Login
Is a 15-week limit on abortion an acceptable compromise?
A recent opinion piece by George F. Will, “Ambivalent about abortion, the American middle begins to find its voice” in the Washington Post made the startling claim that the overturning of Roe v. Wade (Dobbs v. Jackson Women’s Health Organization, 2022) has resulted in “a partial healing of the nation’s civic culture.” One might think exactly the reverse. The Dobbs decision energized voters, especially women and young people, resulting in numerous Republican electoral defeats across the country. However, Will argues that the return of abortion policy to the states gives voters the opportunity of choosing moderate restrictions on abortion. Since most Americans support early abortion while opposing late-gestation abortion, Will thinks that a 15-week ban on abortion would be an acceptable compromise.
Why 15 weeks? Two reasons can be given. Almost all abortions in the US—93%—occur within the first 15 weeks of pregnancy. For this reason, making abortion illegal after 15 weeks would not, it would seem, impose serious burdens on most people seeking abortions.
Another reason is that several European countries limit abortion on request to the first trimester, leading some US lawmakers to suggest that a 15-week ban would bring our abortion law in line with theirs. This is disingenuous, to say the least. While elective abortion is limited in some European countries, it is not banned afterwards, but is allowed on other grounds, including economic or social reasons, or a threat to the woman’s physical or mental health. Moreover, in most European countries, patients do not have to pay for abortion; it is covered under universal health coverage. The fact is that the trend in Europe has not been to limit abortion, but to expand access to it. Countries in Europe “… have removed bans, increased abortion’s legality and taken steps to ensure laws and policies on abortion are guided by public health evidence and clinical best practices.”
Were states to guarantee access to abortion prior to 15 weeks, a 15-week ban might be acceptable. However, even before Dobbs, many women in the US lacked access to abortion, due to a dearth of providers, especially in rural areas. They often had to travel many miles to find an abortion clinic, which meant that they had to arrange childcare if they have other children or take time off work. Delay is also caused by the need to raise money for an abortion, which is not paid for by Medicaid in most states, except in cases of rape, incest, or a life-threatening condition. To be sure, even if there were none of these roadblocks, some women would still not be able to have early abortions because they do not know that they are pregnant, due to youth, being menopausal, chronic obesity, or a lack of pregnancy symptoms. Any time limits will pose hardships for some people. But if access to early abortions were guaranteed, a compromise on a 15-week limit might be worth it.
I suspect that time-limit advocates are not particularly interested in making sure that women who have abortions get them early in pregnancy. They want to place roadblocks in the way of getting abortions, full stop. That these roadblocks increase the numbers of late abortions is of little concern to them, however much they wring their hands over late abortions. Abortion can be reduced by reducing the number of unwanted pregnancies, something that has been shown to be achieved by access to contraceptives and science-based sex education in the schools. Remember when pro-lifers emphasized those methods? Me neither.
“Some US lawmakers suggest that a 15-week ban would bring our abortion law in line with European countries. This is disingenuous, to say the least.”
My second concern is with abortions sought after 15 weeks. The reason for a late abortion may be that the woman has a medical condition that has not developed, or has not been detected, until later in pregnancy. In such cases, the pregnancy is almost always a wanted pregnancy, and the decision to terminate imposes a tragic choice.
It may be responded that all states allow abortions to be performed when this is necessary to save the pregnant woman’s life, and many allow for abortions to protect her from a serious health risk. The problem is that these exceptions conflict with standard medical care, especially in the case of miscarriage. Once the woman has begun to miscarry, the failure to remove the fetus is likely to cause her sepsis, which can be life-threatening. However, in states with restrictive abortion laws, doctors cannot perform an immediate abortion, which is the standard of care in such situations. They have to wait until her death is imminent and, in some states, they cannot remove the fetus until its heart stops.
Ireland’s restrictive abortion law was repealed after a woman who was denied an abortion during a miscarriage died from septicemia. To the best of my knowledge, no woman in the US has died as a result of restrictive abortion laws, but some have come close. An OB-GYN in San Antonio had to wait until the fetal heartbeat stopped to treat a miscarrying patient who developed a dangerous womb infection. The delay caused complications which required her to have surgery, lose multiple liters of blood, and be put on a breathing machine. Texas law essentially requires doctors to commit malpractice.
Conservatives often portray those in the pro-choice camp as advocating abortion until the day of delivery, for trivial reasons. This is deeply unfair. If they want us to compromise on time limits, they should be willing to guarantee access to abortion before 15 weeks. They should be willing to compromise on pregnancy prevention through contraception and sex education. And they should agree to drop all restrictions on late-term abortions that make legislators, rather than doctors, in charge of deciding what is appropriate medical care for their patients.
Featured image: Gayatri Malhotra via Unsplash (public domain)
By Heloise Robinson.
This blog post is about a JME article I have just written, in which I make a new argument on personhood, in relation to pregnancy. I argue that, if we follow a threshold concept of personhood, there are reasons to recognise a second threshold that would be reached because of pregnancy, and that would mean that pregnant women have a superior moral status. It is not an argument on the moral status of the fetus, but on the moral status of the pregnant woman.
Although the argument might seem radical in some sense, it also seems to me that in another sense it should be easy to accept, at least, if we are committed to accepting a threshold approach to personhood. The most surprising point might be that no one, as far as I can tell, has made the argument before. There has already been some consideration of the possibility of recognising two thresholds of personhood, but in the context of future persons who will have been cognitively enhanced through the use of new biotechnologies. I think these are interesting scenarios to think about, although they also make me think of how they might be in line with a rather eager form of enthusiasm for super-heroes – the super-intelligent man, or the super-powerful man. This is science fiction. But in real life, there are some people among us who actually do have real super-powers: and the power to create a new human being is not only real, but surely is much more beneficial. I am not quite sure what is the use of having a super memory, and, perhaps, memorising hundreds of thousands of digits of Pi. I do think it is useful to create another human being.
I doubt I would have started to write this article if I had not read some of the recent and exciting literature on the metaphysics of pregnancy, and which has been associated with the Better Understanding of the Metaphysics of Pregnancy (BUMP) project, led by Elselijn Kingma. I am in no way connected with it, but discovered it with great interest. Having conducted research on the law and ethics of abortion for some years, it was a relief to find an engaging and growing body of literature in philosophy that addressed the significance of pregnancy beyond that context, and where the questions examined were not only about whether or not a pregnancy can be ended. The credit goes to Andrea Mulligan for pointing me towards this literature, through a long and spirited conversation we had in an Oxford senior common room about a shared interest in medical law and ethics, the value of women’s voices, and the many amazing features of pregnancy.
But there was one distinct catalyst for the article, which came later, and which is not directly related to my argument. There has been a recent trend to change the language used to speak about pregnancy. One day I came across a new text speaking about persons undertaking gestational labour, and some mention of producing a ‘product’ of this labour undertaking. There was, I think, some discussion that this undertaking of gestational labour performance had nothing to do with motherhood, but I must admit I was not able to read much of it. It was written in a language I could not read. I think there might well be important reflections and suggestions in that text that I would agree with, but the language created such a barrier for me that I could not get to them. It was the language itself that pushed me in another direction, to another sort of argument, and that helped me to realise what I truly thought about pregnancy – that it was not just a form of labour, or production, or a good to share out, or an injustice to redistribute, but rather a most profoundly human experience, with metaphysical significance. It comes with burdens, but that is not the sum of it. Human pregnancy is not just about doing. It is also about being. And that recognition, for me, also requires a certain kind of language. I do not know what it means to produce a product of gestation as a gestational labourer undertaker. I know what it means to be pregnant, to feel life growing inside my body, and to hold a newborn baby in my arms.
Not everyone will agree with my argument that pregnant women can be regarded as having a superior moral status. A lack of agreement will inevitably arise in the context of any discussions on personhood, because such discussions necessarily rely in part on a metaphysical, or intuitive, understanding, and it seems like we have different intuitions. There are also, here, epistemic barriers arising from the fact that those who have not experienced pregnancy, and the birth of their child, might not be able to fully appreciate the significance of pregnancy which I am trying to convey. Still, we have been having babies for quite some time now, and I think the importance of pregnancy needs additional consideration. I hope that many people will seriously consider the argument, not only for its potential to provide, I think, a richer conception of personhood, but also for the many positive practical and legal consequences that I believe it could, and should, bring.
Paper title: Pregnancy and Superior Moral Status: A Proposal for Two Thresholds of Personhood
Author: Heloise Robinson
Affiliations: Singer Fellow in Law, Exeter College, University of Oxford
Competing interests: None declared
Social media accounts of post author: Twitter: @HeloiseRobinson
The post A new argument on personhood, based on pregnancy appeared first on Journal of Medical Ethics blog.
This was originally published at The Rumpus on September 13, 2017.
No. It’s my mother’s favorite word lately.
Did they feed you?
No.
Are you happy here?
No.
Do you love me?
No.
It’s a Sunday at the tail end of fall. The autumn scents of pumpkin and cinnamon have vanished somewhere with the last of the dying leaves. Above my mother’s bed, skinny leafless branches tap at the glass window in slow rhythmic movements. My mother shifts to her side and draws her blanket close to her face, balling her fists tight under her chin. She shivers like a page caught in a gust of wind.
“No,” she says, although I haven’t said anything. It’s no longer a word, but a sound that’s not meant for anyone but herself. It’s her second day here at Saint Martha’s Nursing Home and although she can’t communicate anymore, I can tell she hates it. Projecting, my husband Jerry said yesterday when I told him about my suspicions. Well, he didn’t say this; he exclaimed it, like a detective would after finally putting together all the clues. He decided I hated Saint Martha’s, I hated leaving my mother here and—as usual—I was making this about myself. Projecting. He was loose with the tongue because he has nothing left to lose: he’s been sleeping on the couch for about two months now, surrounded by his model airplanes and ships. The subject of divorce has been lobbied between us more times this month than a volleyball at the beach.
My mother shakes so much I’m thankful for the rails on each side of the bed. There’s no thermostat in the room, just an absurd antique iron heater that would look out of place except that this whole facility looks like the setting of a Victorian-era novel. Perched on a mountaintop, the structure of Saint Martha’s dates to colonial times when it was used as a lookout during the Revolutionary War. It was abandoned after the war ended and left to rot and ruin, until the late 1800s when it was renovated by Catholic nuns and converted into an asylum. In the 1900s, most of their patients were elderly people with some form of dementia or Alzheimer’s, which led to their decision to turn the asylum into a home for the elderly. This building is so old that all the heat is turned on at the same time—winter. No thermostats; you just open and close the heater’s valves.
I know all of this because I had an argument yesterday with one of the nuns, Sister Frances. She’s in charge of the wing my mother is in, the Alzheimer’s and dementia section of the facility, where they place the residents who suffer from severe forms of these diseases. The ones who repeat the same words over and over like a prayer; the ones who need to be fed and bathed and have their diapers changed.
Sister Frances and I argued because I wanted her to turn the heat on in my mother’s room. She gave me the Saint Martha’s history lesson to explain why she couldn’t do that: it would be too expensive to turn the heat on for the whole building before winter. I told her with what they charged monthly my mother should have her own private sauna if she wanted one. The compromise we arrived on was extra blankets, but even this would take an extra day or two because they “didn’t have any extras.”
I hate to admit it, but Jerry was right about something: I hate this place. But that doesn’t change the fact that I think Mom doesn’t like it either. I like to imagine she’s pretending to be cold, to shiver so much, just to let me know she doesn’t like it here, because that would mean she’s still in there somewhere. I only put her in this place because she’s always been such a devout Catholic. I thought being around nuns and crucifixes might trigger some memories, make her feel more at home, but I’m not so sure anymore. I also didn’t realize these nuns actually operated with amenities from the 1800s.
My mother turns on her side, now facing me. She looks at me through the silver strands of hair that fall across her face.
“No,” she says. Her face is as thin and sharp as I’ve ever seen it. Her eyes are set in deeper than I remember and dark bags hang heavy under her gaze.
“No what, Mom?” I say, standing up from the red cushioned chair next to the bed and walking towards her.
“No.”
“Are you cold, Momma?” I take a measured step forward.
“No,” she says, still shivering.
“Are you hungry?”
She looks away from me and stares at the ceiling as if trying to solve a puzzle. I haven’t been this close to her in a while. For the last month she’s been confusing me with someone else. She’d look at me and turn red and either cry or claw at me. During one of these instances she called me “Marie,” during another she called me a whore. I have no idea who Marie is or was—I don’t even know if she ever existed.
I miss hearing her say my name. Monica, she’d call from downstairs when dinner was ready. Monica, honey, she’d whisper if she found me crying in my room after school. I place one hand on the bed rail and I slide the other into hers. I never get used to the feel of her wrinkled skin, the fluid movement of bluish veins under my thumb, the warmth it radiates. I feel like a child again. I feel like my mother’s daughter for the first time in months.
“Momma,” I whisper.
She stares at me for a few seconds. I think she’s trying to connect the dots. Get the gears grinding. I fear she’s going to see “Marie’s” face in mine. But she looks away. She stares at the wall and coos like a bird.
“No,” she says. “Coo.”
By the time I leave Saint Martha’s, the sun has set. Rain falls hard and angry from the dark gray clouds hiding the hundreds of stars that can be seen from this hilltop on a clear night. On the drive back home, I feel cheated. The first time my older brother, Gabe, and I visited Saint Martha’s was during its open house last spring, when the trees were heavy with green and flowers scattered through plains like wildfire. We drove up the gravel path that cut through the green hill like a scythe through tall grass, unprepared for the beauty we were about to see. Saint Martha’s during springtime looked magical: surrounded by flowers and greenery—the whole color spectrum on top of a hill.
Gabe flew in to Massachusetts from California, where he pretends to be too busy “working” to come help take care of Mom. He calls himself an actor, despite being forty-three and only having two infomercials and one tiny non-speaking role in his portfolio, or whatever actors call their résumés. I practically forced him to come so he could check out the facility where Mom was most likely going to end up. I even paid for his airline ticket. He had lived here in Greetlebay and worked as an English teacher at a local high school for about fifteen years before having some sort of identity crisis and deciding he was going to make it as an actor. Coincidentally, this sudden burst of passion happened at the same time Mom started getting worse, when she started misplacing memories and faces as often as she misplaced her keys. I don’t know why I made him come. Why I spent that money. I didn’t really have to bring back my brother, who didn’t really want to be here. Maybe it was my last attempt at keeping the family together—at having a family at all. In the end, his contribution to the decision-making process amounted to, “This place seems fine.”
My house looks unfamiliar under rainfall: a black and blue silhouette in darkness, unwelcoming and eerie. I sit in my car and listen to the engine run lazily, a soft murmur under the wash of rain. I don’t know when exactly it transformed from a home to a house. The blinds are shut, but I don’t need to see inside to know that Jerry is either slumped on the couch eating macaroni and cheese and watching television or he’s hunched over the dinner table, working on one of his model airplanes, or a tiny ship in a bottle. He finds comfort in repetition, in rituals. He’s built the same ten or twelve different models over and over again because he knows them by now and won’t find any surprise or complication in the process. Among his favorites are the F4U Corsair with its tiny yellow-tipped propellers, the American Airlines Boeing 767 because it’s the only airline he trusts, and the red 1917 Baron Fokker Triplane, with its three sets of wings and the black cross on its tail.
For our last anniversary, I gave him a custom-made model set of the very cruise ship we were on when he proposed, the Carnival Liberty. I had to do a lot of research to get the details right, online searches and many calls. Decks on the ship: 16. Balconies: 28 (all on the 16th deck). Length: 855 feet. Guest capacity: 2052. On-board crew: 920. Emergency lifeboats: 24 (12 on each side). The model is still in the white and red box it came in, gathering dust next to the model planes and ships and bottles. He gave me a scarf that year. One he knew I already owned, because, as he pointed out, “It’s your favorite scarf, but in a different color!” I wish I’d returned it that very day instead of wearing it to work to protect his feelings.
There’s a finished model of a WWII fighter jet gliding in place over the glass dinner table, its target apparently the cheesy white china plate. No Jerry. For half a second I expect to find a note clinging to the model plane (a grey Messerschmitt Me 262) the way he used to let me know he ran out for a quick second to buy more crazy glue or a magnifying glass because he lost another one.
The model plane is dainty and fragile. They’re always lighter than I expect them to be. I hold the Nazi jet by its wings like a baby bird or a dead moth and push with my thumbs until one of the little wings snaps. I consider breaking the other one as well, but settle for one and leave the jet right where it was before I go to bed.
In the morning I hear Jerry creep into the room. He shuffles socked feet and slides closet doors gently, trying not to make a sound. I pretend to be asleep, because I don’t know what I would say or ask if we talked right now. For the first time in years—in our marriage—I don’t know where he spent the night. I know he didn’t come in last night because I got up after midnight to get a glass of water, and where I expected to find a fat blanketed lump on the couch, I found nothing. I shift to my side but pretend to still be sleeping and he freezes for a moment. I hear him open a few drawers and pick up a pair of shoes before leaving the room.
I get out of bed and walk out of the room after I hear Jerry’s car driving away. If someone asks him what his job is, he’ll say he’s a writer. In reality, he works a nine to five in a government building, writing little blog posts about public health and safety. He’s never written a short story or a poem that I know of, and I’ve never seen him writing outside of work. But he likes to pretend things are better than they really are. It’s his way of life: repetition and denial.
Later, at work, my mind is elsewhere, nowhere near the insurance forms I should be filling out. My mind is in Los Angeles with my deadbeat runaway brother; it’s at the top of a hill in a cold ancient building, watching my mother coo at the walls; it’s wherever my husband was last night, watching him do all the things he could have done with a prettier, younger version of me.
Still, it seems absurd—logically—to be angry with him. Even if he was with someone else last night—why should I be mad? We’ve talked about separation many times, called each other many things we can’t take back and put all our belongings in some intangible mental list of division. Most of these conversations ended the same way, me trying to think of new things we could try—marriage counseling, sky-diving, swinging, something, anything—and Jerry saying he’s tired of trying, or that there’s nothing even left to try because we’ve tried it all. Jerry gave up. Jerry is done. He’s been looking at apartments for a month now. We’re only together on paper. Yet, whenever my mind wanders off I picture tiny model planes set ablaze and soaring through the sky or tiny ships in bottles crashing into jagged rocks, pushed by violent waves.
After work, I drive fast to Saint Martha’s, a little recklessly, because I’m eager to see my mother. I’m eager to be in her quiet room and sit by her side and hold her hand while I talk and she listens. I’m eager to touch her hair and tell her stories—her own stories about her own life—and maybe I’ll even sing to her, like the doctors have recommended or I’ll hum, since I don’t have a singing voice. Maybe I’ll finally tell her about my failed marriage.
Crossing the threshold of Saint Martha’s entrance feels like stepping into a different world, where time moves at the same pace flowers bloom and the general atmosphere is perpetually that of a wake. I pass by portraits of Jesus Christ and the Virgin Mary, rosaries hung from their top corners; residents who smile at me, who say hello and hi and good morning (despite the sun having already set), who smell like piss, who look lonely. Some of them seem healthy and alive—more so than my mother. And I can’t help asking why not them?
The Alzheimer’s section of the building is one of the farthest from the entrance. When I’m about halfway there, Sister Frances intercepts me.
“Excuse the intrusion,” she says. “I don’t mean to be nosy, but do you know who Jerry is?”
“Jerry?” I’m surprised because Jerry’s never come to visit my mother. “My husband, Jerry?”
“Oh,” says Sister Frances in a tone that would seem grave, if she didn’t dip every word in the same tenor. “Your mother has been calling for a ‘Jerry’ all day.”
This is odd. My mother was never a fan of Jerry. In fact, when I told her that I was pregnant with his child and that I was planning on marrying him all those years ago, she begged me not to do it, not to have the baby—this was the first and only time I heard her say anything so un-Catholic. It was also the moment I realized how hard it must have been for her to bring me up by herself. It had nothing to do with Jerry, but with how young I was and how hard she’d worked to get us to where we were. I was seventeen and she had raised me by herself, during a time when a single mother was treated like a leper. One day she threatened to poison both our meals if I didn’t abort and promise not to marry anyone until I was at least twenty-one. She was joking—maybe half joking—but it never had to come to that, because I had a miscarriage seven months into the pregnancy, a little after Jerry officially proposed.
“I’ll have to tell Jerry. I’ll bring him with me next time.”
“About that,” Sister Frances says as she fixes the black veil pinned over the white coif, “I didn’t get a chance to talk to you about this during your first visit—transitions and all of that. We find it’s best—this is completely optional and up to you of course—but we find it’s easier for the patients to transition into living here if their families give them space for at least the first one or two weeks.”
“Space?”
“Yes. We encourage families to—”
“Are you asking me not to visit my mother?”
“Well no, it’s just—”
“My mother is seventy-eight. And she’s frail. She could get a cold and die tomorrow.”
“Oh dear. I think I may have upset you.”
“I think you may have,” I say, more coldly than intended. Before I can say anything else, she bows her head and walks away.
I imagine telling my mother, “They don’t want me to visit you for a week or two.” She would be sitting on her bed, her legs crossed at the ankles, a crossword puzzle or a book in her hands. She’d lift a pen to her mouth and pinch it between teeth, the way she always did when stuck.
“What’s a six-letter word for ignoring truth,” she might say, without looking up from the puzzle.
I tell her I don’t know without really thinking of an answer. I’ve made her younger, somewhere in her late twenties. The silver from her hair shed away to make room for a glossy black. Her wrinkles have disappeared and she wears light pink lipstick and blush. For a second I envy her beauty.
“What’s wrong?” she might say and look at me.
“It’s nothing. I’m fine,” I’d say, knowing this answer won’t work. My mother could always tell when something was wrong. She always knew exactly what to say to get me to talk.
“I know you better than you know yourself, Moony.” She only called me Moony on special occasions, particularly when I was sad and didn’t want to talk—post-breakups, job losses, and all the other little failures of life. Days like today.
“Why were you calling for Jerry?” I might ask her.
“Oh, I just wanted to spit on his face one more time, just in case.” She would wait for me to laugh. And I do.
“We’re getting divorced.” Even in this imagined scenario my voice cracks.
“About time!” she would say and maybe throw the puzzle in the air or tear it up. “You’re too good for him, Moony. Too good for anyone! What did I always tell you?”
I know what she wants me to say, but I wait in silence. I want her to say it. And in this scene, she does.
“It’s just you and me in this world. It’ll always be just you and me.”
My mom is asleep when I enter her room. I sit next to her in the red-cushioned chair and I’m glad to find she has an extra blanket wrapped snugly around her. I want it to be like when I was a little girl, when I would walk to her room in the middle of the night and crawl into her bed. She’d wake up and she wouldn’t even say anything; she’d just stroke my hair until I fell asleep next to her, feeling safe by her side.
“Mom,” I say, already feeling guilty about waking her up.
She opens her eyes and stares at me without saying a word.
“I’m getting divorced,” I say, and for some reason I wait for her to say something back. She looks over at the wall behind me.
“I’m sad, Mom. I’m so, so sad.”
“Coo,” she says. “Coo.”
I come home to find Jerry has moved out most of his things. His underwear and sock drawers are empty, his work shirts and pants are missing as well. The model planes and ships have flown and sailed away from the windowsills and shelves where they once resided. I hope to find the cruise ship I gave him has also floated away, but of course he’s left it behind—he has no need for it. I pick up the dusty red and white box from the floor and open it on the dinner table. I spill its contents over the glass and marvel at the infinitesimal pieces that need to be put together. The bright orange lifeboats stand out among the many dull pieces and for a moment I picture myself sitting alone on one of these lifeboats in the middle of the ocean slowly rocking from side to side, letting the ocean currents guide me blindly to my next destination. I hunch over my dinner table inside my new home and I start building the model set of the place where it all began. Coo, I whisper as I begin to put the pieces together. Coo.
***
Rumpus original art by Mark Armstrong.
FreshRSS 