Saturday, February 2, 2019

Are Late-Term Abortions Ever Medically Indicated? [Clinton Wilcox]

The state of New York recently passed a law that establishes the wording of Roe in its own state laws so that if Roe/Casey are ever overturned, abortion will remain legal up until the point of birth for any reason deemed relevant to the woman's life or health. I'll write more on this bill in the future, but right now I want to address some arguments that are going around on-line because pro-life and pro-choice advocates are really talking past each other here.

Pro-life advocates, including pro-life OB/GYNs such as Dr. Omar L. Hamada, are arguing that abortion is never medically indicated in the late-term. Pro-choice advocates disagree, including one Buzzfeed blogger who has linked to several tweets from Dr. Jennifer Gunter, who asserts that these pro-life OB/GYNs are lying about late-term abortions never being medically indicated. (As an aside, don't read Buzzfeed. Just don't.)

The most succinct definition of "medically indicated" I could find is this one: "[T]o make a treatment or procedure advisable because of a particular condition or circumstance." So basically, if a particular condition or circumstance would warrant a late-term abortion, then it is medically indicated, whether or not any other treatments might be available or also advisable.

Now, before I jump in to interact with Dr. Gunter's tweets, I want to explain the difference between types of disagreements one might have. This is information I teach to my intro to logic students but it's something that most people you see interacting on-line haven't had the benefit of. It's one of the reasons it's so difficult to have rational conversations with others. My reason for doing this is because both sides are arguing something about medically indicated procedures. Pro-life OB/GYNs assert that late-term abortion is never medically indicated and pro-choice OB/GYNs assert that it is in rare cases. The problem is that both sides are using a different definition of "medically indicated". Because pro-life people believe that human embryos and fetuses are persons, then late-term abortion is never medically indicated because once the fetus can survive outside the womb, you can simply deliver the fetus alive and work as best you can to save it. C-sections are a lot faster than late-term abortions and are also, in many cases, safer for the mother because you are able to get the fetus out relatively quickly. However, pro-choice doctors either don't believe fetuses are persons or they believe that a woman's right to bodily autonomy outweighs the fetus' right to life. So to a pro-choice doctor, abortion is medically indicated because there is nothing morally wrong with ending the life of the fetus for what they deem to be a sufficiently strong medical reason.

So the three terms I'd like to introduce here are real disagreement, apparent disagreement, and verbal disagreement.

A real disagreement is an actual inconsistency between two statements. The statements "The Dodgers won the 1981 World Series" and "The Yankees won the 1981 World Series" are statements in actual disagreement. It is not possible for both statements to be true, although it is possible for both statements to be false (perhaps I am misremembering and it was two different teams that went to the World Series in 1981). So they are not contradictory, but they are inconsistent. And since there is an actual fact of the matter, all it takes to resolve this inconsistency is to Google it or find a sports almanac somewhere.

An apparent disagreement results from a difference in opinion or perception. So if someone makes the statement "Fifty degrees Fahrenheit is hot" and someone else makes the statement "Fifty degrees Fahrenheit is cold", these statements could actually both be true. Not because language is relative, but because terms sometimes are. Someone who is from Mojave, California might make the first claim, and someone who is from Anchorage, Alaska might make the second claim, because of the temperatures they've gotten used to in their respective locations.

A verbal disagreement is a disagreement that occurs when different meanings are used for the same term. So if someone looks at a pine tree and says, "that tree is really tall", and someone else kind of scoffs and says, "it's not actually very tall at all," this, again, is not a real disagreement. It's a verbal disagreement. If we consider that the word "tall" is somewhat vague, and that the first statement might be made by a child in fifth grade and the second statement is made by someone who is used to seeing towering redwood trees, then we realize that there is really no disagreement here. The word "tall" is being used in two different ways by both speakers.

So based on these three types of disagreements, it should be obvious that what is going on here is a verbal disagreement regarding the term "medically indicated". Because pro-life doctors have taken abortion off the table, they do not consider it medically indicated. And because pro-choice doctors have put abortion on the table as a viable medical procedure, they consider it medically indicated. Accusing the other side of lying isn't helpful, and it certainly isn't a result of critical thinking.

Now with that out of the way, let's look at the tweets from Dr. Gunter.

Doctor Gunter, unfortunately, seems to be a pretty extreme pro-choice advocate, unwilling to reasonably engage with those she disagrees with. As such, she starts her second tweet by asserting that pro-life doctors who disagree with her are lying. Of course, lying is not the only thing that might be going on here. As I have shown, what's really going on here is a difference in understanding of what procedures are medically indicated. I don't think Doctor Gunter is lying, and I don't think the pro-life doctors she's responding to are lying. But this is no way to make your disagreement known.

And while it is true that late-term abortions are much more rare than early-term abortions, the fact of the matter is that they are not just situations with fetal abnormalities or situations in which the woman's life or health is in jeopardy. As Secular Pro-Life recorded, according to research done by Guttmacher Institute, which is Planned Parenthood's research organization, most late-term abortions are not done for medical reasons. The most common reasons for late-term abortion are having a baby would dramatically change her life, she can't afford a child now, and having relationship problems or doesn't want to be a single mother. Many late-term abortions are done for the same reasons as early-term abortions, just later for reasons such as she didn't know she was pregnant or had difficulty procuring an abortion earlier.

The rest of her tweets outline situations in which abortion is medically indicated. Now, of course, that doesn't mean an abortion is necessary to resolve the situation. But abortion would be legally permissible in those cases. Taking a look through them will be instructive, not because they actually prove her case, but because they actually do show just how flimsy the "health" exception is regarding when a woman can procure a late-term abortion.

Here's an example Dr. Gunter gives of a girl who was raped by her brother and couldn't get an abortion because her parents wouldn't consent. This is a situation in which it wasn't because of a fetal abnormality or because of a risk to the mother's life. It was because she was raped. A tragic situation, to be sure, but this abortion was done because the fetus was conceived in rape, not because the pregnancy posed a risk to her life.

Here are two different situations, one focusing on the pregnant woman and the other focusing on the fetus. According to Mayo Clinic, preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to other organ systems. If left untreated, this complication can be fatal for the woman and the child. The most effective treatment if the child is viable is delivery of the baby.

According to Healthline, the term "triploid" refers to the cells of the fetus, rather than the fetus, herself. A triploid fetus has one extra set of chromosomes in its cells. A haploid cell has one set of chromosomes, 23 -- sperm and ovum cells are haploid. A diploid cell has two sets of chromosomes, 46 -- typical cells are diploid cells, and once the sperm and ovum cells fuse together creating a zygote, this zygote consists of a diploid cell which soon starts to divide as the embryo grows. A triploid cell has three sets of chromosomes, 69, and this results in this condition. Triploidy occurs when the embryo inherits two sets of chromosomes from a parent, rather than just one from each parent. Fetuses with this condition rarely survive until birth, and those that do usually last only a short time afterward.

So here we have two different conditions, one threatening the life of the mother and one threatening the life of the child. In both cases, the pregnant woman chose abortion over c-section. Now, Dr. Gunter will likely say these conditions were medically indicated, but again, that's because abortion was on the table. If abortion is immoral because it kills an innocent human child, then it can't be medically indicated. So if pro-life physicians are correct, then these conditions would not indicate abortion. The condition of preeclampsia would indicate a c-section to save the mother's life, whether or not she would prefer to have an abortion. And the condition of triploidy would indicate that the child be born normally, since no one has the right to decide for anyone else whether or not their life is worth living.

In fact, these situations also count as a counterexample to a common pro-choice talking point. Pro-choice people often talk about how no one wants to abort a late-term fetus because these were wanted pregnancies, so late-term abortions are not done frivolously. But these conditions here show that even though these were late-term fetuses, the mothers preferred to kill the child than to undergo a c-section. That's not a loving act from someone who could never kill her own child because of the lateness of the pregnancy, especially since in the case of preeclampsia, according to Mayo Clinic, c-section is the most effective treatment.

Here we have a situation with an anencephalic fetus, which is a fetus where most of the brain has failed to develop. In this case, the pregnant mother asked to induce delivery early because she couldn't take people touching her belly or asking about the baby. She was allowed to deliver early because of this.

These situations show just how pernicious the "health" exception is for abortion restrictions. They're so broad that there are really no legitimate restrictions on abortion in the United States. A woman was allowed to have a late-term abortion because she was distraught over people asking her about the pregnancy and touching her belly. Another girl was allowed to have a late-term abortion because she had been raped. Another was allowed an abortion because she didn't want to deliver her child via c-section. It is obscene that these situations are considered medically indicated, but they also show that pro-life doctors are on firm ground when they say that a woman never needs an abortion in the late-term.

In fact, here is an article written by a pro-life doctor which outlines several situations in which a doctor might prescribe abortion, but after giving these women more information they opted not to abort. These doctors seemed more interested in not being held liable for continuing the pregnancy than in actually saving the life of the unborn patient. On top of that, the author outlines two reasons that doctors prefer to refer for abortion rather than provide needed information to protect the life of the unborn child: "the transference of an ambivalent attitude toward the developing human" and "the unbalanced legal burden of informed consent".

It takes three days for a late-term abortion because the doctor has to forcibly dilate the cervix. A c-section takes roughly 45 minutes. It's faster and it's safer for the mother. An abortion is never necessary in the late-term, and if it is indeed medically indicated, the medical field is in error.