Abortion

Abortion

Abortion is the termination of a pregnancy before the time of extrauterine viability. An abortion terminates the life of the embryo (the fertilized egg before three months of growth) or the fetus (after three months). Spontaneous abortions, also called miscarriages, occur when the fetus or embryo is spontaneously expelled by the body. An induced abortion occurs when there is deliberate human intervention to end the pregnancy. Induced abortions can be accomplished medically or surgically.

Medically induced abortions are accomplished by giving drugs like mifepristone (RU-486), which block the work of the hormone progesterone and soften the lining of the uterus, thus ending the pregnancy. Medically induced abortions can generally only be used if the woman is less than seven weeks from her last menstrual period. Mifepristone is administered in conjunction with another medicine called misoprostol, which causes the uterus to cramp and expel the embryo.

Within the first trimester of pregnancy, the most common form of surgical abortion is vacuum aspiration. During the second trimester, dilation and evacuation procedures (D & E) are performed. Finally, stimulating contractions that expel the fetus from the uterus can also induce abortion.

Ethical issues

Abortion raises significant scientific, legal, religious, and ethical issues: the understanding of life and death, the definition of a human person, the rights of the mother and the fetus, and the impact of new scientific discoveries on reproduction. Certain scientific and technological discoveries, including stem cell research, cloning, and artificial reproduction, have complicated the abortion issue. The status of the fetus is probably the most controversial issue: Is the fetus a person with the same rights as those who are born? Some argue that the embryo from the moment of conception has the same rights as a person extra utero. Others argue that the early embryo is human life but not a human person. The political state also has an interest both in the autonomy of the mother and the health of the baby. Sometimes, the autonomy of the mother can be in tension with her maternal responsibility to the fetus.

With the increased use of fertility drugs and assisted reproductive technologies, many patients can conceive who were unable to conceive in the past. Some of these technologies may result in high order multiple pregnancies (with four or more fetuses), which have a substantial risk of the loss of all fetuses before the period of extra-uterine viability (twenty-two to twenty-four weeks gestation). The parents' options include carrying all of the fetuses until birth, eliminating all of them, or selectively terminating some fetuses. Selective reduction may enhance the chance of survival of some fetuses in a high order multiple pregnancy.

Discovery, diagnosis, prevention, and therapy of certain genetic or medical diseases complicate decisions surrounding abortion. Parents can now determine when the fetus is in-utero whether it carries possible genetic predispositions to diseases like cystic fibrosis, Huntington's chorea, early Alzheimer's, and sickle cell anemia. Prenatal testing also allows detection of chromosomal abnormalities, such as Down syndrome. Ultrasound, now widely used during pregnancy, can document a wide variety of birth defects. Although some of these problems may be treatable in-utero, in most cases no therapy is available, and the parents must decide whether to continue the pregnancy. In addition, some maternal medical conditions, such as pulmonary hypertension, may pose a significant threat to the mother's life if pregnancy continues.

Physicians, parents, and insurance companies face difficult decisions about abortion. The human and economic costs of caring for children with medical or genetic disorders can be great. Opponents of abortions that are performed to address these problems raise the concern that the weak and vulnerable in society will have no rights. There is potential for discrimination based on genetic information.

Religious views

Religious views on abortion are pluriform, ranging from those who consider abortion as murder to those who justify it as a necessary means to an end. The spectrum of diversity can be found not only among world religious traditions, but also within religious traditions. The discussion focuses primarily on the status and rights of the fetus, the status and rights of the mother, the role of medical technology, the value of life (quantity and quality), the political and socioeconomic concerns surrounding fertility and infertility, and the nature of what it means to make difficult ethical decisions in a community of faith.

Judaism, Islam, and Christianity are related monotheistic religions that use religious texts, human reason, and teaching authorities for making ethical decisions. Within and among these three traditions, there are deep and potentially divisive views on abortion. For example, some religious scholars believe that God creates all life. According to this view, the embryo is a human person endowed with rights from the moment of conception. To reject this life is to reject the creation of God. Abortion is considered a sin against life along with murder, genocide, and self-destruction, and any destruction of an embryo would be considered sin, even when done in response to prenatal diagnosis of genetic disease.

In contrast, some scholars of religion, including Daniel Maguire, explain that abortion may be permissible for many reasons. Maguire points out in Sacred Choices (2001) that there is only one direct reference in scripture to accidental abortion—Exodus 21:22, which states that someone who injures a woman and causes her to miscarry must pay a fine paid to her husband. If the woman dies from her injuries, however, the punishment for the person who injured her is death. Clearly, in this text, the fetus is not considered a person with the same status as the woman, and abortion would be permitted for some reasons, such as preventing extreme fetal abnormalities and saving the life of the mother.

Judaism. Some Jewish scholars, such as Laurie Zoloth, connect reproduction to justice. Judaism takes into account the good of the entire community in making decisions about abortion. This approach derives from Judaism's root commitment that every human being is a child of God, born in the image of God. Reproduction is undertaken not merely for its own sake, but for the sake of the community. Abortion is thus permitted for the woman to avoid disgrace or for health reasons of both mother and fetus. In some Jewish traditions, the first forty days of conception are considered like "water" and the fetus does not have an ontological status of a person.

Islam. The approach from Islam concerning abortion and contraception has generally been one that considers the common good of the community. Muslims see themselves as vice regents of God, called to do God's work in this world. Islam's ethical practices are flexible and are often adapted to political and social climates. As Gamal Serour points out in The Future of Human Reproduction (1998), for Muslims abortion can be "carried out to protect the mother's health or life or to prevent the birth of a seriously handicapped child" (p. 196).

Christianity. Within the Christian tradition, perspectives on abortion vary dramatically. For example, within Roman Catholicism different scholars draw different conclusions about permitting abortion. Many consider the official Catholic position on abortion to derive from the 1930 encyclical Casti Connubii (On Christian Marriage) of Pope Pius XI and the 1987 Donum Vitae (Gift of Life) of Pope John Paul II. On the issue of genetic screening for selective abortion, Donum Vitae states thatPage 3  |  Top of Article "a woman would be committing a gravely illicit act if she were to request such a diagnosis with the deliberate intention of having an abortion should the results confirm the existence of a malformation or abnormality." Furthermore, humans cannot assume the role of God when using embryos in research from IVF (in vitro fertilization). Donum Vitae states that the researcher "sets himself up as the master of the destiny of others inasmuch as he arbitrarily chooses whom he will allow to live and whom he will send to death and kills defenseless human beings." However, Maguire and others have pointed out that papal statements on abortion are not considered infallible and explain that abortion would be permitted for some reasons.

Protestant denominations vary on their stance on abortion. Within Protestantism, decisions about abortion are not made by a central teaching magisterium but within a community of shared discernment. Denominations such as the Evangelical Lutheran Church in American and the United Church of Christ do not take an official stand on the status of the fetus. Both the fetus and the mother are taken into account when confronting decisions concerning abortion. Other Protestant teachings are more consistent with Roman Catholicism and consider abortion a sin. In some cases, exceptions are made for the life of the mother.

Asian religions. According to Maguire, Asian religions like Daoism and Confucianism have understood abortion as a necessity in some cases and have extended compassion to those involved. These nontheistic religions emphasize the family and community as the primary social unit, and decisions about abortion are made within this social context. Buddhism considers all life as linked and interdependent, and most Buddhists believe in reincarnation and understand that life begins at conception. These beliefs could preclude abortion at any stage, but many Buddhists permit abortion, particularly for the sake of the mother. Intention is central to Buddhist morality and so the action of abortion must also include the intentions of the moral actors.

Bibliography

ACOG-American College of Obstetricians and Gynecologists. "Medical Management of Abortion." ACOG Practice Bulletin 26 (2001):1-13.

Congregation for the Doctrine of the Faith. Donum Vitae: Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation: Replies to Certain Questions of the Day. Washington, D.C.: United States Catholic Conference, 1987. In Intervention and Reflection: Basic Issues in Medical Ethics, 6th edition, ed. Ronald Munson. Belmont, Calif.: Wadsworth, 2000.

Evangelical Lutheran Church in America. "A Social Statement on Abortion." Adopted at the second biennial Churchwide Assembly of the Evangelical Lutheran Church in America, Orlando, Fla., Aug 28–Sept 4, 1991.

Maguire, Daniel. Sacred Choices: The Right to Contraception and Abortion in Ten World Religions. Minneapolis, Minn.: Fortress Press, 2001.

Paul, Maureen, ed. A Clinician's Guide to Medical and Surgical Abortion. New York: Churchill Livingstone, 1999.

Peters, Ted. "In Search of the Perfect Child: Genetic Testing and Selective Abortion." Christian Century 113, no. 31 (1996): 1034–1037.

Pope Pius XI. "Casti Connubii: Encyclical On Christian Marriage," December 31, 1930. Available from:

Rispler-Chaim, Vardit. "The Right Not To Be Born: Abortion of the Disadvantaged Fetus in Contemporary Fatwas." The Muslim World 89, no. 2 (1999): 130–143.

Rogers, Therisa. "The Islamic Ethics of Abortion in the Traditional Islamic Sources." The Muslim World 89, no. 2 (1999): 122–129.

Serour, Gamal I. "Reproductive Choice: A Muslim Perspective." In The Future of Human Reproduction, eds. John Harris and Soren Holm. Oxford: Clarendon Press, 1998.

Zoloth, Laurie. "The Ethics of the Eight Day: Jewish Bioethics and Research on Human Embryonic Stem

Cells." In The Human Embryonic Stem Cell Debate: Science, Ethics and Public Policy, eds. Suzanne Holland, Karen Lebacqz, and Laurie Zoloth. Cambridge, Mass. and London: The MIT Press, 2001.

Ann Pederson

William J. Watson

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