- Sahin Aksoy, MD.
Centre for Social Ethics and Policy, Manchester University
Humanities Building, Oxford Road, M13 9PL, UK.
Eubios Journal of Asian and International Bioethics 7 (1997), 53-54.
Abortion has always been discussed by doctors, philosophers, lawyers and theologians from different perspectives. Here I shall go over some of these arguments, and try to come to a conclusion about the ethics of abortion. Actually, as Dunstan observes; we shall be considering the ethics of a practice already very widespread, and likely to become more so in all regions of the world, developed and developing (3). At least fifty million abortions are carried out annually worldwide, and, for example in France and Japan, half of all pregnancies end in abortion (4). It was recorded that, one and half million abortions are performed in USA each year, one-third of them on teenagers between 12 and 17 years old (5). Therefore, it is rather difficult to discuss the moral acceptability of something which has already been so widely accepted. A 1991 Harris poll showed 81% of adults in England agreed that women should be able to choose to have an abortion in the first three months of pregnancy (6). Mason states that; "The significant feature is not so much the total number of abortions but, rather, the steady escalation in numbers over the years. The figures indicate that there must be an increasing public acceptance of abortion as a natural way of life" (7). Dunstan commenting on this fact writes: "Abortion is now being more widely legalized and practiced because that is what people want -an indication for medical intervention for the destruction of life unknown in our ethics before" (8).
Two principal kinds of indications have been defined for 'termination of pregnancy'. The first, called 'medical indications', are: 1) The continuance of the pregnancy would involve risk to the life of the pregnant woman, or of injury to the physical or mental health of the pregnant woman or any existing children of her family, greater than if the pregnancy were terminated. 2) There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
The second kind of indications, the so-called 'social indications', are more complex and vary between cultures and epochs. Examples are: pregnancies resulting from extra-marital relations, from rape of incest, unwanted or unplanned pregnancies, pregnancies at too young or too old an age, expecting a baby of 'wrong' sex -the information being provided by recent medical technology. We may note that it is primarily 'social reasons' of this sort that lead parents to seek abortion.
Writers on the abortion issue have concentrated most on two matters: first the 'rights' of the fetus and the mother, in particularly the property right of the woman on her body; second, the question of the 'personhood' of the prenate. Judith Jarvis Thomson is one of the pioneers among writers who approach the issue from the perspective of the 'rights' of the fetus and the mother. She has no difficulty recognizing the 'personhood' of the fetus. She says every person has a right to life, so the fetus has a right to life. However, she believes that the mother has a right to decide what shall happen in and to her body (9).
The 'personhood' or legal, moral status of the prenate is a very involved legal, philosophical question which I have addressed elsewhere (10).
People who have defined views on the issue generally take one of three positions: 1) abortion is always wrong and must never be performed at any time for any reason; 2) abortion may be carried out at any time for any reason; and 3) abortion should only be allowed up to a certain stage of pregnancy, after which it should not be allowed except under certain special conditions.
The people in first group are not very many. They follow the Roman Catholic teaching, which maintains: "We cannot be absolutely certain when animation takes place, or when the conceptus or the fetus is a human person; but it may well be precisely at the moment of conception. This being so, it would be seriously wrong to destroy the fertilized ovum even then, because one might be killing a human person" (11). According to this strict line, abortion is impermissible even when the mother's life is in danger or the pregnancy is the result of an indecent event, like rape or incest.
The second position is held by those who advance the 'personhood' argument. Harris, is one of those writers who suggest that: "A person is a creature capable of valuing its own existence. And non-persons or potential persons cannot be wronged in this way because death does not deprive them of anything they can value. If they cannot wish to live, they cannot have that wish frustrated by being killed" (12).
The third position which may be defined as 'moderate' maintains that abortion should not be allowed after a certain stage of pregnancy and only if particular circumstances justify it. For instance, it is a very common view that abortion should be permitted in order to save the mother's life. Some people believe that abortion is also morally permissible when pregnancy is the result of rape or incest, and when a severe fetal abnormality has been diagnosed, or if the potential mother is too young. It is also argued that pregnancy and delivery pose a risk to the life of a pregnant woman, even a healthy one. At the turn of the century the risk of the mother dying at delivery was about 1:200, and it declined to 1:10 000 today, but not zero. Therefore, abortion may be viewed as the prerogative of all pregnant women as long as the risk of abortion is lower then the combined risk of pregnancy and delivery.
Another exceptional circumstance which justifies abortion, on this view, is the diagnosis of severe abnormalities in the fetus. The argument is that it is wrong to bring avoidable suffering into the world and we are morally obliged to terminate the life of severely handicapped fetuses. One writer has explain that it is a misconception to regard this justification as 'on behalf of' the fetus (13). In reality, the suffering being avoided is being avoided on behalf of the mother and other potential carers. We have to be clear about whether the termination due to disability is being considered in the supposed interest of the child -that it is 'better' for that child not to live at all then live with a foreseeable handicap- or in the 'interest' of those who would have the care and burden of that child's life, including its suffering and pain (14). Williams is explicit that abortion on such grounds relates to the welfare of the parents, whose life may be blighted by having to rear a grossly defective child, with perhaps in the background such secondary considerations as costs to the public purse (15).
For all the debate, the suggestions and counter-suggestions and alternatives, it seems likely that abortion will remain the dilemma it has been for centuries. However, we must bear in mind the fundamental fact that abortion is termination of the life of a living being. We must approach ending the life of a prenate as cautiously and sensitively as we would ending the life of any other being, and we should not end the life of any living being unnecessarily and without very good reason. On the question of the 'personhood' of prenate, we can be sure only that we will never be sure about it, unless we discover some sort of 'Turnasol Paper' like indicator to decide the matter. As the moral status of prenate is not something material, we need to refer to the authority of metaphysical and transcendental knowledge, and the religions are among these sources. As I have tried to examine in elsewhere (16), not only all religions but also many philosophers from Pythagoras (c. 580-497 B.C.) onwards have declared that a human being consists of body and soul. In religious perspective, the earthly existence of a person ends when soul departs from the body. At the other end of this 'silent journey' (17) the human person begins when the soul joins the body. We do not know very much about when and how of the soul's departure, but there are clear statements in the Qur'an (18)) and hadith (Prophet Muhammad's sayings) (19) about the time and the process of ensoulment. There is also detailed explanation in Aquinas's works and some other religious texts.
All the scientific (anatomical and physiological) and metaphysical (religious and spiritual) arguments tell us that, if there is a time between conception to birth at which prenate 'enters humanity', 'becomes a person', 'becomes morally important' or however we call it, it is most likely to be at some time in the eighth week (20). In sum: even at the very beginning of its existence we owe respect to the unborn, but after eight weeks time to terminate its life should be defined as morally unacceptable.
It may be asked, if prenate 'becomes a real person' after eight weeks, then how do we regard embryos? Donceel suggests that, "Although a pre-human embryo cannot demand from us the absolute respect which we owe to the human person, it deserves a very great consideration, because it is a living being, endowed with a human finality, on its way to homonization. Therefore it seems to me that only very serious reasons should allow us to terminate its existence" (21). Apparently, it is one thing to say that an entity lacks the dignity of being a person strict sense of 'person', and another thing to say that it does not have any value. The embryo may, in this respect, be regarded as similar to a human corpse. At the moment in question neither of them are existing human persons. The embryo will be one, as the dead body once was. And we owe respect to both. If we mutilate and disgrace a human corpse it is something immoral and shameful, even though not illegal. Similarly, if we destroy or terminate the life of an embryo, it is not an attack on an individual human being but still inhumane and undignified. However, sometimes it might be necessary to undertake an undignified and inhumane action to undo the signs of another 'more' undignified and inhumane action, like rape.
The way Dunstan has expressed the dilemma
of abortion gives us a most helpful direction to our moral thinking
on it: "We should pass from the question, what harm are
we doing to the fetus by destroying it, to the question, what
harm are we doing to ourselves, to humanity, when we do so?"
I am grateful to Prof. John Harris, not only for helping me to clarify my ideas about this complex issue but also for his invaluable suggestions and encouragement. I also would like to give my special thanks to my colleague -and my wife- Dr. Nurten Aksoy for many helpful comments on an earlier draft of this paper.
1. Price, D.P. 'Selective Reduction and
Feticide: The Parameters of Abortion', Criminal Law Review,
1988, pp. 199-210.
2. Reiser, S.J., Dyke, A.J. and Curran, W.J. Ethics in Medicine: Historical Perspective and Current Concerns, MIT Press, Cambridge (Mass.), 1977, p. 5.
3. Dunstan, G.R. The Artifice of Ethics, SCM Press Ltd., London, 1974, p. 78.
4. Encyclopedia Britannica, Encyclopedia Britannica Inc., Chicago, 15th Edition, 1982:2, p. 1069.
5. Potts, M., Diggory, P. Textbook of Contraceptive Practice, Cambridge University Press,
New York, 1983, p. 287.
6. Cole, L. My Baby, My Body, My Choice, Lloyd Cole Book, Maidenhead, 1992, p. 2.
7. Mason. J.K. Medicolegal Aspects of Reproduction and Parenthood, Dartmounth, Hants, 1990, p. 113.
8. Dunstan, op. cit. p. 87.
9. ibid. p. 203.
10. Aksoy, S. 'Personhood: A Matter of Moral Decisions', EJAIB 7(1997), 3-4.
11. Mahoney, J. Bio-ethics and Belief, Sheed & Ward Ltd., London, 1984, p.69.
12. Harris, J. 'Wrongful Birth', in Bromham, D.R., Dalton, M.E. and Jackson, J.C. (eds.) Philosophical Ethics in Reproductive Medicine, Manchester University Press, Manchester, 1990, pp. 156-71.
13. Mason, op. cit. p.106.
14. Dunstan. op. cit. p.84.
15. Williams, G. Textbook of Criminal Law, Stevens, London, 1987, p. 297.
16. Aksoy, S. 1997, op. cit., pp. 3-4.
17. Aksoy, S. 'The Silent Journey', The Fountain, 2:12, 1995, pp. 42-4.
18. As-Sajdah 32:7-9, Al-Mu'minun 23:13-4
19. Al-Nawawi, Sahih-i Muslim bi-Sharh-i Nawawi, Kitab Al Qadar, Vol.16, Hadith no. 6390, 6392, 6393. Egypt, Matbaa-i Misri, 1965, pp.189,193.
20. Although I have elaborated this argument in a forthcoming article; Aksoy. S. 'Can the time of ensoulment be the beginning of an individual person?'. It may also be possible to refer;
Moore, K.L. Before We Are Born, W.B. Saunders Comp., Philadelphia, 1989, pp. 71-2. Albar, M.A. Contemporary Topics in Islamic Medicine, Saudi Publishing & Distributing House, Jeddah, 1995, Chapter 15.
21. Donceel, J.F. 'A Liberal Catholic's View', in Feinberg, J (ed.) The Problem of Abortion, Wodsworth, Belmont, Calif., 1984, p. 15.
22. Dunstan. op. cit. p. 85-6.