Thursday, January 25, 2007

Do No Harm (Except for That Killing Thing) [Serge]

Note: The following entry was deleted when Scott accidentally blew up the blog on Dec. 22 (shame on him). It's being reposted here so we can link to it in future posts.

Frequently, abortion choice activists are arguing for a woman's right to abort her child based on the principle of bodily autonomy. That is, they claim that even if the fetus is a human being, she has no right to use the biology of another human being for their survival. The most famous example is Judith Jarvis Thomson's argument about the violinist, recently updated and defended by Eileen McDonaugh and David Boonin. A poster at the blog Ourword states this thesis succinctly:
At the cornerstone of western philosophy, morality, and jurisprudence is the concept of individual sovereignty. It is the notion that free individuals have the fundamental right to self determination, the right to go about their lives and choose their courses of action without interference...

Inherent to individual sovereignty is the recognition that an individual has domain over their own body. A corrollary to the principle that "your right to swing your arms ends at the tip of my nose" is the concept of consent. Your arms can only have contact with the tip of my nose if I give my consent. An individual is not required to give up any part of their body without consent. Thus, your right to life ends at the moment you require the use of my kidney to live. I may choose to donate my kidney, or the temporary use of it, to you but the law cannot require me to do so. No individual has a greater right to my own body than me. At the moment you have a greater right over my body than I do, I am enslaved.

Thus, even conceding for the sake of argument that life begins at conception, the right to life only begins at the moment an individual can survive without the biology of another sovereign individual. While i can donate my blood and organs for the use of another, they cannot be taken from me, or used by another, without my consent. To insist otherwise is to deny my sovereignty...

Those who would deny a woman the right to terminate a pregnancy deny that woman's sovereign right to control her own body.
The issue of bodily sovereignty is a very important one and something I deal with every single day of my practice. It is the basis for informed consent. Before anyone allows a surgeon to cut into their body, they must be informed of the risks and give their permission for the procedure. If a surgeon performs on operation without consent it is considered assault.

Conceding that this is a very important right, the question is whether or not a mother's obligation to her offspring in any way infringes on her right for bodily sovereignty. After the child is born, there is no question that the mother's obligation to her child is such that she either provides for the child herself or she has the responsibility to give the child up to someone who is willing to care for the child. A mother who lets her child starve to death because she refuses to feed or to seek help for her child is clearly considered responsible for the child's death.

In the case of pregnancy, however, the mother does not have an opportunity to give the child up to anyone else. The child is completely dependent on her. For this reason, pro abortion choicers argue that she has the right to kill the child since she is the only one that can be responsible to provide nutrition, oxygen, and a safe environment for that child. Since she is unwilling to perform those functions that occur within the confines of her body, and no one else is able to do it for her, it is OK to kill the child on the basis that she has the right to control her own body. Anything other than the right to have an abortion for any reason wrongly impinges on her bodily sovereignty.

This argument may be compelling if and only if we recognize that a woman's right to control her own body is so absolute that carrying another human being inside of her has absolutely no bearing on that right. In other words, pregnant mothers have the absolute right to do whatever they want with their bodies regardless of what it does to the child they are carrying.

It is easy to demonstrate that that last paragraph is clearly false. In fact, the story that I detailed in my first post here is evidence to that fact. Would I be wrong to give a pregnant woman a medication with known teratogenic effects? What if she insisted that I do just that? What if she refused to consider local anesthetic or general anesthesia in the hospital for the procedure, and insisted that I sedate her right away in my office? The safest time to perform surgery on a pregnant Mom is the second trimester - what if a patient did wish to wait until that time to have an elective procedure performed? A physician has the responsibility to take into account the health of the fetus in determining the care for a pregnant woman. We have no obligation to treat the pregnant Mom in a way that can harm her offspring, even if she insists that we do.

Let me offer another example. Lets say a woman has intractable nausea and vomiting, and insists on taking thalidomide to help her symptoms. After having explained the horrific risks of birth defects that have arisen due to this medication, she still insists on taking it based on the fact that the fetus has no right to her body anyway. After being refused thalidomide from her physician, she aquires some and takes it, resulting in her child developing no arms. Do we believe that she did anything wrong? Would we excuse her actions based on her right to bodily autonomy? The fetus after all is an uninvited guest, and has no right even to life let alone an environment free from pathogens.

What about a pregnant patient who wishes to continue her Accutane therapy for her acne? Speaking of reproductive rights, the government actually insists that a woman of child-bearing age use two forms of contraception if she is sexually active before taking that medication. Before she fills the prescription, she must verify the type of contraception she is on via the internet or telephone. I have yet to hear anyone question this as an invasion of her right to control her own body.

In each of the above examples the mother is seeking a medication that does not harm her, has a beneficial effect that she desires, and yet she has no recognized right to be given them because of her bodily autonomy. The only reason these medications are denied to a pregnant mother who may be seeking them is the effect on her fetus. The pregnant mother's right to autonomy is easily recognized not to be absolute in the cases in which she chooses an action that could harm her child. We simply recognize in these scenarios that not every choice that a pregnant Mom makes is a right choice, and have taken steps to protect unborn children from these decisions. What our society recognizes is that in the case of pregnancy, there is a special relationship that exists between a mother and her offspring. Her right to bodily autonomy, albeit very important, does not supercede her responsibility to her child.

Lastly, these scenarios create a very strange situation for physicians. With our current system there is one glaring example to the general rule that the health of the fetus needs to be taken into consideration. That, of course, is elective abortion. Although no OB-GYN would ever consider prescribing accutane or thalidomide because it may harm a human being, they can and do prescibe RU-486, which actually kills a human being. In the above examples, the doctor could (and some would argue should) give the mothers the advice that they could kill their offspring, and then continue whatever medical treatment they would otherwise desire.

When I treat a mother that is pregnant, I often state to them that I have two patients to worry about now, not just one. If I knowingly recommended using a medication that would potentially cause harm to the "second patient" - I would be guilty of malpractice and would have performed a very unethical act. However, if I recommend that she kill the second patient, I am a great defender of women's rights. What a strange world we live in.


  1. That one blows me away: cannot harm but OK to kill... Great post!

  2. Apparently, killing is not the same as harm in the minds of people. We DO live in a strange world.

  3. If anyone finds a way to kill someone without harming them, I will be impressed.


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