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Abortion sparks contentious debate despite legalization in 1973
Not a binary issue
No other bioethics topic stirs passionate debate, political controversy, and religious disapproval quite the way that abortion does and has since its legalization with a decision by the U.S. Supreme Court in the case of Roe v. Wade in 1973.
Perhaps, according to one bioethics expert interviewed by Medical Ethics Advisor, that's because abortion the termination of a pregnancy has much to do with one's religion, one's sense of when life begins, one's sense of a woman's autonomy, and one's sense of the role of science, among other factors.
"Much of religion structurally is about maintaining control and order of time and place and the body," says Laurie Zoloth, PhD, director, Center for Bioethics, Science and Society and professor of medical humanities and bioethics at the Feinberg School of Medicine at Northwestern University in Chicago. "So, an unexpected pregnancy is a violation of the natural order; it's a natural activity; . . . it's linked to sexuality and to passion. And a pregnancy out of time and out of place is seen by some as a religious problem to deal with, because religion has to do with what should be [and] when it's proper to bring forth life."
And while that may be true, Zoloth offers three "possible narratives" as an explanation of why abortion continues to be "this deeply unsettled issue within American political life."
What confers moral status?
"One idea is that it touches on the anxiety that Americans have about the determination of moral status, and one could say . . . or I will say . . . that the moral status issue is an essential American anxiety," she explains. "And the first way it got played out was when Europeans came to what would be the United States . . . [where] they were confronted with Native Americans, and they didn't know what they were, [so] there was a big debate one of the first moral debates in moral philosophy about the New World was whether Indians had souls."
The debate centered on not only whether Native Americans had souls, but also, Zoloth says, "whether they were humans, whether they were animals, whether they could be saved . . . could they be enlightened? What was their moral status?"
The second moral debate had to do with slavery, when questions were considered, such as "Are slaves persons? Are they three-quarters of a person? . . . How does one treat a slave?
"Note that we spent a century debating Native Americans, a century debating slavery I mean, these were long, long debates," she says. "And the third debate is, of course, women. Are women fully entitled? Can they own property? Can they be educated? If you educate their minds, what happens to their bodies? What happens to their fertility? So, the anxiety [existed] around whether women were fully human, in a sense. What's the moral status of a woman? [And it's still] an ongoing issue."
The fourth issue in contemporary time has to do with the moral status of the human embryo.
"The anxieties continue to mount when the science follows the anxiety out, [that is] when the embryo couldn't be seen, couldn't be visualized, which was largely the case in Roe v. Wade," Zoloth notes. "That [case] was before prenatal diagnosis . . . before sonograms."
"Two things have happened to continue the debate to continue the anxiety and uncertainty: One is the fact that you can visualize, from pretty early on in pregnancy, the developing being inside of a woman's body," she says. "And now we name babies [in the womb]; you can create a universe around a gender it's a boy, and it has a certain color room; it's a girl, and it has a certain color room. You can sort of pre-imagine. There's a moral imaginary that takes place that couldn't have taken place before sonograms."
But something else has happened that takes the moral status question in a completely different direction, which is the use of the fetal tissue in research and early embryos for research purposes.
"So, there's a confusion about what exactly you've done here," Zoloth explains. "On the one hand, you're seeing and prefiguring pregnancy, because you can determine if you're pregnant within a week of a missed period."
On the other hand, there's this idea that blastocysts, because the cells of blastocysts are mutable, that they are an "extraordinary source for science and biomedicine."
Women's rights on center stage
The second of Zoloth's "narratives" as a possible explanation of why abortion continues to be so divisive is that Roe v. Wade did not occur in a vacuum of traditional American culture. There was, instead, social upheaval following the 1960s.
"It was not just a beginning of a discussion about abortion it was the beginning of [something] fundamental and profound that had to do with women's liberation as an idea."
That liberation included the birth control pill and the notion that women could work outside the home in a workforce where they had until then largely been absent. Women also began entering colleges and universities in massive numbers, she says.
"I think that when people have anxieties about Roe v. Wade, the anxiety has to do with the larger change in what it means to be a family, what it means to be a woman, [and] what motherhood means," Zoloth says.
A picture existed at that time in people's minds about what a nuclear family should look like, and it has a father, mother, and children. That picture, Zoloth maintains, was "radically disassembled by not just Roe v. Wade, but the birth control pill, the necessity for work, and the ideology that [women] should work."
The accompanying idea of a woman being able to say "no" to a pregnancy is still "one of the disconcerting features that surround Roe v. Wade; it has more to do with anxiety about women's role and women's power over their own bodies that the combination of birth control, your own job, and the ability to end a pregnancy, that gives you an unprecedented power over your body and over your fate."
Science and suspicion
The third possible narrative for the continuing discontent over abortion is that "there is anxiety around science that goes very deep in American life," Zoloth says.
"There was a rupture in a progressive embrace of science that went all the way through the polio vaccine era . . . what we allowed [Jonas Salk] to do, I don't think our IRBs today would have approved it. But there was a bit of a love affair with science; science was seen as redemptive," she says.
A series of events occurred where science was called into question, however, and a consequence of those events was a "return to the idea of naturalness," Zoloth explains. "The idea of naturalness plays right into Catholic moral theology around natural law . . . that once pregnancy has begun, it is an act of unnatural violence to end it a callous abuse of the environment, in some sense."
Finally, love and sex and ultimately, pregnancy "thus begins a natural/sacred embrace of a natural process" that shouldn't be tampered with or interrupted, Zoloth says "I think that's one of the cultural tropes that plays in our continuing discussion about [abortion]," Zoloth says.
An unsettled issue
"For many people, the argument that life begins at the moment of conception, and that such life demands our respect and unequivocal protection, is a religious commitment. I take that seriously as a matter of their sincere understanding of their faith. Such a commitment should never be trivialized," Zoloth says
"However, it also cannot be a matter of public policy in a pluralistic democracy. Other faiths believe differently about when life begins, and there is no agreement among faiths, and among non-believers, about the moral status of embryos. That disagreement is where Roe v. Wade began. Because the matter is a matter of faith, while we can analyze the other issues that animate the debate, we cannot "settle" the question. The argument that abortion is murder of the most innocent of lives, and the argument that abortion is a tragic but imperative part of human free choice are incommensurate arguments," she says.