So, I’ve been thinking a lot about what to do for my first essay on this blog: whether I want to go short and sweet or more in-depth, pick a contentious issue or try to steer away from controversy, etc. And then this story hit my Facebook feed, looking like something I might write a horror tale about:
Actually, what hit my Facebook feed was the much more exaggerated “Actress Patricia Heaton’s Message to MSM about Planned Parenthood Butcher, ‘Hannibal’” – but you get the idea.
So I thought: what the hell, might as well jump in with both feet and get the shock of becoming “politically controversial” out of the way now. No time like the present, eh?
So, abortion. Let’s talk about it.
Let’s talk about it in spite of – or perhaps because of – the fact that it is often a very difficult thing to talk about. Few issues seem to stir up more heated emotions, on the right or the left, than the issue of abortion. I myself have struggled with a lot of internal conflict over this issue, and even now I consider my position fairly tentative and open to revision. On one hand, I am strongly committed to liberalism, feminism, and a secular humanistic approach to life. I believe it is of paramount importance that women have control over their own bodies, especially concerning how and when they will have children. I strongly support efforts to increase the availability of birth control, which I believe both empowers women and aids in curbing overpopulation and its related problems. On the other hand… Like most people, I consider all life to be inherently valuable; and I believe that it is the responsibility of any civilized society to protect the powerless and the voiceless from abuse. (For instance, I am quite passionate about animal welfare). As such, I feel that there are very valid ethical concerns raised by the termination of a pregnancy, and that society/government/etc. has an obligation to explore those concerns and take appropriate action to protect human life and human rights.
In general, I come down on the “pro-choice” side of matters, but it’s been a weird journey getting here. I felt like it would be helpful for me, and possibly for others as well, to outline some of my ideas about the ethicality of legal abortion and where those ideas came from. Enjoy! – (and please don’t be too cruel in the hate mail! ^_^)
WHERE I BEGIN
I suppose my train of thought on abortion begins with the stance that life does NOT begin at conception. Or at least, human personhood does not begin at conception. And this IS an important distinction to make. A “life” can be anything – a human, a dog, a plant, an amoeba… you get the idea. A “person” is a human being with feelings, thoughts, desires, dreams… and most importantly, rights. No matter how wildly my thoughts on abortion have changed over the years, I have never once considered a newly fertilized egg cell a person. If you are seriously going to tell me that a ball of 2 or 4 or 16 undifferentiated cells is a person, and that preventing its further development is murder – well, I’ll just have throw out my philosophical and moral compass entirely, because I don’t even know which way is up anymore.
Some argue that a fertilized egg represents a potential person, and that preventing it from becoming a person amounts to murder. I’ve never seen much value in that argument. Sure, a fertilized egg could become a person if certain conditions are met. But so could an unfertilized egg – the condition being that it is fertilized by a sperm, implants successfully, and is carried to term. If we’re going to be assigning potential people the same rights as actual people, we may as well make masturbation a crime and go around singing “Every Sperm is Sacred!”
No, no, wait, I was being sarcastic! STAHP WITH TEH SINGING!!!
Anyway, now that my attempt at humor has likely fallen flat, I must admit that I take issue with the opposite extreme on subject of personhood as well. To claim that a fetus at, say, 22 weeks is not a person, but a mere collection of tissues that can be claimed as a part of its mother’s body – that seems very disingenuous, and probably flat-out false. It seems more like a parody of a pro-choice argument than one that we would actually use. By 22 weeks the fetus can move, respond to sounds, and is barely shy of being able to survive outside the womb with intensive care (2). It looks something like this:
It seems evident to me that at this stage, an abortion would indeed end the life of a separate, human person. The big philosophical quandary lies not at either extreme of fetal development, but in the middle. When, exactly, does an embryo or fetus cease to be a merely a cluster of cells or tissues supported by its potential mother’s body (which she can ethically choose to cease supporting for any reason), and become an individual person, with a right to life that supersedes (or at least competes with) his/her potential mother’s right to end the pregnancy?
DRAWING THE LINE
Opinions differ widely on when personhood – and the associated right to life – begins, and I doubt that any consensus will be reached for a long, long time. Personally, I would define the beginning of personhood as the beginning of conscious experience. Consciousness is what I think of when I try to explain what it means to be alive… and what people seem to most fear will end upon their deaths. If one never becomes conscious, then there is nothing to end; no unique “self” that dies. But defining when consciousness begins is another tricky, subjective undertaking that is unlikely to be resolved. So where does that leave us?
Personally, I choose to draw my ethical line at the end of the first trimester (weeks 1-12 of pregnancy). At the end of Month 3, the fetus’s most critical development has taken place, but its nervous system has not yet begun to function (2). Consciousness may be an elusive quality to define, but one thing we seem to know with near certainty is that it cannot exist without a functional nervous system – more specifically, a brain that is equipped to generate consciousness. However, the nervous system will begin to function in Month 4, so defining personhood to begin at the end of the first trimester seems to me a good conservative estimate (2).
(On a logistical note as well – up through Week 9, abortion can often be done through chemical means, rather than surgery, making it a safer and less invasive procedure. (4))
If I were ever to find myself with an unwanted pregnancy, I would feel comfortable terminating it within the first trimester. However, after that I would not be able to do so without violating my moral standards, nor do I feel that I could support the decision of a friend or family member who chose to do so.
That’s just me, though. The question remains: should MY definition of personhood – or anybody else’s, for that matter – influence what other women are allowed to do under U.S. law? It might seem from the discussion above that I would support banning abortion after 20 weeks, on the grounds that it was tantamount to murdering a baby. However, that is not necessarily the case, and there are two main reasons why:
REASON 1: BODILY AUTONOMY
For the purposes of discussion, let’s just say that somehow I have come to the correct conclusion about when personhood begins, and any abortion after the first trimester ends a human life. Should such abortions still be legal, even without extenuating circumstances such as rape, incest, risk to the mother, or fatal defects in the fetus? The reflexive answer would be “no”… and for a long time, that was my answer as well. However, that position is challenged by the notion of bodily autonomy, as is so eloquently summarized by Hannah Goff on Tumblr:
“There is a concept called body autonomy. Its generally considered a human right. Bodily autonomy means a person has control over who or what uses their body, for what, and for how long. It’s why you can’t be forced to donate blood, tissue, or organs. Even if you are dead. Even if you’d save or improve 20 lives. It’s why someone can’t touch you, have sex with you, or use your body in any way without your continuous consent.
A fetus is using someone’s body parts. Therefore under bodily autonomy, it is there by permission, not by right. It needs a person’s continuous consent. If they deny and withdraw their consent, the pregnant person has the right to remove them from that moment. A fetus is equal in this regard because if I need someone else’s body parts to live, they can also legally deny me their use.
By saying a fetus has a right to someone’s body parts until it’s born, despite the pregnant person’s wishes, you are doing two things
1. Granting a fetus more rights to other people’s bodies than any born person.
2. Awarding a pregnant person less rights to their body than a corpse.” (5)
I think we can all agree that if, say, John Doe refused to donate his bone marrow to a relative, with the full knowledge that said person would die without it, then John Doe is most likely an immoral douchebag. However, that is within his rights under bodily autonomy, and he has done nothing wrong under the law. To change that would likely invite compelled intrusions of others’ bodies under less clear-cut circumstances (e.g. when the procedure was riskier for the donor). Similarly, I doubt that any sane woman would casually decide to get a late-term abortion without a compelling reason. Rather, she would come to the decision after long contemplation, for one of many highly compelling reasons. Which brings me to my next point:
REASON 2: PERSONAL STORIES AND EXTENUATING CIRCUMSTANCES
The most compelling reasons that I can think of for having an abortion after the first trimester are health risks for the mother and defects in the fetus. Often, severe fetal abnormalities are not detectable until the routine 20-week sonogram. Women with wanted pregnancies, breathlessly anticipating the arrival of their child, may at this point be shocked with the news that their baby has multiple abnormalities and is possibly dying. This is what happened to a woman named Nicole Stewart.
“Nicole is the founder of Oral Fixation, a local theater series featuring true-life storytelling. Each show is loosely themed on a figure of speech. And last spring, Nicole was so overjoyed at being pregnant that she picked “Bun in the Oven” for the start of Oral Fixation’s third season in October.
But happy and funny were not to be.
She and her husband went in for the routine first sonogram at 20 weeks of pregnancy. “We went just to find out the sex of the baby,” she said, “and we found out so much more.”
The sonogram revealed a number of abnormalities in the baby boy. More tests followed. Doctors brought up termination of the pregnancy. And Nicole was devastated. “This was the hardest thing I ever dealt with in my whole life,” she said.
Ultimately, an MRI confirmed the worst. “The entire brain was abnormal,” she said. Another sonogram showed that fluid was building up in the brain and lungs. “The baby was going to stop being able to swallow and essentially drown.”
After much conversation and consultation, the couple decided on an abortion. Nicole was about 22 weeks along.
This was last June. And it so happened that at the very time, the Texas Legislature was debating a bill to forbid such an abortion. It would move the time limit from 24 to 20 weeks.
The new Texas law does create an exemption to the 20-week ban for “severe fetal abnormality,” but Nicole is concerned that the government gets to define that rather than doctors and patients.” (6)
Stories like this make me deeply skeptical of bans on abortion after 20 weeks. Even if we were to reject the “bodily autonomy” argument outlined above, and agree that abortions should be illegal after 20 weeks without intervening health concerns, the question remains: What role should the government have in deciding which maternal and/or fetal complications are severe enough to merit an exemption to the ban? Should it be left entirely between a woman and her doctor; and if so, wouldn’t the ban be largely unenforceable? And if the government were to create strict guidelines on which conditions merit exemption, might that not create serious problems for both doctors and patients? I can easily imagine a situation in which a woman would be forced to postpone her abortion – increasing both the risk and the emotional/moral impact of the procedure – while doctors struggled to navigate through bureaucratic red tape to prove that the mother or fetus was “sick enough” to merit an exemption. I can also imagine doctors altering their recommendations and even compromising patient care for fear of being criminalized after performing a legally questionable procedure.
While the reasoning above would seem to lead to a position against 20-week bans – and for me, it largely has – there are a number of counter-arguments that make my position on the matter a little bit more malleable. For instance, the comparison of blood/tissue donation to abortion is an imperfect one. In the case of tissue donation, doctors must actively intervene to (a) invade the body of the donor and (b) save/improve the life of the recipient. Allowing the situation to continue naturally would result in the death/deterioration of the potential recipient and maintain the bodily integrity of the donor. In the case of abortion, active medical intervention is required to remove the fetus, thus reasserting the bodily autonomy of the woman and ending the life of the fetus. If the fetus is seen as a person, this active intervention may be viewed as a violation of its bodily autonomy. After all, surgical abortions cannot simply disconnect a fetus from its mothers’ body as one might from a life-support machine. The procedure must interfere with the fetus’s body in ways ranging from merely grasping it, to stopping its heart with an injection, to “crushing” parts of it during extraction (7,8).
At this point, the fetus is obviously unable to understand or consent to any of this – as discussed above, it is debatable whether it is even developed enough to count as a person yet. However, if we accept it as a person, its lack of consent means that such procedures violate its bodily autonomy. On the other hand, not performing the procedure, and thus allowing it to continue using its mother’s body without her consent, violates her bodily autonomy. This leaves us with an obvious conflict of interest, and a very complex moral grey area to navigate.
THE GREY AREA
So how does one balance a potential mother’s interests against her fetus’s interests? And what role, if any, should governmental regulation have in this process? When it comes to navigating such an ethical labyrinth, the specifics of each individual situation are of paramount importance. For instance, if a woman came up to me and said:
“I’m 22 weeks pregnant. I’ve known about my pregnancy for a while; and now, for no real reason, I’ve decided that I want to get an abortion. Should I be permitted to terminate my pregnancy?”
Then I would have no problem telling her: “No. And by the way, are you a sociopath? Because it kind of sounds like you are.” But what if a woman came up to you at 20 or more weeks pregnant and told you any of the following?
“I’m single, financially disadvantaged, working 2 jobs, and trying to put myself through school online. I got pregnant because my ex-boyfriend’s condom broke, and ever since I found out I have wanted to terminate the pregnancy. However, circumstances beyond my control prevented me from doing so earlier, and now I’m past the 20 week mark. Should I be permitted to have an abortion?”
“I’ve been happily expecting my first child for the past several weeks, but my doctor just diagnosed me with a deadly illness. My chances of survival will increase significantly if I choose to terminate my pregnancy now rather than carry it to term. Should I be permitted to have an abortion?”
“I was raped by a member of my immediate family, who has until now prevented me from seeking an abortion. However, he has finally been arrested, and I would like to terminate my pregnancy. Should I be permitted to have an abortion?”
“I just went in for my 20-week sonogram and discovered that my baby has severe brain abnormalities. She will most likely lack all higher cognitive functions, be unable to care for herself, experience a low quality of life, and die in her early 20s. I don’t want that for her, my family, or myself. Should I be permitted to have an abortion?”
“I just went in for my 20-week sonogram and discovered that my baby has multiple severe abnormalities. There is a 90-95% chance that she will die before, during, or shortly after birth; and if she lives her health and quality of life will be severely compromised. I would rather terminate my pregnancy than put myself and my family through that. Should I be permitted to have an abortion?”
You can see just how complex and personal these sorts of decisions may be. When it comes to the ideal response to each kind of situation, and what role the law/government should have in regulating such decisions – well, my best response is that I don’t know. I’m not sure that anyone does.
Hypothetically, I could see myself being persuaded to support a thoughtful, well-crafted 20-week ban with wide exemptions for medical complications – leaving the decision of whether a condition was severe enough to merit an exemption almost entirely between a woman and her doctor. But I don’t think there will ever be a “perfect solution” which ideally balances both maternal and fetal interests and doesn’t cause problems or injustices for anyone involved. Any 20-week ban would be imperfect, just as our current cutoff of 24 weeks is imperfect: such a change would only represent a minor shift in the burden of those imperfections from developing fetuses to doctors and pregnant women. And I’m not entirely convinced we need that.
For me, it seems like enough to do all we can to prevent women from needing a second-trimester abortion in the first place. To make sex education comprehensive and birth control universally accessible, to develop earlier screening techniques for potentially fatal abnormalities, etc. And in the rare cases where women do feel the need to seek a second trimester abortion, we must ensure that doctors adhere to strict ethical guidelines, give accurate and unbiased counsel, and make procedures as safe and humane as possible.
Perhaps some additional restrictions around 20+ week abortions would help towards the fairness and ethical betterment of society. Perhaps not. I don’t have any idea. However, I can think of a few things which I consider unhelpful. Emotionally manipulating women with forced ultrasounds and state-mandated propaganda masquerading as “informed consent” is not helpful. Trying to throw roadblocks in the path of women’s access to legal abortions is not helpful (and tends to disproportionately impact the underprivileged). Attempting to shut down abortion clinics with arduous and unnecessary regulations is not helpful. And black-and-white extremist rhetoric on either side of the debate is definitely not helpful.
Crafting better policies around the issue of abortion will be difficult. For many women, making a gut-wrenching decision in the midst of a complex, no-win situation will be even more so. But I believe that, if we approach this issue with rationality and compassion, we can find ways to make tomorrow’s world a brighter and more just place for everyone. A reasonable and productive debate around abortion has no place for extremist rhetoric vilifying abortion providers and pro-choicers as deluded, morally bankrupt murderers… or decrying abortion opponents as ignorant, controlling misogynists.
I may not know what is best for policy, but I do have a bit of advice for politicians, media, and pundits: Start recognizing the grey areas. Step into someone else’s shoes. And for Pete’s sake, try to grow some fucking empathy. Otherwise, you may find yourself causing more problems than you solve.
SO WHAT DO I THINK ABOUT THE NEW PLANNED PARENTHOOD “SCANDAL”?
I have no objection to giving women who undergo legal abortions the option to donate fetal tissue/organs to potentially lifesaving medical research. As a matter of fact, I believe this is a much better option than simply allowing that tissue to go to waste – as long as strict ethical guidelines are observed in the process. For instance, here is a sample of the ethical guidelines for fetal tissue donation outlined by the Office for Human Research Protections:
“(A) in the case of tissue obtained pursuant to an induced abortion—
(i) the consent of the woman for the abortion was obtained prior to requesting or obtaining consent for a donation of the tissue for use in such research;
(ii) no alteration of the timing, method, or procedures used to terminate the pregnancy was made solely for the purposes of obtaining the tissue; and
(iii) the abortion was performed in accordance with applicable State law;” (9)
I deeply and sincerely doubt that Dr. Nucatola or Planned Parenthood are selling fetal tissue/organs for a profit. This would be extremely illegal, and if someone wanted to selfishly enrich themselves by skirting around legal and ethical guidelines, they probably wouldn’t choose a profession in which the media vilified them, their workplace was constantly picketed, and there was always the distant threat of some nut job trying to assassinate them. To me, it seems like the video and its producers are merely exaggerating and slanting a discussion of a completely legal process – the donation of fetal tissue to medical research and the reimbursement of costs associated with shipping and staff hours – in order to produce an emotional impact. As The Atlantic notes:
“… even if there’s nothing illegal, it’s easy to see how the video is a coup for the anti-abortion movement. The pro-choice and pro-life movements tend to talk about abortion in very different terms. Those who support abortion couch their argument in terms of women’s bodily autonomy, or in terms of a right to privacy. Abortion opponents sometimes use similar rights language, speaking of the rights of the unborn. Yet they also often use graphic images of aborted fetuses, for example, to highlight the visceral reality of abortion…
That’s what may make the video potent. Nucatola discusses the use of tissue from aborted fetuses, including the extraction of specific organs, over a casual lunch. That may strike many viewers as callous and inhumane. The disgust factor is real and important. For example, the activists posing as buyers ask Nucatola about the condition of organs after procedures. She responds with a detailed answer about how abortions are conducted to ensure good conditions.” (10)
However, on the other side of things, I don’t trust for-profit companies worth a damn – and that includes biotech and pharmaceutical companies dedicated to curing disease. It is notoriously easy for professional ethics to go downhill as soon as money becomes involved. Numbers for shipping and personnel costs could be rigged “so that it seems like they’re just recouping when in fact they are a revenue stream.” (10) If there is any real evidence behind the accusations of wrongdoing against Planned Parenthood, then I would like to see an investigation conducted by the government and/or a reputable, unbiased third-party agency. And even if there is no evidence of wrongdoing, I would still like to know what procedures and safeguards are in place to prevent ethical violations from happening. For instance, shouldn’t any research study involving human subjects be under the supervision of an Institutional Review Board? What do these studies’ IRBs have to say about all of this?
As to the “callous and inhumane” nature of Dr. Nucatola’s comments: I can definitely see why that discussion would rub people the wrong way, and in all honesty it had the same effect on me. But I also understand that graphic and unnerving aspects of medical procedures must sometimes be discussed in a manner that is frank and detached from the strong emotions that usually – and ought to – go along with them. As a biology student who has often needed to euthanize fish for my own research, I know firsthand how easy it is to become desensitized to tasks that one may initially find disturbing and ethically difficult. That is why oversight by ethical boards and committees is so important: to ensure that such desensitization does not breed a careless or lax approach to important ethical standards.
Dr. Nucatola may have been callous, but she’s not “Hannibal,” and Planned Parenthood is not an evil corporation profiting from sales of dead baby parts. Some investigation may be required to ensure that they are properly complying with established ethical standards, and I welcome that prospect. However, I don’t think that the government should cut funding to (or take other punitive action toward) Planned Parenthood until there is at least some hard evidence of wrongdoing. And I’ve already made clear how I feel about vilifying abortion providers and guilting/shaming women about their abortions.
It doesn’t. Fucking. HELP.
http://www.patheos.com/blogs/lovejoyfeminism/2012/10/how-i-lost-faith-in-the-pro-life-movement.html – (Long article, but worth the read. One of my favorites on the subject.)
http://www.2think.org/abortion.shtml – (One of my favorite articles on abortion from one of my favorite scientists: Carl Sagan.)