1. A True Story
2. What Went Wrong?
- Not long ago a young woman whom I'll call Michelle' came to our family planning clinic. She told me she was pregnant1 and wanted an abortion2. "Do you know for sure that you are pregnant3?" I asked her. "Yes," she said, "I did a test. Besides, my last period was in February."
- I took a closer look at Michelle: a small, slender Chinese- American girl wearing a very loose-fitting top. February was a long time ago, and if she had really been pregnant4 since then (as a brief examination suggested was the case), this meant that Michelle was well into her second trimester, almost into the third. Very few physicians would do an abortion5 at that late stage, and those who did would charge much more than they would for a first trimester abortion6. The necessary procedure would be far more complicated, and the risk to the mother — although small - significantly higher. Fetuses7 delivered at that stage could occasionally survive with major technological support, and many people who do not think abortion8 in general wrong, have moral qualms about abortions9 done so late.
- When I told Michelle an abortion10 now would cost about $2500, which would have to be paid up front, she looked utterly shocked and began to cry. When at last I could explain to her why the procedure would be so expensive, I asked her if she had considered keeping the baby or giving it up for adoption. "No," she replied, "I could never tell my parents that I got pregnant11. They would never forgive me. Besides, I want a career —not children." She was currently in high school and living at home.
- I asked Michelle why, given that she had never intended to carry the pregnancy12 to term, she had not gotten an abortion13 sooner. "I couldn't earn much money until school was out. I've saved $500, and I thought that would be enough." She had done a home pregnancy14 test; had she had her pregnancy15 test with us or with another health care provider, she would have been counseled about the problems that could arise from putting off an abortion16. But Michelle, like many other adolescents, had known none of this and had waited too long.
- I discussed many possibilities with Michelle. Could she perhaps go out of town to have the baby and give it up for adoption? "No, my parents wouldn't understand why I was leaving home; I'd have to tell them I was pregnant17. And besides, I'll have school in the fall." Could she get some help from her boyfriend? "No, he doesn't have any money either." Did she have anything she could sell, or was there anyone from whom she could borrow money? There was nothing and no one, she replied. "What exactly do you think your parents would do if you told them you were pregnant18?" I asked her. All she could tell me was that they would feel disgraced; they had always had high expectations of their children. She was unwilling even to discuss the possibility of telling them.
- After a while, I had nothing more to suggest, and Michelle left. Needless to say, when Michelle had gone, I was distressed and could imagine many different outcomes. Few of them were happy. What could this young woman do, and what might she do? She could only have an abortion19 if she managed to raise $2000 within a week — not likely, since she had only been able to accumulate $500 in several months. Might she or the baby's father resort to theft? Might Michelle attempt to abort20 herself? Or find someone who would try to do it for less money? Even though abortions21 are legal in the United States, there are still obstacles, not the least of which is financial. Might she even commit suicide?
How desperate was she not to let her pregnancy22 be known to her parents? What would they really do if they found out: beat her, kill her, or disown her? Or would they simply be angry for a while, but eventually accept the situation and their coming grandchild?
- I was concerned, too, about the welfare of Michelle's unborn child. Michelle had had no prenatal care and did not look well-nourished. Besides, she had made it clear that she did not want, not only this baby, but any children ever. If she kept it, how would she cope, financially, as well as emotionally? Would she drop out of school and go on welfare? I very much hoped she would give the child up for adoption, since she seemed so poorly equipped and motivated to raise one. But what if there was something wrong with the baby? Would it be adoptable?
- On the other hand, maybe everything would be all right. Maybe the baby would be fine and would find a good adoptive home. Or maybe Michelle's parents would accept her and the baby and help them through the rough spots. Maybe her boyfriend would marry her and they would both come to love the baby. Or maybe some kind friend would suddenly give Michelle the rest of the money she would need for a safe, legal abortion23 by one of the few providers who would perform them at that stage.
3. The Issues
- So far, I have been talking only about what could happen to Michelle and her unborn fetus24. What, however, should she do? What should she have done, or not done, to have avoided the predicament in which she now found herself? What should others — her parents, her boyfriend, society — do, or have done, to prevent or alleviate this tragic situation?
- One might hear many different answers to the question of what should have been done:
- Michelle should not have been having sex when unmarried and unwilling to have children.
- Her boyfriend should not have been having sex until he was willing and able to support a family.
- Given that they did have sex, they should have used contraception.
- Michelle's parents should have done a better job of raising her: either — depending upon whom you hear — they should have taught her more thoroughly that premarital intercourse was wrong, or they should have talked more openly about these matters early on, or they should have given her greater self esteem.
- Michelle should have had better sex education in school — or no sex education, since this could have given her 'ideas.'
- Michelle should have sought help sooner, so that she could either have had a timely abortion25, or received prenatal care in the critical early months. As for what should be done now, one could hear many different opinions.
- Abortions26 should not be done at all, so that no one will be tempted to think that this is a way out.
- Abortions27 should be not only legal, but accessible to and affordable by all.
- Abortions28 are all right in the first trimester, but not later.
- If the money became available, Michelle should go ahead with the abortion29.
- Perhaps the doctor should offer to do it for nothing, or at least accept a payment plan, rather than insisting, as most do, on cash up front.
- We should have universal health care in this country, which includes
paying for abortions30.
- Michelle should never consider abortion31 at all, and go right away for prenatal care, starting as soon as possible to take care of herself and her unborn child. Of those who would say this, some think abortions32 are always wrong, while others think they are wrong at this stage of development and still others that, while there is no moral wrong in having abortions33 this late, Michelle would be exposing herself to an unacceptable risk.
- I can't think that anyone would advise Michelle to attempt to abort34 herself, or seek the assistance of a nonprofessional, given what the outcome of such procedures often were in the past.
- Whatever she does, most would probably agree that Michelle ought to try to discuss the pregnancy35 with her parents, and that they ought to be supportive and help her. Some would say they ought only to support some decisions she might make, but not others. And other people might point out that many parents would not be supportive of any decisions under these circumstances, and would be abusive regardless.
- Most would probably agree that, assuming Michelle does continue the pregnancy36, she would do better to give the child up for adoption. And it ought to be that someone adopt the child, even if it is handicapped or of mixed race. As for Michelle's boyfriend, he ought to marry her — at least if she decides to keep the baby. Maybe he should quit school for a while and get a job, so that he can help her with the pregnancy37 and to care for the child, if Michelle decides to keep it. There should be, most agree, money available — and there is — to help Michelle support herself while she is pregnant38. She will probably also be eligible for welfare after it is born, should she keep the baby. Of course, if she works, even for the low pay she is likely to get, she may be ineligible for payments and therefore will have little incentive to try to support herself. And some in high places maintain that if a baby like Michelle's cannot find an adoptive home right away, it should be put in an orphanage, so that Michelle will not become a public expense.
- Clearly no one would agree to all these suggestions, since many are diametrically opposed to some of the others. It is also clear that wrong things were done, and that there are things wrong with our society, which allowed such a situation to arise, and that whatever Michelle does, further wrongs are likely to occur. Not only have there been wrong actions, but wrongs to individuals. Michelle has no doubt been wronged by her boyfriend and perhaps by her parents and society, as well as having made serious mistakes, and perhaps done wrong, herself.
- There is another individual, who some would say has been wronged, and could be wronged still further, and this is Michelle's unborn child. Others deny that a fetus39 can be wronged, although the child that fetus40 might become could be wronged.'
- . Is it possible to wrong a fetus41? Does a fetus42 have rights? What are the limits upon what it is morally permissible to do to a fetus43? When the interests of a fetus44 conflict with those of its mother or other members of society, how should we resolve the conflict? In other words, the main question is whether the fetus45 is a person in its own right, or whether it is merely an appendage of its mother's body, or whether it is something in between.
- To deal with this question properly, it is necessary to consider not simply the question of abortion46, but the broad issue of personhood. What is it about an individual that makes it a person? Why is being a person relevant to the manner in which some individual ought to be treated? What is the moral status of nonpersons: is their treatment a matter of indifference, or do we have some duties towards them? Are there humans who are not persons, or nonhumans who are persons?
- These questions take us beyond the issue of the human fetus47. Satisfactory answers to them will also shed light upon some other contemporary debates, such as animal rights and the treatment of human beings in a vegetative state. Do we, for example, have a right to experiment on rabbits and mice in order to find cures for our diseases? For their diseases? To develop better cosmetics? Is it wrong to raise chickens in crowded pens so that we may have cheaper drumsticks? Is it wrong to hunt? To eat meat at all?
- When does a person cease to live? When should medical treatment be stopped? Who should decide what treatments will be performed? What are our obligations to those who are no longer capable of communicating their desires? May we experiment on the insane, the senile, or the retarded? When may we harvest organs from individuals with no hope of a conscious life: organs which will prolong and improve the lives of others?
- Do we have any obligations to future generations? If so, how much of our comfort and convenience should we sacrifice in order to insure a decent life for them?
- In discussing these questions we are looking not only for answers, but also for a rationale which generates answers. Such a rationale would enable us also to consider prospectively problems that we have so far had to face only in science fiction fantasy: for example, how we ought to treat extra-terrestrials or computers and robots with certain human characteristics. A large part of this book will be devoted to developing the rationale.
- Some discussions of these issues begin with a descriptive account of what a person is like and use this to argue for what sort of treatment these characteristics entitle persons. I shall argue in a different way. I begin (in Chapter 1) with the assumption that what makes an individual a person is that other persons ought to treat him or her (or it) with full moral consideration: i.e., in accordance with all sound moral principles. Then to find out what sorts of individuals are persons requires two steps: the first to determine what moral principles are sound, and the second to find out what characteristics of individuals make it right to treat them according to those principles. The first step I shall carry out in Part II. Then in Part III I will consider what characteristics of individuals entitle them to treatment in accordance with these principles. Individuals with characteristics which so entitle them are persons.
- An illustration of what I shall be doing is the following. One basic moral principle is that of beneficence: that it is generally right to promote and wrong to frustrate the purposes of individuals. If this is so, then individuals who have purposes have a claim to moral consideration, and have one characteristic of personhood. In other words, how we treat individuals with purposes is not morally indifferent, whether or not they are persons in the full sense. One implication of this is that animals and fetuses48, if they have purposes — even one so simple as avoidance of pain —, ought to have those purposes respected to some extent.
- In Part IV I will discuss some practical issues. Those I consider are animal rights, obligations to future generations, the status of the human fetus49, and what we owe to humans who are no longer rational or even conscious. My hope is that the discussion of who counts as persons and how they should be treated will shed significant light on these major practical problems and provide guidance in resolving related problems, including some which we may not yet have encountered.
Part I: Problems and Persons
Text Colour Conventions (see disclaimer)
- Blue: Text by me; © Theo Todman, 2018
- Mauve: Text by correspondent(s) or other author(s); © the author(s)