Thursday, November 27, 2014

A Moral Theory’s Immoral Outcome

PRINCETON – Is it always wrong to take an innocent human life? Many philosophical defenders of the Roman Catholic natural-law tradition argue that there are no exceptions to this prohibition, at least if we are talking about taking the life intentionally, and directly, rather than as a side effect of some other action. (These moral theorists also define “innocent” to exclude enemy combatants, as long as the war one is fighting is just.)

When this view is combined – as it typically is in Catholic teaching – with the claim that every offspring of human parents is a living human being from the moment of conception, the implication is that abortion is never permissible. But the case of a 22-year-old El Salvadorian woman, identified in the media only as Beatriz, makes the absoluteness of that view very difficult to defend.

Beatriz, the mother of a young son, suffers from lupus, an autoimmune disease, and other complications. Her first pregnancy was very difficult. Then she became pregnant again, and her doctors said that the longer the pregnancy continued, the greater the risk that it would kill her.

For most women, that alone would be sufficient grounds to terminate the pregnancy. But Beatriz had an additional powerful reason to do so: the fetus had anencephaly, a condition in which the cerebral cortex, the part of the brain associated with consciousness, is absent.

Almost all babies with this condition die soon after birth; the few survivors are incapable of responding even to their mother’s smile. In countries with prenatal screening and liberal abortion laws, anencephaly has become very rare, because almost all women who are told that they are carrying an anencephalic fetus choose to terminate the pregnancy.

While traditionally Roman Catholic European countries like Italy and Spain have liberalized their abortion laws, Latin America has remained true to the faith, maintaining some of the world’s strictest legal prohibitions. Last year, in the Dominican Republic, a 16-year-old girl with cancer was, for several weeks, refused chemotherapy because she was pregnant and the doctors worried that the potentially life-saving treatment might induce an abortion. Although the girl was later allowed to begin treatment, both she and the fetus died.

In El Salvador, abortion is prohibited without exception. In April, Beatriz’s doctors asked the courts to allow them to terminate her pregnancy on medical grounds, but were refused. On May 29, the Supreme Court denied Beatriz’s appeal.

To anyone concerned about human well-being – or, for that matter, human flourishing in general – such an outcome makes no sense. Aborting an anencephalic fetus ends a life that may be human, insofar as it is the life of a member of the species Homo sapiens; but it is a life that will have zero well-being, for the infant (if it lives) will be incapable of enjoying anything.

On the other hand, not permitting Beatriz to have an abortion would risk causing the death of a young woman who desperately wanted to live, and had much to live for. It would also risk depriving her one-year-old son of his mother.

After the Supreme Court’s decision, El Salvador’s health minister, Maria Rodriguez, announced that Beatriz would be permitted to undergo a “premature Caesarean section,” which she said was not an abortion, but an “induced birth.” That procedure was carried out on June 3; the anencephalic newborn died five hours later.

If that was supposed to be a better outcome than an earlier termination of the pregnancy, it is hard to see for whom it was better. It was certainly not better for Beatriz, who is still in intensive care, and for whom the long-term health impact of the pregnancy remains unclear. And how did it benefit the anencephalic infant to have another couple of months of life in utero, and then five hours of life outside?

One point overlooked in the discussion of Beatriz’s case is that the same Catholic natural-law theory that insists that killing an innocent human being is always wrong also provides a basis for arguing that it is not wrong to kill an anencephalic fetus. In innumerable texts, Catholic philosophers, theologians, and bioethicists argue that it is always wrong to kill innocent human beings, because, in contrast to nonhuman animals, they have a “rational nature.” Proponents of this argument use that term to include beings that are not yet capable of rationality but will become so in the normal course of their development.

The use of the term “being with a rational nature” is very broad, perhaps too broad even when applied to normal fetuses. To apply it to anencephalic fetuses requires a further, and much more dubious, step.

Thomas Aquinas, for instance, did not think that a rational nature is present in every member of the species Homo sapiens. He believed that some degree of development is necessary for the human animal to become a being with a rational nature. In the case of an anencephalic fetus, no such development is possible. It cannot become a rational being.

For that reason, even those who believe that it is always wrong intentionally to kill an innocent being with a rational nature should not have opposed permitting Beatriz to terminate her pregnancy. They should have embraced a humane solution that minimized the risk of a tragic ending to a story that was already sad enough.

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    1. CommentedCarlos Santos

      @Frances Kissling «From a medical, not religious view, one does not wait till such a patient is on death's door to act, but acts early enough to prevent disaster»
      Precisely: there were no grounds for acting medically - in the real situation, in the present case - from a technical point of view... But it was a "good" case for boosting the ideological agenda that human nature is just a stamp from society, not something we all are.

    2. CommentedMichael Staron

      Two comments about your last three paragraphs: (1) Thomas Aquinas did not believe that there were any humans who lacked a rational nature. Humans are necessarily (and essentially) rational animals. His position was that, prior to the creation of the human rational soul several weeks after conception, there is no human being there. Instead, there was some kind of other animal present, an animal which ceased to exist when God created the human being, which He does by creating a human rational soul and placing it into matter. (2) Almost no natural law theorists accept Aquinas' account anyway since it was based on arguments from a more Aristotelian milieu. All of this is to say that there is no bifurcation of human beings and their rational natures which would allow for what is suggested at the end of this essay, at least for Thomists and related natural law theorists.

    3. Commentedjorge rojas

      @Carlos Santos, Singer's argument still being valid even in the case you mention. Just the fact that a fetus had anencephaly is enough to sustain that the Catholic church shouldn't reject the killing of this being without a "rational nature" (according their own moral theory).

    4. CommentedCarlos Santos

      Reading the medical bulletins, we can see that she was never in danger because of her pregnancy, neither there was any evidence of renal insufficiency throughout the gestation ... Lupus, by itself, is not a contraindication to pregnancy. If you want to question the Catholic Church, please do so in your own arguments, not on someone´s else scientific grounds. Thank you.

        CommentedFrances Kissling

        @Carlos Santos. Each case is different and diagnosing at a distance risky. Her doctors felt she was in danger and appealed to the Supreme Court for permission to perform an abortion early enough to prevent possible loss of life or long lasting complications. Anibal Faundes, a leading expert from the International Federation of Gynecologists wrote of Beatriz: she "has the misfortune of suffering systemic lupus erythematosus (lupus), an autoimmune disease. Pregnancy often exacerbates lupus, with adverse effects on kidney function, potentially leading to accelerated progression to end-stage renal disease. In addition, pregnancies in women with lupus are at high risk for spontaneous abortion and premature delivery, intrauterine growth retardation, and a maternal complication called superimposed pre-eclampsia.

        These were the exact conditions Beatriz faced in her first pregnancy two years ago when she experienced complications of hypertension so severe she had to undergo a cesarean section at 32 weeks, and was then forced to spend several days in intensive care. Several complications arose post-partum in her premature baby, a son, but he survived in good condition and was back with his mother after 32 days under neonatal care. Beatriz, however, was not as lucky, and as result of the pregnancy she was left with chronic hypertension and a kidney dysfunction called lupus nephritis."

        From a medical, not religious view, one does not wait till such a patient is on death's door to act, but acts early enough to prevent disaster. A doctor acts on science, not religious belief.