Transcript Chapter 5: Abortion

Chapter 5: Abortion
Abortion and public opinion
• Among medical ethical issues abortion is
perhaps the most familiar to the general
public and one about which almost everyone
has an opinion.
• And that opinion has been strongly divided
ever since the Supreme Court Decision of
1973, (Roe vs. Wade) which made abortion
legal in the United States.
Ambivalent attitudes
Americans’ ambivalence towards abortion is revealed in a May 2009
poll by the Gallup Organization:
• 23% said abortion should be illegal
• 53% believed it should be legal under some circumstances
• 22% said it should be legal in any circumstance.
• The poll also shows a slight swing in a conservative direction. When
people were asked, “With respect to the abortion issue, would you
consider yourself to be pro-choice or pro-life?” those answering
pro-life rose to 51% from the 44% reported in 2005.
Ambivalent attitudes
• Those describing themselves as pro-choice declined from
48% to 42%. This is the first time a majority of U.S. adults
have identified themselves as pro-life since Gallup first
asked the question in 1995.
• This conservative shift was not accompanied, however, by a
significant increase in the number of people wanting to see
abortion outlawed.
• In a second 2009 Gallup poll, 75% of the interviewees
expressed the view that abortion should be “always” or
“sometimes” legal and only 23% endorsed the notion that
it should always be “illegal.”
Abortion and New Medical Technology
• To some extent, the ambivalence about
abortion and the public clash of opinions
about its moral legitimacy may be due to new
reproductive and life-sustaining technology,
and an increased awareness of the character
of the fetus.
Example: In Vitro Fertilization
• When a genetic disease like Tay–Sachs is present
in a family, in vitro fertilization and the selection
of an embryo free of the disease for implantation
can avoid a problem that might lead to abortion.
• While for some, discarding unused embryos
created by in vitro fertilization is equivalent to
abortion, most people are more comfortable with
the idea of destroying embryos than of aborting a
fetus.
Example: Selective Reduction
• People have become more familiar with the
concept of “selectively reducing” one or more
developing fetuses in a multiple pregnancy
resulting from the use of fertility drugs.
• For some, selective reduction is simply
abortion by another name, but for others it is
a procedure necessary to give the remaining
fetuses a better chance to develop normally.
Example: Plan B
• In the past few decades, new drugs have been developed
which can prevent pregnancies or terminate pregnancies
very early after conception (Emergency Contraception, EC).
These include drugs such as Plan B.
• Plan B is a treatment regimen that consists of taking two
pills containing high doses (.75 mg) of a version of the
hormone progesterone.
• Plan B prevents pregnancy by delaying or preventing
ovulation, inhibiting fertilization, or preventing a fertilized
egg from implanting itself in the wall of the uterus.
Example: Plan B
• Because there is no way to tell when an egg becomes
fertilized after intercourse, Plan B blurs the line
between contraception and abortion.
• A majority of Americans have no objections to
contraception or to very early abortion, so they tend to
see emergency contraception as a legitimate way to
prevent an unintended pregnancy.
• Those opposed to contraception or to abortion,
however, reject the use of Plan B.
Earlier viability of fetuses
• Another relevant development in technology is the ability
to keep alive babies who are so premature that, in
important aspects, they are still developing fetuses.
• A baby is considered full term if it is born forty weeks after
conception, but it is possible to save the lives of infants
who have had only twenty-three or twenty-four weeks of
development.
• The fact that such small babies can survive outside the
uterus has led many people to become more restrained in
their endorsement of abortion or to favor restrictions on
when it can be performed.
Prospects for resolving abortion dispute
• The technological developments just described (as well as others)
have helped to keep America divided over the morality and legality
of abortion.
• What are the prospects that this important social issue can be
resolved?
• Because the deadlock over abortion has gone on for some timed,
and in spite of an enormous amount public attention and litigation,
the issue may appear beyond resolution.
• People simply have different moral intuitions about abortion and
nothing can be done or said to bridge those differences.
Prospects for resolving abortion dispute
• The readings in this chapter can be seen as a
challenge to this moral pessimism. They explore
reason-based arguments for and against
abortion.
• Because these arguments appeal to
considerations that both opponents and
supporters of abortion can accept, they offer the
prospect of developing a consensus.
Ethical focus of chapter readings
The chapter articles focus on two questions:
• Is abortion moral?
• Do medical professionals have an obligation to
provide emergency contraception (EC) even if
they object to their use for ethical reasons?
Comments on readings
• The writers in sections 1 and 2 of this chapter address the
first of the questions: Is abortion moral?
• In section 2, John Noonan (“An Almost Absolute Value in
History”) and Mary Ann Warren (“A Defense of Abortion”)
square off against each over the question of whether a
fetus is a “person”, that is, a being entitled to the same
moral rights as an adult human being, such as, a right to life
and liberty.
• They can be understood as seeing the key issue in the
abortion debate as centering on the qualities or criteria
necessary for making something a person. (Personhood
argument)
Comments on readings
• Judith Jarvis Thompson, in “A Defense of Abortion”
looks at the morality of abortion from a perspective
different from the personhood argument.
• She asks us to assume, for the sake of argument, that
fetuses are persons and therefore entitled to certain
moral rights.
• She then examines and challenges the idea that the
assumption of fetal personhood automatically leads to
the conclusion that abortion is immoral.
Comments on readings
• In section 1, Don Marquis, presents an argument
against abortion which, he claims, is not a
personhood argument but instead rests on an
analysis of what makes killing an adult human
wrong, namely that killing deprives the person of
a valued future.
• From this analysis, Marquis concludes that similar
thinking applies to human fetuses, making
abortion wrong except in special circumstances.
Comments on readings
• Don Brown offers a critique of Marquis based on the claim
that there is a serious ambiguity in the idea of a future of
value.
• This ambiguity means that there is no consistent way to
understand Marquis’ argument that will make it successful.
• Brown’s criticism employs the idea of rights and the
conditions under which those rights can be ascribed. These
explorations suggest that the personhood argument, and
Marquis’ argument, are more closely linked than might at
first appear.
Section 1:
Abortion and the “Deprivation of
Futures” Argument
Reading: Why Abortion Is Immoral
Don Marquis
• The author offers what he considers to be an essentially new
argument to establish the basic wrongness of abortion.
• The reason murder is wrong, according to Marquis, is that it
deprives a person of the value of his or her future.
• Because a fetus, if not aborted, can be assumed to have a future
like ours that is also of value, abortion, like any other kind of killing,
can be justified only by the most compelling reasons.
• Contraception, by contrast, is not wrong, because there is no
identifiable individual to be deprived of a future.
Reading: The Morality of Abortion and the
Deprivation of Futures
Mark T. Brown
• Mark Brown rejects Don Marquis’s argument
that abortion is wrong for the same reason
that killing an adult is wrong: it deprives the
person of a future of value.
• Brown claims that the argument trades on the
ambiguity of “future of value,” which may
mean either “potential future of value” or
“self-represented future of value.”
Reading: The Morality of Abortion and the
Deprivation of Futures
Mark T. Brown
• The first interpretation implies that we commit
homicide whenever we fail to provide someone
with whatever he needs to live, but not to
provide someone with necessities (e.g., medical
care) is not necessarily to treat him unjustly.
• A fetus could have a presumptive right to life only
if women had no right to control their bodies.
Reading: The Morality of Abortion and the
Deprivation of Futures
Mark T. Brown
• Marquis’s argument fails for it “implausibly”
assigns people “welfare rights to valuable
futures” and “liberty rights not to be killed.”
• While the second interpretation makes Marquis’s
argument deductively valid, it cannot be sound
(i.e., have all true premises), because the fetus
lacks the neurological development required for
imagining a future. Marquis’s argument gains its
force only by trading on the ambiguity of “future
of value.”
Section 2: Abortion and the Status of
the Fetus: The Classic
Arguments
Reading: An Almost Absolute Value in History
John T. Noonan, Jr.
• John Noonan argues that at the moment of
fertilization a developing human being becomes a
person.
• Noonan reviews some distinctions used by
abortion proponents who maintain that
personhood is achieved at a later stage of
development (viability, experience, and social
visibility) and concludes that they are all
illegitimate.
Reading: An Almost Absolute Value in History
John T. Noonan, Jr.
• Noonan argues that conception is the decisive moment of
humanization because it is then that the new being
receives a genetic code from its parents.
• The basic principle that should govern our attitude toward
the fetus, Noonan claims, is a theological and humanistic
one:
• Do not injure your fellow man without a sufficient reason.
Thus, abortion is never right, except to save the mother’s
life. Abortion is immoral because it “violates the rational
humanistic tenet of the equality of human lives.”
A Defense of Abortion
Judith Jarvis Thomson
• Judith Jarvis Thomson, in this very influential article, avoids
the problem of determining when the fetus becomes a
person. For the sake of argument only, she grants the
conservative view that the fetus is a person from the
moment of conception.
• She points out, however, that the conservative argument
using this claim as a premise actually involves an additional
unstated premise. The argument typically runs as follows:
• The fetus is an innocent person; therefore, killing a fetus is
always wrong. The argument requires that we assume that
killing an innocent person is always wrong.
A Defense of Abortion
Judith Jarvis Thomson
• But, Thomson claims, killing an innocent person is
sometimes allowable. This is most clearly so when selfdefense requires it.
• Using several moral analogies, Thomson attempts to
show that a fetus’s right to life does not consist in the
right not to be killed, but in the right not to be killed
unjustly.
• The fetus’s claim to life is not an absolute one that
must always be granted unconditional precedence over
the interests of its mother.
A Defense of Abortion
Judith Jarvis Thomson
• Thus, abortion is not always permissible, but
neither is it always impermissible. When the
reasons for having an abortion are trivial, then
abortion is not legitimate.
• When the reasons are serious and involve the
health or welfare of the woman, then
abortion is justifiable.
On the Moral and Legal Status of Abortion
Mary Anne Warren
• Mary Anne Warren takes an even stronger position
than Thomson, arguing that a woman’s right to have an
abortion is unrestricted.
• She attempts to show that there is no adequate basis
for holding that the fetus has “a significant right to life”
and that, whatever right can be appropriately granted
to the fetus, it can never override a woman’s right to
protect her own interest and well-being.
• Accordingly, the laws that restrict access to abortion
are an unjustified violation of a woman’s rights.
On the Moral and Legal Status of Abortion
Mary Anne Warren
• Warren is critical of both Noonan (see earlier article) and
Thomson. Noonan, she claims, fails to demonstrate that
whatever is genetically human (the fetus) is also morally
human (a person).
• Thomson, Warren argues, is mistaken in believing that it is
possible both to grant that the fetus is a person and to
produce a satisfactory defense of the right to obtain an
abortion.
• Contrary to Thomson’s aim, Thomson’s central argument
supports the right to abortion only in cases in which the
woman is in no way responsible for her pregnancy.
On the Moral and Legal Status of Abortion
Mary Anne Warren
• Like Noonan, Warren conceives the basic issue in abortion to be the
question of what properties something must possess to be a person
in the moral sense.
• She offers five traits she believes anyone would accept as central
and argues that the fetus, at all stages of development, possesses
none of them.
• Since the fetus is not a person, it is not entitled to the full range of
moral rights.
• That the fetus has the potential to become a person may give it a
prima facie right to life, but the rights of an actual person always
outweigh those of a potential person.
Section 3: Emergency Contraception and Professional
Responsibilities
• The essay by Robert Card (“Conscientious
Objection and Emergency Contraception”)
highlights an ethical issue created by the
development of “emergency contraceptives”
(ECs) capable of preventing pregnancy early after
intercourse.
• As noted earlier, ECs help to blur the line
between contraception and abortion in the
publics’ mind but, it has also done so in the
minds of medical professionals as well.
Section 3: Emergency Contraception and
Professional Responsibilities
• For medical professionals, the ambiguity can be
particularly acute since on the one hand, their
responsibility, as professionals, requires that they meet
the legitimate medical needs of their patients.
• But what if the professional believes, personally, that
the use ECs is morally objectionable? Do his medical
responsibilities require that he provide them if asked?
• Card, reviews and critiques several arguments that
have been proposed to resolve this dilemma.
Conscientious Objection and Emergency
Contraception
Robert F. Card
• Card argues that pharmacists, nurses, and doctors have
a professional duty to inform women about emergency
contraception (EC) and to provide it when requested.
• He rejects the standard solution to the problem EC
poses to medical professionals who object to it on
conscientious grounds—namely, referring patients to a
willing provider.
• This solution, Card claims, can result in great harm to
women, may compromise patient confidentiality, and
fails to fulfill the obligations of a medical professional.
Conscientious Objection and Emergency
Contraception
Robert F. Card
• In Card’s view, professionals can’t legitimately object to
EC on the same grounds as they might object to
abortion, because EC prevents ovulation and thus
operates before fertilization occurs.
• Professionals might try to object to EC on the grounds
they would use to object to contraception, holding that
EC is unacceptable either because it deprives
reproductive cells of the opportunity to become
persons or because it interferes with procreation,
which is the only acceptable goal of intercourse.
Conscientious Objection and Emergency
Contraception
Robert F. Card
• Card counters the first objection with the argument
that possible persons cannot be harmed by being
prevented from becoming persons.(See the essay
“’Give Me Children or I Shall Die!’ new Reproductive
Technologies and Harm to Children”, Chapter 3 for a
detailed discussion.)
• The second objection he dismisses as injurious to rape
victims (procreation can hardly be their goal) and as
inconsistent with the autonomy-based right of adults
to make reproductive decisions (e.g., to have a sex
without the goal of reproducing).
Conscientious Objection and Emergency
Contraception
Robert F. Card
• If adults have a right to contraception, then medical
professionals must offer and provide EC.
• Unlike other contraceptives, EC must be used within 72
hours after sexual contact, so referral to a willing provider
may delay EC beyond this time, particularly in rural areas
with few providers and for disadvantaged patients who
typically delay seeking help.
•
• For those reasons, Card concludes, medical professionals
cannot ethically refuse to offer and provide EC. Referring
women elsewhere will not let them escape their
professional duty.