Ted Grimsrud—October 30, 2011
I have to admit that I have never been especially exercised by the abortion issue.
On the one hand, I have never found the strict anti-abortion position attractive. While self-labeled as “pro-life,” it has often struck me as rigid, legalistic, ideological, and too easily co-opted by political forces that in other respects are pretty anti-life. Yet I also have a hard time thinking of abortions as positive or even morally neutral acts. I also am uncomfortable with arguments that present abortion is strictly a matter of the pregnant woman’s personal choice.
And it is not an issue I have ever had close personal experience with. So it has been easy to focus on other issues—as I still do.
However, in the introductory ethics course I teach to mostly first-year college students, I use abortion as one of several case studies we briefly consider. So I do find myself getting more interested.
The success of “pro-life” rhetoric
I am struck more and more with how successful the anti-abortion advocates seem have been in setting the terms of the discussion. Most students seem to take it as a given that human life (in the sense of deserving of full human rights, let’s call this “personhood”) begins when the egg is fertilized. So, abortion at a very early stage is understood to be the taking of a human life, morally equivalent to murder. When pushed to consider it, many of these students would see that even “birth control” methods that prevent fertilized eggs from being implanted on the uterine wall (e.g., the “morning after pill”) are abortion.
This seems to paint people into a corner. We have heard several true-life stories from guest speakers about cases where the strict pro-life belief led to actions that many in the class recognize as seemingly problematic.
One woman, a happily married mother of three other kids, got pregnant (by choice) a fourth time and shortly thereafter was diagnosed with an aggressive form of cancer. She was told that if she underwent treatment immediately, her chances of survival would be high—but such treatment would terminate her pregnancy. If she waited for the treatment until the baby was born, her chances of survival would be much less. Due, in large part, to her belief that the fetus was a full human being, she felt she would be guilty of murder if they allowed the pregnancy to be terminated. So she did keep the baby, it was born and was healthy, and she then had her cancer treated. But it was too late and she died shortly afterwards.
In a second case, a married woman nearing the end of her child-bearing years and to that point unable to conceive, became pregnant with triplets thanks to implantation of fertilized eggs. Early in the pregnancy, one of the triplets died. At about 20 weeks, the water broke on one of the remaining babies. That meant that the wastes from that baby threatened to poison the other baby. At that point, the parents faced a choice. They could abort the baby whose water had broken with a 95% chance of survival for the other baby. Or they could try to keep both babies with a 95% chance both would perish. The parents were strongly “pro-life” and agonized terribly with the decision. They were persuaded by medical staff and friends to go ahead with the abortion. The remaining baby was born and was healthy—but the mother continued to be plagued with powerful guilt feelings and had an emotionally difficult time with the birth and the early days afterwards.
Now, certainly, these were both complicated situations. However, it does seem that at least part of what made them complicated was what I consider to be an ideological commitment to an abstract and actually counter-intuitive belief. Certainly, most people would appropriately see great value in the beginnings of life in these mothers’ wombs. Especially since, in both cases, the mothers themselves affirmed the personhood of these babies. However, by equating the beginning lives with full personhood, the mothers put themselves in unnecessarily difficult situations, it seems to me. In the one case, by refusing to treat her cancer, the mother may have made a courageous choice but one that was quite costly to many people beyond herself. In the other case, the mother came within a hairsbreadth of greatly compounding what was certainly a tragic situation and, in making what most would see as the best decision, undermined her emotional health and her relationship with the surviving baby with her bad conscience.
But is abortion actually murder?
As we talked further in the class, it did become clear that even the strongly “pro-life” students operate in actual life as if abortion is not actually the same thing as murder. In our case study, we consider the story of a 19-year-old college student who faces an unintended pregnancy. When asked how they would respond if this student were their friend and she did get an abortion, even the most staunchly “pro-life” students tend to think they would counsel her against the abortion but would remain her friend and try to support her in dealing with the emotional complexities of the situation. But when asked if they would offer such support to a friend who murdered a mutual friend, they said no, of course not.
That is, they intuitively recognize that the pre-viability fetus is not a human being in the same sense as one of their peers. Few, if any, actually want to treat abortion as murder. So, the rhetoric of “full personhood from the time of conception” is a slogan more than a consistent and carefully considered conviction.
When we talk about what they base these “full personhood” convictions on, they tend eventually to recognize that these convictions are confessional—that is, based on their religious beliefs. Then they recognize that these beliefs are not share by everyone and that, in fact, there seems to be no way that they could hope for everyone to agree. So, how might we proceed in face of these differences?
Working against polarization and toward a middle way
Is it possible to work toward a middle way? If we were to find an approach that might work in our society, significant numbers of people on each side of the polarization probably would need to bracket a central “absolute” conviction (I say “bracket,” not “give up,” because all that would be needed would be a willingness to recognize the conviction as not fully applicable for social policy). For the “pro-life” people it is this conviction about full personhood from time of conception. For the “pro-choice” people it is the conviction about the absolute right of privacy that makes abortion totally a private decision concerning what a pregnant woman does with her own body.
Maybe people could acknowledge that beliefs about the moment of full personhood are confessional (and even mysterious), not public facts—allowing for the possibilities of diversity of belief and therefore of practice concerning abortion. Maybe people could acknowledge that from its beginnings, a pregnancy brings into existence a living creature that has its own existence and deserves the benefit of the doubt as much as possible. Hence, society does have an interest in reducing the numbers of abortions.
I would suggest that there are several important moral values that should form the basis of an effort to seek a middle way on abortion. First of all, life is to be valued. Public policies should reflect a commitment to honor and sustain life—both the life of the mother and the emerging life in the uterus. Second, it is not socially healthy for anybody to have the kind of politicized polarization that our society has right now on this issue. Third, it is simply a social fact that unwanted pregnancies do happen. That is, we take up the abortion issue in the midst of what we could call a broken situation, which implies that we don’t have any possibility of a morally pure or even morally clear context for addressing the issue. There are always various stakeholders involved whose interests are not fully compatible with each other. This “social fact” argues strongly for a predisposition toward compromise, where are stakeholders are willing to loosen their insistence on the “absolute right” they are advocating.
Toward a public health approach
So, what if we thought more in public health than moralistic terms? What if we agreed in seeing abortion more as a public health problem than as an issue of absolute moral right and wrong? If we think of it as a public health problem, we will focus more on the big picture, more on prevention, less on moralistic “absolutes.” If abortion is a public health problem, we will not think so much about eradicating it as about minimizing it as much as possible. And we will accept that abortion is indeed a problem; it is problematic and we should desire that we have fewer abortions (a lot fewer).
Here might be one way to think about it: What if we were to think of the “personhood”of the fetus as determined by the mother until the time of viability (which now is approximately 24 weeks)? And then, what if we agree that we want a society where all mothers affirm the personhood of all fetuses from the very beginning of the pregnancy? With this assumptions, we could agree that we should seek a society that greatly reduces the numbers of unwanted pregnancies—and thereby the numbers of abortions.
A public health approach would ask, as a fundamental question, why is it that women have abortions? Then, it would ask, can those reasons be addressed without abortion? The focus would be on addressing the issue as a problem of unwanted pregnancies more than as a problem of abortion.
How do we best reduce abortions?
So, then the question would be, do you reduce the numbers of abortions (a lot) by mainly by limit access to abortions or mainly by creating much less demand for abortion? It would seem clear that creating less demand would be much more effective in reducing the numbers of abortions based on evidence from around the world. For example, the countries in the world with the lowest rates of abortion are western European countries that allow for legalized abortion (in most cases paid for through socialized medicine). A number of countries with the highest abortion rates are places that make abortion illegal. For example, the rate in Holland (with open access to abortion) in recent years was 7 abortions per 1,000 women of reproductive age; the rate in Peru (where abortion has been illegal) was 56 abortions per 1,000 women of reproductive age.
An approach that focuses on limiting access (which is supported by the “pro-life” movement in the U.S.) would emphasize making laws to make abortion illegal, or at least much more difficult. It would eliminate governmental assistance to pay for abortions. It would try to reduce the number and accessibility of abortion providers. It may try to intimidate and “get in the way” of people who seek abortions.
An approach that focuses on reducing demand would would emphasize addressing the factors that lead to unwanted pregnancies. It would encourage sexual education for young people and access to birth control. The sexual education would seek both to inform people as to how the human reproductive system works and to encourage healthy and positive sexual intimacy that does not lead to pregnancy. The demand reduction approach would also seek to address economic and health care issues by providing assistance that would make pregnancy and childbirth less risky and difficult. It would work to empower women and to confront male sexual coercion. It would seek to reduce the stigma that is attached to pregnancies in unapproved contexts (i.e., unmarried mothers).
Of course, this second strategy, the demand reduction approach, would have the virtue of addressing a much broader circle of concern than simply the isolated pregnant woman. It would emphasize healthy relationships, economic equality, and empowerment of women. These virtues, sadly, are also part of the reason why this kind of approach might be resisted by interests who benefit from the problems this approach would alleviate.