Dialogue with a pro-choice women: Part 2

Pro-choice women

According to Fox News, "Under the Reproductive Health Act (RHA), non-doctors are now allowed to conduct abortions and the procedure could be done until the mother's due date if the woman's health is endangered or if the fetus is not viable." I think the health exception there is more questionable since a baby could be born by C-section, but the law still addresses only exceptions not "at will" abortions. Also, being legal doesn't mean people will rush to do it. If the baby's not viable (no brain, for example) I think the mother should get to decide whether to carry it to term. Many do, so they can spend those minutes/hours of life together, but that's their choice.

My Response

I think there are many slippery slopes in “non-doctors doing procedures until mother’s due date if the women’s health is endangered or if the fetus is not viable”.  Women’s health was defined in a companion Roe v Wade court case, Doe v Bolton, and ruled that “health” included any factor that was “physical, emotional, psychological, familiar or related to a women’s age”.   The effect of this ruling was that abortion became legal through the 3rd trimester.  I think that expansion of the meaning of women’s health has been a slippery slope of subjective interpretation among doctors and now NY is going to allow non-doctors to be part of the process.  I am sad to say that the RHA doesn’t auger well for the unborn and “at will” abortions are more likely than not.

As far as a baby being born with no brain (Anencephaly), 75% born at term survive birth, but life expectancy is only a few hours or days.  Anencephaly is more prevalent in girls than boys.  Perinatal hospice and palliative care programs are in place in almost every state.  National and international organ donor programs help in the decision making that parents might have to make.  

When I was a young man I worked at the Ladd School in Exeter, RI.  I worked as an institutional attendant in the high grade ward.  There were times that I had to go to the low grade ward and there I saw hydrocephalic as well as anencephalic human beings.  Hydrocephalic beings looked like large headed aliens and anencephalic beings had the appearance of frogs with bulging eyes because they had no skull; their heads were flat; they had no brain.  That’s a real tough decision to have to make if a women knows that she carries an anencephalic child.  Should she add to her heartbreak a decision to abort the child? Should she make a decision to allow for a live or post death organ donation?  As I mentioned earlier, in these very difficult situations I believe that the mother and the medical community should do everything they can to save both and if the child dies then God’s will be done.

Can a child with anencephaly sense or do anything? 

Doctors will tell you that a child with anencephaly can neither see nor hear, nor feel pain, that he or she is a vegetable. However, that does not match up with the experience of many families who have had a child with anencephaly. The brain is affected to varying degrees, according to the child; the brain tissue can reach different stages of development. Some children are able to swallow, eat, cry, hear, feel vibrations (loud sounds), react to touch and even to light. But most of all, they respond to our love: you don’t need a complete brain to give and receive love- all you need is a heart! (1)

Pro-choice women

Where do natural miscarriages fall in the natural life cycle? Is it possible for an early end to the life cycle to be disordered yet not sinful (or murder)?

My Response

Abortion is the direct, intentional killing of an unborn human. Neither the mother nor the doctor is involved in the miscarriage. My understanding is that a miscarriage is a spontaneous natural cleaning of the uterus because of some abnormality in the life cycle of the unborn. Can that be a sin or considered murder? I think not.

Pro-choice women

So, the natural life cycle is better described as from conception to natural death (no guarantee of birth or certainly old age in the natural order). Are you familiar with ectopic pregnancies?

My Response

I’m unclear as to the first part of your post.  My understanding of the human life cycle is :conception-zygote-embryo-fetus-birth-infant-toddler-early childhood-adolescent-young adult-middle age-old fart (me)-death.

I know that ectopic pregnancy occurs when an ovum is fertilized and is then attached outside the uterus usually to a fallopian tube. The result more often than not is that the zygote naturally miscarriages because it has landed in the wrong place.  I would think that the natural order of an ectopic pregnancy is disordered.  The mother and medical community should do everything to save both and if the unborn doesn’t survive then God’s will be done.  

Pro-choice women

I agree, those *are* very hard decisions to make and I'm touched that you've have some experience with babies in those situations & still choose life. At the same time, I would allow someone to make the other choice. In the situation of an ectopic pregnancy (outside the womb, usually in a fallopian tube) there's no chance of survival for the cells that would develop into a baby. Either they'll be miscarried naturally or their growth will rupture the surrounding tissue, often causing hemorrhaging & infection that can kill the mother. Should she be allowed to abort the zygote or must she carry it, waiting to find out whether she'll miscarry or need emergency surgery that may not save her?

The first part of my post (natural life is from conception to natural death) amends your definition that the natural life order is from conception to embryo to fetus to birth... to young adult to middle age to old age to natural death. It's true in that no one goes backwards in that progression! My point is that it's not unnatural for embryos to die, for babies to die, for children to die, for young adults to die... those deaths don't fit into the "natural order" scenario where everyone gets to be old before they die. So a death prior to old age cuts short that natural order and is therefore "disordered" according to the way you described "disordered" in your earlier post, but an early death is not necessarily an unnatural death. You also said the natural order of an ectopic pregnancy is "disordered," so that indicates that "disordered" can be normal and isn't the same as "sinful." From what I've read about ectopic pregnancies there is zero chance that the unborn will survive - there is no way to "save" it. The only (non-intervention) option is to wait and see whether the death of the "baby" kills the mother or not.

MY Response

If death occurs before old age for any reason that is a disorder in the normal life cycle of a human being.  The death could be cancer, it could be an accident, it could be murder whatever the reason the death of a human before their time is disordered and, in my opinion, an unnatural death.  When a zygote is formed in the fallopian tube that is a disordered event in the life cycle of a human being that needs to be corrected otherwise, in time, the women would perish.  

According to the National Catholic Bioethics Center (NCBC) and the Johns Hopkins Manual of Gynecology and Obstetrics, 5th ed., there are four possible managements of ectopic pregnancy: 

1.   (1)  “Expectant” therapy; i.e., nothing is done, and the doctor and patient wait for the tubal pregnancy to resolve itself by miscarriage. If the woman is asymptomatic and has falling β- hCG levels that start out at less than 200 mIU/ml, then 88% of these patients will resolve without treatment.2 This treatment is morally legitimate. 

2.   (2)  Surgical treatment: Removal of part (partial salpingectomy) or all (salpingectomy) of the fallopian tube, and, with it, the embryo. Morally permissible due to principle of double effect (see below). 

3.   (3)  Surgical Treatment: Direct removal/separation of the embryo from the affected bodily site (salpingostomy), while keeping that bodily site intact (usually, the fallopian tube). Not morally legitimate if the embryo is alive; direct killing of embryo. 

4.   (4)  Drug therapy with methotrexate. Not morally legitimate if embryo is alive; direct killing of embryo. 

Note that, if there is evidence from testing (hormone testing, ultrasound, etc.) that the embryo is already deceased, then any acceptable medical or surgical treatment can be morally utilized. Therefore, when the patient presents with an ectopic pregnancy, testing should be performed to discern whether the embryo is alive. Sometimes, the case can be dire. Women who have a ruptured ectopic pregnancy (i.e., the fallopian tube or other organ where it’s located has burst) classically present in shock with severe abdominal pain, possible shoulder pain, some vaginal bleeding, and signs of acute blood loss secondary to internal bleeding. 

Pro-Choice Women

The original question :Should she be allowed to abort the zygote or must she carry it, waiting to find out whether she'll miscarry or need emergency surgery that may not save her?

MY Response

My response based on what I was able to discover is that an ectopic pregnancy is a very personal decision that is made with the medical community and that can be resolved as soon as possible without the women having to violate her belief about abortion and without harm to herself.  

Principle of Double Effect

1. The Object of the Act Must be Good or at Least Morally Neutral: The object is to stop the destructive action of the embryo's surrounding tissues, which have attached to the fallopian tube and will lead to the rupture of the tube and the loss of the embryo, as well as creating a potentially fatal, or at least very critical, condition for the mother.

2. The Good Effect Must Be Intended and the Bad Effect Merely Foreseen: The intent here is to prevent the rupture of the fallopian tube and its results; the foreseen, but unintended, bad effect is the demise of the embryo.

3. The Bad Effect Cannot Be the Cause of the Good Effect: The bad effect (death of the embryo) is not the cause of the maternal cure; rather, stopping the invasive cells is the cause.

4. The Good Effect Must Be Proportionate to the Bad Effect: Preventing the death of the mother and therefore the deaths of both mother and child together has a moral value not any less significant than the indirect and unintended loss of the embryo.