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.

LTI Q & A #2: Abortion is Self-Defense [Jay Watts]

I recently received this question via e-mail and decided to share my response on the blog. Here is the original message:

Hi,

I recently engaged in an online discussion where one of the commenters said, "I actually think a fetus is at least becoming human, although it hasn't quite gotten there yet, but I support abortion as self-defense. Any thing that threatens a woman's life, happiness, health, finances, and general well-being is something she can choose to defend herself against.  I am wondering how you would respond to this objection/argument.  Thank you all for what you're doing!  I've learned a lot from Mr. K and others!

Response:

This is a tough argument, but not because the substance of the claims are particularly sophisticated. The problem is the arguer is confused about what they are arguing and this commonly leads to confusion in the audience. This is something that we really need to look out for, because in the world of on-line arguing (a world I try hard to avoid) failure to respond immediately is understood as an indication that a comment has some intellectual force.

Here is a good way to begin. Let's ask ourselves questions. How is this person justifying abortion? Why do they think it is a good thing or minimally a necessary thing?

This commenter thinks that abortion is justified as self-defense. This justification is generally a form of the principle of double effect. Defending oneself from an unjustified or unprovoked attack is a good action. If you defend yourself intending to defend yourself and an intrinsically valuable human being dies as a result – because they were attacking you and your defense required killing them – then the act of causing the death of the attacker is justified because you did not intend to do evil. Your intention was to stop or limit evil and the death was a result of the good intentions. The killing was not the purpose of the action. You meant to save yourself and your attacker got killed in the process.

But this is weird. Self defense is a justification. The commenter begins by saying that they believe that the unborn aren't human yet. So if the unborn are not human then why justify your actions toward them at all. Killing non-human life doesn't appear to be the kind of action that requires a system of justification intended to provide moral reasons for killing an attacker. If the unborn are not human then no need for this extra step. The justification is that they are not human in the same way that you and I are and that's that.

Let's give our arguer the benefit of the doubt, though. They actually believe that the unborn are human beings and appeal to self-defense. This argument sounds reasonable enough because it appeals to a commonly held intuition. If a person intended to do me harm or intruded into my house then many people agree I am justified in taking action to protect myself that may end in the death of the aggressor.

But the commenter applies standards that might not be so obviously true by intuition, right? Life? Absolutely. Happiness? So would she be justified in killing a boyfriend in the process of breaking up with her? Do we permit lethal action when our happiness is threatened? If so there some people who talk in movies that are in for a surprise the next time I go to a theater. Health? To what degree? Some lady pushing a whooping cough little kid in the grocery store is threatening my health. The coughing and feverish fellow on MARTA who went to the Falcon's game when he should have stayed home with the flu is threatening the health of us all. Do we condone lethal action in those cases? Flu can be fatal, so this is not trivial. In the last 30 years 3,000 to 52,000 people in the United States die from flu every year with more recent averages being in the 25,000 to 36,000 range. Are inconsiderate people fighting through their symptoms to expose us all a threat we can terminate? Finances? So the guy that is better at my job than me threatens my financial security and I want to rid myself of this threat. Kill him or no? The two year old that got sick at the wrong time threatens the finances of the single mother and her two older children. Kill her? If not, why not? General well being? That is so vague as to mean anything inconvenient. The power of the argument is that most people accept the principle already, but the application here is so broad as to put anyone a woman encounters on any given day at risk of being killed as an aggressor.

Let's look at the traditional self defense model. Is the unborn analogous to a dangerous aggressor? Is it trying to hurt the mother? No. The mother's body and the unborn are working in concert to create a safe environment for the nascent human life to develop and receive nourishment. Most pregnancies do not represent an immediate threat to women. The properly working reproductive system is working in accordance with it's purpose and not being invaded by a parasite or foreign pathogen. Unlike the home invader, the unborn is exactly where it is supposed to be given the predictable and understood developmental process that all human life goes through. Except in the cases of rape, the unborn is not only where it is supposed to be but is there as a direct result of the actions of the woman. This seems wildly different in nature than the kind of aggressor that we accept can be killed by our common intuitions.

So how would I handle this commenter? I would point out that they seem to be confusing their arguments. If they think the unborn aren't human in morally important ways then they need to argue why that is. If they think that women are justified in taking morally important life because that life is analogous to a dangerous aggressor then they need to defend two points: (1) their insanely broad concept of behaviors that justify killing human life and (2) how a life that is exactly where it ought to be in a natural physical relationship that is not - under normal circumstances – dangerous or threatening is comparable to home invaders, assaulters, and attempted murderers.

Hope that helps.

More Answers to Silly Pro-Abortion Choice Questions [Serge]

Continuing:

5. Should fertilized eggs and embryos get social security numbers? What benefits should they be entitled to?

Social security numbers are assigned in order to gain some form of benefit for a child. The only benefit that the prenatal human being is looking for is not to be intentionally killed in their mother's womb. Therefore, the answer is no.

6. What responsibilities and legal consequences should pregnant women face? Should Child Protective Services be able to step in if a pregnant woman does something that could potentially damage the fetus — like eat tuna or drink coffee or exercise heavily? What if a woman isn’t pregnant, but makes her body inhospitable to a fertilized egg — say, for example, that she uses birth control, which thins the uterine lining and makes it difficult for a fertilized egg to implant? What if she’s anorexic? Some anorexics may be able to ovulate, but may not be able to sustain a pregnancy, or even have enough nutrients to allow for implantation. Can such a woman be prosecuted or otherwise punished for creating an environment that was deadly for an egg-child? What if a pregnant woman had a miscarriage, and it could be linked to some behavior — going skiing or flying or not eating properly? We already prosecute pregnant women when they use drugs during their pregnancies. If a pregnant woman otherwise does harm to her fetus, should she be prosecuted for child abuse? Neglect? If she miscarries, can she be tried for homicide?

These laws would remain exactly as they are now, except that they would be more consistent. With the obvious exception of legal abortion, we already treat wanted prenatal humans as valuable. We should continue to strive to provide everything that a pregnant mother needs to support her child.

For example, I just performed surgery under IV sedation for a number of young women. If one of them was pregnant, and I gave a medication that would harm their child (such as thalidomide or accutane), I would be held liable for the damage done to the child. If I did so intentionally, I would be help criminally liable for the death of the child. Likewise, men who give their female partners medications in order to cause an abortion are criminally liable for their actions.

The lone exception to this is legal abortion. I cannot give a medication that could harm a prenatal human, but with the mother's consent, a doctor can give a medication that would intentionally kill the same child. This is grossly inconsistent, and would be rectified. As far as the mother goes, any action which did not intend to end the life of her offspring would be of no significance.

7. I’ve asked this one before, but I rarely get a straight answer: If a woman intentionally terminates a pregnancy in a pro-life nation, how much time should she do? If a fetus is a person and a woman intentionally terminates the life of that fetus, should she go to jail? Be up for the death penalty? In almost any other circumstance, a person who intentionally kills another person — or who pays someone to do the killing for them — is prosecuted. Why should women who terminate pregnancies be exceptions? And if women who terminate pregnancies should be excepted because they just don’t know better, should the same hold true for women who intentionally kill their born children? For women who intentionally kill strangers?

I'm surprised that you have not gotten a straight answer, considering that NRO had an entire symposium on this very topic. I have previously answered this question here, but if you do not wish to read the whole thing, I'll even provide a quote:

Second, there is another reason why laws against abortion may be merciful to the mother. Although the number of illegal abortions that occur would probably be less than our pro-abortion choice opponents claim, it seems clear that some would occur. In that case there is a significant chance that women who received an illegal abortion would be at risk for serious medical complications. These complications would be best treated as quickly as possible in almost every case. If the law would mandate serious punishment for women who have illegal abortions, there would be a great disincentive to seeking medical care for any complication. It is reasonable to argue that the care of those who have made the poor decision to kill their child is paramount. Also, it is reasonable to hold the physician who caused these complications to a higher standard and to hold them primarily responsible for the injury.

Knowing that illegal abortions may occur, and that women would be harmed if they did not seek medical care for them, I believe it is best not to provide a disincentive for care by threatening prosecution. Is there anything wrong with this?

8. If a fetus is entitled to use a woman’s body to sustain its own life, should we begin researching other ways for humans to share bodily functions? It could save lives, after all. If, say, my kidneys fail and there is a way that you and I can be physically attached for about a year, can I can use your body to clean out my own? Sure, it will mean that you will be less physically mobile, it’ll require you to take time off of work, it will significantly alter your health, and getting me off of you when I’m ready will require you to go through a long and expensive process which re-defines the meaning of pain, but if a fetus has those rights, why don’t I?

You can read my article in the Christian Research Journal regarding this question.

I'll get to 9-12 when I have a chance.

Dont Image that Baby! (Unless you Plan On Killing Her) [Serge]

I have a confession. I really try to treat our opponents arguments with respect and to take them seriously. I think that is very important, but in this case I don't think I'll be able to. Sometimes arguments are so bad and poorly thought out that I question whether the author of them actually believes them to be true. In this case, I can only assume that these authors merely needed to make some form of argument about the presence of ultrasounds in pregnancy resource centers, and thus came up with any argument they could think of, without thinking it through or believing it at all. I can come up with no better explanation for this horrendous thinking. You may read the entire article if you wish to, but I can obliterate their points merely from the summary.

Ultrasound - an important medical diagnostic technology - is increasingly being used as a propaganda tool in the abortion wars. Crisis pregnancy centers are investing heavily in this serious medical technology in order to influence women who are considering an abortion.

Let's see if we can understand this. An accurate, true, high definition image of a mother's fetus is a "propaganda tool" that influences unsuspecting women into making a choice for life. I guess a woman who is considering an abortion - an important decision regardless of your stance on the issue, can't be trusted with the truth about the state of their offspring. Isn't the concept of INFORMED consent based on the woman having the most accurate information possible prior to her making the decision? Suppose it is better if we kept them in the dark so that their "choice" can be more, well, consistent with the pro-abortion choice crowd. I'm sure they can't handle the truth.

Funny thing is that I must also be guilty of propaganda. Our office has invested tens of thousands of dollars in order to have the most accurate images of the hard tissues of the head and neck. I also show these images to every patient that I perform surgery on. I must be guilty of using my influence as a physician to propagandize my patients to give them the same view of wisdom teeth that I have. Maybe I should show them no images at all - or maybe blurry ones as to allow them to make a propaganda free decision? This is utterly ridiculous.

But actually not as bad as the next two.

However, there is research indicating that ultrasounds can cause harm, both because of the nature of the ultrasound imaging technology and the faulty operation of equipment or interpretation of results.

There are two equally bad points here. The first is that ultrasounds can possibly cause harm to a fetus, and thus should not be used. In truth, there is no evidence that an ultrasound causes harm to a fetus or a mother. However, regardless of that lies the obvious - the fact that ultrasound is used to stage a pregnancy prior to an abortion. In other words, the author argues that it is OK to ultrasound a fetus in order to assist in its dismemberment, but not OK if you wish to have the fetus live. "We are very concerned about all of the children that could be harmed by this technology - except those that we kill with the aid of this technology". Amazing.

The second argument is that by taking ultrasounds the equipment could malfunction or be misread thus resulting in a missed diagnosis. As someone who looks at images all day, this is true. It is possible to miss something on an ultrasound or misread the results. However, their solution to this problem is a very unique one. In order to avoid a possible mis diagnosis from an ultrasound image - one should not be taken! We can just leave the woman in the dark - then no misdiagnosis is possible! Brilliant!

I can try to apply this thinking to my practice. Let's see how it works:

Patient: I have a painless ulcer in my mouth

Serge: There is a possibility it could be cancer. Normally I would recommend a biopsy, but every biopsy carries a risk of missing the diagnosis, so I don't want to do that. We wouldn't want to misdiagnose you.

Patient: Can you at least take an x-ray?

Serge: Although I usually take an image to rule out bony invasion, there is a chance I may miss something. If I don't take an x-ray there is no chance I'll misread it.

Patient: I have these nodules in my neck, do you think it could be related?

Serge: It could mean lymph node involvement, but I'm not going to examine you there in case I miss one. You just can't be too sure.

Patient: Am I in Canada?

Sorry for the cheap shot at the Canadian health care system, but I hope you get my point. Fear of mis diagnosis is not reason to avoid imaging.

I can't take these arguments seriously, and yet they are featured on the RH reality blog. They can't be serious.