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The Amoral Unborn

I’m not in the political prediction business -and it looks like Romney might be back on top of the polls in Michigan- but if Santorum squeezes out a win in the Mitten State that will certainly be embarrassing for Mitt and will lead to more embarrassing political controversies over reproductive rights and “social issues” that should be settled by now. That said, I understand reasonable people can disagree about a tricky topic like abortion rights. I know Santorum and Gingrich oppose secularism, but in order to get past this moral impasse as a public policy issue let’s appraise the moral foundation of a woman’s right to reproductive control.

Placing an ethical premium on personal autonomy provides a vital safeguard against harm for individuals. The state should only infringe on that autonomy to the extent that a person’s free decision causes measurable suffering to others. Abortion opponents doubtlessly believe that ending a pregnancy harms the “unborn.” They’re wrong.

Our moral concern need only extend to conscious creatures with the ability to perceive experiences. It’s the reason landscapers don’t face an ethical dilemma every time they mangle and sever live grass with steel blades. An unborn blastocyst lacks a brain and nervous system (it doesn’t even have neurons yet); without those faculties a blastocyst cannot suffer. In contrast, developed conscious women can suffer and can experience pleasure. Pro-life activists want the state to restrict the personal autonomy of a full human person. Then, against her will, the pregnant woman must suffer all the consequences and risks in order to protect an entity that, by definition, does not suffer.

The later stages of pregnancy may complicate the biological picture, but no moral obligation yet develops. Despite the growth of a nervous system and brain, a fetus has no awareness that is critical for our moral concern.

[The] fetus is actively sedated by the low oxygen pressure (equivalent to that at the top of Mount Everest), the warm and cushioned uterine environment and a range of neuroinhibitory and sleep-inducing substances produced by the placenta and the fetus itself: adenosine; two steroidal anesthetics, allopregnanolone and pregnanolone; one potent hormone, prostaglandin D2; and others.

The closest parallel may be surgery under anesthesia. Surgical patients do not perceive their experience or conscious pain because, as my nurse anesthetist friend explains, “the brain is unable to receive or remember pain… the nervous system is still intact and signals are still being sent to the sleeping brain.”  A fetus never awakens into consciousness – it won’t notice… it can’t notice or miss its life or its termination anymore than a sperm does.

I thought it’d be unnecessary to discuss, but since Newt Gingrich made the ridiculous, false, and offensive charge that “Barack Obama voted in favor of legalizing infanticide” I might as well explain why infants merit our moral care. Using a comparable moral framework, Will Wilkinson of The Economist believes infants are not persons, but still accepts that the prohibition on infanticide is “wise.” Yet I think he sells the strength of his case a bit short. Wilkinson argues that “birth is a metaphysically arbitrary line.” That’s not entirely false, but it’s less arbitrary than he suggests. Here’s Christof Koch from the Scientific American again:

The dramatic events attending delivery by natural (vaginal) means cause the brain to abruptly wake up, however. The fetus is forced from its paradisic existence in the protected, aqueous and warm womb into a hostile, aerial and cold world that assaults its senses with utterly foreign sounds, smells and sights, a highly stressful event.

As Hugo Lagercrantz, a pediatrician at the Karolinska Institute in Stockholm, discovered two decades ago, a massive surge of norepinephrine—more powerful than during any skydive or exposed climb the fetus may undertake in its adult life—as well as the release from anesthesia and sedation that occurs when the fetus disconnects from the maternal placenta, arouses the baby so that it can deal with its new circumstances. It draws its first breath, wakes up and begins to experience life.

In other words, at birth, infants begin to experience conscious awareness. After delivery, the infant is an autonomous entity that no longer directly risks harm to the mother. The newborn’s ability to perceive harm and pleasure demands that we foster the child’s wellbeing.

Since blastocysts and fetuses can’t consciously experience the consequences of a woman’s decision, any government intervention unnecessarily infringes on personal liberty and causes harm and risk. The only refuge left for abortion opponents is to invent vacuous principles to protect such as “dignity.” Depending on the application, this religious concept is a “vague restatement” of other useful and more precise ethical metrics at best or is an attempt to elevate the interests of nobody above the interests of conscious autonomous persons at worst. In our moral calculus, it’s dispensable.

Secular reason leads us to care for living conscious women against the illiberal assault on their personal autonomy. It’s the moral position.

(image: fetal brain development)

Categories: Reproductive Rights
  1. Bill
    March 2, 2012 at 11:15 pm

    As always, your argument is sound and pragmatic. I too agree with it and support a woman’s right to choose. However, while perhaps not totally pertinent to your post, I wanted to add that despite the logic, there is something about the procedure that is markedly unpleasant, at least to me. I don’t think this unpleasantness can be easily ignored despite reason and logic. I’m not a religious person and I am not a squeamish person. In fact, more than most people, due to the nature of my job, I am exposed to a lot of gruesome things which have hopelessly rendered me quite hardened and detached from experiencing emotion toward unpleasant events. However, the suctioning out of a fetus into a plastic canister is not any easy experience despite all the rationalizing that is built into your argument. Imagine witnessing ten of these in one day. One after another. Imagine that some of those who decide to have an abortion are very young and have had multiple abortions already. Imagine the age of the fetus is uncertain and you find yourself watching arms and legs being pulled out of the vagina. Yes it is just biology. Yes it is just division of cells. Yes there is probably no pain involved. Yet there is something about it that has an emotional edge. Why? I don’t know. Perhaps its just preconceived notions about life and death, perhaps it is just my own personal weakness. Regardless, it is not always easy to emotionally detach-despite the science, despite my atheism, despite the anesthetic. So my point is that while we should take into consideration the science, we should also recognize that the emotional impact does raise some questions worth considering, particularly in terms of why abortion is so controversial. For instance, how much leeway do we give ourselves in condoning the decision to abort a fetus in the name of science, reason and morality particularly when the decision appears to be weak, flawed, hasty, or frequent. I’m not sure of the answer. It is something that I struggle with. I do not like to pass judgement and I do not want religion or government to make decisions for the mother, but there is a side to this that religion and government does approach which pro-choice people tend to ignore: At what point does irresponsible decision making need to be called out? Again, maybe this is not entirely pertinent to your post, but there is something that we lose when we use scientific detachment as a sole handle to an argument.

  2. Bill
    March 3, 2012 at 5:54 am

    …apologize for some of the gruesome imagery in my above statement. These are things I have seen/done that have shaped my views on abortion.

    • March 4, 2012 at 3:45 pm

      Bill no need to apologize. There is no need to ignore the realities of abortion, which I why I chose to frame my moral argument directly at the “unborn” rather than more philosophical discussion about “choice.”

      I do not deny that abortion is emotional and unpleasant. Of course no woman takes the decision carelessly – I’m confident the idea of causal casual abortions is a myth perpetuated by the pro-life movement.

      Yes “the suctioning out of a fetus into a plastic canister” affects our sensibility and seeing “arms and legs” elicits natural emotional responses. Yet, for most people seeing any surgical procedure would be shocking. Witnessing a surgeon rip through a person’s flesh and rip cage with a bone-saw only to then carve at vital organs with sharp blades would certainly make me squeamish. But somehow we don’t go around thinking that we need to grant ethical “leeway” or to “condone” other private and beneficial medical decisions.

      Who’s best decides whether a medical procedure is beneficial? The patient and scientifically-informed medical professionals.

      • Bill
        March 4, 2012 at 9:25 pm

        Dan- I am not familiar with the term “causal abortions”. I agree that the ultimate decision to have an abortion belongs to the woman, however, I cannot be certain that this decision is always made without carelessness. I have no way of truly knowing that, but I sometimes I wonder. I do see a lot of people coming in who have had multiple abortions. There are many people who I work with who choose not to participate in the abortion procedure because of this-and not for religious reasons, but because they do not condone what they believe is the casual use of this procedure by some people. For this reason I do support full access to birth control for every woman because, perhaps, limited access leads to using abortion as birth control-which I do believe sadly occurs (sorry Jack). Despite this, I try not to make personal judgements. Afterall, it is their body and their decision. However, I can also see why some people are opposed to abortion under these questionable circumstances. Of course they have the right to voice this opposition, but they do not have the right to impose their will on someone else. Thanks Dan.

  3. Jack
    March 3, 2012 at 5:24 pm

    Pro-lifer’s like to make this into a morality play, painting the picture as if abortion was a form of birth control. I’ve known several women who have admitted to me that they have had an abortion. In each case it was an incredibly difficult decision that affects them to this day. No one likes the idea of abortion. It’s a personal decision best left to the woman because in the end she is the one who has to make peace with herself.

  4. March 5, 2012 at 1:01 am

    Bill, I meant “casual” not “causal” (I edited my comment to make that clear). Sorry for any confusion; I typed out my whole response and then lost it before I posted it and had to rush my second attempt before work.

    I think you may be too loosely defining “carelessness” and we also don’t know what’s in the mind of these individuals as they make their decision. I think it goes too far to assume nonchalance. Either way, let’s assume they are doing it “casually.” So what? By definition it doesn’t affect anyone else.

    Certainly a good doctor will rightly alert anyone to the potential risks, but as you said, “it is their body and their decision.”

    • Bill
      March 5, 2012 at 8:04 am

      You are right Dan. I think my particular situation is unique, but that is another story…

  5. Jack
    March 5, 2012 at 9:38 pm

    For the record, no one gets pregnant in order to have an abortion. Majority of women who have multiple abortions are older and have had children. The issue is unintentional pregnancy.

  6. Bill
    March 6, 2012 at 5:27 am

    Majority of women who have multiple abortions are older and have had children. Really? That hasn’t been my experience.

    Also, then, for the record, we can say that while a woman should have the right to have an abortion because “its their body” , its not as if they are performing the abortion themselves. When they decide to have an abortion, many people are pulled into that decision-those who perform the abortion, those who assist, those who provide the anesthesia. In most hospitals, these healthcare workers have their own decision to make- to be involved or not. It has been my experience that most people choose not to be involved. Some for religious reasons, some because they fear the decision to abort is often done carelessly or for birth control, and others because they prefer a path of less resistance. Those who choose to be involved use the premise of being non-judgmental. But is being non-judgmental really a virtue that we should aspire towards when we are asked to partake in something that is not particularly virtuous? Is tolerance without question an indicator of higher level thinking or is it simply a scapegoat. I struggle with this. One is not intentionally judgmental. Its not always a factor of bigotry or prejudice.

    • March 6, 2012 at 8:26 am

      Are these same questions relevant to angioplasty for you?

  7. Jack
    March 6, 2012 at 11:01 am

    Bill, with all due respect I believe you are over emphasizing personal experience. You are passing judgement on certain woman which may or may not be true. Regarding multiple abortions: http://www.guttmacher.org/pubs/2006/11/21/or29.pdf

    As Dan is pointing out, Healthcare workers are held to a professional standard. This standard includes being non-judgemental. Providing care for Child molesters, rapists, murderers, or any other class of persons you might find abhorrent is never questioned on the job. They all receive care. The healthcare professional does not get to choose who they care for. They just perform their job. If they have a problem with that then they are free to vote in elections, donate money to whatever organization they feel best reperesents their views or choose another profession entirely.

  8. Bill
    March 6, 2012 at 4:02 pm

    Dan- Yes they are because Its not about the procedure. Its about the behaviors or circumstances surrounding the procedure and my right to draw an opinion on them. So for instance, a 45 year old man who weighs 400lbs and smokes 3 packs per day is coming for his fourth angioplasty. I can have an opinion about his lifestyle behaviors, can’t I? I would never treat this person disrespectfully or without compassion because, as the saying goes, until I walk in his/her shoes I have no way of knowing what went into making those decisions. Well the same goes for abortion when certain behaviors and circumstances surrounding it are subject to opinion. Unfortunately because this procedure has been so politicized, having an opinion about someone else’s sexual behavior is considered bigoted or judgmental (in a bad way). Again, I wouldn’t act on this opinion and I would treat them with any less respect or compassion. I think its when we act on opinion that we are in the wrong. I hope this makes some sense. I’m not so great at articulating my point. I don’t want you to think I am some crazy pro-life nut, because I am not.

    • March 6, 2012 at 4:14 pm

      I don’t think that, Bill, no worries.

      Of course you can have an opinion about behavior, but that opinion shouldn’t affect care. It’d be odd if cardiologists started refusing to treat the obese or if politicians started celebrating doctors that opted out of helping patients with heart problems.

  9. Bill
    March 6, 2012 at 4:33 pm

    Jack- Thank you for the paper. Keep in mind that I am not judging people. I am judging their behavior. I think that there is a big difference and I think that every healthcare professional makes a judgement on bad behaviors. They need to because often it is these behaviors that lead to poor mental or physical health. Holding back from confronting a patient on their bad behaviors does them no good in the long run.

    As to your statement that the healthcare professional does not get to choose who they care for. They just perform their job. Interestingly, this is does not apply to abortion. Conscience clauses have been adopted by a number of U.S. states. including Arkansas, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi,
    Pennsylvania, and South Dakota. http://en.wikipedia.org/wiki/Conscience_clause_%28medical%29
    http://www.consciencelaws.org/laws/usa/law-usa-03.html

    In the hospital I work at there are many nurses and doctors who refuse to be involved in pregnancy terminations. In fact, in my dept. the majority refuse. Out of 20 or so nurse anesthetists, I am one of maybe four who will do them. When I worked in an inner city, I did about 10 a week. Mostly all in one day. For a while I had to stop. There are two Gynecologists I know of that perform late term abortions. Its really much harder to detach from these.

  10. Jack
    March 6, 2012 at 5:13 pm

    I’m aware of the conscience clause and personally I am against it. I’m glad you feel that the time to counsel people on their behaviors is best performed before performing the abortion. Perhaps we should consciously withhold care on obese patients, patients who don’t take their medications (non-compliance), and those that lack insurance.
    So how is it that you know everything about a woman that’s under anesthesia? did your 20min interview provide you with all that information?
    I don’t question the value of behavioral changes I’m just questioning your implementation of it.

    Does anyone see the irony that a group of men are discussing value judgements and women without a single woman’s voice being represented?

    • March 6, 2012 at 5:15 pm

      Yes, which is why Heidi should read the blog more. ;)

      • Bill
        March 6, 2012 at 5:34 pm

        Jack- If you are aware of the conscience clause then why did you make the above statement
        that “the healthcare professional does not get to choose who they care for” when discussing abortion, because clearly under the conscience clause they do. I also don’t appreciate your reach that suggests that someone who has an opinion about behavior might call into action a withholding of care. I have never heard anyone ever suggest that except maybe a fat fascist republican white guy on AM radio. I also don’t appreciate the insinuation that because a woman is not present here on this blog to discuss these issues that somehow our points are not credible or that she would perhaps disagree simply because there is a gender difference. Further, I don’t know everything about a woman who is having an abortion. I never said I did, but I do meet them, talk to them, do a thorough review of their record, and discuss with them the procedure and the anesthetic before administering them anesthesia. Sometimes all I need to know is that a woman is having her fourth abortion and she is only 21. That alone tells me that something is wrong. Don’t you think?? Just like a 40 year old on his 3rd heart attack. Intervention might be needed. Again, no one is judging the person. We all have our issues, but the behavior must be addressed- for the sake of the patient. Tolerance for the sake of tolerance serves no one.

  11. Jack
    March 6, 2012 at 8:45 pm

    The conscience clause is not universally applicable. Are you allowed to opt out of providing anesthesia for criminals or the patient who is a liver transplant recipient who ruined his liver by alcoholism? Surely you’ve heard those stories. Are you suggesting that the norm is the 21 year old on her 4th abortion? Is this your experience? May I point out to you there is reason why Police officers are not Judges, and judges are not police officers. Perhaps your view is only the partial truth.
    Feel free to expound upon your experience of Therapist. How much of your CRNA education was spent on psychiatry/social work/ counseling? You state that “no one is judging the person” but also state “Sometimes all I need to know is that a woman is having her fourth abortion and she is only 21″ sounds like a judgement call to me. Sorry you don’t see the relevance of a female point of view since neither of us can provide a first hand experience of abortion.

    • Bill
      March 7, 2012 at 5:47 am

      Jack-

      Are you saying that only a therapist can have opinions about behavior? Does an undergraduate degree in psychology count? What about a Master’s prepared Psychiatric Nurse Practitioner? Or maybe a PhD is best? Do I need to get special certification? Because I want to get me some so I can have an opinion too dammit. Everyone else should just shut up and accept everyone else’s behavior and just do their job! Why don’t you go down to your local police station and tell everyone there that they can’t have an opinion on the behavior they witness day in and day out because they aren’t therapists.

      Listen, in all seriousness, we wouldn’t be human if we didn’t have opinions about the behavior of other people. I think I made it very clear that my opinions are kept to myself and that I do not act on them for a multitude of compassionate reasons, so your persistence makes me wonder what your true intentions are. Oops, there I go again, making a judgement on behavior.

      Certainly there are many people who do act on their conscience and their opinions when it comes to abortion. Some of these opinions are bigoted, some are prejudiced, some religious-based. Am I allowed to have an opinion about those behaviors or are only therapists allowed??

      • March 7, 2012 at 9:24 am

        Bill, can you clear something up for me? You seem to be saying 2 mutually exclusive things – or maybe I’m just misunderstanding you.

        “I also don’t appreciate your reach that suggests that someone who has an opinion about behavior might call into action a withholding of care.”

        While also writing:

        “In the hospital I work at there are many nurses and doctors who refuse to be involved in pregnancy terminations. In fact, in my dept. the majority refuse.”

        Moreover you claim that “when we act on opinion that we are in the wrong” while simultaneously you seem to favor conscience clause laws.

        So do you think people should act on their opinions or not? If so, should that only apply to abortion or should medical professionals also be able to refuse treatment to heart patients or felons if it’s against their personal moral standards?

  12. Jack
    March 7, 2012 at 12:52 am

    Regarding the statistics of multiple abortions:
    “half of all women getting abortions report that contraception was used during the month they became pregnant.1 Some of these couples had used the method improperly; some had forgotten or neglected to use it on the particular occasion they conceived; and some had used a contraceptive that failed. No contraceptive method prevents pregnancy 100% of the time.

    If abortion were used as a primary method of birth control, a typical woman would have at least two or three pregnancies per year – 30 or more during her lifetime. In fact, most women who have abortions have had no previous abortions (52%) or only one previous abortion (26%).5 Considering that most women are fertile for over 30 years, and that birth control is not perfect, the likelihood of having one or two unintended pregnancies is very high. ”
    http://www.prochoice.org/about_abortion/facts/women_who.html

  13. Jack
    March 7, 2012 at 10:02 am

    You are free to have all the opinions you want. You stated “I think that every healthcare professional makes a judgement on bad behaviors. They need to because often it is these behaviors that lead to poor mental or physical health. Holding back from confronting a patient on their bad behaviors does them no good in the long run.” So are you hurting your patients by not confronting them based upon your opinion which you formulated in a 20min interview regarding anesthesia? Or were you able to establish such a rapport with her that she was able to discuss her sexual behaviors, relationship issues, etc so that you were indeed able to deem it correct that she was using abortion as birth control? With your infinite wisdom regarding human behavior that is usually reserved for those with advanced degrees in Social work or psychiatry, you were able to offer her a few sentences that profoundly affected her life thus breaking the infinite cycle of abortion.

    Oops I missed this quote “I think I made it very clear that my opinions are kept to myself and that I do not act on them for a multitude of compassionate reasons” So you are hurting your patients then? A “multitude of compassionate reasons”? Such as recognizing that your opinion may not be correct? That empathy might be more virtuous than judgement?

    Never once Bill do you ever ask “why would a woman require multiple abortions?”

  14. Bill
    March 7, 2012 at 5:06 pm

    Dan- Let me clarify. No one I know of openly suggests that we should withhold care for a patient-that is, not allow a patient to have an abortion. They just don’t want to be part of it.
    In light of this, no one is openly acting on an opinion they have of the patient. They are acting on an opinion they have of the procedure.

    I am not sure why you think that I favor the conscience clause laws. I brought them up merely to refute Jack who said that health care professionals “do not get to chose who they care for”. I don’t think there was anything in my statement that would give the impression that I support them. However, that being said, I do support them. While I may not agree with a particular decision, I don’t see any reason to force someone to do something that they don’t want to. Do you?

    So as to people acting on their opinions, well I guess you got me here. I know this is going to sound spongy, but while I don’t think people should act on their opinion of a patient, I do think it is OK for them to act on their opinion of a particular therapy or treatment. For example, while many people might have an opinion of a felonious drug abusing pedophile, they do not have an opinion on angioplasty. So no one I know of would refuse to participate in an angioplasty on that patient. Abortion is another story. Dan, you and I may not see a problem with it, but many people do. Its not about the patient, its about the procedure.

    My point, all along, of which I am catching hell for it from Jack, is that for me its not about the procedure, but about the behavior that surrounds this procedure. I’ll try to clarify this in my response to Jack.

  15. Bill
    March 7, 2012 at 5:45 pm

    Jack-

    In your very first reply to me you stated, “I’ve known several women who have admitted to me that they have had an abortion. In each case it was an incredibly difficult decision that affects them to this day. No one likes the idea of abortion.”

    I couldn’t agree more. That’s the whole point.

    So when someone comes in for an abortion I am taken aback. Multiple abortions, flags go up. I wouldn’t be in my profession if I wasn’t sensitive to what a patient is going through. Making an opinion on this behavior, for me, isn’t about sneering and condescending, its a trigger that this patient needs help. I have the same response when I meet a pt who drinks a gallon of Beefeater Gin every day. I’m glad you agree that I can have an opinion on these behaviors because I do-and I don’t think one needs to be a therapist to figure out that these people need help.

    So while it didn’t come up in this conversation, certainly I ask myself “why would a woman require multiple abortions? Or with the other patient, “why would they drink a gallon of alcohol a day?” I believe there are reasons and getting to the core of them is important if we truly want to help someone so that tragedy of these painful moments are not repeated.

    Now let’s be honest Jack. I am just the dope giving anesthesia. It is never my place to counsel a patient on their behaviors and I would never pretend that I have the skills of a therapist to do so. It is never the time, it is never the place, and its never my role or function. However, it is the role of someone- perhaps the gynecologist- to try and step in and help-if only to make a referral-perhaps to a therapist. So I strongly stand by my statement “that every healthcare professional makes a judgement on bad behaviors. They need to because often it is these behaviors that lead to poor mental or physical health. Holding back from confronting a patient on their bad behaviors does them no good in the long run.”

    Jack, I was kind of insulted when you asked me the following questions: “So are you hurting your patients by not confronting them based upon your opinion which you formulated in a 20min interview regarding anesthesia? Or were you able to establish such a rapport with her that she was able to discuss her sexual behaviors, relationship issues, etc so that you were indeed able to deem it correct that she was using abortion as birth control?

    I think you missed my point, but perhaps that is my fault. I am sorry that my written words gave you the impression that I was such an asshole that I would impose myself on a patient coming for surgery in such a manner. I never would. My point is that bad behavior should be recognized as a call for help and that the healthcare professional- probably not the nurse anesthetist- should tactfully confront this behavior. Not to condescend, but to help.

  16. Jack
    March 7, 2012 at 7:13 pm

    Bill, for the record I do not think poorly of you. I was merely trying to point out some things I saw as inconsistencies with your argument. Yes, counseling patients is important. My point was exactly that there is a right time and place for that with the right person. Women’s clinics do provide these services.

    You allude to my statement that “no one likes the idea of abortion”. By reading your posts one could conclude that your opinion is that women use this as a form of birth control despite statistical evidence ( rather than your subjective experience). So for the record, would you clarify your opinion on this?

    Regarding the withholding of care, Does not the ability to consciously object to participating in abortion (even though you are not actually performing the abortion) constitute a level of withholding of care? What if no one in your department wanted to participate? What if you were the only one? What kind of strain would that place on you? Would it not be better for all to have a larger number of CRNA’s who did provide anesthesia for abortion cases? What if we were to visit certain states that are known for their pro-life views, would it not be more difficult to obtain access to abortions?
    “The most recent survey found that 88% of all U.S. counties have no identifiable abortion provider. In non-metropolitan areas, the figure rises to 97%. ” http://www.prochoice.org/about_abortion/facts/access_abortion.html
    and what about the influx of all the restrictive abortion measures we have seen over the past year? Again is this not a form of withholding of care?

    • March 7, 2012 at 8:06 pm

      To expand slightly on Jack’s remarks and specifically that 88% statistic. This is why it is so important to counter anti-abortion activists that defame the moral character of many women and medical professionals. Faulty moral calculation has profound consequences in the lives of real people.

    • Bill
      March 7, 2012 at 9:04 pm

      Jack-

      Why is it important to you that I clarify my opinion on whether or not some woman use abortion as birth control? If you stand by your statements that “In each case it was an incredibly difficult decision that affects them to this day” and that “no one likes the idea of abortion” then isn’t the issue for you the emotional and physical impact the procedure has on the woman regardless of the reasons why they have one?

      Or maybe your premise is wrong. Ever think about that? Maybe not everyone is as emotionally torn by having an abortion as the few people you knew to be? Maybe using abortion as birth control is OK with some people? Maybe abortion isn’t as big a deal for some people as our politicians and our churches make it out to be? Would it not be worse to have a child that was unwanted and neglected? Let me be clear, I’m not passing judgement on that. In fact, if someone truly held those beliefs and were not emotionally impacted by having abortions, then having an opinion about behavior is unwarranted.

      Lastly, as far as the withholding of care issue, yes I fear that in places with the statistics you cite it could happen so your point is well taken. I can’t even begin to imagine the fear and anxiety that a young woman experiences an unwanted pregnancy in an oppressive place where there are no safe options for her. I despise religion and politics for creating such a horrible situation. Nevertheless, do we legally force people to act against their conscience? I am opposed to that. There is no good outcome and that I recognize that as being awful, but this is an imperfect world. And so it goes.

  17. Jack
    March 7, 2012 at 9:48 pm

    Bill, The reason I ask is because it underlies a central tenet of our discussion that you continue to gloss over. If you indeed believe that women use abortion as a form of birth control despite statistical evidence to the contrary then your opinion is as Dan puts it a faulty moral calculation. So again you evade the question?

  18. Bill
    March 8, 2012 at 6:31 pm

    Jack- After reading through the article you referenced, there is no strong supporting data to support your claim that woman do not use abortion for birth control. In fact, under reporting is about 50% so any conclusions we can draw from the article is statistically weak. Despite that, this is a very good article. The data that is available is well represented and seemingly without bias.

    However, what I found in the article makes me think that the premise you are asking me to weigh in on is skewed. I don’t think that woman use abortion intentionally as birth control, but rather they are either not using or misusing contraception and abortion becomes the default mechanism to terminate unwanted pregnancy. As a means of first line choice for birth control, the article suggests not.

    According to the article, it appears that what we need to be concerned about is access to contraceptives and education on the proper use of contraceptives.

    Access:

    “most women obtaining abortions—
    whether for the first or third time—are poor or
    low-income, and they may have difficulties securing
    necessities such as housing, food, jobs and child care;
    contraception is likely to fall low on the list of priorities.”

    and, “Fifty-four percent of women obtaining their first
    abortion were using contraceptives when they became
    pregnant. The percentage did not differ significantly
    among women obtaining their second abortion, but
    was slightly and significantly lower for women obtaining
    their third or higher-order abortion (50%).”

    Education:

    “Approximately three-quarters of pill
    users became pregnant because of (self-reported) inconsistent
    pill use, and this was significantly more
    common among pill users obtaining third or higherorder
    abortions (81%)”

    and, “Little is known currently about the extent to which
    abortion providers are able to or already offer contraceptive
    counseling, referrals or services. Subsequent
    research should assess the level and types of contraceptive
    services offered by abortion providers so that
    effective strategies can be developed to expand and improve
    them.”

    So I think that we can draw from this data a conclusion that while abortion may not be used as a primary means for birth control, by default it is frequently used because there is a lack of access to contraceptives and/or improper use of contraceptives.

    I think that many people make harsh judgements about these conclusions. Such as “Irresponsibility”, “laziness”, “lack of self control” etc. I have heard these words spoken and I believe they can never be proved or admitted to when collecting data on abortions.
    Do I think there are people who are lazy and irresponsible? Of course. Do I make a moral calculation and advocate refusal of care? Absolutely not.

    Jack- thank you for pushing me on this. I actually learned a lot and it has gone far in strengthening an argument against those who do make moral calculations-and act on them.

  19. Jack
    March 8, 2012 at 10:22 pm

    Bill,
    Thank you for your reply and kind words. This will be my last post. Feel free to have the last word if you desire. Since we are in agreement over the legality of abortion the discussion then really was/is about UNINTENTIONAL Pregnancy. I reiterate my position that No woman gets pregnant in order to have an abortion. The question then is why do women have unintentional pregnancies? Besides the info you provided in your post, I would like to remind you that no contraceptive is 100% effective. Secondly if I was interested in finding out why SOME women have multiple abortions (and indeed I am) my primary source would not be the CRNA for the reason that you only have a small window of time with limited knowledge of the patient. I would seek out someone who does work directly in Women’s health / reproductive health. Sadly, we are missing the input of such a person with this discussion.
    Finally, many people who disagree with abortion make exceptions when they know the circumstances surrounding the abortion such as rape,incest, or maternal health. Perhaps some insight regarding why women have multiple abortions from a reliable source might change your opinion and possibly make your job a little less wearing. If it’s worth anything, I spent a number of years working in a high poverty urban area mostly with women who suffered from various forms of mental illness. I found many of the beliefs I once had changed for the better.
    Jack.

    • Bill
      March 9, 2012 at 5:33 am

      Jack-

      Your experience is priceless. I appreciate your insight and admire your advocacy, as well as your ability to frame an argument. For the record though, my only regret is that you feel compelled to state the obvious when it comes to CRNA practice, as though you suspect me of harboring moral authority based on my professional position. Certainly I was very candid about my personal experiences and the opinions I draw from them, but certainly I recognize their limitations. Have a good weekend.

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