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Posted by on Jun 5, 2009 in Health, Politics, Religion, Society | 18 comments

Common Ground on Abortion (Guest Voice)

drtillerandprolife.jpg

Common Ground on Abortion

By Malcolm Potts MD, PhD

The abortion debate, as President Obama stated at Notre Dame in May, will not go away and should not go away. The way towards common ground is through asking the right questions.

As long as one side asserts women’s rights and the other the embryos’ rights, then the war on abortion will go on consuming our energies and confusing the nation. We need to focus on the real question: Can we actually know when life begins?

I am a physician who has done abortions. I have seen the “heart-wrenching” decisions women make and Obama described in his speech. I also have a PhD in embryology, studying the first few days of development, so for me the question of when life begins is a very real question.

Biology is remarkably prolific. Every egg and sperm is genetically unique. A woman uses only a handful of the 400,000 eggs she produces and a man releases half a billion sperm every time he ejaculates. Some people take fertilization as the beginning of life, but not all fertilized eggs give rise to embryos – some produce an abnormality called a hydatidiform mole, which in rare cases go on to form a life threatening cancer. Molar pregnancies are the result of normal intercourse and each is genetically unique, but they have no ethical or legal status.

The Bible tells us that when men cause an abortion without the woman’s permission they should be punished, but it does not suggest abortion is murder (Exodus 21:22). The Holy Koran describes the unfolding complexity of human development in eloquent terms and some Muslim societies permit abortion. Catholic teaching says we don’t know when life begins so respect life from fertilization. Many Protestants take implantation, when the egg attaches to uterine wall as the beginning of life. Yet others point out that identical twins can arise as late as 17 to 20 days after fertilization, and suggest that life cannot begin until human individuality has arisen.

I respect these ideas, but as an embryologist I place the beginning of life later in pregnancy.

Early embryos are highly abnormal and most of these are aborted spontaneously. Natural abortion is a necessary healing process without which few women would wish to become pregnant. Indeed one of the least controversial reasons for abortion is when the woman knows she is carrying an abnormal embryo. Personally, I see offering an abortion for congenital abnormality as comparable to any other healing procedures doctors perform to step in when nature has failed – as in removing a gangrenous limb. I also know that others will sincerely disagree with me. So how do we find a common ground?

By and large, various faiths and agnostics have developed a consensus on when life support machines can be turned off – when there is inconvertible evidence that the brain is no longer functioning. I suggest we should apply the same criterion to the question of when does life begin. I would offer an abortion to a woman who wants it until such time as the brain in functioning. I accept that there are no absolute measures for early brain function, but there is a general consensus it is after 12 weeks.

What I am certain about is that as an embryologist I can no more say when life begins by looking down my microscope than an astronomer can tell if heaven exists by looking thorough a telescope. Our assertion about when life begins is based on our personal beliefs, just as are assertions about life after death. Each religion and denomination charts a different path to heaven. In the sixteenth century the Europeans fought each other to a standstill over issues of religion relating to life after death. America was the one nation founded on religious tolerance.

We need a truce in the wars over life before birth, and to value a diversity of beliefs about the complex question about when life begins.

The murder of Dr George Tiller because he did abortions, as he walked into his church in Wichita last Sunday, is an urgent reminder that religious tolerance is the common ground America must honor.

Malcolm Potts, MB, BChir, PhD, FRCOG, holds the Bixby Endowed Chair at the University of California, Berkeley, where he has established the Bixby Center for Population, Health and Sustainability. A British, Cambridge-trained obstetrician and biologist, Dr. Potts has worked internationally since the late 1960s, when he became the first medical director of the London-based International Planned Parenthood Federation. In 1978, because of the United States’ interest in international family planning, he joined Family Health International in North Carolina as President and CEO, where he initiated research on maternal mortality which helped launch the global safe motherhood initiative in 1987. He also led collaborative research in family planning, contraceptive development, and HIV prevention in 40 countries. He vividly remembers World War II near London, and his professional work has taken him to many war torn situations including humanitarian work in Bangladesh immediately after the War of Liberation, Cambodia during Pol Pot’s attack on the capital and to Afghanistan, Angola, Gaza, Liberia, Ethiopia, Sudan, and Sri Lanka. Dr. Potts has written 12 books and published over 350 papers and articles. Two recent books are Queen Victoria’s Gene, tracking the hemophilia gene in the British royal family; and Ever Since Adam and Eve: The Evolution of Human Sexuality. His newest book with co-author Thomas Hayden, is titled Sex and War: How Biology Explains Warfare and Terrorism and Offers a Path to a Safer World.

The cartoon by David Fitzsimmons, The Arizona Star, is copyrighted and licensed to run on TMV. All Rights Reserved. Unauthorized reproduction prohibited.

  • JulietAwesome

    “We need to focus on the real question: Can we actually know when life begins?”

    100%, absolutely, and categorically wrong. Redefining “life” has been the most useless argument against abortion for 30 years for two reasons: its scientifically inaccurate and it makes a presumption that merely being biologically alive has some kind of moral value. Anything made of cells which metabolizes food to maintain homestasis is alive, including human beings, individidual cells, sex cells, flies, fish, cats, etc. However, almost nobody believes that flies have a right to life comparable to humans.

    How on earth do we account for this distinction between insect and human life? Easy: by making the presumption that life only has conditional value, not intrinsic value; more than that, the value of one individuals life can be measured relative to other individual lives. This sounds like a striking departure from the blanket “human life is sacred” ethic that people have been taught for their entire lives, but it is an absolutely accurate characterization of the moral principles underlying the ethical treatment of humans and all living beings on the planet.

    The abortion debate can be resolved by providing a solid explanation for why human life is even valuable in the first place, then determining whether those reasons extend to fetal human life. Jeremy Bentham, Immanuel Kant, Peter Singer, John Rawls, Robert Nozick, and a whole host of people who have dedicated their lives to solving the puzzle of what makes human life valuable have come orders of magnitude closer to solving the abortion debate than modern pro-life/pro-choice think tanks have ever been.

    Please don’t perpetuate the myth that scientists are still debating whether embryos are alive, its a waste of everyone’s time and you will lose the abortion debate immediately. Focus on what really matters: what relevant characteristics do embryos share in common with rational adult humans which gives them a claim to moral value. In this respect, pro-choicers have the upper hand on pro-lifers by a wide margin who, after 30 years, have yet to identify even a single morally relevant characteristic of embryonic life that could make embryo life valuable even in principle.

  • As I wrote recently I don’t think much common ground exists – especially in the “abortion is murder” crowd. It is simply unacceptable for anyone to compromise on when they think murder is allowable. It isn’t. That’s the definition of murder.

    In seeking common ground, we have to realize that some people are not going to come along. That’s fine. Everyone is free to disagree with any law they like. However, they must agree to abide by the democratic process and stay within the confines of law in their dislike of the law. There is not an opt-out policy for those who disagree (see also: Civl war, secession).

    I find this piece to have an uncommon understanding and level of nuance. I appreciate what the doctor is trying to say and do. But science, no matter how well grounded, cannot supplant an article of faith – that is why so many people have a reflexive distaste for any mention of faith in politics. The answer lies in matching faith for faith, not in abandoning it entirely or condemning it as the hallmark of a small mind (as has been done elsewhere).

  • Good post, Dr. Potts, and excellent comment Juliette. These are interesting debates and useful, I suppose. I’m staunchly pro choice, for a reason that Dr. Potts might just corroborate. There are many many things that can go wrong in a pregnancy, right up to birth. The question is not when life begins, but when citizenship does. In this debate, we are asking if a current citizen can be compelled to make a medical decision to benefit a potential citizen.

    Women have a right, as do all citizens, to “life, liberty and the pursuit of happiness.” From a Constitutional perspective, we do not allow one person’s rights to be subordinated to another’s. As I’ve pointed out, a parent is not required to give up a kidney to save her or his child’s life, nor even to give blood. One person cannot be compelled to make a medical decision to benefit another. Period. The concept that a woman can be compelled to make a decision that affects her life or health, on behalf of a mass of cells that *might* become a citizen, is Constitutionally unsupportable, in my opinion.

  • The OP’s points are very interesting, and I think the discussion about “when life begins” is important to have on a philosophical level. However, while focusing on the embryo and whether or not it is “alive” is one way to look at abortion, this view leaves the woman carrying the embryo entirely out of the equation. I don’t think the entire abortion issue comes down to “If it’s alive, we must outlaw abortion, and if it’s not, it doesn’t matter so abort if you want.” I just don’t see it as ethical to force a woman to share her organs and bloodstream and body with something – even if it is “alive” – against her will. On a certain level, the 3rd amendment says that we don’t have to let people reside in our homes without consent, yet so many are willing to say we have to house someone in our womb against our consent?

  • GD — I think you said it better. 🙂

  • casualobserver

    @roro——-Anti-choice advocates have also slandered the women who get abortions….as women who don’t “take responsibility” for their actions, as women who are looking for a quick “out”,

    I just don’t see it as ethical to force a woman to share her organs and bloodstream and body with something – even if it is “alive” – against her [email protected]

    To put our debate on the right course, roro, please answer this question first………are you here to only espouse your view to your like minded cohorts, or, would you wish to possibly move one or more of the 80% of the population that doesn’t share your view for totally unfettered abortion rights?

    http://www.pollingreport.com/abortion.htm

    If it is the former, read no further.

    If the latter, then I will politely suggest you reflect on how you think the other 80% of the population view unfettered abortion rights. While I do not know your views completely, (as you do not know mine), I suspect a whole lot of very reasonable people would interpret your sentences above to mean you believe if consensual sex without forethought and appropriate protection results in pregnancy, then that damned fertilized egg ought to be removed from the womb with as little thought and guilt as a pimple on the skin.

    The reason why you compose 19% of opinion is that the other 80% of the people view human procreation with some modicum of reverence and that sexual activity SHOULD involve some responsibility……..and even if you don’t, they don’t just think you ought to get to just say “oops” and go about your business. The reason why your group has gotten nowhere on Roe v. Wade in 36 years is that the 80% really don’t understand why you think you need more than 3 months to figure your act out. Those 80% don’t view the human procreation process as entirely meaningless unless and until YOU happen decide to go to the delivery room.

    If carrying a fetus to term is a violation of your will, then they will most assuredly ask where was your will when it first came about.

    After reading the explicit arguments (and implicit attitudes) above, I don’t see how you are going to get any liberalization Roe v. Wade in the next 36 years either………..your group approaches it all wrong and the results to date bear that out.

    • Ryan

      casual: Maybe ‘responsibility’ can include abortion, too – and if 80% of people want to exercise control over a woman’s body they had damn well better come up with a better reason than a “modicum of reverence”.

  • tidbits

    Dr. Potts –

    A very thoughtful piece from an interesting perspective. Thank you.

    The comments, all of them, raise critical points and questions. To you, Dr. Potts: how do you convince all sides to accept a clinical definition as opposed to a constitutional standard (postulated by GD) or a religious standard? Following on GD’s point, the Constitution, at Amendment XIV, defines “citizens” as follows: “persons BORN…in the United States…are citizens.” Do we not need to re-write the Constitution to confer citizen’s rights on the unborn more than 12 weeks post fertilization? And, of course, those with religiously based definitions are likely unpersuadable about the unborn less than 12 weeks post fertilization. Much as I appreciate your piece and your perspective, I’m not sure it breaks the logjam, as pointed out previously by ThurmanHart.

  • casualobserver —

    There’s a lot to get through there, certainly, and I’ve only got a minute, but I think you’re mischaraterizing my views. First — thanks for the link, lots of fascinating stuff there. Also, I would actually put myself in the 33% of people who think that abortion should be legal in most cases. I think the way Roe is worded fits my views pretty darn well. It breaks the pregnancy into trimesters: first trimester — no obstruction, easy access, you don’t even have to provide a reason; second trimester — much more difficult (and the procedures are a lot more extensive) to obtain, higher barriers; third trimester — there must be either significant risk to the mother or there has to be something wrong with the fetus, otherwise, you can’t get an abortion.

    As for your comment about “unprotected sex with no foresight” — this argument does make a lot of sense. However, it does fall apart when you consider the poor state of sex education in this country, as well as the poor access to birth control for the very people who would likely need it most: young, poor, uneducated, uninsured. Not to mention the fact that birth control, even when used by someone very diligent, isn’t 100%, let alone when used by someone who hasn’t really been taught about correct usage.

    “…sexual activity SHOULD involve some responsibility…” Yes, it should. In many cases, the most responsible thing to do is to abort.

    “If carrying a fetus to term is a violation of your will, then they will most assuredly ask where was your will when it first came about.” Sure. It would be awesome if all the young women in this country has such great education about what their bodies are doing and had such great access to both birth control and cheap and easy first-trimester abortions that there was no need for abortions past 3 months except when the fetus or mother’s health are at risk. So sure, I’d be totally happy to concede that point if those things were true. 90% of counties in the US do not have a single abortion clinic, even those that perform only first-trimester abortions. RU486 is available, but only works up to about 6 weeks after conception. Unless your period comes spot-on every 28 days with no exceptions (almost nobody), it’s very difficult to tell in that little time.

    The link you provided has some very interesting points. What jumped out at me was that while 49% of people consider themselves “pro-life”, 75% of people think that abortion should be legal in some cases. I realize that I’m way to the left of average here, and I’m ok with that, but let’s not pretend that those who think that abortion should be illegal all the time are in the majority. In fact, it looks like those who think it should be legal in MOST cases actually compose about 55% of the population.

  • EEllis

    It’s kind of surprising because I would of thought and believe a majority would have agreed that it would be the Pro-Life crowd that would be the least willing to talk and totally unbending in their views. I’m surprised that the Pro-Choice crowd seems to be the group least willing to talk.

    I guess to stay on point I should give my viewpoint. I think if a child could be born and live then there are major ethical questions with abortion. Basically it would be little different from taking a unwanted child and exposing them to the elements to die. Then again we withhold treatment from some people who are hurt/sick and allow them to pass so medical issues would have to be taken in to consideration. The mother should not have to risk her life to carry a child to term, but the whole “heath and well being” thing is way to vague. Would you kill a downs child? Well at 7 months the child could easily be born and live so doesn’t it seem wrong to abort at 7 months for that reason? If you see no ethical questions involved in that then there really is no debate. There is only a minority that are fervent over life at conception, but those that consider a baby nothing more than a tumor or parasite, that think that abortions should be allowed for any reason up until the time of birth, are just as fringe, just as crazed, as anyone I can think of.

  • casualobserver

    Ryan, you are as politically tonedeaf as roro. Here’s how it works, buddy,….people who believe there should either be some or a lot of restrictions on abortion hold 80% of the votes…….you and roro hold 19.

    You don’t get to say “they had better damn well” anything and expect to get anywhere.

  • casualobserver

    roro, thanks for the further elucidation. Talking “with” a person always results in better communication than talking “at” a person.

    I think Roe v. Wade is reasonable and should continue to stand as is. I think that’s the 55% group you cite (recognizing “most” cases is a fairly ambiguous term).

    Where we will have to agree to disagree is on the personal responsibility front. Your philosophy as a liberal is to go easy on the personal responsibility thing…….as a libertarian, personal responsibility is utmost to me.

  • CStanley

    tidbits- shouldn’t the more advanced scientific knowledge that we have now inform our interpretation of the Constitution? I don’t necessarily disagree that the Constitution may need to be amended (I’m a pretty strict literalist so if the words as written don’t comport with current thinking than the words should be amended) but I”m also puzzled why it’s not a problem for many people that wanted fetuses do enjoy some Constitutional protection of life (many states have homocide laws that enable prosecution of homocide when a fetus is killed during a violent attack against a pregnant woman.) Why is the situation different for wanted vs. unwanted fetuses?

    @roro:

    I think the discussion about “when life begins” is important to have on a philosophical level. However, while focusing on the embryo and whether or not it is “alive” is one way to look at abortion, this view leaves the woman carrying the embryo entirely out of the equation.

    And your analysis of the situation completely leaves out any consideration of the fetus whatsoever, so that just shows that you are being as much of an extremist on the issue as are the people who you feel give no consideration to the women’s rights.

  • @ casual: “Where we will have to agree to disagree is on the personal responsibility front. Your philosophy as a liberal is to go easy on the personal responsibility thing…….as a libertarian, personal responsibility is utmost to me.”

    Fair enough, although I certainly wouldn’t say that liberals are simply easy on personal responsibility. As a liberal, I think it’s important to take into consideration the fact that some people are given betters tools with which to excersize the type of responsibility you’re talking about, whether that’s education or access or culture or money. I know that such ideas are generally very against the tenets of libertarianism. Also, as a liberal, I think that every two people you put into a room would have a different definition of “taking responsibility”.

    • “And your analysis of the situation completely leaves out any consideration of the fetus whatsoever, so that just shows that you are being as much of an extremist…”

      It does nothing of the sort. I acknowledged the importance of the issue, while saying I don’t think it’s THE most important issue. I thought the life-of-the-fetus point of view was already well represented in the post.

  • CStanley

    I’m sorry, roro, when I made that comment I hadn’t carefully read one of your later ones where you expounded on your views. What I was pointing out though, is that people who only consider the mother’s rights without any consideration of right to life for the fetus at any stage represent the other polar extreme in the debate. I see now that you weren’t representing that view.

    I dispute some of the points you made in that comment though which point to lack of sex ed and poor availability of contraception as the problems. Here’s an article showing how the UK has been unable to come even close to their target of reducing teen pregnancies by 50% even though they have thorough sex ed and contraception available at the schools.

    At some point you have to admit that impulsivity, not ignorance or lack of access to birth control, are the main problems. And that article also points out that the shift toward liberal sex ed and free access to birth control have some undesirable effects, like removing the parent’s knowledge or potential to influence their kids’ decisions and making girls less empowered to say no.

    What would be interesting is to compare other countries that are doing better at reducing pregnancy rates, to see what they might be doing right.

  • L_i_g_h_t

    Our children don’t stand a chance against you people. Shame on you all. We are supposed to protect the weak and the innocent. You are sorry excuses for men. No wonder society is going down the drain. We have no true leaders. Only cowards. Sure, you’ll role your eyes at this reply, but I don’t care. It needs to be said. Your conscience is dead and your logic for that matter. You’re so backwards. “…a mass of cells that *might* become a citizen…”? Well, Tiller was a mass of cells that *might* have grown to become an old man that would die of natural causes, but we’ll never know. Why? Because some whack job cut that process short. You call THAT wrong, but when someone cuts short the process of a “mass of cells” that *might* become a citizen, you’re okay with that? Inconsistent. Dr. Potts defends his position with rare possibilities? A majority of abortions are simply mothers that don’t want children yet. Dr. Potts, what is the incidence of pregnancies becoming hydatidiform moles? From what I’ve found, about 1 in 1200. So, you mean to tell me that you are basing your argument on a condition that has less than 0.1% chance of even occurring? Okay, when we enforce the law against murder, we don’t just put our hand over our eyes and say, “You took a life, therefore, you are guilty of murder.” We examine the situation. We can have exceptions for things that have a 0.083% chance of occurring! Such shallow arguments, here. Let me go on. “Personally, I see offering an abortion for congenital abnormality as comparable to any other healing procedures doctors perform to step in when nature has failed – as in removing a gangrenous limb.” This comment is VERY scary coming from someone who would be considered a “professional” in the field of medicine (at least in title, if not in practice). You look a person with Downs Syndrome or a child with Cystic Fibrosis in the eye and tell them that because of their congenital abnormality, they are no better than a “gangrenous limb” and should have been cut off long ago. Heartless! It’s sickening, sir. It’s views like this that led to Nazi Germany “cutting off” the “gangrenous limb” that were the disabled of their society. That was an equally appalling atrocity. I won’t compare you to Hitler yet, however. I’ll give you people the benefit of the doubt and just assume that you are sorely misled in your thinking. I believe Hitler was a murderous bigot that had no respect for human life. So far, I only see you as having the latter. I don’t believe you to be murderous bigots. Good day!

  • rlwemm

    A view which is accepted by a majority of the population is not a valid argument for its correctness. It is just a statement of how many people in a particular region believe that to be so. A survey of the Japanese or Chinese would be likely to reveal that at least 80 percent of these populations disagree with what “80 percent of percent” of Americans believe to be “moral” in regards to induced abortions.

    All these figures suggest is that America is socially backward in this area, as in many others of international importance. This is a cause for shame and a call for the upgrading of the nation’s education system. It is not a cause for smug “we are right and you are out-numbered” statements.

    It is strange that so few people in these debates considers the incidence of “natural” abortions compared with “induced” abortions. Except in countries like India, where the two may be on a comparable level, (around 30 percent in some counties) the incident of natural termination of pregnancies is magnitudes higher than medically induced abortions. If naturally aborted living cells are as intrinsically important as those which are medically terminated then why are there no anti-abortionists making a similar fuss about them? Why are there not campaigns to provide funds to save these life forms?

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