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The Problem of Spontaneous Abortion: Is the Pro-Life Position Morally Monstrous?

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Abstract

A substantial proportion of human embryos spontaneously abort soon after conception, and ethicists have argued this is problematic for the pro-life view that a human embryo has the same moral status as an adult from conception. Firstly, if human embryos are our moral equals, this entails spontaneous abortion is one of humanity’s most important problems, and it is claimed this is absurd, and a reductio of the moral status claim. Secondly, it is claimed that pro-life advocates do not act as if spontaneous abortion is important, implying they are failing to fulfill their moral obligations. We report that the primary cause of spontaneous abortion is chromosomal defects, which are currently unpreventable, and show that as the other major cause of prenatal death is induced abortion, pro-life advocates can legitimately continue efforts to oppose it. We also defend the relevance of the killing and letting die distinction, which provides further justification for pro-life priorities.

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... This criticism seems unwarranted. As we have noted, a very significant research programme into spontaneous abortion already exists (Blackshaw and Rodger 2019). 15 Further, consider an analogy. ...
... Colgrove (2021) here refers to spontaneous abortions as miscarriages.18 Blackshaw and Rodger (2019) explain that induced abortion is the most common preventable cause of prenatal death. ...
Article
Opponents of abortion are commonly said to be inconsistent in their beliefs or actions, and to fail in their obligations to prevent the deaths of embryos and fetuses from causes other than induced abortion. We have argued that these ‘inconsistency arguments’ conform to a pattern which is susceptible to a number of objections, and that consequently they fail en masse. In response, Joshua Shaw argues that we misrepresent inconsistency arguments, and that we underestimate the extent to which our opponents have anticipated and addressed counterarguments. In this essay we draw on aspects of Shaw’s alternative formulation of inconsistency arguments to present an improved inconsistency argument structure. While we agree with Shaw that inconsistency arguments must each be examined on their merits, we reject Shaw’s assertion that our objections are dependent on misrepresentations. Our initial objections remain largely successful, therefore, in dealing with the inconsistency arguments of which we are aware.
... They assert that this obligation entails strongly counterintuitive, if not absurd, implications that demonstrate that the substance view is implausible. Defences have been made against these claims (Friberg-Fernros 2015, Blackshaw and Rodger 2019, but many critics seem unpersuaded so far. ...
... 3 Amy Berg responds by claiming that substance view proponents are bystanders with respect to induced abortion, and so these are also cases of letting die (2017, p. 1222). Blackshaw and Rodger (2019) counter this by citing Thomas Pogge's view that in a democratic society, all citizens are responsible for a legal system that permits induced abortions, and so all citizens participate to an extent in killing (Pogge 2010, p.127). Pogge suggests an analogy with slavery, arguing that all citizens were similarly morally responsible for laws permitting slavery. ...
Article
Recently, the substance view of persons has been heavily criticized for the counterintuitive conclusions it seems to imply in scenarios such as embryo rescue cases and embryo loss. These criticisms have obscured the considerable success of the substance view in supporting other intuitions that are widely shared, and that competing accounts such as the psychological view have difficulties accounting for. Here, I examine common intuitions regarding identity, human exceptionalism, the moral equality of children and adults, infanticide, and prenatal injury. I conclude that when we broaden the range of intuitions examined, the substance view emerges as just as plausible an account of our nature as the more widely accepted psychological view.
... As Blackshaw and Rodger explain, induced abortion is the leading preventable cause of death of human beings, as spontaneous abortions are largely unpreventable. 5 If OAs sincerely believe these claims, then they are acting consistently with their beliefs, and the Other Beliefs Objection succeeds. ...
... Induced abortion is the leading preventable cause of death for all human beings, however, so charges of inconsistency seem dubious. 5 Relatedly, as Colgrove notes, the number of lives affected is not the only relevant factor-PAC theorists must also consider the probability of success in their efforts. 6 Preventable causes can reasonably be preferred over apparently intractable ones. ...
Article
William Simkulet has recently criticised Colgrove et al ’s defence against what they have called inconsistency arguments—arguments that claim opponents of abortion (OAs) act in ways inconsistent with their underlying beliefs about human fetuses (eg, that human fetuses are persons at conception). Colgrove et al presented three objections to inconsistency arguments, which Simkulet argues are unconvincing. Further, he maintains that OAs who hold that the fetus is a person at conception fail to act on important issues such as the plight of frozen embryos, poverty and spontaneous abortion. Thus, they are morally negligent. In response, we argue that Simkulet has targeted a very narrow group of OAs, and so his criticisms are inapplicable to most OAs. We then explain why his responses to each of Colgrove et al’s objections do not succeed, even for this restricted group. Finally, we note that Simkulet fails to provide evidence for his claims regarding OAs’ supposed failures to act, and we show that OAs veritably do invest resources into these important issues. We conclude that Colgrove et al ’s reasons for rejecting inconsistency arguments (en masse) remain intact.
... Treating frozen embryos as neighbors requires securing them a life like ours through adoption and gestation, and as well as opposing abortion, Christians must work toward this goal for the vast numbers of frozen embryos that would otherwise be discarded. Blackshaw and Rodger (2019) attempt to justify OA disinterest in spontaneous abortion, claiming that most cases of spontaneous abortion are not currently preventable; but notes that "if we regard all human life as equally valuable, we have at least some obligation toward helping reduce deaths from spontaneous abortion where possible". This paper argues that inconsistency arguments matter. ...
Article
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Most opponents of abortion (OA) believe fetuses matter. Critics argue that OA act inconsistently with regards to fetal life, seeking to restrict access to induced abortion, but largely ignoring spontaneous abortion and the creation of surplus embryos by IVF. Nicholas Colgrove, Bruce Blackshaw, and Daniel Rodger call such arguments inconsistency arguments and contend they do not matter. They present three objections to these arguments — the other beliefs, other actions, and hypocrisy objection. Previously, I argued these objections fail and threaten to undermine ethical inquiry. Colgrove et al. have recently replied, but here, I argue their reply fails as well and raises a new criticism of the other actions’ objection. This essay sets out to show, as well as any philosophical argument can, that inconsistency arguments are morally significant.
... In response, pro-life philosophers have pointed out that a high percentage of miscarriages are not preventable, and shown that induced abortion is the most significant preventable cause of death prior to birth. 62 They have, however, acknowledged that miscarriage is an important issue that deserves more attention from pro-life advocates. 63 Clearly, on the view that fetuses are persons, if induced abortion is a public health crisis that requires quite drastic action in the form of abortion prohibitions, it must be agreed that miscarriage is also a public health crisis. ...
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Pro- life advocates commonly argue that fetuses have the moral status of persons, and an accompanying right to life, a view most pro- choice advocates deny. A dif-ficulty for this pro- life position has been Judith Jarvis Thomson’s violinist analogy, in which she argues that even if the fetus is a person, abortion is often permissible be-cause a pregnant woman is not obliged to continue to offer her body as life support. Here, we outline the moral theories underlying public health ethics, and examine the COVID- 19 pandemic as an example of public health considerations overriding individual rights. We argue that if fetuses are regarded as persons, then abortion is of such prevalence in society that it also constitutes a significant public health crisis. We show that on public health considerations, we are justified in overriding individual rights to bodily autonomy by prohibiting abortion. We conclude that in a society that values public health, abortion can only be tolerated if fetuses are not regarded as persons.
... [24][25][26][27][28][29][30][31][32][33][34][35][36] OAs have continued these discussions through 2019 as well. [37][38][39][40][41] ii Typically, the main concern of these projects is to undermine the view that embryos and fetuses possess the moral status of persons. But each argues that OAs are hypocritical (or inconsistent) in some way, as a means of trying to show that OAs' views are implausible. ...
Article
Opponents of abortion are often described as ‘inconsistent’ (hypocrites) in terms of their beliefs, actions and/or priorities. They are alleged to do too little to combat spontaneous abortion, they should be adopting cryopreserved embryos with greater frequency and so on. These types of arguments—which we call ‘inconsistency arguments’—conform to a common pattern. Each specifies what consistent opponents of abortion would do (or believe), asserts that they fail to act (or believe) accordingly and concludes that they are inconsistent. Here, we show that inconsistency arguments fail en masse. In short, inconsistency arguments typically face four problems. First, they usually fail to account for diversity among opponents of abortion. Second, they rely on inferences about consistency based on isolated beliefs shared by some opponents of abortion (and these inferences often do not survive once we consider other beliefs opponents of abortion tend to hold). Third, inconsistency arguments usually ignore the diverse ways in which opponents of abortion might act on their beliefs. Fourth, inconsistency arguments criticise groups of people without threatening their beliefs (eg, that abortion is immoral). Setting these problems aside, even supposing inconsistency arguments are successful, they hardly matter. In fact, in the two best-case scenarios—where inconsistency arguments succeed—they either encourage millions of people to make the world a (much) worse place (from the critic’s perspective) or promote epistemically and morally irresponsible practices. We conclude that a more valuable discussion would be had by focusing on the arguments made by opponents of abortion rather than opponents themselves.
... The high number of spontaneous abortions is problematic, thoughcritics such as Simkulet (2017) have suggested that at a minimum equal resources should be directed towards both preventing spontaneous abortions and preventing induced abortions, perhaps moreand yet substance theorists rarely even raise spontaneous abortion as an issue. I have explored this incongruence elsewhere (Blackshaw and Rodger 2019), and here note two key points. Firstly, considerable healthcare resources are already invested into preventing miscarriage, as this is a widely experienced issue for couples wishing to conceive, both naturally and by in vitro fertilization (IVF). ...
Article
The substance view is an account of personhood that regards all human beings as possessing instrinsic value and moral status equivalent to that of an adult human being. Consequently, substance view proponents typically regard abortion as impermissible in most circumstances. The substance view, however, has difficulty accounting for certain intuitions regarding the badness of death for embryos and fetuses, and the wrongness of killing them. Jeff McMahan’s time-relative interest account is designed to cater for such intuitions, and so I present a proposal for strengthening the substance view by incorporating McMahan’s account – the Dual-Aspect Account of the morality of killing. I show that it resolves some important issues for the substance view while preserving its central premise of moral equality for all human beings. I then compare the Dual-Aspect Account with McMahan’s Two-Tiered Account of the morality of killing, which he derives from his time-relative interest account.
... For a response to Räsänen (2018), see Kaczor (2018). Lastly, while this paper was under review, Blackshaw and Rodger (2019) published a response to Ord's style of argument. Blackshaw and Rodger come the closest to offering the same type of response as me (particularly with respect to the first of three responses I develop), though as I note below, there are several ways in which our arguments are importantly different. ...
Article
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Some opponents of abortion claim fetuses are persons from the moment of conception. Call these “Personhood-At-Conception” (or PAC), opponents of abortion. Amy Berg (2017, Philosophical Studies 174:1217–26) argues that if fetuses are persons from the moment of conception, then miscarriage kills far more people than abortion. Thus, PAC opponents of abortion must “immediately” and “substantially” shift their attention, resources, etc., toward preventing miscarriage or admit they do not believe that personhood begins at conception (or, at least, they should recognize they are not acting in ways consistent with this belief). Unfortunately, Berg’s argument fails at every step. After outlining her argument, I show that her claim—that “miscarriage . . . is much deadlier than abortion”—is false (when taken literally) and misleading otherwise. Further, Berg’s argument is identical in structure to a criticism sometimes levied against the “Black Lives Matter” movement. In the latter context, the argument has been vehemently rejected. Berg’s argument should be rejected for the same reasons. Finally, Berg cites no evidence when claiming that PAC opponents of abortion are “not doing enough” to prevent miscarriage. And, even if PAC opponents of abortion are not diverting substantial funds toward miscarriage prevention, Berg fails to notice that this may be for good reason.
... I am not denying that they could be solved without Schrödinger's fetus. Attempts have recently been made to solve the spontaneous abortion problem (Friberg-Fernros 2018;Blackshaw & Rodger 2019) and the embryo rescue case (Hendricks 2019), and I am confident that the last word on these topics has yet to be said. My proposal simply is that with Schrödinger's fetus, we don't even have to solve these problems, because with Schrödinger's fetus these problems do not arise in the first place. ...
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This paper defends and develops Elizabeth Harman’s Actual Future Principle with a concept called Schrödinger’s Fetus. I argue that all early fetuses are Schrödinger’s Fetuses: those early fetuses that survive and become conscious beings have full moral status already as early fetuses, but those fetuses that die as early fetuses lack moral status. With Schrödinger’s Fetus, it becomes possible to accept two widely held but contradictory intuitions to be true, and to avoid certain reductiones ad absurdum that pro-life and pro-choice positions face. It also gives a simple solution to the problem of prenatal harm.
Article
Recent publications debate the value of inconsistency arguments. Here, I argue that ‘Cause of Death Arguments’ — inconsistency arguments that claim miscarriage causes death far more often than induced abortion — are unsound or invalid. ‘Miscarriage’ ambiguously refers both to intrauterine death, an outcome that does not itself cause death, and preterm delivery, which only sometimes causes death. The referential ambiguity also obscures actions people do take to prevent ‘miscarriage.’ When using the most plausible versions of each premise, these arguments equivocate. Thus, they cannot prove anything. However, missing the equivocation also causes those responding to Cause of Death Arguments to make unconvincing arguments; they inadvertently make or grant false claims themselves. To avoid such mistakes and expose the merely rhetorical power of Cause of Death Arguments, philosophers should replace ‘miscarriage’ with disambiguated terms. Doing so should lead people across the abortion debate to finally abandon the Cause of Death Argument.
Article
One of the most influential philosophical arguments in favour of the permissibility of abortion is Judith Jarvis Thomson’s violinist analogy, presented in ‘A Defense of Abortion’. Its appeal for pro-choice advocates lies in Thomson’s granting that the fetus is a person with equivalent moral status to any other human being, and yet demonstrating—to those who accept her reasoning—that abortion is still permissible. In her argument, Thomson draws heavily on the parable of the Good Samaritan, arguing that gestating a fetus in some circumstances is what she calls a Good Samaritan act, and claiming that we are not morally required to be Good Samaritans. Here, I argue that Thomson has subverted the parable to justify an action that is the antithesis of its meaning. I contend that Christians are required to be Good Samaritans, and explain that for Christians, this entails abortion is impermissible in all circumstances. Further, I argue that the parable shows the fetus is our neighbour in need of our mercy and assistance, and consequently Christians should be actively involved in helping to ensure the unborn are protected, whether they are fetuses in danger of induced abortion or miscarriage, or surplus frozen embryos.
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Purpose To clarify the associations of the maternal age, history of miscarriage, and embryonic/fetal size at miscarriage with the frequencies and profiles of cytogenetic abnormalities detected in spontaneous early miscarriages. Methods Miscarriages before 12 weeks of gestation, whose karyotypes were evaluated by G-banding between May 1, 2005, and May 31, 2017, were included in this study. The relationships between their karyotypes and clinical findings were assessed using trend or chi-square/Fisher’s exact tests and multivariate logistic analyses. Results Three hundred of 364 miscarriage specimens (82.4%) had abnormal karyotypes. An older maternal age was significantly associated with the frequency of abnormal karyotype (ptrend < 0.001), particularly autosomal non-viable and viable trisomies (ptrend 0.001 and 0.025, respectively). Women with ≥ 2 previous miscarriages had a significantly lower possibility of miscarriages with abnormal karyotype than women with < 2 previous miscarriages (adjusted odds ratio [aOR], 0.48; 95% confidence interval [95% CI], 0.27–0.85). Although viable trisomy was observed more frequently in proportion to the increase in embryonic/fetal size at miscarriage (ptrend < 0.001), non-viable trisomy was observed more frequently in miscarriages with an embryonic/fetal size < 10 mm (aOR, 2.41; 95% CI, 1.27–4.58), but less frequently in miscarriages with an embryonic/fetal size ≥ 20 mm (aOR, 0.01; 95% CI, 0.00–0.07) than in anembryonic miscarriages. Conclusions The maternal age, history of miscarriage, and embryonic/fetal size at miscarriage may be independently associated with the frequencies or profiles of cytogenetic abnormalities in early miscarriages.
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In a recent article, William Simkulet has argued against the anti-abortion view by invoking the fact that many human fetuses die from spontaneous abortion. He argues that this fact poses a dilemma for proponents of the anti-abortion view: either they must abandon their anti-abortion view or they must engage in preventing spontaneous abortion significantly more than at present—either to the extent that they try to prevent induced abortion or at least significantly more than they do today. In this reply, I acknowledge that, if the latter would follow, the anti-abortionist view would imply implausibly strong obligations. My aim with this reply is to demonstrate that anti-abortionists can hold on to their view without having implausibly strong obligations to prevent spontaneous abortion. My conclusion is that Simkulet clearly overstates his position by not sufficiently considering the differences between the act of killing versus death by natural causes and between positive and negative rights.
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Opponents of abortion sometimes hold that it is impermissible because fetuses are persons from the moment of conception. But miscarriage, which ends up to 89 % of pregnancies, is much deadlier than abortion. That means that if opponents of abortion are right, then miscarriage is the biggest public-health crisis of our time. Yet they pay hardly any attention to miscarriage, especially very early miscarriage. Attempts to resolve this inconsistency by adverting to the distinction between killing and letting die or to the difficulty of preventing miscarriage fail, leaving a dilemma. Opponents of abortion should either advocate a substantial shift in our political and medical priorities or else give up the view that fetuses are persons from the moment of conception.
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The New York State Early Pregnancy Detection Study was a prospective study of early pregnancy loss, between implantation and menses, in 217 women attempting to become pregnant during 1989–1992. Women collected urine samples on three consecutive mornings during the late luteal phase of their menstrual cycle, for up to 12 cycles, contributing samples for 1253 menstrual cycles. Urinary human chorionic gonadotrophin (HCG), measured using an immunoradiometric assay, was the biomarker for pregnancy. We observed a range of early pregnancy loss (EPL) rates, from a low estimate of 11.0% to a high estimate of 26.9%, depending on the definition used and the subgroup analysed. Based on a definition of 3 days of HCG concentration > 4.00 pmol/1, 2 days 3=533 pmol/1 or the last, day of HCG 2 = 6.67 pmol/1, we identified 115 positive cycles; 95 cycles were clinically confirmed pregnancies and 20 cycles were EPL, giving an EPL rate of 17.4% [95% confidence interval (CI) 11.0-25.6]. In addition, we observed an EPL rate of 19.5% (95% CI 113-30.1) for samples collected within a 15 day window around menses, and a rate of 203% (95% CI 113-32.2) for samples limited to the first three menstrual cycles. Because studies use urine collection schemes other than daily sampling, the definition of pregnancy will be crucial in defining EPL.
Article
In his article ‘The substance view: A critique’, Rob Lovering argues that the substance view –according to which a human person comes into existence at the moment of conception – leads to such implausible implications that this view should be abandoned. I responded to his reductio arguments in ‘A critique of Rob Lovering's criticism of the substance view’ and concluded that his arguments did not justify a rejection of the substance view. Now Lowering and William Simkulet have both responded to my criticism, claiming that my criticism of Lovering's article did not refute his original arguments. In this article I respond to their criticism and conclude that, while the substance view has some less plausible implications, none of them justify a complete refutation of this view.
Book
Bleeding during pregnancy is not a rare phenomenon and has been associated with significant maternal and fetal morbidities and even mortality. Although vaginal bleeding occurs mainly during the first trimester, it can appear at any stage of pregnancy and during the post-partum period. This sometimes life-threatening event requires an extensive work-up in order to recognize its cause and establish a rapid and effective therapeutic approach. Bleeding During Pregnancy: A Comprehensive Guide draws on evidence-based data and brings together updated information on all aspects of pregnancy-related bleeding. Chapters were contributed by a multidisciplinary team of international experts, including obstetricians, gynecologists, anesthesiologists, hematologists, oncologists and epidemiologists. Topics covered include: bleeding during early pregnancy (early pregnancy loss, ectopic pregnancy, gestational trophoblastic disease, and cancer of the reproductive tract during pregnancy; bleeding in late pregnancy (preterm delivery, placental abruption, placenta previa, vasa previa and uterine rupture); and post partum-hemorrhage. Intensive care of a patient with excessive bleeding and coagulotherapy during pregnancy or the post-partum period are also discussed. This book is an essential guide for a broad spectrum of clinicians and health care professionals who treat pregnant patients.
Article
Many people believe human fetuses have the same moral status as adult human persons, that it is wrong to allow harm to befall things with this moral status, and thus voluntary, induced abortion is seriously morally wrong. Recently, many prochoice theorists have argued that this antiabortion stance is inconsistent; approximately 60% of human fetuses die from spontaneous abortion, far more than die from induced abortion, so if antiabortion theorists really believe that human fetuses have significant moral status, they have strong moral obligations to oppose spontaneous abortion. Yet, few antiabortion theorists devote any effort to doing so. Many prochoice theorists argue that to resolve this inconsistency, antiabortion theorists should abandon their opposition to induced abortion. Here, I argue that those who do not abandon their opposition to induced abortion but continue to neglect spontaneous abortion act immorally. Aristotle argues that moral responsibility requires both control and awareness; I argue that once an antiabortion theorist becomes aware of the frequency of spontaneous abortion, they have a strong moral obligation to redirect their efforts towards combating spontaneous abortion; failure to do so is morally monstrous.
Book
Doing harm seems much harder to justify than merely allowing harm. If a boulder is rushing towards Bob, you may refuse to save Bob's life by driving your car into the path of the boulder if doing so would cost you your own life. You may not push the boulder towards Bob to save your own life. This principle—the Doctrine of Doing and Allowing—requires defence. Does the distinction between doing and allowing fall apart under scrutiny? When lives are at stake, how can it matter whether harm is done or allowed? Drawing on detailed analysis of the distinction between doing and allowing, Fiona Woollard argues that the Doctrine of Doing and Allowing is best understood as a principle that protects us from harmful imposition. Such protection against imposition is necessary for morality to recognize anything as genuinely belonging to a person, even that person's own body. As morality must recognize each person's body as belonging to her, the Doctrine of Doing and Allowing should be accepted. Woollard defends a moderate account of our obligations to aid, tackling arguments by Peter Singer and Peter Unger that we must give most of our money away and arguments from Robert Nozick that obligations to aid are incompatible with self-ownership
Article
Defending Life is the most comprehensive defense of the prolife position on abortion ever published. It is sophisticated, but still accessible to the ordinary citizen. Without high-pitched rhetoric or appeals to religion, the author offers a careful and respectful case for why the prolife view of human life is correct. He responds to the strongest prochoice arguments found in law, science, philosophy, politics, and the media. He explains and critiques Roe v. Wade, and he explains why virtually all the popular prochoice arguments fail. There is simply nothing like this book.
Chapter
Reproductive failure occurs in all forms of life, plant and animal. I have been asked to make a few introductory or general remarks about the problem in man. Whatever I have to say is based upon 35 years’ experience in obstetric and gynecologic pathology, seasoned by interest in the early embryology of the human and interspersed with a nine-year interval as clinical obstetrician. These remarks are in no sense an exhaustive review of reproductive anatomy, physiology and pathology, even as applied to the human, let alone to mammals in general. Comments will be confined to my observations on the early or potentially abortive phases of human development and a pathologic evaluation of a thousand consecutive human abortions, most of them spontaneous.
Article
Pregnancy loss occurs in about 15% of recognized pregnancies. In the vast majority of cases, the loss is the consequence of an abnormal fetal karyotype. Hence chromosome analysis of spontaneous abortus material should be part of the standard clinical evaluation of miscarriage. In a small subset of couples experiencing pregnancy loss, especially those with younger women and a history recurrent loss, other factors may be involved and these are presented along with their significance.
Article
Appealing to reason rather than religious belief, this book is the most comprehensive case against the choice of abortion yet published. The Ethics of Abortion critically evaluates all the major grounds for denying fetal personhood, including the views of those who defend not only abortion but also infanticide. It also provides several (non-theological) justifications for the conclusion that all human beings, including those in utero, should be respected as persons. This book also critiques the view that abortion is not wrong even if the human fetus is a person. The Ethics of Abortion examines hard cases for those who are prolife, such as abortion in cases of rape or in order to save the mother’s life, as well as hard cases for defenders of abortion, such as sex selection abortion and the rationale for being “personally opposed” but publically supportive of abortion. It concludes with a discussion of whether artificial wombs might end the abortion debate. Answering the arguments of defenders of abortion, this book provides reasoned justification for the view that all intentional abortions are morally wrong and that doctors and nurses who object to abortion should not be forced to act against their consciences.
Article
Introduction Miscarriage is the most common complication of pregnancy, with as many as 15-20% of clinically recognised pregnancies ending in spontaneous failure. The main causes of miscarriage are sporadic lethal chromosomal abnormalities and these pregnancies are destined to fail from the outset. In fact, if all conceptions were included in the definition of miscarriage, around 40% would end in failure, with the majority occurring before the pregnancy could be clinically recognised. However, in some couples, miscarriage can be recurrent, which is defined as three consecutive pregnancy losses before fetal viability at 24 weeks of gestation. The prevalence of this condition is approximately 1%. As the most common cause of miscarriage is aneuploidy, which is directly related to maternal age, the risk and prevalence of early pregnancy loss rises with increasing maternal age. The overall prevalence of recurrent miscarriage in the population is higher than would be expected by chance alone. Statistically, the prevalence should be only 0.34%, indicating that in some couples there may be an underlying cause that puts them at higher risk. However, the calculation of the risk of three consecutive losses is based on the assumption that the baseline risk of miscarriage is 15%. This calculation does not take into account the fact that the risk of miscarriage increases with advancing maternal age. For example, the risk of miscarriage in a 40-year-old woman is at least 45% and therefore the expected prevalence of recurrent miscarriage in this age group is approximately 9%.
Article
Sporadic miscarriage is the most common complication of early pregnancy. Two or three consecutive pregnancy losses is a less common phenomenon, and this is considered a distinct disease entity. Sporadic miscarriages are considered to primarily represent failure of abnormal embryos to progress to viability. Recurrent miscarriage is thought to have multiple etiologies, including parental chromosomal anomalies, maternal thrombophilic disorders, immune dysfunction and various endocrine disturbances. However, none of these conditions is specific to recurrent miscarriage or always associated with repeated early pregnancy loss. In recent years, new theories about the mechanisms behind sporadic and recurrent miscarriage have emerged. Epidemiological and genetic studies suggest a multifactorial background where immunological dysregulation in pregnancy may play a role, as well as lifestyle factors and changes in sperm DNA integrity. Recent experimental evidence has led to the concept that the decidualized endometrium acts as biosensor of embryo quality, which if disrupted, may lead to implantation of embryos destined to miscarry. These new insights into the mechanisms behind miscarriage offer the prospect of novel effective interventions that may prevent this distressing condition
Article
To identify modifiable risk factors for miscarriage and to estimate the preventable proportion of miscarriages that could be attributed to these. Nationwide observational follow-up study. Denmark. Ninety-one thousand four hundred and twenty seven pregnancies included in the Danish National Birth Cohort between 1996 and 2002. Information on potentially modifiable risk factors before and during pregnancy was collected by means of computer-assisted telephone interviews and linkage with Danish registers, ensuring almost complete follow-up of pregnancy outcome. Modifiable risk factors for miscarriage were identified by multiple Cox regression analysis, which provided the background for our estimations of population attributable fractions. In all, 88 373 pregnancies had full information on all covariates and were included in this analysis. Miscarriage before 22 completed weeks of gestation. The potentially modifiable pre-pregnant risk factors associated with increased miscarriage risk were: age of 30 years or more at conception, underweight, and obesity. During pregnancy the modifiable risk factors were: alcohol consumption, lifting of >20 kg daily, and night work. We estimated that 25.2% of the miscarriages might be prevented by reduction of all these risk factors to low risk levels. Modification of risk factors acting before and during pregnancy could lead to prevention of 14.7 and 12.5%, respectively, of the miscarriages. Maternal age at conception and alcohol consumption were the most important risk factors. Miscarriage risk is increased by multiple potentially modifiable risk factors and a considerable proportion of miscarriages may be preventable.
Article
The frequency with which congenital malformations occur varies considerably from country to country and, within countries, from area to area and social class to social class. For example, neural-tube malformations are five times commoner in England and Wales than in Japanl and nearly three times commoner in the coalmining valleys of South Wales than along its coastal plain2: in Scotland they are three times commoner in infants born into social class v than in infants born into social classes I and II.1 From these and similar observations it has been inferred that environmental teratogens must be at work, but in making such an inference few research workers stop to consider what relation, if any, the prevalence of malformations at birth bears to their incidence at the time they are laid down-early in the first trimester of pregnancy.
Article
Extending work of Cook et al. (1999, 1996), this paper examines abortion funding cutoffs for poor women in North Carolina, a unique setting allowing for a strong quasi-experimental design. Using vital registration data and additional administrative data from North Carolina, we decompose program effects on the abortion/birth ratio into two components: coverage (i.e., the proportion of all abortions that are state funded) and substitutability (the proportion of state funded abortions that would have been births in the absence of the state program). We show that both components are crucial for understanding the effects of fund cutoffs and that both components vary by age and by race. We offer explanations for these differences. Overall, we conclude that: the North Carolina State Abortion Fund (SAF) had powerful and pervasive effects: i.e., the SAF cutoffs reduced abortions and increased births.
Article
Abortion legislation in Singapore has gone through dramatic changes in the past 25 years. In this paper, we studied the effect of abortion legislation on abortion trends in Singapore. The Ministry of Health, Singapore, collects data on all abortions performed in Singapore. These data have been analyzed and are presented in this paper. The liberalization of abortion legislation resulted in a dramatic increase in the number of abortions performed beginning in 1974. The rate peaked at 23,512 abortions in 1985, and in fact, 35% of all pregnancies were terminated in 1985. The introduction of mandatory abortion counseling in 1986 resulted in a decline in the number of abortions to 16,476 in 1993 with only 24.6% of pregnancies being terminated. The teenage abortion rate was 0.2 per 1000 female teenagers under 20 years of age in 1970. With the liberalization of abortions, the rate reached a peak of 13.7 per 1000 female teenagers in 1985. In 1993, the teenage abortion rate was 9.5%. The proportion of nulliparous women seeking abortion has increased phenomenally from 0.5% in 1976 to 40.6% in 1993. Close to 95% of the women seeking abortions in 1993 did so for social reasons, 3.7% for medical reasons, and 2.0% for failed contraception (Table 3). Mandatory abortion counseling and a change in the government policy which now encourages Singaporeans to have more children if they can afford it, have resulted in a decrease in the number of abortions being performed. The problems of teenage abortions, nulliparous abortions, and repeated abortions need to be further addressed.
Article
Production of the pregnancy-specific protein early pregnancy factor (EPF) was monitored by the rosette inhibition test in a group of 13 nulliparous women. EPF could be detected in serum within 48 hours of fertilization; of 28 cycles in which intercourse took place at the time of ovulation, EPF was detected in 18. However, EPF production continued for more than 14 days in only four cases. Successful pregnancy was maintained in two of these while in the other two, disappearance of EPF preceded miscarriage. In the remaining 14 cases, EPF disappeared from the serum before the onset of menstruation. A high incidence of early embryonic loss is suggested.
Article
This paper re-examines some well-known and commonly accepted arguments for the non-individuality of the embryo, due mainly to the work of John Harris. The first concerns the alleged non-differentiation of the embryoblast from the trophoblast. The second concerns monozygotic twinning and the relevance of the primitive streak. The third concerns the totipotency of the cells of the early embryo. I argue that on a proper analysis of both the empirical facts of embryological development, and the metaphysical importance or otherwise of those facts, all three arguments are found wanting. None of them establishes that the embryo is not an individual human being from the moment of conception.
Article
Theory suggests that abortion restrictions will influence fertility outcomes such as pregnancy, abortion, and birth. This paper exploits the variations in abortion policy generated in Eastern Europe in the late 1980s and early 1990s to examine their impact on fertility outcomes. We distinguish among countries with severe, moderate, and few restrictions on abortion access and examine the impact of changes across all three categories. As we hypothesize, the results indicate that countries that changed from very restrictive to liberal abortion laws experienced a large reduction in births. Changes from modest restrictions to abortion available on request, however, led to no such change in births despite large increases in abortions, which indicates that pregnancies rose in response to more liberal abortion availability. This evidence is generally consistent with the situation that was brought about by changes in abortion access in the United States.
Article
. Through the use of ancient healing techniques, such as ora-cles, astrology, shamanism and collective ritual, contemporary therapists and counselors can enhance their work with women clients, whose natural condition may predispose them to "letting nature take its course." Tapping into unseen, energetic and magical realms can be the source of deep heal-ing and illumination in the therapeutic process. Using nonrational knowl-edge techniques takes the pressure off the individual therapist to figure everything out and relieves the client of helplessness and despair. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <getinfo@haworthpressinc.com> Website: <http://www.HaworthPress.com> © 2001 by The Haworth Press, Inc. All rights reserved.] The focus of my healing work, whether individual or group work, has always involved an attempt to find and then follow the natural process that is trying to occur. Although that's easy to say, in our maddeningly modern civilization, with all of its high-tech approaches to intervention and "crisis resolution," it is much harder to do. I have only now and then Vicki Noble is a healer and teacher and is affiliated with Motherpeace in Freedom, CA.
Article
It is often claimed that from the moment of conception embryos have the same moral status as adult humans. This claim plays a central role in many arguments against abortion, in vitro fertilization, and stem cell research. In what follows, I show that this claim leads directly to an unexpected and unwelcome conclusion: that natural embryo loss is one of the greatest problems of our time and that we must do almost everything in our power to prevent it. I examine the responses available to those who hold that embryos have full moral status and conclude that they cannot avoid the force of this argument without giving up this key claim.
Article
This article examines the effect of abortion legalization on fertility rates in the United States. Fertility rates were compared over time between states that varied in the timing of abortion legalization. States legalizing abortion experienced a 4% decline in fertility relative to states where the legal status of abortion was unchanged. The relative reductions in births to teens, women more than 35 years of age, non-White women, and unmarried women were considerably larger. If women did not travel between states to obtain an abortion, the estimated impact of abortion legalization on birth rates would be about 11%. A complete recriminalization of abortion nationwide could result in 440,000 additional births per year. A reversal of the Roe v Wade decision leaving abortion legal in some states would substantially limit this impact because of the extent of travel between states.