Estimated reading time: 9 minutes

Pro-life people really don’t like abortion. Shocking, right? But I don’t just mean that pro-life people believe abortion is morally wrong, which we do; pro-lifers have a strong emotional reaction—a moral aversion—to abortion which is often right and healthy.

Sometimes, though, this otherwise healthy aversion leads us astray. The most common example of this is the insistence, by much of the pro-life movement, that abortion is never medically necessary. For them, an action doesn’t “count” as an abortion if it’s lifesaving treatment in life of the mother cases. Take this tweet, for example:

Aside from the issue of lumping surgical treatment following miscarriage in with treatment for ectopic pregnancy (the child is sometimes still alive in the latter, which is why there’s ethical disagreement over appropriate treatments), this is a pretty common statement of the pro-life attitude. The problem is, it seems more driven by the desire to avoid complicity in abortion, to maintain that it is never acceptable, than by a reasonable engagement with medical facts. The ACOG definition cited—”induced abortion: intervention to end a pregnancy so that it does not result in a live birth”—would absolutely include, say, a salpingectomy (the removal of the fallopian tube) to treat an ectopic pregnancy as an abortion, since it is an intervention which ends the pregnancy in such a way that it does not result in a live birth. The fact that the ectopic pregnancy would not result in a live birth absent that treatment doesn’t change the fact that it is the surgery which ends the pregnancy and results in the death of the embryo. A salpingectomy—a procedure which is almost universally accepted by pro-life advocates to treat ectopic pregnancy—IS an abortion under ACOG’s definition. Trying to claim otherwise makes the pro-life movement appear anti-science while we ignore medical definitions that don’t fit our desired narrative.

Double-Effect and Double Meanings

That’s not to say that this pro-life position is pure emotion and lacks any philosophical argument; in fact, it draws on Aquinas’ idea of double effect, a doctrine which (right or wrong) sees use in other areas of medical ethics. Even in this case, though, it has issues which make it read more like an ad hoc attempt to avoid endorsing anything that could be categorized as an abortion.

The following is the text of the Dublin Declaration, signed by over 1,000 pro-life medical professionals and researchers:

As experienced practitioners and researchers in obstetrics and gynaecology, we affirm that direct abortion – the purposeful destruction of the unborn child – is not medically necessary to save the life of a woman.

We uphold that there is a fundamental difference between abortion, and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child.

We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.

The language in the first paragraph about “direct abortion” as “purposeful destruction” is an immediate signal that double effect is being utilized here. As a very low-level explanation, double-effect reasoning involves the idea that you cannot intend to do a bad action (like kill someone except in certain cases), but you can do a good action (e.g., saving someone’s life, or ameliorating pain) while knowing that a bad result that you do not intend will also occur inevitably (e.g., an embryo dying, the pain medication hastening death).

Without getting into whether or not this is a viable approach, all we need to note for our purposes here is that “direct abortion” is defined according to the first category, an intentional, “purposeful” bad action. This, naturally, leads to the question: what is “direct abortion” here being contrasted with? The implicit analogy is that the (presumptively ethical) procedure which terminates a pregnancy in order to save the life of the mother must be an “indirect abortion.” Worth noting: an “indirect” abortion is still an abortion.

The distinction between direct and indirect abortions as morally weighty certainly isn’t universally accepted, but it’s at least tenable based on accepting certain premises from Scholastic philosophy. What isn’t tenable is the ad hoc move in the following two paragraphs to combine “direct abortion” and “abortion” into the same concept, somehow moving the implicit idea of “indirect abortion” outside the realm of abortion entirely. “Necessary medical treatments” are contrasted as fundamentally different from abortions. This is half true; abortions to save the life of the mother are “necessary medical treatments” that are certainly fundamentally different from elective abortions, but they can’t be fundamentally different from all abortions because they are a member of the set of objects which includes all abortions, direct or indirect.

To spell that out a bit, a workable version of the Dublin Declaration’s second paragraph would say something like this: “We uphold that there is a fundamental difference between elective abortion, and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child.” Necessary medical treatments to save the mother’s life are still within the category of abortions, but not within the category of elective abortion. 

The last paragraph expands upon the error in a dangerous direction: the signatories maintain that abortion bans don’t affect “the availability of optimal care to pregnant women,” which can only be true if a) all abortion bans contain clear “life of the mother” exceptions, or if b) no abortion is ever medically necessary to provide optimal care. B) is untrue, as shown above; but, worse yet, the language of the statement undercuts a). After all, if I’m a legislator, and a thousand medical experts tell me abortion is never medically necessary, why would I include an exception for medical necessity in an abortion ban? Then doctors are left, understandably, believing they can’t perform a salpingectomy, since it is medically coded as an abortion (more on that below), and the letter of the law says that all abortions are banned with no exceptions for the life of the mother.

Defining “Medically Necessary” Abortion Properly Matters

Let’s restate the latter point: “life of the mother” exceptions can only be included in legislation when we properly define medical interventions that result in the death of the embryo to save the life of the mother as “abortions.” This is one of the two biggest reasons that we need to define abortion properly in cases of medical necessity. Sure, I think words have meaning and we have a duty to use them in accordance with reality, but that is a tertiary consideration. Way more important is the fact that pro-life states might write laws without clear “life of the mother exceptions” because they don’t think it’s an abortion when it’s done to save a life—even though the pro-life legislators would support the life-saving interventions that doctors are now left thinking they can’t legally perform!

And that leads us to the second major point. For many pro-lifers, defining “life of the mother” cases as “not abortions” and banning all abortions (which doesn’t include medically necessary ones, by the definition of abortion they’re operating with) works in their head and leaves them emotionally satisfied that they’re not supporting any abortions. They can call themselves a “no-exceptions pro-lifer.” But no one else thinks this way about abortion. Pro-choice people, uncommitted moderates, and even many pro-life people understand that an action, direct or indirect, that brings about the end of a pregnancy in such a way that the baby doesn’t survive is an abortion. I think this is the real definition of abortion, and it also happens to be the common-sense definition.

Be aware, though, that many pro-choice people in the medical establishment use the term “abortion” more broadly than even the common-sense definition. Take a look at the medical coding used by The American College of Obstetricians and Gynecologists: for these medical practitioners, a miscarriage is called a “spontaneous abortion.” The code goes onto define “complete spontaneous abortion,” “incomplete spontaneous abortion,” “missed abortion,” “incomplete abortion,” “medical abortion,” “septic abortion”…you get the idea. Everything is called an abortion. In the American Medical Association coding system, CPT Code 59820 is a code under the heading “Abortion Procedures,” but this specific code is referring to a procedure to remove a dead fetus after a miscarriage has occured.

Arguably, “spontaneous abortion” is a term for miscarriage that made a lot more sense in a pre-1973 America. On the other hand, it’s just plain delusional and out of keeping with more basic medical definitions—like “pregnancy,” which inherently involves a living embryo/fetus—to refer to removing the body of a deceased fetus as an “abortion,” when an abortion (as stated above) ends a pregnancy in such a way that a living human dies. Just like the “no abortions are necessary” definition, the “basically everything is an abortion” definition is wrong. But even though you should agree with and use the accurate, common-sense definition, it’s valuable to know how pro-choice elements within the medical establishment are using the word so you’re not confused when they play around in the margins of their questionable definitions to score PR points against pro-lifers. If we care about creating clear abortion laws, which we do, then they need to be clear to medical providers as well, so we ought to know the definitions in their heads. And it’s important to use a definition that is intelligible to other people to keep us from scoring PR points against ourselves.

Which brings us to the clip from a recent congressional hearing that went viral on Reddit for all the wrong reasons:

The head of one of the biggest pro-life organizations in America presents the common pro-life idea that medically necessary abortions aren’t abortions, and she gets pounced on by a smarmy Democrat. Thousands of people are personally attacking her and other pro-life leaders in ways that are uncharitable and inaccurate, and they’re claiming that pro-lifers shouldn’t oppose abortion when they don’t even know what it is.

All of this is the result of an unforced error by pro-life people. Trying to change the definition of abortion so we can say that all abortions are bad doesn’t work; it’s incorrect, and it makes it impossible for us to intelligibly communicate with people who have the correct definition of abortion and the wrong definition of person. We’re fighting on the wrong ground. Contesting this definition, which is a losing battle, is costing us the ability to persuade people that abortion is wrong and to pass good pro-life legislation.

Instead, we should grant what everyone believes: that “life of the mother” cases are still abortions; the fetus still dies even if the action taken to save the life of the mother isn’t direct killing of the fetus. Pro-life legislators should incorporate this understanding into laws by making clear exceptions for “life of the mother” cases so everyone is aware that we don’t intend for any women to die in triage situations in a pro-life world. (For what it’s worth, the pro-choice woman in the video clip is blatantly lying about Ohio’s law, which does have such an exception—not that MSNBC cares.) Imposing the erroneous pro-life definition as a legislative purity test, in the style of the abolitionists, isn’t doing women, babies, or the pro-life movement any favors.

Postscript: We’re simultaneously publishing a resource on our blog to equip pro-life people, especially those in public-facing roles, to respond well and clearly to questions on this and related topics in a press conference or similar scenario. You can find that resource here, and we hope leaders and politicians find it useful in avoiding pro-choice traps while articulating the pro-life position.

Please tweet this article!

• Tweet: Abortion and Medical Necessity: Improving the Pro-Life Approach
• Tweet: Contesting this definition, which is a losing battle, is costing us the ability to persuade people that abortion is wrong and to pass good pro-life legislation.
• Tweet: Pro-life legislators should incorporate this understanding into laws by making clear exceptions for “life of the mother” cases so everyone is aware that we don’t intend for any women to die in triage situations in a pro-life world.
• Tweet: Imposing the erroneous pro-life definition as a legislative purity test, in the style of the abolitionists, isn’t doing women, babies, or the pro-life movement any favors.

The post Abortion and Medical Necessity: Improving the Pro-Life Approach originally appeared at the Equal Rights Institute blog. Subscribe to our email list with the form below and get a FREE gift. Click here to learn more about our pro-life apologetics course, “Equipped for Life: A Fresh Approach to Conversations About Abortion.” 

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