20070202

More "A Moderates View on Abortion"

I was once again thinking about the abortion issue from my own point of view, which I like to describe as being a "moderate's" point of view.

(See here) where I last took up the issue in any great detail. In that piece I explored whether it would be possible to resolve the abortion issue by defining at what point that which is developing in a woman's womb is "a person", and as "a person" would enjoy all the other rights of us "persons" (including the right to life). I wondered when the brain had developed enough so that the "fetus" (or whatever you wish to call it) is capable of "human thought".

Now in my piece, I had remarked:
I do not know at what stage of development the fetus starts to think.

Well, my recent explorations of the internet have helped me narrow to which state of development it is now my opinion this occurs. More on this later. First I want to point out the interesting discussion I had on this subject in the comments section of my last piece with Michael Tam. Michael Tam is an Australian citizen studying to be a Doctor. In American terms, I think we would describe him as being an intern. Michael, with his superior knowledge of medicine, was able to prove over and over in our discussion my own ignorance on the subject. But please note that Michael either did not know the answer to my concern, that being at which point does the "fetus" or "premature baby" start to think, or else he was intentionally with-holding any evidence of the point in the development within the womb this happens. Michael revealed that he was more concerned about the rights of the mother to receive an abortion after the point modern medical science can determine whether or not the fetus was developing "normally" then he was about protecting the rights of the fetus when it would, by my definition, qualify as being a "person". I will note that I would describe Michael Tam as being unreasonably pro-choice because he seemed to want to allow unrestricted abortions even late into the pregnancy because his viewpoint is that the "baby" is "asleep" (or in a state of anaesthesia) until late in the pregnancy.

Now, what have I stumbled on that has helped me narrow my opinion on when a fetus becomes a "person"? I am first going to give credit to tigtog at tigtogblog for pointing me towards the evidence in (this piece) which presents a lot of factual analysis interlaced with some opinion. Please note that while tigtog makes a convincing argument for when cognition probably occurs within the fetus, she herself is not willing to accept this determination as being an acceptable point to determine when most abortions should be allowed. She herself, in the ensuing comments section, reveals she seems to be in favor of the viability argument (which is the minimum criteria most pro-choice extremists defend and insist upon).

A better analysis of the subject, with less one sided opinion, is (this piece) by Margaret Sykes that appears at eileen.250x.com, and it is from this piece that I am going to lift my quotes as I discuss the issue.

First I am going to reveal my own ignorance on the subject and ask anyone who has knowledge on this one point to help me clear up my own personal confusion about the difference between "gestation" and "conception". Apparently, there is about a two week difference between the two and my attempts to clear up my confusion have been unsuccessful. For example, when I enter gestation into the Merriam-Webster online dictionary, I get back: "2 : conception and development especially in the mind". Egads, Merriam-Webster uses one word to define the other but there is supposed to be a slight difference between what the two words mean!

Margaret provides this quote from the review article Pain and its effects in the human neonate and fetus," by K.J.S. Anand, a leading researcher on pain in newborns, and P.R. Hickey, published in the NEJM:
Functional maturity of the cerebral cortex is suggested by fetal and neonatal electroencephalographic patterns...First, intermittent electroencephalographic bursts in both cerebral hemispheres are first seen at 20 weeks gestation; they become sustained at 22 weeks and bilaterally synchronous at 26 to 27 weeks.

OK, now we're getting somewhere. Brainwaves from other then the brain stem (which has nothing to do with cognition) are first, intermittently noticed at 20 weeks gestation (which I guess would be 18 weeks after conception). So it is at this point, I guess, that neurons and synapses within the cortex of the fetus start to function. Prior to this point, nothing is going on in the brain of the fetus that in any way could be described as "human thought".

That just about sums it up for me. The "embryo" or "fetus" is not a "person" prior to 20 weeks of gestation (or 18 weeks after conception) and up to this point, I would agree that a woman should have the "right to choose" because that which inside her is incapable of thought. Perhaps I would desire to further narrow the "permissive zone" by an additional couple of weeks, just to be on the safe side and protect the "early developer", but now I believe that I have at least a zone that I can narrow my reasoning where there is no "person" being harmed when a woman chooses to have an abortion. Until it can think for itself, it is nothing but a clump of cells with ONLY the POTENTIAL of becoming a thinking human being.

Certainly I can now come to the decision that unrestricted rights to an abortion should be enjoyed by all women throughout the first trimester. During this period, it is no more harmful for a woman to terminate the pregnancy then there would be harm for her to have a cyst or cancerous tumor (or any other unthinking clump of cells) cut from her body. There is no "person" being harmed by her chosen action.

Now, I have made my mind up. I will still be open to arguments that the evidence presented is not valid or factual, however the evidence I have thus far encountered is pretty convincing.

I am not going to argue that this is going to convince everybody. Pro-life extremists are still going to argue that it is wrong to even use a condom for birth control even though with the use of a condom there is not even conception (and I still am willing to agree that "life" begins at conception - however that life is not yet capable of thinking for itself) while pro-choice extremists are going to continue to insist upon the right to terminate the pregnancy all the way up till the umbilical cord is cut after the baby is born because up till then it is still, technically, part of the woman's body.

To accentuate my point, I wish to point (to this) piece by Ned Williams that appears at nedwilliams.wordpress.com. Now please note that this piece actually begins on the subject of homosexuality and the resulting discussion first starts off on this subject. However if you continue to scroll through the comments, you will find where elliemay breaks the subject of when the fetus becomes a person by seeming to quote from some of the same subject matter addressed in the two pieces I linked to earlier. However notice how, while elliemay uses the subject matter to argue that a fetus is not a "person" prior to 20 weeks after gestation, she later reveals that she would not be willing to compromise on even this determination when she states:
I would be in favor of restricting late term abortions where the fetus is viable outside the mother. Don’t twist arguments, just obey the law and don’t mess with my rights. By every poll ever taken America is pro-choice as it should be. Find another battle.

So while elliemay made a convincing argument, she is unwilling to abide by where her argument leads. I also wish to point out that even "anti-gay, strongly pro-life, conservative extremist" Ned Williams seems to show a willingness, at least for arguments sake, to compromise when he asks:
Now, again, focus: can I count you in on a law prohibiting abortion after the 5th month of pregnancy?

I would have replied to Ned that we're probably talking about something like prohibiting unrestricted abortion after about the 4th month, not the 5th month, while allowing for some very restrictive exceptions after that. (Just what would compromise an exception? That starts up another argument, let's first come to terms on what should be permitted under the majority of cases first!)

Now I also wish to take elliemay to task for her statement, quoted above, about every poll taken showing America to be pro-choice. I will point to (these polls) which include a CBS poll conducted on Jan 18-21, 2007 that shows 63% of Americans think there should at least be "greater restrictions" on a woman's right to abortion and only 31% thinking a woman should have the right to an abortion in "all cases". In fact, this same poll shows that levels perilously close to a majority, 47%, think abortions should at a minimum be restricted to cases involving rape, incest or when the woman's life is in danger. It would seem that the pro-choice crowd are most in danger of completely losing everything they value if they exhibit an unwillingness to compromise on the issue, and perhaps they are the least willing to compromise. (I will acknowledge that if those polled were restricted to women only, the results probably would not be as stark.)

I guess I would have to describe myself as being "pro-limited choice". I see nothing wrong with forcing a woman, if she is going to continue to enjoy the right to choose, to make the choice early.

9 Comments:

Blogger Ned Williams said...

David,
I appreciate your reasoned approach to this issue (and others, from what I can see) and hope you'll visit--and contribute to the discussion at, my blog in the future.

2/03/2007 12:14:00 AM  
Blogger Michael said...

I'm glad that our discussions in the past has had you thinking but I would like to make a few corrections.

Firstly, I am not studying to become a doctor. I AM a doctor and have been so for 5 years. That is, I am not an intern. I am not sure how my position is analogous to the American system -- probably somewhere around chief resident (excpet that I've left hospital to work in private practice).

Secondly, you mischaracterise our previous discussions. I am not a rabid "pro-choice" advocate. With regards to our previous discussions on when a foetus starts to think, I maintain that it was not a good criteria. I'll reiterate the key points:

1. There is no real way we can measure this.
2. EEG activity does not equal thinking.

Further, look at the NEJM article you linked: all activity seems to be post 20 weeks. Does this then justify post-20 week terminations? I do not believe so.

Why?

The key to my criteria is pragmatism. The question being: at what stage can a foetus survive alive independently ex-utero (i.e., delivered)?

We know that with intensive modern neonatal care, that the cut off is around 20 weeks. As such, regardless as to whether an embryo is thinking or not (and the answer is probably not) I do not think that it is ethical for a termination of pregnancy after 20 weeks unless the mother is in dire medical risk.

In Australia at least (and most Western nations), the cut off for a termination is 20 weeks.

Cheers.

2/03/2007 04:29:00 AM  
Blogger Little David said...

Ned,

Thanks, I just might do that.

2/03/2007 08:56:00 AM  
Blogger Little David said...

Michael,

Congratulations on becoming a full fledged Doctor. I think I was mislead by the self description you had posted on your blog, which I first saw several years ago and which may not have itself been updated for several years.

Anyway, I should have realized on my own that significant time had passed and that by now you would have either become a full fledged Doctor or you would have washed out. I should have been confident that you would have been too intelligent to have washed out.

I think I might be in agreement with you on approximately where the cutoff for most abortions should be, however I differ with you on the reasoning behind it. I am troubled by "pragmatic" arguments that rest only on "viability".

My own justification for my viewpoint is the evident limits of modern medical science to determine my criteria for when a fetus becomes a person. Until medical science can come up with a better determination of when this might happen (which may be never) I am going to insist that when the brain has developed enough so that there is evidence of some organized electrical activity within the cortex (that is until we until we know more), this should be the cutoff point.

2/03/2007 09:29:00 AM  
Blogger Michael said...

Eh... I was already a doctor when we last had our discussion as well. In fact, I did not even start that blog until after I was an intern and the your first comment was 3 years into the life of the blog.

In any case... ;-)

With regards to your criteria, my criticism still remains. I do not believe that we can show a foetus is thinking in utero. In terms of the capacity to think, I think that it will be shown in the longer term that it will be beyond 20 weeks gestation.

As before, if a foetus is viable ex-utero but not yet capable of thinking, which is more important? I think its viability is.

Presumably with advance of medical technology, the age of viability for a foetus will progressively go down in terms of weeks of gestation. I do not see this as a criteria changing for a while.

Regards.

2/03/2007 09:38:00 AM  
Blogger Michael said...

Note: I don't know if Americans use the term "registrar" but in Australia, it is a level above resident.

Cheers.

2/03/2007 09:40:00 AM  
Blogger Little David said...

I think you might be onto what mislead me. I am ignorant of the term "registrar".

No, I want to settle this issue once and for all.

With advances in medical science, while it might never be able to determine when the fetus actually "thinks" probably will push the limits of what is considered a "viable" fetus into earlier and earlier stages of pregnancy. I think a good argument could almost already be made that the single cell that results after conception is already viable. If it is removed from one host mother and placed into another, it would continue to develope. As medical science continues to evolve, an artificial environment that provides all the life support necessary for such a single cell to "be viable" will one day be possible.

I think my own determination, grounded on some semblance of morality (although pro-life extremists will hiss at such a statement) is more elegant.

What makes me a "person"? If medical science could remove my brain and place it in jar with life support, would I reside in the jar or would I reside back on the operating table where my body lays absent a brain?

What is it the is special about the brain the enables "human thought"? It is all the electrical activity between neurons etc etc correct?

When does similar activity first become evident within the fetus? Evidence is this first normally only happens 20 weeks after gestation.

Do I need to drive home my point with a sledge hammer or will taps from the carpenter's hammer suffice?

2/03/2007 10:25:00 AM  
Blogger Michael said...

Viable ex-utero - i.e., the foetus is able to survive (with medical support), grow and develop without the need of the mother's body.

It will go earlier but probably not much earlier. It is very doubtful whether it can be accomplished prior to organogenesis.

As before Little David, what if we are able to establish that foetuses are not CAPABLE of thought (due to neurological development) before (hypothetically speaking) 22 weeks? By your definition, does that mean that it is henceforth acceptable to abort a 21 week gestation pregnancy? However, in this hypothetical time frame, a baby who is prematurely delivered at say 19 weeks can be reliably kept alive and develop in a neonatal unit?

Surely if the mother wishes to abort, even in the worst case scenario the moral action would be to DELIVER the child.

Regards.

2/03/2007 11:58:00 AM  
Blogger Little David said...

My determination is at what point does the developing brain first exhibit signs of neural activity within the Cortex. Not "any" activity such as that introduced due to external stimulus, but self generated activity.

Evidence, thus far, is that this does not happen in most cases, even intermittently, prior to 20 weeks gestation.

Medical science might come up with more sensitive instruments that record earlier evidence of more minute electrical activity in the fetus, however at some point a finite point is going to be reached.

A single cell "individual" will not evidence any "brain activity" since the brain has not yet been formed.

To answer you questions. If medical science proves that electrical activity in the developing brain (other then the brain stem) exists prior to 20 weeks this discovery should be taken into account.

However, if a mother chooses to abort a pregnancy prior to this happening, even if medical science would capable of "saving" the potential human being, it would be up to the mother to choose.

The mother gets to choose whether or not her tissues can be used to save the life of another human being because the tissues she would donate are by themselves incapable of "thought".

Until the fetus progresses so far that it is capable of independent thought, the mother retains all rights to decide for the tissues that are not thinking.

Once the mother allows the "tissue" to become capable of independent thought, society can intervene to protect the rights of that which, until then, was only tissue.

All of this depends upon acceptance of the defintion of a "person" as being that which is capable of unstimulated, self generated, organized electrical activity within the cortex.

2/03/2007 12:41:00 PM  

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