Facets of Medicine (9)


By William Wetherall

Unpublished article intended for publication in
Kokutai, 17(1), January 1996

You are pregnant. Or your wife, girl friend, sister, mother, friend, or patient is pregnant. You, or they, don't want the child.

Problem: Would you seek, permit, advise, or perform an abortion? Question: What would be your biological, medical, philosophical, or religious reasons for approval or disapproval?

Medically, an abortion is the termination of pregnancy by surgery, drugs, or other means, including physical and even psychological abuse. Pregnancy begins with conception, which usually takes place in a uterus when a spermatozoon penetrates an ovum. Conception usually results from heterosexual intercourse, but it may also be brought about by artificial insemination using the sperm of any male, including a third-party donor.

An ovum may also be fertilized by a spermatozoon in vitro. The embryo that develops from an in vitro fertilized ovum may be implanted into the uterus of any woman, whether the woman who donated the ovum, or a woman who loans her uterus to an infertile couple that wants a child. This "surrogate" mother could be anyone, even the child's grandmother. Many infertile couples are resorting to these and other advanced medical procedures in order to have their own (or at least partly their own) child, regardless of the child's sex. Some fertile couples, who have no difficulty conceiving but desire a child of a specific sex, are using abortion to end pregnancies involving an unwanted sex.

Biologically, abortion is also the interruption of a complex life process that begins before conception and continues after delivery. All prerequisites of conception are also part of this life process. For example, production of the male and female gametes, by fertile males and females; delivery of an ovum to the uterus by the female; and delivery of sperm to the ovum by the male in intercourse with the female.

Interruption of these prerequisites to conception prevent conception. Female birth control pills prevent production and delivery of ova. Condoms and diaphragms prevent delivery of sperm. Spermacides kill spermatozoa, which are mobile living organisms.

So when does human life begin? With the production of the male and female gametes? With the union of the two gametes into the zygote? With the cleavage of the zygote into the embryo? A few weeks after conception, when the embryo begins to be called a fetus?

The fetus, though, has practically no chance of surviving outside the womb until it is twenty-odd weeks old. So does its life as a human begin only when it becomes sufficiently developed that, prematurely born or delivered, at a hospital with state-of-the-art incubators and other life-support facilities, it has a chance of surviving?

Or does the fetus become a human being only after it has cleared the birth canal and been cut from the mother's placenta. After it has begun to breathe its own air, take its nourishment orally, and eliminate its own wastes? The abortion debate is usually described as having two factions: the "pro-choice" camp, which favors abortion by stressing the "right to choose" of the woman who conceived the fetus; and the "pro-life" camp, which emphasizes the "right to life" of the fetus.

Arguments against abortion vary widely. Some opponents stress, in a very religious vein, that birth and death are God's provinces. Humans are not to violate these holy territories with their technology. Some naturalists take essentially the same position by replacing "God" with "Nature". That is, humans should not tamper with nature.

While abortion is usually resorted to as a means of birth control, birth control is not itself a form of abortion. Some anti-abortionists, however, also object to mechanical, pharmaceutical, and surgical methods of birth control, as intervening in divine or natural processes.

Some people oppose any practice of birth control, because they view family planning itself as being anti-life and anti-family. They believe that the purpose of sex is procreation, and that procreation is the purpose of life. They also regard the family as being the venue for life procreated by sex; the more children, the bigger the family, and the better is life. Some reject even the rhythm method, because it promotes abstinence in the name of wanting sex but not children.

Supporters of abortion are divided into two polar camps. On one extreme are those who advocate the supremacy of a woman's rights over any rights that may be ascribed to an embryo or fetus. At the other pole are proponents of family rights who consider abortion a means of maximizing the survivability of the family. This situation is sort of like an anti-Ampo demonstration: rightists and leftists alike want U.S. Forces out of Japan, but for very different reasons.

The "individual rights" faction consider abortion a means of giving a woman complete control over her own body and life. A woman who knows that she can have an abortion on demand is freer to engage is sex without fear that she may be burdened with an unwanted child.

Most advocates of a woman's right to an abortion also argue that surgical abortion, because they entail a certain physical risk, should be used only as a backup means of birth control. They argue that safe, reliable, inexpensive birth control pills should be made available to any woman who wants them. Feminist pro-choicers would add that men should share the side-effect risk, however small, by taking pills designed for them.

Pro-choicers are divided over the implications of easily-available birth control pills for woman. Some argue that total freedom from fear of pregnancy, whether before marriage, or inside or outside of marriage, would result in a breakdown of traditional sexual and family bonds. Others counter that sexual mores--the instilling of judgment and self-control in matters of sex--is another issue that should be left to families and schools.

But not all pro-choicers defend abortion in terms of individual rights. Indeed, a growing number of people take the conservative "pro-family" stance that abortion is a means of keeping family size down to an economically manageable number of children.

In the past, before the technological and industrial revolutions that brought us the "miracles" of medical science, families needed to produce large numbers of children, in order to guarantee that enough children would survive the high mortality rates to provide the labor necessary for the family to survive. Big families were the norm.

My maternal great grandmother died shortly after giving birth to her ninth child, a son. My maternal grandmother raised her youngest brother as her own son. She already had two daughters of her own, including my mother, who did not learn until she was much older that her younger brother was really her uncle. But to her he was always her brother, and so I learned to call my great uncle simply uncle.

In most societies today, large families are often the most impoverished. What family wealth there is must be shared ten or fifteen ways instead of four or five ways. The pro-family case for abortion is that it gives families a means to control family size, to provide more economic resources and educational opportunities for its children.

Enter the problem of teen pregnancy. Your high-school daughter conceives a child. Should she drop out of school and start a family? Or should she receive an abortion, finish school, and pursue a career?

Another choice would be to bear the child, but put it up for adoption and then finish school. Yet another option would be to keep the child, and then go on welfare, since the job market for uneducated unmarried mothers will be worse than for even educated single woman.