Abortion

I’m not sure I have anything new to say on the topic of abortion, but I’ll take a stab at clarifying my thoughts. I’ve been working on this little essay for about a month, off and on; it’s a complicated issue.

Abortion is an interesting point of contention in the U.S. because both sides generally agree on the facts. In many issues in the so-called culture wars, the various sides disagree about the truth of the matter. In the case of abortion they generally do not. Also, aside from some cases of domestic terrorism, which have fortunately become much less popular since 9/11, both sides of the abortion debate stake out relatively thoughtful and well reasoned positions. The chosen names of the two sides, pro-life and pro-choice, are perhaps indicative of this, as both names are reasonable shorthand expressions of their respective points of view, yet very few people are either anti-life or anti-choice.

The moral question of abortion requires a balancing of rights. The rights in question are: 1) a pregnant woman has the right to absolute control over her own body; and 2) a fetus has an absolute right to protection.

In general, in our society, a non-pregnant woman, or a man, has considerable rights over her or his own body. Suicide is not permitted. Major mutilation is not (as far as I know) illegal, but it may be grounds for an involuntary committment to an asylum if somebody brings you in. Minor mutilation such as piercings or tattoos are permitted. Obesity, and in general the failure to treat your body as a temple, is common. Engaging in activities which are extremely dangerous, but do not always lead to certain death, is permitted.

Similarly, after birth, a child has a near-absolute right to protection. Newborn babies require a great deal of care, and failing to provide it is illegal. Harming a baby or child is in fact considered to be worse than harming an adult.

The issue of abortion pits these two rights against each other. However, before delving further into this conflict, I want to tackle some side issues.

The U.S. Supreme Court has said that any law which forbids abortions must have an exception in the case where the mother’s life is in danger. Pro-life supporters periodically pass laws which do not have such exceptions. There are indeed cases where the pregnant mother is likely to die if the pregnancy continues, but it may nevertheless be possible to save the fetus. Forbidding an abortion in such a case means that the life of the fetus is taken to be more important than the life of the mother. That is not a morally supportable decision. We require that children be reasonably protected; we do not require that mothers lay down their lives for their children. We honor the mother who runs into a burning house to save her child, but we do not imprison the mother who can’t bring herself to do so. A pregnant woman who is endangered by the pregnancy faces a very difficult choice, but it is her choice. We may not forbid her to choose her own life over that of her potential future child. (Similarly, we must permit her to attempt to complete the pregnancy if she so chooses.) (As a historical note, the main line of reasoning of Justice Blackmun in his controlling opinion in favor of Roe v. Wade was to preserve the right of the doctor to make a medical choice in cases such as this.)

A common argument made by pro-choice proponents is that a fetus should not have the rights of a child because a fetus is not fully developed. Often there is some attempt to draw a line between a fetus which can survive on its own outside the womb and one which can not. However, this is really unsatisfactory as a way of making a moral choice, as it is inherently dependent on technology. At one time many children miscarried or died during birth (and many women died in childbirth). With modern medicine the number of miscarriages is significantly down, and many children born as early as seven months survive. It is easy to envision the development of an artificial womb which can carry a fetus all the way from conception to birth (Lois McMaster Bujold has written a number of science fiction stories centered on such devices). I would not be surprised if such a device were developed in this century–if you doubt this, consider the astonishing advancements in medicine in the last century. In any case, my point is that you can not draw a strict moral line based on the viability of the fetus, because that line is flexible.

Neither side appears to have made the argument that a pregnant woman should only be required to carry the fetus to the point of viability, at which point perhaps labor could be induced artificially and the baby placed in a respirator. This is a somewhat facetious argument today, but if artifical wombs are indeed developed it will not be. It would then become possible to require a woman carrying a fetus who does not want to go through the complete pregnancy to submit to surgery to move the fetus into an artificial womb. This would still be a balancing of rights between the life of the fetus and the woman’s control over her own body, but the infringement on the woman’s right would now be at most the surgery and perhaps a few days recovery, rather than nine months of pregnancy.

This leads us directly into an issue which is often not clearly discussed in the debate: what happens to the baby after birth? The majority of abortions are for an unintended pregnancy. There are undoubtedly many reasons in general to abort an unintended pregnancy, but I believe that three of them stand out: 1) the woman feels that she is too young to have a child (her parents may also have some say); 2) the woman is older, but feels that she can not care for a child because of poverty, drug addiction, no support from the father, too many other children, or some such reason; 3) the woman will lose her job if she becomes visibly pregnant (this reason was perhaps more common in the past than today). Is the pro-life position arguing that we can force a pregnant woman to carry the fetus to term, or is it arguing further that we can force a pregnant woman to care for the baby after birth? The first is a challenge to the right of the woman to control over her body for nine months; the second is a challenge to the right of the woman to make decisions about her life for many years into the future. In general we do permit a new mother to put a new baby up for adoption, or to give the baby to some organization which will take care of him or her. It seems likely that making abortions illegal would lead to a significant increase in unwanted babies which will require support from society. Society would have to be willing to pay that price.

There is also the case of abortions of an intended pregnancy. The usual reason for this is that the fetus is discovered to have some uncorrectable genetic abnormality. Some of these are extremely serious and will cause the fetus to die before, or during, birth. In such a case it seems clear to me that an abortion should be permitted. A harder case is a fetus which is certain to die a few years after birth. The hardest cases are ones in which the baby can live a complete and fulfilling life, but one which is somehow diminished in the eyes of the mother, such as a fetus with Down’s syndrome, or some other significant handicap.

Let’s return to the central issue of balancing the rights of the pregnant woman and the fetus. In society we are often required to balance different rights and make a decision. We have the right of free speech, but it is illegal to verbally incite a riot. It is illegal to take food away from a starving man, but it is not illegal to walk past that man and refuse to give him the food you are carrying but do not need. Abortion is an actively argued issue, but nobody is seriously arguing that a pregnant woman should be forbidden from smoking, or drinking alcohol, or taking other actions which are proven to harm the fetus. (Perhaps I should say that nobody is arguing that yet.)

The example of walking past the starving man shows that in general taking action to harm somebody is forbidden, but avoiding action, walking away, is not, even if that causes harm. Put that way, we learn nothing about abortion, since having an abortion is certainly taking action. Now let’s turn the example around. If you are starving, you may ask for food, but it is illegal for you to take it. That is a case where you may not infringe on the rights of others, even if your own life is at stake. This may seem like a borderline case, but I think that the way our society treats homeless people makes it clear that property rights take precedence over the right to life. For example, homeless people routinely freeze to death in wintertime, but stealing a coat will land them in jail.

If a homeless person could only survive if the pregnant woman paid him or her $10,000, we would say that the woman could choose to pay, but the woman would not be required to pay. The fetus is making a comparable demand on the pregnant woman. Is the situation analogous? A fetus is not like a homeless person, because we do extend a right of protection to babies and children which we do not extend to adults.

Is there a limit to what a child can demand, even for life itself? Clearly there is. Failing to take a child to the doctor is illegal. Failing to obtain the best possible medical care for a child is not. Surgeons and pharmeceutical companies will often donate the expenses of caring for a child, but this is not considered to be obligatory. But at the same time let’s not lose sight of the fact that children may demand, and must receive, a great deal to survive.

I don’t know how to push these arguments much further. It seems to me that we are still left with a balancing decision. I don’t see a clear case for either an absolute pro-choice or an absolute pro-life position. While the fetus has a strong claim to life, we can not disregard the costs to the pregnant woman. There are cases where the cost will be too high. Counting the cost must include not only the cost of the pregnancy itself, but the cost of raising the child, or the emotional cost of giving him or her away for somebody else to raise. Any detectable genetic defect, such as Down’s syndrome, which requires extra care after birth, must also be factored in.

Who gets to count the cost and make the final decision? In principle it should clearly be the pregnant woman, since she will bear much of the costs. And in principle she is morally required to consider the opinions of the father very seriously. However in practice our society does not normally permit people to make these sorts of decisions entirely by themselves. Consider the case of organ donations, for example: even when donating an organ specifically for a close relative, we require counseling.

So it seems to me that, today, abortion should be permitted, and the final decision should be made by the pregnant woman. However, in cases where the woman’s life is not in danger, there should be mandatory counseling, and a mandatory waiting period of a few days before making the final decision. We should require notification of the father, if known, unless there is a good reason not to. In the case of a minor, we should require notification of the parents, again unless there is a good reason not to (e.g., incest).

In order to support the fetus as much as possible, and to make the argument against an abortion as strong as possible, we, as a society, must support the pregnant woman as much as possible. We should provide free medical care for pregnant women, we should permit women to leave work for the final months of pregnancy and the early months of childhood and have the government pay their salary, and we should require their employer to give them the same or a similar job afterward (or if they are in school they should be permitted to study at home, if necessary, and return as part of the same class, if possible). If the woman can not or will not care for the baby after birth, society must provide ways to care for the child, as we already do via adoption, foster homes, etc. And, it should go without saying, but apparently does not: we should try to avoid unwanted pregnancies by teaching teenagers how to prevent them.

I don’t see any ethical requirement to forbid an abortion at any particular point in the pregnancy. However, having such a requirement (e.g., forbidding abortions the third trimester) is not unreasonable, as the woman may be presumed to have had time to think about her situation.

I recognize that nobody is going to adopt these proposals in their entirety. But if they were adopted, we would have to reconsider them as technology advances to the point of creating artificial wombs. I’m not going to speculate on that here, as the right approach is inevitably going to depend upon details which we can not know.

All that said, there are a few more issues I want to touch upon.

First, contraception. There are some forms of contraception which are used after sex, when conception may have occurred. These are arguably equivalent to abortion, in that they may eliminate a blastocyst which could in principle develop into a baby. While I am generally reluctant to draw lines, I don’t think there should be any difficulty in saying that this form of abortion should always be permitted. In our society, sex has been substantially divorced from reproduction. Considering the world’s overpopulation, this is a good thing, and we should strongly support it.

Second, it’s worth noting that history tells us that if abortions are illegal, many woman will have them anyhow. Since illegal abortions are dangerous for the woman as well as the fetus, that is a strong argument for making abortions legal. However, it’s also worth noting that, as far as I know, there has never been a society in which accidental pregnancy is socially permitted and society supports the pregnant woman, but abortions are illegal. It seems at least possible that strong social support for pregnancy will significantly cut down on the number of abortions. We should recognize that it will not cut them down to zero. But we should also recognize that people will always break the law (laws which nobody breaks are unnecessary, and do not get written), and that breaking the law can be dangerous.

Third, I’m a man, and abortion is sometimes framed as a woman’s issue. Is it appropriate for a man to comment on it at all? Obviously, I think the answer is yes. I don’t believe that one can properly restrict ethical discussion to any subset of humanity. We all have our own individual experiences, and ultimately we are all in this together.