Abortion & Forced Organ Donation

Forced Organ Donation & Abortion

Why I don’t need to agree with forced organ donation in order to believe that abortion is wrong.

The Argument

Forcing a woman to remain pregnant by denying her an abortion is like forcing her to donate all her bodily organs to sustaining another life. Unless you also believe that it’s okay in general to force people to donate their organs to sustain the lives of others, you hold a hypocritical and illogical position and your opinion can be dismissed. If you don’t believe that it’s okay in general to force people to donate their organs to sustain the lives of others, then you have no grounds for then thinking that it’s okay to force the pregnant woman to donate hers to sustain the life of the embryo/foetus.

The Problems with this Argument

1. Firstly, I’m going to take issue with pregnancy being described as organ or tissue donation, when it is nothing of the kind.

  • The pregnant woman does not donate her uterus to her unborn child. The uterus is designed to house the unborn child, and to say that this means that it is donated to the unborn child is akin to saying that a women’s vagina is donated to a man during sexual intercourse, or that a nursing mother’s breasts are donated to her breastfeeding child. An organ used as it was intended to be used by another human being does not constitute a donation.
  • Similar to the above, the pregnant woman does not make a tissue donation of her endometrial lining (which would otherwise be discarded during menstruation) to the unborn child, as this is the intended use of the endometrium.
  • The pregnant woman does not donate her blood to the unborn child. Unlike an actual donation of blood, where the blood is removed from the donor and placed into the recipient, no blood is removed from the mother and no blood is placed into the embryo. Bear with me, because it does get somewhat technical in order to demonstrate this;- Until three weeks after conception, the embryo receives oxygen and nutrients via the trophoblast, which is the precursor to the placenta and forms the outer layer around the embryo. Picture the trophoblast as an eggshell, and and the embryo as the egg yolk. The trophoblast is in contact with lacunae, which are cavities within the endometrium that are filled with maternal blood. Material diffuses from the lacunae through the trophoblast and to the embryo.

    – At two weeks after conception, the embryonic circulatory system begins to form. By three weeks after conception, embryonic blood is moving through capillaries (very small blood vessels) within the chorionic villi, which can be pictured as stalks sprouting from the layers surrounding the embryo. These villi project into the lacunae, and material diffuses from the blood in the lacunae into the embryonic blood vessels, where it is circulated via the embryonic cardiovascular system, which – by the end of the third week – includes a beating heart.

    – The pregnant woman does not donate her body to the unborn child. Her body systems do work together to provide nutrition and shelter for the unborn child, but to claim that this is akin to organ or tissue donation makes no more sense than claiming that my use of my body to provide nutrition and shelter to my three born children is akin to organ or tissue donation.

2. It doesn’t take into account the relative rights at stake. By this I am saying that it fails to recognise the difference between not acting to save a life (non-organ donation) and acting to end a life (abortion). It is important to realise here that my stance on abortion is based primarily on the concept that the unborn child, as a human being, deserves the same human rights as the rest of us.

The key right here is the right not to be arbitrarily killed. Other rights of the unborn child are also violated by abortion, but this one is the most outstanding. However, refusing to donate an organ does not result in the arbitrary killing of the ill individual. We have a right not to be killed; we do not have a right not to die. The most relevant right for the individual requiring an organ transplant is the right to health, but this only covers a right to ethical treatment, and so does not cover forcing another person to undergo a intervention in order to acquire treatment.  Therefore no rights of the would-be organ recipient are violated by a refusal to donate.

3. It minimises and trivialises the bodily autonomy of the unborn child while elevating the bodily autonomy of born human beings, including the pregnant women. Let me illustrate what I mean;

  • A person dying of kidney disease MAY NOT violate the bodily autonomy of another in order to save their own life, even though death may considered one of the most drastic of consequences.
  • A pregnant woman MAY violate the bodily autonomy of her unborn child in the most extreme manner in order to avoid the continuation of her state of pregnancy.

So, on one hand we say that bodily autonomy is so important that we may not violate it even to save our own lives. On other hand, we say that bodily autonomy is so unimportant that we can violate it drastically in order to not be pregnant. The only way to escape this illogical conclusion is to argue that the unborn child does not deserve human rights – and I’ve yet to see one convincing argument on this presented to me.

4. It fails to mirror the state of pregnancy in its analogy of forced organ donation. Even if we were to ignore that pregnancy is not organ/tissue donation (see point 1) and pretend instead that it is in some way, it still does not resemble the organ/tissue donation that takes place between born human beings. For example, if I am pregnant, than the embryo or foetus is already using my uterus; the ‘donation’ has already taken place. The only way to stop the foetus using my uterus is to forcibly remove them, at the cost of their life. Likewise, after a kidney donation has taken place, the only to stop a donor recipient from using my kidney is to force them to undergo a surgical procedure and reclaim my kidney from their body. Regardless of how my kidney ended up in their body to begin with – forced, voluntary or as a foreseeable consequence of my own actions – most people would see that this remedy for reclaiming my bodily autonomy is not sufficiently justifiable.

5. It fails to recognise that that granting a right does not grant every remedy to that right. I have a right to bodily autonomy, but I may not pursue any avenue that I feel is appropriate to exercise that right. To give an example, if I overheard a plan to kidnap me and forcibly remove my kidney in order to give it to the child of the main conspirator, and I know that the only way to stop this from taking place was to kill the unknowing and essentially innocent child, am I justified in doing so? I am not, even if this is the only remedy available that will uphold my right to bodily autonomy.

6. It doesn’t differentiate between an active violation and a denial of intervention (e.g. operation to remove donor organ versus denial of abortion procedure). A doctor needs to meet a high bar to treat a patient without consent (example here), but a much lower bar to refuse to treat a patient (example here). An example in my own personal experience has been an elderly and demented female patient with a cancerous lesion in her gastrointestinal system. Should the surgical team discover spread of the cancer or other complications, they are well within their rights to refuse to perform surgery on this lady. However, they cannot decide of their own accord to perform surgery on her; not without the consent of the relevant family members.


The Challenge of this Argument

It was put to me that it is immoral to refuse to save a life when it is within your power to do so. I am inclined to agree somewhat with this, so how can I then defend myself from being called hypocritical when I fail to advocate for forced organ donation, but advocate for so-called forced pregnancy?

The answer is that it doesn’t matter if I think refusing to donate an organ is immoral. For the above reasons listed, this argument is as relevant to pregnancy as suggesting that because I think lying is immoral, but don’t advocate for legislation banning it, I don’t have a right to advocate for the banning of abortion.


Conclusion

Consideration of the unique situation of pregnancy, awareness of the affected rights of all individuals involved in both pregnancy and organ donation and recognition of the very significant differences between organ donation and pregnancy have led me to the conclusion that this argument, although seemingly relevant and powerful on the surface, can be refuted when it is thoroughly explored


I found the following links useful:

Debunking the Pro-Choice Argument, Part VI

Standford Students for Life: the Kidney Donation Argument

Information on embryological development came from ‘The Developing Human: Clinically Orientated Embryology, 9th Edition’ Moore et al. 2013

Bodily Integrity and Abortion Part III: Consent to Pregnancy

Consent To Pregnancy

(Although this was originally intended to be a three-part series, I will be writing one more post to address Judith Jarvis Thompson’s famous violinist analogy)

“Consent to sex is not consent to pregnancy.”

If you’ve been challenged by the above statement, then I hope you’ll find this blog post helpful.  In it, I’ll discuss why I think consent is not actually a relevant concept in the specific case of pregnancy.

 1. Pregnancy is an outcome, not an action.

Put simply, you are able to consent to actions, but not to outcomes. For example, you may need cataract surgery, which carries a 0.7% risk of retinal detachment. If you give your consent for the surgery to be carried out (the action) and then develop a detached retina (the outcome), it is superfluous to insist that you did not give your consent to this outcome. You cannot sue the surgeon on the grounds that you did not consent to a retinal detachment. Your consent to the surgery indicated your acceptance of the known risks of that surgery. Likewise, consent to sex is not consent to pregnancy, but it is consent to an action where pregnancy is a possible outcome. In essence, you accepted the risk of pregnancy when you consented to place yourself in the situation where pregnancy was forseeable. This acceptance of risk applies equally to men and women, as is seen in the legal obligation of the father to support his offspring.

However, if an unfavourable outcome occurs, we do endeavour to correct that outcome. In the example of retinal detachment following cataract surgery, the patient would have the option of undergoing further treatment in order to correct the problem. So the suggestion could be made that, as laser surgery is to retinal detachment, so abortion is to pregnancy. When pregnancy occurs, it is corrected by undergoing an abortion.

In answer to this, I would say that in correcting the unfavourable outcome, we have an obligation to do so in a manner that results in a minimum of harm, and does not violate the rights of another. In the case of the patient with retinal detachment, they may have laser surgery, but they may not kidnap another person and remove their eyes to use for themselves (imagining that whole-eye transplants were possible). A less fantastical example would be that if I gambled (the action) and lost my money (the outcome), I may not resolve my debt by killing my debtor, no matter how much mental anguish or financial pressure I was under.

Taking responsibility for the outcomes we create by consenting to place ourselves in situations where there is risk of those outcomes, means resolving things in a way that minimises the adverse effects to other people, even if it means taking these effects onto ourselves to some degree. Therefore abortion is not an appropriate resolution of pregnancy, as the harm to the foetus is maximised rather than minimised, and its human rights are undoubtedly violated.

It’s worth noting that if pregnancy was not an interruptible process, consent would likely not even be worth discussing.  For example, we don’t talk about consent for the process of digestion, even though it follows an action that we are able to consent to (the consumption of food).  Also, as with any risk, steps can be taken to minimise that possibility of pregnancy.  Barrier methods, such as condoms or diaphragms, and avoiding sex during the woman’s fertile times, can be used in an effort to prevent conception.  However, as both sides of the abortion debate tend to agree, contraceptive methods are not 100% effective.  So the risk of pregnancy may decrease, but it is still present and still needs to be acknowledged as a possible outcome.

 

2. Requiring pregnancy to have ongoing consent redefines it as assault, with all the implications.

Pregnancy is the use of your body by another person. Unwanted pregnancy is the use of your body by another person without your consent. The normal term given to a situation where your body is used without your consent is assault; in the context of pregnancy, I will refer to it as pregnancy-assault.

Imagine now that we are talking about a man and a woman in a long-term, but rocky relationship. Even though the implication of a long-term relationship is that sex is mutually consensual, there are times when the woman does not wish to have sex. Consider the following situations:

  • The man requests sex and the woman says no. He persists and eventually forces her to have sex.
  • The woman has drunk too much alcohol and is unconscious on the bed. The man has sex with her before she regains consciousness.
  • The woman agrees to have sex and engages in foreplay, but loses consciousness before intercourse commences. The man continues, and has sex with her before she regains consciousness.
  • The woman has not lost consciousness, but is drunk to the point of incoherence. She does not resist when the man begins to have sex with her.

In which of these situations did assault take place? I hope you will agree with me in saying that assault took place in every situation. It should be clear that in a situation where consent is either withheld or unable to be given, any actions that proceed are non-consensual and are assault. Imagine again that any of the above situations are taking place, but you have the opportunity and the capacity to intervene. Should you? I would argue that you have an obligation to intervene; that to stand by would be morally untenable.

Now consider the following situations:

  • A woman is pregnant. She does not wish to be.
  • A woman is pregnant and unconscious. Her attitude towards the pregnancy is unknown.
  • A woman is pregnant and unconscious. Prior to falling unconscious, she had expressed her willingness to be pregnant.
  • A woman is pregnant and hospitalised after suffering an adverse reaction to medication. She is incoherent and does not appear to understand what is happening around her.

If pregnancy requires ongoing consent that may be withdrawn at any time, then a woman in any of the above situations is experiencing an assault. If a doctor has the opportunity and the capacity to intervene by performing an abortion, should he? The logical conclusion is that he should, however counter-intuitive this may seem.

Perhaps the idea of pregnancy as assault seems too extreme to be concerned about.  But this is exactly what Elaine McDonagh argues in her book (emphasis mine):

“Even in a medically normal pregnancy, the fetus massively intrudes on a woman’s body and expropriates her liberty. If a woman does not consent to this transformation and use of her body, the fetus’s imposition constitutes injuries sufficient to justify the use of deadly force to stop it. While it is not usual to think of pregnancy as an injury, that is exactly how the law already defines it when it is imposed on a woman without her consent. For example, when men or physicians expose women to the risk of pregnancy by means of rape or incompetent sterilization, and a pregnancy follows, the law clearly establishes that women have been seriously injured. The term the law uses for such a coerced pregnancy is wrongful pregnancy, and the law holds the perpetrators responsible for the injuries entailed by it. This book expands the concept of wrongful pregnancy to include what the fertilized ovum does to a woman when it makes her pregnant without her consent. It is the only entity that can make a woman pregnant, and when it does so without her consent, it imposes the  serious injuries of wrongful pregnancy even if the pregnancy in question is medically normal. . . . [T]o the extent that the law protects the fetus as human life, the law must hold the fetus accountable for what it does.”

(Quote taken from Beckworth & Thomas 2003)

I considered some arguments that dispute the comparison I have made between sexual assault and the condition of pregnancy, should ongoing consent be required.

It probably wouldn’t cause the woman any harm to remain pregnant until her consent is ascertained.

If this were true, the doctor is not under an obligation to immediately intervene.  However, if we accept this, we could also be argue that it probably wouldn’t cause the woman in the first set of scenarios any harm to let her partner have sex with her, and then ascertain her consent after the fact.  Since this is clearly unacceptable, it should also be unacceptable not to intervene in the case of a pregnancy-assault.

Aborting a wanted pregnancy would cause considerable trauma.

To be on the safe side and avoid this possibility, the doctor should not intervene.  But when we go back and consider this in the context of the first set of scenarios (and here we might add to them, and state that your intervention would result in considerable harm to the man – say he becomes extremely aggressive and rushes at you, requiring you to defend yourself and grievously injure him in the process) considerable trauma could also be caused to the woman in these cases, depending on the manner and outcome of the intervention.  Would this justify standing by and potentially allowing a rape to take place?  If not, then it would not justify standing by and potentially allowing a pregnancy-assault to take place.

An unwanted abortion would violate a woman’s bodily integrity.

Intervening in a potential rape would also likely involve violating the bodily integrity of the woman.  If it eventuated that the sex was actually consensual, you would have prevented her from doing with her body what she would have chosen, and therefore you have violated her bodily integrity.  If it was indeed rape, then the intervention was justified, but cessation of the act of rape could still have required violation of the woman’s bodily integrity, i.e. the need to touch her in order to prevent the assault.  If this is not a sufficient reason for not intervening in the potential rape, it is not a sufficient reason for not intervening in a potential pregnancy-assault.

Clearly, our intuition in this should be that we should certainly not perform abortions on unconscious pregnant women.  But if we are to construe pregnancy as assault, this seems an inescapable conclusion.  I hope, therefore, that you can see the problem with requiring ongoing consent to pregnancy.

 

To conclude, and to paraphrase my opening statement: “Consent to sex is consent to accept the risk of pregnancy”, or – even more specifically – “consent to sex acknowledges the possibility of pregnancy and accepts responsibility should it occur.”  It is not practical or relevant to require explicit consent to pregnancy.

 

I welcome feedback. If you have any comments or questions, whether you agree or disagree, I would be delighted to hear from you.