Abortion

[Peter]

Originally Posted by Didymos Thomas

But even using conciousness may be problematic. For example, what is conciousness? Does a fetus ever have it? What I recall from psychology is that conciousness still develops in young children... I wish someone who knew more about fetal development could help us out with this one.

It is certainly true that consciousness is not a simple phenomenon. It is complex, and variable in its complexity. As I mentioned in previous postings, it seems reasonable to assume that the consciousness which is experienced by foetuses is of a simple kind (ie limited to sensory awareness rather than including abstractions and self-consciousness). The search I carried out for information on this proved disappointing since the answers reflected the writers' attitudes towards abortion. Anti-abortionists claim an early onset of awareness while the pro-choice people place it much later, both thus justifying their attitudes to abortion in a circular manner. But it seemed to be accepted by all that the foetus develops consciousness at some point before birth.

Peter

[Aedes]

I do know a fair amount about fetal development, both because I'm a pediatrician and because my wife and I are expecting a baby in about 3 months and we've been learning a lot about it.

But I think that in this debate, it is simply impossible for there to be complete synonymity between 1) ethical views of humanity and human rights, 2) law, and 3) biology.

Are we prepared to make our ideas of humanity hinge upon technology (like amniocentesis and fetal ultrasound), and have interpretation of this technology depend upon scientifically standardized criteria and expert operators? If not, then we CANNOT talk about pain perception, heartbeat, consciousness, etc as criteria for humanity because in any individual case no one knows when they occur unless you look using technology.

Clearly biological human life begins at conception. But that does NOT mean that a conceptus is morally a human being. Why? Because some fertilized eggs develop into hydatidiform moles, some develop into invasive choriocarcinomas, some implant ectopically, etc. And these are things that will NEVER under ANY circumstances develop into a live human -- and in many cases will also kill the mother. So if treating choriocarcinoma with chemotherapy is considered murder simply because this cancer arises from a fertilized egg, then we've got some serious problems in how we define a human.

But it's seldom clear early on that one of these errors has taken place, so even identifying these 'exceptions' requires medical technology. Furthermore, there are more subtle sorts of genetic and developmental error than this, and so the moral distinctions are unclear. I mean, I have ZERO moral problem with aborting an anencephalic baby -- this is a fetus that has no brain due to a neural tube defect, but there are enough brainstem functions for the infant to survive for a few months on a ventilator. I have ZERO moral problem with aborting a baby with Tay Sachs disease, which is fatal in 100% of cases by age 4 or 5. And I'd have no problem aborting a baby with Duchenne's muscular dystrophy, spinal muscular atrophy, or even cystic fibrosis, knowing what I do about these diseases (and also knowing that some people with CF have long and productive lives).

So we get to the point where our ability to identify a healthy fetus also forces us to make decisions about an unhealthy fetus -- and unless you're going to throw up your hands and call it God's will that some children suffer horribly for a 4 year long miserable life, then you're also going to have to weigh the moral implications of abortion versus the moral implications of not aborting in some cases.

Thus, this decision in the end is almost always utilitarian -- not moral (and certainly not some weird marriage between morality and biology). Furthermore, we never know when conception occurs except in retrospect after pregnancy has been identified (this is excepting in vitro fertilization), the use of conception as a morally significant moment has no practical utility at all.

Thus, abortion laws must be compromises, and moral humanity must be different than biological humanity.

[Tainted]

Im inclined to agree with you, not just because I respect your opinion as a paediatrician, but because I can relate. A few years ago I had a chemical pregnancy...so conception occurred but there was no implantation. I have also lost a baby at 32 weeks...he had a lot of growth problems and the whole pregnancy was dogged with speculation as to whether he would survive, until nature made the decision that he was just not meant for this world.

Im still unsure of my feelings on abortion....i'm pro-choice but not sure Its something I could do...though I have never been faced with having to make that choice so its hard to say. I do know that it wouldn't feel right, to me, to terminate over 10-12 weeks, but why I feel that way....i'm not entirely sure.

[Peter]

Congratulations on your family news, Aedes. Please pass on my best wishes to your wife.

Originally Posted by Aedes

Thus, this decision in the end is almost always utilitarian -- not moral (and certainly not some weird marriage between morality and biology).

The trouble with this statement is that, as I argue earlier in this thread, every utilitarian decision is taken on the basis of some value, such as "avoiding suffering." Sometimes, it is true, the individual is not conscious of the value or principle on which he is acting, especially if his attention is concentrated on the process of taking practical action; but it is always possible to infer a person's values from the actions he takes.

I'm with you in the view that early abortion requires little justification and that later abortion is also justified when it is necessary to avoid particularly debilitating conditions. This seems to be the consensus view and it can easily be justified on utilitarian grounds (given the basic value of minimising suffering). Later abortions can be justified on the basis that the process of abortion involves less pain than a post-natal life of suffering; the early abortions are justified partly on the grounds that the conceptus or early foetus is not conscious at all and therefore incapable of any suffering.

My own moral values lead me to the position that I would not like to be party to inflicting pain on a late foetus, which we assume to have some form of consciousness, unless this is justified by the avoidance of greater post natal suffering. My problem is that in order to make this stand consistently, it would be helpful to have some insight into the gestational stage at which awareness of pain emerges. I appreciate the points you make about the difficulty in determining when this stage occurs, but that does not negate the importance of establishing it.

Peter

[Aedes]

Originally Posted by Peter

Congratulations on your family news, Aedes. Please pass on my best wishes to your wife.

Thanks, Peter, much appreciated.

My problem is that in order to make this stand consistently, it would be helpful to have some insight into the gestational stage at which awareness of pain emerges. I appreciate the points you make about the difficulty in determining when this stage occurs, but that does not negate the importance of establishing it.

If abortion could be performed painlessly would that make this issue disappear for you? Say in the course of a routine abortion an obstetrician could catheterize the umbilical vessels (which can technically be done) and instill high enough doses of narcotic pain meds that the fetus would feel no pain at all. Then what issues would remain for you?

I don't recall where nociception (pure pain sensation) begins in fetal life, but it's relatively early. The thing is there is so little cortical development at that time that it's unclear what that pain really means. Its perception by the brain changes as development occurs.

[Peter]

Originally Posted by Aedes

If abortion could be performed painlessly would that make this issue disappear for you? Say in the course of a routine abortion an obstetrician could catheterize the umbilical vessels (which can technically be done) and instill high enough doses of narcotic pain meds that the fetus would feel no pain at all. Then what issues would remain for you?

Anaesthetising the foetus would certainly meet one of my objections to late abortion. I would advocate that this should be done routinely since I do not believe that we should inflict pain needlessly on sentient creatures. What would be the reaction, do you think, if women undergoing late abortions were routinely asked, "Do you wish anaesthesia to be administered to avoid the possibility of the foetus experiencing pain during the abortion process?" Would anyone ever say No to this question? The trouble is that the question of foetal suffering is never raised, but once it is raised the answer is obvious and compelling.

It is easy to see why the issue of foetal pain is never considered. Once you have decided to abort a foetus you have already decided to treat it as an object to be disposed of, a mere thing whose interests count for nothing. The thought of foetal suffering would undermine this abortion mindset; therefore the ego defence mechanism of denial is brought into play to ensure that the subject is never raised.

Foetal anaesthesia would certainly meet one of my objections to late abortion but would leave untouched another, more fundamental objection - the question of at what stage the foetus should be thought of as having and independent right to life. My own position is that women should have complete freedom to abort at the early stages of pregnancy when the foetus is not a separate entity, has no independent rights and is not conscious. At the later stages, however, abortion should be permitted only in comparatively rare cases such as the debilitating medical conditions you mentioned, or following rape.

The question is where should the line be drawn. Even the most liberal pro-abortionist accepts some upper limit. Traditionally this has been placed at the point of foetal viability but this is variable dependant on the degree of advancement of medical techniques. Most countries have reduced the upper time limit in recent years as medical procedures have improved, and it does seem unsatisfactory to place our definition of the beginning of separate human life on the accidental fact of how effective our medical services happen to be at any given time. The purpose of this thread is to pose the question of whether the emergence of foetal consciousness can provide a dividing point on which the onset of the separate right to life can be rationally based.

Originally Posted by Aedes

I don't recall where nociception (pure pain sensation) begins in fetal life, but it's relatively early. The thing is there is so little cortical development at that time that it's unclear what that pain really means. Its perception by the brain changes as development occurs.

This brings us to the crux of the question of when pain sensitivity begins. Those (anti-abortion) writers who proclaim an early date for the emergence of pain sensitivity are referring to nociception only. The pro-abortion writers who insist on a late start-date are linking it to activity in the cortex. The question of the role of the higher brain centers in the subjective experience of pain is crucial to identifying a gestational stage for the onset of pain awareness.

Peter

[Aedes]

People who talk about abortion a lot, especially those who concentrate on pain, seem not to have spent much time in a neonatal intensive care unit. I've spent many months of my life working in neonatal intensive care units -- 1 month as a student, 4 months as a resident, and I've been consulting in NICUs as a subspecialist ever since.

Believe me that the pain that extremely premature babies go through just to sustain their possible survival is VASTLY greater than what any baby goes through in the course of an abortion. Imagine weeks on a ventilator, multiple needlesticks daily, painful medication infusions, having to get a spinal tap nearly every time there is a fever, and all kinds of medical complications. All to preserve possible survival, and in the case of extremely premature and low birth weight infants, the majority of them are neurologically handicapped and some of them blind. We also do heroic surgeries on neonates to repair hypoplastic left heart syndrome and gastroschisis and all kinds of congenital abnormalities, and these surgeries in themselves are extremely painful and complicated, and often infants become habituated to pain medications as a result.

We tolerate a LOT of pain among premature infants who have been born -- and this is justified by the desired outcome of a healthy, live child in the end. There is sedation and analgesia, but it's clearly insufficient -- especially in infants who are not on ventilators and they cannot be completely sedated (without needing to put them back on the ventilator).

So I guess in this case a huge amount of pain is ethically perfectly fine given the desired outcome (whether or not its achieved). Or maybe it's acceptable until we come up with better strategies for dealing with it, but no one proposes a moratorium on neonatal intensive care pending those better strategies. And it's hard enough to actually tell when these infants are in pain -- if their heart rate goes up is that equivalent to pain? Maybe, maybe not -- maybe things other than pain cause the heart rate to go up if you're doing a painful procedure on a 24 weeker, maybe pain medications bring down the heart rate not through analgesia but through direct effects on the autonomic nervous system and consciousness (probably partially true).

But you'll now argue that the possible momentary pain felt during an abortion (however great it is in that moment) is not ok by comparison?

Look, I'm all for relieving pain whenever possible. But this is a fairly clear case of the means being justified by the end, and it's a double standard if a month of pain is ok for a 23 weeker in a NICU but a minute of pain is not ok for a 23 weeker being aborted. I'd like to see all those who crusade against abortion because of pain go into children's hospitals around the country and crusade against real pain.

[krazy kaju]

Pain begins when the nervous system develops, which is at the beginning of the third trimester.

However, if you use pain as a measure of moral personhood, you might as well become a vegan.

[Peter]

Originally Posted by Aedes

the pain that extremely premature babies go through just to sustain their possible survival is VASTLY greater than what any baby goes through in the course of an abortion.

Thanks for supplying these details. The general picture you paint of neonatal care is not new to me but it is useful to have these helpful details from a first-hand observer.

Originally Posted by Aedes

So I guess in this case a huge amount of pain is ethically perfectly fine given the desired outcome.

But you'll now argue that the possible momentary pain felt during an abortion (however great it is in that moment) is not ok by comparison?

Sorry, Aedes, I have never argued for aggressive intervention in the case of marginally viable babies. You are criticising me for a position that I do not hold and have never proposed.

Originally Posted by Aedes

I'd like to see all those who crusade against abortion because of pain go into children's hospitals around the country and crusade against real pain.

Do I take it that you are suggesting that I "crusade against abortion"? A reading of my last posting will reveal that I am in favour of abortion on demand at the early stages and in special cases later in pregnancy. If this counts as crusading against abortion then the word "crusade" has acquired a somewhat elastic definition!

It is surprising that you should attribute, and criticise me for views which I do not hold and have never promoted. Perhaps you would acknowledge that I have never advocated aggressive interventions for marginally viable babies and that I have not crusaded against abortion?

Peter

[Aedes]

Originally Posted by krazy kaju

Pain begins when the nervous system develops, which is at the beginning of the third trimester.

The nervous system begins developing within a few days of conception with the formation of ectoderm. The neural plate forms around day 18, and the neural tube has closed by day 28. The nervous system finishes developing the day you die as an adult. There is nothing sacred about the third trimester.

Originally Posted by Peter

It is surprising that you should attribute, and criticise me for views which I do not hold and have never promoted.

That would be surprising. Fortunately, I didn't do that. I wasn't talking about you, Peter in any part of that post. You've presented issues that inspired a lot of interesting discussion. Just because I've built upon it doesn't mean I'm throwing you into the center of it. Don't take it personally, I was only talking about the issue and not assuming a thing about you. I only even used the word 'you' once, late in the post, and it was directed at the expected counterargument, not at you personally.