Developments in medical technology have increased the possibility of diagnosing severe structural abnormalities in the fetus If these occur, a woman may request termination of her pregnancy. This raises serious ethical and legal questions, in particular if the anomalies are discovered in the third trimester when the fetus is considered viable. Should doctors be allowed to act upon a request for abortion in such a situation, and, if so, which safeguards should be in place? These questions are discussed (...) with special reference to the Netherlands where a commission established by the government recently published a report on this matter. (shrink)

In the past few years considerable attention has been given to a relatively new method of prenatal diagnosis known as chorionic villus sampling (CVS). Because CVS can be performed in the first trimester it is hailed by many as a significant advance over amniocentesis. What has not been as publicized, however, are the disadvantages of CVS and earlier prenatal diagnosis. The emotional costs of CVS in terms of the greater number of both spontaneous and selective abortions following CVS, the (...) use of CVS for sex selection and, because of the greater social acceptability of first trimester abortion, the possibility of increased pressure on women to undergo prenatal diagnosis by health insurance companies, medical professionals and government agencies, all need to be weighed against the advantages of early prenatal diagnosis. (shrink)

ABSTRACTSince 2007, when Mexico City decriminalized abortion during the first trimester, a debate has been taking place regarding abortion and the right to conscientious objection. Many people argue that, since the provision of abortions is now a statutory duty of healthcare personnel there can be no place for “conscientious objection.” Others claim that, even if such an objection were to be allowed, it should not be seen as a right, since talk about a right to CO may (...) lead to a slippery slope where we may end up recognizing a right to disobey the law. In this paper, I argue that there is a right to CO and that this may be justified through the notions of autonomy and integrity, which a liberal democracy should respect. However, it cannot be an absolute right, and in the case of abortion, it conflicts with women’s reproductive rights. Therefore, CO should be carefully regulated so that it does not obstruct the exercise o... (shrink)

The legitimacy of the refusal of South Australian nurses to care for second trimester abortion patients on grounds of conscience is examined as a test case for a theory of permissible limits on the autonomy of health care professionals. In cases of health care professional (HCP) conscientious refusal, it is argued that a balance be struck between the HCPs' claims to autonomous action and the consequences to them of having their autonomous action restricted, and the entitlement of patients (...) to care and the consequences for them of being refused such care. Conscientious action that results in the disruption or termination of health care services, however, is always impermissible on two grounds. Firstly, because it is at this point that the action '... invades a patient's autonomy, puts a patient at serious risk ... [and] treats a patient unjustly' (1) Secondly, because the consequences of such refusals turn them into political acts--acts of civil disobedience. It is arguable that in order for acts of civil disobedience to be legitimate, certain obligations are required of the dissenter by the community. It is concluded that the actions of the South Australian nurses, which have over the last few years both terminated and disrupted second trimester services, are morally impermissible. (shrink)

In ‘Public Reason and Prenatal Moral Status’ (2015), Jeremy Williams argues that the ideal of Rawlsian public reason commits its devotees to the radically permissive view that abortion ought to be available with little or no qualification throughout pregnancy. This is because the only (allegedly) political value that favours protection of the foetus for its own sake—the value of ‘respect for human life’—turns out not to be a political value at all, and so its invocation in support of considerations (...) bearing upon the permissibility of abortion is beyond public reason’s remit. Thus, it will scarcely if ever be legitimate to restrict women’s equality and bodily autonomy for the sake of the foetus, even at full term. In this paper, I argue that Williams fails to establish that Rawlsian reasonable citizens must endorse the radically permissive stance vis-à-vis abortion. Citizens can, I claim, reasonably accord the value of respect for human life weight, and indeed converge on the claim that it outweighs other salient political values, during later stages of gestation. Nevertheless, Williams’s argument gets something right in that it reveals why the value of respect for human life is inadmissible at the bar of public reason in early stages of pregnancy. But then, far from throwing Rawlsian public reason into disrepute, Williams’s argument actually (albeit inadvertently) provides arguably more compelling grounds than any hitherto rallied for endorsing Rawls’s much maligned claim that opposition to the duly qualified right to abortion in the first trimester of pregnancy is ‘unreasonable’. (shrink)

It has become common, in both popular and scholarly discourse, to appeal to ‘delayed animation’ as an argument for abortion (DAAA). Augustine and Aquinas seemingly held that the rational soul was infused midway in pregnancy, and therefore did not regard early abortion as homicide. The authority of these thinkers is thus cited by some contemporary Christians as a reason to tolerate or, for proportionate reasons, to promote first-trimester abortion and embryo experimentation. The present essay is an (...) exercise in aetiology. It examines the origins of DAAA. Distinctions are drawn between different forms of DAAA in historical context, premises, and conclusions. Some forms raise important anthropological questions, though these arguments are not indefeasible. The most popular forms of DAAA, which are typically framed as appeals to precedent, are the weakest, in that there is little precedent for DAAA before 1950. The argument is in fact a novelty in the tradition. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:TOWARD A THOMISTIC PERSPECTIVE ON ABORTION AND THE LAW IN CONTE:MPORARY AMERICA M. CATHLEEN KAVENY Yale University New Haven, Oonnecticut Introduction W;HEN THE SUPREME COURT handed down its abortion decision Webster v. Reproductive Health Services 1 in the summer of 1989, it was widely prel 109 S. Ct. 3040 (1989). All further citations to Webster will be given parenthetically in the text. To summarize the most significant (...) aspects. of the decision: A. Chief Justice Rehnquist authored an opinion of the Oourt (of the highest precedential value) which was joined by Justices White, Kennedy, Scalia, and O'Connor. The majority found the lower courts to be in error in striking down as unconstitutional the preamble to a Missouri statute which asserted that "the life -0f each human being begins at conception." The opinion of the Court also found that Missouri could constitutionally prohibit the use of public employees and facilities in the performance of abortions not necessary to save the mother's life. B. The Court also upheld the Missouri statute's provision requiring a. doctor to perform viability tests before aborting a fetus the doctor believes is of 20 or more weeks gestational age. In the plurality opinion (of less precedential value than an opinion -0f the Court, since it is not joined by a majority of the justices), Chief Justice Rehnquist, Justice White, and Justice Kennedy argued that since most fetuses are not viable at twenty weeks, the provision would impose substantial restrictions unrelated to the health of the mother upon what are, in fact, simply sec-0nd trimester abortions. Because they believed such restrictions to be in tension with Roe's trimester system, the plurality decided to abandon that system, along with its stipulation that the state's interest in unborn life became compelling only at viability. The plurality contended, however, that Webster presented no occasion for reconsidering Roe's holding, which deemed unconstitutional a statute prohibiting all abortions except those necessary to save the life of the mother. In a concurring opinion, Justice Scalia went further, arguing that the Court should explicitly overrule Roe v. Wade. On the other hand, Justice O'Connor, 848 344 M. CAT'HLEEN KAVENY dieted that this would exaicerbate a dangerously bitter social·struggle. In its 1973 decision Roe v. Wade (410 U.S. 113), the court had e1abo:raJted.a woman's right to abortion, and, in rthe sixteen years that fo11owed it, it ga,V'e that right unwavering support. Webster 'seemed to mark a retl.'eat from that support. The new scope it offered for state regulation of rubortion promised rto ignite gra,ss-roots forvor and a stiate..:by-state battle between those seeking rto maintain the abortion rights est1ab1isihed by Roe and its sequalia and those st:dving to limit the s1oope of these rights in 1 significant ways. Much of the criticism of Webster has fooused narrowly upon how weM the,decision has aiocorided with various views on the morality of abortion. Yet important 1as this issue is, thorough ethicaJ ana:lysis of Webster must address severa1l additional fac~ tors. The ethiicatl aidequacy of positive law, induding judicial interpretations of faw siuch as Webster, must he ev1alruated in terms of whetheir it aidvanices or impedes the common good. The common good requires not only that we consider the moml substance of legal requirements but tha:t we ailso attend to the manner in which law is made, promulgated, ml!d interpreted. Such an analysis is,sorely needed; it should. specify the severa1l factors involved in determining whether any given legal also concurring in the plurality's judgment, maintained that this provision of the statute could be upheld without any reconsideration of Roe, since it co· hered with that decision's recognition of the compelling state interest in viable fetal life. C. Justice Blackmun authored an opinion dissenting from the majority on the issues discussed above, and he was joined by Justices Brennan and Mar· shall. The thrust of his opposition is directed against the plurality's treatment of the viability testing,provisions. Blackmun first suggested that i.f understood according to the canons of proper statutory interpretation, these provisions unconstitutionally restrict the attending physician... (shrink)

In Brazil, abortion is only allowed in cases of rape, serious risk to a woman's life or fetal anecephaly. Legal abortion services cover less than 4% of the Brazilian territory and only 1,800 procedures are performed, in average, per year. During the COVID‐19 pandemic, almost half of the already few Brazilian abortion clinics shut down and women had to travel even longer distances, reaching abortion services at later gestational ages. In this paper, we describe three bottom‐up (...) advocacy strategies that emerged from difficulties deepened during the COVID‐19 pandemic at a single abortion service in Brazil, amidst anti‐gender policies from the federal government. Telemedicine abortion, outpatient surgical abortion and the provision of abortion after 20 weeks' gestation are important strategies that may reduce inequalities that impact the most vulnerable populations, such as black and indigenous women, children, adolescents and women experiencing domestic violence. (shrink)

When a woman is pregnant, how should we understand the moral status of the life within her? How should we understand its status as conceptus, as embryo, when an early or again matured fetus? According to some, human life in all of these forms is inviolable: early human life has a moral status equivalent to a person from the moment of conception. According to others, such life has no intrinsic status, even late in pregnancy. According to still others, moral status (...) emerges when sentience does. Until the fetus is conscious - a point somewhere at the end of the second trimester, it has no moral status at all; after it is conscious, it does. (shrink)

More than thirty-four years after the United States Supreme Court initially recognized a woman’s constitutional right to choose whether or not to terminate a pregnancy (at least within the first two trimesters) in its landmark abortion decision Roe v. Wade, the issue of whether women ought to have this right continues to affect public debate. Presidential candidates are asked about the issue, and potential Supreme Court nominees and their prior judicial decisions, academic writings, and speeches are thoroughly scrutinized for (...) any inkling of how they would likely rule in a future case on the issue. Perhaps even more important is the way the debate over this issue has impacted federal funding for stem cell research in the United States. Because of moral concerns regarding the personhood status and level of dignity owed to the human embryo as a form of human life, in September of 1999, the National Bioethics Advisory Commission recommended against providing federal funding for the use and derivation of embryonic stem (ES) cells and embryonic germ (EG) cells except when obtained from “cadaveric fetal tissue” or “embryos remaining after infertility treatment.” In this article, I will suggest that the abortion debate and its offshoots into embryonic medical research persist because of a failure to properly separate human personhood from human biology. I will argue further that a proper analysis of the problem will not only enlighten the abortion and fetal tissue research debate, but will have implications for end-of-life issues as well. (shrink)

Jan Narveson criticizes the view expressed in my Libertarian Philosophy in the Real World that there is no orthodox libertarian position on the ethics of abortion. He asserts that fetuses lack the defining characteristics of personhood, and thus are ineligible for what he terms “intrinsic” rights under his, and presumably any other, plausible libertarian theory. My counterargument is threefold: Narveson’s contractarianism can be interpreted in a way that is consistent with the pro-life perspective; because his theory permits no principled (...) distinction between the moral status of third trimester fetuses and newborns, the contrary reading of his social contract produces a result that is implausible and even repellent; and even if his version of contractarianism does imply a unique, aggressively pro-choice stance on abortion, there are competing libertarian theories that are receptive to pro-life views. (shrink)

Background: While being prepared for abortions, some women experience decisional ambivalence during their encounters with health personnel at the hospital. Women’s experiences with these encounters have rarely been examined. Objective: The objective of this study was to explore ambivalent abortion-seeking women’s experiences of their encounters with health personnel. Research design: The data were collected in individual interviews and analysed with dialogical narrative analyses. Participants and research context: A total of 13 women (aged 18–36 years), who were uncertain of whether (...) to terminate their pregnancies during the first trimester, were interviewed before and after they made their decisions. The participants were recruited at six Norwegian outpatient clinics. Ethical considerations: Approval was granted by the Regional Committee for Medical and Health Research Ethics. Findings: The ambivalent pregnant women sought to make autonomous decisions while simultaneously involving their closest confidants and health personnel in the process. The following three types of narratives of women’s experiences with encounters with health personnel were identified: the respected women; the identified women; and the abandoned women. Discussion: The findings are discussed in terms of the ambivalent pregnant woman’s autonomous responsibility in considering an abortion and how her autonomy can be enabled or impaired during encounters with health personnel. Conclusion and implication: Although the women considered themselves autonomous and responsible for their final decisions, they wished health personnel were involved in their situations. The health personnel contributed by enabling or disabling the possibility of decision-making in accordance with the women’s values. The findings indicate that health personnel who care for women considering abortions must be trained in dialogical competence. (shrink)

Over the past few years, over a dozen states have proposed, and almost as many have passed, something referred to as the Pain-Capable Unborn Child Protection Act, a piece of legislation that makes abortion impermissible once fetal pain is possible and that further stipulates the fetus can feel pain at or before 20 weeks of gestation. Some very important questions immediately relevant to the abortion debate, perhaps even to the more complex issue of fetal rights, are raised by (...) this legislation, especially because it would impinge on the second-trimester abortion rights guaranteed by Roe. We first inquire whether the claim of fetal pain perception at or before 20 weeks is true and how such a claim should be substantiated. Next, we inquire whether the fetal capacity to experience pain, at whatever stage of development, reflects on the morality of abortion and whether it should be at all relevant to determining its legality. Finally, we would like to explore the implications that a commitment to a pain-related or sentience criterion of rights might have for a pro-life agenda. (shrink)

In this paper we undertake an examination of the presence of similar “women-protective” discourses in policy debates occurring over two bills on reproductive-related topics considered during the 2013 California legislature session. The first bill, now signed into law, allows nurse practitioners, certified nurse midwives, and physician assistants to perform first-trimester aspiration abortions. The second bill, had it passed, would remove the prohibition on paying women for providing eggs to be used for research purposes. Using frame analysis we find evidence (...) of similar protective arguments by opponents of both bills, although these advocates do not share ideological positions on abortion rights or women's autonomy. In the case of AB154, anti-abortion advocates use language and frames that call for protecting the health of women against the imputed interests of the “abortion industry.” In the case of AB926, feminists and pro-choice advocates evoke similar frameworks for the protection of women against the interests of the “medical research industry.” Both sides argue for the “protection of women,” from opposing positions on the rights and autonomy of women in relationship to reproductive freedom. (shrink)

This essay concerns what people should do in conflict situations when a doubt of fact bears on settling whether an alternative under consideration is legitimate or not. Its principal audience are those who believe that abortion can be legitimate when not having an abortion gives rise to serious harms that can be avoided by having one, but who are concerned that fetuses might feel pain when being aborted, and who believe that causing unnecessary pain should be avoided when (...) doing so would not pose an undue burden. The essay remains neutral on the substantive questions of the moral status of the unborn and the morality of abortion. The question of fetal pain has taken center stage in the last few years in the .. (shrink)

During preparation for early abortion in Norway, an ultrasound examination is usually performed to determine gestation and viability. This article aims to provide a deeper understanding of women’s and health care personnel’s (HCP) experiences with ultrasound viewing during abortion preparation in the first trimester. Qualitative in-depth interviews with women who had been prepared for early abortion and focus group interviews with HCP from gynaecological units were carried out. A hermeneutic-phenomenological analysis, inspired by van Manen, was chosen. (...) Thirteen women who were pregnant and considering abortion in their first trimester and 20 HCP, namely, 19 registered nurses and one medical doctor, were recruited from gynaecological units at six hospitals. The study was approved by the ethics committee (2014/1276). The essential meaning structure of ‘autonomy under pressure’ consisted of two themes that expressed the different experiences of both the women and the HCP, namely, expectations versus precautions and choice versus protection. The women and HCP expressed different attitudes before the consultation that affected their experiences of the ultrasound examination. While the women had expectations of a clarification based on their choice to either see or not see the ultrasound image, HCP seemed to be more concerned with predetermined rules that they believed would protect the women. Consequently, the basis for dialogue was not optimal, and women’s autonomy was under pressure. Health care personnel are ethically challenged during preabortion ultrasound examinations. Meeting the individual woman’s needs and respecting her autonomy during preparation for abortion requires sensitivity, involvement, and dialogue skills by health personnel. According to the woman’s desire to be informed about the possibility of viewing the image during the abortion preparations, a dialogue that is focused in this direction should arise before the examination. (shrink)

The recent Supreme Court decision upholding Roe v. Wade and in particular, the dissent by Justice Sandra Day O'Connor, sheds new light on the issue of abortion. Let us consider any stage of a pregnancy when abortion is medically safe for the mother. If at that stage it is also medically viable to save the fetus, is an abortion performed at that stage of pregnancy morally justifiable? For example, if it is, or becomes, medically safe to perform (...) abortions after first trimester of pregnancy and at the same time saving a fetus is, or becomes, medically viable or not unusual during some stage of the second trimester, can abortions during and after that stage of pregnancy be justified? With a number of qualifications I shall argue the thesis that as a general rule, but not an absolute rule, abortion in these instances is not usually justifiable. For if it is, then one will also have to grant the moral justification for a number of other highly questionable medical practices. This thesis is not to be identified with the stronger claim that abortions of viable fetuses can never be performed. There are surely exceptions such as when the life or health of the mother is in danger. But, I shall argue, the justification for making such exceptions is on different grounds than is sometimes claimed because one must weigh the health of the mother against the life of another human being. (shrink)

BackgroundThere are two types of voluntary interruption of pregnancy: elective and therapeutic abortion. These forms are different for many reasons, and it is reasonable to assume that they can have negative consequences that can last until a subsequent gestation. However, no study has analyzed the psychological experience of gestation after a previous abortion, distinguishing the two forms of voluntary interruption of pregnancy.ObjectiveThis study aims to explore the level of prenatal attachment and centrality of pregnancy in nulliparous low-risk pregnant (...) women with a recently previous elective or therapeutic abortion.MethodsA total of 34 nulliparous pregnant women with a history of abortion, aged from 27 to 48 years, were recruited in the maternity ward of a public hospital of the metropolitan area of Tuscany and Lombardy during the third trimester of gestation. The participants filled out a battery of questionnaires aimed at assessing prenatal attachment and centrality of pregnancy.ResultsAnalyses of variance showed that women with a history of elective abortion reported a higher centrality of pregnancy than women with a past therapeutic abortion. On the contrary, women with a past therapeutic abortion reported higher prenatal attachment.ConclusionElective and therapeutic abortions are different experiences that impact the way women experience a subsequent pregnancy. Future research should further investigate the psychological experience of gestation after abortion. (shrink)

One thousand women. Ten years. Diana Greene Foster’s epic Turnaway Study, and its namesake book, followed a thousand women who sought abortions across the United States for a decade after they were or were not successful in ending unwanted pregnancies to document how their lives changed. The result is a book rich in detail, full of facts about abortion in the United States—and somewhat more generally—that perhaps many of us knew or suspected but few could find in print. These (...) facts include why some women do not realize until the second trimester that they are pregnant, why women seek abortions later in their pregnancies, or... (shrink)

Background While most countries that allow abortion on women’s request also grant physicians a right to conscientious objection (CO), this has proven to constitute a potential barrier to abortion access. Conscientious objection is regarded as an understudied phenomenon the effects of which have not yet been examined in Germany. Based on expert interviews, this study aims to exemplarily reconstruct the processes of abortion in a mid-sized city in Germany, and to identify potential effects of conscientious objection. Methods (...) Five semi-structured interviews with experts from all instances involved have been conducted in April 2020. The experts gave an insight into the medical care structures with regard to abortion procedures, the application and manifestations of conscientious objection in medical practice, and its impact on the care of pregnant women. A content analysis of the transcribed interviews was performed. Results Both the procedural processes and the effects of conscientious objection are reported to differ significantly between early abortions performed before the 12th week of pregnancy and late abortions performed at the second and third trimester. Conscientious objection shows structural consequences as it is experienced to further reduce the number of possible providers, especially for early abortions. On the individual level of the doctor-patient relationship, the experts confirmed the neutrality and patient-orientation of the vast majority of doctors. Still, it is especially late abortions that seem to be vulnerable to barriers imposed by conscientious objection in individual medical encounters. Conclusion Our findings indicate that conscientious objection possibly imposes barriers to both early and late abortion provision and especially in the last procedural steps, which from an ethical point of view is especially problematic. To oblige hospitals to partake in abortion provision in Germany has the potential to prevent negative impacts of conscientious objection on women’s rights on an individual as well as on a structural level. (shrink)

Most Act-Utilitarians, including Singer are Permissivists who claim that their theory usually permits abortion. In contrast, a minority, including Hare and Tännsjö, are Restrictionists who assert that Act-Utilitarianism usually limits abortion. I argue that both Permissivists and Restrictionists have misunderstood AU’s radical implications for abortion: AU entails that abortion is, in most cases in the economically developed world, morally obligatory. According to AU, it is morally obligatory for A to do F in circumstances C if and (...) only if A’s doing F in C produces at least as much total net value as any other action that A could do in C. As mentioned above, AU has generally been seen to be fairly permissive about abortion. A little more exactly, AU is usually thought to hold that abortion is morally permissible in most cases, even during the second and third trimester. But not all AUs are Permissivists. Restrictionists maintain that the value of the future good that the fetus will experience over an entire life is likely to often outweigh the value of the good that its female parent will lose if the fetus is not aborted. Neither Permissivists nor Restrictionists have understood AU’s implications for abortion, at least as it concerns those living in economically developed countries today. First, Restrictionists have failed to recognize the marginal costs that a person in the developed world incurs on future people. One life lived now in the developed world consumes more resources than a life lived in the developing world, and in the process makes the prospects of future people considerably worse. Restrictionists ignore these costs when they claim that it is often morally impermissible to abort fetuses. Second, Permissivists have not gone far enough when they have claimed that abortion is morally permissible. Singer and others have argued that we in the developed world ought to redirect much of our wealth to the underdeveloped world because its marginal value is much higher there than here. But the average cost of raising a child in the United States is almost $13,000 per year. Hence, by forgoing a child one can save and maintain, on average, between 6 and 65 people per year. Thus, AU entails that almost everyone in the developed world who is financially capable of supporting a child should not do so, even if that means aborting a fetus. (shrink)

The traditional approach to the abortion debate revolves around numerous issues, such as whether the fetus is a person, whether the fetus has rights, and more. Don Marquis suggests that this traditional approach leads to a standoff and that the abortion debate “requires a different strategy.” Hence his “future of value” strategy, which is summarized as follows: (1) A normal fetus has a future of value. (2) Depriving a normal fetus of a future of value imposes a misfortune (...) on it. (3) Imposing a misfortune on a normal fetus is prima facie wrong. (4) Therefore, depriving a normal fetus of a future of value is prima facie wrong. (5) Killing a normal fetus deprives it of a future of value. (6) Therefore, killing a normal fetus is prima facie wrong. In this paper, I argue that Marquis’s strategy is not different since it involves the concept of person—a concept deeply rooted in the traditional approach. Specifically, I argue that futures are valuable insofar as they are not only dominated by goods of consciousness, but are experienced by psychologically continuous persons. Moreover, I argue that his strategy is not sound since premise (1) is false. Specifically, I argue that a normal fetus, at least during the first trimester, is not a person. Thus, during that stage of development it is not capable of experiencing its future as a psychologically continuous person and, hence, it does not have a future of value. (shrink)

In a recent book, I attempt to use the metaphysics of Thomas Aquinas to defend a moderate view regarding abortion: that an abortion at any time during a pregnancy should be considered a grave loss, but that it should be considered murder only after roughly the middle of the second trimester. John Haldane and Patrick Lee contend that I have misunderstood the implications of Aquinas's view, and that in fact his metaphysics supports the conclusion that a human (...) being comes into existence at the moment of conception. In this paper, I make a brief reply. (shrink)

Fetal pain has long been a contentious issue, in large part because fetal pain is often cited as a reason to restrict access to termination of pregnancy or abortion. We have divergent views regarding the morality of abortion, but have come together to address the evidence for fetal pain. Most reports on the possibility of fetal pain have focused on developmental neuroscience. Reports often suggest that the cortex and intact thalamocortical tracts are necessary for pain experience. Given that (...) the cortex only becomes functional and the tracts only develop after 24 weeks, many reports rule out fetal pain until the final trimester. Here, more recent evidence calling into question the necessity of the cortex for pain and demonstrating functional thalamic connectivity into the subplate is used to argue that the neuroscience cannot definitively rule out fetal pain before 24 weeks. We consider the possibility that the mere experience of pain, without the capacity for self reflection, is morally significant. We believe that fetal pain does not have to be equivalent to a mature adult human experience to matter morally, and so fetal pain might be considered as part of a humane approach to abortion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Fetal Sentience and Women’s RightsBonnie Steinbock (bio)A growing number of states have banned abortion after twenty weeks on the grounds that the fetus at that stage experiences pain. Such laws run contrary to current abortion law, and so are almost certain to be challenged in court. In Roe v. Wade the Supreme Court said that the constitutional right to abortion extends until the fetus is viable, (...) between twenty-four and twenty-eight weeks. After viability, states may ban abortion entirely except where continuing the pregnancy would threaten the woman’s life or health. The viability threshold was upheld in Planned Parenthood v. Casey.Why viability? The Roe court said that this is “the ‘compelling’ point... because the fetus then presumably has the capability of meaningful life outside the mother’s womb.” Some commentators point out that this is no justification; the capacity for independent life does not explain the significance of viability. It merely gives the meaning.Another problem with viability is that it seems to depend on medical technology. What if fetuses under twenty-three weeks could be placed in an artificial uterus and brought to development there? Would we then say that even a first-trimester fetus was viable? This focuses on one aspect of viability only—namely, the capacity for independent existence. Another aspect is development. The justification for viability is that a fetus of twenty-four to twenty-eight weeks is so substantially developed, so similar to a newborn, that it has a claim to societal protection—so long as this does not threaten the pregnant woman’s life or health. Any attempt to ban abortions much earlier in pregnancy—as in a bill passed by the Ohio state legislature in June that would ban abortion after a fetal heartbeat is detectable, which can occur as early as six weeks—would be so restrictive as to vitiate the right to abortion altogether.It could be argued that sentience is a more rational threshold than viability because of the connection between sentience and moral considerability. If, as many experts believe, sentience and viability occur around the same time, then from a practical standpoint, it does not matter whether sentience or viability is chosen. But if sentience is the standard, and if it occurs earlier than viability, then abortion rights are restricted. Thus, much of the debate has turned on when fetal sentience occurs. Some are adamant that fetal sentience prior to twenty-four weeks is impossible, but other researchers do not rule it out. The development of neural networks necessary for the experience of pain might be present as early as seventeen weeks.Opposition to these laws should not be based on when sentience occurs, since this might change with more evidence. All we can say now is that the fetus almost certainly cannot feel pain during the first trimester and almost certainly can during the third. The exact onset of sentience in the second trimester is not just unknown; it may even be unknowable. It depends on the development of neural connections, which is a process, not an event. Drawing any exact line within a process is likely to be arbitrary.The choice between sentience and viability to justify the prohibition of late abortions is not the real issue. What really matters—and what pro-choice advocates should stress—is that late abortions are not denied to women who need them to preserve their own lives or health. Roe makes this clear, and subsequent cases have affirmed it.That is what is so upsetting about the story of Danielle Deaver. Deaver was at twenty-two weeks in a wanted pregnancy when her water broke, and the amniotic fluid did not rebuild. Her doctors said that fetal development had stopped and that the fetus stood only a remote chance of being born alive. Deaver also faced a risk of serious infection. She and her husband opted for inducing labor. But because inducing labor, if not done to save the life of the fetus, is legally defined as abortion, and Nebraska law prohibits abortion after twenty weeks, doctors and hospital lawyers concluded that the procedure would be illegal.After ten days, Deaver went into labor... (shrink)

Criticism of court decisions is a favored American pastime. Typically, such criticisms are grounded in extra-legal criteria such as common sense (or lack of it) and morality (or immorality). Thus Tennessee Valley Authority v. Hill (1978) in which the Supreme Court halted the construction of the nearly completed Tellico Dam because it endangered the habitat of the snail darter, an action forbidden by the Endangered Species Act, was said to confound common sense; and many have called immoral Roe v. Wade (...) (1973) which said the right to abortion, at least through the first trimester, was constitutionally guaranteed. 1 However, even if such criticisms are justified, they do not address the legal issue, which is whether the court got the law wrong. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Prayer for the BabyKatherine J. GoldWe didn’t talk much about religion in medical school. Rightly so, it seemed to me at the time. I didn’t know how or why it would fit in to my patient care other than respecting patients who used their faith as a coping strategy. I was not at all religious and didn’t like the thought of talking about such things with patients. And (...) in my clinical experiences, it rarely came up.When I got to my last year of school, I signed up to work for a month with an obstetrician–gynecologist in her outpatient clinic. I don’t recall how I met her but remember she was respected for her outpatient teaching so it seemed like it would be a good experience to work with her. (I’ll refer to her by a fictional name here.)“Call me Maria,” she told new patients, enveloping them in a warm, supportive style. They did, and I adjusted to her caring approach, shadowing her as we saw patients during pregnancy, those with abnormal uterine bleeding, patients with pelvic pain, others needing pelvic surgeries. It was an odd experience for me, six months pregnant myself, to be seeing other patients during their own pregnancies.One day, about a week in to my rotation, a couple came in together for an appointment two weeks after an early miscarriage. I watched Dr. Copeland (as a student I just couldn’t call my attending by her first name) give them a hug and we sat down. She asked how they were doing and they shared their story, tears flowing as the mother recounted her emotions over the last week and support from their friends. I had the impression that they attended the same church as Dr. Copeland from their conversation. At the end of the visit everyone stood up.“Shall we pray?” Dr. Copeland asked, and they all took hands. I edged back, away from their small circle, uncertain what to do. I had never seen prayer in medical practice and certainly not initiated by the doctor. Not being religious myself, I felt uncomfortable. I didn’t know the protocol. This was not a setting where I knew what to do. So I leaned [End Page 200] quietly against the wall, trying to be unobtrusive, feeling my baby kicking while I watched. All of them bowed their heads and Dr. Copeland said a brief prayer. I watched the mother as her shoulders relaxed. They said “amen” and squeezed hands and hugged one last time. I thought about that interaction for weeks afterwards. I was uncomfortable, but clearly the patients were not. If there were a role for religion in medicine, I reflected, this might be a place for it. It had been accepted by the family without hesitation, so somehow Dr. Copeland knew it would be alright. It had been used in a healing way.There were several other visits where Dr. Copeland prayed with patients. Sometimes she seemed to know them from her church; at other times, I wasn’t sure. But there never seemed to be a misstep—patients never seemed surprised or awkward with her approach. Did they choose her because of shared beliefs? Did she have a reputation of using faith in her practice and patients selected her for this reason? I wasn’t sure. But it was always the same. They would bow their heads and pray. I would stand back a little uncertainly, but the patients were always grateful and appreciative, thanking Maria by her first name as they left.As I spent more time with her, I looked for other ways that faith might impact Dr. Copeland’s practice and asked questions when I thought there might be relevance. I knew from others that she was opposed to abortion, though I never heard her talk about it openly and I was unsure how this might be manifest in her practice. I watched her prescribe birth control (I knew some religious physicians who did not). I watched her send a patient with a second trimester fetal death to the hospital to be induced for delivery. I wondered if someone... (shrink)

sirIn the January 4 issue of the New England Journal of Medicine three articles appeared on the unapproved use of Misoprostol , which raise an interesting ethical question. The synthetic prostaglandin analogue, Misoprostol, has been successfully used by obstetricians and gynaecologists for a number of years for the induction of a medical abortion in the first or second trimester, for the induction of labour, and for the prevention of postpartum haemorrhages.1 Strangely enough the pharmaceutical company which produces and (...) markets the drug, Searle, …. (shrink)

Analyser av cellefritt DNA fra foster i gravide kvinners blod gir nye muligheter innen fosterdiagnostikk: Testene er bedre enn eksisterende tester, de reduserer risikoen og er billigere. Flere land har tatt i bruk disse testene, og Helsedirektoratet i Norge har mottatt søknad om å ta i bruk en test som erstatter tidlig ultralyd og blodprøver. Likevel nøler norske myndigheter. Hvorfor gjør de det? Ett av svarene er at non-invasive prenatale tester fører med seg en rekke faglige og moralske spørsmål og (...) gir flere grunnleggende etiske utfordringer. Denne artikkelen gjennomgår et bredt knippe av de utfordringene som NIPT reiser. Hensikten er å synliggjøre hvorfor NIPT påkaller etisk refleksjon og å bidra til en åpen debatt og en transparent beslutningsprosess. Artikkelen identifiserer fem sentrale og konkrete spørsmål for vurderingen av NIPT.Nøkkelord: non-invasiv prenatal diagnostikk, testing, fravalg, foster, blodprøve, ekspressivisme, statsliberalt dilemma, dilemma, abort, retten til ikke å viteEnglish summary: Ethical challenges with non-invasive prenatal tests Non-invasive prenatal testing performed with the use of massively parallel sequencing of cell-free DNA in maternal plasma gives extended possibilities in prenatal screening. The tests are claimed to be better than existing alternative tests, they reduce the risk, and it is claimed they are cheaper. They have been used in several countries since 2012, and the University Hospital of North Norway has applied to the Directorate of Health to replace first trimester ultrasound and plasma screening with NIPT. The Directorate of Health is reluctant to reply. Why is this? One of the answers may be that NIPT raises a series of professional and moral questions, and poses profound ethical challenges. This article reviews a series of the challenges with NIPT. The aim is to highlight why NIPT calls for ethical reflection and to contribute to an open debate and a transparent decision-making process. The article identifies five major questions to address in the assessment of NIPT: What are the criteria for screening and removing certain conditions? How certain do we have to be that these conditions do appear in living children? How should we handle information from NIPT for living persons? How can we avoid that persons with the conditions that are selected for screening and removal are insulted, stigmatized, or discriminated? How can we avoid that systematic screening and removal of fetuses with certain conditions develop norms and values that breach with basic social or ethical principles? (shrink)

The Onion, a widely known satirical newspaper, frequently finds its articles taken as the literal truth. One article from May 2011, “Planned Parenthood Opens $8 Billion Abortionplex,” featured teenage girls gushing over the amusement park amenities like a ten-screen theater, nightclub and “lazy river” and a fake PR representative touting, “Whether she’s a high school junior who doesn’t want to go to prom pregnant, a go-getter professional who can’t be bothered with the time commitment of raising a child, or a (...) prostitute who knows getting an abortion is the easiest form of birth control—all are welcome” and “Our hope is for this facility to become a regular destination where a woman in her second trimester can whoop it up at karaoke and then kick back while we vacuum out the contents of her uterus.”The Onion, “Planned Parenthood Opens $8 Billion Abortionplex” . Given the extremity and arguable tastelessness of this joke, it is nearly impossible to imagine this as anything .. (shrink)

We argue that the future-like-ours argument against abortion rests on an important assumption. Namely, in the first trimester of an aborted pregnancy, there exists something that would have gone on to enjoy conscious mental states, had the abortion not occurred. To accommodate this assumption, we argue, a proponent of the future-like-ours argument must presuppose that there is ontic vagueness. We anticipate the objection that our argument achieves “too much” because it also applies mutatis mutandis to conscious humans. (...) We respond by showing that an explanation can be given for why it is wrong to kill conscious humans that is independent of the underlying metaphysics. Our response brings into focus a reason why—at least in the context of an ethical argument like the future-like-ours argument—appeal to a highly controversial metaphysics is ad hoc. Such metaphysics is not necessary to explain the wrongness of killing conscious humans, only nonconscious fetuses. (shrink)

David Boonin has written the most thorough and detailed case for the moral permissibility of abortion yet published. Critically examining a wide range of arguments that attempt to prove that every human fetus has a right to life, he shows that each of these arguments fails on its own terms. He then explains how even if the fetus does have a right to life, abortion can still be shown to be morally permissible on the critique of abortion's (...) own terms. Finally he considers several pro-life arguments that do not depend on claims that the fetus has a right to life and concludes that these too are ultimately unsuccessful. This major book will be especially helpful to those teaching applied ethics and bioethics in philosophy departments or professional schools of law and medicine. It will interest students of women studies and general readers for whom abortion remains a high-profile issue. (shrink)

In this paper I argue that selective abortion for disability often involves inadequate counselling on the part of reproductive medicine professionals who advise prospective parents. I claim that prenatal disability clinicians often fail in intellectual duty—they are culpably ignorant about intellectual disability. First, I explain why a standard motivation for selective abortion is flawed. Second, I summarize recent research on parent experience with prenatal professionals. Third, I outline the notions of epistemic excellence and deficiency. Fourth, I defend culpable (...) ignorance as the best explanation of inadequate disability counselling. Fifth, I rebut alternative explanations. My focus is pregnancies diagnosed with mild or moderate intellectual disability. (shrink)

This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe (...) abortion for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. (shrink)

In the polarized debates about abortion and voluntary euthanasia, disability advocates, who normally align with left-wing social forces, have tended to side with conservative and religious voices in expressing concerns about the impact of technological and sociopolitical developments on disabled futures. This paper draws on the social model of disability and the virtue ethics tradition to explain the alignment between the religious and disability perspectives, and the theory of transformative choice to highlight the limits and biases of the pro-choice (...) logic. Yet, it also recognizes the inherent contradiction of disabled advocates taking a paternalistic position against the personal agency of women and people facing terminal illnesses. A disability perspective serves the discussion of abortion and euthanasia as an encouragement to work together for the building of a society that enables people with diverse disabilities to exist and flourish, and helps pregnant women, people facing disabling and terminal illnesses, and politicians and social influencers to make informed choices. (shrink)

In this paper it is argued that physicians’ restrictive attitudes in offering abortions during 1946–1965 in Sweden were due to their private values. The values, however, were rarely presented openly. Instead physicians’ values influenced their assessment of the facts presented—that is, the women's’ trustworthiness. In this manner the physicians were able to conceal their private values and impede the women from getting what they wanted and needed. The practice was concealed from both patients and physicians and never publicly discussed. It (...) is also argued that a similar tacit practice could currently be applied by palliative care physicians. Such practice might allow palliative care physicians to be restrictive when offering sedation therapy without appearing paternalistic or declaring conscientious objections. However, the practice runs counter to patients’ right to participate in making decisions. The women seeking abortion began to oppose the situation and eventually a new abortion law was introduced 1975. Patients at the end of life will never be able to protest against palliative care physicians’ restrictive attitudes. This is a vulnerable and weak group, unable to lodge complaints after the treatment. In order to respect patients’ autonomy, even suffering patients at the end of their lives, it is suggested that physicians should openly declare their values when it comes to providing treatments that might shorten life. Such transparency might facilitate more genuine shared decision-making and accordingly less suboptimal end-of-life care. (shrink)

There is no issue more central to the abortion debate than the controversial issue of whether the fetus is a moral person. Abortion-rights opponents almost universally claim that abortion is murder and should be legally prohibited because the fetus is a moral person at the moment of conception. Abortion-rights proponents almost universally deny the crucial assumption that the fetus is a person; on their view, whatever moral disvalue abortion involves does not rise to the level (...) of murder and hence does not rise to the level of something that should be legally prohibited.In this essay, I argue that, under dualist assumptions about the nature of mind, the fetus is not a person until brain activity has begun.i First, I argue it is a necessary condition for a thing to be a moral person that it is a self. Second, I argue it is a necessary condition for a fetus to be a self, under dualist assumptions, that there has been some electrical activity in the brain. I conclude that a dualist can take the position that abortion ought to be legally permitted at least until the beginning of brain activity in the fetus. (shrink)

Background: This study investigated the factors affecting the acceptability in France of abortions. Method: 80 study participants from Toulouse and 124 from Metz judged the acceptability of abortion in 64 vignettes composed of five factors: 1) the adolescent's age (15 or 17.5 years), 2) the adolescent's plans to continue schooling or not, 3) the fetus' age (1, 2, 3, or 4 months), 4) the adolescent's parents' agreement or not, and 5) the agreement or not of baby's father. Results: Three (...) clusters were noted: 1) abortion is never acceptable (8% of participants), 2) abortion is always acceptable (23%), and 3) acceptability of abortion depends on the circumstances (63%). In the majority cluster (3), all five factors had significant effects, but the fetus's age accounted for most of the variance (78%). Conclusion: Most subjects in this study judged, in accordance with French law, that the acceptability of induced abortion in minors depends on the circumstances and, in particular, on the fetus' age. (shrink)

This essay seeks to introduce representative beliefs, attitudes, policies, and practices from the Confucian tradition concerning the ethical aspects of abortion and bring these into productive engagement with some of the best and most influential philosophical accounts of abortion available in contemporary Anglo-American philosophy. The essay begins with a discussion of the ethical dimensions of abortion and a critical review of two of the best and most influential contemporary Western accounts; it then moves on to describe and (...) discuss an alternative Confucian approach. The aims are to demonstrate the resources within the Confucian tradition for providing a distinctive philosophical account of abortion and to show that comparative work has the potential to augment, amend, and ultimately enrich our understanding of this morally challenging aspect of human life. (shrink)