Insufficient Data

On the 31st of May this year, George Tiller was shot dead. He was the medical director of an abortion clinic, one of only three clinics in the USA that publicised their willingness to provide so-called “late-term” abortions, and he was murdered by an anti-abortion activist.

Those who approve of abortion have hailed Dr Tiller as a martyr to their cause. Those who disapprove of abortion have been placed in the difficult position of condemning Dr Tiller’s murder while also condemning his actions. They seem to be saying something like, “Killing Dr Tiller was wrong but he deserved it.”

Dr Tiller provided late-term abortions, which means that he aborted foetuses after the 21st week of pregnancy. The “limit of viability”, the gestational age at which an infant has at least a 50% chance of survival, is approximately 24 weeks given modern neonatal intensive care. However, such a premature baby would be very likely to develop neurological disorders. Neonatal clinicians are unlikely to provide intensive care for infants born as early as 23 weeks but would almost certainly provide such care for infants born at 26 weeks or later. Dr Tiller was well known for providing very late-term abortions: in a speech to the National Abortion Federation in 1995, Dr Tiller said, “We have some experience with late terminations: about 10,000 patients between 24 and 36 weeks and something like 800 fetal anomalies between 26 and 36 weeks in the past 5 years.” It was his willingness to perform such late abortions that made him such a target for hate, over and above other abortion providers.

Some who disapprove of abortion equate it with murder. However, this equivalence is not as obvious as they suggest. Before we can equate abortion with murder, we must show that abortion involves the killing of a person. Those that approve of abortion claim that it does not involve such a killing, instead they say that it is the prevention of the creation or development of a person, which is not the same thing at all. The difficulty comes from the impossibility of logically distinguishing between the two options.

For example, imagine that you have a female friend who is dating a man that you strongly dislike. You don’t think that this relationship is good for her, so you persuade her to dump him. If you hadn’t done that, perhaps she would have gone on to have children with that man. Your actions may have prevented the birth of a child. The morality of your meddling in your friend’s relationship is arguable itself, but I do not think any reasonable person would accuse you of murder.

Let us go further. Imagine you are a surgeon in the service of a state that enforces a programme of eugenics (such as, say, Virginia in the 1920s or Sweden in the 1930s). A woman is diagnosed as mentally deficient and brought to you for sterilisation. You perform the procedure. Most people today would have some strong qualms about the morality of enforced eugenics. However, no reasonable person would equate sterilisation with murder.

Let us go further still. How about the use of condoms? The Roman Catholic church has condemned condoms ever since their invention, which was a cause of great anguish to the Roman Catholic that invented them. However, even those who ardently oppose the use of condoms usually (although not always) stop short of calling such use murder.

Then there is emergency contraception, also known as the “morning after pill”. Emergency contraception prevents ovulation or fertilisation. Some people equate this with abortion. This is a mistake, no embryo is terminated, but clearly we are on less stable ground than we were a couple of paragraphs ago.

Beyond contraception, we reach abortion. But the continuum does not stop here. Within abortion there are many grades, as the embryo develops into a foetus, and the foetus continues to develop into a human child. Exactly how one divides up the stages of pregnancy is to some extent arbitrary. However, most people appear to distinguish between very early abortion, when the baby is still only an embryo, and very late abortion, when it is a foetus indistinguishable from a baby living outside the womb.

As we progress along the chain of causation, getting closer and closer to the point at which a human is born, fewer and fewer people are willing to countenance deliberately breaking that chain.

We can move along the chain in the other direction as well. If someone were to deliberately kill a healthy baby the day after it is born, we would not hesitate to call that murder. What if it were the day of the birth itself? What if the baby were still partially in the birth canal when it was killed? That would still clearly be murder. What if it were killed the day before it was born? Or a week before? Or a month?

I think I am safe in saying that nearly everyone draws the line somewhere in between murder after the baby has been born and the use of condoms. But in between those two extremes there is a great variation in the exact point that different people choose.

Nobody would call meddling in a relationship murder but many people call abortion murder. Some people think all abortion is murder, some only late-term abortion. Some think condom use is murder, some think even late-term abortion is acceptable. We have a chain of causation and different people consider it acceptable to break that chain at different points.

Personally, I am quite comfortable as far as contraception, including the morning after pill. The benefits of contraception are so great, especially when we consider the role condoms play in the prevention of disease, and the probability that we are doing harm to a potential person is so small, that it seems clear to me that contraception is a moral good.

As soon as we get as far as abortion, I begin to get uncomfortable. I think I can tolerate early abortion but not for any very good reason. I suspect it is just that an embryo does not look much like a person, so its abortion does not seem much like murder. On the other hand, late term abortion, especially when the foetus is past the limit of viability and hence indistinguishable from children in neonatal care, seems just like murder. I really can’t see a difference between very late abortion and murder.

I have no logical reason for accepting earlier abortion. The line must be drawn somewhere and I suppose it is easy, given a very young foetus’ or embryo’s dissimilarity to a person, to accept the majority opinion of the culture in which I live. But in the back of my mind is a niggling doubt, a feeling that really I know it is wrong but I don’t want to admit it.

However, I do not have a problem with abortion in some circumstances. For example, if the health of the mother is seriously at risk then I would not condemn her or her doctor for choosing to abort the foetus rather than risk her own death. Surely if the foetus has a right to life then the mother must have one also? I would praise a parent for risking their life for their child but if their death seemed almost certain, and perhaps the child seemed likely to die or suffer anyway, then I would not condemn them for saving themselves.

There is also the issue of rape. This is a more difficult case, since obviously no blame for the crime can be placed on the foetus, but again we must balance the rights of the mother with those of the child. In such an unhappy situation it would be cruel and heartless to condemn a rape victim who opted for abortion.

The health of the foetus must also be taken into account. In some cases it is discovered that the child has a serious developmental defect. Some people would claim that it is better for the child to be born, perhaps to have corrective surgery after birth, and to live the best life he can than to have no chance at all. I am not sure: I think this sort of thing is better decided upon on a case by case basis. It seems unlikely to me, given the variation possible in the severity of defect and the fact that this situation is likely to also entail some risk to the mother, that one can reasonably decide this issue in advance for all cases.

Finally, there are so-called “lifestyle” abortions. Here there is no medical reason for abortion. The mother simply does not wish to have a child. Presumably in most cases she did not intend to get pregnant in the first place. I have an awful lot of difficulty coming to terms with this. I find it very hard to distinguish between a lifestyle abortion and murder for convenience. As mentioned above, I find it easier to accept early abortions. A very young embryo is not much like a person, hence its abortion seems less like murder. But the late-term abortion of a healthy foetus that poses no unusual threat to the mother, especially an abortion so late that the child has passed the limit of viability, is for me indistinguishable from murder.

So, to return to Dr Tiller, was he a noble martyr or a mass murderer? I have read a few discussions of Dr Tiller’s career and his death. Those that supported Tiller point out that the law of Kansas, the state in which Dr Tiller lived and operated his clinic, prohibits abortion after the limit of viability unless two doctors independently certify that continuing the pregnancy would cause the mother “substantial and irreversible impairment of a major bodily function”. They therefore claim that all of Dr Tiller’s most controversial abortions, those carried out late into the second trimester of pregnancy or later, would fall under the first category described above, in which the risk to the mother justifies abortion of her child.

Those who condemned Dr Tiller claim that he performed late-term abortions when the mother was not at risk. He was accused by various “pro-Life” groups of deliberately underestimating the gestational age of foetuses in order to circumvent Kansas law. I don’t have much faith in the state but it seems odd to me that Tiller was not prosecuted for such crimes if the evidence against him really was that conclusive. The activists suggest that he was protected by a conspiracy amongst the police and government, which seems rather far-fetched.

Nevertheless, even if Dr Tiller did not break the law, he certainly performed elective abortions. An elective abortion, as opposed to a therapeutic abortion, is an abortion for any reason other than the protection of the health of the mother. It is not clear to me whether those elective abortions that Dr Tiller provided were motivated by defects in the foetuses or were simply lifestyle abortions. His own promotional material strongly suggests that he performed abortions for reasons of convenience but without knowing the case history of each of his patients we cannot be sure.

George Tiller’s murder has given me cause to think carefully about the morality of abortion. However, without further information, I am in no position to pass judgment on the doctor himself.

Published in: on June 9, 2009 at 9:44 pm  Leave a Comment  

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