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Leslie A.'s avatar

Many SM commenters seem to be forgetting about self-defence in their attempts to separate morality from utility. A fetus/baby is pretty much always an added threat to the mother in the short term. One could assert that having a child is also always a threat to one’s own liberty, even if at the same time the child in question is always innocent of malicious intent. Therefore, IF abortion is murder, then it must always be immoral, even in the cases of serious medical threat to the mother. Are we saying she has no right to defend herself against such threat? I bet anyone who says so would not feel the same about an attacker on the street.

Any attempt to separate morality from utility when it comes to abortion is a futile attempt to free abortion from degrees of complications versus reinstated opportunities.

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Steven's avatar

Medical triage ethics are well-established. Similarly, medical ethics also cover a variety of other situations of Innocent patients who present an involuntary threat to the health of others (mentally ill patient, carrier of a contagious disease, etc). Even at the height of COVID panic, when concentration camps were seriously being planned, I don't recall ANY medical authority arguing that it would be potentially justified to actively execute the infected for the safety of others.

Likewise, self-defense ethics are also pretty clear cut in law. Use of lethal force is generally only acceptable under conditions where a reasonable person believes they are in imminent danger from a lethal threat that cannot reasonably or reliably be stopped with less than lethal means available. Even if we accepted the rather dubious argument that pregnancy by itself represents a potentially lethal threat to the mother, it would very rarely meet the requirement of immediate lethal threat unless there are other medical complications actively happening (in which case triage protocols would be appropriate) and all other treatment options that preserve BOTH patients (reasonable and reliable less than lethal alternatives are available) would be legally mandated for attempt before escalating to lethal force.

AFAICT every "abortion ban" proposed or implemented in any State of the US already includes exceptions for medical triage situations. I've read the "Doctors told me 'your condition needs to get worse before we can legally kill your baby'" 'horror stories' about "further endangering women" by waiting until the threat is imminent before taking a life. It's unpleasant reading, sure, but not nearly as horrific to me as the accounts of partial-birth abortions. I've also read several rebuttals by legal and medical professionals pointing out that those doctors were either ignorant of the law or deliberately spreading BS, because they absolutely could have legally acted sooner if they genuinely had a reasonable basis that the abortion was inevitably medically necessary to save the mother rather than treatable by other means. The self-defense argument isn't so much ignored as already solved for.

You can't morally choose to kill somebody until the situation forces you to choose WHICH person dies, not IF somebody dies. Frankly, depending on your preferred answer to the Trolley Problem, you might not be morally allowed to deliberately kill someone even then. Most people regard acts of commission morally worse than functionally equivalent acts of ommission. Likewise, most people will recognize that an act that merely has a low probability of a negative outcome is not equivalent to an act that has a high probability of a negative outcome, much less equal to an act with a guaranteed negative outcome. Allowing the child to be born naturally (act of omission) may present a low probability of negative outcome for the mother, whereas killing the unborn child (act of commission) has a guaranteed chance of negative outcome for the child. I know quite a few philosophical and ethical frameworks, but none that can both admit the child is a human being morally equal to the mother AND support allowing the mother to electively kill her child (at least, no philosophical framework that doesn't likewise allow parents to electively murder their children at any age).

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Leslie A.'s avatar

There is no such thing as “well established medical ethics.” I believe that is the very reason for publications like Sensible Medicine? We are talking about humans making decisions with and for other humans. Not to mention continued advancements in medical technology, particularly fertility and genetic screenings, have made things quite gray.

The notion that any one person can predict an exact timeline of when a situation becomes critical is also a false premise. I may sincerely believe that I am about to die and that can be true or false but only one of those realities plays out and we can’t live out the other infinite possibilities. I might choose to use lethal force on an attacker even though that might not have been “necessary.” It will be other flawed humans who make that judgment for me as well.

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Steven's avatar

Hey Google, "Is medical ethics a required course in medical school?"

Yes, medical ethics is considered a required course for medical school in the United States, with all accredited medical schools incorporating ethics training as part of their core curriculum due to the Association of American Medical Colleges (AAMC) mandating adherence to ethical principles for graduates; meaning every medical student will take a formal ethics course.

Key points about medical ethics in medical school:

Mandatory: All U.S. medical schools require medical ethics training.

AAMC requirement: The AAMC mandates that medical school graduates demonstrate a commitment to ethical principles.

Would you like some textbooks on that?

https://letmegooglethat.com/?q=medical+school+textbook+medical+ethics

The oldest recognized treatise on medical ethics is considered to be the "Hippocratic Oath," attributed to the ancient Greek physician Hippocrates, which outlines ethical principles for doctors and is considered the earliest expression of medical ethics in the Western world. The Hippocratic Oath is over 2,500 years old. Yes, medical ethics are 'well-established'. They're much older than most countries, older than the entire concept of "nations", quite literally "older than feudalism", older even than "Anno Domini". I'm not trying to be sarcastic here, but that's like saying "I don't think this whole "United States of America" thing is "well-established" in history, only an entire magnitude less accurate.

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Leslie A.'s avatar

And yet, here we are existing in a world of constantly evolving treatments and protocols and ways of looking at life and quality of life, and death.

To ‘first, do no harm’ - we can all clearly define what that means in every medical situation that arises? It might be ethical to have the stated goal, but if one has a narrow view of what constitutes harm, then we do actually have to look beyond morality to utility (which was the basis of this author’s thesis).

Your “sarcastic” (read: condescending) tone is wildly unnecessary, so I felt somewhat compelled to respond in kind while also wondering why this conversation has to be so…

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Steven's avatar

This argument shows a misunderstanding of what ethics are and do for us. We can debate what the facts are all day, known facts can change over time, but that doesn't change the ethical framework used to evaluate them. You're confusing the inputs to a process with the process itself.

For a comparison, the scientific method is also a well-established methodology. Do constantly evolving technologies and protocols and ways of looking at reality and the nature of reality ever invalidate or require an update to the scientific method? No, of course not. The scientific method works today just as it did in the past and just as it will in the future.

"First, do no harm" is fairly straightforward.

The saying “first do no harm” (\(primumnonnocere\) in Latin) is associated with the ethical principle of nonmaleficence. Nonmaleficence is the obligation to not cause harm to others.

Nonmaleficence is a fundamental principle of medical ethics in the Western world.  It's often considered the first rule of medicine. 

It's closely associated with the principle of beneficence, which is the obligation to do good. 

Physicians must weigh the benefits and burdens of any treatment or intervention. 

They must choose the best course of action for the patient. 

Patients have the right to be free from harm and to have the risk of harm minimized. 

Let's start from the inputs: the mother and child are BOTH 'patients'.

The child, as a patient, has the right to be free from harm. Abortion is death for the patient, the worst possible harm. The child therefore has a right to not be aborted.

The physician must choose the best course of action for the patient. Again, death is by definition the worst possible medical outcome, it literally CANNOT be the "best" course of action for the patient, therefore a course that does not unnecessarily harm the child must be chosen.

Physicians must weigh the benefits and burdens of any treatment or intervention. Death is the worst possible outcome for a patient, therefore literally ANY outcome for the mother short of her dying is necessarily a better outcome than the child dying.

There's logically no possible input other than a Trolley Program scenario (someone will die no matter what and intervention can only determine which person will die) aka medical triage, where the deliberate choice to even allow the child to die (much less actively seek the child's death) is at all compatible with the Hippocratic Oath. Abortionists are blatantly Hypocritical rather than Hippocratic.

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Leslie A.'s avatar

You have certainly highlighted an imperative for a mother and fetus to have separate physician advocates. Except in such a limited ethical lens, the certain death of a fetus by abortion wins out every time - there is no scenario in which a mother with competing rights to life gets to choose a CHANCE for survival. It doesn’t matter if she is rearing other children, if she is a physician herself in a role of saving lives, etc.

Your framework also assumes that death is always the worst case scenario rather than cumulative human suffering. Death is simple to define so it’s easy to use it as an ethical benchmark. I don’t know how I would be convinced that physicians aren’t in the business of limiting human suffering.

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Steven's avatar

I shouldn't need to repeat myself here. The FIRST and foremost medical imperative is "FIRST, Do NO harm". The Principle of Nonmaleficence is and always has been given priority in medical ethics over the Principle of Beneficence. "Do good" for one patient CANNOT ethically come at the expense of greater harm to another. That's a physician's greatest responsibility to patients, period. It's NOT "do good for whoever pays me, at whatever cost to anyone who isn't paying me." Physicians aren't supposed to be contract killers. Sorry, but this is like arguing that one person's doctor would be ethically entitled to steal medications or even organs from other doctor's patients and then argue that it's fine because "those other patients weren't MY patient, so I did what was best for MY patient". That's not how medical ethics works. All physicians have the same ethical responsibility to all patients.

You don't know how you would be convinced that physicians aren't in the business of reducing human suffering? That's an easy one for me. I'm intimately familiar with the question. I happen to suffer from a medical condition that causes constant pain. My pain level on a 1-10 scale hasn't gone below a 3 in decades and only gets worse as I age. So I'm ahead of the curve a bit in confronting the reality, but talk to pretty much any old person and they'll happily tell you about all their chronic aches and pains. Being born is painful, growing is painful, aging is painful, and that's even before considering all the external life circumstances that inevitably cause you to suffer. Choose the suffering of loneliness or the suffering of eventually mourning the loss of people you loved? Life is full of accidents, malice, and unavoidable trade-offs where we suffer no matter which choices we make. Suffering is an inherent part of life. If the primary ethical responsibility of physicians was merely to "reduce suffering" rather than "save lives" then forget merely being willing to provide abortions upon request, physicians would have an obligation to not let ANY child be born. After all, the living always suffer. The utilitarian logic is clear: the optimal way to reduce suffering is to reduce life. Only when there are no longer living humans will human suffering be reduced to zero. The mothers would obviously need to die too. Medication can dull pain, but only death truly ends it. 'Life' is a terminal condition that necessarily involves chronic suffering. Physicians dedicated primarily to "reduce suffering" would have a moral imperative to kill their patients. All of them. Kill everyone, actually. The "best course of treatment" for reducing human suffering would ALWAYS be "a painless death". Only in Death does suffering finally end.

Seriously, attempting to judge the value of a life based on "quality of life" is a philosophical line of inquiry that inevitably leads to justifying euthanasia and genocide. As soon as you assert that a Life can truly be "not worth living" and therefore no longer possessing of the inalienable "Right to Life", you've condoned killing entire classes of people. That's literally genocide. "Life" is a categorical Good, not a qualified one. Yes, "Death" is quite literally the WORST possible medical outcome that all other courses of treatments are designed to avoid and hold off more than anything else.

You likewise see this same ethical weighting in every other legal context. Self-defense legal standards require the use of non-lethal force be preferred over lethal force wherever practical because killing someone is considered worse than merely hurting them, no matter how severely. Law enforcement and even military Rules of Engagement treat non-lethal force as preferable to lethal force wherever practical. Our criminal code puts even the most intense torture under the charge "assault and battery", which carries a maximum sentence of only 20 years. Even if we add rape as an aggravating factor to the assault, the maximum penalty is still merely life in prison. ONLY if the victim DIES does it then become a capital crime eligible for the Death Penalty. There is, quite literally, NO amount or type or duration of suffering you can inflict on another human being, no matter how extreme, that the law regards as worse than murdering a person, no matter how painless the murder victim's death. I'm very tired of this "but abortion" Fallacy where otherwise seemingly rational people irrationally treat abortion as somehow an exception to the same ethical standards we apply to life, death, and suffering in every other context.

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Leslie A.'s avatar

This last reply has definitely given me some insight as to where you are coming from. I don’t agree that each generation cannot continue to discuss and refine the principles that we are discussing, as if all has already been decided. That’s not even how the law work. I am sorry for your chronic pain and wish you well.

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Robird's avatar

Please clarify. A threat to the mother? If a woman cannot survive a pregnancy due to a medical condition, why has she not been sterilized? Why is absolute prevention of pregnancy not secured? Uh oh I screwed up hardly qualifies as a justification for murder.

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ADWH's avatar

It’s great you think that women should die in childbirth. My mother was a healthy, physically active, Physical Education teacher. Until pre-eclampsia escalated and caused her death when she was 32 weeks pregnant with me. Now we need to sterilize women? Come on. Just say you value potential life MORE than the woman carrying it.

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Robird's avatar

How would you have solved the issue for your other? She apparently loved you more than her own life. I am sorry for your loss.

Hypertension in pregnancy is a real issue and should be addressed promptly and diligently. Pre-eclampsia and HELLP syndrome need to be treated aggressively and go to early c-section if inadequate response to treatment.

So please clarify how this justifies abortion , in particular since pre-eclampsia occurs 90% of the time at 34+ weeks gestation, and never prior to 20 weeks gestation.

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ADWH's avatar

It wouldn’t have. But if something comes up in pregnancy, a woman should absolutely be able to save her life, even if her baby dies. Why does it matter to you so much that babies enter this world? I have never understood this. Why does it matter what other people do with their bodies? I would have terminated my pregnancies in a heartbeat had my life been at risk. I will never know her love, and it is a pain that you, judging others behind your keyboard, cannot fathom.

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Leslie A.'s avatar

There are indeed very few situations where the risk in pregnancy is guaranteed death or permanent disability, but that is the case in virtually all medical conditions. The point is that calling abortion murder automatically assumes there is no risk threshold under 100% for which a mother can decide the risk is too great.

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Robird's avatar

Pregnancy is nearly 100% preventable with conscientious application of contraception; certainly 100% with permanent sterilization. It would appear that self defense should occur prior to becoming pregnant. Self control is part of self defense.

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Leslie A.'s avatar

Key word is “nearly” - and in cases of rape or coercion or paternal abandonment? The whole point of these discussions is that we are asking philosophical questions that take into account all possibilities. If abortion is “murder” then it must be so in all cases because the fetus that results knows no difference.

Importantly, life-threatening conditions can arise after and as a result of pregnancy. I’m not sure how one can expect to “secure” the avoidance of things like cancer, infections, eclampsia, or catastrophic accidents.

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Robird's avatar

In cases of rape there is ready availability of “Plan B” OTC to prevent implantation of a fertilized ovum. In 2023 there were 1,037,000 elective abortions in the U.S. How many were due to factors outside of the female’s control?

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Leslie A.'s avatar

Plan B is also not 100% effective. Anyway you have taken my original comment, and its argument against abortion as murder, in another direction. If you feel that a pregnant woman in a catastrophic car accident having an abortion to help save her own life is murder, I don’t know that we have much else to discuss.

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ADWH's avatar

Yep, her pregnancy with me killed my mother. I guess I am a murderer too!

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Sharon Smith's avatar

I'm so sorry you lost your mother. I have witnessed more than my share of maternal deaths and it is horrible in every way imaginable. But if you ever believe for one minute that you are responsible, please take it from this OBGYN that more often than not, mothers struggle for their babies much longer than it would seem to be humanly possible.

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