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. A look at the data, however, indicates that this ethical dilemma may be altogether unnecessary.
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:
It is only in extremely rare cases that abortion can even be mentioned as a potential means of saving the mother's life. Former Surgeon General C. Everett Koop, stated in a 1996 New York Times editorial that because of the advances in modern medicine, "partial-birth abortions are not needed to save the life of the mother" (1). Sixteen years earlier, he wrote: "In my thirty-six years in pediatric surgery I have never known of one instance where the child had to be be aborted to save the mother's life." Even Planned Parenthood's Dr. Alan Guttmacher acknowledged, â??Today it is possible for almost any patient to be brought through pregnancy alive, unless she suffers from a fatal illness such as cancer or leukemia, and, if so, abortion would be unlikely to prolong, much less save, life.â?? (2)
As it relates to abortion, the "life" of the mother is much different than the "health" of the mother. This is true because the Supreme Court's 1973 abortion ruling defined "health" so broadly that it almost becomes a throw-away term. Technically, abortion is illegal during the last trimester of pregnancy, unless it threatens the "health" of the mother. Since the Supreme Court defined health to include "physical, emotional, psychological, (or) familial" trauma, they effectively made abortion legal through all nine months of pregnancy, for virtually any reason at all. Therefore, making an exception for the life of the mother is by no means comparable to making an exception for the health of the mother.
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 trimester, 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 â?? 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 .0118%, this according to the most recent report from the Centers for Disease Control. In other words, for every pregnancy-related death, there are 8,475 successful 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 .0118% 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, pregnancy-related conditions that pose a significant threat to a woman’s life during the first trimester? 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.
The first problem with the statement on the WebMD site is that there have been a number of documented cases where undiagnosed ectopic pregnancies have yielded successful live births. 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. 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, despite the fact that she 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. 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. Without question, the odds of survival for ectopic babies is extremely slim, but clearly it is erroneous to claim that “there is no way to save an ectopic pregnancy”. If more ectopic pregnancies weren’t ended prematurely, who’s to say there wouldn’t be far more examples of successful births?
Of course, we still must give adequate consideration to the mother. How severe a threat does an ectopic pregnancy realistically pose, 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 tells us a number of things:
1) Ectopic pregnancy occurs at a rate of 19.7 cases per 1,000 pregnancies in North America.
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.
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. In most of these cases, the embryo is naturally miscarried and the pregnancy ends without further incident. If we split the difference for the estimate that between 68% and 77% of ectopic pregnancies go untreated, we get 72.5%. Assuming that all of the deaths related to ectopic pregnancy (in 1989) 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. Emedicine, a website maintained by WebMD 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. This is consistent with what the Centers for Disease Control reportis in Pregnancy-Related Mortality Surveillance. Between 1991-1999, 237 women died as a result of complications associated with ectopic pregnancy â?? an average of 26 deaths per year. Returning to the emedicine report, we find that in 20% of all ectopic pregnancies, tubal rupture is the initial symptom. 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, ruptured tube. If that is the case, then we could 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 of .119%. In other words, if ectopic pregnancy is left untreated, the likelihood that the mother will die lies somewhere between .05%-.119%.
In light of this data, it is safe to say that ectopic pregnancy, even an untreated ectopic pregnancy, is not as life-threatening as most people are led to believe. At the same time, the risk that an ectopic pregnancy poses to the mother’s life is real and sometimes fatal, while the baby’s chance of survival is extremely slim. There are no easy answers and no “one-size-fits-all” solution. If you’re facing an ectopic pregnancy, make sure you have a pro-life doctor to walk this road with youâ??one that prescribes abortion as a means of last resort, not as a means of first resort. Ask lots of questions. Find out what kind of alternative treatments are available. If something doesn’t sit right with you, get a second opinion. This is not a decision to be made lightly, so make sure you have enough information to make the best decision possible.
(1) A19 of the national edition–of the New York Times on 9/26/96.)
(2) Alan F. Guttmacher, “Abortionâ??Yesterday, Today and Tomorrow,” in The Case for Legalized Abortion Now (Berkeley, Calif.: Diablo Press, 1967).