TOM DOUGLAS WELLCOME TRUST RESEARCH FELLOW UNIVERSITY OF OXFORD THE ETHICS OF ABORTION.

TOM DOUGLASWELLCOME TRUST RESEARCH FELLOWUNIVERSITY OF [email protected]

THE ETHICS OF ABORTION

medicine is normally about saving lives, but sometimes doctors are asked to (help) end lives

euthanasia or treatment withdrawal of terminally ill or permanently unconscious patients

abortion

medicine is normally about saving lives, but sometimes doctors are asked to (help) end lives

euthanasia or treatment withdrawal of terminally ill or permanently unconscious patients

abortion

what is abortion?

the medical definition:

the termination of pregnancy prior to the age of viability (approximately 20-22 weeks gestation)

spontaneous = caused by natural processes

artificial = caused by the actions of a person (e.g. the mother, a doctor)

what is abortion?

the common sense definition:

bringing about the death of an embryo or foetus

doesn’t include ‘spontaneous abortion’

does include terminating a pregnancy by bringing about the death of a viable foetus

methods

medical abortion (9-24 weeks, not permitted in Japan)

mother takes two drugsmifepristone & prostaglandin

after 20 weeks, prostaglandin is injected into uterus

cause expulsion of embryo similar to a natural miscarriage (spontaneous abortion)

methods

suction termination (7-15 weeks)

methods

surgical dilation and evacuation (from 15 weeks)

early history

abortions performed in ancient egypt, greece, rome, china (and in 12th century in Japan)

...when couples have children in excess, let abortion be procured before sense and life have begun--Aristotle

…when…the men and the women have passed the age of lawful procreation,…. [they should] preferably not even to bring to light anything whatever thus conceived, but if they are unable to prevent a birth [they should] dispose of it on the understanding that we cannot rear such an offspring--Plato

for much of western history, foetus regarded as part of the mother, or property of the father, at least until quickening (when the foetus began to move, 18-20 weeks)

opposition in the West came gradually with rise of Christianity

strict regulations introduced in Western countries and Japan in the 19th century—various motives:

religious protecting health of mothernational interest in population growth

regulations – UK • abortion after quickening made a crime punishable by

death in 1803

• 1837—death penalty abandoned, significance of quickening abandoned

• prohibitions based partly on concern to protect the pregnant woman from a dangerous medical procedure

• from 1920s—abortion not a crime if done to prevent the life of the mother

• from 1937—not a crime if done to protect mental or physical health of mother

• from 1967—also allowed if risk to the mother’s existing children or if child likely to suffer from a serious abnormality

regulations - Japan

• abortion banned nationwide in 1869 (rarely punished)

• liberalization since 1948—initially permitted for risk to mother’s life and health, rape, and to prevent passing on of defective genes—now also for socioeconomic reasons

• used as a major form of birth control

• increasing availability of conctraception reducing demand

• only permitted for non-viable foetuses

• prosecution for illegal abortion uncommon

the gap between law and practice

abortion has typically been widely practiced even where banned

1965 UN Conference on World Population in Belgrade: abortion the chief method of birth control in the world at that time

the plan

the ethics of early abortion

the ethics of late abortion

who should decide whether an abortion is done?

Anna has just discovered that she is 12 weeks pregnant, but she doesn’t want to have a child. She is not in a stable relationship and doesn’t have much money. She comes to see Dr Stevens and asks whether he will perform an abortion. Abortion is legal in the country where Anna and Dr Stevens live. Should Dr Stevens perform an abortion?

Anna has just discovered that she is 12 weeks pregnant with a female child, but she wants to have a son, not a daughter; where she lives, women have much harder lives than men. She comes to see Dr Stevens and asks whether he will perform an abortion so that she can try again for a male child. Abortion for this reason is legal in the country where Anna and Dr Stevens live. Should Dr Stevens perform an abortion?

Anna was brutally raped 12 weeks ago, and has just discovered that she is pregnant as a result. She doesn’t want to have the child as she feels that the child will be a constant reminder of what was done to her. She comes to see Dr Stevens and asks whether he will perform an abortion. Abortion is legal in the country where Anna and Dr Stevens live. Should Dr Stevens perform an abortion?

the abortion debate

religious views

catholicism—abortion a ‘grave moral wrong’, embryo/ foetus has right to life from the point of conception, Pope John-Paul II described abortion as murder

buddhism—variety of views, traditionally opposed to abortion as the intentional destruction of human life (which begines at conception), but most Western and Japanese buddhists believe abortion to be permissible

the abortion debate – secular arguments

most opponents argue that

(1) killing an adult human is wrong(2) killing an embryo or foetus is morally equivalent to killing an adult humanTHEREFORE(3) killing and embryo or foetus is wrong

let’s consider…

why it would be wrong to kill an adult human like you or me

whether the same explanation could be used for a 12 week foetus

whether there are other arguments against killing a 12 week foetus

why would it be wrong to kill you or me?

answer one—because human life is sacred

the sanctity of life view• always wrong to kill a living

human being

but…• what about anhedonic infants,

brain dead humans? • what about a super-chimp?

humans versus persons

only some humans are persons

personhood requires mental capacities e.g. consciousness, ability to think, ability to feel pain

we are personsa super-chimp would be a person but an anhedonic infant or a brain dead adult is not a person


answer two—because we’re persons

and persons have the right not to be killed


answer three—because of the loss that will result

Marquis – loss of a good future life

Sinnott-Armstrong & Miller – loss of current abilities


answer four—because it will harm others

assuming others want us to keep living!

what do these answers apply for the ethics of abortion?

‘because we’re living human beings’

ll harm othersimplies abortion of a 12 week old foetus is wrong, because it’s a living human being

but, as we’ve seen, this is not a good answer—it’s not wrong to kill an anhedonic infant, and it would be wrong to kill a super-chimp

what do these answers imply for the ethics of abortion?

‘because we’re persons and persons have a right not to be killed’

ll harm othersimplies abortion of a 12 week old foetus is not wrong, because it doesn’t have the mental capacities necessary to be a person

but, some argue that we should treat it as if it’s a person, because it has the potential to become one


‘because we’ll lose our current abilities’

probably implies abortion of a 12 week old foetus is not wrong, because they don’t have (important) abilities


‘because we’ll lose our valuable future’

probably implies abortion of a 12 week old foetus is wrong, because it’s otherwise likely to go on to have a good life

but some would argue only conscious beings have an interest in surviving to have a future of value—nothing wrong with killing an ant even if one could magically give it a life containing great pleasures


‘because it will harm others’

implications for abortion depend on whether others (e.g. the parents) want to have a child

these arguments have slightly different implications: the second argument implies that it’s more wrong to abort a foetus that will go on to be treated well than one that will be treated badly

argument one: wrong because the foetus is a potential person, potential persons should be treated like actual persons, and actual persons have a right not to be killed

argument two: wrong because abortion deprives the foetus of a valuable future life

so we’ve discovered two arguments for the wrongness of aborting a 12-week old foetus

how do defenders of abortion respond?

1 – by denying the relevance of potential

acorns are not oak trees, nor eggs omelettes. It does not follow from the fact that something has potential to become something different that we must treat it always as if it had achieved that potential. We are all potentially dead but it does not follow that we must be treated now as if we are already dead. -John Harris & Soren Holm


2 – by arguing that only conscious beings have an interest in enjoying a future of value

it would be ok to kill an ant even if one could somehow give the ant a future life containing much happiness—because the ant is not conscious, it has no interests

(Feinberg)


3 – by showing that arguments against abortion have counter-intuitive implications

Sam and Edwina are infertile. Edwina produces an egg. Sam produces some sperm. Doctors extract a single sperm for the purposes of ICSI (intracytoplasmic sperm injection), the preferred method of IVF. Just as they are about to inject the sperm, Sam and Edwina interrupt them and tell them they have changed their minds. They don't want children. The sperm and egg are destroyed.

-Julian Savulescu



when Sam and Edwina decide not to have a child, a valuable future is lostso on the ‘future of value’ argument, they have acted wrongly

when Sam and Edwina discard their egg, a potential person is destroyedso according to the potentiality argument, they have acted wrongly

but they haven’t acted wrongly!



• many embryos die in the early weeks of pregnancy – perhaps as many as (spontaneous abortion)

• if we should treat embryos like persons, then we should regard spontaneous abortion as a huge problem—worse than war, famine and most diseases

• we should spend a lot of money trying to prevent it

• but most of us think this would be crazy—we don’t think spontaneous abortion is a big problem


4 – by arguing that, even if embryos and foetuses are persons (or morally equivalent to persons) abortion could be acceptable

• in the course of a normal pregnancy, a woman provides nutrients and other kinds of support to the foetus

• this comes at significant cost—pregnancy is painful and tiring and can damage the health of the mother

• so we could think of abortion as removing costly support from the foetus, with the result that the foetus dies

• and sometimes withdrawing costly support from a person is acceptable, even if it results in their death



• suppose your neighbour is sick and the only way he will survive is if you go to his house for 5 hours every evening and connect your blood system up to his

• this will be very painful and tiring from you, and you may become sick as a result

• you will need to do this for nine months



• suppose you start with this programme, but after a while you decide you don’t want to continue and stop

• your neighbour dies as a result

did you act wrongly?

JJ Thomson would say ‘no’—maybe it would have been better had you continued with the programme, but it was OK for you to stop—no one is required to provide such costly assistance for 9 months, even to save a person’s life

we have been considering the possibility that abortion might be wrong because it’s like killing an adult person

but are there other reasons why abortion might be wrong?

‘abortion involves destroying something of beauty—it’s like destroying a beautiful painting or a beautiful rainforest’

but… doesn’t avoid the criticisms we’ve discussed:e.g. implies the high rate of spontaneous abortion is a great tragedy that we should make great efforts to prevent

‘abortion involves abandoning your child, and thus failing to be a responsible parent’

question: when do the obligations of parenthood begin?

Anna has just discovered that she is 12 weeks pregnant, but she doesn’t want to have a child. She is not in a stable relationship and doesn’t have much money. She comes to see Dr Stevens and asks whether he will perform an abortion. Abortion is legal in the country where Anna and Dr Stevens live. Should Dr Stevens perform an abortion?

should governments allow abortion?

could think that abortion is always immoral, but the government should allow it

because abortions will be done anyway, and it’s better if they are done safely

could think that abortion is often morally acceptable, but the government should ban it

e.g. because allowing it will increase tolerance of other kinds of killing

late abortion

Anna is 28 weeks pregnant. She was looking forward to having a baby, but now she and her husband have both lost their jobs and they don’t think they can afford to have a baby. She comes to see Dr Stevens and asks whether he will perform an abortion. Should Dr Stevens perform an abortion (if he’s permitted to do so)?

What if Anna’s health is seriously at risk?

late abortion

late abortion

what is different in late abortion?

the foetus is viable—a live birth is possibleso even if it’s OK for a mother to withdraw support for the baby by ending pregnancy, it might be wrong for her to end the pregnancy in a way that kills the foetus

the foetus is probably consciousso could be argued that the foetus is a person

what if she thinks having a child in the world that she can’t raise is a large burden?

what if a foetus of 28 weeks has only the same mental capacities as an adult pig?

conscientious objection

Anna has just discovered that she is 12 weeks pregnant, but she doesn’t want to have a child. She is not in a stable relationship and doesn’t have much money. She comes to see Dr Stevens and asks whether he will perform an abortion.

Abortion is legal in the country where Anna and Dr Stevens live, the government funds abortions, and the majority of the population support the availability of abortion.

Suppose Dr Stevens is a catholic and is strongly opposed, for religious reasons, to abortion at any stage of pregnancy and for any reason. He refuses to perform an abortion.

Should Dr Stevens be allowed to refuse to perform the abortion?

What if Anna couldn’t have an abortion unless Dr Stevens does it?

(Suppose she lives in a remote town, Dr Stevens is the only doctor in the town, and Anna can’t afford to travel to another town.)

Suppose Dr Stevens refuses to perform the abortion. However, suppose also that there is one other doctor in the town – Dr Williams. Dr Williams is prepared to perform abortions, and Dr Stevens knows this. Should Dr Stevens be required to tell Anna that she can go to Dr Williams for an abortion? (Anna doesn’t know that there is another doctor in the town, so won’t be able to get an abortion if Dr Stevens doesn’t tell her.)

What if Anna’s instead wanted an abortion because the foetus was female?

What if she wanted an abortion because her pregnancy was the result of rape?

arguments for and against allowing conscientious objection

FOR

allows doctors to maintain moral integrity (remain

true to their values)

AGAINST

interfere’s with the ability of the medical profession to live up to its

social responsibilities

unfair inequalities in access to abortion services

brock’s compromise

conscientious should sometimes be allowed if:1. doctor informs the patient about the possibility of abortion2. doctor refers the patient to someone who will perform the abortion3. going to another doctor is not burdensome for the patient

but, shouldn’t always be allowed in such cases:consider the doctor who refuses to treat black patients

a concern

doctors remain complicit in practices they take to be wrong: they still cause abortions to happen that wouldn’t otherwise have happened

brock’s response

the degree of complicity is low, and the threat to the doctor’s moral integrity is outweighed by the benefit of ensuring doctors fulfil their social responsibilities

hope for the future

more agreement about the ethics of abortion!

will require more agreement about what gives something moral status

TOM DOUGLAS WELLCOME TRUST RESEARCH FELLOW UNIVERSITY OF OXFORD THE ETHICS OF ABORTION.

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