Marek Vácha
2013
PREGNANT WOMEN AND
CHILDREN
ABORTIONS
Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.
 A 16-year-old female is in your office because she has just
found out she is pregnant. She discusses her options and
asks you to refer her for an abortion. She states that her
parents do not know she is pregnant and she does not want
them to know. What should you do?
Refer her for the abortion without parental notification.
2. Make a „reasonable effort“ to contact the parents, but still
refer for the abortion if you cannot contact them
3. Do not refer for abortion without parental consent
4. Strongly encourage her to discuss the issue with her parents.
1.
Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.
 A 16-year-old female is in your office because she has just
found out she is pregnant. She discusses her options and
asks you to refer her for an abortion. She states that her
parents do not know she is pregnant and she does not want
them to know. What should you do?
Refer her for the abortion without parental notification.
2. Make a „reasonable effort“ to contact the parents, but still
refer for the abortion if you cannot contact them
3. Do not refer for abortion without parental consent
4. Strongly encourage her to discuss the issue with her parents.
1.
Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.
 Althought competent adults have an unfettered legal right
to abortion within the first trimester, this right is not
universal for minor. A minor is generally defined as a
person below the age of 18. The necessity of parental
consent or at least notification is a mixed issue across states
nationally. Some states require parental notification and
some states not. hence, there is not clear answer.
 The only thing that is always clear is that we should strongly
encourage the patient herself to have the discussion with her
parents. Even if you are within your rights to walk up to a
brain-dead patient and remove the ventilator without consent
of the family, the boards will always want you to answer
„discuss with the family“ first if that is one of the options.
Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.
 A 35-year-old married woman with four children is in
your office seekingta termination of an unwanted
pregnancy in the first trimester. Later in the day after
you give the patient the referralm her husband calls
and is very distressed because he does not want the
abortion to occur. He very much wants to keep the
baby and tells you that he even has a name picked out.
What should you tell him?
Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.

A 35-year-old married woman with four children is in your office seekingta termination of an unwanted
pregnancy in the first trimester. Later in the day after you give the patient the referralm her husband calls and
is very distressed because he does not want the abortion to occur. He very much wants to keep the baby and
tells you that he even has a name picked out. What should you tell him?
1.
2.
3.
4.
5.
You will try to talk his wife out of the abortion.
You will cancel the procedure immediately.
You say you cannot hold up the termination without a
court order.
You cannot prevent the abortion without paternity
testing confirming that he is the father.
You say you have an absolute duty to the mother to
honor her wishes no matter what his personal feelings
are.
Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.

A 35-year-old married woman with four children is in your office seekingta termination of an unwanted
pregnancy in the first trimester. Later in the day after you give the patient the referralm her husband calls and
is very distressed because he does not want the abortion to occur. He very much wants to keep the baby and
tells you that he even has a name picked out. What should you tell him?
1.
2.
3.
4.
5.
You will try to talk his wife out of the abortion.
You will cancel the procedure immediately.
You say you cannot hold up the termination without a
court order.
You cannot prevent the abortion without paternity
testing confirming that he is the father.
You say you have an absolute duty to the mother to
honor her wishes no matter what his personal feelings
are.
Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.
 Woman does not ned consent fron the father of the
child or any member of the family.
 Although a fetus may genetically contain half the
genetic elements of both parents, it is the female htat
must go through the delivery. Hence, the woman has a
„right of ownership“ over any undelivered child
because it inhabits her body.
Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.
 A 30-year-old woman presents to the clinic furing her
third trimester. The estimated gestational age of the
fetus is 28 weeks and she is seeking an abortion. The
patient is generally healthy. An ultrasound of the fetus
at 26 weeks and routine genetic testing showed no
abnormalities. What you should tell the patient?
It´s okay; you will go ahead with the abortion.
You will be happy to comply if she can get a court
order.
3. No way, third-trimester abortions are prohibited
4. Legally you can only do it if her life is at risk
5. No, you can´t do it because the fetus is normal
1.
2.
Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.
 A 30-year-old woman presents to the clinic furing her
third trimester. The estimated gestational age of the
fetus is 28 weeks and she is seeking an abortion. The
patient is generally healthy. An ultrasound of the fetus
at 26 weeks and routine genetic testing showed no
abnormalities. What you should tell the patient?
It´s okay; you will go ahead with the abortion.
You will be happy to comply if she can get a court
order.
3. No way, third-trimester abortions are prohibited
4. Legally you can only do it if her life is at risk
5. No, you can´t do it because the fetus is normal
1.
2.
Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.
 You cannot ehtically freely abort a potentially viable
fetus unless htere is a very sifnificant extenuating
circumstances such as risk to the mother or a fetus so
developmentally abnormal that fetal demise is certain.
Case report: Ms. A.
 Ms. A is 19 years old and 25 week s pregnant.
Although her pregnancy was unplanned, at no time
she considered pregnancy termination. During a
prenatal office visit, Ms. A reveals that she has a
daily drug habit that includes crac cocaine and
intravenous narcotics. She refuses to consider a
change in her behavior, despite a thorough review of
the potential effects of her substance abuse on her
pregnancy outcome. Specifically, she refuses to
participate in a methadone or other substance-abuse
program.

(Baylis, F., et al. (2008) Ethical dilemmas in the care of pregnant women: rethinking „maternal-fetal conflicts“. in
(Singer, P.A., Viens, A.M., (eds.) (2008) The Cambridge Textbook of Bioethics. Cambridge University Press,
Miss A.
 there is a conflict between woman´s autonomy and
the best interest of the fetus
Miss A.
 A decision of the Supreme Court of Canada in
Winnipeg Child and Family Services (Nortwest
Area) v.g. (D.F.) (1997)


at issue was whether there was legal authority to order a
pregnant woman to undergo counseling and hospital
admission to manage a drug addiction in absence of her
consent
The Supreme Court held that forced detention and treatment
would violate the woman´s constitutional rights and that there
was no legal basis on which to do so.
Miss A.
 A decision of the Supreme Court of Canada in
Winnipeg Child and Family Services (Nortwest
Area) v.g. (D.F.) (1997)

this decision also confirmed that the fetus is not protected
before birth and that courts have no legal grounds on which to
order a competent pregnant woman to undergo a medical
intervention that she does not want.
Miss A.
 A decision of the Supreme Court of Canada in
Winnipeg Child and Family Services (Nortwest
Area) v.g. (D.F.) (1997)

„Pregnant woman suffering from alcohol or substance abuse
addictions may not seek prenatal care for fear that their
problems would be detected and they would be confined
involuntarily and/or ordered to undergo mandatory treatment.
(…) In the end, orders made to protect a fetus´health could
ultimately result in its destruction.“
Miss A.
 When a physician´s view of the best interest of the
fetus conflicts with the view of the pregnant woman,
the role of the physician is to provide counseling and
persuasion, but not coercion.

(Baylis, F., et al. (2008) Ethical dilemmas in the care of pregnant women: rethinking „maternal-fetal conflicts“. in
(Singer, P.A., Viens, A.M., (eds.) (2008) The Cambridge Textbook of Bioethics. Cambridge University Press, p.100)
 Royal College of Obstetricians and Gynaecologists
in the UK 1996:

obstetricians must respect the woman´s legal liberty to
ignore or reject professional advice, even to her own
detriment and that of the fetus.“
Miss A.
 Physicians who treat competent patients (including
competetnt pregnant patients) without their consent
put themselves at risk of both criminal and civil
liability
Miss A.
 in many countries, the courts have recognized that
the fetus does not have legal rights until it is born
alive and with complete delivery from the body of the
pregnant woman

legal rights attach only at birth, making clear that the fetus has
no legal rights that could override the pregant woman´s right
to determine her own health care (Council of Europe, 1984)
Miss B. Case
 Ms. B is 24 years old and has been in labor for 18 hours.
The cervical dilatation has not pregressed past 3 cm.
The fetal heart rate tracing has been worrisome but is
now seriously abnormal, showing a profound
bradycardia of 65 beats per minute. This bradycardia
does not resolve with conservative measueres. Repeat
pelvic examinations reveals no prolapsed cord and
confirm a vertex presentations at 3 cm dilatation. The
obstetrician explains to Ms. B that a cesarean section
will be necessary because of suspected fetal distress.
Ms. B absolutely refuses, saying „No surgery“.

(Baylis, F., et al. (2008) Ethical dilemmas in the care of pregnant women: rethinking „maternal-fetal conflicts“. in
(Singer, P.A., Viens, A.M., (eds.) (2008) The Cambridge Textbook of Bioethics. Cambridge University Press)
Case of Miss B.
 further discussion clarifies that Ms. B i terrified of
general anesgthesia because her mother died from
anesthesia complications.
 Moreover, Ms. B has a strong distrust of physicians and
believes that too many cesarean sections are done.
When it is explained that the cesarean can be done
with spinal anesthesia, and in view of the risks of the
ongoing bradycardia, Ms. B agrees to the surgery.
Miss B. Case
 However, if the patient had continued to refuse the
surgery, the physician would have been obliged to
respect her decision despite the serious risks to the
fetus.


Baby Doe was born with Down syndrome and a
congenital blockage of his oesophagus.
Baby Doe´s esophageal atresia, with a
tracheoesophageal fistula, made it impossible
for him to eat.
 With such a malformation, anything that he
swallowed would end up not in his stomach but in his
lungs.

This is a condition for which surgical repair is
routine and routinely succesful.
 Without a surgical repair of this congenital anomaly,
he ould die of either starvation or pneumonia.


the birth weight was 2 722g and the lenght
50,8 cm from crown to heel.
After consideration of all medical information
the parents decided not to authorize surgery.
The infant was given phenobarbital (5mg)
and morphine (2,5mg) as needed for pain and
restlessness. The parents visited and held the
child frequently until his death six days later.

Legal Facts
 parents declined repair of the fistula
 parents felt that „a minimally acceptable quality
of life was never present for a child suffering from
such a condition“ and further that it was not in
the best interest of the infant, their other two
children, and the family entity as a whole for the
infant to be treated.

Legal Facts
 he court heard testimony form the mother´s
obstetrician that he and other members of the
obstetrical group believed that the infant should
remain at the hospital where he was born, knowing
that surgery was not possible there and that the child
would sioon die.
 the infant´s pediatrician, although agreeing with the
obstetrician´s prognosis, recommended in testimony
that the infant be immediately transferred to another
hospital where corrective surgery could be performed.

Legal Facts
 the trial court determined that the parents „have
the right to choose a medically recommended
course of treatment for their child in the present
circumstances.“

Ronald Reagan
himself asked aides
to find a way to
use federal law to
prevent such cases
from happening
again.

„What more dramatic confirmation could we have of
the real issue than the Baby Doe case in Bloomington,
Indiana? The death of that tiny infant tore at the
hearts of all Americans because the child was
undeniably a live human being — one lying helpless
before the eyes of the doctors and the eyes of the
nation. The real issue for the courts was not whether
Baby Doe was a human being. The real issue was
whether to protect the life of a human being who had
Down's Syndrome, who would probably be mentally
handicapped, but who needed a routine surgical
procedure to unblock his esophagus and allow him to
eat.

A doctor testified to the presiding judge that,
even with his physical problem corrected,
Baby Doe would have a "non-existent"
possibility for "a minimally adequate quality
of life" — in other words, that retardation was
the equivalent of a crime deserving the death
penalty. The judge let Baby Doe starve and
die, and the Indiana Supreme Court
sanctioned his decision.“

The Justice Department propsed a
controversial mechanism for intervening:
 they difined decisions like the one made for Baby
Doe as discrimination against children with
disabilities, a violation of federal civili rights laws
 Any organization that was found to be in violation
of civil rights laws could lose all of its funding.
▪ for hospitals, this potentionally meant that they could
lose their Medicar, Medicaid and NIH funding

Neonatologists had been arguing for years
that newborns had a right to medical car
equivalent to that of all other citizens
 The Baby Doe regulations enshrined tat right in
federal law.

But the regulation also represented an
unprecedented intrusion of the federal
government into the doctor-patient
relationship.

Ultimately, the U.S. Supreme court struck
down the Baby Doe regulations
 Hospitals, court said, could be jidged only if they
refused to provide treatment for which the
parents did consent.

New amendments specified three criteria for
situations in which it woud permissible for
doctors and parents to withhold or withdraw
life-sustaining therapy:
1.
2.
3.
The infant is chronically and irreversibly
comatose
The provision of such treatment would merely
prolong dying, not be effective in ameliorating
or correcting all of the infant´s life-threatening
conditions, or otherwise be futile in terms of
the survival of the infant.
The provisions of such treatment would be
virtually futile in terms of the survival of the
infant and the treatment itself under such
circumstances would be inhumane.
 Has the fetus
 right to life?
 right to prenatal care?
 right to be born of sound mind and body?
HISTORY
 accordind to Assyrian laws, the penalty
given a woman who induced her own
abortion was impalement on stakes
without burial
 it seems likely that the primary aim of these
societies was not to protect unborn human life,
but to ensure that the society did not lack
military manpower

(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer
Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 32)
Cicero
 Cicero (106 – 43 B.C.E.):
 „I remember a case which occurred when I was
in Asia: how a certain woman of Miletus, who
had accepted a bribe from the alternative heirs
and procured her own abortion by drugs, was
condemned to death: and rightly, for she had
cheated the father of his hopes, his name of
continuity, his family of its support, his house of
an heir, and the Republic of a citizen-to-be.“
 Notice that there is no mention or concern for the
destruction of the conceptus, per se.

Jones, W.H., (2012) Personhood Revisited. Reproductive Technology, Bioethics, Religion and the
Law. Langdon Street Press. Minneapolis, MN. p.128
 „...This concern was expressed in 1861 by
the Parliament of the United Kingdom, which
passed the act, Offences Against the Person
Act, which outlawed abortion at any stage.
(...)
 1869 Canada banned abortion in all
provinces.
 In 1873, the Congress of the United States
passed the Comstock Law, which made it a
crime to sell, distribute, or own abortionrelated products and services.

Jones, W.H., (2012) Personhood Revisited. Reproductive Technology, Bioethics, Religion and the Law. Langdon
Street Press. Minneapolis, MN. p.135
History
 until 1973, except
in cases where
the mother´s life
was in danger,
abortion was a
statutory crime in
every state of the
USA.
Roe versus Wade
 The alias "Jane Roe" was used for Norma
McCorvey, on whose behalf the suit was
originally filed, alleging that the abortion
law in Texas violated her constitutional
rights and the rights of other women.
 The defendant was the district attorney of
Dallas County, Texas, Henry B. Wade.
„Roe versus Wade“
Trimester system
 The case created the "trimester" system that:
 gives American women an absolute right to an
abortion in the first three months of pregnancy
 allows some government regulation in the second
trimester of pregnancy
 declares that states may restrict or ban abortions
in the last trimester as the foetus nears the point
where it could live outside the womb; in this
trimester a woman can obtain an abortion despite
any legal ban only if doctors certify it is necessary
to save her life or health.
Trimester System
 First Trimester: unrestricted access to
abortion
 Second Trimester: the decision is still
between woman and the physician
 states may place regulation on free access to a
second-trimester abortion
 second-trimester abortins are preponderantly still
performed at the patient´s discretion
 Third Trimester: abortions are not freely
available, because the fetus is potentially
viable
Other remarks
 Consent by the father for an abortion is not required
 the fetus is considered as a part of the woman´s body
and does not have the individual rights of „personhood“
until after birth.
 there is no compulsion on the part of the physician to
perform an abortion if performing this procedure is
ethically unacceptable to the physician.
 the patient has a right to have an abortion, but they don´t
have a right to force you to do it, if it is objectionable to you.
 it is considered unethical for a patient to seek an
abortion for the purpose of gender selection.
Other remarks
 It is considered ethically unacceptable to
determine the gender of the fetus and
then abort the fetus if the sex is
unacceptable to the patient.

Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam
Kaplan Publishing, New York.
.
GALLUP OPINION POLL, USA
 According to a USA Today, CNN Gallup Poll in May,
1999, 16 percent of Americans believe abortions
should be legal for any reason, at any time during
pregnancy and 55 percent of Americans believe
abortion should be legal only to save the life of the
mother or in cases of rape or incest.
 In Gallup Poll in January 2001, people who considered
themselves to be pro-life rose from 33 percent to 43
percent in the past five years, and people who
considered themselves to be pro-choice decline from
56 percent to 48 percent.

(Edge, R.S., Groves, J.R., (2007) Ethics of Health care. A Guide for Clinical Practice. 3rd ed. Thomson,
Delmar Learning. NY. p.253)
http://www.gallup.com/poll/1576/abortion.aspx
http://www.gallup.com/poll/147734/Americans-Split-Along-Pro-Choice-Pro-LifeLines.aspx
CZECH REPUBLIC
spontaneous abortions – miniinterruptions – other legal interruption – extrauterine pregnancies
Legal
Abortions
QUESTIONS
Requests for Abortions
Child is
unlikely to
survive and
the pregnancy
threatens the
mother´s life
?
Child is the „wrong“
sex or does not have
some cosmetic
features the parents
desire.
Mother wants to wait
with pregnancy to an
end of skiing season
"I´d be looking at
that dumb man´s
face in that child and
resenting it"
Reasons for Abortion
ABORTIONS
 the debate is
sometimes
viewed as one
of good versus
evil, with each
side demonizing
the other
Michael Griffin case
1993
"Don't kill any more babies"
Victim: Dr George
Tiller was gunned
down in May 2009
Scott Roeder received in 2010 50 years in prison
Contestable statemetns
 A woman has a right to limite her
pregnancy.
 Once a woman has chosen to continue
her pregnancy, she incurs the obligations
to protect and promote the health and
well-being of her fetus
 The state incurs obligations to limit or
preclude actions that would irreversibly
harm the future person.
 some view abortion as morally akin to
contraception - that is,
 preventing the maternal-child relationship from
developing, whereas others may view abortion
as
 "exiting a parental relationship" that has
already begun

Paola, F.A., Walker, R., Nixon, L.L., (2010) Medical Ethics and Humanities. Jones and Bartlett Publishers,
Sudbury, MA. p. 250
The wrongful birth and the wrongful life
 „the wrongful birth“ – physicians failed to
warn prospective parents that they are at
risk of conceiving or giving birth to a child
with a serious genetic disorder
 „the wrongful life“ – parents can also
bring wrongful life suits on behalf of their
children. These are more controversial
because they must allege that the child
would have been better off not being born
Types of Interceptions
 "the morning after pill" (="Plan
B pill")
 effective only within seventytwo hours after unprotected
sexual intercourse
 Mifepristone (= RU-486; = "the
abortion pill") may be used
within the first sixty-three days
of pregnancy
 interferes with the progesterone
supply and stops a prregnancy
already in progress.
 surgical abortion
 RU 486
 was approved by the U.S. Food and Drug
Administration (FDA) in September 2000
REMARKS, OPINIONS ETC.
Three Positions
 not everyone agrees that membership in the
species Homo sapiens is a sufficient, or even
a necessary, condition for moral
consideration
 gradualist view holds that an embryo or fetus
gains moral status during its journey toward
birth.
 from the point of fertilization onward, the
conceived being has the same rights or
interest as an adult human being, including a
right to life.
PRO-LIFE
Pro-life
 various positions
 abortion is never morally permisible
 in cases where continuing a pregnancy
presents a threat to the life of the woman,
abortion is morally permissible, though not
morally required.
 one should refrain from killing the embryo or
fetus both because it is a person from the
moment of fertilization but because it has the
potential to become a person.
 "There is no difference between a first
trimester, a second trimester, a third
trimester abortion or infanticide. It´s all the
same human being in different stages of
development. I finally got to the point I
couldn´t look at those tiny bodies
anymore."

Dr. Arnold Halpern, former director of a Planned Parenthood clinic
 http://www.personhoodusa.com/
Stop To Genocide
Moderate positions
 pro-life
 but wiling to allow abortions in special
cisrcumstances, like rape or severe fetal
abnormalities
 pro-choice
 but wiling to make moral distinctions among
reasons for abortions, like rejecting sex
selection as morally invalid

(Pierce, J., Randels, G., (2010) Contemporary Bioethics. Oxford University Press, NY, Oxford. p.
247)
PRO-CHOICE
Pro-choice
 various positions
 there are no limitations on abortion
 the government should not restrict access to
abortions
 to criminalize it constitutes an injustice against
pregnant women
 genetic humanity is neither necessary or
sufficient for personhood
Mary Ann Warren
 criteria for personhood
1.
2.
3.
4.
5.
consciousness
reasoning capacity
self-motivated activity
the capacity to communicate
the presence of self-concpets and selfawareness
 (1) and (2) may well be sufficient... and quite
probably (1) - (3) are sufficient
 but she does not explain why this criteria are
morally relevant?
Mary Ann Warren
 it would be morally permissible for "a
woman in her seventh month of
pregnancy to obtain an abortion just to
avoid having to postpone a trip to
Europe."

Paola, F.A., Walker, R., Nixon, L.L., (2010) Medical Ethics and Humanities. Jones and Bartlett Publishers,
Sudbury, MA. p. 253
Mary Ann Warren
 Warrens view has been criticized because
it suggests the moral permissibility of
infanticide as well as abortion, given that a
late-term fetus is not significantly different
from a newborn infant in terms of its ability
to meet the criteria for personhood put
forth by Warren.

Paola, F.A., Walker, R., Nixon, L.L., (2010) Medical Ethics and Humanities. Jones and Bartlett Publishers,
Sudbury, MA. p. 253
Mary Ann Warren
 Warren find this implication of her view
unacceptable.
 Her response to this objection was to focus
on the significance of the location of fetuses
compared with newborn infants
 whereas a pregnant woman can free herself of the
burdens of sustaining fetal life only by detaching
the fetus from her body, no such action is required
in the case of a newborn.
 A woman who does not want to nurture a newborn
infant can walk away, leaving the burden of child
rearing to others.

Paola, F.A., Walker, R., Nixon, L.L., (2010) Medical Ethics and Humanities. Jones and Bartlett Publishers, Sudbury,
MA. p. 253
Peter Singer
"We protest his hiring because Dr.
Singer denies the intrinsic moral worth
of an entire class of human beings newborn children - and promotes
policies that would deprive many
infants with disabilities of their basic
human right to legal protection against
homicide." ... Princeton University student
petition protesting Peter Singer's hiring.
 Joseph Fletcher: "postnatal abortion"
After-Birth Abortions
 the moral status of an infant is equivalent to
that of a fetus, that is, neither can be
considered a "person" in a morally relevant
sense.
 Hardly can a newborn be said to have aims,
as the future we imagine for it is merely a
projection of our minds on its potential lives.
It might start having expectations and
develop a minimum level of self-awareness
at a very early stage, but not in the first days
or few weeks after birth.
After-Birth Abortions
 potential people cannot be harmed by not being
brought into existence
 Actual people´s well-being could be threatened
by the new (even if healthy) child requiring
energy, money and care which the family might
happen to be in short supply of.
 if economical, social or psychological
circumstances change such that taking care of
the offspring becomes an unbearable burden on
someone, then people should be given the
chance of not being forced to do something they
cannot afford.

Giubilini, A., Minerva, F., (2012) After-birth abortion: why should the baby live? J Med
Ethics doi:10.1136/medethics-2011-100411
The moderate Pro-choice view
 abortions are not morally unproblematic
 but abortins are not equivalent to murder
 Daniel Callahan:
 "abortion is justifiable only if there is a serious
health or family reason; simply an unwanted or
unplanned pregnancy is not a sufficiently
grave reason."
 "the legalization of abortions emerged as a
way of helpig women with troubled
pregnancies, not that of legitimating the killing
of embryos."
The moderate Pro-choice view
 L.W.Sumner
 there is not the same moral status to all stages of
prenatal development and for ignoring the obvious
differences between zygotes and forty-week
fetuses.
 third-trimester fetus is sentient and equally
confident that the first-trimester fetus is not.
 = woman´s autonomy is absolute in the first and
early second trimesters but a compellig justification is
required for abortions in the late second trimester or
third trimester.
 if a fetus is experiencing pain, we ought to assume
that it has an interest in not experiencing pain
The moderate Pro-choice view
 point of viability
 500 g
 20-23+
 capable of living, especially outside the womb
ARGUMENTS FOR AND
AGAINST
Arguments FOR Abortions
 is an acorn an oak tree?
 the mother and the unborn children are
not like two tenants in a small house
which has been rented to both: the mother
owns the house
Arguments FOR Abortions
 My body, my right, my life, my choice,
 incest, rape, „my situation“
Arguments AGAINST Abortions
 abortion for genetic defect is a peculiar
innovation in medicine (or in preventive
medicine) in which a disease is treated by
eliminating the patient
 or, if you prefer, a disease is prevented by
"preventing" the patient
Arguments AGAINST Abortions
 "...not long ago, at my own university, a
physician making rounds with medical
students stood over the bed of an
intelligent, otherwise normal ten-year-old
boy with spina bifida. "Were he to have
been conceived today," the physician
casually informed his entourage, "he
would have been aborted."

Kass, R.L., (2002) Life, Liberty and the Defense of Dignity. Encounter Books, New York, London. p. 130
RELIGIONS
 islam, judaism, christiantiy
 all against
A Jewish Perspective
 generally, abortion is prohibited. An
abortion is possible when
 Jewish law requires abortion if the mother´s
life or her physical or mental health is at stake
 Jewish law permits abortion when the risk to
the woman´s life or health (again, physical or
mental) is greater than than of a normal
pregnancy but not so greta as to constitute a
clear and present danger to her.
A Jewish Perspective
 ...but "mental health" has not been
interpreted broadly
A Jewish Perspective
 Jewish law restricts the legitimacy of abortion to a
narrow range of cases
 Judaism does not see all abortion as a murder, as
Catholicism does, because biblical and rabbinic
sources understand the process of gestation
developmentally
 Talmud determines that within the first forty days
after conception the zygote is "simply water".
 during the rest of pregnancy, when the fetus is
legally categorized "like the thigh of its mother."
Because our bodies are God´s property, neither men
nor women are permitted to amputated their thigh
except to preserve their life or health, and so, by and
large, abortion is forbidden.
A Jewish Perspective
 abortion may surely not be used as a post
facto form of birth control

Dorff, E.N., (2003) Matters of Life and Death. A Jewish Approach to Modern Medical Ethics. The Jewish
Publication Society. Philadelphia. p. 128-133
Roman Catholic Church
 the modern church asserts that "two
deaths are better than one murder"
(Jakobovits 1973)

(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer
Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 38)

Jakobovits, I., (1973) Jewish views on abortion. In D.Walbert and J.Butler (eds.) Abortion, Society
and Law. The Press of Case Western Reserve Unoversity, Cleveland and London
 ...which is not true at all (M.V.)
Donum Vitae
 Thus the fruit of human generation, from the
first moment of its existence, that is to say
from the moment the zygote has formed,
demands the unconditional respect that is
morally due to the human being in his bodily
and spiritual totality. The human being is to
be respected and treated as a person from
the moment of conception; and therefore
from that same moment his rights as a
person must be recognized, among which in
the first place is the inviolable right of every
innocent human being to life. (Donum Vitae)
Islam
 From a hadith we can learn that the
embryo becomes a person at 120 days:
Islam
 On the authority of Abdullah bin Masud, who said : the messenger
of Allah, and he is the truthful, the believed narrated to us :
"Verily the creation of each one of you is brought together in
his mother's belly for forty days in the form of seed, then he is
a clot of blood for a like period, then a morsel of flesh for a
like period, then there is sent to him the angel who blows the
breath of life into him and who is commanded about four
matters: to write down his means of livelihood, his life span,
his actions, and whether happy or unhappy. By Allah, other
than Whom there is no god, verily one of you behaves like the
people of Paradise until there is but an arm's length between him
and it, and that which has been written over takes him and so he
behaves like the people of Hell-fire and thus he enters it; and one
of you behaves like the people of Hell-fire until there is but an
arm's length between him and it, and that which has been written
over takes him and so he behaves like the people of Paradise and
thus he enters it."
(Sahih al-Bukhari and Muslim)
Islam
 You can see that it is 40 day + 40 days +
40 days, when the soul enters the embryo
a person is created with a purpose in life.
Islam
 In principle, the Qur'an condemns the killing of humans
(except in the case of defense or as capital
punishment), but it does not explicitly mention abortion.
This leads Islamic theologians to take up different
viewpoints: while the majority of early Islamic
theologians permitted abortion up to day 40 of
pregnancy or even up to day 120, many countries
today interpret these precepts protecting unborn
children more conservatively.
 Although there is no actual approval of abortion in the
world of Islam, there is no strict, unanimous ban on it,
either. Islam has not given any precise directions with
regard to the issue of abortion.

http://www.islamawareness.net/FamilyPlanning/Abortion/abortion3.html
 full human life, with its attendant rights,
begins only after the ensoulment of the
fetus
 some Muslim scholars agree that
ensoulment occurs at about 120 days
after conception, while other scholars hold
that it occurs at about 40 days after
conception

(Albar, M.A., (1995) When is the soul inspired? Contemporary Topics in Islamic Medicine.
Ch.1.Jeddah: Saudi Arabia Publishing and Distributing House, pp.3-11
 abortion has been allowed after
implantation and before ensoulment in
cases in which there were adequate
juridical or medical reasons.
 however, many Shias and some Sunnis
have generally not permited abortion at
any stage after implantation, even before
ensoulment, unless the mother´s life is in
danger

Daar,A.S., Bakdash,T., Khitami, A.B., (2008) Islamic Bioethics in Singer, P.A., Viens, A.M., (eds.) The
Cambridge Textbook of Bioethics. Cambridge University press, Cambridge. pp.408-415
 abortion after ensoulment is strictly
forbidden by all islamic authorities, but the
vast majority do make an exception to
preserve the mother´s life
 If a choice has to be made to save either
the fetus or the mother, the the mother´s
life would take precedence
 she is seen as a root, the fetus as an offshot

Daar,A.S., Bakdash,T., Khitami, A.B., (2008) Islamic Bioethics in Singer, P.A., Viens, A.M., (eds.) The
Cambridge Textbook of Bioethics. Cambridge University press, Cambridge. pp.408-415
SOME OTHER CASE REPORTS
Nicolas Perruche
 In 1982, Josette Perruche discovered red spots
covering her four year old daughter. The child
was diagnosed with German measles. Mrs
Perruche told her doctor that if she was infected,
she should have an abortion rather than risk
giving birth to a severely handicapped child.
 Mrs Perruche underwent two blood tests, two
weeks apart. Mrs Perruche's doctor assured her
that it was safe to go on with the pregnancy. In
fact, the tests had been contradictory. Instead of
pursuing the question, Mrs Perruche's doctor
reassured her. A later blood test would show that
the lab had made a mistake.
Nicolas Perruche
 Nicholas Perruche was born in 1983 deaf, part-blind
and with severe brain damage. Within two years, Mrs
Perruche had suffered a "nervous breakdown",
requiring psychiatric care. Today the boy is cared for by
a government institution. He spends alternate
weekened with his divorced parents.3–5
 In 2000, France's highest appeals court awarded
compensation to 17 year old Nicholas Perruche. The
significance of the Perruche ruling was that it
recognised the child's right to seek damages allegedly
for being born. Prior to that only parents could seek
damages. Perruche's parents were compensated in
February 1997 and then Nicholas himself was granted
compensation in November 2000.
 Is it better to be dead than have Down’s syndrome?
Some people do believe that Down’s syndrome
constitutes a life not worth living. But this view seems
false. Children with Down’s syndrome can and often do
lead happy and worthwhile lives. After all, we do not
suggest that other (non-human) animals have a right
not to be born or a life not worth living because their
intelligence does not measure up to the human
average.
 Is there a “right not to be born”? Reproductive decision
making, options and the right to information
 J Savulescu