Abortion at 33

This past week marked the 33^rd anniversary of Roe v. Wade. Thirty-three is not a landmark year in the typical way we mark anniversaries (10^th, 25^th, 50^th, etc.), but it does have an oddball resonance. In the Christian tradition, 33 was Christ’s age when he was crucified.

Though I consider myself an anti-abortionist, I do not hold that abortion is murder. Murder is the intentional, unjustified, malicious killing of a human being. Even law recognizes that a person can justifiably kill another person in certain circumstances. Substitute a 6 week old fetus for “person,” and “certain circumstances” becomes a murky question.

But not too murky. Many people justify their tolerance for abortion by arguing that it is not knowable when life begins. This is foolish talk. A fetus may not be a full person, but it is not dead. Not by any biological definition of life I have heard of. A rock is not alive; a single cell is. A fertilized egg is a cell. Not fully human as we understand it, but a living, functioning cell.

One of the interesting features of anti-abortion arguments is that they tend to be very biological. They focus on things like when the heart starts beating, when the organs form, and when the fetus starts to suck its thumb. Anti-abortion arguments are very factual, perfused with statistics and blood and gore. Pro-abortionists tend to argue about rights and the imposition of morality upon others. It is an irony of the abortion debate that the side most concerned about morality (anti-abortion) argues biological facts, and the side most concerned about health issues and the mental health of mothers argues the legal ethics. Shouldn’t it be the other way around?

Many people have wondered aloud if the issue of abortion will ever be settled in public life. I don’t think so. Abortion is about pregnancy, which is about sex. As long as humans have lived in societies there have been fundamental disagreements over who should be having sex with whom and when. One side says sex is about pleasure, and that people should do it whenever and wherever they want. The other argues that sex carries the attendant responsibility of reproduction and emotional attachment and that people should do it only with the confines of committed relationships. Or to simplify it, one side considers pleasure the goal of sex, and the other places primacy on reproduction and social structure.

I do not think pleasure should be excluded from discussion about sex by any means. But neither should the potential of reproduction. One of the things that riles moralists most about pro-abortionists is that they seem willing to make sexual intercourse a free lunch. If one drives drunk and kills someone, it is not possible to pay a cash sum for a replacement person and go back to work on Monday. In almost all ethical situations, when a person behaves recklessly, that person must take responsibility for a bad outcome. With sex, a person can behave recklessly ( not use birth control or use it improperly) and still get away from taking responsibility for an undesirable outcome via abortion.

As I see it, this pleasure/reproduction conflict is at the center of the abortion debate, and explains why the battle is likely to go on and on. The pleasure side is willing to jettison the consequences of sexual decisions; the reproductive side is not. Since this difference in views is as old as human civilization, it is hard to see why it should be resolved any time soon.

We all know that the main use for abortion in this country is birth control. There are 1.3 million abortions a year in the U.S., and there is no way the condom broke all those times, or that all those pregnancies are from rape or incest. The vast majority result from women (and men) who simply did not use adequate birth control, and now want a “do over.”

Pro-abortionists argue that a woman’s right to emotional well-being supersedes the rights of a clump of cells to continue to live. In other words, a woman’s right to happiness gives her the right to kill. Note I did not say murder, I said kill. It may be debatable whether abortion is murder, but I do not think it is debatable that abortion is killing. Some have argued that a life form must exist independently from its parent to be considered alive, but I know of no biological concept that supports this. Parasites are dependent on their hosts, completely, to exist, but no one argues that they are not alive. You have to kill a tapeworm to get rid of it.

At the very least, pro-abortionists should have the honesty to admit that abortion is not an absolute, but rather a relative right. It is dishonest to argue that abortion is not killing; instead, the more honest argument is utilitarian: abortion is the greater good trumping the lesser. I versus a cockroach. Both have some right to live, but one clearly is more valuable than the other, and there is no way both can live together. (I will not live with a cockroach. So it goes.)

Of course, abortionists shrink from this argument because they know as soon as they admit the fetus is alive they have opened themselves up to being tagged as killers. In the interest of fair play, anti-abortionists can ease the pain of this admission by making the counter-concession that abortion is not murder. If both sides could at least come that far, there might be a way for us to tolerate each other.

If we could just come to agree that abortion is killing, and that it is undesirable, we could start to make progress. It bothers me a little that abortion is considered a civic right, but what really bothers me is that it happens 1.3 million times a year. If pro and anti people could agree that abortion is killing but not murder, we could get to the important part – getting that 1.3 million number down.

Would I like to see Roe v. Wade overturned by the Supreme Court? Actually, I am indifferent to that. Many people think that if Roe v. Wade were overturned abortion would be illegal in the U.S. Not so. Roe v. Wade made it illegal for states to write laws banning abortion. But if Roe is overturned, all that means is that states can ban abortion if they want to. Many, including California, New York, and Massachusetts are almost certain make abortion explicitly legal if Roe is undone. Others, like Utah and Louisiana, are just as certain to restrict or ban it. Conservatives, who think they are winning a great battle by packing the Supreme Court with conservative judges, will find the abortion question thrown to each state legislature. There will be a state-by-state battle for abortion, and pro-abortionists will win some and lose some, creating a patchwork quilt of abortion laws nationwide. Then abortion will become like gambling is in this country – banned in most places but available within a 2 hour drive from almost anywhere. Only Alaska and Hawaii are remote enough to have a realistic chance of eliminating abortion access for their citizens should they choose to do so.

If this sounds like further politicization of an already over-politicized issue, it is. No matter what the law says about abortion, one side or another will always be rallying to defeat the other. If the Supreme Court recuses itself by abandoning Roe, the national battle will balkanize into 50 state battles. This will never forward the cause of morality.

In the case of murder, every state has laws against it. For the average citizen, this means the problem of legalities is settled, leaving individuals to get down to the more substantial work of creating a society in which no one wants to commit murder. Good schools, good jobs, a fair legal system, and so on. We ban murder, but it still happens. The hardest work is not banning it, it is getting the numbers down.

Perhaps we could all agree to set aside the legal issue and concentrate on the numbers. If anti-abortionists and pro-abortionists would just agree that abortion is killing but not murder, and that it is not a desirable form of birth control, we could skip over the legal wrestling match and start teaching people to behave responsibly.

As a doctor, I have never turned down a request for birth control unless it was medically contraindicated, which is a very rare situation. I feel every birth control prescription I write potentially saves an abortion, and with that mentality I would write for it all day every day until my fingers bled, if necessary.

Abortionists say that women must be allowed the right to choose it because they have the right to their own bodies. I am not willing to concede that women have the freedom to kill under for any reason whatsoever, whether it be because the pregnancy is life-threatening or because the woman is going to the Bahamas in 3 months and doesn’t want her stomach to pooch out in a bikini. Certainly anyone can see that those two situations are completely different and that completely different ethical standards apply.

If there were only 10,000 abortions a year in this country, the question of legality would be important. In that case, abortion would be rare and only carried out for serious reasons. The battleground would be over hard cases, like 14 year olds who had been raped by their fathers, or women with cancer who need chemotherapy immediately. The more cases there are, the more safely we can assume that abortions are being performed for convenience rather than necessity.

Who are you to decide what constitutes convenience or necessity, some will ask. Well, I guess I am nobody. It has never been my desire to tell people how to live their lives – I have my hands full living mine. But if we can agree that abortion is killing in some form, then we can agree that there is some moral value in preventing it. Certainly if two people go to bed together thinking, “Well, if she gets pregnant we’ll just go for the abortion,” something is amiss. There can’t be that many people around who consider abortion a form of birth control ethically on-par with condoms, or even abstinence.

It is also reasonable to argue that if abortions are moral in all cases then we should also legalize euthanasia for people who are depressed. After all, the justification of abortion is that the suffering the mother would endure in having the child is greater than the harm done in killing a fetus. This implies that killing may be justified to relieve emotional pain. Hence, a deeply depressed person should be put down if that is his choice.

Laws, if enforced properly, might prevent almost all abortions. Or they might engender distrust and hatred and put society in the uncomfortable position of having to imprison doctors and formerly pregnant teenagers. (Those arguing that only abortion doctors need be prosecuted are fooling themselves. How do you ban something and then let the person who makes the choice to violate the law go free?) As for me, I would be satisfied with preventing as many abortions as I can and leaving the most painful decisions to the people making them.

Before I close, I want to tie up two loose ends. First, the problem of exceptions. A friend of mine once criticized my anti-abortionism by saying that my readiness to consider exceptions for rape and incest is a flaw. I don’t think so. Society recognizes exceptions to killing in other contexts, such as the person who shoots an intruder in his home or the soldier who kills an enemy. I am not above saying that killing is sometimes necessary. My way out with abortion is that I do not consider it murder, but rather killing. Killing can be justified. Although I am dubious about rape and incest as a justification for killing, I am willing to admit that not everyone sees things my way and that many consider the emotional pain of bearing the product of a rape of greater importance than the life of a fetus. Again, I want to reduce abortions, and if an agreement to exceptions brings both sides together and lays the groundwork for a concerted effort to prevent abortions, then is a concession I am willing to make. Better that than having the pro-abortionists banging the table and demanding full moral amnesty for all abortions no matter what, as they are doing now.

The second loose end: the reader may have noticed that I do not use the words “pro-life” and “pro-choice.” These are silly phrases that obscure the real issue at hand. I support life and I support choice. I want more women to choose not to have abortions, or even better, to choose the medical means we have to keep from ever getting pregnant in the first place. I am not against choosing. I am against abortions.

Comments

[Liz]

Dear Dr. Hebert, I've been reading you faithfully since I stumbled across your blog. Your Louisiana posts are powerfully affecting.

My position on birth control and abortion: I am strongly in favor of looking at what the Scandinavian countries do, and figuring out how we can emulate it. Somehow, they manage to have teens who are sexually active and who do not become pregnant.


Of every 1,000 Swedish women aged 15 to 19 in 1965, 50 became pregnant. By 1995, the rate dropped to 10 pregnancies for every 1,000 women in that age range, according to research Milsom presented at the conference here.

In comparison, the pregnancy rate among women aged 15 to 19 in the US during that same time period dropped slightly from 70 pregnancies per 1,000 American women to 60 per 1,000.

I believe that safe, effective contraception--for men and women--should be widely and easily available. Choosing to terminate a pregnancy is always a sad decision. For a number of reasons, I believe that safe, available, affordable chemical and surgical pregnancy termination should be widely and easily available. I heartily wish that every baby is a wanted baby.

I am in favor of keeping abortion legal, safe and widely available.

The majority of pregnancies do not end in the live birth of a healthy baby. According to an article by Wayne Z. McBride in The American Family Physician: "The true incidence of spontaneous abortion (including unrecognized pregnancy loss) has been estimated to be 50 to 78 percent of all conceptions"

The rate of failed conception implies something to me about the onset of personhood and the moral choices facing a woman considering terminating a pregnancy.

I believe that medical interventions that prevent ovulation or conception or implantation (birth control pills, barrier methods, IUDs) are entirely ethical.

[Michael Hebert]

I thank you for your response. I debated posting this essay for several days because I considered it possibly too heavy a topic for typical internet traffic.

I don't expect everyone to agree with me, though I see we agree in many aspects. But shoving this very important topic into the closet (which sometimes happens) or preaching it to the choir (which often happens) serves no one.

[Moof]

Dr. Hebert ... thank you for posting this article. It's an entirely new "take" on abortion, and I think it would be excellent reading for those on either side of the issue.

I personally have a few minor items of disagreement with you, however I found the article both challenging and stimulating. You touch upon a number of issues which were recently raised in a "conversation" between myself, Dr. Rangel ( http://www.rangelmd.com/ ) and Dr. Crippen ( http://nhsblogdoc.blogspot.com/ ) regarding Assisted Suicide ( http://concordiadiscors.blogsplot.net/category/assisted-suicide/ ) ... in which I compared the two issues morally. One of the two gentlemen, although asked twice, never responded to my challenge that abortion/euthanasia ... etc. ... was in almost all instances, a matter of convenience taking a precedence over life.

I've posted a link to your article from my own web site. ( http://moof.blogsplot.net/ )

Again, thank you for addressing this issue so honestly.

[Michael Hebert]

Thanks, Moof, but I don't think my thinking is entirely original. What makes it seem different is that it is coming from a conservative point of view.

I have heard a few people from the liberal side of the fence make similar arguments.

[quietnewyorker]

Though from the other side of the argument, I do agree with you that much could be accomplished if both sides could conceed a bit and work to prevent further abortions.

I was a bit surprised when you said this, though: "Certainly if two people go to bed together thinking, “Well, if she gets pregnant we’ll just go for the abortion,” something is amiss."

First of all, it seems to me that when most people go to bed they are not having thoughts that come in complete sentences. Very few of them are thinking about pregnancy. Secondly, I know women who have had abortions, and none of them have had such a casual attitude towards it. No well-informed, halfway intelligent woman thinks that abortion is "just an abortion", just an alternative form of birth control - if for no other reason that it a greater gamble, healthwise, than a condom or the pill.

I personally find abortion morally ambiguous, something that I would not want to be illegal, but something that I wish were much rarer.

[quietnewyorker]

I should clarify - I would agree that something would indeed be amiss with a couple who thought of abortion as a casual form of birth control. My point was that, among all my radical free-thinking liberal feminist acquaintances, I don't know one of them who thinks that way or who treats her health so lightly.