Читать книгу Bioethics - Группа авторов - Страница 30

Some “pro‐choice” philosophers have attempted to justify abortion by denying that all abortions are intentional killing. They have granted (at least for the sake of argument) that an unborn human being has a right to life but have then argued that this right does not entail that the child in utero is morally entitled to the use of the mother’s body for life support. In effect, their argument is that, at least in many cases, abortion is not a case of intentionally killing the child, but a choice not to provide the child with assistance, that is, a choice to expel (or “evict”) the child from the womb, despite the likelihood or certainty that expulsion (or “eviction”) will result in his or her death (Little, 1999; McDonagh, 1996; Thomson, 1971).

Various analogies have been proposed by people making this argument. The mother’s gestating a child has been compared to allowing someone the use of one’s kidneys or even to donating an organ. We are not required (morally or as a matter of law) to allow someone to use our kidneys, or to donate organs to others, even when they would die without this assistance (and we could survive in good health despite rendering it). Analogously, the argument continues, a woman is not morally required to allow the fetus the use of her body. We shall call this “the bodily rights argument.”

It may be objected that a woman has a special responsibility to the child she is carrying, whereas in the cases of withholding assistance to which abortion is compared there is no such special responsibility. Proponents of the bodily rights argument have replied, however, that the mother has not voluntarily assumed responsibility for the child, or a personal relationship with the child, and we have strong responsibilities to others only if we have voluntarily assumed such responsibilities (Thomson, 1971) or have consented to a personal relationship which generates such responsibilities (Little, 1999). True, the mother may have voluntarily performed an act which she knew may result in a child’s conception, but that is distinct from consenting to gestate the child if a child is conceived. And so (according to this position) it is not until the woman consents to pregnancy, or perhaps not until the parents consent to care for the child by taking the baby home from the hospital or birthing center, that the full duties of parenthood accrue to the mother (and perhaps the father).

In reply to this argument we wish to make several points. We grant that in some few cases abortion is not intentional killing, but a choice to expel the child, the child’s death being an unintended, albeit foreseen and (rightly or wrongly) accepted, side effect. However, these constitute a small minority of abortions. In the vast majority of cases, the death of the child in utero is precisely the object of the abortion. In most cases the end sought is to avoid being a parent; but abortion brings that about only by bringing it about that the child dies. Indeed, the attempted abortion would be considered by the woman requesting it and the abortionist performing it to have been unsuccessful if the child survives. In most cases abortion is intentional killing. Thus, even if the bodily rights argument succeeded, it would justify only a small percentage of abortions.

Still, in some few cases abortion is chosen as a means precisely toward ending the condition of pregnancy, and the woman requesting the termination of her pregnancy would not object if somehow the child survived. A pregnant woman may have less or more serious reasons for seeking the termination of this condition, but if that is her objective, then the child’s death resulting from his or her expulsion will be a side effect, rather than the means chosen. For example, an actress may wish not to be pregnant because the pregnancy will change her figure during a time in which she is filming scenes in which having a slender appearance is important; or a woman may dread the discomforts, pains, and difficulties involved in pregnancy. (Of course, in many abortions there may be mixed motives: the parties making the choice may intend both ending the condition of pregnancy and the death of the child.)

Nevertheless, while it is true that in some cases abortion is not intentional killing, it remains misleading to describe it simply as choosing not to provide bodily life support. Rather, it is actively expelling the human embryo or fetus from the womb. There is a significant moral difference between not doing something that would assist someone, and doing something that causes someone harm, even if that harm is an unintended (but foreseen) side effect. It is more difficult morally to justify the latter than it is the former. Abortion is the act of extracting the unborn human being from the womb – an extraction that usually rips him or her to pieces or does him or her violence in some other way.

It is true that in some cases causing death as a side effect is morally permissible. For example, in some cases it is morally right to use force to stop a potentially lethal attack on one’s family or country, even if one foresees that the force used will also result in the assailant’s death. Similarly, there are instances in which it is permissible to perform an act that one knows or believes will, as a side effect, cause the death of a child in utero. For example, if a pregnant woman is discovered to have a cancerous uterus, and this is a proximate danger to the mother’s life, it can be morally right to remove the cancerous uterus with the baby in it, even if the child will die as a result. A similar situation can occur in ectopic pregnancies. But in such cases, not only is the child’s death a side effect, but the mother’s life is in proximate danger. It is worth noting also that in these cases what is done (the means) is the correction of a pathology (such as a cancerous uterus, or a ruptured uterine tube). Thus, in such cases, not only the child’s death, but also the ending of the pregnancy, are side effects. So, such acts are what traditional casuistry referred to as indirect or non‐intentional, abortions.

But it is also clear that not every case of causing death as a side effect is morally right. For example, if a man’s daughter has a serious respiratory disease and the father is told that his continued smoking in her presence will cause her death, it would obviously be immoral for him to continue the smoking. Similarly, if a man works for a steel company in a city with significant levels of air pollution, and his child has a serious respiratory problem making the air pollution a danger to her life, certainly he should move to another city. He should move, we would say, even if that meant he had to resign a prestigious position or make a significant career change.

In both examples, (a) the parent has a special responsibility to his child, but (b) the act that would cause the child’s death would avoid a harm to the parent but cause a significantly worse harm to his child. And so, although the harm done would be a side effect, in both cases the act that caused the death would be an unjust act, and morally wrongful as such. The special responsibility of parents to their children requires that they at least refrain from performing acts that cause terrible harms to their children in order to avoid significantly lesser harms to themselves.

But (a) and (b) also obtain in intentional abortions (that is, those in which the removal of the child is directly sought, rather than the correction of a life‐threatening pathology) even though they are not, strictly speaking, intentional killing. First, the mother has a special responsibility to her child, in virtue of being her biological mother (as does the father in virtue of his paternal relationship). The parental relationship itself – not just the voluntary acceptance of that relationship – gives rise to a special responsibility to a child.

Proponents of the bodily rights argument deny this point. Many claim that one has full parental responsibilities only if one has voluntarily assumed them. And so the child, on this view, has a right to care from his or her mother (including gestation) only if the mother has accepted her pregnancy, or perhaps only if the mother (and/or the father?) has in some way voluntarily begun a deep personal relationship with the child (Little, 1999).

But suppose a mother takes her baby home after giving birth, but the only reason she did not get an abortion was that she could not afford one. Or suppose she lives in a society where abortion is not available (perhaps very few physicians are willing to do the grisly deed). She and her husband take the child home only because they had no alternative. Moreover, suppose that in their society people are not waiting in line to adopt a newborn baby. And so the baby is several days old before anything can be done. If they abandon the baby and the baby is found, she will simply be returned to them. In such a case the parents have not voluntarily assumed responsibility; nor have they consented to a personal relationship with the child. But it would surely be wrong for these parents to abandon their baby in the woods (perhaps the only feasible way of ensuring she is not returned), even though the baby’s death would be only a side effect. Clearly, we recognize that parents do have a responsibility to make sacrifices for their children, even if they have not voluntar[il]y assumed such responsibilities, or given their consent to the personal relationship with the child.

The bodily rights argument implicitly supposes that we have a primordial right to construct a life simply as we please, and that others have claims on us only very minimally or through our (at least tacit) consent to a certain sort of relationship with them. On the contrary, we are by nature members of communities. Our moral goodness or character consists to a large extent (though not solely) in contributing to the communities of which we are members. We ought to act for our genuine good or flourishing (we take that as a basic ethical principle), but our flourishing involves being in communion with others. And communion with others of itself – even if we find ourselves united with others because of a physical or social relationship which precedes our consent – entails duties or responsibilities. Moreover, the contribution we are morally required to make to others will likely bring each of us some discomfort and pain. This is not to say that we should simply ignore our own good, for the sake of others. Rather, since what (and who) I am is in part constituted by various relationships with others, not all of which are initiated by my will, my genuine good includes the contributions I make to the relationships in which I participate. Thus, the life we constitute by our free choices should be in large part a life of mutual reciprocity with others.

For example, I may wish to cultivate my talent to write and so I may want to spend hours each day reading and writing. Or I may wish to develop my athletic abilities and so I may want to spend hours every day on the baseball field. But if I am a father of minor children, and have an adequate paying job working (say) in a coal mine, then my clear duty is to keep that job. Similarly, if one’s girlfriend finds she is pregnant and one is the father, then one might also be morally required to continue one’s work in the mine (or mill, factory, warehouse, etc.).

In other words, I have a duty to do something with my life that contributes to the good of the human community, but that general duty becomes specified by my particular situation. It becomes specified by the connection or closeness to me of those who are in need. We acquire special responsibilities toward people, not only by consenting to contracts or relationships with them, but also by having various types of union with them. So, we have special responsibilities to those people with whom we are closely united. For example, we have special responsibilities to our parents, and brothers and sisters, even though we did not choose them.

The physical unity or continuity of children to their parents is unique. The child is brought into being out of the bodily unity and bodies of the mother and the father. The mother and the father are in a certain sense prolonged or continued in their offspring. So, there is a natural unity of the mother with her child, and a natural unity of the father with his child. Since we have special responsibilities to those with whom we are closely united, it follows that we in fact do have a special responsibility to our children anterior to our having voluntarily assumed such responsibility or consented to the relationship.⁵

The second point is this: in the types of case we are considering, the harm caused (death) is much worse than the harms avoided (the difficulties in pregnancy). Pregnancy can involve severe impositions, but it is not nearly as bad as death – which is total and irreversible. One needn’t make light of the burdens of pregnancy to acknowledge that the harm that is death is in a different category altogether.

The burdens of pregnancy include physical difficulties and the pain of labor, and can include significant financial costs, psychological burdens, and interference with autonomy and the pursuit of other important goals (McDonagh, 1996: ch. 5). These costs are not inconsiderable. Partly for that reason, we owe our mothers gratitude for carrying and giving birth to us. However, where pregnancy does not place a woman’s life in jeopardy or threaten grave and lasting damage to her physical health, the harm done to other goods is not total. Moreover, most of the harms involved in pregnancy are not irreversible: pregnancy is a nine‐month task – if the woman and man are not in a good position to raise the child, adoption is a possibility. So the difficulties of pregnancy, considered together, are in a different and lesser category than death. Death is not just worse in degree than the difficulties involved in pregnancy; it is worse in kind.

It has been argued, however, that pregnancy can involve a unique type of burden. It has been argued that the intimacy involved in pregnancy is such that if the woman must remain pregnant without her consent then there is inflicted on her a unique and serious harm. Just as sex with consent can be a desired experience but sex without consent is a violation of bodily integrity, so (the argument continues) pregnancy involves such a close physical intertwinement with the fetus that not to allow abortion is analogous to rape – it involves an enforced intimacy (Boonin, 2003: 84; Little, 1999: 300–3).

However, this argument is based on a false analogy. Where the pregnancy is unwanted, the baby’s “occupying” the mother’s womb may involve a harm; but the child is committing no injustice against her. The baby is not forcing himself or herself on the woman, but is simply growing and developing in a way quite natural to him or her. The baby is not performing any action that could in any way be construed as aimed at violating the mother.⁶

It is true that the fulfillment of the duty of a mother to her child (during gestation) is unique and in many cases does involve a great sacrifice. The argument we have presented, however, is that being a mother does generate a special responsibility, and that the sacrifice morally required of the mother is less burdensome than the harm that would be done to the child by expelling the child, causing his or her death, to escape that responsibility. Our argument equally entails responsibilities for the father of the child. His duty does not involve as direct a bodily relationship with the child as the mother’s, but it may be equally or even more burdensome. In certain circumstances, his obligation to care for the child (and the child’s mother), and especially his obligation to provide financial support, may severely limit his freedom and even require months or, indeed, years, of extremely burdensome physical labor. Historically, many men have rightly seen that their basic responsibility to their family (and country) has entailed risking, and in many cases, losing, their lives. Different people in different circumstances, with different talents, will have different responsibilities. It is no argument against any of these responsibilities to point out their distinctness.

So, the burden of carrying the baby, for all its distinctness, is significantly less than the harm the baby would suffer by being killed; the mother and father have a special responsibility to the child; it follows that intentional abortion (even in the few cases where the baby’s death is an unintended but foreseen side effect) is unjust and therefore objectively immoral.