Mappes & DeGrazia, Chapter 8: Lecture Notes/Outline by Larry Hauser

Abortion and Maternal-Fetal Conflicts

Abortion: The Ethical Issue

Presuppositions of intelligent debate

and awareness of the various sorts of reasons that may be given for having an abortion
a basic acquaintence with the biological development of the human fetus

Normative & Philosophical Issues

Moral question: When, if ever, is abortion morally permissable?
Social-political question: Under what circumstances, if any, should abortion be legally allowed?

Reasons for Abortion

A nonexhaustive list

to save the mother's life: "In certain extreme cases, if the fetus is allowed to develop normally and come to term, the pregnant woman will die."
to preserve the mother's health

physical or
mental

cases in which the pregnancy will produce an impaired child

certainly or
probably

cases in which the pregnancy is the result of rape or incest
cases where the pregnant woman is unmarried: to avoid the social stigma

of illegitimacy for the child
shame for the woman

cases where having (another) child will impose an unbearable financial burden on the woman or family
cases where having another child will interfere with the happiness of the woman or family

Discussion

cases 1-3 -- being undertaken of medical reasons -- are commonly deemed therapeutic
case 4 is sometimes also -- less justifiably -- deemed "therapeutic"

"Perhaps it is presumed that pregancies resulting from rape or incest are traumatic and thus a threat to mental health" (433)
"Alternately, perhaps calling such an abortion `therapeutic' is just a way of indicating that it is thought justifiable"

case 7 is probably the most common & includes almost endless possibilities (bit of a catch all category)

woman's desire for a professional career
couples desire not to take have (additional) children

Biological Development of a Human Fetus

Notable Stages

Conception

a male germ cell (the spermatazoon) carrying 23 chromosomes from the father
a female germ cell (the ovum) carrying 23 chromosomes from the mother
unite to form a single cell zygote which embodies a full human genome of 23 pairs or chromosomes

Implantation: 0-2 wks.

the single-cell zygote begins a process of cellular division
the resultant multicell zygote continues to grow as it proceeds through the fallopian tube
upon reaching the uterus the zygote undergoes gradual implantation at the uterine wall
until it's fully implanted, approximately 2 weeks after conception
when fully implanted, the zygote is deemed an embryo

Embryonic development: 2-8 wks.

organ systems and other human characteristics begin to noticably develop
brain waves can be detected around the end of the sixth week
at the end of the eighth week, the embryo is deem a fetus (though the word "fetus" is commonly used to designate the unborn child whatever its stage of development)

Fetal development: 9-36 wks. (following dates calculated not from conception but from the date of the woman's last mentstruation)

quickening: wk.12-16: the point at which the woman is able to feel the movements of the fetus
viability: wk. 24: the point at which the fetus is capable of surviving outside the womb
trimestesters

months 1-3: first trimester
months 4-6: second trimester
months 7-9: third trimester

Abortion techniques at various states

First trimester (through wk. 12)

formerly was done by dilation and curettage (D&C) which involves

strecthing (dilation) of the cervix to allow insertion of a surgical instrument (a curette)
scraping of the uterine walls with this instrument (curretage)

now commonly performed by uterine aspiration (aka vacuum aspiration)

a tube connected to a suction pump is inserted into the uterus
and the fetus is sucked -- or vacuumed -- out

Later stages (after wk. 12)

dilation and evacuation (D&E): early stages of the second trimester

a forcepts is used to dismember the fetus within the uterus
the fetal remains are withdrawn through the cervix

induction techniques induce premature labor:

saline induction a common type

a saline solution is introduced into the amnioutic cavity
which induces labor, thereby expelling the fetus

prostoglandin induction: employs these hormonelike substances to induce abortion

hysterotomy: in essence a minerature ceasarian-section

a major surgical procedure
seldom used in the U.S.

The Ethical Question: When -- if ever -- is abortion morally permissable?

Up to what stage of fetal development, if any?
For what reasons, if any?

Three (sets of) views

Conservative: abortion is never morally acceptable (some allow acception to save the life of the mother)
Liberal: abortion is always ethically acceptable at any stage for whatever (standard) reason
Moderate views hold either

abortion is permissable to a certain stage of fetal development, but not later
abortion is permissable for certain reasons but not others (among the standard ones)

The Conservative View and the Liberal View

The moral status of the fetus is a pivotal issue in these discussions

full moral status is that due to fully developed human beings, mentally competent adults like us

assigning the fetus full moral status entails it has
a right to life on a par with the rights of a normal human being

no (significant) moral status

assigning the fetus no moral status entails that it has
no rights worth talking about and no significant right to life

partial moral status

rights -- including perhaps rights to life -- worth talking about
but not to the full extent that a normal human being has

Liberal vs. Conservative deductions (from their takes on the moral status of the fetus)

extreme liberal position

since the fetus has no moral standing
it has no more right to life than a piece of tissue, such as an appendix
and "aborition is no more morally objectionable than an appendectomy" (p. 429)

extreme conservative position

since the fetus has full moral standing
it has as much a right to life as anyone else -- including the mother
abortion -- "except perhaps to save the life of a pregnant woman" -- is murder and "as morally objectionable as any other murder"

Drawing the line: determining moral status

Frequently posed question:

"At what point in the continuous development does the fetus become human?"
In the moral sense, i.e., a sense in which

human implies full moral status and
nonhuman implies lack of moral status

Standard Conservative Approach

The fetus becomes human at the moment of conception
Supporting argument from the continuity of development

conception is the only point at which the line can nonarbitrariliy be drawn

quickening is not a morally significant dividing line
not even birth: it's the same organism whether it's in or outside of the womb

the zygote is endowed with a full -- and unique -- human genome
that undergoes a continuous and gradual development

from the moment of conception
through birth and beyond

Standard Liberal Approach

The fetus remains nonhuman even in the later stages of development.
Supporting argument

Biological vs. moral humanity distinguished

human organism: any organism with a human genome
a person: a rational and self-conscious being

Mary Anne Warren's argument (this volume)

The fetus is not a person
& the fetus is so far from possessing the crucial elements of personhood
that it cannot be said to have a significant right to life
Objection & Reply

Objection: This same line of argument would justify infanticide
Reply: no it wouldn't

because newborns "are so very close to being persons"
because the mother's overriding rights cease at birth

The presumption argument: an nonstandard conservative approach

We don't know for certain whether the fetus is a person on not.
So there's a chance -- for all we know -- that abortion kills a person.
And it's not morally permissable to take that chance, just as

suppose you were considering setting off an explosion in a mine
it would be morally wrong to go ahead with the blast if you thought, possibly, that someone was still in the mine

The potential person argument

though not fully a person, yet, the fetus is a potential person
potential persons are entitled to the same rights as fully developed ones (Warren argues against this)

Don Marquis argument from the wrongness of killing (akin to the potential personhood argument)

Killing a person is wrong because it deprives them of future satisfactions -- a future
Killing a fetus, similarly, deprives the fetus (or the person they would become) of just such a future
So it's morally wrong to kill a fetus for the same reason it's morally wrong to kill a person.
Marquis stops short of the standard conservative claim of no exceptions except, possibly, to save the life of the mother, e.g.,

would perhaps allow abortions for severely impaired fetuses
with dismal future prospects

Moderate Views

Simplicity of the extreme liberal & conservative positions

Conservative: it's immoral at any stage, for any reason
Liberal: it's permissable at any stage, for any reason

Moderate position: It's more complicated. Permissibility varies depending on

the stage of development
the reasons for the abortion
or both

Different paths leading to or strategies for developing a moderate positon

Moderation of the Conservative View (e.g, Judith Jarvis Thompson)

even granting the fetus is a person
having as such a right to life -- i.e., a right not to be killed unjustly
this does not give the fetus a moral right to the use of the woman's body
the woman has no moral obligation to allow the fetus to use her body for a life support system
the pianist

Moderation of the Liberal View

granting the fetus has no (significant) moral status at any stage of pregnancy
nevertheless some abortions -- especially later stage abortions -- are immoral due to their negative social consequences
late state abortions -- since the fetus increasingly ressembles a newborn infant -- arguably

"have a brutalizing effect on those involved"
"and, in various ways, lead to the breakdown of attitudes associated with respect for human life" (431)

Moderation in Drawing the [person/nonperson] Line

drawing the line somewhere in between

conception: the conservative standard position
and birth: the liberal standard position

some suggested dividing lines: in order of increased liberality

implantation
the beginning of brain activity
quickening
viability

the burden of support: to show that the specified point is nonarbitrary

point up to which abortion is morally permissible
and after which abortion is morally objectionable

Moderation in the Assignment of Moral Status

recognize intermediate grades of moral status between

full moral status: the conservative standard position
and no (significant) moral status: the liberal standard position

Callahan's approach

partial moral status confers a prima facie right to life (and a converse maternal duty)
which may nevertheless be overridden by a womans duties to herself, her family, and society

Singer's approach

biological humanity carries no moral significance
it's the psychological humanity -- personhood -- that matters
the fetus acquires increasing moral status at different psychological stages of development

no moral status until the beginning of brain activity
moral status akin to those of pain-feeling organisms from the time they can feel pain which -- sometime between the 8th and 17th week.
has not yet acquired full moral status or personhood even at birth

is not rational or self-aware
nevertheless once born infants enjoy full status -- de jure or "by proxy" you might say if

they're wanted
or if they're unimpaired

euthanasia is warranted for newborns which are both seriously impaired and unwanted

Abortion and Social Policy

Roe v. Wade (1973) the fountainhead of subsequent legal developments

had the effect, for all practical purposes, of legalizing "abortion on request" up to the point of viability
Court held it to be unconstitutional for a state to legally prohibit aborition of a previable fetus
reserved rights of states

to restrict the manner and circumstances in which abortions are performed
subsequent to the end of the first trimester
for reasons related to maternal health

predictable reactions

right to choice proponents were delighted
right to life proponents were appalled

Right-to-life movement's 1st response: "head 'em off at the pass" or full-frontal assault strategy

plan A: a constitutional -- right to life -- ammendment

explicitly declaring the legal personhood of the fetus
thereby directly overturning Roe v. Wade

plan A': a states-rights-to-ban-abortion ammendment
right-to-choose counterargument:

these proposals represent illicit attempt of one segment of society
to impose their moral & religious views on others

Right-to-life movement's second response: "death by a thousand cuts" or war of attrition strategy: impose restrictions

1980: cutoff of Medicaid funding for abortion

The so-called "Hyde ammendment" restricted Medicaid funding to

cases where the mothers life was in danger
cases of rape and incest

The Hyde rationale:

the right of a woman to have an abortion doesn't imply
a right to have society to fund the abortion

Upheld by the Supreme Court in a 5 to 4 decision: Harris v. McRae
The remaining moral question (legality having been decided)

whether refusal to fund abortions for poor women is morally sound social policy
considerations of social justice are often urged to the contrary

1989 high water mark (to date): Webster v. Reproductive Health Services

court upheld a Missouri law

banning the use of any public facility or public employee in the performance of an abortion
requiring physicians to perform tests to determine the viability of any fetus believed to be 20 weeks or older.

symbolic victory raised conservative hopes for overturning Roe v. Wade

reperesenting the success of the "stacking the Supreme Court strategy" (as I call it: M & D's description on p. 432 is more delicate)
court seemed to indicate it's willingness to abandon Roe v. Wade

1992 setback (following further court appointments): Planned Parenthood of Southeastern Pennsylvania v. Casey, Governor of Pennsylvania

court reaffirmed the "essential holding" of Roe
the controlling opinion being written by justices O'Connor, Kennedy, and Souter

RU 486 (mifepristone) further complicates the debade

a controversial drug developed in France

can be taken as an "abortion pill"
96% effective in inducing mentruation, expelling the fetus,
when taken within 49 days of a missed mentrual period

worries about safety aside: minor side effect

heavier than normal bleeding
nausea & fatigue

how it complicates the debate

if it became legally available in the U. S.
would provide a very private non-surgical form of abortion

no need to go to a clinic
no worry about having to run a gauntlet of protestors yelling "Baby killer!" at you
just get a prescription, have it filled, and take the pills

predictable reactions

pro-choice: hail it
pro-life forces deplore it as

"`a human pesticide'" and
"`chemical warfare against the unborn'" (p.432)

Maternal-Fetal Conflicts

At issue:

"If a pregnant woman has made the decision to carry her fetus to term" and has decided against abortion
"does she havea moral obligation to conduct her life so as to minimize the possibility that her child will be born unhealthy?" (p. 433)

Variously lifestyle choices known to risk adversely affecting fetal development

maintaining an unhealthy diet
smoking
excessive consumption of alcohol
use of various recreational drugs, e.g., cocaine: "crack babies"
improper management of medical conditions (e.g., diabetes)

Further issue of coercive treatment

should a woman be obliged to accept invasive medical procedures in the name of fetal well-being

if she is told that Ceasarian delivery -- which is more risky to her -- is less risky to the fetus is she morally obliged to have the C-section?
is she morally obliged to undergo treatments that might be described as "fetal therapy"

Surely is makes a difference

how well established and effective the procedure is
how necessary it would seem for the woman
and how great the risks are for the woman

Question remains: supposing there's a safe effective procedure physicians deem necessary for the well-being of the fetus

"If educational efforts fail to elicit a woman's consent . . . is persuasion in order?"
"If efforts to persuade also fail, is coercion in order?" (433)

Thomas H. Murray

"a pregnant woman has a moral duty to avoid harming her `not yet born child'"
but "this duty must be balanced against a multitude of other moral considerations"
leading to "strong reservations about the employment of coercian against pregnant women"

Rosemarie Tong: it's a package deal from a care perspective

to the extent that "we take good care of pregnant women"
we can expect them "to take good care of their fetuses"