Contrasting perspectives on abortion (part 2)

This is part two of my four part series on the quagmire that is the abortion debate. If you’ve not read part one, I’d encourage you to do so or this won’t make a lot of sense.

As stated in part one, AVfM itself does not take a view one way or the other on the subject and the ideas expressed in this article are expressly not endorsed by AVfM in any respect. At most, this is my opinion in my personal capacity — and even then, you should not assume that I personally espouse any of the following ideas (unless I explicitly state that I do).

In part one, I covered the medical perspective and the mother’s and father’s perspectives. Now the hard work begins.

The foetus’ perspective

Human foetuses are quite evidently not parasites as I glibly suggested in part one because no other parasite grows into anything like an approximation of its host and no other parasite has anything like the neural complexity that most mammals do.

As such, this is where things get really difficult because, unlike each of the parents, the foetus (later, child) is incapable of forming an opinion, nor articulate it if it could, nor consent in respect of a termination. It’s not even clear that any of those things are meaningful in respect of a foetus because they all require a level of cognition of which even a newborn is incapable; indeed, theory of mind doesn’t develop until the age of three or four years. Since we can’t ask even a newborn for their opinion on the subject, we’ll have to take a different approach.

Term limits, viability and when terminations are unavoidable

One way to do that is to consider how term limits are (or should be) bounded. At one extreme, willful, deliberate killing of a newborn is unambiguously murder. Since the difference between that newborn and a foetus a day or two before birth is vanishingly small, the difference between termination late in the third trimester and murder must likewise be vanishingly small.

At the other, given the number of zygotes that fail to reach second trimester (which, even at the lower bound of 25%, is still pretty common), the difference between natural miscarriage and artificially induced miscarriage seems likewise negligible. Moreover (and many people may not be aware of this), the antiprogestogen class of ‘morning after’ pills (emergency contraceptives, including mifepristone, aka RU-486) — the only class proven effective post ovulation — are, in fact, abortifacients, the same drugs used for early-term abortions. Between these two factors, it seems that there is no rational argument against first trimester terminations, only moral arguments (which, as I hinted at in part one, are not universal and are legitimately diverse).

Apparently, it’s okay before the second trimester but not okay by some point during the third trimester (or late second trimester). So where is that point?

One common test is whether the foetus is “viable”, i.e. can live outside the mother’s body (however much medical intervention is required). It used to be thought that that point was at about 24 weeks, which is why the term limit is set there in many countries. Modern medicine has sometimes been able to sustain even a 22-week old foetus (now baby) ex utero, which is why there has been some debate (with good arguments on both sides) as to whether to reduce the term limit from 24 weeks to 20.

The Telegraph reported that though “later abortions were always distressing, […] early scans could miss abnormalities that became evident only later” and that a “BMA briefing document says that 22 weeks is the earliest that babies have survived a premature birth. But only one per cent born so prematurely survive and the chances of disability are high”.

Another test is whether the life of the mother is at risk. Most jurisdictions permit abortions in order to save the mother’s life (even in the Republic of Ireland). Make no mistake, pregnancy can kill: ectopic pregnancies (incidence 1–4%; maternal mortality 0.1–10% when treated [though at the cost of the foetus], invariably fatal to the mother if left untreated) and pre-eclampsia (incidence 2–8%, mortality 10–25% making it one of the most frequent causes of maternal deaths) to name but two common causes of maternal death. Term limits aren’t really a question here because where indicated, the baby will be delivered by Caesarian-section and otherwise an abortifacient will be used. If the baby dies after delivery, then no blame attaches to the clinicians who saved the mother’s life.

Why does any of that matter? It establishes that abortion is not okay after 24 weeks at the very latest, and also one circumstance where premature delivery/abortion is, regardless of the stage of gestation.

That concentrates the question in dispute to a window of weeks 12–20, with weeks 20–24 being a grey (or thoroughly muddy) area. That’s an 8 week window in 40, or just 20% of total duration of pregnancy. Of course, there will be plenty who think that termination in the first trimester is equally unacceptable but, as explored in part one, there seems little basis to forbid first trimester terminations except on moral grounds.

We’ll have to wait to see what Paul has to say about the developmental state of the foetus during that window so, for now, I’ll contemplate a few questions and their implications — and I’m looking forward to seeing your perspectives in the comments section.

The value of the human condition

Is a foetus human?

Genetically, yes. Beyond that, I’m not sure how to answer that question except to say that the answer is a matter of definition and degree. An embryo, for example, doesn’t much resemble either a child or an adult (which misled Haeckel into his now-discredited theory), and has few of the characteristics usually connoted by the word. The closer a foetus gets to term, the more human characteristics it acquires, although mainly only in appearance.

The question also invites the reply, “what if it is?” Well, what if it is? Let’s see where we get with this next approach:

What makes a 12–20 week-old foetus so special that it is set apart from and warrants special status over any other animal (born or not)?

If the answer was “nothing significant”, then abortion wouldn’t be any more controversial than destroying a farmed animal for food or any animal to end suffering where there is no hope of recovery. Since it is more controversial, clearly there must be something special about human foetuses. But what?

Anybody who’s owned or lived with cats or dogs will tell you that they each certainly have their own personalities, so it’s not personality. Even though identical twins are genetically identical and have nearly identical life experiences, they can have quite distinct identities and personalities — and anyway, nearly all gametes (sperm and ova) are wasted, so it’s not purely genetics qua human genetic material, either.

Nor is it the human body itself, because brain-dead people can still be “alive” in the biological respiratory sense, yet can’t be murdered (because clinically, they’re already dead and you can’t kill something that is already dead); indeed, they can be harvested for organs, where doing that to somebody not clinically dead is a rather extraordinary form of assault (and, unfortunately, not one unknown to happen in some parts of the world).

Is it cognition or sentience, then? No, again, cats and dogs are certainly capable of feeling emotions and problem solving (indeed, as well as some quite extraordinary feats of comprehension and action) — and if they were the only criteria, then we’d have to reconsider public policy in respect of many animals because nearly all of those upon which we rely for food can feel fear and pain, etc.

Is it the potential of what a child could become? Ah, now we’re probably getting warmer, but that’s not enough on its own. To begin with, each gamete is potentially a person, given the right conditions and yet, as I’ve already said, a zygote isn’t guaranteed to become a person, and nobody cares about wasted gametes (not even hard-core Catholics, who only seem to care about interfering with the union of gametes, and then only after the sperm has left the man’s body; the contradiction lies in the fact that spermatogenesis is an ongoing process, with 200–300 million sperm produced daily, and unused sperm are eventually destroyed and reabsorbed by the body. In contrast, a woman is born with all the ova she will ever have, although she loses one (sometimes more) roughly every 4-8 weeks.)

In the event that a termination (or premature Caesarian-section) is the only way to save a mother’s life, the mother wins out. Shall we infer that the mother is more valuable than the foetus, or else that the mother’s only value is to care for babies and that, if by terminating this time, perhaps she may live to have another baby?

Neither are appealing alternatives but, if there is a third, I can’t think what it is just now. This may tip the scales, though:

If being a living human is the only characteristic relevant to personhood (and associated rights and protection under law), then on what basis do we restrict the rights of children (say, to vote, drive or have sex)? The fact that we do (and that nobody sees any objection that we do) says that children are qualitatively different from adults and that, in some circumstances, it’s proper to make decisions based on level of development. That doesn’t mean children have less value than adults, but when it comes to the rights of children versus the rights of adults, apparently the rights of adults win.

As applied to a foetus, there is an argument that because even a 20 week-old foetus’ level development is so low (not even viable ex utero) compared with even that of a newborn (and the moreso with a four year-old, apropos theory of mind), there is some justification for treating a 12-20 week-old foetus differently in terms of rights from those of a newborn.

How is human life valued? I don’t know if there is any sensible secular answer, but it looks like it rather depends on personal perspective. I do know that in many areas of practice and law, it doesn’t seem valued very much because all the evidence suggests that the right to life seems more highly prized than quality of life. If the BMA is correct about the prognosis for 22 week-old premature babies, what quality of life can such premature babies ever hope to have even if they do survive? For my part, I value quality of life above life itself (particularly with respect to end-of-life care issues, which is an entirely separate debate) because there seems no point in living if living means enduring an earthly hell (by way of example, tormented by one’s dying, terminally-ill body). For the avoidance of doubt, nobody but the person in question has the right to decide whether to endure or not because of the same reasons of autonomy and self-determination I outlined in part one.

If I have any criticism for the pro-life perspective, it is that it does not go anything like far enough. If a human life is worth fighting for before birth, then it is worth fighting for the sufficiency of the necessities of life (adequate nourishment, housing, health care and an education until the child is old enough to fend for his- or herself) also — yet few who argue that the state should prohibit abortion seem inclined to argue, in the context of the abortion debate, that the state should also provide for the child should the parents be unable (or unwilling).

To the extent that where life exists it seeks to thrive, it is quite reasonable to assume that a foetus “wants” to survive (but, by that argument, so do bacteria and insects) and that therefore, termination deprives life of its goal to thrive.

The question is, does a foetus have any positive right to oblige another in order for it to thrive? In the secular context, only civil law can answer that, which I shall address in part three.

Other grounds for termination

No treatment of the subject can be complete without considering two special cases: pregnancy from rape and pregnancies in which the child would have serious congenital abnormalities that will lead to poor quality of life.

It seems too much to ask of a woman, who has already been violated once, to endure the pregnancy she never consented to (in any sense). I cannot see how that can be regarded as anything other than a second violation, in which case there is a strong argument in favour of permitting the termination pregnancies resulting from rape. That said, making an exception in the case of rape is, while compassionate, inconsistent with any philosophy, perspective or conclusion that would otherwise prohibit it. If it’s not okay to terminate for other reasons, then it ought not be okay to terminate on this basis (however compassionate the motivation).

The question of serious congenital abnormalities is unanswerable in the general case without resorting to moral argument. I know how I feel about it, but I also acknowledge that those feelings are based on my own personal values that may change were I ever actually faced with that situation, so I don’t expect or require anybody else to agree with me. This class, I think, is one of those where only the couple involved can decide.

In part three: The perspective of the law and the question of the moral argument.

I invite and encourage civil debate in the comments section below, but please keep in mind that there’s more to come and, regardless, such a complex topic would not cover every aspect in dozens of articles of this size. I’d also suggest that, because Paul and I are restricting ourselves to secular arguments, religious points of view are probably best avoided.

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