Weighing in on abortion invites scorn and derision from all sides. However, physicians should help frame the medical context with the aim of therapeutically healing the gaping societal wounds that the abortion debate has opened.
Our Declaration of Independence identifies an individual’s unalienable rights to life, liberty, and the pursuit of happiness. The question arises: Who defines when a human life begins? At what point does a fetus become an “individual” with a right to life? Is it at conception, or could it be when the fetus is capable of survival on its own with basic medical support?
The American Academy of Pediatrics provides helpful standardized terms: a fetus is defined from 8 weeks after conception until term while in the uterus. A live birth is defined as the complete delivery of a product of human conception (one not subject to intended termination) that shows signs of life, such as breathing and a beating heart.
Medically, a 28-week-old fetus is viable. If born then, 80 to 90 percent survive. One may even be viable at 24 weeks, but 15 weeks seems a stretch. Medically, such an early delivery would result in a stillbirth, as defined by the Academy.
Most abortions occur in the first trimester and should be legal, as a birth at that stage would not be viable and would be considered a stillbirth by medical definition. That said, a majority of states (38), including blue California, have laws charging those who murder a pregnant woman not just with homicide but also infanticide. Such laws imply classifying any fetus as a human being entitled to protection. Of course, fetal death caused by a pregnant woman’s homicide is not the mother’s choice. Yet, does the mother’s choice define human life even beyond fetal viability? Cases exist of women who chose to dispose of their newborns in the trash being charged with homicide. Could a mother’s choice to terminate a pregnancy one day before delivery be prosecuted?
The issue of abortion, therefore, seems to be a question not just about choice but also about timing. When is a fetus legally an individual entitled to “life, liberty, and the pursuit of happiness,” or, in other words, equal protection under the law?
The answer to what constitutes “human” life needs rational discourse. Using the relatively recent widely publicized tragic case of a raped 10-year-old needing to travel out of state for an abortion to support the politics of absolute choice for any situation seems extreme. Only the most rigid zealot would argue against a medically advised and morally valid choice in that 10-year-old girl’s case. Yet, has a woman who knows she is pregnant for 28 weeks had enough time to exercise her choice by then? Rape and incest are known well before then.
Obviously, prioritizing the mother’s life if seriously threatened by the pregnancy even at 36 weeks makes sense. Her conscious choice for her own survival, guided by her physician’s advice, should trump the protection of even a viable fetus. We allow killing in self-defense.
We allow individuals in an end-of-life vegetative state the protection of individual rights, despite the obvious societal and, in many cases, heavy family burden. Are they truly “viable”? We allow choice for medically guided assisted suicide in a number of states, but the constitution is silent on it. There is no constitutional right to assisted suicide. People have to travel to states that allow it. It’s a rough comparison, to be sure, given the number of women seeking abortions versus those seeking suicide. Forty-six thousand die from “chosen” suicide annually, and another 100,000 from drug overdoses. There are close to 1,000,000 abortions (2021 estimate). How many of these deaths are appropriately chosen?
I have no idea. However, I would opine that a society can be judged by its valuation of human life at both ends of the spectrum. Medical and ethical considerations around the value of human life should influence informed democratic debate and potentially representative legislation but probably not impinge on a woman’s choice over the fate of her fetus prior to its viability as a human. Judicial rulings are meant to adjudicate specific cases and points of constitutional law. Yet, we are prone to letting emotions hijack our collective intellect and guide our societal ethical underpinnings.
The definition of a human life deserves careful, reasoned discussion, including medical evidence, as such a discussion elevates our ultimate choices to an ethically humane level from the sordid, calculated, cynical depths of pure vote-counting politics. How our society values human life at its incipient – as well as end stages – has yet to be consensually defined, and a valid societal answer has yet to appear as to whether such a definition should be left to a single person, a state, the nation, or a Supreme Court.
I would posit, as a general logical starting point for compromise between those who advocate for absolute “choice” and those “right to lifers” even at conception, that we discuss and agree on the notion of when a fetus is not just conceived but becomes a viable individual life once out of the womb, allowing for the termination of even that inchoate individual life when the mother’s own life is in medically determined physical danger.
Politicians looking for a compromise should become aware of the somewhat conflicting laws regarding infanticide vs. abortion and the impact of “choice,” as well as the medical evidence of viability after the second trimester, which could potentially legally define the fetus as an individual eligible for equal protection under the law.
Many pro-choice folks would argue that abortion should be allowed unconditionally, even after 26 weeks. Could they concede only allowing abortion if the mother’s life was in physical danger? Adoption is still available at that point and beyond. The pro-life crowd would say that even at six weeks, an embryo is human, pointing to infanticide laws. Yet, medically, this is not accurate, as premature births are medically termed stillbirths up to 20 weeks. Room for compromise would, therefore, consider the gap between 20 and 26 weeks regarding the constitutional rights of an “individual.”
The discussion thus turns to medical ethics and evidence, as well as legal precedent regarding infanticide, one less influenced by religious and political zealotry.
The author is an anonymous physician.