* For an assignment for an ethics class for my MA program at Biola University with Dr. Scott Rae.
Moral Choices: An Introduction to Ethics—4th ed. By Scott Rae (Zondervan, 2018), pp. 163-164
Case 5.2
You and your spouse have found out in the last few weeks that child with whom you are pregnant has been diagnosed with anencephaly, a fatal genetic disorder in which the cerebral cortex of the brain does not develop at all. The skull is somewhat flat and quite deformed looking. Only the brain stem, which controls all the nonvoluntary actions of the body, such as heartbeat, respiration, and digestion develops. The child will be born in a permanent vegetative state and is not likely to live longer than a few months, though some have lived as long as a year. At present the pregnancy is just into the second trimester.
Your physician has recommended ending the pregnancy as soon as possible. Your doctor want to avoid labor and delivery for you, and there are some additional risks in a natural delivery of an anencephalic child due to the larger shape of the baby’s skull. A cesarean section would not carry those risks, but that is a more invasive way to deliver the baby. You have strong feelings about the morality of abortion when done for nonmedical reasons. You wonder if this child is actually a person, since he or she will be born with only a brain stem and no higher brain.
Questions for Discussion
1. What are the primary moral issues to be resolved in this case?
2. What decision will you make? If you choose to end the pregnancy, what will you tell your neighbor, who knows how you feel about abortion in general? If you choose to carry the pregnancy to term, what will you tell your doctor, who insists that you are carrying a terminally ill child who will die shortly after birth, and you are subjecting yourself to unnecessary risks and emotional heartache?
3. Your physician suggests that ending the pregnancy is parallel to turning off life support from terminally ill patients who are going to die very soon because keeping the person on life support is futile. He argues that your womb is the equivalent of a life support system for the baby and you are simply turning it off because the child will be born with a terminal illness. Do you agree with the doctor’s reasoning? Why or why not?
Primary moral issues
Some of the key moral issues in this scenario are as follows:
· Should the pregnancy be terminated or not?
· Should the mother be placed in a difficult and risky situation with potential harms to her health?
· Should we seek to alleviate or mitigate the risk to the mother’s health?
· How does one balance the life and health of the mother and the value of the fetus?
· How is a person’s character best expressed in light of their fundamental values?
· How will the choice affect one’s moral character?
· What is the nature of the pre-born entity in this case? Does the failure of the cerebral cortex entail a lack of full personhood?
Decision made and what to tell the doctor
I believe my wife and I would choose to go ahead with the pregnancy and chose to deliver the child in the manner most conducive to her health and the health of the baby. The doctor’s argument, “you are carrying a terminally ill child who will die after birth, and you are subjecting yourself to unnecessary risks and emotional heartache” would need to be answered in the following manner.
First, the nature of our Christian worldview is such that a specific value structure flows from it. It is here that reality of the integration of metaphysics, epistemology, and ethics would come out. My metaphysical (or, ontological) assumptions are such that there is a God who is the Creator of all things, sovereign, good, and omniscience—to name just a few of the key elements relevant to the decision. Further, human beings are composed of more than mere matter. I deny physicalism and allow for an immaterial soul.[1] In terms of epistemology, I hold to the validity of empirical scientific knowledge but also to natural revelation and special revelation as valid modes of knowledge. Philosophical reasoning based on the nature of the human person is possible. Furthermore, as a Christian I affirm that there is scriptural revelation in the Bible that is relevant to the situation. Both philosophical reasoning and scriptural data give us insight into the nature of the human person as well as provide guidance for the values to be pursued and exemplified.
A full case from the Bible for the personhood of the pre-born entity from the moment of conception could be given. The cumulative case argument would include the following items:[2]
i. The Bible makes a distinction between conception and birth. The biblical writers demonstrate an awareness of the life of the unborn.
· Hosea 9.11; Ruth 4.13; Isaiah 7.14
· Genesis (11xs): 4.1, 17; 21.2; 29.32, 33, 34, 35; 30.5, 19, 23; 38.3, 4
ii. Personal language is applied to the preborn.
· Genesis 4.1; Job 3.3; Psalm 51.5
iii. Personality traits are attributed to the fetus in utero.
· Genesis 25.22; Luke 1.41, 44
iv. The unborn are called “children.”
· Luke 1.41, 44—Greek word for baby (brephos) is applied to unborn
· Cf. Luke 2.12 where this word is applied to newly born Jesus
v. The unborn are known by God in a personal way.
· God oversees the development of the fetus: Job 31.13-15; Psalm 119.73; Psalm 139.13-16
· God relates personally to the unborn in preparing them as individuals for a specific calling: Isaiah 49.1; Jeremiah 1.5; Judges 13.3-5; Romans 9.11; Galatians 1.15
Philosophical reflection upon the nature of personhood also moves me to consider to the full personhood of the human from the moment of conception. It is important to grasp the nature of this point. In popular pro-choice argumentation it is sometimes alleged that no one knows when a human being comes into existence. This is scientifically false. There is widespread agreement that at the moment of conception a human being is brought into existence.[3] Even the radical pro-choice philosopher and defender of infanticide, Peter Singer, acknowledges this point:
It is possible to give ‘human being’ a precise meaning. We can use it as equivalent to ‘member of the species Homo Sapiens.’ Whether a being is a member of a given species is something that can be determined scientifically, by an examination of the nature of the chromosomes in the cells of living organisms. In this sense, there is no doubt that from the first moments of its existence an embryo conceived from human sperm and eggs is a human being.[4]
What is at issue is whether the human life which is in existence from the moment of conception should be accorded “personhood”—the value and dignity accorded to persons. This is a philosophical question which cannot be adequately addressed by merely a biological examination.
I affirm the full personhood of the human from the moment of conception. This understanding of personhood rejects “decisive moment” metrics after conception at which personhood is attained. There are different criteria offered by various viewpoints as to when the benchmark of personhood is reached: detectable brainwaves, viability, sentience, cognitive actions comprising complex communication, birth, and even after birth.[5] Until such criteria are met the pre-natal human life is, at best, only a “potential person.” This view of the human person is functionalist in nature; only if an entity possesses a certain specified set of properties can it be considered a person. The alternative view, which I affirm, is that of a substance view of the human person. Francis Beckwith articulates this understanding of personhood:
Because one can only develop certain functions because of the sort of being one is, a human being, at every state of her development is never a potential person; she is always a person with potential even if that potential is never actualized due to premature death or the result of the absence or deformity of a physical state necessary to actualize that potential.[6]
Such a substance view of the human person entails that the anencephalic child in the womb is a person with a damaged developmental system. She is nevertheless still a human person. As a human person she has all the capacity for higher mental functions, but a developmental error has not allowed the latent capacity for these higher mental functions to develop. Nonetheless, she is the kind of entity—a human being—with the capacity for such functions. Patrick Lee helpfully explains this view when he argues:
But there is a sense in which human embryos and fetuses also have a capacity for higher mental functions. Human embryos and fetuses cannot of course immediately perform such acts. Still, they are related to such acts differently than, say, a canine or feline embryo is. They are members of a natural kind—a biological species—whose members, if not prevented by some extrinsic cause, in due course develop the immediately exercisable capacity for such mental functions. The fact that they do shows that members of this species come to be with whatever it takes to develop that immediately exercisable capacity, given a suitable environment and nutrition, and that only the adverse effects on them of other cause will prevent it.[7]
Such a view of the human person allows me to see the child in the womb with anencephaly as a full human person with damage to their development. But a damaged person is still a person and should be accorded the full range of love and protection as befits their status as a human person.
The above view of the human person as a substance-kind of entity also helps to answer the doctor’s concerns regarding “unnecessary risk and emotional heartache.” Yes, there is increased risk in the pregnancy but since there is a human person involved this risk is not unnecessary. It is precisely this kind of risk that may manifest one’s character—an aspect of virtue ethics. The virtuous person will risk in appropriate ways for the sake of others—especially when that other is one’s own child. This concern for virtue ethics and one’s character also serves to nuance the role of suffering in the “emotional heartache.”
There will be the suffering of heartache but this, too, is in alignment with the Christian worldview. Daniel Hurst accurately notes the dynamic of suffering in the Christian life:
The notion of suffering and its ability to produce character and make possible a deeper experience with God is littered throughout Scripture. This is a point that opponents to our position will not be fond of, yet it is one that Christian tradition and Scripture stand upon and must not forfeit.[8]
Not only this, but there is also the consequence that flows from those who nobly suffer in the cause of love—they become moral exemplars to others. They serve to manifest a unique kind of love which both allures and motivates others to acts of love in the midst of suffering.[9]
The doctor’s analogy
In this scenario the doctor has suggested “that ending the pregnancy is parallel to turning off life support from terminally ill patients who are going to die very soon because keeping the person on life support is futile.” In his argument, the womb is equivalent of a life support system for the baby and that one is simply “turning it off because the child will be born with a terminal illness.”
The doctor is correct that there can be morally appropriate times to “turn off the life support” for someone who is terminally ill. It is not required that one always do everything possible to avoid death. Gilbert Meilaender writes:
Nevertheless, the fact that we ought not to aim at death for ourself or another does not mean that we must always do everything possible to oppose it. Life is not our god, but a gift of God; death is a great evil, but not the ultimate evil. There may come a time, then, when it is proper to acknowledge death and cease to oppose it. Our aim in such circumstances is to care for the dying person as best we can—which now, we judge, means withdrawing rather than imposing treatment.[10]
Where the doctor’s reasoning goes astray is in his failure to recognize the disanalogies in his parallel between life support and the womb. His reasoning is, thus, a faulty comparison that fails to accurately reflect the difference between the two cases.
First, a life support system for a terminally ill patient is an artificial environment whereas the womb is the natural place for fetal life to be. There is a prima facie case to be made that the fetus has a right to the mother’s womb. As Francis Beckwith notes: “This period of a human being’s natural development occurs in the womb. This is the journey which we all must take and is a necessary condition for any human being’s post-uterine existence.”[11]
Second, in the act of aborting the anencephalic child one is not merely “turning off life support.” One is actively aiming at the death of the developmentally challenged child. Nor can the death of the child in this scenario be justified under the guise of “double effect” reasoning. Double effect reasoning is as follows: “It is permissible to do one action with two effects, one good and one bad, so long as the action itself is ethically acceptable, the evil effect is not chosen as a means or as an end, and there is a proportionately serious reason for allowing the evil side effect.”[12] In the abortion of the anencephalic child, however, the evil effect (the death of the child) is chosen as an end—the goal is to produce a dead child. Thus, the doctor’s “parallel” between life support for a terminally ill patient and abortion of an anencephalic child is without merit.
[1] The substance dualism I hold to is more in line with a Thomistic view of the soul rather than a strict Cartesian view. See J. P. Moreland, “In Defense of a Thomistic-like Dualism” The Blackwell Companion to Substance Dualism, eds. Jonathan J. Loose, Angus J. L. Menuge, and J. P. Moreland (Wiley-Blackwell, 2018), 102-122.
[2] A fuller case utilizing this framework is available in my essay, “The Bible and Abortion: Making the Case for Respect for Pre-natal Life from Scripture,” White Rose Review (July 17, 2022)—online: https://whiterosereview.blogspot.com/2022/07/the-bible-and-abortion-making-case-for.html.
[3] See "The Origin of Human Life at Fertilization: Quotes from Medical Textbooks and Peer-Reviewed Scientific Literature" by M. L. Condic (September 2017)—online: https://bdfund.org/wp-content/uploads/2016/05/Condic-Sources-Embryology.pdf-old
[4] Quoted in Christopher Kaczor, “Abortion as Human Rights Violation,” in Kate Greasley and Christopher Kaczor, Abortion Rights: For and Against (Cambridge: Cambridge University Press, 2018), 91. Kaczor is quoting from Peter Singer, Writings on an Ethical Life (New York: Ecco Press, 2000), 127.
[5] Mary Anne Warren, for example, delineates the following criteria of personhood: consciousness, reasoning, self-motivated activity, capacity to communicate and self-concepts with self-awareness. See Mary Anne Warren, “On the Moral and Legal Status of Abortion,” The Monist 57.1 (1973), 55. Warren was forced to admit that such a high bar for personhood would not be met by a newborn infant and, thus, would justify infanticide. This reasoning was also taken by Alberto Giubilini and Francesca Minerva in their essay arguing for the moral permissibility of infanticide, “After-Birth Abortion: Why Should the Baby Live?” Journal of Medical Ethics 39 (2013), 261-263.
[6] Francis J. Beckwith, “The Explanatory Power of the Substance View of Persons,” Christian Bioethics 10 (2004), 36.
[7] Patrick Lee, “A Christian Philosopher’s View of Recent Directions in the Abortion Debate,” Christian Bioethics 10 (2004), 14.
[8] Daniel J. Hurst, “Physician-Assisted Suicide and Euthanasia: A Slippery Slope Indeed,” The Ethics & Religious Liberty Commission Blog (July 29, 2015)—online: https://erlc.com/resource-library/articles/physician-assisted-suicide-and-euthanasia-a-slippery-slope-indeed/.
[9] For a deeply moving reflection and example of this see Aaron D. Cobb, Loving Samuel: Suffering, Dependence, and the Calling of Love(Eugene, Ore.: Cascade Books, 2014). Cobb and his wife discovered that their pre-born child had Trisomy 18 and would only live a few hours, if born at all. Cobb’s reflections on love and suffering are profound and exemplary.
[10] Gilbert Meilaender, Bioethics: A Primer for Christians (Grand Rapids, Mich.: Eerdmans, 1996), 71.
[11] Francis J. Beckwith, “Personal Bodily Rights, Abortion, and Unplugging the Violinist,” International Philosophical Quarterly 32.1 (1992), 113. Beckwith adds, “the unborn entity is a human being who is by her very nature dependent on her mother, for this is how human beings are at this stage of their development.”
