

Child welfare Adoption Counseling Medication

(3) The mothers right to health and quality of life vs. the fetus right to life. n In this instance, the mothers health and quality of life are threatened not by her pregnancy but by a progressive debilitating disease such as Alzheimers, Parkinsons or diabetes. n The mother might contemplate getting pregnant for the sole purpose of growing tissue which can be harvested and transplanted into her brain or pancreas in an

attempt to restore her health. The issue of fetal tissue transplantation has long been subject of intensive debate. (4) The right of the father. n Some worry that, if the paternity rights debate is allowed to progress to its logical extreme, it could have paved the way for even rapists to prevent their victims from having abortions, and to press for access rights after the baby has been born. It has also been suggested that recognition of paternal rights may see the courts inviting rapists to be present at the birth. Maternal-Fetal Conflicts

At issue: "If a pregnant woman has made the decision to carry her fetus to term" and has decided against abortion "does she havea moral obligation to conduct her life so as to minimize the possibility that her child will be born unhealthy?" (p. 433) Variously lifestyle choices known to risk adversely affecting fetal development maintaining an unhealthy diet smoking excessive consumption of alcohol use of various recreational drugs, e.g., cocaine: "crack babies" improper management of medical conditions (e.g., diabetes) Further issue of coercive treatment

1. 2. 3. 4. 5.

should a woman be obliged to accept invasive medical procedures in the name of fetal well-being if she is told that Ceasarian delivery -- which is more risky to her -- is less risky to the fetus is she morally obliged to have the C-section? is she morally obliged to undergo treatments that might be described as "fetal therapy" Surely is makes a difference

how well established and effective the procedure is how necessary it would seem for the woman and how great the risks are for the woman

Question remains: supposing there's a safe effective procedure physicians deem necessary for the well-being of the fetus

"If educational efforts fail to elicit a woman's consent . . . is persuasion in order?" "If efforts to persuade also fail, is coercion in order?" (433) Thomas H. Murray

"a pregnant woman has a moral duty to avoid harming her `not yet born child'" but "this duty must be balanced against a multitude of other moral considerations" leading to "strong reservations about the employment of coercian against pregnant women" Rosemarie Tong: it's a package deal from a care perspective

to the extent that "we take good care of pregnant women" we can expect them "to take good care of their fetuses"