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Is Abortion Ever Justified?

A moral examination of the "life of the mother" exception.

Page Summary:

If continued pregnancy threatens the life of the mother, and there is no way to save the child, an ethical case can be made for the justifiability of abortion—whether you want to call it abortion or not.

Of all the circumstantial variables you can attach to the abortion question, none is more ethically challenging than when the life of the mother is threatened by continued pregnancy. Before sorting through the ethics of the matter, we would do well to first lay out some context:

As an overarching principle, when the life of the mother is threatened by continued pregnancy, everything possible should be done to save both the mother and the child. During the second half of pregnancy, the pregnancy can be ended prematurely by inducing labor and using aggressive neonatal care to sustain the life of the child outside the womb.

When pregnancy endangers the life of the mother during the first half of pregnancy, the most ethical course of action is much harder to pinpoint. Here's the tension. The fundamental reason that abortion is condemnable is because it kills an innocent human being. What do you do, then, when the existence of one human being, through no fault of their own, threatens the life of another human being? Do you end the life of the child, to save the life of the mother? This is the dilemma we face. Philosophically, we might justify the decision to abort a life-threatening pregnancy this way:

A) If the pregnancy continues, the mother will die. If the mother dies, the child will die.

B) If the pregnancy is ended through abortion, the child will die, but the mother will live.

In both instances the child will die. Since there is no way to save the child, but there is a way to save the mother, it is morally expedient (even necessary, perhaps) to save the mother by ending the life of the child—on the premise that is better to save one life, than to lose two. This conclusion has nothing to do with valuing one life over the other. It merely recognizes that since there is no way to save the baby, the most ethical course of action is to save the mother.

Though such thinking may be ethically sound as it applies to the hypothetical conditions above, real-world circumstances are never so cut and dry. Quite simply, statement A is flawed. We can say with certainty that if the mother dies, the child will die, but we can never say with certainty that if the pregnancy continues, the mother will die. In order to be accurate, the beginning of Statement A would need to be re-rendered as such:

A) If the pregnancy continues, the mother might die...

There is a huge difference between "will" and "might," and this is where it gets sticky. Does the morality of aborting a life-threatening pregnancy depend on the severity of the threat to the mother? Is it a matter of percentages and probability? In the United States, the overall, pregnancy-related mortality rate is .0151% (15.1 deaths per 100,000 live births), this according to data published by the Centers for Disease Control (CDC) in 2012.4 In other words, for every pregnancy-related death, there are 6,622 live births. Pregnancy, by its very nature, carries the risk of death. It is generally an infinitesimally small risk, but a risk nonetheless. Is a .0151% risk to the life of the mother severe enough to morally justify abortion? What if the risk to her life were 1%, or 10%, or 50%? What if there was a 90% chance the mother would die? Is that enough of a threat to justify abortion?

At this point, we would do well to get as specific as we can. What are the real-world, first-trimester scenarios in which continued pregnancy poses a legitimate threat to the mother's life? Really, there is only one: ectopic pregnancy, a condition that occurs when the embryo implants in the fallopian tubes (or in the ovary, abdomen, or cervix) instead of in the uterus. It has been generally reported and generally believed that an ectopic pregnancy is always fatal to the child and, if left untreated, often fatal to the mother. For instance, WebMD says this of an ectopic pregnancy:

There is no way to save an ectopic pregnancy. It cannot turn into a normal pregnancy. If the egg keeps growing in the fallopian tube, it can damage or burst the tube and cause heavy bleeding that could be deadly. If you have an ectopic pregnancy, you will need quick treatment to end it before it causes dangerous problems.5

The first problem with the statement on the WebMD site is that there have been a handful of documented cases where undiagnosed ectopic pregnancies have yielded successful live births. Such cases are exceedingly rare, but they do exist. In 1999, a healthy baby boy was delivered in London after having implanted in his mother's fallopian tube. When the tube ruptured, the embryo attached itself to the mother's uterus and spent the rest of the pregnancy in the mother's abdominal cavity. The doctor who delivered the baby estimated that an embryo has a one in 60 million chance of surviving an ectopic pregnancy. In 2000, a healthy baby girl was delivered in Nottingham (UK) despite the fact that she spent the duration of her ectopic pregnancy attached to the lining of her mother's bowels. In 2005, a woman in Hertfordshire (UK) gave birth to a healthy baby girl who spent the entire pregnancy in her mother's abdomen. In 2008, an ovary-based, ectopic pregnancy delivered a healthy baby girl in northern Australia.

Percentages are hard to come by, but the BBC News piece on one of the successful deliveries listed above reports that the baby had a 5% chance of survival, while there was a 10% chance that the mother would die.6 A 2003 Canadian Broadcasting story on the successful delivery of an ectopic pregnancy in Canada quotes Dr. Robert Sabbah as saying that the baby only had about a 1% chance of survival.7 Without question, the odds of survival for ectopic babies are extremely slim, but it has happened. The question then becomes: How severe a threat does an ectopic pregnancy actually pose to the mother, and is it reasonable to suggest she put her life on the line, when there is such a painfully small chance that her baby will survive? A report on ectopic pregnancy published by the American Academy of Family Physicians (AAFP) tells us a number of things:8

1) Ectopic pregnancy occurs at an estimated rate of 19.7 cases per 1,000 pregnancies in North America. Though this rate was arrived at by analyzing data from 1990–1992, a 2012 CDC report cites that it is still the most reliable in existence.9

2) In the United States, the case-fatality rate has declined from 35.5 maternal deaths per 10,000 ectopic pregnancies in 1970 to only 3.8 maternal deaths per 10,000 ectopic pregnancies in 1989. Using different metrics, the CDC reports that between 2003–2007, there were 0.5 maternal deaths related to ectopic pregnancy for every 100,000 live births.10

3) To date, at least 14 studies have documented that 68 to 77 percent of ectopic pregnancies resolve without intervention.

The first thing to note is that a significant majority of ectopic pregnancies are never treated, somewhere between 68–77%. In most of these cases, the embryo miscarries without medical intervention, and the pregnancy ends without further incident. If we split the difference between between 68% and 77%, we get 72.5%. Using the AAFP estimate that there are 3.8 maternal deaths per every 10,000 ectopic pregnancies, and assuming that all of the deaths occurred to women who received no medical intervention, we can say that there are 3.8 deaths for every 7,250 (10,000 x 72.5%) untreated ectopic pregnancies—putting the likelihood of maternal death at just .05%.

Another way to look at the data would be to compare tubal ruptures with total deaths. Medscape reports that in 1992, there were 108,800 cases of ectopic pregnancy in the United States, with a maternal death rate of 2.6 deaths per 10,000 ectopic pregnancies.11 This is consistent with what the CDC reportis in Pregnancy-Related Mortality Surveillance. Between 1991–1999, 237 women died as a result of complications associated with ectopic pregnancy—an average of 26 deaths per year.12 Returning to the Medscape report, we find that in 20% of all ectopic pregnancies, tubal rupture is the initial symptom.13 In other words, these women were not aware that their pregnancy was ectopic until their fallopian tube ruptured. Since tubal rupture, and subsequent hemorrhaging, is the primary threat that an ectopic pregnancy poses to the life of the mother, let's conservatively assume that all maternal deaths relating to ectopic pregnancy happened as a result of an untreated, tubal rupture. If that is the case, we can divide the total number of deaths (26) by the total number of untreated tubal ruptures (108,800 x 20% = 21,760) to arrive at an overall maternal death rate for untreated ectopic pregnancy of .119%. Placing this number alongside the AAFP estimates, we arrive at a fatality rate for untreated ectopic pregnancy somewhere between .05–.119%.

In light of this data, it becomes clear that even an untreated ectopic pregnancy is not generally fatal. Nevertheless, the risks of continuing an ectopic pregnancy are real, and the baby's chance of survival are almost nonexistent. The American Association of Pro-Life Obstetricians & Gynecologists (AAPLOG) goes so far as to say, "Continuation of [an ectopic] pregnancy cannot result in the survival of a baby and entails a very substantial risk of maternal death or disability."14 Though they're not being totally honest in asserting that it is "impossible" for a baby to survive an ectopic pregnancy, you get the point. The prospects for survival are not good. AAPLOG also notes that by the time an ectopic pregnancy is discovered (usually by 7 to 8 weeks gestation), "the embryo has (already) died in the majority of cases."15 This may simplify the ethics of medical intervention, but even when the embryo is still alive, AAPLOG unequivocally recommends removing the embryo by medical or surgical intervention. The process is always fatal to the embryo, and though such treatment bears procedural similarities to abortion, it must viewed through an entirely different lense. The death of the embryo or fetus is the sole purpose of an elective abortion. It is the undesired and unavoidable result of surgically or medically treating an ectopic pregnancy. For these reasons, AAPLOG "does not consider treatment of ectopic pregnancy by standard surgical or medical procedures to be the moral equivalent of elective abortion, or to be the wrongful taking of human life."16 

Some anti-abortion groups argue that the removal of the fallopian tube is the only ethical way to treat ectopic pregnancy, but this approach does far more damage to the mother's body and still results in the death of the baby.

This page was last updated on March 15, 2013. To cite this page in a research paper, visit: "Citing Abort73 as a Source."

    Footnotes

  1. C. Everett Koop, “Why Defend Partial-Birth Abortion?” The New York Times, Sep 26, 1996.
  2. C. Everett Koop, “Abortion: Deception-on-Demand,” Moody Monthly, May 1980, 24.
  3. Alan F. Guttmacher, “Abortion–Yesterday, Today and Tomorrow,”The Case for Legalized Abortion Now (Berkeley, Calif.: Diablo Press, 1967).
  4. Centers for Disease Control and Prevention, “Pregnancy-related Mortality in the United States,” Mar 28, 2012.
  5. WebMD, “Ectopic Pregnancy - Topic Overview,” May 21, 2009.
  6. BBC News, “Bowel Baby Born Safely,” Mar 9, 2000.
  7. CBC News, “Rare Baby Survives Outside Womb: Montreal Doctor,”  Aug 12, 2003.
  8. American Academy of Family Physicians (AAFP), “Ectopic Pregnancy,” Feb 2000.
  9. Centers for Disease Control and Prevention, “Ectopic Pregnancy Mortality — Florida, 2009–2010,” Feb 17, 2012, Editorial Note.
  10. Ibid.
  11. Vicken P Sepilian, MD, MSc, “Ectopic Pregnancy,” Medscape. Aug 2, 2012, Overview.
  12. Centers for Disease Control and Prevention, “Pregnancy-Related Mortality Surveillance—- United States, 1991—1999,” Feb 4, 2003.
  13. Vicken P Sepilian, MD, MSc, “Ectopic Pregnancy,” Medscape. Aug 2, 2012, Presemtatopm.
  14. American Association of Pro-Life Obstetricians & Gynecologists, “What is AAPLOG’s Position on Treatment of Ectopic Pregnancy?” July 2010.
  15. Ibid.
  16. Ibid.
  17.  

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19 Comments on Is Abortion Ever Justified?

.(JavaScript must be enabled to view this email address) (Jun 17, 2011 / 08:43 CST)

Moral Questions Never Involve Numbers:

The secular humanist utilitarian philosophy, of John Stuart Mills calls for “doing the greatest good for the greatest number.” The moral relativism of utilitarianism contrasts with the simple biblical command to “obey God” (Acts 5:29), which never requires solving multiple simultaneous equations to determine right from wrong. God does not ask us to calculate arithmetically the number of possible future positive or negative responses to our actions. Those following Christ would never submit to the criminal who says, “shoot this one in the head and we’ll spare those,” nor would they support funding the killing of some children to defund the killing of others. Instead of requiring advanced math skills, God refers to entire nations as “children,” and gives men commands that even a child could understand. “Do not steal.” “Do not bear false witness.” “Do not kill the innocent.” And don’t “do evil that good may come of it.” The pro-life movement initially was motivated by Christ but it has become an industry after having been hijacked by lawyers, politicians, and fundraisers. Now, the remnant of the ministry has reappeared within the growing personhood movement, the simplicity of which has become a litmus test showing whether a leader actually advocates enforcement of the right to life of the unborn child!...

more at http://americanrtl.org/exceptions

.(JavaScript must be enabled to view this email address) (Jun 17, 2011 / 08:38 CST)

This is a fantastic site!!!

However, please consider the following perspective from AMERICAN Right to Life on the “life of the mother” exception:

Exception for Life:
A Personhood amendment has no exceptions, so what if a pregnancy threatens the life of the mother? The doctor’s goal should be to save mom and the baby if possible. The goal should never be to kill the mother to save the baby, nor to kill the child to save the mother. In an ectopic pregnancy for example, we save mom and the baby tragically dies. But our goal should always be, if possible, to save the baby also. Society’s attempt to justify killing unborn children leads to absurdities like the exception for the life of the mother in the partial-birth abortion ban. In reality, if the mother’s life is threatened by her pregnancy, her doctor would deliver the baby as soon as possible, and never stop midway to kill the baby. The PBA ban itself has no authority to save a single child because the abortionist can simply use a variation of PBA or some other late-term technique. However, the very idea of delaying the saving of a mom in order to stop midway to kill the baby is such an obvious cruelty and deception that it exposes the hard-heartedness of those who argue for such exceptions. Abortion is always wrong, without exception, and should be abolished.

mandarinnetwork (Oct 08, 2010 / 20:49 CST)

In China where I live, Family planning has been put forward for many years. It rules that in one family only one child can be borned and unplanned pregnancy will be forced to abort. I think it’s cruel.

Abortion is often happening in China now. Chinese people are triditional, and they do not want to have a baby before marriage. I think it is terrible.

But if the pregnancy influent the health, I think abortion is accepted.

http://www.mandarinnetwork.com

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