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NRL News
Page 22
February/March 2010
Volume 37
Issue 2-3

Unethical Advice to Ob-Gyns on Abortion

BY Randall K. O'Bannon, Ph.D. and Dave Andrusko

Wesley J. Smith is one of NRL News readers’ favorite authors. At the end of 2009 he wrote a piece, “Technological Morality: the top ten bioethics stories of the decade,” for National Review. Smith made this crucial point early in his essay.

This isn’t an idle exercise. Bioethics matters. The field exerts tremendous influence over the most important questions of public policy and moral values: How should we treat the most vulnerable and dependent among us? What makes us human? Indeed, is it even morally relevant that one is human? Trends in bioethics, thus, illuminate where we are as a society and the nature of the culture we are creating for our progeny.”

These thoughts came to mind while reading an essay that appeared in the prestigious American Journal of Obstetrics & Gynecology in December. Written by Frank Chervenak and Lawrence McCullough, it bills itself as offering a resolution to the “divisive debates about a fetal right to life that have been going on for decades.” Shrouded in academese, its “beneficence” argument is simply that the unborn child has no inherent right to life before viability—the child lives or dies at the whim and will of the mother—and that after viability the imperfect child is at severe risk as well.

Chervenak is a member of the ob-gyn department of Weill Cornell Medical Center in New York City, and McCullough is a bioethicist at the Baylor College of Medicine.

They call their approach an “ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide.” (Chervenak and McCullough make a meaningless distinction between abortion—“expulsion from the uterus of an embryo or fetus prior to viability”—and feticide—“destruction of the embryo or fetus in the uterus”—distinguishing by the location and timing of the child’s death, but the end result is obviously the same.)

Though there is discussion about moral principles and “Respecting the fetus as patient,” the autonomy of the mother—her desires, her choices, no matter the basis—holds utter sway. Why? Because the child lacks some mystical “capacity to generate a perspective on its interests,” whatever that is supposed to mean.

Specifically, “Because of the immaturity of the fetal central nervous system, the fetus lacks the capacity to generate a perspective on its interests,” they write. “The ethical principle of respect for autonomy and the concept of autonomous rights therefore do not apply to the fetus.... This is one of the concept’s [beneficence] main advantages because it prevents ethical analysis of induced abortion and feticide in medical ethics from being paralyzed by divisive debates about a fetal right to life....”

Think about for a second. The unborn child, unable to express his or her desires at this point, or to mount an argument, has no say in the matter. They later say that they would oppose killing the child after viability, but it isn’t clear why this principle wouldn’t allow killing the child up until birth or even after.

The previable fetus has no claim to the status of being a patient independently of the pregnant woman’s autonomy,” Chervenak and McCullough continue. “The link, therefore, between a previable fetus and the child and person it can later become can be established only by the pregnant woman’s decision to confer the status of being a patient. The pregnant woman is free to withhold, confer, or, having once conferred, withdraw the status of being a patient on or from her previable fetus according to her own values and beliefs, an important clinical implication of respecting the pregnant woman’s autonomy.” (Emphasis added.)

Putting aside the issue of the unborn child’s inability to make “autonomous” choices, couldn’t the case be made that abortion wasn’t good for the child, that it wasn’t in the child’s best interest, that abortion, in other words, violates the ethical value of beneficence? Not to Chervenak and McCullough.

Beneficence-based obligations to the fetus exist when the fetus is reliably expected to achieve moral status as a child and person,” Chervenak and McCullough write. “One such link is viability, which should be understood in terms of both biological and technological factors. When a fetus is presented to the physician and when it is of sufficient maturity that, given the biotechnological support, it can survive into the neonatal period and later achieve moral status, the fetus is a patient.”

What happens then?

After viability, there is a beneficence-based prohibition against feticide of viable fetuses without severe anomalies because the beneficence-based obligation to protect the life and health of the fetal patient remains intact. As a consequence, the physician has beneficence-based obligations to protect the health and life of the viable fetal patient without severe anomalies.”

After viability, the authors say the physician has the duty to treat the child as a patient in his or her own right, unless the child suffers from a severe disability, one that involves a high probability of death or the “virtual absence of cognitive developmental capacity.” Then, the woman and the physician have a “beneficence-based obligation” to prevent the live birth of that child to avoid the “increased risk of preventable neonatal morbidity.” In other words, if you kill the kid in the womb, there is no chance she will die soon after birth, an unassailable, if morally bizarre, conclusion.

And if physicians object? They shouldn’t be required to abort or directly refer, but “[b]eneficence requires the physician to provide information about clinics such as Planned Parenthood that provide competent and safe induced abortion or feticide.”

In the end the basic error goes beyond misapplying the principle of beneficence, or even autonomy. It begins at the initial decision to exclude the previable unborn child from the community of rights and make the older unborn child’s chances contingent on avoiding some serious disability.

Whether the exclusion is done on the basis of “viability,” which continues to shift, or the function of the central nervous system, the ability to feel, to think, to cry, to vote, etc., the use of any criteria other than membership in the human race, which begins at conception, makes all rights tenuous.