At the heart of the current debate over abortion is the question of what is at stake: for the liberal feminist group it is the woman's autonomy over her own body; for the conservative/ pro-life" group it is the life of the fetus itself. Rejecting both of these views as extremes, L W. Sumner opts for a moderate position for which he provides a moral foundation.
Originally published in 1981.
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Abortion and Moral Theory
By L. W. Sumner
PRINCETON UNIVERSITY PRESSCopyright © 1981 Princeton University Press
All rights reserved.
The Abortion Debate
* * *
As late as two decades ago abortion was nowhere a prominent public issue. In virtually every nation of the world, performing an abortion was, under all but the rarest of circumstances, a criminal act. Abortions were done none the less, whether in the penumbra of the law where they could be disguised as orthodox medical procedures or in the backstreets, but transactions in the abortion market were shrouded in secrecy. Abortionists, qualified and unqualified alike, risked prosecution for practicing their trade. Their patients were liable to subtler but surer pressures from a public that regarded abortion, like sex itself, as dark and shameful. Few voices were raised against this conspiracy of silence and guilt. An organized women's movement was nonexistent in the fifties. Although the control of reproduction had been an issue for decades, the energies of reform groups were largely directed to securing legal access to contraceptives. Most such groups, whether out of principle or pragmatism, took pains to distinguish the availability of contraception from that of abortion. The consensus on all sides was that abortion was a further and much more troubled question, one that it was premature to place on the public agenda.
Once introduced onto that agenda, the revision of traditional abortion laws was accomplished with astonishing swiftness. In many countries the prohibition of abortion was weakened by broadening the grounds on which the procedure would be permitted. Other jurisdictions went even further by decriminalizing the act altogether, except for the requirement (common to all medical procedures) that it be performed by a licensed physician in appropriate facilities. Today the policies in force in Canada, the United States, Great Britain, Eastern Europe, the Soviet Union, China, India, Japan, and most of the countries of Western Europe permit millions of abortions to be carried out legally every year. The old prohibitions are now the nearly exclusive property of Latin America, Africa, and parts of Asia. The tide continues to run in the direction of liberalization. Once the former controls have been loosened or removed they are seldom restored, and nearly every year new jurisdictions introduce reforms. These changes of law have been grounded in equally dramatic shifts in public opinion. In most countries only a small minority continues to favor the old restrictions; the majority appears to support at least a moderate policy permitting a significant number of legal abortions.
The period of reform has also been the period of public debate concerning the status of abortion. In the democracies of the West that debate has been dominated by two parties: "prolife" organizations advocating the traditional restrictive policies, and feminists lobbying for the reform or repeal of abortion laws. The political goals of these parties are quite obviously incompatible: any policy acceptable to one side must of necessity offend the other. Neither group is lacking in commitment, energy, or resources. Since the rate of unwanted pregnancies, and hence the demand for abortion, shows no sign of declining, the practical problem that elicits these conflicting responses is unlikely to resolve itself spontaneously. Further, these opposed views on the specific question of abortion are embedded within equally opposed ideologies concerning the status of women, the significance of marriage and the nuclear family, and the morality of sex and reproduction. On these larger issues the principal parties to the abortion debate simply inhabit different worlds. For each there is too much at stake for any accommodation of the other to be acceptable. Although legislative compromises can be imposed upon the parties, there is a deeper sense in which the political issue of abortion is insoluble. No policy, however judiciously drafted, can fail to violate principles held dear by at least one of these groups.
For most of us the important question is not how this political conflict will actually be resolved, but how it ought to be resolved. Answering this question requires deciding what to think about abortion. Since each of the two main parties to the public debate is telling us what to think about abortion, it is natural to begin with a critique of their positions, a critique whose objective will be to discover which, if either, of them merits the allegiance of thoughtful and conscientious persons. Conducting this critique requires that we bring into sharper focus the issues on which the established views are so deeply divided.
1. The Elements of Conflict
Abortion is a moral problem. The existence of a moral problem presupposes some conflict of values or goals or interests. A solution to a moral problem is a resolution of such conflict; the purpose of moral principles is to tell us how to resolve moral conflicts. Where the conflict is genuine, any resolution will require some degree of sacrifice of at least one of the competing elements, and our moral principles will therefore direct us to the proper balance or trade-off among them. The paradigm of moral conflict is a collision between the good or well-being of different persons. If abortion is a moral problem, we should expect it to display this dimension of interpersonal conflict.
Pregnancy in our species consists in a special relation between a sexually mature member of the species (so far at least, invariably a woman) and an immature member (a child). The relation is, roughly, that the child is resident within the woman's body and dependent upon her body for life support. If we describe the child throughout the duration of pregnancy as a fetus, then pregnancy consists in a special relation between a woman and a fetus. This condition normally begins with conception and ends when the fetus has emerged from the woman's body and the life-support connection between the two has been broken. The normal outcome of pregnancy is live birth. In general a process or sequence of events has aborted when it has been interrupted before issuing in its normal or natural outcome. In the broadest sense, therefore, a pregnancy has aborted when it has terminated before issuing in live birth. Usually, however, the term "abortion" is reserved for two special cases. Spontaneous abortion is the expulsion of a previable fetus by natural causes, that is, where the expulsion has not been intentionally brought about by any agent. Induced abortion is the intentional termination of a pregnancy before the fetus is viable. In the discussion to follow, "abortion" will mean induced abortion.
Before viability the fetus is dependent for survival on the maternal life-support system. By definition, abortion deprives the fetus of the life support that has nurtured it up to the time at which the abortion is performed. Most techniques for inducing abortion involve killing the fetus while it is still lodged within the uterus. There is thus a close causal connection between induced abortion and the death of the fetus, a connection close enough to tempt one to suppose that abortion necessarily (by definition) brings about fetal death. If this were so, abortion would necessarily be an act of killing. But it is not so. This is suggested by the fact that one abortion technique — hysterotomy — does not involve killing the fetus before it is separated from its mother. Since hysterotomy is usually performed close to the stage of viability, it can produce a live fetus with some chance of extrauterine survival — a premature birth. Technically, this may no longer count as an abortion since the fetus, as it turned out, was not previable. But there is no point in pregnancy at which a fetus becomes viable; the probability of extrauterine survival becomes more than negligible sometime after the midpoint of pregnancy and increases steadily until the normal term of forty weeks. Any cutoff point distinguishing abortions from stillbirths or premature births is thus highly arbitrary. Certainly in cases like the one mentioned, hysterotomy is intended as abortion.
But we do not need the rare case in which a fetus survives abortion in order to show that abortion does not necessarily include killing, or otherwise causing the death of, the fetus. Abortion does necessarily deprive the fetus of the life-support system on which it has hitherto depended, but it does not preclude substituting another such system. Imagine that we develop a technology of fetal transfer enabling us to relocate a previable fetus from its natural mother either to another woman or to an artificial placenta. For the woman whose pregnancy is thereby terminated such a transfer has precisely the same effect as an abortion — indeed, it is an abortion. The abortion technology that we now employ generally precludes the possibility of such transfers by killing the fetus in the uterus. But abortion is not to be identified with any particular abortion technique; if techniques are possible (at least in principle) that preserve the life of the fetus, then abortion need not (logically) bring about the death of the fetus. It is a necessary truth that abortion interrupts pregnancy, not that it is fatal to the fetus.
The relation between abortion and fetal death is therefore not logical but causal. This conceptual fact notwithstanding, it remains the case that the three abortion techniques now in commonest use — dilatation and curettage, vacuum aspiration, and saline injection — all invariably kill the fetus. The fourth and least common — hysterotomy — nearly always results in fetal death. Until we develop an abortion technology compatible with fetal survival, the practice of abortion will continue to present us with a moral conflict.
The principal parties to the conflict are the two individuals whose special relation constitutes pregnancy. What is at stake for the fetus is life itself. In the normal case in which the fetus is healthy we assume that its life, were it to continue, would be one worth living. To abort the fetus is to deprive it (or the individual into whom it will develop) of that life. What is at stake for the woman is autonomy — control of the uses to be made of her body. Pregnancy is a parasitic relation: whereas the mother supplies essential nutrients to the fetus and disposes of its wastes, the fetus makes no comparable contribution to her well-being. For nine months of a normal gestation another creature lives off a woman's body. Not only does pregnancy violate a woman's physical integrity, but it also produces side effects ranging from the merely disagreeable (weight gain, damage to muscle tone, nausea, fatigue, depression) through the positively painful (giving birth) to the downright dangerous (complications). Some of these side effects, moreover, are permanent and irreversible. As one feminist has put it, "Childbirth hurts. And it isn't good for you."
In a mammalian species pregnancy is the (so far) indispensable means of producing offspring. If its normal end is wanted or valued, being pregnant may have its own unique rewards. These rewards, however, are dependent upon the bond created with the infant. It would be strange to encounter someone who valued pregnancy as an experience while caring not at all whether it culminated in the birth of a child. If a woman does not want a baby (or does not want one now), prolonging a pregnancy will understandably have little appeal for her. Once an unwanted pregnancy is under way, abortion is the only means available of preventing it from continuing through its normal duration. If a woman seeks an abortion, then denying her access to it imposes upon her the costs of pregnancy; more importantly, it also erodes her ability to control the disposition of her body.
Once an unwanted pregnancy is under way, therefore, the life of the fetus may conflict with the autonomy of the woman who is carrying it. In such cases, given our present technology, one good must inevitably be sacrificed to the other: thus the moral dilemma of abortion. The dilemma can be avoided only by avoiding unwanted pregnancies. Although research continues on contraceptive techniques, every method developed to date has serious drawbacks. Unless women either decrease their sexual activity or increase their desire to bear children (neither tendency being currently visible), the frequency of unwanted pregnancies will remain at least constant. In that case we need moral principles that will tell us how to weigh the lives of fetuses against the autonomy of women.
The conflict that generates the moral problem of abortion is particularly perplexing because it has two special features. The first is the unique relation between mother and fetus. In no other human context is one person's body necessary over a lengthy period as life support for the body of another. The mother/fetus relation resembles in some respects the relation between blood or organ donor and recipient, but the disanalogies are highly significant. In these latter cases the burden upon the donor is typically of brief duration, voluntarily assumed, and transferable to others. An unwanted pregnancy is continuous through nine months, unsought, and nontransferable. Perhaps a closer parallel is with the task of caring for an aged or chronically ill member of the family. But even here the fit is imperfect since this burden can often be shared with or turned over to others. Further, all these other cases feature individuals with previous histories and perhaps a previous relationship with one another. A woman can have no acquaintance with her fetus before she finds herself serving as its host. The mother/fetus relation lacks an exact, or even a near, analogue elsewhere in human life. We thus have no model available to guide our moral reflection upon it.
The second special feature of the abortion conflict is the unique nature of the fetus. Interpersonal conflict is conflict among persons. Our paradigm of a person is a mature human being; although the mother fits this paradigm nicely the fetus does not. Again we have no exact analogue to which to turn. A human fetus is not a nonhuman animal; it is a stage of a human being. But it is not quite like any other stage, although it is closer to some (infants) than to others (adults). Further, the term "fetus" masks the fact that we are here dealing with a being who undergoes enormous changes over a period of nine months. Are we to think of a fertilized ovum, an embryo, and a nine-month fetus in the same way? To what extent can we apply notions like interest, good, or well-being to such creatures? Indeed, should we think of abortion as containing an interpersonal conflict at all (perhaps only one person is involved)?
The moral problem of abortion is uncommonly perplexing because it turns on this special relation between a woman and a special sort of thing. A view of the morality of abortion will tell us what to think of both of these features by offering us models to which they may be assimilated. In doing so, it will explain the moral significance of each feature and show how each bears upon the proper resolution of the abortion conflict.
2. Contexts of Decision
Abortion is not one moral problem but two. Better, it is two sets of problems, each arising in its own context. The primary context is that in which a woman decides whether or not to have an abortion, and a physician decides whether or not to perform it. Here the focus is on the moral status of abortion itself. In what moral category does abortion belong? Is having an abortion, or performing one, right or wrong, moral or immoral, good or evil? What sort of act is an abortion? With what other acts should we associate it? Is it more like murder or unplugging a life-support system or removing an appendix? How should we compare it to the two acts that lie, so to speak, just on either side of it — contraception and infanticide? Is it worse than the former but not so bad as the latter? Which is it more like? Is completing an unwanted pregnancy obligatory? Can abortion ever be obligatory? Does abortion violate the rights of the fetus?
Excerpted from Abortion and Moral Theory by L. W. Sumner. Copyright © 1981 Princeton University Press. Excerpted by permission of PRINCETON UNIVERSITY PRESS.
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Table of Contents
- Frontmatter, pg. i
- Contents, pg. vii
- Preface, pg. ix
- Acknowledgments, pg. xi
- CHAPTER ONE. The Abortion Debate, pg. 1
- CHAPTER TWO. The Liberal View, pg. 40
- CHAPTER THREE. The Conservative View, pg. 82
- CHAPTER FOUR. A Third Way, pg. 124
- CHAPTER FIVE. Morality and Utility, pg. 161
- CHAPTER SIX. Life and Death, pg. 195
- List of works cited, pg. 229
- Index, pg. 241