The Safety and Quality of Abortion Care in the United States (2018)
Chapter: 5 conclusions, 5 conclusions.
This report provides a comprehensive review of the state of the science on the safety and quality of abortion services in the United States. The committee was charged with answering eight specific research questions. This chapter presents the committee’s conclusions by responding individually to each question. The research findings that are the basis for these conclusions are presented in the previous chapters. The committee was also asked to offer recommendations regarding the eight questions. However, the committee decided that its conclusions regarding the safety and quality of U.S. abortion care responded comprehensively to the scope of this study. Therefore, the committee does not offer recommendations for specific actions to be taken by policy makers, health care providers, and others.
1. What types of legal abortion services are available in the United States? What is the evidence regarding which services are appropriate under different clinical circumstances (e.g., based on patient medical conditions such as previous cesarean section, obesity, gestational age)?
Four legal abortion methods—medication, 1 aspiration, dilation and evacuation (D&E), and induction—are used in the United States. Length of gestation—measured as the amount of time since the first day of the last
1 The terms “medication abortion” and “medical abortion” are used interchangeably in the literature. This report uses “medication abortion” to describe the U.S. Food and Drug Administration (FDA)-approved prescription drug regimen used up to 10 weeks’ gestation.
menstrual period—is the primary factor in deciding what abortion procedure is the most appropriate. Both medication and aspiration abortions are used up to 10 weeks’ gestation. Aspiration procedures may be used up to 14 to 16 weeks’ gestation.
Mifepristone, sold under the brand name Mifeprex, is the only medication specifically approved by the FDA for use in medication abortion. The drug’s distribution has been restricted under the requirements of the FDA Risk Evaluation and Mitigation Strategy program since 2011—it may be dispensed only to patients in clinics, hospitals, or medical offices under the supervision of a certified prescriber. To become a certified prescriber, eligible clinicians must register with the drug’s distributor, Danco Laboratories, and meet certain requirements. Retail pharmacies are prohibited from distributing the drug.
When abortion by aspiration is no longer feasible, D&E and induction methods are used. D&E is the superior method; in comparison, inductions are more painful for women, take significantly more time, and are more costly. However, D&Es are not always available to women. The procedure is illegal in Mississippi 2 and West Virginia 3 (both states allow exceptions in cases of life endangerment or severe physical health risk to the woman). Elsewhere, access to the procedure is limited because many obstetrician/gynecologists (OB/GYNs) and other physicians lack the requisite training to perform D&Es. Physicians’ access to D&E training is very limited or nonexistent in many areas of the country.
Few women are medically ineligible for abortion. There are, however, specific contraindications to using mifepristone for a medication abortion or induction. The drug should not be used for women with confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass; an intrauterine device in place; chronic adrenal failure; concurrent long-term systemic corticosteroid therapy; hemorrhagic disorders or concurrent anticoagulant therapy; allergy to mifepristone, misoprostol, or other prostaglandins; or inherited porphyrias.
Obesity is not a risk factor for women who undergo medication or aspiration abortions (including with the use of moderate intravenous sedation). Research on the association between obesity and complications during a D&E abortion is less certain—particularly for women with Class III obesity (body mass index ≥40) after 14 weeks’ gestation.
A history of a prior cesarean delivery is not a risk factor for women undergoing medication or aspiration abortions, but it may be associated
2 Mississippi Unborn Child Protection from Dismemberment Abortion Act, Mississippi HB 519, Reg. Sess. 2015–2016 (2016).
3 Unborn Child Protection from Dismemberment Abortion Act, West Virginia SB 10, Reg. Sess. 2015–2016 (2016).
with an increased risk of complications during D&E abortions, particularly for women with multiple cesarean deliveries. Because induction abortions are so rare, it is difficult to determine definitively whether a prior cesarean delivery increases the risk of complications. The available research suggests no association.
2. What is the evidence on the physical and mental health risks of these different abortion interventions?
Abortion has been investigated for its potential long-term effects on future childbearing and pregnancy outcomes, risk of breast cancer, mental health disorders, and premature death. The committee found that much of the published literature on these topics does not meet scientific standards for rigorous, unbiased research. Reliable research uses documented records of a prior abortion, analyzes comparable study and control groups, and controls for confounding variables shown to affect the outcome of interest.
Physical health effects The committee identified high-quality research on numerous outcomes of interest and concludes that having an abortion does not increase a woman’s risk of secondary infertility, pregnancy-related hypertensive disorders, abnormal placentation (after a D&E abortion), preterm birth, or breast cancer. Although rare, the risk of very preterm birth (<28 weeks’ gestation) in a woman’s first birth was found to be associated with having two or more prior aspiration abortions compared with first births among women with no abortion history; the risk appears to be associated with the number of prior abortions. Preterm birth is associated with pregnancy spacing after an abortion: it is more likely if the interval between abortion and conception is less than 6 months (this is also true of pregnancy spacing in general). The committee did not find well-designed research on abortion’s association with future ectopic pregnancy, miscarriage or stillbirth, or long-term mortality. Findings on hemorrhage during a subsequent pregnancy are inconclusive.
Mental health effects The committee identified a wide array of research on whether abortion increases women’s risk of depression, anxiety, and/or posttraumatic stress disorder and concludes that having an abortion does not increase a woman’s risk of these mental health disorders.
3. What is the evidence on the safety and quality of medical and surgical abortion care?
Safety The clinical evidence clearly shows that legal abortions in the United States—whether by medication, aspiration, D&E, or induction—are
safe and effective. Serious complications are rare. But the risk of a serious complication increases with weeks’ gestation. As the number of weeks increases, the invasiveness of the required procedure and the need for deeper levels of sedation also increase.
Quality Health care quality is a multidimensional concept. Six attributes of health care quality—safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity—were central to the committee’s review of the quality of abortion care. Table 5-1 details the committee’s conclusions regarding each of these quality attributes. Overall, the committee concludes that the quality of abortion care depends to a great extent on where women live. In many parts of the country, state regulations have created barriers to optimizing each dimension of quality care. The quality of care is optimal when the care is based on current evidence and when trained clinicians are available to provide abortion services.
4. What is the evidence on the minimum characteristics of clinical facilities necessary to effectively and safely provide the different types of abortion interventions?
Most abortions can be provided safely in office-based settings. No special equipment or emergency arrangements are required for medication abortions. For other abortion methods, the minimum facility characteristics depend on the level of sedation that is used. Aspiration abortions are performed safely in office and clinic settings. If moderate sedation is used, the facility should have emergency resuscitation equipment and an emergency transfer plan, as well as equipment to monitor oxygen saturation, heart rate, and blood pressure. For D&Es that involve deep sedation or general anesthesia, the facility should be similarly equipped and also have equipment to provide general anesthesia and monitor ventilation.
Women with severe systemic disease require special measures if they desire or need deep sedation or general anesthesia. These women require further clinical assessment and should have their abortion in an accredited ambulatory surgery center or hospital.
5. What is the evidence on what clinical skills are necessary for health care providers to safely perform the various components of abortion care, including pregnancy determination, counseling, gestational age assessment, medication dispensing, procedure performance, patient monitoring, and follow-up assessment and care?
Required skills All abortion procedures require competent providers skilled in patient preparation (education, counseling, and informed consent);
TABLE 5-1 Does Abortion Care in the United States Meet the Six Attributes of Quality Health Care?
a These attributes of quality health care were first proposed by the Institute of Medicine’s Committee on Quality of Health Care in America in the 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century.
b Elsewhere in this report, effectiveness refers to the successful completion of the abortion without the need for a follow-up aspiration.
clinical assessment (confirming intrauterine pregnancy, determining gestation, taking a relevant medical history, and physical examination); pain management; identification and management of expected side effects and serious complications; and contraceptive counseling and provision. To provide medication abortions, the clinician should be skilled in all these areas. To provide aspiration abortions, the clinician should also be skilled in the technical aspects of an aspiration procedure. To provide D&E abortions, the clinician needs the relevant surgical expertise and sufficient caseload to maintain the requisite surgical skills. To provide induction abortions, the clinician requires the skills needed for managing labor and delivery.
Clinicians that have the necessary competencies Both trained physicians (OB/GYNs, family medicine physicians, and other physicians) and advanced practice clinicians (APCs) (physician assistants, certified nurse-midwives, and nurse practitioners) can provide medication and aspiration abortions safely and effectively. OB/GYNs, family medicine physicians, and other physicians with appropriate training and experience can perform D&E abortions. Induction abortions can be provided by clinicians (OB/GYNs,
family medicine physicians, and certified nurse-midwives) with training in managing labor and delivery.
The extensive body of research documenting the safety of abortion care in the United States reflects the outcomes of abortions provided by thousands of individual clinicians. The use of sedation and anesthesia may require special expertise. If moderate sedation is used, it is essential to have a nurse or other qualified clinical staff—in addition to the person performing the abortion—available to monitor the patient, as is the case for any other medical procedure. Deep sedation and general anesthesia require the expertise of an anesthesiologist or certified registered nurse anesthetist to ensure patient safety.
6. What safeguards are necessary to manage medical emergencies arising from abortion interventions?
The key safeguards—for abortions and all outpatient procedures—are whether the facility has the appropriate equipment, personnel, and emergency transfer plan to address any complications that might occur. No special equipment or emergency arrangements are required for medication abortions; however, clinics should provide a 24-hour clinician-staffed telephone line and have a plan to provide emergency care to patients after hours. If moderate sedation is used during an aspiration abortion, the facility should have emergency resuscitation equipment and an emergency transfer plan, as well as equipment to monitor oxygen saturation, heart rate, and blood pressure. D&Es that involve deep sedation or general anesthesia should be provided in similarly equipped facilities that also have equipment to monitor ventilation.
The committee found no evidence indicating that clinicians that perform abortions require hospital privileges to ensure a safe outcome for the patient. Providers should, however, be able to provide or arrange for patient access or transfer to medical facilities equipped to provide blood transfusions, surgical intervention, and resuscitation, if necessary.
7. What is the evidence on the safe provision of pain management for abortion care?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended to reduce the discomfort of pain and cramping during a medication abortion. Some women still report high levels of pain, and researchers are exploring new ways to provide prophylactic pain management for medication abortion. The pharmaceutical options for pain management during aspiration, D&E, and induction abortions range from local anesthesia, to minimal sedation/anxiolysis, to moderate sedation/analgesia, to deep sedation/
analgesia, to general anesthesia. Along this continuum, the physiological effects of sedation have increasing clinical implications and, depending on the depth of sedation, may require special equipment and personnel to ensure the patient’s safety. The greatest risk of using sedative agents is respiratory depression. The vast majority of abortion patients are healthy and medically eligible for all levels of sedation in office-based settings. As noted above (see Questions 4 and 6), if sedation is used, the facility should be appropriately equipped and staffed.
8. What are the research gaps associated with the provision of safe, high-quality care from pre- to postabortion?
The committee’s overarching task was to assess the safety and quality of abortion care in the United States. As noted in the introduction to this chapter, the committee decided that its findings and conclusions fully respond to this charge. The committee concludes that legal abortions are safe and effective. Safety and quality are optimized when the abortion is performed as early in pregnancy as possible. Quality requires that care be respectful of individual patient preferences, needs, and values so that patient values guide all clinical decisions.
The committee did not identify gaps in research that raise concerns about these conclusions and does not offer recommendations for specific actions to be taken by policy makers, health care providers, and others.
The following are the committee’s observations about questions that merit further investigation.
Limitation of Mifepristone distribution As noted above, mifepristone, sold under the brand name Mifeprex, is the only medication approved by the FDA for use in medication abortion. Extensive clinical research has demonstrated its safety and effectiveness using the FDA-recommended regimen. Furthermore, few women have contraindications to medication abortion. Nevertheless, as noted earlier, the FDA REMS restricts the distribution of mifepristone. Research is needed on how the limited distribution of mifepristone under the REMS process impacts dimensions of quality, including timeliness, patient-centeredness, and equity. In addition, little is known about pharmacist and patient perspectives on pharmacy dispensing of mifepristone and the potential for direct-to-patient models through telemedicine.
Pain management There is insufficient evidence to identify the optimal approach to minimizing the pain women experience during an aspiration procedure without sedation. Paracervical blocks are effective in decreasing procedural pain, but the administration of the block itself is painful, and
even with the block, women report experiencing moderate to significant pain. More research is needed to learn how best to reduce the pain women experience during abortion procedures.
Research on prophylactic pain management for women undergoing medication abortions is also needed. Although NSAIDs reduce the pain of cramping, women still report high levels of pain.
Availability of providers APCs can provide medication and aspiration abortions safely and effectively, but the committee did not find research assessing whether APCs can also be trained to perform D&Es.
Addressing the needs of women of lower income Women who have abortions are disproportionately poor and at risk for interpersonal and other types of violence. Yet little is known about the extent to which they receive needed social and psychological supports when seeking abortion care or how best to meet those needs. More research is needed to assess the need for support services and to define best clinical practice for providing those services.
Abortion is a legal medical procedure that has been provided to millions of American women. Since the Institute of Medicine first reviewed the health implications of national legalized abortion in 1975, there has been a plethora of related scientific research, including well-designed randomized clinical trials, systematic reviews, and epidemiological studies examining abortion care. This research has focused on examining the relative safety of abortion methods and the appropriateness of methods for different clinical circumstances. With this growing body of research, earlier abortion methods have been refined, discontinued, and new approaches have been developed.
The Safety and Quality of Abortion Care in the United States offers a comprehensive review of the current state of the science related to the provision of safe, high-quality abortion services in the United States. This report considers 8 research questions and presents conclusions, including gaps in research.
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Important conclusions from abortion studies
- PMID: 12287992
In general, it can be concluded that the initiative on the determinants and consequences of induced abortion has shown some important patterns. For example, induced abortion is not restricted to adolescents but occurs also within marriage to limit family size. Induced abortion is prevalent both where family planning services are available and contraceptive prevalence is high as well as where family planning is not common, but for different reasons. In the former, motivation to limit family size is high and women would use any option if contraception fails or an unwanted pregnancy occurs. In the latter case, induced abortion forms part of a mix of incipient fertility regulation alternatives, most of which are traditional and of little effectiveness but including some use or improper use of modern methods. Few abortion seekers, and among them even fewer adolescents, were using a modern contraceptive at the time the pregnancy started. High use of traditional methods in some countries leads to abortion as women/couples fail to follow proper instructions with regards to the safe period. Unsafe clandestine abortions are more likely to be sought by poorer women and by adolescents. The findings of this research are increasingly being used to question the legal status of abortion in countries where the law is restrictive, or to strengthen family planning efforts in order to reduce abortion incidence.
- Abortion, Induced*
- Evaluation Studies as Topic*
- Family Planning Services
- Research Design
An Argument That Abortion Is Wrong by DON MARQUIS
Don Marquis is Professor of Philosophy at the University of Kansas. He defends the view that, except in unusual circumstances, abortion is seriously wrong.
The purpose of this essay is to set out an argument the claim that abortion, except perhaps in instances, is seriously wrong. One reason for these exceptions is to eliminate from consideration cases whose ethical analysis should be controversial detailed for clear-headed opponents of abortion. Such cases include abortion after rape and abortion during the first fourteen days after conception when there is an argument that the fetus is not definitely an individual. Another reason for making these exceptions allow for those cases in which the permissibility of abortion is compatible with the argument of this essay. Such cases include abortion when continuation of a pregnancy endangers a woman's life and when the fetus is anencephalic. When I wrongness of abortion in this essay, a reader she presume the above qualifications. I mean by an abort ion an action intended to bring about the death of a fetus for the sake of the woman who carries it. (Thus, as is standard on the literature on this subject, I eliminanate spontaneous abortions from consideration.) I mean by a fetus a developing human being from
time of conception to the time of birth. (Thus, as is standard, I call embryos and zygotes, fetuses.)
The argument of this essay will establish that abortion is wrong for the same reason as killing a reader of this essay is wrong. I shall just assume, rather than establish, that killing you is seriously wrong. I shall make no attempt to offer a complete ethics of killing. Finally, I shall make no attempt to resolve some very fundamental and difficult general philosophical issues into which this analysis of the ethics of abortion might lead.
WHY THE DEBATE OVER ABORTION SEEMS INTRACTABLE
Symmetries that emerge from the analysis of the major arguments on either side of the abortion debate may explain why the abortion debate seems intractable. Consider the following standard anti-abortion argument: Fetuses are both human and alive. Humans have the right to life. Therefore, fetuses have the right to life. Of course, women have the right to control their own bodies, but the right to life overrides the right of a woman to control her own body. Therefore, abortion is wrong.
Judith Thomson (1971) has argued that even if one grants (for the sake of argument only) that fetuses have the right to life, this argument fails. Thomson invites you to imagine that you have been connected while sleeping, bloodstream to bloodstream, to a famous violinist. The violinist, who suffers from a rare blood disease, will die if disconnected. Thomson argues that you surely have the right to disconnect yourself. She appeals to our intuition that having to lie in bed with a violinist for an indefinite period is too much for morality to demand. She supports this claim by noting that the body being used is your body, not the violinist's body. She distinguishes the right to life, which the violinist clearly has, from the right to use someone else's body when necessary to preserve one's life, which it is not at all obvious the violinist has. Because the case of pregnancy is like the case of the violinist, one is no more morally obligated to remain attached to a fetus than to remain attached to the violinist.
It is widely conceded that one can generate from Thomson's vivid case the conclusion that abortion is morally permissible when a pregnancy is due to rape (Warren, 1973, p. 49; and Steinbock, 1992, p. 79). But this is hardly a general right to abortion. Do Thomson's more general theses generate a more general right to an abortion? Thomson draws our attention to the fact that in a pregnancy, although a fetus uses a woman's body as a life-support system, a pregnant woman does not use a fetus's body as a life-support system. However, an opponent of abortion might draw our attention to the fact that in an abortion the life that is lost is the fetus's, not the woman's. This symmetry seems to leave us with a stand-off.
Thomson points out that a fetus's right to life does not entail its right to use someone else's body to preserve its life. However, an opponent of abortion might point out that a woman's right to use her own body does not entail her right to end someone else's life in order to do what she wants with her body. In reply, one might argue that a pregnant woman's right to control her own body doesn't come to much if it is wrong for her to take any action that ends the life of the fetus within her. However, an opponent of abortion can argue that the fetus's right to life doesn't come to much if a pregnant woman can end it when she chooses. The consequence of all of these symmetries seems to be a stand-off. But if we have the stand-off, then one might argue that we are left with a conflict of rights: a fetal right to life versus the right of a woman to control her own body. One might then argue that the right to life seems to be a stronger right than the right to control one's own body in the case of abortion because the loss of one's life is a greater loss than the loss of the right to control one's own body in one respect for nine months. Therefore, the right to life overrides the right to control one's own body and abortion is wrong. Considerations like these have suggested to both opponents of abortion and supporters of choice that a Thomsonian strategy for de-
fending a general right to abortion will not succeed (Tooley, 1972; Warren, 1973; and Steinbock, 1992). In fairness, one must note that Thomson did not intend her strategy to generate a general moral permissibility of abortion.
Do Fetuses Have the Right to Life?
The above considerations suggest that whether abortion is morally permissible boils down to the question of whether fetuses have the right to life. An argument that fetuses either have or lack the right to life must be based upon some general criterion for having or lacking the right to life. Opponents of abortion, on the one hand, look around for the broadest possible plausible criterion, so that fetuses will fall under it. This explains why classic arguments against abortion appeal to the criterion of being human (Noonan, 1970; Beckwith, 1993). This criterion appears plausible: The claim that all humans, whatever their race, gender, religion or age, have the right to life seems evident enough. In addition, because the fetuses we are concerned with do not, after all, belong to another species, they are clearly human. Thus, the syllogism that generates the conclusion that fetuses have the right to life is apparently sound.
On the other hand, those who believe abortion is morally permissible wish to find a narrow, but plausible, criterion for possession of the right to life so that fetuses will fall outside of it. This explains, in part, why the standard pro-choice arguments in the philosophical literature appeal to the criterion of being a person (Feinberg, 1986; Tooley, 1972; Warren, 1973; Benn, 1973; Engelhardt, 1986). This criterion appears plausible: The claim that only persons have the right to life seems evident enough. Furthermore, because fetuses neither are rational nor possess the capacity to communicate in complex ways nor,possess a concept of self that continues through time, no fetus is a person. Thus, the syllogism needed to generate the conclusion that no fetus possesses the right to life is apparently sound. Given that no fetus possesses the right to life, a woman's right to control her own body easily generates the general right to abortion. The existence of two apparently defensible syllogisms which support contrary conclusions helps to explain why partisans on both sides of the abortion dispute often regard their opponents as either morally depraved or mentally deficient.
Which syllogism should we reject? The anti-abortion syllogism is usually attacked by attacking its major premise: the claim that whatever is biologically human has the right to life. This premise is subject to scope problems because the class of the biologically human includes too much: human cancer-cell cultures are biologically human, but they do not have the right to life. Moreover, this premise also is subject to moral-relevance problems: the connection between the biological and the moral is merely assumed. It is hard to think of a good argument for such a connection. If one wishes to consider the category of "human" a moral category, as some people find it plausible to do in other contexts, then one is left with no way of showing that the fetus is fully human without begging the question. Thus, the classic anti-abortion argument appears subject to fatal difficulties.
These difficulties with the classic anti-abortion argument are well known and thought by many to be conclusive. The symmetrical difficulties with the classic pro-choice syllogism are not as well recognized. The pro-choice syllogism can be attacked by attacking its major premise: Only persons have the right to life. This premise is subject to scope problems because the class of persons includes too little: infants, the severely retarded, and some of the mentally ill seem to fall outside the class of persons as the supporter of choice understands the concept. The premise is also subject to moral-relevance problems:
Being a person is understood by the pro-choicer as having certain psychological attributes. If the prochoicer questions the connection between the biological and the moral, the opponent of abortion can question the connection between the psychological and the moral. If one wishes to consider "person" a moral category, as is often done, then one is left with no way of showing that the fetus is not a person without begging the question.
Pro-choicers appear to have resources for dealing with their difficulties that opponents of abortion lack. Consider their moral-relevance problem. A pro-
choicer might argue that morality rests on contractual foundations and that only those who have the psychological attributes of persons are capable of entering into the moral contract and, as a consequence, being a member of the moral community. (This is essentially Engelhardt's  view.) The great advantage of this contractarian approach to morality is that it seems far more plausible than any approach the anti-abortionist can provide. The great disadvantage of this contractarian approach to morality is that it adds to our earlier scope problems by leaving it unclear how we can have the duty not to inflict pain and suffering on animals.
Contractarians have tried to deal with their scope problems by arguing that duties to some individuals who are not persons can be justified even though those individuals are not contracting members of the moral community. For example, Kant argued that, although we do not have direct duties to animals, we "must practice kindness towards animals, for he who is cruel to animals becomes hard also in his dealings with men" (Kant, 1963, p. 240). Feinberg argues that infanticide is wrong, not because infants have the right to life, but because our society's protection of infants has social utility. If we do not treat infants with tenderness and consideration, then when they are persons they will be worse off and we will be worse off also (Feinberg, 1986, p. 271).
These moves only stave off the difficulties with the pro-choice view; they do not resolve them. Consider Kant's account of our obligations to animals. Kantians certainly know the difference between persons and animals. Therefore, no true Kantian would treat persons as she would treat animals. Thus, Kant's defense of our duties to animals fails to show that Kantians have a duty not to be cruel to animals. Consider Feinberg's attempt to show that infanticide is wrong even though no infant is a person. All Feinerg really shows is that it is a good idea to treat with care and consideration the infants we intend to keep. That is quite compatible with killing the infants we intend to discard. This point can be supported by an analogy with which any pro-choicer will agree. There are plainly good reasons to treat with care and consideration the fetuses we intend to keep. This is quite compatible with aborting those fetuses we intend to discard. Thus, Feinberg's account of the wrongness of infanticide is inadequate.
Accordingly, we can see that a contractarian defense of the pro-choice personhood syllogism fails. The problem arises because the contractarian cannot account for our duties to individuals who are not persons, whether these individuals are animals or infants. Because the pro-choicer wishes to adopt a narrow criterion for the right to life so that fetuses will not be included, the scope of her major premise is too narrow. Her problem is the opposite of the problem the classic opponent of abortion faces.
The argument of this section has attempted to establish, albeit briefly, that the classic anti-abortion argument and the pro-choice argument favored by most philosophers both face problems that are mirror images of one another. A stand-off results. The abortion debate requires a different strategy.
THE "FUTURE LIKE OURS" ACCOUNT OF THE WRONGNESS OF KILLING
Why do the standard arguments in the abortion debate fail to resolve the issue? The general principles to which partisans in the debate appeal are either truisms most persons would affirm in the absence of much reflection, or very general moral theories. All are subject to major problems. A different approach is needed.
Opponents of abortion claim that abortion is wrong because abortion involves killing someone like us, a human being who just happens to be very young. Supporters of choice claim that ending the life of a fetus is not in the same moral category as ending the life of an adult human being. Surely this controversy cannot be resolved in the absence of an account of what it is about killing us that makes killing us wrong. On the one hand, if we know what property we possess that makes killing us wrong, then we can ask whether fetuses have the same property. On the other hand, suppose that we do not know what it is about us that makes killing us wrong. If this
is so, we do not understand even easy cases in which killing is wrong. Surely, we will not understand the ethics of killing fetuses, for if we do not understand easy cases, then we will not understand hard cases. Both pro-choicer and anti-abortionist agree that it is obvious that it is wrong to kill us. Thus, a discussion of what it is about us that makes killing us not only wrong, but seriously wrong, seems to be the right place to begin a discussion of the abortion issue.
Who is primarily wronged by a killing? The wrong of killing is not primarily explained in terms of the loss to the family and friends of the victim. Perhaps the victim is a hermit. Perhaps one's friends find it easy to make new friends. The wrong of killing is not primarily explained in terms of the brutalization of the killer. The great wrong to the victim explains the brutalization, not the other way around. The wrongness of killing us is understood in terms of what killing does to us. Killing us imposes on us the misfortune of premature death. That misfortune underlies the wrongness.
Premature death is a misfortune because when one is dead, one has been deprived of life. This misfortune can be more precisely specified. Premature death cannot deprive me of my past life. That part of my life is already gone. If I die tomorrow or if I live thirty more years my past life will be no different. It has occurred on either alternative. Rather than my past, my death deprives me of my future, of the life that I would have lived if I had lived out my natural life span.
The loss of a future biological life does not explain the misfortune of death. Compare two scenarios: In the former I now fall into a coma from which I do not recover until my death in thirty years. In the latter I die now. The latter scenario does not seem to describe a greater misfortune than the former.
The loss of our future conscious life is what underlies the misfortune of premature death. Not any future conscious life qualifies, however. Suppose that I am terminally ill with cancer. Suppose also that pain and suffering would dominate my future conscious life. If so, then death would not be a misortune for me.
Thus, the misfortune of premature death consists of the loss to us of the future goods of consciousness.
What are these goods? Much can be said about this issue, but a simple answer will do for the purposes of this essay. The goods of life are whatever we get out of life. The goods of life are those items toward which we take a "pro" attitude. They are completed projects of which we are proud, the pursuit of our goals, aesthetic enjoyments, friendships, intellectual pursuits, and physical pleasures of various sorts. The goods of life are what makes life worth living. In general, what makes life worth living for one person will not be the same as what makes life worth living for another. Nevertheless, the list of goods in each of our lives will overlap. The lists are usually different in different stages of our lives.
What makes the goods of my future good for me? One possible, but wrong, answer is my desire for those goods now. This answer does not account for those aspects of my future life that I now believe I will later value, but about which I am wrong. Neither does it account for those aspects of my future that I will come to value, but which I don't value now. What is valuable to the young may not be valuable to the middle-aged. What is valuable to the middle-aged may not be valuable to the old. Some of life's values for the elderly are best appreciated by the elderly. Thus it is wrong to say that the value of my future to me is just what I value now. What makes my future valuable to me are those aspects of my future that I will (or would) value when I will (or would) experience them, whether I value them now or not.
It follows that a person can believe that she will have a valuable future and be wrong. Furthermore, a person can believe that he will not have a valuable future and also be wrong. This is confirmed by our attitude toward many of the suicidal. We attempt to save the lives of the suicidal and to convince them that they have made an error in judgment. This does not mean that the future of an individual obtains value from the value that others confer on it. It means that, in some cases, others can make a clearer judgment of the value of a person's future to that person than the person herself. This often happens when one's judgment concerning the value of one's own future is clouded by personal tragedy. (Compare the views of McInerney, 1990, and Shirley, 1995.)
Thus, what is sufficient to make killing us wrong,
in general, is that it causes premature death. Premature death is a misfortune. Premature death is a misfortune, in general, because it deprives an individual of a future of value. An individual's future will be valuable to that individual if that individual will come, or would come, to value it. We know that killing us is wrong. What makes killing us wrong, in general, is that it deprives us of a future of value. Thus, killing someone is wrong, in general, when it deprives her of a future like ours. I shall call this "an FLO."
ARGUMENTS IN FAVOR OF THE FLO THEORY
At least four arguments support this FLO account of the wrongness of killing.
The Considered Judgment Argument
The FLO account of the wrongness of killing is correct because it fits with our considered judgment concerning the nature of the misfortune of death. The analysis of the previous section is an exposition of the nature of this considered judgment. This judgment can be confirmed. If one were to ask individuals with AIDS or with incurable cancer about the nature of their misfortune, I believe that they would say or imply that their impending loss of an FLO makes their premature death a misfortune. If they would not, then the FLO account would plainly be wrong.
The Worst of Crimes Argument
The FLO account of the wrongness of killing is correct because it explains why we believe that killing is one of the worst of crimes. My being killed deprives me of more than does my being robbed or beaten or harmed in some other way because my being killed deprives me of all of the value of my future, not merely part of it. This explains why we make the penalty for murder greater than the penalty for other crimes.
As a corollary the FLO account of the wrongness of killing also explains why killing an adult human being is justified only in the most extreme circumstances, only in circumstances in which the loss of life to an individual is outweighed by a worse outcome if that life is not taken. Thus, we are willing to justify killing in self-defense, killing in order to save one's own life, because one's loss if one does not kill in that situation is so very great. We justify killing in a just war for similar reasons. We believe that capital punishment would be justified if, by having such an institution, fewer premature deaths would occur. The FLO account of the wrongness of killing does not entail that killing is always wrong. Nevertheless, the FLO account explains both why killing is one of the worst of crimes and, as a corollary, why the exceptions to the wrongness of killing are so very rare. A correct theory of the wrongness of killing should have these features.
The Appeal to Cases Argument
The FLO account of the wrongness of killing is correct because it yields the correct answers in many life-any-death cases that arise in medicine and have interested philosophers.
Consider medicine first. Most people believe that it is not wrong deliberately to end the life of a person who is permanently unconscious. Thus we believe that it is not wrong to remove a feeding tube or a ventilator from a permanently comatose patient, knowing that such a removal will cause death. The FLO account of the wrongness of killing explains why this is so. A patient who is permanently unconscious cannot have a future that she would come to value, whatever her values. Therefore, according to the FLO theory of the wrongness of killing, death could not, ceteris paribus, be a misfortune to her. Therefore, removing the feeding tube or ventilator does not wrong her.
By contrast, almost all people believe that it is wrong, ceteris paribus, to withdraw medical treatment from patients who are temporarily unconscious. The FLO account of the wrongness of killing also explains why this is so. Furthermore, these two unconsciousness cases explain why the FLO account of the wrongness of killing does not include present consciousness as a necessary condition for the wrongness of killing.
Consider now the issue of the morality of legalizing active euthanasia. Proponents of active euthanasia argue that if a patient faces a future of intractable pain and wants to die, then, ceteris paribus, it would not be wrong for a physician to give him medicine that she knows would result in his death. This view is so universally accepted that even the strongest opponents of active euthanasia hold it. The official Vatican view (Sacred Congregation, 1980) is that it is permissible for a physician to administer to a patient morphine sufficient (although no more than sufficient) to control his pain even if she foresees that the morphine will result in his death. Notice how nicely the FLO account of the wrongness of killing explains this unanimity of opinion. A patient known to be in severe intractable pain is presumed to have a future without positive value. Accordingly, death would not be a misfortune for him and an action that would (foreseeably) end his life would not be wrong.
Contrast this with the standard emergency medical treatment of the suicidal. Even though the suicidal have indicated that they want to die, medical personneI will act to save their lives. This supports the view that it is not the mere desire to enjoy an FLO which is crucial to our understanding of the wrongness of killing. Having an FLO is what is crucial to the account, although one would, of course, want to make an exception in the case of fully autonomous people who refuse life-saving medical treatment. Opponents of abortion can, of course, be willing to make an exception for fully autonomous fetuses who refuse life support.
The FLO theory of the wrongness of killing also deals correctly with issues that have concerned philosophers. It implies that it would be wrong to kill (peaceful) persons from outer space who come to visit our planet even though they are biologically utterly unlike us. Presumably, if they are persons, then they will have futures that are sufficiently like ours so that it would be wrong to kill them. The FLO account of the wrongness of killing shares this feature with the personhood views of the supporters of choice. Classical opponents of abortion who locate the wrongness of abortion somehow in the biological humanity of a fetus cannot explain this.
The FLO account does not entail that there is another species of animals whose members ought not to be killed. Neither does it entail that it is permissible to kill any non-human animal. On the one hand, a supporter of animals' rights might argue that since some non-human animals have a future of value, it is wrong to kill them also, or at least it is wrong to kill them without a far better reason than we usually have for killing non-human animals. On the other hand, one might argue that the futures of non-human animals are not sufficiently like ours for the FLO account to entail that it is wrong to kill them. Since the FLO account does not specify which properties a future of another individual must possess so that killing that individual is wrong, the FLO account is indeterminate with respect to this issue. The fact that the FLO account of the wrongness of killing does not give a determinate answer to this question is not a flaw in the theory. A sound ethical account should yield the right answers in the obvious cases; it should not be required to resolve every disputed question.
A major respect in which the FLO account is superior to accounts that appeal to the concept of person is the explanation the FLO account provides of the wrongness of killing infants. There was a class of infants who had futures that included a class of events that were identical to the futures of the readers of this essay. Thus, reader, the FLO account explains why it was as wrong to kill you when you were an infant as it is to kill you now. This account can be generalized to almost all infants. Notice that the wrongness of killing infants can be explained in the absence of an account of what makes the future of an individual sufficiently valuable so that it is wrong to kill that individual. The absence of such an account explains why the FLO account is indeterminate with respect to the wrongness of killing nonhuman animals.
If the FLO account is the correct theory of the wrongness of killing, then because abortion involves killing fetuses and fetuses have FLOs for exactly the same reasons that infants have FLOs, abortion is presumptively seriously immoral. This inference lays the necessary groundwork for a fourth argument
in favor of the FLO account that shows that abortion IS wrong.
The Analogy with Animals Argument
Why do we believe it is wrong to cause animals suffering? We believe that, in our own case and in the case of other adults and children, suffering is a misfortune. It would be as morally arbitrary to refuse to acknowledge that animal suffering is wrong as it would be to refuse to acknowledge that the suffering of persons of another race is wrong. It is, on reflection, suffering that is a misfortune, not the suffering of white males or the suffering of humans. Therefore, infliction of suffering is presumptively wrong no matter on whom it is inflicted and whether it is inflicted on persons or nonpersons. Arbitrary restrictions on the wrongness of suffering count as racism or speciesism. Not only is this argument convincing on its own, but it is the only way of justifying the wrongness of animal cruelty. Cruelty toward animals is clearly wrong. (This famous argument is due to Singer, 1979.)
The FLO account of the wrongness of abortion is analogous. We believe that, in our own case and the cases of other adults and children, the loss of a future of value is a misfortune. It would be as morally arbitrary to refuse to acknowledge that the loss of a future of value to a fetus is wrong as to refuse to acknowledge that the loss of a future of value to Jews (to take a relevant twentieth-century example) is wrong. It is, on reflection, the loss of a future of value that is a misfortune; not the loss of a future of value to adults or Joss of a future of value to nonJews. To deprive someone of a future of value is wrong no matter on whom the deprivation is inflicted and no matter whether the deprivation is inflicted on persons or nonpersons. Arbitrary restrictions on the wrongness of this deprivation count as racism, genocide or ageism. Therefore, abortion is wrong. This argument that abortion is wrong should be convincing because it has the same form as the argument for the claim that causing pain and suffering to non-human animals is wrong. Since the latter argument is convincing, the former argument should be also. Thus, an analogy with animals supports the thesis that abortion is wrong.
REPLIES TO OBJECTIONS
The four arguments in the previous section establish that abortion is, except in rare cases, seriously immoral. Not surprisingly, there are objections to this view. There are replies to the four most important objections to the FLO argument for the immorality of abortion.
The Potentiality Objection
The FLO account of the wrongness of abortion is a potentiality argument. To claim that a fetus has an FLO is to claim that a fetus now has the potential to be in a state of a certain kind in the future. It is not to claim that all ordinary fetuses will have FLOs. Fetuses who are aborted, of course, will not. To say that a standard fetus has an FLO is to say that a standard fetus either will have or would have a life it will or would value. To say that a standard fetus would have a life it would value is to say that it will have a life it will value if it does not die prematurely. The truth of this conditional is based upon the nature of fetuses (including the fact that they naturally age) and this nature concerns their potential.
Some appeals to potentiality in the abortion debate rest on unsound inferences. For example, one may try to generate an argument against abortion by arguing that because persons have the right to life, potential persons also have the right to life. Such an argument is plainly invalid as it stands. The premise one needs to add to make it valid would have to be something like: "If Xs have the right to Y, then potential Xs have the right to Y." This premise is plainly false. Potential presidents don't have the rights of the presidency; potential voters don't have the right to vote.
In the FLO argument potentiality is not used in order to bridge the gap between adults and fetuses as is done in the argument in the above paragraph. The FLO theory of the wrongness of killing adults is
based upon the adult's potentiality to have a future of value. Potentiality is in the argument from the very beginning. Thus, the plainly false premise is not required. Accordingly, the use of potentiality in the FLO theory is not a sign of an illegitimate inference.
The Argument from Interests
A second objection to the FLO account of the immorality of abortion involves arguing that even though fetuses have FLOs, non sentient fetuses do not meet the minimum conditions for having any moral standing at all because they lack interests. Steinbock (1992, p. 5) has presented this argument clearly:
Beings that have moral status must be capable of caring about what is done to them. They must be capable of being made, if only in a rudimentary sense, happy or miserable, comfortable or distressed. Whatever reasons we may have for preserving or protecting non sentient beings, these reasons do not refer to their own interests. For without conscious awareness, beings cannot have interests. Without interests, they cannot have a welfare of their own. Without a welfare of their own, nothing can be done for their sake. Hence, they lack moral standing or status.
Medical researchers have argued that fetuses do not become sentient until after 22 weeks of gestation (Steinbock, 1992, p. 50). If they are correct, and if Steinbock's argument is sound, then we have both an objection to the FLO account of the wrongness of abortion and a basis for a view on abortion minimally acceptable to most supporters of choice.
Steinbock's conclusion conflicts with our settled moral beliefs. Temporarily unconscious human beings are nonsentient, yet no one believes that they lack either interests or moral standing. Accordingly, neither conscious awareness nor the capacity for conscious awareness is a necessary condition for having interests.
The counter-example of the temporarily unconscious human being shows that there is something internally wrong with Steinbock's argument. The difficulty stems from an ambiguity. One cannot take an interest in something without being capable of caring about what is done to it. However, something can be in someone's interest without that individual being capable of caring about it, or about anything. Thus, life support can be in the interests of a temporarily unconscious patient even though the temporarily unconscious patient is incapable of taking an interest in that life support. If this can be so for the temporarily unconscious patient, then it is hard to see why it cannot be so for the temporarily unconscious (that is, non sentient) fetus who requires placental life support. Thus the objection based on interests fails.
The Problem of Equality
The FLO account of the wrongness of killing seems to imply that the degree of wrongness associated with each killing varies inversely with the victim's age. Thus, the FLO account of the wrongness of killing seems to suggest that it is far worse to kill a five-yearold than an 89-year-old because the former is deprived of far more than the latter. However, we believe that all persons have an equal right to life. Thus, it appears that the FLO account of the wrongness of killing entails an obviously false view (Paske, 1994).
However, the FLO account of the wrongness of killing does not, strictly speaking, imply that it is worse to kill younger people than older people. The FLO account provides an explanation of the wrongness of killing that is sufficient to account for the serious presumptive wrongness of killing. It does not follow that killings cannot be wrong in other ways. For example, one might hold, as does Feldman (1992, p. 184), that in addition to the wrongness of killing that has its basis in the future life of which the victim is deprived, killing an individual is also made wrong by the admirability of an individual's past behavior. Now the amount of admirability will presumably vary directly with age, whereas the amount of deprivation will vary inversely with age. This tends to equalize the wrongness of murder.
However, even if, ceteris paribus , it is worse to kill younger persons than older persons, there are
good reasons for adopting a doctrine of the equality of murder. Suppose that we tried to estimate the seriousness of a crime of murder by appraising the value of the FLO of which the victim had been deprived. How would one go about doing this? In they first place, one would be confronted by the old problem of interpersonal comparisons of utility. Second place, estimation of the value of a would involve putting oneself, not into the shoes of the victim at the time she was killed, but rather into the shoes the victim would have worn had the victim survived, and then estimating from that perspective the worth of that person's future. This task difficult, if not impossible. Accordingly, there are reasons to adopt a convention that murders equally wrong.
Furthermore, the FLO theory, in a way, explains why we do adopt the doctrine of the legal equity of murder. The FLO theory explains why we murder as one of the worst of crimes, since depriving someone of a future like ours deprives more than depriving her of anything else. This gives us a reason for making the punishment for younger victims very harsh, as harsh as is compatible with civiliazed society. One should not make the punishment younger victims harsher than that. Thus, the doctrine of the equal legal right to life does not seem incompatible with the FLO theory.
The Contraception Objection
The strongest objection to the FLO argument immorality of abortion is based on the claim that, because contraception results in one less FLO, the FLO argument entails that contraception, indeed, abstention from sex when conception is possible, is immoral. Because neither contraception nor abstention from sex when conception is possible is immoral, the FLO account is flawed.
There is a cogent reply to this objection. If argument of the early part of this essay is correct, then the central issue concerning the morality of abortion is the problem of whether fetuses are individuals who are members of the class of individuals whom it is seriously presumptively wrong to kill. The properties of being human and alive, of being a person, and of having an FLO are criteria that participants in the abortion debate have offered to mark off the relevant class of individuals. The central claim of this essay is that having an FLO marks off the relevant class of individuals. A defender of the FLO view could, therefore, reply that since, at the time of contraception, there is no individual to have an FLO, the FLO account does not entail that contraception is wrong. The wrong of killing is primarily a wrong to the individual who is killed; at the time of contraception there is no individual to be wronged.
However, someone who presses the contraception objection might have an answer to this reply. She might say that the sperm and egg are the individuals deprived of an FLO at the time of contraception. Thus, there are individuals whom contraception deprives of an FLO and if depriving an individual of an FLO is what makes killing wrong, then the FLO theory entails that contraception is wrong.
There is also a reply to this move. In the case of abortion, an objectively determinate individual is the subject of harm caused by the loss of an FLO. This individual is a fetus. In the case of contraception, there are far more candidates (see Norcross, 1990). Let us consider some possible candidates in order of the increasing number of individuals harmed: (1) The single harmed individual might be the combination of the particular sperm and the particular egg that would have united to form a zygote if contraception had not been used. (2) The two harmed individuals might be the particular sperm itself, and, in addition, the ovum itself that would have physically combined to form the zygote. (This is modeled on the double homicide of two persons who would otherwise in a short time fuse. (1) is modeled on harm to a single entity some of whose parts are not physically contiguous, such as a university. (3) The many harmed individuals might be the millions of combinations of sperm and the released ovum whose (small) chances of having an FLO were reduced by the successful contraception. (4) The even larger class of harmed individuals (larger by one) might be the class consisting of all of the individual sperm in an ejaculate and, in addition, the individual ovum released at the time of the successful contraception. (1) through (4) are all candidates for being the subject(s) of harm in the case of successful contraception or abstinence from sex. Which should be chosen? Should we hold a lottery? There seems to be no non-arbitrarily determinate subject of harm in the case of successful contraception. But if there is no such subject of harm, then no determinate thing was harmed. If no determinate thing was harmed, then (in the case of contraception) no wrong has been done. Thus, the FLO account of the wrongness of abortion does not entail that contraception is wrong.
This essay contains an argument for the view that, except in unusual circumstances, abortion is seriously wrong. Deprivation of an FLO explains why killing adults and children is wrong. Abortion deprives fetuses of FLOs. Therefore, abortion is wrong. This argument is based on an account of the wrongness of killing that is a result of our considered judgment of the nature of the misfortune of premature death. It accounts for why we regard killing as one of the worst of crimes. It is superior to alternative accounts of the wrongness of killing that are intended to provide insight into the ethics of abortion. This account of the wrongness of killing is supported by the way it handles cases in which our moral judgments are settled. This account has an analogue in the most plausible account of the wrongness of causing animals to suffer. This account makes no appeal to religion. Therefore, the FLO account shows that abortion, except in rare instances, is seriously wrong.
Beckwith, F. J., Politically Correct Death: Answering Arguments for Abortion Rights (Grand Rapids, Michigan: Baker Books, 1993).
Benn, S. 1., "Abortion, Infanticide, and Respect for Persons," The Problem of Abortion, ed. J. Feinberg (Belmont, California: Wadsworth, 1973), pp. 92-104.
Engelhardt, Jr, H. T., The Foundations of Bioethics (New York: Oxford University Press, 1986).
Feinberg, J., "Abortion," Matters of Life and Death: New Introductory Essays in Moral Philosophy, ed. T. Regan (New York: Random House, 1986).
Feldman, F., Confrontations with the Reaper: A Philosophical Study of the Nature and Value of Death (New York: Oxford University Press, 1992).
Kant, I., Lectures on Ethics, trans. L. Infeld ( New York: Harper, 1963).
Marquis, D. B., "A Future like Ours and the Concept of Person: a Reply to Mcinerney and Paske," The Abortion Controversy: A Reader, ed. L. P. Pojman and F. J. Beckwith (Boston: Jones and Bartlett, 1994), pp. 354-68.
---, "Fetuses, Futures and Values: a Reply to Shirley," Southwest Philosophy Review II (1995): 263-5.
---, "Why Abortion Is Immoral," Joumal of Philosophy 86 (1989): 183-202.
McInerney, P., "Does a Fetus Already Have a Future like Ours?," Journal of Philosophy 87 (1990): 264-8.
Noonan, J., "An Almost Absolute Value in History," in The Morality of Abortion, ed. J. Noonan (Cambridge, MA: Harvard University Press, 1970).
Norcross, A., "Killing, Abortion, and Contraception: a Reply to Marquis," Journal of Philosophy 87 (1990): 268-77.
Paske, G., "Abortion and the Neo-natal Right to Life: a Critique of Marquis's Futurist Argument," The Abortion Controversy: A Reader, ed. L. P. Pojman and F. J. Beckwith (Boston: Jones and Bartlett, 1994), pp. 343-53.
Sacred Congregation for the Propagation of the Faith, Declaration on Euthanasia (Vatican City, 1980).
Shirley, E. S., "Marquis' Argument Against Abortion: a Critique," Southwest Philosophy Review II (1995): 79-89.
Singer, P., "Not for Humans Only: the Place of Non humans in Environmental Issues," Ethics and Problems of the 2 I st Century, ed. K. E. Goodpaster and K. M. Sayre (South Bend: Notre Dame University Press, 1979).
Steinbock, B., Life Before Birth: The Moral and Legal Status of Embryos and Fetuses (New York: Oxford University Press, 1992).
Thomson, J. J., "A Defense of Abortion," Philosophy and Public Affairs I (1971): 47-66.
Tooley, M., "Abortion and Infanticide," Philosophy and Public Affairs 2 (1972): 37-65.
Warren, M. A., "On the Moral and Legal Status of Abortion," Monist 57 (1973): 43-61.
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Comparison/Contrast Essays: Two Patterns
First Pattern: Block-by-Block
By Rory H. Osbrink
Abortion is an example of a very controversial issue. The two opposing viewpoints surrounding abortion are like two sides of a coin. On one side, there is the pro-choice activist and on the other is the pro-life activist.
The argument is a balanced one; for every point supporting abortion there is a counter-point condemning abortion. This essay will delineate the controversy in one type of comparison/contrast essay form: the “”Argument versus Argument,”” or, “”Block-by-Block”” format. In this style of writing, first you present all the arguments surrounding one side of the issue, then you present all the arguments surrounding the other side of the issue. You are generally not expected to reach a conclusion, but simply to present the opposing sides of the argument.
Introduction: (the thesis is underlined) Explains the argument
The Abortion Issue: Compare and Contrast Block-by-Block Format
One of the most divisive issues in America is the controversy surrounding abortion. Currently, abortion is legal in America, and many people believe that it should remain legal. These people, pro-choice activists, believe that it is the women’s right to chose whether or not to give birth. However, there are many groups who are lobbying Congress to pass laws that would make abortion illegal. These people are called the pro-life activists.
Abortion is a choice that should be decided by each individual, argues the pro-choice activist. Abortion is not murder since the fetus is not yet fully human, therefore, it is not in defiance against God. Regardless of the reason for the abortion, it should be the woman’s choice because it is her body. While adoption is an option some women chose, many women do not want to suffer the physical and emotional trauma of pregnancy and labor only to give up a child. Therefore, laws should remain in effect that protect a woman’s right to chose.
Abortion is an abomination, argues the pro-life activist. It makes no sense for a woman to murder a human being not even born. The bible says, “”Thou shalt not kill,”” and it does not discriminate between different stages of life. A fetus is the beginning of life. Therefore, abortion is murder, and is in direct defiance of God’s will. Regardless of the mother’s life situation (many women who abort are poor, young, or drug users), the value of a human life cannot be measured. Therefore, laws should be passed to outlaw abortion. After all, there are plenty of couples who are willing to adopt an unwanted child.
If we take away the woman’s right to chose, will we begin limiting her other rights also? Or, if we keep abortion legal, are we devaluing human life? There is no easy answer to these questions. Both sides present strong, logical arguments. Though it is a very personal decision, t he fate of abortion rights will have to be left for the Supreme Court to decide.
Second Pattern: Point-by-Point
This second example is also an essay about abortion. We have used the same information and line of reasoning in this essay, however, this one will be presented in the “”Point-by-Point”” style argument. The Point-by-Point style argument presents both sides of the argument at the same time. First, you would present one point on a specific topic, then you would follow that up with the opposing point on the same topic. Again, you are generally not expected to draw any conclusions, simply to fairly present both sides of the argument.
Introduction: (the thesis is underlined)
Explains the argument
The Abortion Issue: Compare and Contrast Point-by-Point Format
Point One: Pro-life and Pro-choice
Supporters of both pro-life and pro-choice refer to religion as support for their side of the argument. Pro-life supporters claim that abortion is murder, and is therefore against God’s will. However, pro-choice defenders argue that abortion is not murder since the fetus is not yet a fully formed human. Therefore, abortion would not be a defiance against God.
Point Two: Pro-life and Pro-choice
Another main point of the argument is over the woman’s personal rights, versus the rights of the unborn child. Pro-choice activists maintain that regardless of the individual circumstances, women should have the right to chose whether or not to abort. The pregnancy and labor will affect only the woman’s body, therefore it should be the woman’s decision. Pro-life supporters, on the other hand, believe that the unborn child has the right to life, and that abortion unlawfully takes away that right.
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Home — Essay Samples — Social Issues — Abortion Debate — Pro Choice (Abortion)
Argumentative Essays on Pro Choice (abortion)
Pro-choice argument in the debate on abortion.
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Pro-choice Arguments in Support of Abortion
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Pro-life and Pro-choice Abortion: The Rights of The Foetus Vs The Rights of The Woman
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Abortion in The United States: Why I Choose Pro-choice
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A Pro-choice View of The Issue of Abortion
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The pro-choice movement is a collective advocacy effort that upholds the principle of individual autonomy and reproductive rights, asserting that individuals should have the legal freedom to make decisions regarding their own bodies, including the choice to have an abortion.
The pro-choice movement has a rich history that spans several decades, characterized by significant milestones, activism, and legal battles. It emerged as a response to the restrictive abortion laws and societal stigmatization surrounding reproductive choices, aiming to challenge and change the status quo. During the mid-20th century, trailblazers such as Margaret Sanger played a crucial role in advocating for birth control and setting the stage for reproductive rights activism. The pro-choice movement reached a significant milestone with the landmark U.S. Supreme Court case of Roe v. Wade in 1973. This pivotal decision granted women the constitutional right to choose abortion, solidifying the legal foundation upon which the movement was built. However, the pro-choice movement has not been without its challenges. It has faced opposition from anti-abortion groups, prompting pro-choice advocates to organize, mobilize, and form influential organizations like Planned Parenthood and the National Abortion Rights Action League (NARAL). Grassroots activism, public awareness campaigns, and strategic lobbying have been vital in defending and expanding access to abortion services. Throughout its history, the pro-choice movement has also sought to address the societal stigma surrounding abortion. By sharing personal stories, fostering empathy, and promoting open dialogue, activists have aimed to destigmatize abortion and create a more compassionate and understanding society.
A significant portion of the population supports the principles and goals of the pro-choice movement. Many people believe that individuals should have the right to make decisions about their own bodies, including the choice to have an abortion. They argue that access to safe and legal abortion services is essential for reproductive autonomy, gender equality, and the overall well-being of women and marginalized communities. This perspective emphasizes the importance of comprehensive reproductive healthcare and the removal of barriers that restrict access to abortion. At the same time, there are individuals who hold reservations or have moral objections to abortion. Some may believe in the sanctity of life from conception or have religious or cultural values that influence their stance. These individuals may align themselves with the anti-abortion movement and advocate for stricter regulations or the complete prohibition of abortion. Public opinion on the pro-choice movement is also influenced by factors such as education, socioeconomic status, political ideology, and personal experiences. Cultural shifts, increased awareness about reproductive rights, and public discourse have contributed to a greater acceptance and understanding of the pro-choice position in many societies. In recent years, there has been a growing emphasis on intersectionality within the pro-choice movement, recognizing that reproductive justice intersects with other social justice issues, including race, class, and LGBTQ+ rights. This broader perspective aims to address the diverse needs and experiences of individuals seeking reproductive healthcare and advocates for policies that promote equitable access to comprehensive reproductive services.
The topic of the pro-choice movement is crucial as it centers on the fundamental principles of bodily autonomy, reproductive rights, and gender equality. It emphasizes the importance of individuals having the freedom to make decisions about their own bodies, including the choice to have an abortion. The pro-choice movement highlights the significance of safe and legal access to reproductive healthcare, ensuring that individuals have the power to determine their reproductive futures. By advocating for reproductive rights, the movement challenges oppressive structures, fights against stigma, and strives to create a society where individuals are empowered to make informed choices about their reproductive health, free from judgment and coercion.
The topic of the pro-choice movement is worthy of an essay because it encompasses profound social, ethical, and legal dimensions. Exploring this subject provides an opportunity to delve into the complexities surrounding reproductive rights, bodily autonomy, and the ongoing struggle for gender equality. Writing about the pro-choice movement allows for an examination of historical milestones, legal battles, and the impact on individuals and society. Additionally, it prompts critical analysis of the intersections between reproductive justice and other social issues like healthcare access, socioeconomic disparities, and cultural norms. By exploring this topic, one can contribute to the discourse, promote awareness, and foster a deeper understanding of the multifaceted nature of the pro-choice movement.
1. The pro-choice movement extends beyond the United States: While the pro-choice movement gained significant momentum in the United States, its influence is not limited to a single country. 2. Intersectionality plays a crucial role in the pro-choice movement: The pro-choice movement recognizes that reproductive rights intersect with other social justice issues, such as race, class, and LGBTQ+ rights. 3. Access to abortion services remains an ongoing battle: Despite the landmark ruling of Roe v. Wade in the United States, access to abortion services continues to be a contentious issue. Numerous states have implemented restrictive laws, such as mandatory waiting periods, targeted regulation of abortion providers (TRAP) laws, and limitations on insurance coverage. These efforts have led to a patchwork of access across the country, with disparities in availability and barriers for individuals seeking reproductive healthcare.
1. Steinem, G. (2015). My Life on the Road. Random House. 2. Norris, A., Bessett, D., Steinberg, J. R., Kavanaugh, M. L., & De Zordo, S. (2011). Abortion stigma: A reconceptualization of constituents, causes, and consequences. Women's Health Issues, 21(3), S49-S54. 3. McNeil, R. M., & Berer, M. (2017). The abortion law in Northern Ireland: Lessons for the United States. Guttmacher Policy Review, 20, 98-103. 4. Luker, K. (1984). Abortion and the politics of motherhood. University of California Press. 5. Rees, D. I., Sabia, J. J., & Argys, L. M. (2017). A review of the effects of abortion policies. Southern Economic Journal, 83(4), 823-869. 6. Stotland, N. L., & Bryant, A. G. (2020). ACOG practice bulletin No. 225: Management of pregnancies with substance use disorders. Obstetrics & Gynecology, 135(6), e274-e298. 7. Jones, R. K., & Jerman, J. (2017). Population group abortion rates and lifetime incidence of abortion: United States, 2008-2014. American Journal of Public Health, 107(12), 1904-1909. 8. Clark, A. (2017). Reproductive rights and the state: Getting the birth control, RU-486, and morning-after pills and the Gardasil vaccine to the US market. Law and Policy, 39(2), 139-165. 9. Upadhyay, U. D., Weitz, T. A., & Jones, R. K. (2013). Barriers to abortion and their consequences for patients traveling for services: Qualitative findings from two states. Perspectives on Sexual and Reproductive Health, 45(2), 84-91. 10. Roth, R. A. (2003). Making women pay: The hidden costs of fetal rights. Cornell University Press.
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For important issues, we need well-developed reasons or arguments to decide what to believe and do about the issues. Many people say they just “feel” that abortion is wrong or their “opinion” is that it’s not wrong. But complex issues require informed, fair and honest critical thinking, not just mere “feelings” or “opinions,” and we hope this essay has modeled this type of systematic and serious engagement with the arguments and evidence. We hope that readers’ reflective observations about how we have stated and evaluated arguments will help them improve their own skills at engaging arguments on this and other issues, on their own and in discussion with others.
We have focused on disagreements about abortion, but we want to end on an agreement. Everyone agrees there should be fewer abortions. Even people who believe abortions are generally not wrong don’t think that having an abortion is just a great way to spend time and resources. So everyone could agree that we, as a society, should do more to reduce the “demand” for abortions: we could address the many causes that lead women to seek abortions.  Some other countries don’t have as many abortions as the US does. In many cases this is because of deliberate choices they have made to make their countries more supportive of all of their citizens and make it easier for them to meet their economic, medical and familial needs. We too could be Good Samaritans, in these ways and more. This would be very good, not just for this issue but for who we are as people.
 For examples, see this 2012 Washington University Press release “ Access to free birth control reduces abortion rates ” and the Guttmacher Institute’s 2016 “ New Clarity for the U.S. Abortion Debate: A Steep Drop in Unintended Pregnancy Is Driving Recent Abortion Declines ,” and other proposals for what types of efforts would reduce the number of abortions.
Thinking Critically About Abortion Copyright © 2019 by nathannobis and Kristina Grob is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.
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Pros and Cons of Abortion to the Society Argumentative Essay
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If you’re studying the pros and cons of abortion, the essay below will be a great place to start your research.
For a very long time now, the right to abortion has been one of the most controversial topics on the planet, pitying two major sides. On one side, pro-lifers insist that it is immoral and amounts to murdering an innocent child, while pro-abortionists argue that it is just a form of birth control. The latter claim that there is absolutely nothing wrong with it as all children should be born when they are wanted.
The numerous legislations, policies by governments and even hard-line stands by some organizations like the church have made this subject more controversial instead of offering solutions. At one point, one may argue that there would never be a consensus on abortion’s pros and cons in any essay or discussion.
This debate is likely to go on for several years unless the sturdy stands taken by both pro-lifers and pro-abortionists are softened. People have to find ways of accommodating the views of each other regarding the subject. The author will evaluate the issues surrounding the abortion debate. Analyzing the pros and examining the cons of abortion, the essay will seek to find solutions to the conflicting ideas.
There are several arguments that one forward in support of abortion. First of all, any birth of a child should occur when the parents want and not by chance (Potts et al. 229). This way it would go a long way in assisting the world to have an environment where all children that are born in this world have an environment conducive for proper development.
There is no need for inflating the world with many children who cannot have access to basic needs like adequate clothing, food, shelter, and education. It should also be noted that when a person decides to carry out an abortion it is not out of her dislike for children but because she feels that it would not be a wise decision to proceed with the pregnancy as it is still not yet the right time to have a baby (Potts et al. 229).
In the case of rape or incest, keeping a pregnancy is very traumatizing to the person raped as no one would wish to keep a child that is a result of this, and the best solution to this problem would be to abort the unborn child.
For the case of rape, the emotional effects of the occurrence are too traumatizing and take time to heal, and some rape victims do not recover at all. Adding a child to the rape victim is like adding more salt to a wound and would be a constant reminder that is likely to add more emotional trauma to the victim (Khoster 35).
Many studies on the morality or immoralities of abortion have found that some of those against the morality of abortion tend to agree that it is acceptable to abort a pregnancy that is a result of rape.
For instance, the gulp poll carried out in Canada found only 13% of the respondents were against the practice completely while interestingly a whopping 65% were of the view that it is acceptable to abort an unwanted pregnancy in certain conditions like if it is a result of rape (Flanagan 130).
There has also been an unending debate on the exact time that a fetus acquires life and becomes a person with rights and ability to have feelings (Sather 159). Sather further argues that before the 24 th – 28 th week, the fetus has not yet acquired human features and it does not amount to murder if you perform an abortion before this time.
Pro-lifers led by the Catholic Church insist that life begins at conception and anyone who is found guilty of having performed an abortion could be excommunicated from the church because of committing murder (Kohmescher 137). That is not all several studies when life stars in the case of an unborn child have resulted in conflicting dates.
The impending standoff as to, when a person can and cannot have an abortion, have left it possible for anyone to conduct an abortion. It is not clear as to when life begins, and as so long as a woman feels that she cannot have a baby, she has the freedom to do it since it is not yet clear when the life of a person begins.
Sometimes complications can occur to a pregnancy that may put the life of the mother or unborn child in danger and even at times all of them. In this case, abortion ought to be permitted to save the physical health of the mother although some of those advocating for abortion have often argued that the mental health of the mother ought to be included when talking about health (white & Baldwin 113).
At this point, the life of the mother is given first consideration as the fetus cannot survive without the mother, and in any case, the chances are that the mother can always get other children if she wants, but there is no way a fetus can survive on its leave alone getting other parents which is impossible.
Several disadvantages of abortion are argued out by pro-lifers. Most of the books on the subject are mostly in support of the drawbacks of abortion as compared to the advantages. According to Koster abortion is only a temporary and irrational decision that make women feel that they have gotten some relief to an unwanted child against chances of permanent loss of infertility (Koster 304).
She further argues that although removing an unwanted pregnancy may somehow offer relief to the woman the possibility of becoming infertile especially if an unqualified person performed the operation is very significant and once you lose your fertility there is zero chance that you will regain it.
Even when performed by a qualified medical doctor there is a chance that complications may arise like in some medical procedures and if this happens, you could definitely lose your fertility. In fact, interviews conducted on women who had complications when performing an abortion revealed that a majority of them had lost the ability to conceive or hard a miscarriage (Koster 304)
The relief that one feels after procuring an abortion is usually short-lived, and it dies after some time leading to a permanent feeling of guilt and sadness. In fact, in most of the times, this feeling of relief is just a deliberate attempt by the psychology of a person to delete the sense of guilt and shame that creeps in immediately one procures an abortion (Holman 321).
Holman further adds that although most of the legislation and policies concerning abortion allow the practice in the case of schoolgirls the idea that you once killed part of you is not likely to go away and will haunt you forever.
A lot of pro-lifers would equate abortion to murder, and it is therefore morally wrong and should be outlawed. Genovesi defines murder as an intentional act of taking away the life of a human being (Genovesi 340). Fro this he further adds that since the fetus of a person has life, then taking it away will amount to killing it, which is the same as murder.
Of course from this reason arguments are bound to arise as to when the life of a person actually begins. To all Christians led by the Catholic Church, it is completely unacceptable to allow a person to take away another person’s life for whichever reason and at whatever stage in life as it is still murder.
The late Pope John Paul is on record as having condemned the practice and even stating that it would threaten the freedom and dignity of humankind as it promotes a culture of accepting death as a normal thing (Zastrow & Kirst 82)
Procuring an abortion is not the only solution in the event of unwanted pregnancy as the child could also be put to adoption. It is estimated that in all married couples in the United States alone, between 10% -15% of them do not have the ability to have children (Grunlan 217).
This figure is so high that more and more Americans are turning to other countries overseas in order to get children of their own and as Grunlan further adds; this figure has been increasing in the recent years as more mothers turn to abortion as a way of controlling birth.
Furthermore, as Zastrow & Kirst add, in this age where there are so many available contraceptive methods; there should be very minimal unwanted pregnancies that warrant the need to abort a baby who has already been conceived (Zastrow & Kirst 82).
The main concern in the abortion controversy is whether it is morally and ethically right or wrong. Ethics and morality are significantly discussed in unit one of the course.
In unit one, the main issue discussed is how to know what is right and what is wrong. As argued by Aristotle in part of the course, to become ethical he should first reason well and have good character, and total happiness can only be achieved if people are noble.
The abortion debate centers on ethics in that while those who are for abortion argue that it offers a solution to lots of problems that could be brought about by having unwanted children, those against it argue that this relief is only temporary.
Unit three of the course is mainly on how to live a good life as Christians. In this essential part, the unit deals on acceptable Christian virtues and values. One such virtue is having unconditional love towards others. On abortion, it is argued that when one performs an abortion automatically, she does not have love for that child regardless of the conditions.
Moreover, all Christians should preserve human life and have respect for Gods creations, and failure to do so is a sin. People are also supposed to think critically of their actions and be held accountable to these actions, and, as discussed in the unit, they should avoid searching for quick-fix solutions to problems facing them.
The Catholic Church has been the most vocal in speaking against abortion for a long time, and as it stands, there is no chance that this sturdy stand will be reverted. In the book Catholic morality and human sexuality, the author argues that immediately after fertilization, the resulting zygote has human features and should be respected as a human being. Removing it from the uterus amounts to murder (Genovesi 344).
Furthermore, if you reject human life at any point, it is like rejecting God as humans are created in the image of God (Ferrara & Ireland 20). Accepting abortion has been argued by the church as accepting a culture of death and living without Jesus Christ as it amounts t killing an innocent creature of God who has not yet performed any sin.
Even in cases of rape or incest, the church does not permit abortion (Kohmescher 138). In this case, a woman may seek treatment immediately after the incident but not abortion weeks after the incident, and even if the pregnancy is a threat to human life, there should be an attempt to save both lives human lives are sacred and equal before God an none is unique to the other.
As it stands today, it seems the debate on abortion will not come to an end soon. The stands taken by both the pro-abortionists and anti-abortionists are so rigid, and there have not been any attempts to build a consensus.
For instance, the church will certainly not relent on its claim that abortion is murder and therefore a capital sin while pro-abortionists argue that having a child should be a choice. The conflicting policies by different governments regarding the issue have added more controversy to this subject instead of offering guidelines.
There should be efforts to provide a clear policy on this issue that would be acceptable in the whole world through an international body like the United Nations. Apart from that the church and other organizations that are anti-abortion ought to soften their stand in some incidences like rape which are too traumatizing.
Ferrara, Jennifer & Ireland, Patricia. The catholic mystique: fourteen women find fulfillment in the Catholic Church. Huntington: Sunday visitor publishing, 2004. Print.
Flanagan, Thomas . Game theory and Canadian politics . Toronto: University of Toronto Press, 1998. Print.
Genovesi, Vincent. In pursuit of love: Catholic morality and human sexuality . Minnesota: Hutts Publishing, 2002. Print.
Grunlan, Stephen . Marriage and the family . Michigan: Zondervan. 1983. Print.
Holman, Thomas . The family in the new millennium . Westport: Praeger Publishers. 2007. Print liturgical press, 1996. Print.
Khoster, Winnie. Women and abortion in the Yoruba society, Nigeria . Amsterdam: Aksant academic publishers, 2003. Print.
Kohmescher, Matthew. Catholicism today: a survey of Catholic belief and practice the third edition. New Jersey: Paulist Press, 1999. Print.
Potts, Malcolm, Diggory Peter & Peel John . Abortion . Cambridge: Cambridge University Press, 1977. Print.
Sather, Trevor . Pros and cons: a debaters handbook 18 th edition . London: Routledge, 1999. Print.
White, Stuart & Baldwin, Timothy . Legal and ethical aspects of anesthesia, critical care, and preoperative medicine. Cambridge: Cambridge university press, 2004. Print.
Zastrow, Charles & Kirst, Karen. Understanding human behavior and the social environment: 8 th edition. Belmont: Brookscole, 2007. Print.
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