Chapter 5: Abortion

Abortion and public opinion Among medical ethical issues abortion is perhaps the most familiar to the general public and one about which almost everyone has an opinion. And that opinion has been strongly divided ever since the Supreme Court Decision of 1973, (Roe vs. Wade) which made abortion legal in the United States.

Ambivalent attitudes Americans’ ambivalence towards abortion is revealed in a May 2009 poll by the Gallup Organization: 23% said abortion should be illegal 53% believed it should be legal under some circumstances 22% said it should be legal in any circumstance. The poll also shows a slight swing in a conservative direction. When people were asked, “With respect to the abortion issue, would you consider yourself to be pro-choice or pro-life?” those answering pro-life rose to 51% from the 44% reported in 2005.

Ambivalent attitudes Those describing themselves as pro-choice declined from 48% to 42%. This is the first time a majority of U.S. adults have identified themselves as pro-life since Gallup first asked the question in 1995. This conservative shift was not accompanied, however, by a significant increase in the number of people wanting to see abortion outlawed. In a second 2009 Gallup poll, 75% of the interviewees expressed the view that abortion should be “always” or “sometimes” legal and only 23% endorsed the notion that it should always be “illegal.”

Abortion and New Medical Technology To some extent, the ambivalence about abortion and the public clash of opinions about its moral legitimacy may be due to new reproductive and life-sustaining technology, and an increased awareness of the character of the fetus.

Example: In Vitro Fertilization When a genetic disease like Tay–Sachs is present in a family, in vitro fertilization and the selection of an embryo free of the disease for implantation can avoid a problem that might lead to abortion. While for some, discarding unused embryos created by in vitro fertilization is equivalent to abortion, most people are more comfortable with the idea of destroying embryos than of aborting a fetus.

Example: Selective Reduction People have become more familiar with the concept of “selectively reducing” one or more developing fetuses in a multiple pregnancy resulting from the use of fertility drugs. For some, selective reduction is simply abortion by another name, but for others it is a procedure necessary to give the remaining fetuses a better chance to develop normally.

Example: Plan B In the past few decades, new drugs have been developed which can prevent pregnancies or terminate pregnancies very early after conception (Emergency Contraception, EC). These include drugs such as Plan B. Plan B is a treatment regimen that consists of taking two pills containing high doses (.75 mg) of a version of the hormone progesterone. Plan B prevents pregnancy by delaying or preventing ovulation, inhibiting fertilization, or preventing a fertilized egg from implanting itself in the wall of the uterus.

Example: Plan B Because there is no way to tell when an egg becomes fertilized after intercourse, Plan B blurs the line between contraception and abortion. A majority of Americans have no objections to contraception or to very early abortion, so they tend to see emergency contraception as a legitimate way to prevent an unintended pregnancy. Those opposed to contraception or to abortion, however, reject the use of Plan B.

Earlier viability of fetuses Another relevant development in technology is the ability to keep alive babies who are so premature that, in important aspects, they are still developing fetuses. A baby is considered full term if it is born forty weeks after conception, but it is possible to save the lives of infants who have had only twenty-three or twenty-four weeks of development. The fact that such small babies can survive outside the uterus has led many people to become more restrained in their endorsement of abortion or to favor restrictions on when it can be performed.

Prospects for resolving abortion dispute The technological developments just described (as well as others) have helped to keep America divided over the morality and legality of abortion. What are the prospects that this important social issue can be resolved? Because the deadlock over abortion has gone on for some timed, and in spite of an enormous amount public attention and litigation, the issue may appear beyond resolution. People simply have different moral intuitions about abortion and nothing can be done or said to bridge those differences.

Prospects for resolving abortion dispute The readings in this chapter can be seen as a challenge to this moral pessimism. They explore reason-based arguments for and against abortion. Because these arguments appeal to considerations that both opponents and supporters of abortion can accept, they offer the prospect of developing a consensus.

Ethical focus of chapter readings The chapter articles focus on two questions: Is abortion moral? Do medical professionals have an obligation to provide emergency contraception (EC) even if they object to their use for ethical reasons?

Comments on readings The writers in sections 1 and 2 of this chapter address the first of the questions: Is abortion moral? In section 2, John Noonan (“An Almost Absolute Value in History”) and Mary Ann Warren (“A Defense of Abortion”) square off against each over the question of whether a fetus is a “person”, that is, a being entitled to the same moral rights as an adult human being, such as, a right to life and liberty. They can be understood as seeing the key issue in the abortion debate as centering on the qualities or criteria necessary for making something a person. (Personhood argument)

Comments on readings Judith Jarvis Thompson, in “A Defense of Abortion” looks at the morality of abortion from a perspective different from the personhood argument. She asks us to assume, for the sake of argument, that fetuses are persons and therefore entitled to certain moral rights. She then examines and challenges the idea that the assumption of fetal personhood automatically leads to the conclusion that abortion is immoral.

Comments on readings In section 1, Don Marquis, presents an argument against abortion which, he claims, is not a personhood argument but instead rests on an analysis of what makes killing an adult human wrong, namely that killing deprives the person of a valued future. From this analysis, Marquis concludes that similar thinking applies to human fetuses, making abortion wrong except in special circumstances.

Comments on readings Don Brown offers a critique of Marquis based on the claim that there is a serious ambiguity in the idea of a future of value. This ambiguity means that there is no consistent way to understand Marquis’ argument that will make it successful. Brown’s criticism employs the idea of rights and the conditions under which those rights can be ascribed. These explorations suggest that the personhood argument, and Marquis’ argument, are more closely linked than might at first appear.

Section 1: Abortion and the “Deprivation of Futures” Argument

Reading: Why Abortion Is Immoral Don Marquis The author offers what he considers to be an essentially new argument to establish the basic wrongness of abortion. The reason murder is wrong, according to Marquis, is that it deprives a person of the value of his or her future. Because a fetus, if not aborted, can be assumed to have a future like ours that is also of value, abortion, like any other kind of killing, can be justified only by the most compelling reasons. Contraception, by contrast, is not wrong, because there is no identifiable individual to be deprived of a future.

Reading: The Morality of Abortion and the Deprivation of Futures Mark T. Brown Mark Brown rejects Don Marquis’s argument that abortion is wrong for the same reason that killing an adult is wrong: it deprives the person of a future of value. Brown claims that the argument trades on the ambiguity of “future of value,” which may mean either “potential future of value” or “self-represented future of value.”

Reading: The Morality of Abortion and the Deprivation of Futures Mark T. Brown The first interpretation implies that we commit homicide whenever we fail to provide someone with whatever he needs to live, but not to provide someone with necessities (e.g., medical care) is not necessarily to treat him unjustly. A fetus could have a presumptive right to life only if women had no right to control their bodies.

Reading: The Morality of Abortion and the Deprivation of Futures Mark T. Brown Marquis’s argument fails for it “implausibly” assigns people “welfare rights to valuable futures” and “liberty rights not to be killed.” While the second interpretation makes Marquis’s argument deductively valid, it cannot be sound (i.e., have all true premises), because the fetus lacks the neurological development required for imagining a future. Marquis’s argument gains its force only by trading on the ambiguity of “future of value.”

Section 2: Abortion and the Status of the Fetus: The Classic Arguments

Reading: An Almost Absolute Value in History John T. Noonan, Jr. John Noonan argues that at the moment of fertilization a developing human being becomes a person. Noonan reviews some distinctions used by abortion proponents who maintain that personhood is achieved at a later stage of development (viability, experience, and social visibility) and concludes that they are all illegitimate.

Reading: An Almost Absolute Value in History John T. Noonan, Jr. Noonan argues that conception is the decisive moment of humanization because it is then that the new being receives a genetic code from its parents. The basic principle that should govern our attitude toward the fetus, Noonan claims, is a theological and humanistic one: Do not injure your fellow man without a sufficient reason. Thus, abortion is never right, except to save the mother’s life. Abortion is immoral because it “violates the rational humanistic tenet of the equality of human lives.”

A Defense of Abortion Judith Jarvis Thomson Judith Jarvis Thomson, in this very influential article, avoids the problem of determining when the fetus becomes a person. For the sake of argument only, she grants the conservative view that the fetus is a person from the moment of conception. She points out, however, that the conservative argument using this claim as a premise actually involves an additional unstated premise. The argument typically runs as follows: The fetus is an innocent person; therefore, killing a fetus is always wrong. The argument requires that we assume that killing an innocent person is always wrong.

A Defense of Abortion Judith Jarvis Thomson But, Thomson claims, killing an innocent person is sometimes allowable. This is most clearly so when self-defense requires it. Using several moral analogies, Thomson attempts to show that a fetus’s right to life does not consist in the right not to be killed, but in the right not to be killed unjustly. The fetus’s claim to life is not an absolute one that must always be granted unconditional precedence over the interests of its mother.

A Defense of Abortion Judith Jarvis Thomson Thus, abortion is not always permissible, but neither is it always impermissible. When the reasons for having an abortion are trivial, then abortion is not legitimate. When the reasons are serious and involve the health or welfare of the woman, then abortion is justifiable.

On the Moral and Legal Status of Abortion Mary Anne Warren Mary Anne Warren takes an even stronger position than Thomson, arguing that a woman’s right to have an abortion is unrestricted. She attempts to show that there is no adequate basis for holding that the fetus has “a significant right to life” and that, whatever right can be appropriately granted to the fetus, it can never override a woman’s right to protect her own interest and well-being. Accordingly, the laws that restrict access to abortion are an unjustified violation of a woman’s rights.

On the Moral and Legal Status of Abortion Mary Anne Warren Warren is critical of both Noonan (see earlier article) and Thomson. Noonan, she claims, fails to demonstrate that whatever is genetically human (the fetus) is also morally human (a person). Thomson, Warren argues, is mistaken in believing that it is possible both to grant that the fetus is a person and to produce a satisfactory defense of the right to obtain an abortion. Contrary to Thomson’s aim, Thomson’s central argument supports the right to abortion only in cases in which the woman is in no way responsible for her pregnancy.

On the Moral and Legal Status of Abortion Mary Anne Warren Like Noonan, Warren conceives the basic issue in abortion to be the question of what properties something must possess to be a person in the moral sense.   She offers five traits she believes anyone would accept as central and argues that the fetus, at all stages of development, possesses none of them. Since the fetus is not a person, it is not entitled to the full range of moral rights. That the fetus has the potential to become a person may give it a prima facie right to life, but the rights of an actual person always outweigh those of a potential person.

Section 3: Emergency Contraception and Professional Responsibilities The essay by Robert Card (“Conscientious Objection and Emergency Contraception”) highlights an ethical issue created by the development of “emergency contraceptives” (ECs) capable of preventing pregnancy early after intercourse. As noted earlier, ECs help to blur the line between contraception and abortion in the publics’ mind but, it has also done so in the minds of medical professionals as well.

Section 3: Emergency Contraception and Professional Responsibilities For medical professionals, the ambiguity can be particularly acute since on the one hand, their responsibility, as professionals, requires that they meet the legitimate medical needs of their patients. But what if the professional believes, personally, that the use ECs is morally objectionable? Do his medical responsibilities require that he provide them if asked? Card, reviews and critiques several arguments that have been proposed to resolve this dilemma.

Conscientious Objection and Emergency Contraception Robert F. Card Card argues that pharmacists, nurses, and doctors have a professional duty to inform women about emergency contraception (EC) and to provide it when requested. He rejects the standard solution to the problem EC poses to medical professionals who object to it on conscientious grounds—namely, referring patients to a willing provider. This solution, Card claims, can result in great harm to women, may compromise patient confidentiality, and fails to fulfill the obligations of a medical professional.

Conscientious Objection and Emergency Contraception Robert F. Card In Card’s view, professionals can’t legitimately object to EC on the same grounds as they might object to abortion, because EC prevents ovulation and thus operates before fertilization occurs. Professionals might try to object to EC on the grounds they would use to object to contraception, holding that EC is unacceptable either because it deprives reproductive cells of the opportunity to become persons or because it interferes with procreation, which is the only acceptable goal of intercourse.

Conscientious Objection and Emergency Contraception Robert F. Card Card counters the first objection with the argument that possible persons cannot be harmed by being prevented from becoming persons.(See the essay “’Give Me Children or I Shall Die!’ new Reproductive Technologies and Harm to Children”, Chapter 3 for a detailed discussion.) The second objection he dismisses as injurious to rape victims (procreation can hardly be their goal) and as inconsistent with the autonomy-based right of adults to make reproductive decisions (e.g., to have a sex without the goal of reproducing).

Conscientious Objection and Emergency Contraception Robert F. Card If adults have a right to contraception, then medical professionals must offer and provide EC. Unlike other contraceptives, EC must be used within 72 hours after sexual contact, so referral to a willing provider may delay EC beyond this time, particularly in rural areas with few providers and for disadvantaged patients who typically delay seeking help.   For those reasons, Card concludes, medical professionals cannot ethically refuse to offer and provide EC. Referring women elsewhere will not let them escape their professional duty.