Jonah Rubin
MD, soon Pulmonary/Critical Care fellow, views my own.

Debating abortion (and brain death): How to not miss the point

Pro-choicers are not murderers and pro-lifers do not hate women. Proponents of accepting brain death as death are not ghouls and opponents do not hate organ donation. The divisive political climate in the United States nevertheless often pervades these discussions which degenerate into unproductive zingers and one-upsmanship that neither advances the discourse nor respects the intelligent arguments on either side. Unilateral ideas are reinforced in their own echo chambers, while distance and misunderstanding outside these chambers widen ever further.

Just this month, Georgia and Missouri became the latest in a wave of states to pass a “fetal heartbeat bill”, banning abortion after a fetal heartbeat can be detected, usually around 6 weeks. Alabama banned abortion altogether. This stands in stark contrast with New York’s Reproductive Health Act, passed in January, which legalizes abortion up until 24 weeks, and even at full term if the fetus is not “viable”. Unsurprisingly, pro-choice and pro-life advocates are outraged, respectively.

The debates on abortion and brain death center on opposite ends of life’s spectrum, and yet the underlying issue is the same. Understanding this is crucial because only by distilling viewpoints to their axiomatic origins can discussions and counterarguments be focused and mutually understood.

The fundamental point of contention is the definition of life. Superficially, this seems like a question for physicians to answer, and yet, as is perhaps most clear in the abortion debate, it’s actually not a scientific question. A physician may tell you when conception occurred, when the heart forms and beats, when the brain or hands develop, or when the fetus can survive if birthed. But each happens at different times. Which criterion, if any, renders the fetus “alive”? This question is philosophical and social, not medical, and is thus a debate in the courts, not the hospitals. This question drives the abortion debate to this day, and society has not reached a consensus. Everyone agrees that murder, killing an innocent living human, is immoral. Defining a “living human” is the challenge.

To conclude that abortion is not murder, pro-choicers must maintain that a fetus, at whatever point they find abortion acceptable, is not alive. “My body, my choice” is a catchy mantra that perfectly misses this point and will therefore never sway anyone who considers the fetus alive; one’s right to self-determination ends well before murder. More importantly, this mantra reflects a misunderstanding of a pro-choicer’s own position, and exposes the influence of political bias in what should be a non-partisan debate. A pro-choicer (and pro-lifer) must first earnestly define life, and then deduce when abortion should be allowed. It would be intellectually dishonest and immoral to first choose the desired social outcome – abortion at month X – and then reverse engineer a definition of life to achieve this result. This was the shocking and misguided approach of Nobel laureate James Watson, who advocated for waiting three days after birth before declaring a newborn “alive.”

Conversely, to conclude that abortion is murder, pro-lifers must maintain that a fetus, at whatever point they find abortion unacceptable, is alive. Therefore, understandable appeals to allow abortion specifically in cases of rape or incest, tragic as those circumstances are, will not move a pro-lifer. If the fetus is alive, then rape does not justify its murder, and if the fetus is not alive, then abortion should be allowed regardless. Only if another life – the mother’s – is at risk, could abortion be justified by a pro-lifer. But others may define life differently, and reasonably so. Mindlessly labeling abortionists as murderous baby-killers similarly misses the point and will convince no one who disagrees. The poor branding of “pro-life” and “pro-choice” perpetuates this confusion by implying that the other is anti-life or anti-choice. Both sides, when argued thoughtfully, are pro-life, pro-choice, and anti-murder.

One could also reasonably develop a middle-ground position that a fetus has a unique status, something between life and not-life, which will directly impact the morality of abortion. This gray middle area is precisely where the two sides may meet to refine and define the nuanced differences between signs of life and life itself, and its implications for society including cases of rape, incest, or other significant conflicting factors. Secondary political gain must not influence this discussion.

While there is no consensus in defining life at its start, there is societal consensus in defining its end, with either cardiac or brain death. As in abortion, however, this discussion is social, not scientific. Brain-dead patients do show signs of life, including sexual maturation, wound healing, and can even give birth. A physician can tell you that the heart is beating, the body is growing, and that the patient will never regain consciousness and lacks integrated function, but to state that the patient is therefore not alive is for society, not the physician, to decide. Western society has broadly accepted brain death as death, and society has a right to define life for itself. But those who for personal, philosophical, or religious reasons oppose this definition of death are not defying science by disagreeing with the societal view. Appropriately, New York State therefore includes a clause requiring hospitals to reasonably accommodate those who do not accept brain death.

Although possibly the least emphasized, life is the first of the three unalienable rights mentioned in the Declaration of Independence. To protect everyone’s right to life, we, as a society, must first define it, without allowing ourselves to be influenced by political agendas and understandable emotional appeals from either side.

About the Author
Jonah Rubin received his BA from Yeshiva University and MD from Columbia University, is completing Internal Medicine residency at Columbia University Medical Center/NewYork-Presbyterian Hospital, and will be a Pulmonary & Critical Care fellow at Harvard University/Massachusetts General Hospital. He has a strong interest in the intersection of medical ethics, end of life care, and secular and Jewish law. Views are his own.
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