The problem of miscarriage for pro-lifers

FeaturedThe problem of miscarriage for pro-lifers

It isn’t widely known, but a high proportion of human pregnancies end in miscarriage, also known as spontaneous abortion. The majority of these miscarriages occur very soon after pregnancy, often before the pregnancy is known, and for this reason, precise figures are difficult to obtain. Estimates for the rate of miscarriage vary widely, but many are in excess of 60%. These estimates are usually based on some very old studies, together with data obtained by observing in vitro fertilisations (IVF), which may not reflect what occurs in nature.

Let’s tentatively accept a 60% rate of miscarriage. What’s the main issue for the pro-life position? Many philosophers have pointed out that this means hundreds of millions of human beings are dying by miscarriage, and according to pro-lifers, these are all human beings with moral value equivalent to any adult. But these numbers are far in excess of any other cause of death. In fact about 56 million human beings die each year, while perhaps 200 million miscarriages occur. The question has been asked, why don’t pro-lifers care about this huge loss of human life? They are certainly concerned with preventing induced abortions, which account for far few human lives, about 56 million. But their lack of concern about the 200 million deaths from miscarriage seems to indicate they don’t really believe their own claims about the moral value of embryos and fetuses. In fact, their stance has been criticised as ‘morally monstrous’.

It’s an important question for pro-lifers to answer, and the PA and Daniel Rodger have just published a comprehensive reply in The New Bioethics entitled The Problem of Spontaneous Abortion: Is the Pro-Life Position Morally Monstrous?. I’ll summarise our response below. If you don’t have access to academic journals and would like a copy of this paper, please request it from here.

The underlying question is what moral obligation do pro-lifers have towards combating miscarriage, and how does this obligation compare to their obligation to oppose induced abortions. Certainly, on a pure numbers basis, there is a prima facie obligation to do something about miscarriageit certainly seems to trump induced abortion in this regard. But we identify two important considerations that should influence our obligations:  the preventability of death and the moral badness of death. If deaths are not preventable, this reduces our obligation towards these deaths, and if certain deaths are morally worse than others, we should prioritise them.

Preventability of miscarriage

It is too simplistic to directly compare deaths by miscarriage to deaths by, say, cancer, or even induced abortion. Miscarriage is not a cause of death, but rather refers to all natural deaths prior to birth, irrespective of cause. It has a variety of underlying causes, and these must be examined to determine which are the most prevalent. The most common cause of miscarriage turns out to be chromosomal abnormalities, accounting for perhaps 70% of all miscarriages. These abnormalities are mostly aneuploidies, an abnormal number of chromosomes in cells, and they are rarely compatible with life. Aneuplodies cannot be preventedthis would require gene-editing of embryos, which is not currently possible.

There are a variety of other lesser causes of miscarriage, such as uterine abnormalities, thrombophilias, immunological and immunogenetic causes, and acute maternal infections. Certain lifestyle factors have been implicated in increasing the risk of miscarriage, including smoking, alcohol and caffeine consumption, and obesity, and finally increasing maternal age is also a factor.

Killing vs Letting Die

Some pro-lifers have claimed induced abortions are far morally worse than miscarriages, and that this justifies concentrating efforts on fighting induced abortion. The problem with this claim is that even if there is a moral distinction between deliberate killing (induced abortion) and letting someone die (miscarriage), it’s not clear that this matters. To explore this, let’s assume there is a moral difference—that it is far worse for someone to deliberately kill someone rather than letting them die, say by failing to rescue them. The issue for pro-lifers is that as far as they are concerned, it seems that induced abortions are also a case of letting die—they are not directly involved in killing themselves, and so they are bystanders with respect to induced abortions and miscarriages. Unless pro-lifers wish to make nebulous claims about induced abortions contributing to more evil in the world, it seems there is no good reason to prioritise opposing induced abortions over miscarriages on the grounds of moral evil.

Here Thomas Pogge sheds some light on the issue, stating that with regard to induced abortions ‘we are responsible for helping to bring these deaths about by participating in maintaining and enforcing a legal system that, by permitting abortions, foreseeably results in these extra deaths’ (Pogge 2010, p. 127). Citizens in the United States prior to 1860 were all responsible for laws permitting slavery, irrespective of whether they owned slaves themselves. Similarly, all citizens in a democracy permitting induced abortion bear some moral responsibility for these deaths. So if induced abortions are morally worse than miscarriages and all citizens bear some responsibility for them, this is a strong reason to oppose it.

In ethics, the killing vs letting die distinction is widely debated. Intuitively, most of us feel there is something worse about deliberate killing compared to allowing someone to die, but it is difficult to pin this down. Philosophers are very good at coming up with counter-examples to accounts of this difference. We take the approach of looking at a comparison that is as analogous as possible (on the pro-life view) to most induced abortions and miscarriages: the deliberate killing of a newborn baby who could be expected to live a normal life, and allowing a newborn with a fatal and incurable chromosomal disorder to die. It seems clear that letting the newborn die in this case may not be morally problematic at all, while killing a newborn baby is always gravely wrong. We conclude that similarly, it is far worse morally to deliberately kill a fetus than to fail to save it.

Conclusion

Even though the number of deaths are much higher for miscarriages than induced abortions, they both represent tens of millions of deaths of morally valuable human beings, according to the pro-life position. If we allow that our moral obligations with regard to these deaths are influenced by what can be done to prevent them, and that induced abortions are morally worse than miscarriages, then it seems reasonable for pro-lifers to concentrate on opposing induced abortions. If we consider prenatal deaths by preventable causes, induced abortion is by far the most preventable cause of death.

It is important, however, for pro-lifers not to ignore miscarriages. Although much medical research is dedicated towards the problem, the scale of deaths means the issue should be discussed widely in pro-life circles and consideration given to what might be done.

 

 

 

 

Artificial wombs and violinists

Artificial wombs and violinists

The most well-known argument for the permissibility of abortion is Judith Jarvis Thomson’s violinist analogy, described in ‘A defense of abortion‘. Here, she imagines someone waking up to find themselves kidnapped and a famous, unconscious violinist plugged into their body. The violinist needs the use of their body for nine months to survive, and unplugging the violinist would kill him. Thomson claims the victim would be under no obligation to keep the violinist plugged in, and likewise a pregnant woman is under no obligation to continue providing life support for her fetus. Yes, it would be nice if she did so – performing what Thomson calls a ‘Good Samaritan’ act – but she is not obliged to.

Thomson’s argument is important because it does not rely on the moral status of the fetus. She claims that even if the fetus is regarded as a person in the moral sense – possessing the same moral status as an adult human being – her argument is still valid. Of course, there are various objections to Thomson’s reasoning, and debate is ongoing. A thorough and recent evaluation can be found in Kate Greasley’s excellent Arguments about Abortion: Personhood, Morality, and Law. But for those who rely on Thomson’s violinist as support for their pro-choice position, a distant storm is slowly brewing.

That storm is the relentless advance of new technology: the artificial womb is coming, and it may eventually have a significant impact on Thomson’s violinist. It has been mooted for a long time, but in 2017 it was announced that premature lambs were kept alive for four weeks in bags of fluid. They appeared to develop as normal, and those that were brought to term were removed and bottle-fed, and were doing well. As the technology improves, it should eventually be available for premature human babies. It’s a long way off, but it’s even possible that IVF embryos could be brought to term entirely in artificial wombs, a process known as ectogenesis. No female womb required.

So what? Well, a crucial point of Thomson’s argument is that she does not think there is a right to the death of the fetus. Her argument is that there is a right to extract the fetus to end its use of the mother’s body for its life support. For Thomson, the death of the fetus is an unfortunate byproduct of ending the pregnancy. Ectogenesis alters this situation dramatically. If we assume that the technology also includes the ability to safely extract the fetus at any stage of pregnancy (yes, this is a big assumption), then Thomson’s argument (as far as she is concerned) is no longer an argument for abortion, but rather for ectogenesis. The fetus gets to survive.

This possibility is rather awkward for the pro-choice position. There aren’t any other significant arguments that grant the permissibility of abortion in the case that the fetus is regarded as morally equivalent to an adult. Thomson’s argument has allowed pro-choice advocates to sidestep arguments about moral status. Ectogenesis will bring these arguments to the forefront, and they are controversial. Moreover, even if the fetus is not regarded as having the same moral status as an adult, killing a viable human being that is not reliant on its human mother is very different to abortion. Ectogenesis might mean a seismic shift in the abortion debate.

Some philosophers have anticipated this possibility, and tried to counter it by claiming that there is, in fact, a right to the death of the fetus. We (the PA and Daniel Rodger) examine (and reject) three of the most popular arguments in our recent paper published in Bioethics.  This paper also provides a detailed look at Thomson’s violinist and ectogenesis for those who are interested. Contact the PA if you’d like a copy.

 

Abortion legalised in Queensland

Abortion legalised in Queensland

Sadly, the state parliament in Queensland, Australia, has voted 50-41 to legalise abortion. Abortion is now legal for any reason up to 22 weeks gestation, and at any stage provided two doctors can be found who agree it can be performed. As we have previously discussed, this gives Queensland some of the most liberal abortion laws in the world. It is a significant change in what was once regarded as a very conservative state. We must now wait to see what impact this has on abortion rates.

There’s three aspects of the reaction to this decision that I want to comment on.

Firstly, the cheering. According to this report, there was ‘loud cheers in the legislative assembly chamber’ when the vote succeeded. I suppose if you are convinced that a woman’s right to end the life of her child is crucial, then the vote is something to celebrate, but this should be tempered with sadness that firstly, many women are forced to make this decision, secondly that abortion is used worldwide to discriminate against women by sex selection, and finally, that abortion kills innocent human beings. Unless you think a fetus is a bunch of cells no more important than a fingernail (and hardly anyone does), that last fact should result in sober reflection. It is likely this decision will increase the numbers of abortions in Queensland. Cheering seems inappropriate for a decision that has such serious consequences.

Secondly, the references to the age of the previous laws. They have been variously referred to as ‘archaic’, needing ‘reform’ and being ‘119 years old’ in an attempt to cast them as hopelessly outdated. This was an important part of the campaign to remove them. And yet the vast majority of our criminal code is old. The age of legislation does not necessarily mean it needs to be jettisoned. Our 119 year old code also includes section 201, ‘Indecent treatment of children under 16’, section 219, ‘Taking child for immoral purposes’ and section 242, ‘Serious animal cruelty’. Are these also archaic? Traditionally, the law is meant to protect the most vulnerable members of society. In Queensland, this is no longer the case.

Finally, the references to abortion as ‘access to healthcare’. Abortion is not healthcare. The vast majority of the time it kills healthy human beings in a healthy mother, and provides no health benefits. It is expensive, and forces many healthcare providers to be complicit against their moral convictions, even if it is by referral. By almost any definition of healthcare, abortion does not qualify¹.

Of course, this setback does not mean pro-life supporters will give up. Laws have been changed, but they can be changed again. I’ve recently been reading William Hague’s excellent political biography of William Wilberforce, the anti-slavery campaigner. Wilberforce was a consumate politician who fought for 18 years against sometimes overwhelming odds to pass his bill abolishing the British slave trade, and then for the rest of his life to abolish slavery altogether. His opening speech to parliament in 1789 is regarded as ‘one of the greatest ever in an age of eloquence’. It’s an inspiring read, and lends hope after a such demoralising defeat for the pro-life cause this week.

 

1. Thanks to Calum Miller for this argument.

A simple argument against abortion: possible replies

A simple argument against abortion: possible replies

I recently posted a simple argument against abortion for pro-choice advocates to consider. I challenged them as to how certain they were of their conclusions, comparing this to the certainty associated with applying the death penalty, and noting the dismay most people feel when someone who is on death row is exonerated.

I’d now like to examine the most common replies to the first premise: it is morally wrong to kill innocent human beings. Rejecting this premise seems the only possible defense against this argument, unless the humanity of the fetus is denied, an extremely dubious proposition.

But how can this premise be rejected? Isn’t it always wrong to kill innocent human beings? Certainly, the onus is on pro-choice advocates to find good reasons why this may not be the case. Innocent people are sometimes killed in war, but no-one thinks this is permissible, but rather deeply regrettable: deliberately targeting the innocent in war is morally wrong. There are two general approaches, and I’ll briefly examine them both.

Bodily autonomy

The first approach is to claim that in some situations, innocent human beings can be killed. Usually, these situations involve a reference to a woman’s bodily autonomy, and come in two forms. One is to argue that a women has sovereign control over her body, and can whatever she likes with anything within her body. This doesn’t seem to be true, as it doesn’t seem permissible for a pregnant woman to deliberately ingest a drug that will result in a deformed child. More generally, having sovereign control of a space doesn’t usually confer the automatic right to kill people who enter it, say our private property.

Judith Jarvis Thomson presents the more sophisticated version of bodily autonomy in her famous article ‘A defense of abortion‘. She constructs a rather bizarre analogy about someone waking up to find a famous, unconscious violinist plugged into their body. The violinist needs the use of their body for nine months to survive, and unplugging the violinist would kill him. Thomson claims the victim would be under no obligation to keep the violinist plugged in, and likewise a pregnant woman is under no obligation to continue providing life support for the fetus.

There has been a lot of ink spilled over Thomson’s argument, and debate among philosophers continues to this day. We cannot examine it in detail here. But it’s worth noting some important points. Firstly, the argument is controversial, and not even all pro-choice advocates agree it is a valid defense for abortion in all circumstances (e.g. Kate Greasley). For example, the violinist is attached involuntarily, but some philosophers contend that voluntarily engaging in sexual intercourse implies consenting to pregnancy, should it occur. Others claim a mother has special obligations to her child. Secondly, Thomson never intended her argument to mean abortion is permissible in all circumstances, especially late-term abortions. In fact Thomson notes that she is not arguing for the death of the fetus at all, but rather its removal, which currently inevitably means its death. Artificial wombs could change this. So Thomson’s reasoning isn’t a slam-dunk argument for rejecting the first premise of our simple argument against abortion.

Persons, not human beings

The second approach is to modify the first premise to remove the reference to human beings, replacing it with ‘persons’: it is morally wrong to kill innocent persons. Here,  person is a moral term, meaning an entity with certain rights, in particular the right to life. So the modified premise is really saying it is wrong to kill human beings who have a right to life. Because it is claimed that a fetus does not meet the criteria for being a person, it does not have a right to life, and consequently it can be permissibly killed.

Defining persons also occupies a lot of space in philosophy journals, but it usually involves possessing certain rational capacities such as being conscious and self-aware. Herein lies the problem for this approach: these definitions of person invariably exclude infants. If the ‘personhood’ approach is taken, it is implicitly granting that infanticide is permissible in addition to abortion. For most people, that’s a bridge too far. And if it isn’t, there are implications beyond infanticide.

Conclusion

So there we have it. If the simple argument against abortion is to fail, it will have to fail at the first premise: it is morally wrong to kill innocent human beings. The two main options are rejecting it, via Thomson’s rather controversial argument, or changing the premise to refer to persons, not human beings, and all that implies for infanticide. Are these compelling enough to confidently reject the simple argument against abortion? You decide.

 

 

 

A simple argument against abortion

A simple argument against abortion

Arguments for and against abortion choice can get complex extremely quickly. I wouldn’t be able to do a PhD in the ethics of abortion if that wasn’t the case. But there is a simple argument against abortion that everyone who is pro-choice must face and have good reason to reject. I’ve outlined it below.

  1. It is morally wrong to kill innocent human beings.
  2. A fetus is an innocent human being.
  3. Abortion kills a fetus.
  4. Therefore abortion kills an innocent human being.
  5. Conclusion: abortion is morally wrong.

Let’s leave the first premise for a moment, and examine the second. Certainly, a fetus is innocent, more so than any other human being. It hasn’t had a chance to be otherwise – it isn’t guilty of anything, other than existing. And that’s not its fault! Some people might argue that a fetus isn’t a human being (this is in a biological sense), but that’s difficult to sustain – just check an embryology textbook. If you want something more technical, try this academic discussion on whether human organisms start existing at fertilisation.

Okay, so the second premise can’t be denied by any reasonable person. The third point is obviously true, and the fourth point follows directly from the second and third, so if you accept the second and third premises, you have to accept the fourth. It’s time to look at the first premise – if this is also accepted, the conclusion – that abortion is morally wrong – must also be accepted.

Is it always morally wrong to kill an innocent human being? The only way that abortion isn’t morally wrong is if this premise is rejected. It commits you to agreeing that sometimes, it’s not wrong to kill innocent human beings.  That’s a big step to take! You would want to have very good reasons for believing this! What if you are wrong? There can’t be many bigger moral errors you could make if you are mistaken!

So in the end, this argument comes down to a challenge. What reasons can you give that would make it okay to kill an innocent human being in some circumstances? Are you confident these are good reasons? How confident? A comparison with the death penalty is instructive. In the United States, the average time spent on death row after being given the death penalty is over ten years. Why so long? Because there is widespread agreement that every avenue should be explored to ensure that condemned prisoners are guilty. No-one wants to execute someone who is innocent. There have been 162 exonerations since 1973 at the time of writing. That’s about 1.6% of death row prisoners, but it’s enough to cause serious concern about the death penalty, as it prompts the question, how many were innocent that we don’t know about who were executed? Even a single person wrongly executed is too many.

But do we apply a similar degree of commitment towards the unborn? How certain are you that it is okay to kill innocent human beings? 99% 50%? Even philosophers disagree about this issue! Unless you are highly confident of your reasoning, prudence would suggest taking the safe option, especially since abortion takes millions of lives annually, not the hundreds taken by the death penalty. The safe option is to assume that it is morally wrong to kill innocent human beings unless a compelling case demonstrating otherwise is provided, one that is highly certain to be correct. If you do feel you have such a compelling case, I’d love to hear from you.

I’ve tried to anticipate some of the most common replies here.

 

Queensland’s proposed abortion laws

Queensland’s proposed abortion laws

The Termination of Pregnancy Bill 2018 has just been introduced to parliament in Queensland, a state of Australia. The bill is based on recommendations put forward by the Queensland Law Reform Commission, which published its Review of termination of pregnancy report in June. The most pertinent conclusion was to ‘alter the current law to provide that a termination is lawful if it is performed by a medical practitioner and, for terminations after 22 weeks, in accordance with the stated requirements for a lawful termination’. In short, the intention is to decriminalise abortion, making it a ‘health matter’, not a criminal matter.

Currently in Queensland, having an abortion or assisting in an abortion is technically a criminal offence under sections 224-226 of the Criminal Code, although section 282 allows for exceptions if it is ‘to preserve the mother’s life’. However a Victorian ruling by Justice Menhennit in R v Davidson (1969) declared that abortion was lawful if a doctor thought it was

necessary to preserve the woman from a serious danger to her life or physical or mental health (not being merely the normal dangers of pregnancy and childbirth) which the continuance of pregnancy would entail; and in the circumstances not out of proportion to the danger to be averted’

and the 1986 McGuire ruling in the District Court opined that this was also the case in Queensland. Since that ruling, abortion has become widely available. According to Children by Choice, it is ‘generally accepted that somewhere between 10,000 and 14,000 abortions take place each year in Queensland’. It seems obvious that most abortions in Queensland are not necessary to preserve the woman from a serious danger to her life or physical or mental health, and the law is being ignored.

According to the Queensland Law Reform Commission and the Labor Party of Queensland, the solution is to decriminalise abortion for up to 22 weeks, and with the consent of two doctors, make it permissible at any time until birth. What are the key conditions for abortions after 22 weeks? The doctors must give regard to ‘the woman’s current and future physical, psychological and social circumstances’. But of course this is less stringent that the current restriction that the abortion must be necessary to preserve from a serious danger to life or health, and which is ignored anyway! Effectively, it gives the green light to abortion up until birth, giving Queensland some of the most liberal abortion laws in the world.

It seems from the latest opinion polling that 60% of voters oppose abortion after 13 weeks, and 52% oppose abortion for any reason, putting the recommended new laws out of step with community views. Unfortunately, Queensland does not have an upper legislative house, and so there is not a check on legislation, unlike in New South Wales where the Senate voted down changes into abortion law in 2017. Hopefully, there will sufficient opposition from both the public and parliament to prevent the bill being passed. Public submissions will open in the near future, so when this is available, be sure to make a submission. Concerned Queensland voters should contact their Member of  Parliament. A summary of their personal views can be found here. Labor is permitting a conscience vote, so the result is not predetermined.

A final note: it is a scandal that abortion statistics are not officially recorded in Queensland. We do not know how many human beings have their lives ended this way – we can only guess.

Starting a PhD!

Starting a PhD!

True to form, the PA is starting a PhD to add to the long list of superfluous university qualifications gained over many years.

For the next few years I’ll be studying at the University of Birmingham. My PhD is in the ethics of abortion, an area I’ve been keen on researching for a long time, so it’s going to be rather interesting! I’ve already contributed a little in this area (see here and here), and have just had another paper (with Daniel Rodger) accepted for publication in Bioethics, so things are going well so far.