UnSpace

Subtitled: Let's see if I can alienate absolutely everyone on the planet.

A 2003 law prohibiting "partial birth" abortions was never enforced because Federal judges ruled it contained no exception if the life or health of the mother required it. Congress declared, without scientific review or research, that a "partial birth" abortion was never medically necessary. The Supreme Court, with two new members chosen by George W. Bush, will determine whether the law truly is unconstitutional.

My Personal Biases

Let me state my own biases up front. I do not believe that a child that can survive on its own should be able to be killed simply because it is still in the mother's womb. That's legal gerrymandering that is both absurd and heinous. A woman has a right to her body, but at some point, the child has to acquire its own rights. Where that point is can be debated endlessly, whether at conception or once it is viable. But I can see no reasonable way to claim that the child has no rights once it is viable that do not also take away those same rights once it is born.¹ Some in the Pro-Choice camp have suggested that children should be able to be terminated up to about age five or so. I see no reason to take their arguments seriously. Just because someone claims something does not mean it needs to be given any serious consideration. I see no reason to pay attention to the folks 5 sigma out on the Bell Curve in either direction.

I also believe in the right to self-defense. Faced with someone attempting to kill a woman, I would not hesitate to use lethal force if that is the only option available to me. That the someone happens to be a child and inside the mother's womb makes no difference to me.

While there may be many gray areas and questions in the debate on abortion, these two principles themselves are very clear in my mind.

As a medical professional, I am also used to working with risk/benefit analysis. In making medical judgements, one looks at what dangers there are to the proposed action and the probability and consequences of those dangers, and compares them to what might be gained by the proposed action — and it's probability and consequences. Risk/benefit is a terrible way to have to make decisions, second only in badness to every other possible method of deciding.

The Name "Partial Birth"

"Partial Birth" abortion is not a medical term: it is a PR term developed by the Pro-Life groups to make a point, and the point it makes is important: in many cases of Intact Dilation and Extraction (IDE — the proper medical term), the child could be born alive. The purpose of killing the child prior to birth is simply that killing the child after birth is illegal. If the only purpose of an IDE is to ensure the child will not live, there is no question in my mind that it should be banned. In evaluating the Risk/Benefit, the only benefit is that the mother won't have to deal with a child even enough to give the child to someone who would take it away permanently. The risk is the certainty of the death of the child. The analysis is clear.

The Evolutionary Problem of the Human Head

Giving birth is not benign, because of a quirk in evolutionary biology. The human brain is an energy hog. Both growth and activity burn up nutrition at an amazing level. Human sinuses, for example, are as large as they are simply to provide cooling to the brain. If humans had smaller sinuses, the brain could not be as large as it is. The metabolic requirements are so extreme that most of the development of the brain must take place in utero, where nutrition can be supplied by the mother through the placenta. This is why children are born with such large heads and with baby fat. The human brain grows as much as possible in the womb and then relies on the baby fat to continue meeting it's extreme nutritional needs once the child is born. An infant simply could not process enough of the mother's milk in its intestines to permit the continued growth of the human brain.

The human head, at birth, is oversized. Before medical treatment became available, the risk of death in childbirth of either the mother, the child, or both the mother and child balanced the benefit of having the child be born with a larger brain. Medical treatment changed that balance somewhat, but the concomitant improvement in nutrition counters that advantage somewhat.

Medical Intervention in Delivery

With modern methods, delivery can be accomplished either via "normal" childbirth or by Cesarian section (C-section). Normal childbirth carries a host of risks which doctors attempt to mitigate. The C-section is one of those ways doctors deal with the danger of childbirth. If the mother or child cannot easily tolerate a normal birth, a C-section is performed. This decision is not always easy, and it's not uncommon for a normal birth to suddenly be switched to a C-section due to changing conditions. C-sections are surgery, though, and carry their own risks for the mother. No surgery is benign.²

Both normal childbirth and C-section carry a risk to the life and health of the mother. Neither is benign. The stress on the body, heart, respiratory system, circulatory system, brain, and other organs is significant in either case. Normal childbirth carries with it an additional risk, the introduction of amniotic fluid into the mother's circulatory system. This fluid does not behave like blood and is often fatal or results in significant permanent damage to the mother. C-sections carry with them the risk of infection, blood clots, and medical errors. I've discussed only a few of the possible dangers. Should you be interested, feel free to compile your own list — it will be extensive.

The choice to assume these risks is one that most parents are willing to accept. This is also probably why humans have most of their children before their parents lose the illusion of immortality. The ability to realistically evaluate this risk/benefit ratio may be deliberately impaired by the design of the human brain as part of the strategy for continued human survival.

In talking about risks, it's worth remembering that "Partial Birth" abortion is also a medical procedure. Because the intact infant head does not pass through the birth canal, it lacks some of the classic risks of childbirth and has far fewer than a C-section. Still, it too is a medical procedure that carries it's own risks.

The Need for "Partial Birth"/IDE Abortions

Both the Pro-Life and Pro-Choice sides of the abortion debate have tremendous emotional involvement in the debate. As a result, neither side can be trusted to provide an unbiased answer to the question "Is 'Partial Birth' abortion ever necessary?"

The Pro-Life side claims that Partial Birth" is never necessary. They contend that all risks can be adequately managed by C-section. From the discussion above, it should be obvious that is not always the case. The IDE obviates the need to make an incision in the mother's abdomen or to deal with the passage of an intact head through the vaginal opening.

The question is rather, is it worth the risk to deliver a living child? In extreme cases, the answer is obviously "no." IDE is a preferred method for dealing with a child that dies late in utero. There are serious questions as to whether the current law, as crafted, might actually prohibit even this use of IDE. Even though one would hope the current law was not intended to ban IDE in this situation, how it will be implimented is another question. Forcing a mother, grieving over the loss of her child, to defend herself against murder charges sounds exactly like the sort of idiocy our court system regularly manages to produce.

A more disturbing question is the incipent birth of a child with Trisomy 13, Trisomy 18 or extreme anencephally. None of these children will live for a significant time after birth. The risk of a normal childbirth or C-section becomes significant in comparison to the benefit of delivering a child that will not survive. I personally know a woman who continued a pregnancy where the child was known to not be viable. She chose to continue the pregnancy in the hope that bones and organs could be harvested when the child died. This was her choice, and one I greatly admire. But we as a society do not force civilians to rescue others; those who do so, either professionally or as volunteers, have made a personal choice. We cannot demand that all pregnancies be carried to term, at risk of the mother's life, to harvest parts for transplantation.

In the case where a child cannot survive for significant time outside the womb, a reasonable individual may decide to terminate the pregnancy. This may not be acceptable to all religions, but this is not a place where another's religion should have the ability to force another to make a specific choice.

It's worth pointing out that in the cases of Trisomy 13, Trisomy 18 and anencephally, abortions earlier in pregnancy would seem to be a wiser course. It may be that another form of abortion in the late stages might be preferable to "Partial Birth." For most in the Pro-Life movement, that's no more an acceptable option, so to argue it would be disingenuous. Sometimes genetic abnormalities are either missed or not tested for. The examples cited also stand in substitute for abnormalities that might not be discoverable until late in pregnancy. They are rare, this is true. But can we say to someone confronted with a rare medical abnormality "We're sorry, but statistically, you don't count?"

I can think of other situations where "Partial Birth" Abortion/IDE would be necessary. In the case of a pulmonary embolus, stroke, or myocardial infarction of the mother, the mother's life might be so tenuous as to require the death of the baby to save the mother. Some might choose to save the child and risk the mother's death. That is their choice, but this is not the sort of decision we as a society should attempt to dictate. Again, to risk one's life for another is, in our society, an option, not a mandate.

Life Vs. Health

Making an exception for the life of the mother is, to me, obvious. Health is a little more questionable. How big a stroke in the mother's brain is worth the life of a child? I don't know, and I don't think that's the sort of question our politicians are good at answering — or have any business answering. Do we really have any business forcing someone to choose one way or another?

Psychological reasons for abortion do exist. Certain psychoactive medications are totally contraindicated in pregnancy; to use them in such a setting is worse than an abortion. To not be able to use them, when other drugs, talk therapy, and ECT do not work, might well elevate a psychological risk up to a matter of life and death. Forcing someone to go through 9 months of insanity under constant suicide watch is not reasonable, and would probably result in permanent mental damage.

To claim that suicide under such circumstances is a moral failing of the patient would be to completely fail to understand the nature of most mental illnesses.

On the other hand, if gestation is far enough along but the question is the mental health of the mother didn't result in an abortion far earlier, I can't honestly see any difference in the mother's health whether there is a delivery or abortion. An abortion for psychological reasons when a child is viable doesn't make sense. I'd be fascinated to learn of a scenario where it would be both plausible and reasonable.

Deciding what the acceptable trade-offs are will not be easy. Avoiding difficult decisions by making a patently absurd decision is not an acceptable method of dealing with difficulties.

The Loophole Argument

Some have argued that a clause permitting "Partial Birth" Abortions/IDE to preserve the health or life of the mother creates a loophole one could drive a Mac truck through. The argument is made that such abortions are so rarely necessary that the occasional death of the mother is an acceptable loss. Some Catholics have even argued that because sex carries the taint of sin with it, and because the mother chose to have sex, the mother should be willing to die rather than be a participant in the death of an innocent — even if in dying the child will also die.

Neither argument seems reasonable. In the latter case, I once again suggest that just because someone says something does not obligate one to consider that position. To the former, to say that someone should be left to die for policy's sake is unacceptable. Devising a mechanism that would permit review of necessary "Partial Birth" abortions might be difficult; one could anticipate both sides attempting to abuse such a review. But frankly, that's legal mechanics. Working it out may be difficult, but that difficulty is no reason to condem someone to death who might otherwise have lived.

Conclusion

Had a law banning "Partial Birth" abortions included an exception for the life and health of the mother, President Bill Clinton would have signed the law. The Pro-Life group insisted that no such exepmtion be permitted in the law. The death of all the children thus aborted can only be placed at the feet of the extremists in the Pro-Life group.

I have been told that because I feel this way and because I am not opposed to contraception as well, I am not Pro-Life. So be it. I'm rather surprised to hear I'm Pro-Choice. I suspect the "Pro-Choice" folks would be no happier to have me in their camp than the Pro-Lifers. Of course, my typical response would be that if I'm honking off both sides in a terrible argument, I'm far more likely to be right than anyone else.

I would point out that such a definition of Pro-Life clearly and unequivocally puts the majority of people in "Not Pro-Life" camp. I seem to spend a lot of time thinking about strategy, and I'm certain this particular strategy is amazingly counter-productive.

The lack of an execption clearly violates the American tradition of the right to self-defense. I hope the Supreme Court will take a reasonable stand on this law, upholding the law in all cases except where the life or health of the mother is at risk. By banning the enforcement of the law in such cases (as it did in another recent decision), the Supreme Court can reach a sane compromise to a difficult situation.

Should they reach a reasonable compromise as I suggest, expect Christian fatwas to be issued by Pat Robetson and Ann Coulter and the ilk. We'll have stuff to blog about for years to come. Come to think of it, no matter what the Supreme Court decides, expect everyone to spaz out.

1. Update: Once again, I am limiting the discussion to one particular area. In the case of a difficult problem, I find it useful to pick some small segment of the problem to work on. At the extremes, the problem often simplifies itself. In this case, discussing whether life begins at conception in no way affects the discussion, and so I'm ignoring the question at this time. [back]
2. The recent insistence on C-sections by hospital and physician insurers is a topic for another time. [back]