Abortion Notes

Different stages of Fetal Development

        Since most of the controversy surrounding the abortion issue concerns precisely when a a human individual or "person" is considered to exist, it is important to have some background about the development of the human fetus and familiarity with the terms that designate the various developmental stages. Conception or fertilization occurs when a female germ cell, or ovum, is penetrated by a male germ cell, or spermatozoon. The result is a single cell, containing a full genetic code of forty-six chromosomes, called the zygote. The zygote then journeys down the fallopian tube, which carries ova from the ovaries to the uterus. This passage generally takes two or three days. During the journey the zygote begins a process of cellular division that increases its size. Occasionally, the zygote ends its journey in the fallopian tube, where it continues to develop. This is known as an ectopic pregnancy. Because the tube is so narrow, such a pregnancy generally must be terminated by surgery.
       When the multicell zygote reaches the uterus, it floats free in the intrauterine fluid and develops into what is known as a blastocyst (some older texts term the developing entity at this stage a conceptus), a ball of cells surrounding a fluid-filled cavity. By the end of the second week, the blastocyst implants itself in the uterine wall. From the end of the second week until the end of the eighth week, the unborn entity is termed an embryo. In the interim (four to five weeks), organ systems begin to develop, and the embryo takes on distinctly human external features.
       The eighth week is important in the biological development and in a discussion of abortion, because it is then that brain activity generally becomes detectable. From this point, the beginning of the ninth week, until birth, the embryo is termed a fetus, although in common parlance throughout the literature the term fetus is used to designate the unborn entity at all stages of development.
       Two other terms designating events in fetal development sometimes come up in discussions of abortion, and thus need to be mentioned. One is quickening, which refers to when the mother begins to feel the movements of the fetus. This occurs somewhere between the thirteenth and twentieth weeks. The second term is viability, the point at which the fetus is capable of surviving outside of the womb. The fetus ordinarily reaches viability around the twenty-fourth week. Generally, then, events during pregnancy unfold as follows:

    Developmental Timetable

    zygote: first through third day
    blastocyst: second day through second week
    embryo: third week through eighth week
    fetus: ninth week until birth
    quickening: thirteenth week through twentieth week
    viability: around the twenty-fourth week

Types of Abortion

Should the unborn entity be terminated at any point during the above timetable, an abortion is said to occur. Thus, abortion simply refers to the termination of a pregnancy.
       Abortions can happen for a number of reasons . Sometimes the abortion occurs "spontaneously," because of internal biochemical factors or because of an injury to the woman. Such spontaneous abortions are ordinarily termed miscarriages. These abortions generally involve no moral issues.
        Abortions can also result directly from human intervention, which can occur in a variety of ways. Sometimes this happens very early in the pregnancy, as when a woman takes a drug such as the "morning-after pill" in order to prevent the blastocyst from implanting in the uterine wall.
       Subsequent intervention during the first trimester (through the twelfth week) usually takes the form of vacuum aspiration. In this procedure the narrow opening to the uterus, the cervix, is dilated, and a small tube is then inserted into the uterus, and its contents are vacuumed or emptied by suction.
       Up through the 15th week fetal tissue is easily broken, and thus a procedure known as dilation and curettage (D&C) is sometimes used in place of vacuum aspiration. In this procedure the cervix is also dilated, but the contents of the uterus are removed through the use of a spoon-shaped surgical instrument known as a curette rather than through a vacuum tube. The curette is used to scrape the uterine walls to ensure that no fetal tissue remains.
       After week fifteen, the fetus is generally too large to pass through the cervix, and its bones, having become more rigid, are less likely to break off. In that case, an abortion is usually performed through a procedure known as a dilation and extraction (D&X). There are two variants of D&X that may be used. In the first, known as intact dilation and evacuation, D&E, the skull of the fetus is collapsed by a sharp instrument before the entire fetus is pulled through the cervix. In the second, the position of the fetus is reversed to the breech position (feet first) and the skull is collapsed after the fetal body is pulled through the cervix. (Nebraska recently tried to ban this procedure, dilation and extraction, and in the ensuing court battle Stenberg v. Carhart the title "partial birth abortion" was applied to this procedure.)
        Before the widespread use of D&E in second trimester abortions, the most common method in use was saline injection. In this procedure the amniotic fluid (the fluid in the amnion, which is a membrane sac surrounding the fetus) is drawn out through a hollow needle and replaced by a solution of salt and water. This leads to a miscarriage.
       Another, but far rarer method after the sixteenth week is hysterotomy. This is a surgical procedure whereby the fetus is removed from the uterus through an incision. This procedure is generally called a cesarean section and is rarely performed for an abortion.
       There is one other form of abortion to consider, mifepristone, or RU-486, the abortion pill. Mifepristone works by blocking the action of progesterone, a steroid hormone needed to maintain a pregnancy. Approved first by France and China in 1988, and then by thirteen other countries since, it did not receive approval in the United States until September 28, 2000, when the Federal Drug Administration (FDA) declared it safe and effective. Abortion by mifepristone is a three-step process. First, the woman takes the drug in her doctor's office. Second, she returns within 36 to 48 hours to take another drug, misoprostal, which forces the uterus to contract and expel the fetus. Third, she returns to the doctor's office two weeks later to make sure the pregnancy is terminated and her uterus is free of the fetal tissue. In approving mifepristone, the FDA issued a number of restrictions. Most important, the drug cannot be used after the seventh week following the woman's last menstrual period. Sinice most abotions are performed later than that, no one yet knows how common its use will be.

    We can list the various abortion possibilities as follows:

1. Internally induced:
        a. Spontaneous abortion (Miscarriage): anytime
2. Externally induced:
        a. Drug such as "morning-after pill": immediately following intercourse
        b. RU-486 (mifepristone): through week 7
        c. Uterine or vacuum aspiration: through week 12
        d. Dilation and curettage: through week 15
        e. Dilation and Extraction: after week 16
        f. Saline injection: after week 16
        g. Hysterotomy (extremely rare): after week 16

Primary issues of concern in the abortion debate

Ontological Status of the Fetus:

    In philosophy the term ontology refers to the theory and nature of being and existence. When we speak of the ontological status of the fetus, we mean the kind of entity the fetus is. Determining the ontological status of the fetus bears directly on the issue of fetal rights and, subsequently, on permissable treatment of the fetus.
    Actually, the problem of ontological status embraces a number of questions, such as (1) whether the fetus is an individual organism; (2) whether the fetus is biologically a human being; (3) whether the fetus is psychologically a human being; (4) whether the fetus is a person.  Presumably, to affirm question (2) is to attribute more significant status to the fetus than to affirm question (1); and to affirm question (3) is to assign even greater status. To affirm question (4), that the fetus is a person, probably is to assign the most significant status to the fetus, although this, as well as other presumptions, depends on the precise meaning of the concepts involved.
    Complicating this issue is the notion of what is meant by "human life." The concept of "human life" can be used in two distinctively different ways. It can be used to refer to a strict set of biological characteristics that distinguish the human species from other non-human species. In this sense, the term "human life" might be consistent with the "individual organism," as in question (1). On the other hand, the term "human life" might refer to psychological human life, that is, to life that is characterized by the properties that are distinctly human. Among these properties might be the ability to use symbols, to think, and to imagine. Without these distinctions,  abortion discussions can founder. For example, many who would agree that abortion involves the taking of a human life in the biological sense would deny that it involves the taking of a human life in the psychological sense. Moreover, they might see nothing immoral with taking life exclusively in the biological sense, although they would consider taking life in the psychological sense morally unacceptable. Thus they find nothing morally objectionable about abortion. Of course, at the root of this judgment is an assumption about the meaning of human life.
    Linked with one's conception of human life is one's concept of "personhood." The concept of personhood may or may not differ from either the biological or the psychological sense of "human life." Some would argue that to be a person is simply to have the biological and/or psychological properties that make an organism human. Others, however, would propose further conditions for personhood, such as consciousness, self-consciousness, rationality, even the capacities for communication and moral judgment. In this view, an entity must satisfy some or all of these criteria, possibly even additional ones, in order to be a person. Thus they might argue that a person must be the bearer of legal rights and social responsibilities, and must be capable of being assigned moral responsibility, of being praised or blamed.
    Clearly the conditions that one believes are necessary for "person" status directly affect the ontological status of the fetus. For example, if the condition is only of an elementary biological nature, then the fetus can more easily qualify as a person than if the conditions include a list of factual properties. Further, if "personhood" must be analyzable in terms of properties bestowed by human evaluation, it becomes infinitely more difficult for the fetus to qualify as a person.
    In the final analysis, the ontological status of fetuses remains an open issue. But some viewpoint ultimately underpins any position on the morality of abortion. Whether conservative, liberal, or moderate, one must be prepared to defend one's view of the ontological status of fetuses.

    When Ontological Status Is Attained

    Further complicating the problem of the ontological status is the question of when in fetal development the fetus gains full ontological status. Whether one claims the fetus is an individual organism, a biological human being, or a full-fledged person, one must specify at what point in its biological development the fetus attains this status. It is one thing to say what status the fetus has; it is another to say when it has attained such status. A judgment about when the fetus has the status bears directly on abortion views as does a judgment of the status itself.
    We can identify a number of positions on when status is attained. An extreme conservative position would argue that the fetus has full ontological status from the time of conception; at the time of conception the fetus must be regarded as an individual person. In direct contrast to this position is the extreme liberal position, which holds that the fetus never achieves ontological status.
    Viewing these as polar positions, we can identify a cluster of moderate views that fall between them. In every instance, the moderate view tries to pinpoint full ontological status somewhere between conception and birth. For example, some would draw the line when brain activity is first present; others draw it at quickening; still others draw the line at viability.

Moral Status of the Fetus

    The issue of moral status of the fetus is generally, but not always, discussed in terms of the fetus' rights. What rights, if any, does it have? Any position on abortion must at some point address this question, and all seriously argued positions do, at least by implication.
    Various views on the moral status of the fetus are currently circulating. Each view can be associated with one or another views on the fetus' s ontological status.  For example, claiming that the fetus has full ontological status at conception, the extreme conservative view also holds that it has full moral status at the same stage. From the moment of conception on, the unborn entity enjoys the same rights we attribute to any adult human. In this view, abortion would be a case of denying the unborn the right to life. Therefore, abortion could never be undertaken without reasons sufficient to override the unborn's claim to life. In other words, only conditions that would justify the killing of an adult human--for example, self-defense--would morally justify an abortion.
    Liberals similarly derive their view of moral status from their theory of ontological status. The extreme liberal view would deny the fetus any moral status. In this view, abortion is not considered comparable to killing an adult person. Indeed, abortion may be viewed as removing a mass of organic material, not unlike an appendectomy. Its removal raises no serious moral problems. A somewhat less liberal view, while granting the fetus ontological status as being biologically human, claims it is not human in any significant moral sense and thus has no significant rights.
    Likewise, moderates would assign moral status to the fetus at the point that the entity attained full ontological status. If brain activity is taken as the point of ontological status, for example, then abortions conducted before that time would not raise serious moral questions; those conducted subsequent to that development would. Currently, viability seems to be an especially popular point at which to assign ontological status. And so, many moderate theorists today insist that abortion raises significant moral questions  only after the fetus has attained viability. This view is reflected in some of the opinions delivered in the Roe v. Wade case.
    It is important to note that granting the fetus moral status does not at all deny the moral status to the woman. Indeed, the question of whose rights should take precedence when a conflict develops raises thorny questions, especially for conservatives and moderates. For example, while granting the fetus full moral status, some conservatives nonetheless approve of therapeutic abortions--abortions performed to save  the woman's life or to correct some life-threatening condition. These are viewed as cases of self-defense or justifiable homicide. Since self-defense and justified homicide commonly are considered  acceptable  grounds for killing an adult person, they are taken as moral justification for killing a fetus. But other conservatives disapprove of even therapeutic abortions.
    Similarly, while moderates grant the fetus moral status at some point in development, they too must arbitrate cases of conflicting rights. They must determine just what conditions are sufficient for allowing the woman's right to override the fetus's right to life. Here the whole gamut of conditions involving the pregnancy must be evaluated, including rape, incest, fetal deformity, and of course physical and psychological harm to the woman.

    Moral Implications

    Determining the moral status of the fetus, then, is directly related to determining when the fetus is actually a person. There is no question that even at the zygote stage, and from then on, the fetus is at least potentially a person (until it becomes actually so). At whatever point it becomes an actual person, we face a set of serious moral issues regarding abortion, among which are:

1.    Does the fetus have a right to be carried full term?
2.    Under what circumstances, if ever, can we take an innocent human life?
3.    Is any other right more important than the right to life--for example, the woman's right to privacy?
4.    If the woman's life is in danger because of the pregnancy, how do we decide whose right prevails?

If, as is the case at present, we can't determine with reasonable certainty at what point the fetus becomes fully a person, we're confronted with another set of problems:

1.    Can we morally disregard the possibility that the fetus might actually be a person (or may not)? If we
        do, does that imply, at best, an indifference to an important moral value? And is not such an attitude of
        not caring about a moral value itself morally questionable at least?
2.    Can we ever act morally on a doubt--for example, a doubt about our obligation, the morally relevant
        facts, the morally correct means? How are we to resolve our doubts?

Important Legal Precedents

Roe v. Wade - On January 22, 1973 the U.S. Supreme Court decided that the right to privacy applies to a woman's choice to terminate her pregnancy, but that her right is not absolute. Her right may be limited by the state's legitimate interests in safeguarding the woman's health, in maintaining the proper medical standards, and in protecting human life. Justice Blackmun, in presenting the majority opinion of the court, went on to point out that fetuses are not included within the definition of person as used in the  Fourteenth Amendment. Most important, he indicated that prior to the end of the first trimester of pregnancy, the state may not interfere with or regulate the attending physician's decision, reached in consultation with the patient, that the patient's pregnancy should be terminated. After the first trimester, and until the fetus is viable, the state may regulate the abortion procedure only for the health of the mother. After the fetus becomes viable, the state may prohibit all abortions except those necessary to preserve the health or life of the mother.
    In dissenting opinion, Justices White and Rehnquist said that nothing in the language or history of the U.S. Constitution supported the Court's judgment, that the Court had simply manufactured a new constitutional right for pregnant women. The abortion issue, they said, should have been left with the people and the political processes they had devised to govern their affairs.

Webster v. Reproductive Health Services - On July 3, 1989 the U.S. Supreme Court upheld a Missouri law that declared in its preamble that the "life of each human being begins at conception." The law also requires physicians to conduct viability tests on the fetuses of women twenty weeks pregnant and prohibits the use of public funds, employees, and facilities to perform, assist, or counsel abortions not necessary to save the mother's life. Moreover, four justices indicated a willingness to overturn the Roe decision. Since then, the Court has upheld state laws requiring parental consent for abortions on minors.

Planned Parenthood v. Casey - The most significant ruling since Webster occurred on June 29, 1992. The issue in this case was a Pennsylvania law regulating abortions. Although the court upheld the right to abortion by a five-to-four majority, it also upheld two of the law's restrictions. The first requires a twenty-four-hour waiting period following a mandatory presentation intended to dissuade the woman from having an abortion. The second requires teenagers to have the consent of a parent or judge. Also upheld were two other provisions: one specifying medical emergencies that exempt a woman from the restrictions, the other requiring clinics to provide the state with statistical reports on abortions performed. One other requirement, that married women first tell their husband's, was struck down as placing an "undue burden" on them.

Stenberg v. Carhart - The Court's decision in this case, announced on June 28, 2000, is also significant. At issue was a Nebraska law banning in all circumstances except to save the woman's life a rare but highly controversial abortion technique called dilation and extraction (D&X). The law did not use that term, however. Instead, it referred to the procedure with the term commonly used by abortion opponents, "partial birth abortion," which the law defined as "deliberately and intentionally delivering into the vagina a living unborn child, or a substantial portion thereof, for the purpose of performing a procedure that the person performing the procedure knows will kill the unborn child." The majority opinion cited two chief reasons for declaring the law unconstitutional. First, the law allowed no exception to preserve the woman's health. Second, the law's definition of "partial birth abortion" was broad enough to cover another abortion procedure, the one most commonly used in the second trimester (dilation and evacuation, or intact D&E). In doing so it placed an "undue burden on a woman's right to terminate her pregnancy before viability."

Abortion Specific Links

An very good on-line powerpoint presentation on the abortion issue

The Ethics Updates "Abortion & Ethics" page

CLRP Abortion Page

The Abortion Law Homepage

Abortion: All Sides of the Issue

Abortion in American History

Abortion's Past

On Abortion: A Lincolnian Perspective

Abortion (from the Internet Encyclopedia of Philosophy)

Feminism and Abortion

One Woman's Abortion

The Moral Question of Abortion  (A text emphasizing a "pro-life" perspective. The full text is on-line!)

Abortion: Questions and Answers (Another "pro-life" slanted piece.)

Abortion  (Another piece by Judith Jarvis Thomson)

When an Abortion is Not an Abortion

The Right of Abortion

An interesting overview of faulty reasoning on both sides of the debate

Against the Sanctity of Life

Feminist Ethics