Warning: this article discusses pregnancy and infant loss.
“We are not monsters.”
This isn’t the first line of the open letter posted on AbortionPatients.com, but I almost wish it were. The website is a response to controversy over recent reproductive health bills introduced in Virginia and New York that would expand abortion access to women in need of “late-term abortions” after 24 weeks, in cases involving fetal viability after birth and/or a danger to the mother’s health.
Some pro-life doctors and thought leaders feverishly claimed that late-term abortion is never, ever necessary. Some pro-choice doctors disagreed. The Catholic internet (and America’s internet in general) erupted into debates. Are women casually asking their doctors to kill their children just a few moments before birth? Are doctors gleefully watching babies suffocate to death?
Statistically, this is not the case, with the most recent CDC data stating that only 1.3% of abortions take place after 21 weeks, and of those, all are medically indicated. "Medically indicated" seems to be an undefinable range, somewhere between fetal abnormalities (that may or may not be fatal) and severe pregnancy complications that could be physical or mental.
What is certainly clear is the tangible heartbreak in stories from later-abortion patients. While some pro-life advocates are almost entirely dismissed as out of touch and ignorant, the Catholic perspective on bioethics, especially combined with a feminist ethic, has much to offer women and families discerning how to respond to serious pregnancy complications.
[T]he Catholic perspective on bioethics, especially combined with a feminist ethic, has much to offer women and families discerning how to respond to serious pregnancy complications.
I wish I could tell every woman in this situation that I believe her when she says that she is not a monster. I believe these women are just like me: sisters, mothers, and friends trying to do the best they can in very difficult situations.
And so we must believe our sisters, holding them with grace and mercy. As pro-life advocates, there is space for both supporting and challenging women during discussions on abortion. But we can only challenge effectively after we have seriously grappled with the complex issues involved. Here are 10 considerations we need to keep in mind.
1. “Late-term abortion” is not a medical term.*
Let's stop using it in our think-pieces (it pains me to use it in this one). When we discuss issues surrounding abortion, it's vital to know the full meaning of the terms we use. And to that end...
2. In medical terminology, "abortion" is a broad term that refers to more than you might think.*
Medically speaking, abortion is not solely birth control that kills a living baby. It is a surgical procedure that can help save lives in necessary situations. Imagine being pregnant. You’re 12 weeks along. Everything has been fine thus far. You’re excited. And then, at your next ultrasound appointment, you receive the most awful news: there is no heartbeat. Your provider tells you the baby’s remains need to be removed, and that it is a medical necessity for your health.
Whether this hypothetical woman undergoes a D&E/D&C, a D&X, induction of labor in the hospital or at home, or a c-section, in a medical sense, it is an abortion procedure and will be medically charted as such. In this instance, it is a spontaneous abortion completely independent philosophically and ethically from an induced, elective abortion used as a form of birth control when the baby is still alive. But the procedure performed is still an abortion and considered an abortion-related death. It is critical that pro-lifers, especially those crafting legislation, understand that in medical terms, abortion is sometimes necessary in situations of pregnancy loss.
3. Medical terminology and practice do not account for theology.
When the bills were first introduced, pro-life responses all over the country exclaimed, “Abortion isn’t healthcare.” As mentioned up above, yes it is, though perhaps only on a technicality.
Many pro-lifers also claimed that late-term abortion is never necessary, even in cases when a mother’s health is at risk. As an allied health professional that attends births for a living, I agree 100% with their ethical rationale - but not with their medical accuracy. It is incorrect to say that late-term abortion is never necessary when, medically speaking, any early “interruption” or termination of a pregnancy (even in miscarriage) is considered an abortion.
It is incorrect to say that late-term abortion is never necessary when, medically speaking, any early “interruption” or termination of a pregnancy (even in miscarriage) is considered an abortion.
Consider a woman who is 30 weeks along in pregnancy and receives a fatal fetal diagnosis such as anencephaly, where a baby’s brain does not form properly. Most likely, this mother will be informed that her baby will not live very long outside the womb. She will be given the choice between abortion now or delivery later at full-term.
If she has any other life-threatening condition, such as preeclampsia, or if there is any pregnancy complication that could make waiting for delivery more dangerous (such as placenta previa), her doctor will suggest direct abortion now rather than waiting for delivery and the child's natural death.
Ethically, she could choose an immediate induction of labor or c-section, which would result in the child's natural death instead of direct death. To be clear, even in this instance, early induction or c-section resulting in the natural death of a child would still be medically considered an abortion. Many medical providers - informed more by health risks than by pro-life ethics - would strongly suggest direct abortion, since it carries fewer potential complications for the mother.
One pro-life solution is to lobby to change medical terminology to exclude miscarriage and early induction of labor or c-section from the definition of "abortion," although the probability of this happening is doubtful. However, an important step that is often overlooked in the legal approach to this issue is the need to change women’s health care and maternity care to better allow for life-affirming choices (see points 5, 6, and 7 below).
One pro-life solution is to lobby to change medical terminology to exclude miscarriage and early induction of labor or c-section from the definition of "abortion"
4. In cases where a woman’s health is at risk, labor induction or pregnancy “interruption” - even though it results in the death of a child - can be considered ethical perinatal hospice care.
Dr. Jen Gunter, “Twitter’s Resident Gynecologist,” writes extensively on late-term abortion. She and many other pro-choice advocates don’t understand what seem like uninformed pro-life arguments, since even a c-section for a non-viable pregnancy is still considered abortion. Why would we want to legislate that? Again, while she is correct in a medical sense, she overlooks the ethical dilemma.
Catholic teaching prohibits the direct killing of any human life, yet allows for “legitimate defense”: if medically treating a woman unintentionally causes the death of her unborn child, there is no moral wrong. For example, take the case of ectopic pregnancy, a life-threatening situation where an embryo implanted in the fallopian tube instead of the uterus. The treatment for ectopic pregnancy (removing a portion of the fallopian tube) saves the mother’s life, but ends the pregnancy. The intention is not to kill the baby; it is to save the mother. In the context of abortion, a pregnant woman whose life depends on an early induction of labor or a c-section - which would result in the death of a baby - could ethically pursue early induction or a c-section, according to the United States Conference of Catholic Bishops' Ethical and Religious Directives for Catholic Health Care Services (ERD):
"Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child."
Catholic teaching offers considerations for ordinary versus extraordinary means to save or sustain a person’s life. There is no moral imperative to take on extraordinary means, which do not offer sufficient health benefits to the patient or may cause an excessive burden or expense for the family. From the same document on ordinary and extraordinary means:
"A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community."
In cases where a family is not able to afford several weeks or months of NICU care for a baby that is not likely to survive, they are not morally required to choose this health care option, nor should they be made to feel guilty for this decision. Perinatal hospice care, where a baby is treated with dignity and a family is given the space and necessary means to process and grieve, is a Catholic answer to this problem.
Perinatal hospice care, where a baby is treated with dignity and a family is given the space and necessary means to process and grieve, is a Catholic answer to this problem.
5. There are several reasons why perinatal hospice care doesn’t happen in every case where it could or should.
Perinatal hospice care is not the norm in every hospital. While delaying induction or c-section is not always medically possible, the option for perinatal hospice is sometimes not presented, and women may not know that they can ask for it.
Some providers are unfamiliar with perinatal hospice. Others might assume that the most compassionate choice for both mother and baby is to deal with fetal viability cases as quickly and efficiently as possible with direct abortion. This could be compared to euthanasia, causing death in order to alleviate suffering, which is never ethically permissible. According to the ERD, there are moral alternatives to euthanasia, which could also support parents as they make choices for their unborn child with a fatal diagnosis:
"Dying patients who request euthanasia should receive loving care, psychological and spiritual support, and appropriate remedies for pain and other symptoms so that they can live with dignity until the time of natural death."
In my work as a doula, I meet clients at various points in their parenting journeys. Some have previously experienced fetal demise and stillbirth pregnancies and, of these, many express sorrow that they do not “know where their children are.” Some parents weren't given the opportunity to see their children’s remains. They weren't presented with any options for hospice or burial. The doubt and resulting trauma, the fear of having “failed” to protect their children, is excruciating for them and can require years of psychological and spiritual healing. Perinatal hospice needs to be a more accessible option in our healthcare system.
6. There are simply not enough resources for families that receive a diagnosis of a fatal fetal abnormality or a pregnancy complication where abortion is the first line of medical defense.
In cases where a woman receives an unexpected diagnosis, especially a fatal fetal diagnosis, things have a tendency to go right over her head. What did the doctor say? What was that statistic? Why did the nurse look at me like that? What was she trying to say?
It is so important to give parents time and direct support to make medical decisions. Every diocese should have a well-funded and well-trained pregnancy loss ministry, perhaps as part of their overall diocesan pro-life ministry. Train women as bereavement doulas to minister directly to other women. Publicly address this need within our parish communities. What should a family do if they receive such a diagnosis? Who are they supposed to call?
Every diocese should have a well-funded and well-trained pregnancy loss ministry, perhaps as part of their overall diocesan pro-life ministry.
Christian and Catholic medical communities need to take the lead on this matter, conducting new research on the efficacy of perinatal hospice care, as well as introducing new papers to relevant medical journals and medical bodies, such as the American College of Obstetrics and Gynecology (ACOG).
There is also a need for serious retraining of medical and nursing staff on how to deal with these difficult situations in the delivery room. While there are amazing stories of compassionate care, this isn't always the case. I was recently informed of a woman who experienced a stillbirth and is still traumatized by a young medical resident’s enthusiastic excitement about the opportunity to perform genetic testing, even as the child's family was mourning their loss within earshot in the same room. Sadly, this is not the worst story I’ve heard.
7. We must challenge ableism at every opportunity.
We need to eliminate the phrase, “I just want a healthy baby.” This feeds the mentality that an unhealthy baby is unwanted and it supports a culture that devalues those with disabilities. Consider what kind of life and opportunities are available to a person with disabilities in America. Consider healthcare, therapy, education, and employment. Consider the support systems available for families of those with disabilities. Does our culture reflect the fundamental pro-life value that every person - including those with chronic health problems or disabilities, including the unborn facing a life with these conditions - is created with purpose and deserving of the dignity that obliges? If a woman believes that euthanasia is a better choice for her unborn baby than life with a disability in the United States of America, we need to do some serious self-reflection as a country.
When we create a culture that values disabled and abled people as equal, we will have created a culture that is more open to celebrating all life, especially when facing a difficult fetal diagnosis.
8. In order to change the “Culture of Death,” we need to acknowledge some uncomfortable history.
There is one line of pro-life thinking tantamount to a disenchanted, “How did we get here? How did we get to the point of debating whether a newborn should have access to medical care?” If you’re wondering how the medical community “got here,” you need to crack open a history book. Experimentation. Disenfranchisement. I could go on, but the point is that we’ve been here.
Virginia Governor Ralph Northam’s blackface photos were taken in medical school in 1979. I, a former fetus (and a black one at that), was born in 1988. Northam still would have been in his residency by the time I was born. Unchecked and clearly unchallenged several decades later, he’s now arguing for infanticide. But the fact is, none of us should really be surprised when the cusp of his medical career included mocking a vulnerable population of the American citizenry. It was black people then, why shouldn’t it be babies now? The medical community has always needed to be checked by ethics, philosophy and, yes, articulate people of faith.
9. This issue is bigger than whether abortion is legal or illegal.
We need to recognize the various complexities of the abortion issue: that the medical language of abortion affects miscarriage protocol as well as the medical options available for saving a pregnant mother's life; that it begs the expansion of perinatal hospice knowledge and accessibility; that it's reflective of larger cultural issues around chronic health problems and disability care; and that it requires understanding ordinary versus extraordinary care for medically frail infants (recognizing that palliative care short of extraordinary means is ethically permissible and in no way the same as euthanasia). Given the complication of this issue, the seemingly simple solution to "make abortion illegal" is a red herring.
We will see a shift in the choices that women make when they are empowered in their health journeys prenatally, during pregnancy, and postpartum. It’s why women who are given time, options, and ultrasounds usually choose life when facing an unplanned pregnancy.
We will see a shift in the choices that women make when they are empowered in their health journeys prenatally, during pregnancy, and postpartum.
10. Collective confusion over abortion is a symptom of a greater problem.
It is indeed disheartening to be in a culture that is so confused about the sanctity of every human life. Herein lies the confusion we see with abortion, where sometimes a pregnancy loss is a baby lucky enough to spend his last moments being held by his mother and father. But across the hall or across the country, another family's pregnancy loss might be treated as nothing more than a bad dental appointment.
Who are we supposed to believe? I suggest that we start with women, with or without faith, who face these issues every day.
As for the Church, more clear guidance and understanding is needed on end-of-life decisions. More spiritual and practical support at the diocesan and parish level is needed for perinatal hospice care. Catholic feminists can play an important role in shaping this guidance by declaring and insisting upon a fundamental understanding by the pro-life movement within the Church that women are not monsters. Indeed, they are not, and it is our responsibility to ensure that women’s voices are treated with respect, all the while remembering our duty to protect every human life.
*Editor's Note: Updated on 4/1/19. Following thoughtful feedback from one of our readers, we changed the phrasing of these points to better clarify our meaning.