reflection on abortion and medical technology

[jrtom]

In response to "driving past an empty cemetery" (courtesy of vito_excalibur), I offer the following thoughts, which have been running around in my brain for a few years now.



(Prefatory note the first: this has not been a personal issue, in any of the obvious senses of the word, for me for some time. Don't overinterpret the fact that I'm talking about this issue. *wry smile* )

(Prefatory note the second: lots of good stuff in the original post and in the responses. I'm just going in a different direction here.)

I think it's a truism that there are no easy stances to take here. Deciding to raise a child is a huge thing. So is deciding to make sure that you won't be doing so, either on an individual basis (abortion) or as a matter of enforced policy (consistent birth control or sterilization).

However, the advantage in terms of simplicity of position clearly goes to the pro-life group: life begins at conception, and you should take no direct action to prevent its development. While one can joke about the trillions of sperm and billions of eggs that never get the chance to fulfill their potential, there's at least an obvious decision boundary for this stance. (Plus the obvious point that there are simply far more sperm than eggs, thus ensuring that several nines of them will get "wasted" (in the fine old traditional wording of Monty Python) regardless of what you do.)

Part of the problem for the pro-choice folks is that while on the face of it, their stance is "life begins at birth", the movement as a whole does not have a coherent response to the obvious question: "does it have to be birth after 9 months--and if not, where's the cutoff?"

Larry Niven (hard SF author, for those of you who don't recognize the name) has said that "Technology changes ethics"; this theme has informed several of his books and short stories. I might amend that statement slightly to "changes in technology enable changes in ethics", but that's mostly a quibble.

So what has this got to do with this issue?

Well, it used to be that children born prematurely died much more often. I'm sure there's still an effect, but I now have second-hand knowledge of children that were born four months premature, and we now have the technology to at least alleviate the problems that such children encounter--this sort of problem is not "routine", but it is dealt with on a regular basis. As we get better at medical technology, the probability of viability of a child X months along will continue to increase, and ultimately it's a reasonable guess that we'll be able to do this at any point back to conception.

So if we have, or are getting, this technology, we'll have a choice: if someone doesn't want to be pregnant any more, we will be able to take the zygote/blastocyst/fetus out, place it in what the SF author Bujold calls a uterine replicator, and let it mature there, with no further risk to the mother's health.

Once you can do this, it seems to me that the terms of the abortion debate are changed. Up to that point, one could counter objections to abortion with responses such as "I don't want to carry a child of incest/rape" or "it's my body, I get to make the decisions". But if there is a straightforward, safe, reliable procedure to remove the fetus at any stage past conception, then at that point, it seems to me that the remaining questions may look like this:

(a) who has the right to decide when/whether this will be done?
(b) if it is done, who retains decision-making power/custody?
(c) who pays for it?
(d) are there ever any circumstances under which abortion, per se, is permissible if this is possible?

Or to look at it another way: once the technology is there, the question of what is ethical may change, depending on the resources available--arguably, this becomes a question whose answer will depend more on economics than anything else, unless this procedure (and artificial gestation) are unexpectedly cheap.

And at that point the _real_ cans of worms get opened: for example, would women be forced to pay everything they had in order to get this procedure rather than an abortion?

I don't have any answers for this, obviously. And I don't claim that these thoughts are original. But I think it's worth thinking about these issues, and how the debate may be changed, before it happens.

Comments

the simple pro-choice position

[cos]

Actually, there is a very simple pro-choice stance: at the level of laws and politics, which is what we're fighting about, "a woman cannot be forced to carry a pregnancy if she chooses to end it". That's it. It doesn't wave away any of the individual complexity of making the decision, nor does it say anything about when a life begins or whether a fetus is a person or anything else. It's entirely possible to hold this pro-choice view while still believing that abortion is almost always the wrong choice. Women who would never choose to have one themselves and who would always try to talk their friends out of it, can hold this view. This view is consistent with advocating for government-paid support for viable fetuses whose mothers want to abort them - thus keeping them alive and letting them grow up, perhaps in foster care. The one thing this view does not allow, is compelling a woman to continue to carry a pregnancy she chooses to end, under force of law.

You're right, available technology does change the choices available, and the tradeoffs between making those choices. Right now, we talk about today's technology.

Re: the simple pro-choice position

[jrtom.livejournal.com]

Actually, there is a very simple pro-choice stance at the level of laws and politics

For the record, at the level of laws and politics I am essentially in the pro-choice camp.

However, as I implied at the beginning of my post, I'm not really looking at this issue in those terms. I'm looking at it in terms of the reasons why people take the stance that they do, and considering how those reasons may change or be undermined by changes in technology.

That said, I think that I could have expressed myself better: I think that pro-life folks are pro-life because they hold the view that (a) life begins at conception and (b) such pre-conceived (so to speak) life should not be ended for any reason. (This is a simplification--some pro-life folks allow exceptions--but it's close enough for this purpose. And yes, I am aware that some pro-life folks also support the death penalty. I won't argue that point here.) However, I think that pro-choice folks are pro-choice based on a variety of motivations and beliefs, which are often harder to express clearly, and which do not necessarily arise from a single ethical principle as do generally the beliefs of those who are pro-life.

To similarly respond to the last part of your comment, I am explicitly considering tomorrow's technology rather than today's; this is really a different aspect of the issue than was being discussed, for the most part, in the post I referenced. Of course they should be discussed in terms of today's tech as well, but my point is that it's a good idea to consider these anticipated changes and to recognize the consequences of the choices that we'll be able to make.

Re: the simple pro-choice position

[gwyd.livejournal.com]

I like the woman can't be forced to carry thing. It works as long as she isn't forced to pay for support whatever the law is.

My position incidentally is pragmatic and based on a knowledge of history. Basically, the choice comes down to abortion vs. infanticide for some segment of the population. You can grow or shrink that portion through public policy, but without something like the agent in the water in Silver Metal Lover, abortion will be always with us. (Universal contraceptive in the water supply. You need a counter agent to concieve.)

[vito-excalibur.livejournal.com]

Here's my take on the uterine replicator issue. It's very tempting to look at it as a science issue. And it's not. Or at least it's not just.

"Life begins at conception" is not the only possible arbitrary point to pick as the beginning of the cycle. It is also possible to pick implantation in the uterus. Or gastrulation. Or quickening. Or, my personal favorite of course, birth. And certainly it is very traditional to pick "when the sperm form in the balls." ;) We laugh, but it's not a joke: Catholicism has a rule against masturbation for that reason!

One big problem with the sperm-egg thing is that it's uncomfortably in debt to the Aristotelian view that a man produces a baby and then it just grows in a woman for a while. Pregnancy is not just sort of providing house room. You know how much work is involved and how many stages of development there are. Saying it was a person right from the moment sperm touches egg really ignores how much has to be done before it's the kind of person you have to diaper.

[jrtom.livejournal.com]

It's very tempting to look at it as a science issue.

I'm still apparently not making my point clear. Of course it's not a science issue. Arguably, as long as it's a science issue ("we don't know how to do this yet") or an engineering issue ("we can't do this yet") it's not any other kind of issue. What I'm talking about is what happens after it's no longer a science issue.

My point is this: if we gain uterine replicator technology, we are confronted with, among other things, a number of _economic_ questions (such as: who's going to pay for the procedure, and the gestation, and the care of the child after birth).

Perhaps even more on point: once we _can_ do this, we will be forced to decide _whether_ to do this, and under what circumstances.

And as you correctly point out, there are other issues as well (the costs of bearing a child, or even of becoming impregnated in some cases, are not just economic; and the emotional component is not likely to change, either). This technology won't necessarily even touch those issues. No argument here.

The very thing that shoutingboy was proposing--that is, mandatory utilization of uterine replicators in all cases where the woman decided not to continue her pregnancy--is the kind of proposal that we'll be confronted with as soon as the technology is available. This is why I think it's a good idea to at least recognize this as an impending issue.

As for "life begins at conception": of course that's not the only possible point to pick. That just happens to be the point that the pro-life contingent seems to have settled on. I don't claim that it's the best one, or even that I happen to agree with it.

[vito-excalibur.livejournal.com]

I don't claim that it's the best one, or even that I happen to agree with it.

Sorry, didn't mean to imply that I thought you did agree with it! I was just bringing up one of the problems with it which I think is not often recognized.

And yes, you are quite right about the economic questions. I mean - if we had the resources and the will to provide that kind of option to every pregnant woman, we could provide so much free contraception and help with child care and infant nutrition and etc. that I suspect we'd have a huge number in the drop of abortions without even bringing the actual uterine replicator into it.

And yes, we will develop them. And people will try to enforce them as an alternative to abortion. But I am certain that the state isn't going to offer to be responsible for all the costs. So it'll be a moot point for almost all of the world.

[jrtom.livejournal.com]

if we had the resources and the will to provide that kind of option to every pregnant woman, we could provide so much free contraception and help with child care and infant nutrition and etc. that I suspect we'd have a huge number in the drop of abortions without even bringing the actual uterine replicator into it.

I wish I believed that we _would_ do so. But we have the resources to do that now, and we're deliberately not doing it--at least so far as contraception is concerned (and, it seems, in any program which provides/promotes contraception). The motivation to disallow abortions (and to fail to provide contraception) is unfortunately apparently not springing from the same source as the motivation to actually care for the children once they're born.

[(Anonymous)]

Have you read "Freakonomics" yet? If not I would definitely recommend it, he makes some very interesting points (although it is occasionally a bit redundant). One of the featured problems that it tackles is "why has the crime rate dramatically dropped over the last decade or so?" He argues (fairly convincingly) that safe and readily available abortion is the sole cause of most if not all of that decline. He doesn't pass judgement on the morality of abortion, but his conclusion (paraphrased since I don't have the book in front of me) is that when given the option to end their pregnancy, women are remarkably good at determining if they will be able to raise their child well or not.

The technology that you're describing essentially boils down to "we have the ability to produce a baby at will" either from an aborted fetus or from a donated sperm and egg. The question in my mind is then not one of biology or morals, but one of sociology and ethics - will the parents of that baby (biological or adopted) be able to raise it well? If the answer is no then it shouldn't happen, period. A child should never be forced into an unwilling or incapable family.

I consider myself rabidly pro-choice, and I believe I've found a good framework for that position. First of all, the child is not "alive" until implantation. (It's a travesty that emergency contraception to prevent implantation is not available over the counter in this country) After implantation it is a wholly dependent lifeform, a sort of parasite (sarah was fond of this analogy during her pregnancy). Therefore, I agree with laws that make it murder in the case of assualt with incidental termination of pregnancy (despite the pro-life agenda that pushes those laws), but I also firmly support the legal right of the mother to terminate the pregnancy at will. The fact that you can change the source of the dependency from mother to test tube to uterine replicator or even NICU (in the case of late term abortions) doesn't change the fundamental fact that it is dependent, and the decision remains with the mother as to whether she is well equipped to care for the child. Obviously the later in the pregnancy the more distasteful abortion becomes, but that's another issue... If distastefulness was truly a factor in most people's decisions then steak would be outlawed. I personally love a good tenderloin.

Okay, now it's your turn to play devil's advocate and blow my arguments to shreds. :)

-Judson

[jrtom.livejournal.com]

You could be right about abortion and crime rates. But the question is not whether there's a causal connection, but whether people will be willing to enact certain sorts of legislation...which willingness is generally dependent on emotionally appealing arguments and cultural biases rather than an appeal to facts and reason. (True on both sides of the aisle; this is a statement about people in general, not those of a particular political affiliation.)

We already have the ability to produce a baby at will. Heck, our wives have each done this. :) What that technology would give us is the ability to allow a fetus to survive to parturition once removed from the mother. Different problem.

If "a child should never be forced into an unwilling or incapable family": (1) who defines what 'unwilling or incapable' means? (2) if someone else gets to define this, does this imply universal reversible sterilization? (Gives a whole new meaning to 'Child Protective Services', huh?)

Dependency: Corwin's still dependent on us. Still will be, for various senses of the word, for quite some time. Should this give us a right to "terminate" him until he can hold down a job? What if he never can? (Basing your position on "dependency" is a tricky business at best.)