Abortion and the personhood of the fetus

In my post last week I addressed the idea that uncertainty about the personhood of a human embryo or fetus should lead us to think that we should refrain from causing harm to any entity that might be a person. Therefore, if we are uncertain about whether a human embryo or fetus is a person we should protect that embryo or fetus in case it is a person.

One of my students, Mark Taylor, wrote a paper this spring in the Medical Ethics class I teach that took a different approach to the disagreement in our society about the personhood of the human fetus in relation to the issue of abortion. In contrast to Judith Jarvis Thomson who took the position that abortion should be permissible even if the fetus is a person, he suggested that there are reasons to consider abortion impermissible even if the fetus is not a person.

His arguments are based on the idea that the impermissibility of an action is based more on the moral obligations of the person performing the action than on the rights of the object being acted upon. He presented an argument from aesthetics and virtue and an argument from justice that supported the position that abortion is impermissible even if the fetus is not a person. The first argument says that a fetus is a complex human organism which is a thing of beauty which has been created in most cases by an action chosen by the mother which was known to lead to the creation of such a beautiful being. To choose an abortion would be an irrational act that would be wrong in the same way that it would be wrong to create a great work of art only to destroy it. It would also violate the virtue of responsibility by engaging in an action know to add beauty to the world only to destroy that which is beautiful rather that caring for it. This argument only applies to the abortion of pregnancies that result from consensual sex, but those make up the vast majority of abortions. He argues that failure of contraception does not negate this argument since it is know that contraception is not foolproof.

The argument from justice is based on Rawls’ concept of justice as fairness and the use of the veil of ignorance. Central to Rawls’ system is the idea that a just society is one in which a person who does not know what role he or she will play in that society would judge the society to be fair. Taylor argues that one of those roles that the one judging the fairness of the society might assume behind the veil is the role of the fetus. Even if the fetus is not a person, we all go through the stage of being a fetus so just as the person behind the veil might take on the role of a child the role of the fetus should also be considered in whether the society is just. If the role of fetus is one that the one judging the fairness of the society may assume then it would not be concluded that if would be just to allow a fetus to be aborted.

These arguments suggest the possibility of being able to argue for the impermissibility of abortion no matter what position is taken on the personhood of the fetus. If the fetus is a person then the traditional arguments against of killing an innocent person apply. If we do not know whether a fetus is a person then we should refrain from killing an entity that could be a person. If the fetus is not a person there are still reasons why a person would have a duty not to destroy the fetus based on obligations of virtue and justice that are not dependent on fetal rights or personhood.

The implications of uncertainty about personhood

Many times the different parts of my life conflict with each other, but sometimes they come together in interesting ways. Susan Haack’s recent post on the article “The Fetus, the “Potential Child,” and the Ethical Obligations of Obstetricians” from the journal Obstetrics and Gynecology contained a quote that connected with a reference to an article by Christopher Tollefson by one of my students in a recent paper. The authors of the Obstetrics and Gynecology article stated that the issue of whether a fetus has full moral status is “irresolvably disputable” and from that drew the conclusion that the fetus has no independent moral status and subsequently reached the conclusion that abortion is permissible. Tollefson, however, has argued that an inability to decide whether a human being at a certain point in development has full moral status should actually lead to the opposite conclusion.

In his article “Embryos, Individuals, and Persons: An Argument Against Embryo Creation and Research” in the Journal of Applied Philosophy in 2001, Tollefson argued that in order to conclude that destructive research on human embryos is permissible it would be necessary to establish conclusively that the human embryo is not a person. His argument is that if it is uncertain whether an entity is a person or not it would be wrong to intentionally kill it. Therefore, it is wrong to conclude that it is permissible to do destructive research on early human embryos because we don’t know or can’t know whether those embryos have full moral status. The uncertainty about their moral status means that we should avoid the possibility of killing a person if those embryos would happen to be persons. That same idea can be applied to the “irresolvably disputable” issue of whether a fetus has full moral status. If the issue is unresolved then there exists the possibility that a fetus is a person with full moral status and we should not kill a fetus if that possibility exists.

An example that would be readily understandable to many of my rural Midwestern patients and neighbors can illustrate this point. Assume you are a deer hunter in the woods of rural Indiana and you see something move in the underbrush. You are not sure whether it is a person or a deer. It would be morally wrong to shoot at whatever was moving without determining with certainty that it was not a person. In the same way doing embryo destructive research or an abortion is wrong unless you are able to determine with certainty that what is being killed is not a person. Uncertainty about the personhood of the embryo or fetus means that it would be morally irresponsible to kill it.

It would be sad to think that the typical deer hunter has more moral responsibility than a medical researcher or physician.

Autonomy, Moral Status, and Consequential Conundrums

At times our unreflective declarations, pronouncements, and moral positions made without adequate forethought consequentially lead to moral conundrums, with which we are then left to wrestle. A recent article entitled “The Fetus, the “Potential Child,” and the Ethical Obligations of Obstetricians,” in Obstetrics and Gynecology exemplifies an effort to reframe just such a conundrum. In this article, the authors attempt to justify a physician’s obligation to deny maternal requests that jeopardize her unborn child without rationally jeopardizing her right to abort the unborn child if she so chooses. Secondarily it addresses the issue of how an obstetrician is to define his or her moral responsibility to a being in utero.

Quickly setting aside the issue of abortion, which is stated to be grounded on the essentially unassailable right to bodily integrity (“negative” autonomy) and supported by “mainstream” ethical opinion, the issue of “positive” autonomy is addressed: are there limits on the right of a woman to demand treatment that negatively impacts her child? Acknowledging that physicians also possess negative autonomy rights and consciences (defined as “professional integrity”), on what basis can a physician refuse a maternal demand for treatment or care that is not in the unborn child’s best interests? The answer: distinguish “fetus” (having “value” but no interests) from “potential child” (having anticipatory interests that will “evolve and ultimately attain at delivery”). According to the authors, the fetus has no independent moral status because the issue is “irresolvably disputable,” confirming the arbitrary nature of that determination. So what is it that determines this distinction in moral status? Maternal choice. By the decision to eschew abortion and continue the pregnancy a woman grants moral standing to the child within while simultaneously constraining and limiting her own affirmative autonomy. This decision also enables the physician to resume the fiduciary role to the unborn that has traditionally been entailed in the care of pregnant women.

And so in an attempt to keep previous moral proclamations from overflowing their banks and being carried to their logical conclusions—conclusions which would invalidate our standing as providers of obstetrical care–they are shored up by creating new categorical boxes. But as I am so fond of saying these days, flesh and bones do not fit into boxes without remainder; embodied life is not that simple. Having created the box labeled “potential child” it is then poked full of “subjunctive” holes that make room for contingencies: “the interests of the potential child might infringe on a pregnant woman’s right…”; and “as those interests (of the fetus) rise to a level at which they can be considered…” Oh, what tangled webs we weave!

Life is fragile; and from this particular perspective, so is our moral standing as human beings, contingent as it is upon the good graces of those upon whom we are relationally dependent. Our moral agency becomes not something inherent in our nature as beings created in the image of God, but a goal to be attained–not by any act of our own but by the circumstantial whims of another.

Treating the concept of moral standing with irreverence has greater implications for other vulnerable humans as well, dependent as they often are on the grace of others for their care. Their moral standing is also now jeopardized, hanging in the balance.

And so we must return to the basic questions, as difficult and painful as they might be: What is the source and meaning of our moral standing? Who has the authority and right to determine the moral standing of another human being—and on what moral ground?

In playing with the concept of moral agency, we play with our human nature and identity; and we do so to our own detriment. In our efforts to distinguish grounds for granting degrees of moral status to the unborn in order to support our own changing personal and political agendas, we dehumanize ourselves. Moral agency has become so capricious, arbitrary, and contingent as to be meaningless.

Ultrasound before Abortion: Consideration of Recent Research–Closing Comments

In my previous two posts (April 22 and April 29) I discussed an article in the January edition of Obstetrics & Gynecology entitled, “Relationship Between Ultrasound Viewing and Proceeding to Abortion.” The authors found that in Planned Parenthood clinics in LA, the voluntary viewing of ultrasounds by patients seeking abortions appeared to dissuade a very small percentage from continuing on to abortion. From their data the authors concluded that women should not be required to view ultrasounds prior to elective abortions. They state that, “…because fewer than half of women select this option, mandatory viewing “may have negative psychological and physical effects even on women who wish to view.”

Three points regarding the authors’ ethical calculus: First, their equation is incomplete; second, to weigh “effects” we must be more precise in what they are; third, they fail to describe the one group of people who ought to be doing this ethical calculation, but are not.

First, this article certainly does not weigh all the adverse psychological and physical consequences involved in the act of abortion, or even all the consequences—good or bad—of mandated ultrasounds. It is premature, therefore, on the basis of this study to argue that they are either harmful or beneficial psychologically or physically. The authors make no mention of the possibility that harm or benefit of one’s actions may proceed well into the future, or of the possibility that simply because there is “certainty” regarding abortion that the decisions are informed, or not coerced.

Second, the authors cite “negative psychological and physical effects,” but this is a most imprecise description—by design, I believe. What are these untold effects but modern society’s taboos of guilt and regret? These words must not be spoken of by those in favor of abortion because they would remind of us of right and wrong existing beyond personal choice. Guilt and regret, after all, do not spring de novo. They are born of some sense of wrongness, and point to values beyond simple autonomy. To hold to the thin reed of “choice”, however, one must disallow discussion beyond “psychological and physical effects.” But this blinds us to the existence of a greater morality than individual choice, and therefore to the reality of the human condition.

Finally, in this research the focus on whether or not women changed their mind after viewing their ultrasound or even desired to view it at all fails to acknowledge that there is one group of moral agents whose decision-making is central to the issue of abortion, including to the decisions of the women themselves: physicians. As Justice Blackmun stated in Roe v. Wade’s majority opinion, “the abortion decision in all its aspects is inherently, and primarily, a medical decision, and basic responsibility for it must rest with the physician.” A reading of the subsequent opinion will show that this medical decision-making is ultimately a moral endeavor. But where is the physician in this article’s abortion process? Where is the seeking of each patient’s story, fears, concerns, goals, needs, and so on, that are all necessary for rendering a proper “medical” (but truly moral) decision? In pro-abortion arguments, no allowances whatsoever of physician judgment are allowed to eke into the discussion, yet the Supreme Court justified the legality of abortion on its active (and determinative) role in each decision to abort.

This “medical” decision is supposed to have a certain inherent moral authority, or imprimatur, born of the professional judgment and obligations of physicians. If such individualized contemplation regarding each procedure of abortion is not modeled by those medical professionals whose careers ostensibly carry the moral credentials stemming from caring for others, then there is no surprise when a woman in crisis does not reach a moral epiphany that directs her to the exit. It is sad that our society, which once had a physician profession that was firmly and universally dedicated to the well-being of the unborn, now senses some need to get moral awareness awakened by some other means. The problem, then, wasn’t that the women viewing the ultrasounds failed to change their minds, it’s that the physicians performing them didn’t.

 

Ultrasound before Abortion: Consideration of Recent Research, part 2

Last week I began a discussion about an article in the January edition of Obstetrics & Gynecology entitled, “Relationship Between Ultrasound Viewing and Proceeding to Abortion.” The authors found that in Planned Parenthood clinics in LA, the voluntary viewing of ultrasounds by patients seeking abortions appeared to dissuade a very small percentage from continuing on to abortion. Overall there appeared to be 0.6% absolute risk reduction (99.0% of those who did not view the ultrasound, and 98.4% of those who did, proceeded to abortion).

This is a small reduction indeed. If we calculate the “number needed to treat,” or NNT (we might use the term “number needed to scan” in this setting), we find that it took 151 ultrasounds to cause one woman to change her mind. But how should we interpret these results? That is, how should we assign a value to raw numbers?

If one considers that an ultrasound could be a “screening” test to find that cohort of patients who would change their minds about abortion, and that the outcome is a saved human life, then the numbers become quite appealing. In other words, if the number needed to treat (or scan) to save one life is 151, then scanning is an outstanding intervention. In contrast, nine times as many women aged 50 to 59 years must be screened for breast cancer with mammograms to achieve the same number of lives saved.  One could try to calculate in the relative risks to women’s lives from abortion vs. term pregnancy, but these numbers are quite small compared to the relative risk to the fetus’s life from abortion vs. term pregnancy.

Is not one human life gained worth the time, effort, and cost of 151 ultrasounds? As a physician I perform or order countless tests, including many as part of standard prenatal screening, with much slimmer hopes of benefit. And, with succeeding generations of lives produced from each fetus saved, the NNT drops dramatically. For those opposed to abortion, the statistics seem to provide little hope for a significant change of minds that they would hope for. But whenever I observe the dramatic miracle of a single birth I see an outcome grand enough to justify the effort.

It is a fundamental flaw of the research to impose a moral equivalency on all outcomes. It is not simply a matter of weighing 150 choices in one direction for every one choice in another—it is the weighing one human life gained vs. all other outcomes. Isn’t the saving of lives what we’re here for? Or do physicians direct their lives’ work toward simply accumulating “choices” satisfied?

Next post will discuss the ethical conclusions made by the authors, who raised concerns about risks of viewing the ultrasound itself.

Ultrasound before Abortion: Consideration of Recent Research

In the January edition of Obstetrics & Gynecology was an article entitled, “Relationship Between Ultrasound Viewing and Proceeding to Abortion” by Gatter et al that has already received publicity. There is no doubt that this article will be oft-cited for many years, so it merits discussion.

The authors performed a retrospective review of one year’s worth of records at Planned Parenthood clinics in Los Angeles, finding that in that particular practice setting the voluntary viewing of ultrasound (after being asked, “Do you want to see your ultrasound picture on the screen as the clinician performs the examination?” or a similar question) did very little to dissuade women who were seeking an abortion from going through with it. They found that, “Most women presenting for abortion care in our sample had high decision certainty, and ultrasound viewing had no effect on their abortion decision.” Even among those who had “medium or low decision certainty” about having an abortion, 95.2% of those who viewed the ultrasound proceeded to abortion, compared to 98.7% who had not. Overall the difference was even smaller: 98.4% compared to 99.0%.

We can all probably agree on one conclusion— that this particular article certainly does not provide data to support the notion that viewing ultrasounds of pregnancies causes women seeking abortions to change their minds in significant numbers. But it is, unlike what the authors might nudge us toward believing, too early to write off the merits of offering and performing ultrasounds for these patients.

But what critiques can we make? I can think of a few, which I will enter over the coming weeks.

First, the reader must note that the ultrasounds were done in Planned Parenthood clinics in Los Angeles. The article did not attend to any details of what the “viewing” of the ultrasound entailed; the authors did not indicate that there was any attempt to “script” that process. I would propose that in the setting of a clinic dedicated to providing abortions, the discussion surrounding the ultrasound may bear little resemblance to the detailed explanation of fetal anatomy that a happily expectant couple may get from her obstetrician. Features like the brain, spine, heartbeat, limbs, fingers and toes, spontaneous movements as well as reactions to the pressure of the ultrasound are all part of what I discuss with my patients. For the woman seeking abortion, the physician performing it seems unlikely to attend to these details. I propose that not all ultrasound experiences are alike.

The article later raises concerns about mandated ultrasound viewing (arguing against it). It is a contentious notion already; to suggest that the viewing of an ultrasound ought to contain specific content and discussion would make it only more so. But would not true informed consent require it? And for the purposes of research, would not a dismissal of the impact of ultrasound’s effects on a woman’s decision require a more descriptive effort of what happens inside the exam room?

This is a reflection on the method of the intervention; in coming blogs I will add more thoughts about interpretation of results, and the ethical conclusions made by the authors.

Euthanasia, pediatric and adult, and the underlying concept of a life not worth living

Jon Holmlund’s recent post about pediatric euthanasia in Belgium made me think about what I had posted a couple of weeks ago about PGD and lives not worth living. There is a way in which the concept of a life not worth living underlies a whole spectrum of ethical issues from PGD and selective abortion to pediatric and adult euthanasia. There is a basic conflict between those who take different ethical positions on these issues over whether there are certain quality of life issues that can allow one person to decide that another person’s life not worth living.

For those who take the position that it is permissible for couples who are at risk to have a child with a serious genetic disorder to use PGD or prenatal diagnosis with selective abortion to try to insure that any child that is born is free from the genetic disorder, a part of the argument for their position is that it is permissible to discard the embryos found to have the disorder or abort the fetuses found to have the disorder due to the poor quality of life that would be experienced by those children if they were born. That is saying that the lives of those children would not be worth living. That decision is being made by the parents for their children and being confirmed by the physicians and others who participate in the process.

Those who support the permissibility of active infant euthanasia as practiced in the Netherlands under the Groningen protocol are also saying that the infants whose lives are being ended have lives that are not worth living. Again this decision is being made by the parents and confirmed by the physicians involved that the infant’s life is not worth living.

The situation with voluntary euthanasia of children as it has recently been allowed in Belgium is more complex. If the child does not actually have full decision making capacity or is being overtly or covertly coerced, it is again someone other than the child who is making the decision that the child’s life is not worth living and the situation is similar to infant euthanasia. If the child has full decision making capacity then it could be reasonable to consider the situation to be the same as adult voluntary euthanasia.

With adult voluntary euthanasia some would argue that the concern about one person deciding that another person’s life is not worth living is not an issue because it is the one whose life is being ended who is making that decision. However, whether what is being done is voluntary active euthanasia in which a physician is administering a lethal drug or physician assisted suicide in which the physician prescribes the drug with the intent that the patient will self-administer it, the physician who is involved must make the decision that the act of ending that patient’s life is warranted. Few would be willing to take respect for autonomy so far as to say that anyone who requested assistance to end his or her life should be provided the means to do so without a judgment by the physician that the decision to do so was an appropriate one. Assisting someone to commit suicide who is despondent over a break-up of a relationship is irresponsible. Thus physician participation in voluntary active euthanasia or assisted suicide requires an independent decision by the physician that the decision to request assistance in ending life is reasonable. The only way a physician can make the decision to participate is to decide independently that the patient’s life is not worth living.

The only situation in which ending a life to avoid a poor quality of life could be done without one person deciding that another person’s life is not worth living would be unassisted suicide. There are Christian and Kantian arguments for why that is not morally permissible, but that lies outside the realm of these thoughts.

Since all of these actions, from PGD to adult voluntary assisted suicide involve one person making a decision that another person’s life is not worth living, a crucial issue is whether it is morally permissible for us to make such a decision about another person’s life. For those of us who have an understanding that every human life has value simply because of being human, we must answer that it is not permissible to make that decision. We understand that no matter how difficult a life may be that person still has value and our response to those whose quality of life is poor and who are having to endure more suffering than it would seem that they ought to is to affirm the value of that person’s life by caring for the person’s needs. We cannot say that another’s life is not worth living.

Life, death, technology, and really hard questions

A tragedy is unfolding in Texas, unfortunately in the public eye, of a 33-year old woman who suffered a severe injury to her brain on November 26th, when she was 14 weeks pregnant. Her brain, we are told, has stopped functioning; her other bodily functions are being maintained artificially. Her now 20-week old fetus is still alive. Her family has asked the hospital that, in accordance with the woman’s previously expressed wishes, her bodily functions no longer be maintained mechanically. The hospital has refused, citing a Texas law that prohibits the removal of life-support for a pregnant woman; the husband has sued the hospital to have the life-support removed.

Here is a tragedy in which all choices are fraught with deep sorrow, and in which difficult questions are legion; if we think we have answered one, seven more spring up to take its place. Before I discuss them any further, let me lay my cards on table: First, I am pro-life. This implies far more than that I am simply against abortion! But I do believe that in most situations, abortion is not the right or best option. Among other reasons, I believe this because I am a physician still enamored of the Hippocratic tradition, and because I am a Christian — that is, I believe Christ’s claims that he is divine, and that therefore his statements such as “Do unto others as you would be done by,” and “Whatever you do to the least of these you do to me,” are more than just suggestions, and apply to how I treat all people, whether in utero or ex utero. However, there are rare instances in which abortion is the “least bad” alternative, such as when continuing a pregnancy places the mother at risk of serious harm or even death (and while this is indeed rare, I have known patients for whom this was judged to be true).

Second, I have some pretty strong beliefs about technology, which readers of this blog may have divined. I do not believe in the technological imperative which states that “Because we can do such-and-such, we are obligated to do it.” I strongly hold that people should be free to choose not to have technological interventions performed upon themselves. Related to this, I believe “Technology creep” is a rampant problem in medicine: techniques designed for one application are indiscriminately generalized and applied everywhere they can be applied, just because they can be, just because they are technology, and because we assume that technology always makes things better — when often all it does is dehumanize the situation.

That said — of all the questions this tragedy raises, the two questions I pose today are, Is stopping life support for the mother equivalent to abortion? And a related question, Does the pro-life position necessitate holding that this woman should be kept on life support for the sake of her unborn baby? The reasons to answer Yes are compelling. There are two people on life support: one who will almost certainly never get off of it alive, and another who has the potential to get off of it alive if the other stays on a little while longer. If the machines are disconnected, two people will die. As far as we can tell, the machines are not a burden to the mother (if she is indeed “brain-dead,” then by definition she isn’t suffering). When she said that she would never want to be maintained on machines, she probably wasn’t considering being pregnant and on machines, and who knows what she would have wanted in that case? It seems it would be better to err on the side of temporarily maintaining her bodily functions for the sake of her unborn child.

And yet there are enough caveats here to make me wonder. Is stopping the life support in this situation tantamount to abortion? I am not sure that it is. By withdrawing the life support, we withdraw a technique and allow the natural course of events to take place; the intention is not to kill the fetus (although that is what surely will happen as a result).  By induced abortion, we introduce a technique to change the natural course of events, with the intention to kill a human being. It seems to me that there is enough of a difference between the two that we should not conflate them. Again – it is well-accepted that there is no ethical difference between withholding treatment and withdrawing treatment. If we are to say that withdrawing the treatment in this case is abortion, does that not imply that withholding (not starting) the treatment in the first place would also be abortion? That smacks of a tyrannical technological imperative, a place I don’t think we want to go. Again –  The second formulation of Kant’s categorical imperative runs something like, “We should never use someone only as a means to someone else’s ends.” I am no philosophy major, but it sure feels like keeping this woman on life support against her express wishes is making her a means without considering her as an end.

If one were to abstract this situation from its context, consider it as a theoretical problem, the “least bad” outcome would be for the woman to be supported until her baby is born. But this is not an abstract, theoretical problem. I have sat at the bedsides of many, many patients who have been trapped in webs woven by dubious uses of technology. I have seen many, many people enduring the “living hell” that this woman’s husband has described experiencing over the last few months. Granted, these experiences of mine don’t carry the weight of rational arguments; but they remind me that these decisions are not carried out in the academic ether. I do not believe that withdrawing the life support for this woman is equivalent to abortion; and, related to that, I don’t believe the pro-life position necessitates holding that keeping this woman’s body functioning in order to allow her baby to reach viability, against the express wishes of her and her family, is the only ethical solution. There are those who will disagree with me, some vehemently; I understand their positions and respect them. (I am not speaking for Trinity International University, so don’t get mad at them!)

I don’t have space to go into all of the other issues this situation raises (one of them being the definition of “brain death” — see here for a thoughtful reflection on the matter). But one more issue I will address: There are a lot of people who have written and said uncharitable and judgmental things about this woman’s husband and family. While I am uncertain about what is the right thing to do in this situation, I’m quite certain that passing judgment on the family is wrong.

Pro-Life Vegetarians: Can’t We All Just Get Along?

I broached the ethical linkage between the pro-life and vegetarian movements in a blog post a couple of weeks ago, where I introduced an essay by Matthew Scully that purports to make a case for vegetarianism on ethical grounds. I have mentioned before my dislike of the moniker “pro-life,” though I have yet to find a more politically-palatable name when “anti-choice” is offered as its replacement. Given my options, I’ll run with “pro-life” henceforth. I have also mentioned my dislike for the manner in which Scully makes this argument, appealing less to rationality than engaging a PETA-like appeal to theatrics.

In this second overview of the issue, I reference an article in First Things from over four years ago written by Mary Eberstadt, an author and research fellow at the Hoover Institution, and someone for whom I have a high regard. She finds herself in agreement with Scully’s overall principles, with a more intellectually cautious, less bombastic approach than his, but carries the moral imperative for vegetarianism further, connecting it to the defense of human life. That the proponents of each appear to find little common ground today she finds less an issue of intellectual and moral acrimony than a failure of competing ethical frameworks to engage one another. This dedication to the ethical agenda of various groups has essentially led (as I quite loosely paraphrase) to people that can’t play well together in the sandbox.

She describes the principal proponents of ethical vegetarianism (if I can call it that; it suggests that people like Bill Clinton who have essentially embraced veganism to avoid an imminent death from cardiovascular disease are “unethical vegetarians;” I will leave it to political non-partisans to parse those terms). They are a group of utilitarians like Peter Singer and postmodern eco-feminists like Carol J. Adams. Neither group is especially amenable to the views from an alliance of conservative Catholics and evangelicals that make up much of the pro-life movement. Evangelical Christians and conservative Catholics put away their differences in a conjoined white-hot lather against people like the utilitarians and eco-feminists who do the same against them. It’s like the 1980s where the Moral Majority and People for the American Way largely existed to antagonize each other and finally just got tired of it. But these groups aren’t tired yet.

Eberstadt notes that, among the “pro-animal” (again, I dislike the term, but will stick with it) adherents within utilitarianism and feminism, “both are hostile to the idea of admitting unborn human life to their circle of approved moral sympathy.” In the case of utilitarianism, animals can suffer pain in ways that unborn humans cannot, so they “trump” the unborn ethically. Eco-feminists find that both women and animals have been victimized, by rape and slaughter, respectively. Protection for animals means that they should not be killed for food; the protection of women means that all rights, including reproductive rights like abortion, must be preserved at all costs. Add that to an open hostility of both groups to matters of religious faith and you have created a very inhospitable sandbox indeed.

The pro-life forces, in Eberstadt’s view, are largely against vegetarianism because it is so often associated with wackos. We’re against it because they’re for it. This defensive crouch, she finds, is counter to the long history in the church of vegetarians like Francis of Assisi and John Chrysostom. Unfortunately this is where her explanation of this position ends, failing to address Biblical scholarship that permits meat-eating, in moderation like most things, as morally-acceptable.

Her solution rests upon an appeal to moral intuition (she avoids the term “natural law” for whatever reason). The comparison is made between those who joined the pro-life or pro-animal (i.e., vegetarian) cause as a consequence of a moral epiphany. Something happens, and we realize that our prior position is wrong. Certainly pro-life supporters use ultrasound images to sway the thinking of those who don’t seem to fully comprehend the moral significance of an unborn human. Likewise, images from grievous practices in some commercial farming or slaughter operations can create a moral reprehension toward the eating of livestock. Eberstadt now finds that we really are all playing in the same sandbox, one where our deepest, most intuitive assessments will prevail to embrace the value of all life, human and animal.

But this is where natural law, or moral intuition, loses me. Moral intuition is a terrific system in the absence of sin, when separated from the realities of the fall. It is still with us in some form, as the notion of “common grace” would have it, but it isn’t perfect. Our moral intuition may change with a compelling argument, perhaps a morally-invalid one. Moral intuition is not disembodied from our feelings at any given time.

During a recent time-wasting exercise of clicking-on-a-link-from-another-link, I was led to an advice column in Salon magazine, that sentinel of moral rectitude. I didn’t expect a lot, but was taken aback by the comment of what should prevail in moral decision-making:

“I think, within certain limits, in our social arrangements, it is right for us to behave according to how we feel. Feeling is a great regulator of human behavior.”

I won’t go further in how ghastly that idea is; I’m glad flash mobs are so in touch with their feelings. Fallen human beings can and do fall prey to their feelings and emotions when setting a moral compass. There need to be deeper principles than just profound moral intuition when processing ethical claims.

More importantly, frankly there are frankly moral issues that trump others. It is not necessary to make false equivalencies to justify moral repugnance to meat-eating and taking the lives of unborn humans. Both are substantial moral quandaries, but they aren’t the same. To make them so is little better than how the utilitarianism of Peter Singer or the rights-theory of Tom Regan sentimentalize all life, with no distinctions made for the moral weight of human beings. At some point, there needs to be recognition that there are indeed two very different games being played in the sandbox.

The End of Amniocentesis? (and the Discontents Thereof)

This blog has carried posts about the development of non-invasive prenatal testing for chromosomal or genetic abnormalities.  Because some DNA of a fetus (unborn baby) circulates in the mother’s bloodstream, it is now possible to identify genetic abnormalities just by drawing a blood sample from a pregnant woman’s vein.  The more traditional techniques, done much later in pregnancy, are amniocentesis and the related procedure chorionic villus sampling.  Those techniques are invasive, requiring obtaining a sample directly from a pregnant woman’s womb (with some risk to the fetus).  Because diagnosis of conditions such as Down syndrome may lead to the decision to have an abortion, pro-life advocates such as the late Dr. C. Everett Koop called amniocentesis “a search-and-destroy mission.”  One does not have to be too prescient to see the day, fairly soon, when the mission moves much earlier in pregnancy, is done non-invasively, and covers a host of not only serious disorders that greatly shorten the life of a born child, or abnormalities like Down syndrome, but other genetic diseases or even variations that may or may not be desirable.  It is also a short but timely step to consider how this will affect the number and timing of abortions in the future.

Geneticists remind us that we should be careful not to let concerns run ahead of the state of the art.  They point out, for example, that:

  • The current non-invasive tests are mainly focused on chromosomal abnormalities—specifically, three trisomies:  Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), and Patau syndrome (trisomy 13).
  • By professional guideline and, in some states, law, non-invasive testing should only be done in pregnant women who are at high risk for bearing babies with one of these syndromes.
  • The tests are not fully diagnostic, but only screening tests.  A positive result should still be confirmed with one of the more invasive tests.
  • The tests may be highly sensitive and specific for what they are assessing, but that is not the same as having a high predictive value.  The predictive value of positive or negative results may not be well-established, and depends critically on how prevalent, or common, the condition being tested for is in the population being tested.  For example, a positive result of a very accurate test for a rare disease still has a low likelihood of having actually detected the disease in an individual who tests positive.  This is an entirely trustworthy, if seemingly counterintuitive, fact—trust me.
  • Consequently, at the present, non-invasive prenatal genetic testing should not be done routinely, and should be done only with prior and ongoing careful medical counseling.  Also, care should be taken that women not rush into a decision to terminate a pregnancy based on one of these tests, out of a sense of feeling pressured not to wait too late into pregnancy.  This last point is likely to be apropos as legislative restrictions on abortions after 20 weeks—which I generally consider laudatory—gain some traction.

It seems to me that the basic ethical issues are the same, but one’s day to day approach should keep the current state of the art in mind.   This post was prompted by my morning email from Medscape, with more detailed discussions here and here, a brief visionary statement here, and a brief very top-level comment on the implications for abortion, by Dr. Arthur Caplan, here.