It Is Wrong to Make People Worse Off: Bodily Autonomy, Abortion, and Forced Organ Donation

It’s a dark and stormy night when your plane touches down in Analogyland. You, a pro-life apologist, have been invited to give a speech about bodily autonomy and abortion at a local convention center. You get into your rental car and begin to drive to your hotel. The storm worsens. A local violinist named Hector clutches his bright yellow raincoat tightly around him while he takes his dog out for a bathroom break. Out of nowhere, a drunk driver speeds towards you, out of control. He first careens into Hector and then veers into you, sending your car flying into a telephone pole.

You wake up in a hospital bed with minor damage. The doctor informs you that the drunk driver died on impact, and both of Hector’s kidneys were destroyed in the car accident. Fortunately, you and Hector just happen to have the same rare blood type such that you can save Hector’s life. So, the doctor plans to remove one of your kidneys and give it to Hector, restoring him to health.

You begin to protest: Hector has no right to one of your kidneys! You weren’t even the one who hit him! The doctor informs you that, here in Analogyland, the law guarantees the right to life. But, they can keep Hector alive on dialysis temporarily to let you appeal your case to the high court. You think about your anti-abortion speech and arguments about bodily autonomy, aware that your conviction that a right to bodily autonomy cannot ground a right to an abortion and your assertion that Hector has no right to your kidney seem inconsistent. When your day in court comes, what will you say to convince the judge that you should not have to give Hector one of your kidneys but also doesn’t even seem to imply that abortion is permissible because you have a right to refuse to use your body to help another person?

Estimated reading time: 14 minutes

Use Better/Worse Off Instead of Killing/Letting Die

Many are tempted to ground the differences in these cases in the killing vs. letting die distinction. The right to life is, therefore, the right not to be killed; allowing someone to die does not violate it. In the Hector case, refusing to allow your organs to be used to help another doesn’t constitute killing, but rather letting die. Hector dies of his own underlying pathology, not as a result of your actions. In the case of abortion, you are poisoning or dismembering the baby (as in surgical abortions), or effectively suffocating the baby (as with medical abortions like RU-486, hysterotomy, or hysterectomy)[1]. Abortion cases look far more like killing than letting die.

But the killing/letting die distinction is a confusing and controversial distinction. Some people are convinced the distinction is robust and explanatory, others find it nonsensical. After all, whether or not you killed or let die, someone ends up dead and you could have kept that from happening. Turning the discussion away from the topic of abortion and to the killing/letting die distinction often just muddies the water.

As such, rather than introduce a fraught distinction into an already difficult conversation, I—building off Tim Brahm’s “don’t freaking kill people” distinction—suggest framing the dilemma instead as the obligation to make someone better off vs. the obligation to not make someone worse off. Organ or blood donation makes the recipients better off: it saves lives. Abortion, on the other hand, makes the baby worse off: it takes lives. The pro-life person can consistently believe that no one has a right to be made better off, and thus you do not owe Hector a kidney, while also believing that everyone has a right not to be made worse off.

Consider the following cases as helpful illustrations of this better off/worse off distinction:

1)    Little John places a $20 bet with the Sheriff of Nottingham that Robin Hood will win the archery tournament. They give the purse to Prince John for safe keeping. Robin Hood wins, and the Sheriff  loses the $20 that he agreed to bet. It turns out that the Sheriff was broke, and that $20 was supposed to cover his food for the week. He will now starve and die. In following through with the bet, Prince John does not make the Sheriff worse off if he hands the $20 she bet over to Little John. Prince John also doesn’t make the Sheriff worse off if he chooses not to give the sheriff $20 of his own money. The Sheriff is out $20 and will die of starvation, but it would be inappropriate for King Richard to use the power of the law to compel Prince John or Little John to give the Sheriff back the $20.

2)    Little John places a $20 bet with the Sheriff of Nottingham that Robin Hood will win the archery tournament. They give the purse to Prince John for safe keeping. Before the contest finishes, the Sheriff and Little John call off the bet because Friar Tuck convinces them to do so. Prince John gives Little John his $20 back, but Prince John keeps the Sherrif’s $20 for himself. Prince John makes the Sheriff worse off by this. The Sheriff is out $20 through an act of theft. Prince John has an obligation to give the Sheriff back his $20 and return him to his state of financial health. King Richard may use the power of the law to compel Prince John to give the Sheriff back the $20—but King Richard may not compel Little John to give the Sheriff $20.

Case 1 is analogous to forced organ and blood donation or the famous violinist case. The sheriff, like the person with kidney failure or massive blood loss is in a bad state for pre-existing reasons, and the force of law should compel neither Prince John nor Little John to help him (though it would be good if either man did help him of his own volition).

Case 2 is analogous to the abortion case. The sheriff, like the unborn baby, is in a good state for pre-existing reasons. Something that is a proper part of that good state (his $20) has been taken/destroyed by Prince John. The sheriff is now worse off because of Prince John’s actions. Thus, the force of law should compel Prince John to return his $20. It should not compel Little John to give the sheriff $20, but it would certainly be kind if he did.

Abortion Makes a Baby Worse Off

Unlike people who can be made better off via organ or blood donation, babies in utero are not needy persons who can be made better off by using another person’s body. Babies in utero have everything that they need to survive already right where they are because their bodies, particularly their placentas, are functioning in concert with the larger pregnant body system the way placentas are supposed to function. While some organs, like the heart, work in utero as they do ex utero, a baby in utero uses his placenta instead of most other organs. The placenta is not just a passive tube through which blood flows; it is an organ that produces hormones and regulates the exchange of oxygen, nutrients, carbon dioxide, and waste products between maternal and fetal blood supply. The outer layer of the baby’s body during the blastocyst stage becomes the placenta over the course of the baby’s development, meaning a large part of the placental tissue is the baby’s genetic material. The proper function of the placenta is inseparable from the work of the maternal heart, lungs, digestive system, etc. The placenta and other organs work together during pregnancy as a complete pregnant-body system (mother + baby), which functions in notably different ways than mature non-pregnant female bodies. Abortion, then, takes a baby who, in most cases, is perfectly healthy and destroys that which belongs to the baby.[2]  To destroy the placenta before his kidneys, lungs, stomach, etc. are ready to do the placenta’s job clearly makes the baby worse off.

Doesn’t Pregnancy Make the Mother Worse Off?

But hold on, you might say, isn’t the baby violating the “don’t make others worse off” principle himself? Isn’t he making his mother worse off by occupying her body? I think there are three senses in which the baby could be said to make the mother worse off.

First, the baby can make the mother worse off by unintentionally interfering with the mother’s daily life and goals. Children, in or ex utero, often complicate parents’ lives dramatically. However, that baby Jack makes his mom Jill worse off because his existence significantly impairs Jill’s ability to live her life as she wishes does not seem to give Jill grounds to make Jack worse off by destroying her organs. To illustrate, imagine that your lifelong goal is to be a cruise ship lounge singer on Antarctic cruises. Because these are not particularly popular cruises, there’s only one cruise line running them, and they leave once every nine months. You get a last-minute call from your agent saying the Frozen Princess’s lounge singer quit this morning, and if you can make it to the docks before Kristen Bell (your competition), the job is yours. Knowing that the traffic around the port is a nightmare this time of day, you don’t take your normal car. Instead, you hop in your monster truck, which enables you to take an off-road route and bypass the traffic. This faster route requires crossing an old railroad bridge. When you get to the railroad bridge, you find that Snidely Whiplash has tied a woman, Nell Fennwick, to the tracks in classic vaudeville villain fashion. You can either get out of the truck and untie Nell, which will give Kristen enough time to get to the docks before you, or you can just crush Nell beneath your tires and make it to the docks first. If you don’t get to the docks, your career will be on hold for at least nine months, and you may never get the opportunity to sing aboard the Frozen Princess ever again. You worry that your parents will blame you for “squandering” your opportunity for success and kick you out of the house. Your community, who paid for your voice lessons, will feel betrayed and shun you. Your life will be significantly harder unless you just run Nell over right now.

You should not run Nell over. She’s a person. While she’s literally in your way and allowing her to stay in your way will make you worse off financially, emotionally, and socially, I don’t think that justifies making Nell worse off by killing or even just maiming her.

[3]“>The second sense in which the fetus might make the mother worse off is that the mother’s short or long-term health will be negatively impacted by pregnancy. First off, I want to clarify that I don’t think causing pain or discomfort is what makes someone worse off. I think to be made worse off is to be damaged in some way: to no longer be able to function properly. Oftentimes, physical pain is a symptom of such damage, but not always. Growing pains, the physical discomfort that comes with puberty, and even much of the discomfort associated with pregnancy are all examples of pain caused by our bodies functioning properly. But there are cases, such as Hyperemesis gravidarum, where the normal physical ailments of pregnancy reach abnormal or pathological levels. I still don’t think this justifies making another person worse off through an act of violence. To illustrate, imagine that you’re on a small submarine in the middle of the ocean. You start to feel increasingly sick. It turns out, you have an unexpected passenger on board: Snidely Whiplash, that villain, kidnapped a little old lady, doused her in strong smelling perfume, and left her on your submarine. It took a while for the perfume to make it all the way through the sub, but now that it has, you just cannot stop vomiting. You happen to have plenty of IV fluids on board that will keep you from getting dehydrated, but it’s really burdensome to a) be vomiting all the time and b) have to drag around an IV bag on its pole through the cramped submarine. You can either make your way slowly back to port, which will take at least 12 weeks given how often you need to rest and take in fluids from your IV, or you can take the sub to the surface and put the little old lady on the roof where her perfume will no longer taint the air. She will die of exposure or drown before you reach port. But you’ll immediately stop being nauseous if you take that route.

I don’t think you get to kick her out of the sub. That someone’s mere existence makes us worse off—especially through no intentional act of his or her own—does not justify us making them worse off in turn. 

The last sense in which a baby might make his mother worse off is in the cases where the pregnant body does not function properly, and the life of both mother and child are endangered should the pregnancy continue. For example, pre-eclampsia, eclampsia, gestational diabetes, ectopic pregnancy, etc. can be dangerous for both mother and baby. Only delivery cures these conditions. Many pro-life people think that if carrying a pregnancy to the point where a baby stands a chance of surviving delivery endangers a woman’s life, abortion is morally permissible. I think the “don’t make people worse off” principle still works in such a case: if his mother is in imminent danger of dying, then you don’t make the baby worse off by removing him from her uterus. You take him from a position of imminent death within the pregnant body and move him to a position of imminent death outside the pregnant body. You cause his death, but you don’t make him worse off.

Can You Be Better Off Dead?

Before I close, I want to acknowledge a limitation to the better off/worse off distinction. Anyone who thinks that someone can be better off dead than alive will have reason to think that abortion does not actually make the baby worse off under some circumstances. In such cases, the abortion debate is essentially the same as the euthanasia debate: is a life ever not worth living? Who should be the proper person to decide that a life is not worth living? What, if any, role must an individual’s consent play in determining whether to euthanize that person? These are big questions and need to be wrestled with by anyone who thinks of abortion and euthanasia as the same kind of thing.

For Better or Worse

Given all this, let us return to our starting case: how can you explain to the Analogyland judge why Hector’s right to life does not justify using legal force to take one of your organs and give it to him while also explaining why a human fetus’s right to life does justify making abortion illegal? You could say the following:

As I understand it, the right to life is a negative right: it is the right of innocent persons to not have their life taken from them. It is not a right to everything that one might need to survive in cases where one does not already have it. Because Hector’s kidneys no longer function in the way an adult human male’s kidneys should function, he no longer has all he needs to function and survive. Thus, refusing to aid Hector does not make him any worse off than he already is. It leaves him in his current state and does not make him better off. While making him better off would be selfless and good to do, the force of law should not be used to ensure one person makes another better off.

However, lest anyone be confused by my remarks here, I do not see this as having any bearing on the abortion conversation. During most pregnancies, babies’ bodies are healthy and are functioning properly as part of the whole pregnant-body system. The baby is not unhealthy because his kidneys, lungs, digestive system, etc. do not function the way an adult human’s organs function. A healthy human fetus’s organs are supposed to function via the placenta’s exchange between the baby’s blood supply and the mother’s blood supply; they would be abnormal if they functioned like yours or mine do. In the same manner, it isn’t a mark against my prepubescent daughter’s health that she does not menstruate the way an adult female does; it would be a bad thing if she did menstruate at her age and stage of development. With this in mind, doing anything to the baby that destroys his organs’ ability to function as they ought to given his stage of development (in other words, doing anything that destroys his placenta) makes him worse off, and the force of law should be used to ensure one person does not makes another worse off. 


[1] While it’s theoretically possible to perform a hysterotomy (C-section) or a hysterectomy to abort a baby, these are drastic and invasive medical procedures for the mother that I don’t know of anyone using as abortive procedures.
[2]  I have argued elsewhere that the placenta also belongs to the mother as a shared organ. That is consistent with this claim, as I am not saying it only belongs to the baby here. But even those who reject the parthood view or pregnancy should at least view the placenta, in part or in totality, as belonging to the baby and a part of his body.
[3] I designed this case to be analogous to pregnancy following rape. However, I certainly don’t think you get to run Nell over if she’s only there because your practicing the bagpipes kept her awake all night and she finally passed out on the tracks out of exhaustion. Such a case would be more analogous to pregnancy after consensual sex.

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The post It Is Wrong to Make People Worse Off: Bodily Autonomy, Abortion, and Forced Organ Donation 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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Elizabeth Lollar writes under a pen name. She has a master's degree in philosophy and teaches ethics at a small university. Her ever-patient and ever-loving husband stays up until the wee hours of the morning listening to her talk through whatever philosophical puzzle currently prevents her from sleeping. She has four children, three of whom are standing before the throne of God and interceding on her behalf.

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