When does life begin?

Malcolm Potts | 14 September 2019
Church and State

(Credit: Steve Rainwater / Flickr / CC BY-SA 2.0)

One in three American women has had, or will have, an induced abortion. Abortion demands an answer but refuses to submit to black and white rules. Sincere and informed people recommend opposing options. Ultimately most differences over abortion circle back to what the 1973 Roe v. Wade ruling called “the difficult question of when life begins.” Possibly, I am the only obstetrician in America who has performed abortions and is also a research embryologist. I know what I destroy.

As a young obstetrician in a London hospital in the 1960s, when abortion was illegal, I found myself alternately delivering babies and cleaning up other people’s botched abortions. Since then I have the opportunity to study abortion in many countries. Let me try to share what I think I have learnt. First, I have never found a country where an abortion law, however strict, has had any demonstrable impact on the number of abortions taking place. In fact, when New York State legalized abortion in 1970 there were fewer safe abortions then there had been unsafe abortions previously. Illegal abortionists don’t offer post-abortion contraceptive advice, but physicians do.

Second, I have seen, time and time again, that making abortion illegal inevitably kills women. The Guttmacher Institute estimates there are 6 million unsafe abortions annually in Africa and 26,000 women die. I visited a hospital in Ghana where abortion patients were three in bed – the sickest woman on the bed and two slightly less ill on a wafer-thin mattress on the floor. For every death many are injured. I remember a Colombian woman in her 20s who had needed a hysterectomy to control infection after an unsafe abortion. The bacteria had also lodged in the blood vessels in her fingers and her fingers needed to be amputated. An unsafe abortion left her sterile and seriously handicapped.

In my experience, most abortions take place because the woman knows she cannot give the child, if born, the love, nurture, and attention every infant deserves. In the 1970s I was asked to offer an abortion to a Filipino wife of a poor fisherman. She knew a third child would force the two older children to drop out of school. I was assisted by one Catholic and one Moslem women doctors. I proceeded with some trepidation, as I was doing something illegal and because I had no local anesthetic. Fortunately, the manual vacuum aspiration went smoothly. The woman got down and opened the door onto the sunlit ground outside. She raced towards her husband waiting with their two children, flinging herself into his arms. The Catholic doctor, who had helped me, leaned across to her Moslem friend saying, “I may go to Hell later but that woman is in Heaven now!”

Most women, like the fisherman’s wife, seek abortion in the first thee months of pregnancy. The embryo at this stage is not a baby without a diaper seen through the wrong end of a telescope. As a reproductive scientist I learnt that mammalian development is an awesome, but also a messy, wasteful process. A man makes 1,500 genetical unique sperm every second. Even before she was born, a women had half a million genetical unique eggs in her ovaries. Up to half of all fertilized eggs are abnormal. They are eliminated as spontaneous abortions, often before the women suspects pregnancy. Spontaneous abortion is a natural, necessary, and healing process. When I had a patient with a serious chest infection I supplement their natural immune response with an antibiotic. If a woman has abnormal fetus, if she wishes, I would offer an abortion to complete what nature has left unfinished.

Those who identify as pro-life or as pro-choice are divided by their perception of when life begins. The trouble is that as a scientist who has spent hundreds of hours looking at embryos under an electron microscope, I can no more tell when life begins than an astronomer can tell you if Heaven exists by looking through a telescope. The much revered Catholic moral theologian, Fr Bernard Haring, wrote, “The moment of ‘conception’ does not belong to the data of revelation.” The only verse in the Bible dealing with abortion (Exodus 21: 22) does not outlaw abortion, but it does condemn injuring a pregnant woman.

Contrary to most peoples’ understanding, the Supreme Court in Roe v Wade did not say whether abortion is right or wrong. They said something more modest, but also more profound: “We need not resolve the difficult question of when life begins when those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary at this point in the development of man’s knowledge is not in a position to speculate as to the answer.” Abortion decisions, for good reason, are often driven by religious beliefs. Since the First Amendment was enacted in 1791, ”Congress shall make no law respecting an establishment of religion,” we have been a society based on religious toleration: No state legislature would take up a bill telling Catholics, Mormons, Moslems, or Jehovah’s Witnesses what to believe. I suggest it is equally inappropriate for legislatures to “speculate” about “when life begins.” The solution to the political and intellectual log jam between those asserting the embryo’s right to life and those maintaining the woman’s right to choose, is best solved by individuals, not by the Supreme Court and certainly not be a state legislature.

Malcolm Potts is a British trained ObGyn and reproductive scientist, and professor emeritus at UC Berkeley.

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