By J. Norman Berry

Just as light reveals both itself and the darkness, so truth is the standard of itself and of the false.
-----Spinoza

To preserve life and to relieve suffering: These have been the goals of the physician. The first of these principles has been challenged in “modern” civilizations by advocates of

1. Euthanasia (“mercy killing”), and

2. Induced abortion.

The physicians’ reply to these challenges was first prescribed by the “Father of Medicine”:

I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.

---from the Hippocratic Oath

c. 400 B.C.

This ethic has been the consistent policy of the medical profession, and was reiterated in the Declaration of Geneva in 1948:

I will maintain the utmost respect for human life, from the time of conception; even under threat, I will not use my medical knowledge contrary to the laws of humanity.

Yet today the challengers persist, especially those advocating “liberalization” of existing abortion laws. Their numbers have grown legion, both without and within the medical profession.

Why?

Because of the increasing popularity of humanitarianism. This is the doctrine that man’s obligations are limited to the welfare of mankind and that man may perfect his own nature without the aid of divine grace. An attractive philosophy, but hardly worthy of man, who long ago discovered that the earth was not the center of the universe. Nevertheless, it becomes even more attractive when combined with utilitarianism, which states that any action is ethical or moral so long as it accomplishes the greatest good for the greatest number (the end justifies the means).

This combination thinking has been used to justify eugenic sterilization, abortion, medical experimentation without consent, genocide and war. Some of these are obviously anti-humanitarian as to mislead very few today (let us not forget history!); but such is not the case with induced abortion, which we shall examine in detail.

What is induced abortion?

For the purpose of this discussion, it is the surgical removal of the human fetus from its attachment to the lining of the uterus, resulting in the destruction of the fetus (feticide); the risk to the potential mother is small if properly performed.

What is “THERAPEUTIC” ABORTION?

As currently stated in Georgia law, this is induced abortion performed in order to save the life of the mother. What about the fetus? Is it a human being?

Here we find no definite answer from revelation, theology, law or the biological sciences; we may never have one. Current theological and legal opinions are discussed elsewhere. Let us examine what we know medically:

From the moment of fertilization the ovum contains the 46 chromosomes peculiar to the human species; these in turn carry within their DNA the genetic blueprint for one complete human being, including its sex determination. This fertilized ovum divides in an orderly manner as it travels down the Fallopian tubes, implanting on the inside lining of the uterus about four days after conception (prevention of implantation of the ovum by scraping the uterus or by use of the “morning after” pill would technically not be an abortion as it does not destroy the ovum, although the result is obvious).

Once it begins its intra-uterine life, the human embryo develops rapidly so the heart begins to beat at about three weeks, and by six weeks a recognizable human form has developed. By eight weeks the major internal organs are well formed and in about sixteen weeks the fetus begins to move (“quickening”). By 26 weeks the infant might survive outside the womb with proper medical attention, and it is “born” after 38 weeks.

Thus, interruption of pregnancy would destroy either a living organism with all the potential to become a human being or a human being itself.

If this is so obvious, why do we allow “therapeutic” abortion?

Many physicians feel conscientiously and intuitively that the life of the mother should be spared in preference to that of the fetus. If faced with that choice; many feel also that the destruction of a fetus is justified if the mother’s health is seriously threatened.

Since the operation is “therapeutic” only for the mother, how much has the maternal mortality been reduced by this procedure?

None! Maternal mortality is the same in hospitals where on therapeutic abortions are performed as in those where they are allowed. This is a reflection of the advances in medicine and the excellent state of maternal medical care in this country.

In that case, shouldn’t “therapeutic” abortions be performed less often?

Yes, and this is the case. The number has dropped to about 10,000 a year in the U.S., and many obstetricians feel that it should be much less. Serious threats to the life and health of the mother solely due to pregnancy rarely, if ever, occur. A recent example is that of a 35-year-old woman with rheumatic heart disease who had an artificial valve implanted while pregnant, improved remarkably, and delivered a normal infant. This was a much more satisfying solution to the mother and physician (and we assume to the infant) than the “simple” alternative of abortion.

Since the incidence of “therapeutic” abortion is already declining, why all the pressure to “liberalize” the existing laws?

Obviously the reasons are not medical; they are socio-economic and “humanitarian.”

But aren’t the proposed changes said to be based on medical considerations?

Yes. These changes were originally proposed as a part of the Model Penal Code by the American Law Institute, which have been approved with slight modifications by the A.M.A. as of June 1967. At that time, the A.M.A. declared that while it still opposed “therapeutic” abortion in principle, it now considered it ethically permissible with documented medical evidence that pregnancy might threaten the life or health of the mother; might result in incapacitating physical deformity or mental deficiency in the infant; or results from legally established statutory or forcible rape or incest, which might constitute a threat to the physical or mental health of the patient.

In addition, the A.M.A. attached the qualifications that two other physicians, chosen for their professional competence, must have concurred in writing, and that the procedure be performed in an accredited hospital.

Now let us examine each of these supposed medical considerations critically:

1.(a.) The life of health of the mother: This has already been discussed.

(b.) The mental health of the mother: Solomon himself would have trouble with this category! Yet, presumably certain women would commit suicide if pregnancy were not terminated. This has not proved to be the case (for example, in several hundred Swedish mothers who were refused legal abortions, 75 percent had their baby, 25 percent had illegal abortions, and none committed suicide). Considerations based on a supposed threat to the mental health of the mother are even more tenuous. The facts are that mental as well as physical health is a state basically independent of pregnancy and that treatment should be directed toward the basic problem, not toward destruction of the innocent fetus.

2. That the infant might be born with incapacitating physical deformity or mental deficiency: Certainly a valid point for medical consideration. The most prominent examples are:

(a.) Rubella (German measles): About one in four infants born to mothers who contract the disease in the first eight weeks of pregnancy will have minor or major deformities. Most are minor, and many are correctable. Obviously, if all are aborted, three normal fetuses will be killed or each with some degree of deformity.

(b.) Thalidomide and other teratogenic drugs: The use of this tranquilizer in early pregnancy resulted in the birth of about 7,000 children with phocomelia, a condition characterized by serious deformity or absence of limbs; this occurred in about 50 percent of drug exposures during early pregnancy. Almost all of these births occurred in Europe (Thalidomide was not licensed in the United States). These children (who are generally of normal intelligence) are now being treated intensively and lovingly in special orthopedic clinics.

The only known teratogenic drugs available for prescription in the United States are those used to treat leukemia and certain malignancies; non-teratogenic drugs are available for use during pregnancy. Of drugs available illegally, LSD has recently been shown to be teratogenic as well as to cause direct damage to human chromosomes. Obviously the use of all medications not absolutely necessary should be avoided during pregnancy.

(c.) Genetic disorders resulting in serious physical or mental deficiency: Most of these are the result of recessive genes (e.g., hemophilia) and could be prevented by proper genetic counseling. Some disorders, which would otherwise result in mental deficiency can be prevented entirely by early identification and proper treatment. Others can presently be neither predicted nor treated.

In each of these instances, the medical approach should be prevention, not abortion. An effective vaccine against German measles is on the horizon, and gamma globulin may afford some protection for those exposed. Injections can now be given to prevent Rh antibodies in prospective mothers who are Rh negative. Teratogenic drugs should be avoided. Genetic counseling is becoming more precise, and those born with non-lethal defects can be effectively cared for by medical science and by society. Many of these will become useful and some will become outstanding citizens.

It should be noted that the first heart transplant done in this country was from one infant with a lethal brain defect to another with a lethal cardiac defect, so that two “halves” might make a whole. The fact that the latter child died after 61/2 hours does not detract from this positive proper use of the advances in medicine. Under the proposed changes in the abortion law, both of these infants could have been killed legally. The conclusions are obvious.

3. Rape or incest: Surely the victim of established forcible rape or incest deserves and should get the best and most sympathetic medical care immediately. In such cases, pregnancy rarely, if ever, becomes established. But let us suppose the physician is asked to perform an abortion on an unmarried girl, already pregnant, claiming to be the victim of rape. Most likely this cannot be proved or disproved on medical grounds.

Surely the mental health of the patient is threatened in either case. If so, are they all to be aborted? If not, who is to decide?

In any event, the medical indication for termination of pregnancy is non-existent and if there is any indication for abortion it must be social. The physician is an instrument of the healing art, not a tool to be used at the capricious whim of society for the destruction of innocent life.

All the above conclusions are my own, and are based on reading, intuitive reasoning, and hopefully, at least, a glimmer of faith and of grace. They may be subject to change. I do not pretend to speak for the majority of physicians, nor necessarily for the majority of Catholic physicians, and I do not hold my conscience superior to theirs. Certainly it would not be candid to withhold the results of a recent Modern Medicine survey to which 14,000 physicians replied: 87 percent of all physicians replying, and nearly 50 percent of those who identified themselves as Catholic, favored some liberalization of existing abortion laws.

Even if the present laws are “liberalized” (becoming more popular now are the terms “modernized” or “humanized”) along the lines of the Model Penal Code of the American Law Institute as modified by the A.M.A., this will not materially reduce the number of illegal abortions in this country. Much more liberal laws have not reduced the number of illegal abortions in Sweden, Denmark, Norway, Hungary and Japan.

What would the true humanitarian like to see done with our abortion laws? The following is a verbatim quote of an answer by Ralph M. Crowley, M.D., past president of the American Academy of Psychoanalysis, when said, “Should the laws on abortion be liberalized?”

“No and yes.”

“No, because I have long thought that abortion should not be subject to legal jurisdiction any more than an appendectomy is. I think that abortion should be taken altogether out of the hands of the law and placed where it belongs, in the hands of the woman involved and her physician. There should be no restrictions on any physician doing an abortion at any time for any reason. (underline mine) I would agree to laws forbidding abortions by non-medical persons.

“My reasons for not believing in liberalizing abortion laws -- short of abortion being the province of the woman and her physician -- are many.”

“First: Liberalization, such as that advocated by the American Law Institute, does not grant a woman freedom not to bear a child. Any denial of this freedom is abhorrent to me.”

“Second: Most liberalizations do not attempt to concern themselves with social, economic and the resulting emotional factors, which I believe to be the basis for most abortions today.”

“Third: With liberalization, too many children will still be born without being wanted. As far as is possible, all children deserve to be wanted.”

“Fourth: Liberalization will not materially reduce illegal abortions and the criminal rackets associated with them. An example of this is Sweden, with its laws far more liberal than those being seriously considered in the United States today.”

“Fifth: This means that the psychological and emotional traumas associated with unsanctioned and illegal abortions will not be avoided. There is considerable evidence that abortions under sanctioned auspices result in few or no psychological sequelae.”

“Yes, I do believe in liberalization, because I see no possibility at present that lawmakers or their constituents will accept what I believe in.”

“I do not think that enactment of partial legislation will slow down or prevent the eventual acceptance of abortion on the terms I advocate, so let us have what liberalization we can. It will help physicians feel supported by the law and society in doing what the medical and personal consciences allow them to do in order to make this a better world in which to live.”

“Our present laws and physicians’ fears of them make in respect to the operation of abortion a travesty of man’s humanity to man.”

Unbelievable?

Almost, but go back and read it again. It is later than I thought. It is later than you think. Write to your state senator and ask him to review the present state law on abortion, and if necessary revise it so that

1. No physician acting in his best medical judgment and to the best dictates of his conscience could be prosecuted, provided that

2. The legal right of life of the innocent unborn and the rights of both prospective parents are also protected to the fullest extent of the law.

We can do no less, and we should allow no more.

COMMENT FOR THE PHYSICIAN

Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult. The physician must not only be prepared to do what is right himself, but also make the patient, the attendants and externals cooperate.

---first aphorism of Hippocrates

SUMMARY:

1. The preservation of life and the relief of suffering have been and are the highest goals of the medical profession.

2. Proposed changes “liberalizing” the current abortion laws are based largely on the dubious doctrine of humanitarianism and the questionable ethic of utilitarianism. PURELY MEDICAL INDICATIONS ARE ABSENT OR LACKING IN SUBSTANCE.

3. Nowhere in the proposed changes is the inherent right of the unborn child to life even mentioned, much less provided for.

4. Enactment of these changes would not reduce the number of illegal abortions, as we know from the example of certain countries which have long had far more liberal abortion laws.

The proposed changes should be defeated, and the present law concerning therapeutic abortion in Georgia should be reviewed. If necessary the law should be changed to provide maximum protection for the potential parents, the unborn child and the conscientious and ethical physician.

TO BE OR NOT TO BE?