Bioethical Aspects of Abortion and Abortion Law
September 08, 2022Information
September 6, 2022
I. Glenn Cohen, JD
Jennifer A. Herdt, MA, PhD
Sarah Hull, MD, MBE
Katherine Kratschel, JD
Mark R. Mercurio, MD, MA
ID8049
To CiteDCA Citation Guide
- 00:02Well, welcome to the kickoff
- 00:04session for this academic year of
- 00:06the Evening Ethics Seminar series
- 00:08for the program for about medical
- 00:10ethics at Yale School of Medicine.
- 00:12My name is Mark Mercurio.
- 00:13I'm the director of the program and on
- 00:15behalf of Sarah Hall and Jack Hughes,
- 00:17our associate directors, and Karen Colby,
- 00:19our manager, I welcome you.
- 00:21I'm delighted that you're here tonight.
- 00:23The program for Biomedical Ethics,
- 00:25as many of you know,
- 00:26but I know many of you are also knew this
- 00:28twice a month during the academic year,
- 00:30and we have evening ethics seminars.
- 00:32We share this space, if you will,
- 00:34with the with the Yale Pediatric
- 00:36ethics program and various one group
- 00:38or the other sponsors these seminars.
- 00:40It doesn't much matter to you.
- 00:42You can find the the schedule on
- 00:46biomedicalethics@yale.edu and of course
- 00:47we have a wide mailing list and we send
- 00:51out notifications of these things as well.
- 00:53And you're cordially invited to attend as
- 00:56many as your schedule and interest dictate.
- 01:00There has.
- 01:02It's been an amazing summer.
- 01:04Much has happened in the few months
- 01:06that we were off offline with the
- 01:08program for biomedical ethics.
- 01:10And as I think everybody
- 01:11on this call is aware,
- 01:12of course,
- 01:12the the jobs decision by the US
- 01:15Supreme Court has had tremendous
- 01:17impact and implication and has
- 01:18led to widespread discussion,
- 01:20including a series of seminars and
- 01:23webinars here at Yale University.
- 01:26My friend Katie Cashell over
- 01:28at the law school.
- 01:30Has been one of the major players in
- 01:32putting all of this together as well,
- 01:34and she's one of our speakers tonight.
- 01:36There have been sessions that focused
- 01:39on how this decision is going to what,
- 01:42what the legal nuances of this are,
- 01:44what the influence this is going
- 01:45to be on the medical profession,
- 01:47what this is going to do for public health.
- 01:49There's all sorts of different
- 01:50discussions that have been had tonight.
- 01:52Specifically,
- 01:53what we're going to try and
- 01:55focus on are the ethical,
- 01:57ethical issues at work as well as the
- 02:00ethical implications of this and so.
- 02:02Tonight's session on the ethics of
- 02:05abortion and abortion law is really.
- 02:08Focused as to some extent on the
- 02:09Dobbs decision and on Roe V Wade,
- 02:11which is of course been overturned,
- 02:13but also on the question of abortion,
- 02:15which has plagued ethicists for
- 02:17as long as ethicists have been
- 02:20having conversations over many,
- 02:22many, many years.
- 02:24I have.
- 02:25I'm very,
- 02:25very pleased with the Group of people
- 02:27we were able to assemble tonight,
- 02:29and I'm going to introduce them
- 02:30to you one at a time to let you
- 02:31know how the night will work.
- 02:33We have 4 speakers tonight.
- 02:35Each will speak for roughly 10 to 15 minutes.
- 02:38And then at about 6:00 o'clock or so,
- 02:42the speakers will finish and then
- 02:44I will moderate a Q&A session
- 02:45and I invite you to send your
- 02:47questions or comments in through
- 02:49the Q&A function on zoom.
- 02:50I'll then read the questions to the panelists
- 02:53at 6:30. I will wrap it up.
- 02:56So if you're wondering
- 02:57how long does this go on,
- 02:58it goes on until 6:30 and then we will stop.
- 03:01So I apologize, I know in advance
- 03:03because I know many of you won't
- 03:05be able to get your questions in.
- 03:06I expect it's going to be
- 03:08a great presentation.
- 03:09Word rate presentations followed
- 03:10by a very interesting discussion,
- 03:12so let me get right to it,
- 03:14please, by starting out to
- 03:16introduce my friend and colleague,
- 03:18attorney Katie Kraschel,
- 03:19who is the Executive director of
- 03:21the Salomon Center for Health Law
- 03:23and Policy at Yale Law School,
- 03:24where she also Co teaches the
- 03:27reproductive rights and Justice
- 03:29Project Clinic.
- 03:30Katie Scholarship focuses on the
- 03:32intersection of reproduction,
- 03:33gender, bioethics, and health policy.
- 03:36She holds a bachelor's degree in
- 03:38biochemistry from Mount Holyoke
- 03:40College and a law degree from
- 03:42Harvard Law School.
- 03:43She also completed Harvard Law
- 03:45School's Fellowship in bioethics.
- 03:46And Katie has been a long standing
- 03:48friend of the program for biomedical ethics.
- 03:50And we're delighted you could
- 03:51join us again tonight, Katie.
- 03:52And with that,
- 03:53I will turn this over to
- 03:55attorney Katie Kraschel.
- 03:58Thanks mark. It's always a pleasure
- 03:59to get to be part of the discussion.
- 04:01I'm going to go ahead
- 04:03and share my screen here.
- 04:05Hopefully this will run smoothly.
- 04:09Can you all see my the screen?
- 04:12Mark, can you see it?
- 04:16Yes, ma'am, we can see it.
- 04:17OK, great, excellent.
- 04:18So I will try to be brief this evening.
- 04:22Many of you who have been part of this
- 04:24series have heard from me previously
- 04:26and I'm really excited about the other
- 04:28speakers that you'll get to hear tonight.
- 04:30Just my sort of boring disclaimers that I
- 04:32provide at the beginning of the of talks,
- 04:35especially on this topic that I wear a
- 04:37lot of different hats at the law school,
- 04:40at the within the university and in the
- 04:43community and just want to clarify.
- 04:46That the views that I share in
- 04:49the presentation is my own.
- 04:51OK, so today I I'm my first.
- 04:55My charge today is sort of to set up,
- 04:57set the stage for the discussion
- 04:58and to provide a brief overview of
- 05:01the bioethical under underpinnings.
- 05:03Specifically,
- 05:04I'll focus on the two major precedential
- 05:07cases that were overturned in Dobbs,
- 05:10Roe V Wade and Casey.
- 05:12And I'll describe what many people
- 05:15thought the court might do in
- 05:17jobs that would respond to many of
- 05:19the criticisms of the reasoning.
- 05:22Or the ethical reasoning that underlie
- 05:25a lot of the reasoning in those cases.
- 05:28And then I'll touch on what the
- 05:30court ultimately said in Dobbs,
- 05:32and what it tells us about the legal
- 05:35terrain and the ongoing ethical
- 05:37debates that we're in today,
- 05:39and how we consider the earliest
- 05:41stages of life and the bodily
- 05:43autonomy of pregnant people.
- 05:47And and so at first,
- 05:50I start here with the Dobbs decision.
- 05:52This is what, as Mark mentioned,
- 05:54what brings us here today.
- 05:56And as you can see,
- 05:57the court held that the US
- 05:59Constitution does not confer
- 06:01a right to abortion and that
- 06:02it overruled Roe and Casey.
- 06:06So first, let's go
- 06:07back to 1973, when the court held
- 06:10that the US constitutions right to
- 06:12privacy found in the 9th and 14th
- 06:16amendments encompassed a women's
- 06:17right decision to end pregnancy and
- 06:20how that the ban on abortion at stake
- 06:23in that case was unconstitutional.
- 06:26In Roe. The court was very careful
- 06:28to note that the right to abortion
- 06:30was not absolute and that the state's
- 06:32interest and potential life must
- 06:33be balanced against the pregnant
- 06:35persons interest in autonomy.
- 06:37Equality and bodily integrity.
- 06:40In its most simple framing,
- 06:43the bioethical debate about abortion
- 06:44in the United States and in the
- 06:47Supreme Court has long been a debate
- 06:49of balancing these two interests
- 06:51the individual persons interest
- 06:52and deciding their fate of their
- 06:55body and deciding whether or not
- 06:57to remain pregnant against the the
- 07:00stated interest of the state in
- 07:03protecting life wherever the state
- 07:05would argue that interest would begin.
- 07:11So subsequently, in 1992,
- 07:14the Supreme Court decided
- 07:16another abortion case,
- 07:17Planned Parenthood V Casey,
- 07:19often just referred to in
- 07:20shorthand as Casey, that held up.
- 07:23It upheld rose right to abortion,
- 07:25as found specifically in the 14th
- 07:28amendment of the US Constitution,
- 07:30due process clause, and a doctor.
- 07:33And it adopted a standard relying on
- 07:36viability that pregnancy that states
- 07:38can't impose an undue burden on
- 07:40the right to terminate a pregnancy.
- 07:43Such that complete bans on
- 07:45abortion before viability were an
- 07:47unconstitutional infringement on rights
- 07:49articulated in the Constitution.
- 07:52As the court said,
- 07:53viability marks the earliest point
- 07:55at which the state's interest and
- 07:57fetal life is constitutionally
- 07:59adequate to justify a legislative
- 08:01ban on non therapeutic abortions.
- 08:05So to bring it back to where we were
- 08:08in that in Casey, as I mentioned,
- 08:10the court found that the 14th amendment
- 08:13of the Constitution is sort of
- 08:15where this right to abortion lives,
- 08:17specifically in the substantive
- 08:19due process clause,
- 08:19which I have highlighted here on my slide.
- 08:23So this is where there's been a
- 08:25lot of debate about whether or not
- 08:27the right to abortion really lives
- 08:29in the US Constitution and whether
- 08:31or not the federal government
- 08:33should provide this sort of floor.
- 08:34Against states who have enacted
- 08:38restrictive abortion laws.
- 08:44So along came came Dobbs. So the law is.
- 08:50And what makes Dobbs so important is
- 08:53that the case was squarely challenging
- 08:55what was held in Roe and Casey.
- 08:57The law at issue in Dobbs was in
- 09:00Mississippi is Mississippi law that
- 09:02bans abortion at 15 weeks viability.
- 09:04The gestational age at which the
- 09:06fetus can survive outside a person's
- 09:08uterus is around 23 or 24 weeks.
- 09:11So the Mississippi law.
- 09:12And it sort of unambiguously flew
- 09:14in the face of the standard set by
- 09:16row and interpreted by Casey since
- 09:1915 weeks as well before viability.
- 09:21So the issue of viability is not
- 09:24the in the Dobbs case was not the
- 09:27first time that people have many
- 09:29have critiqued the standard set
- 09:31forward in row and as interpreted by
- 09:34Casey anti abortion since the 1980s.
- 09:37Ethicists, lawyers, physicians,
- 09:38academics,
- 09:39and advocates alike to have
- 09:41criticized it as being insufficient
- 09:44or ethically incoherent demarcation,
- 09:47after which the state interest in fetal
- 09:49life is sufficiently significant to tip.
- 09:51Balance in favor of the state against
- 09:53the pregnant person's interest
- 09:55in bodily autonomy and equality.
- 09:58The Supreme Court has repeatedly
- 09:59opted not to list a particular
- 10:01time and fetal development,
- 10:03and instead stuck with viability
- 10:05as a concept.
- 10:06So,
- 10:06among other things,
- 10:08viability and the time and development
- 10:11at which a fetus is able to survive
- 10:14outside of a person's uterus has
- 10:15changed even since Roe passed.
- 10:18Others have noted that the idea of viability.
- 10:21Not tethered to any part of
- 10:23the Constitution and States
- 10:24and especially in the 19,
- 10:26have passed laws on claims.
- 10:31Or have passed laws to define
- 10:33viability in different ways.
- 10:35So many have argued for a long time
- 10:38that the viability line demarcation
- 10:40at which the state can no longer
- 10:43put in place total bans on abortion
- 10:46was an unworkable standard.
- 10:49So when we think about what an
- 10:51alternative to that may be,
- 10:53some states have passed laws
- 10:55based upon the claims that there
- 10:57is a moral duty to prevent,
- 10:59for example fetal pain and that
- 11:01the fetus on claims that the fetus
- 11:03can feel pain at pre viability
- 11:05stages of development such that
- 11:07they would argue a ban on abortion
- 11:09is appropriate prior to viability
- 11:11based upon the moral duty to
- 11:13prevent the fetus from feeling pain.
- 11:15Now peer review studies have
- 11:17refuted claims that.
- 11:18Fetal pain is really experienced
- 11:20at these stages,
- 11:22but I provide this example as a
- 11:25moral justification that people
- 11:26have provided in support of for
- 11:29for arguing for abortion bans
- 11:31earlier in gestation,
- 11:32as many of you have probably heard.
- 11:34Also we've had,
- 11:35we've heard heartbeat bands,
- 11:37which are generally abortion bands,
- 11:38at approximately 6 weeks Jason gestation,
- 11:41which notably is about two
- 11:43weeks after a person might know
- 11:44that they are pregnant.
- 11:49So with the viability being sort of the
- 11:52high viability being this hot button,
- 11:54very heavily criticized and.
- 11:59Watts written about viability as a morally
- 12:03justifiable and legally coherent standard.
- 12:05For years. There were a couple of
- 12:08outcomes that many scholars thought
- 12:09might happen in the DOPS case,
- 12:12so one which I intentionally crossed
- 12:13out because it was not what happened?
- 12:16Would it be to uphold Roe and get
- 12:18rid of the viability standard?
- 12:20That is, that the court could have
- 12:22held that the Constitution in the 14th
- 12:25amendment per Roe and Casey might
- 12:27still protect the right to abortion.
- 12:29But this?
- 12:29Specific 15 week ban that was at issue
- 12:31in the case doesn't impinge on that
- 12:34right because viability is no longer
- 12:35the standard that the state interest
- 12:37might best earlier in development,
- 12:39but that there was still a constitutionally
- 12:41protected right to abortion.
- 12:44We saw that Justices Gorsuch and Roberts
- 12:46were very asked questions suggesting that
- 12:49they were looking for an alternative
- 12:51point in development in oral arguments,
- 12:55and you can see here with the
- 12:57quote that I've included.
- 12:59That Justice Gorsuch seemed to
- 13:01be sort of asked,
- 13:02trying to elicit from the people arguing
- 13:04the case in alternative standard.
- 13:08And as you can see,
- 13:09even in his concurrence, Justice Roberts,
- 13:11one of the more moderate of the
- 13:14conservative members of the Supreme Court,
- 13:16said that there is a clear path to
- 13:19deciding this case correctly without over
- 13:21ruling Roe all the way down to the studs,
- 13:23recognize that viability line must be
- 13:26discarded as the majority rightly does,
- 13:28and leave for another day whether to
- 13:31reject any right to an abortion at all.
- 13:34Again, that's not how the case went down,
- 13:36but to specifically focus on the
- 13:39bioethical arguments underpinning a lot
- 13:41of US jurisprudence around abortion.
- 13:44For the past 50 years,
- 13:45there was a lot of discussion
- 13:48about viability.
- 13:49So as I mentioned,
- 13:51this is the hypothetical outcome.
- 13:52#1 didn't happen as scholars were talking
- 13:55about different things that could happen.
- 13:57Hypothetical outcome #2 was to
- 13:59overturn overturn rate Roe on the
- 14:01basis that there was no abortion
- 14:03right found in the Constitution.
- 14:05And that is in fact what happened.
- 14:08Again,
- 14:08it that the court held that the Constitution
- 14:10does not confer a right to abortion,
- 14:12and that Roe and Casey were or overruled
- 14:15and the authority to regulate abortion
- 14:16should be returned to the States
- 14:19and their elected representatives.
- 14:23So today you can find any
- 14:26number of maps similar to this.
- 14:28This happened to just be the one
- 14:30I took a screenshot of today,
- 14:32tracking the status of various abortion
- 14:34restrictions across the United States.
- 14:36As you can see,
- 14:37there's a pretty dark red region
- 14:40of the country in the South where
- 14:42it would be very difficult to find
- 14:45to get access to legal abortion.
- 14:47And as you can see on the map on the right,
- 14:50there are there's ongoing litigation
- 14:52that is a very dynamic situation changing
- 14:55everyday about which laws have been enjoyed,
- 14:59meaning they cannot be enforced while
- 15:00the court, while the case is pending
- 15:03and where lawsuits have been filed.
- 15:06Some of the bands go as far as to say
- 15:09that life begins at fertilization,
- 15:11and so that's another issue that we can
- 15:15I'd be happy to discuss discuss in the Q&A.
- 15:18I know that Professor Cohen is also
- 15:21planning to talk a bit about the moral
- 15:23status of an embryo and what what the
- 15:25Dobbs decision means for continuing
- 15:28bioethical discussions about that.
- 15:30Again, another map of abortion restrictions.
- 15:32This one I believe is from the
- 15:34Center for Reproductive Rights and
- 15:36I highlight here that it another
- 15:37topic that I'm happy to cover if
- 15:40people have questions about that.
- 15:41In Connecticut we have passed a abortion
- 15:45provider protective Shield law that
- 15:48helps keep to the extent other states
- 15:50are trying to enforce their abortion
- 15:53restrictive laws outside of their
- 15:55own borders for against physicians
- 15:57or clinicians who are providing.
- 15:59Abortion care that's legal in their state.
- 16:02Some states have enacted these laws in
- 16:04order to sort of keep the states judicial
- 16:07infrastructure from being used to enforce.
- 16:11Civil claims or criminal actions
- 16:14against residents of their state
- 16:17when they might usually facilitate
- 16:19that between two different states.
- 16:24So we talked a lot.
- 16:25I talked a lot about sort
- 16:27of the viability line.
- 16:28And, you know, with the decision
- 16:31really being about the claim that
- 16:34there's no substantive due process
- 16:36right in the US Constitution that
- 16:39protects the right to abortion,
- 16:41brings us into the reality of the moral,
- 16:45the bioethical problems with
- 16:47that being the law of the land,
- 16:49so in denying abortion care.
- 16:53It is denying the bodily autonomy
- 16:55of people who become pregnant
- 16:56and don't want to be pregnant.
- 16:58It is an unequal situation for people
- 17:01who are able to get pregnant because
- 17:03there's nothing and among other things
- 17:06and have sort of formal equality sense.
- 17:09There's no similar restriction on people
- 17:12who are unable to become pregnant.
- 17:14And there are also health consequences,
- 17:17of course, for denying abortion,
- 17:19financial consequences,
- 17:20consequences and.
- 17:21Isn't also,
- 17:23of course,
- 17:24important to note that there
- 17:26is a disproportionate burden
- 17:27and racial justice issues that
- 17:29are very important and salient
- 17:31in denying abortion care.
- 17:35So on the last, my last second here,
- 17:38because I know I'm tied on time,
- 17:41I I'll just say that I would
- 17:43be happy also to discuss that.
- 17:45The response from more abortion friendly
- 17:49States and from the federal government,
- 17:53that being the SHIELD bus that I mentioned,
- 17:56as well as recent action from
- 17:58the federal government under the
- 18:00Emergency Emergency medical treatment
- 18:02and Labor Act that requires. Umm.
- 18:05Healthcare facilities with emergency
- 18:07departments that participate in federal
- 18:11health programs such as Medicare.
- 18:12So most emergency departments,
- 18:14if not all that they must provide
- 18:18care in emergency situations.
- 18:20So for the especially in states
- 18:22where there is no emergency life,
- 18:24life exception when the life of
- 18:27the pregnant person is at risk,
- 18:30the federal government is is doing
- 18:31its best at this point under the Biden
- 18:34administration to provide a safe.
- 18:35Charge so that at a minimum,
- 18:37when someone's life is in danger or
- 18:38they're in an emergency medical situation,
- 18:40they could access abortion care.
- 18:44So with that,
- 18:44I will turn it back over to Mark
- 18:47to introduce our next speaker.
- 18:49I will stop my share.
- 18:50And welcome all sorts of any questions
- 18:54that and I'm looking forward to the Q&A.
- 18:57Thank you so much, Katie.
- 18:59That was a a beautiful job of setting the
- 19:01table for us for the ongoing conversation.
- 19:03Our next speaker is going to be I,
- 19:06Glenn Cohen, and Glenn is the James A
- 19:08Atwood and Leslie Williams professor
- 19:10of law at Harvard Law School,
- 19:12as well as the faculty director of the
- 19:14Peachtree Flom Center for Health Law Policy,
- 19:16Biotechnology and Bioethics Professor Cohen
- 19:18is one of the world's leading experts on
- 19:21the intersection of bioethics and the law,
- 19:24as well as health law.
- 19:26He has had a storied.
- 19:28Rear He's very involved
- 19:30in government work with,
- 19:31he's advised US Vice president
- 19:33on reproductive rights.
- 19:35He's reached out widely to the
- 19:37media and everything from PBS to
- 19:39New York Times to Mother Jones.
- 19:41I just learned this week that
- 19:42Mother Jones was a real person.
- 19:43I confess, I never knew that.
- 19:46Glenn was the youngest professor
- 19:48on the faculty at Harvard Law
- 19:50School when he was first brought
- 19:52to the faculty a few years back,
- 19:54and prior to being on the faculty there,
- 19:56he was clerking for the US Court of Appeals,
- 19:59and it was involved in cases
- 20:01that went as far as the Court of
- 20:03Appeals and the US Supreme Court.
- 20:05Professor Cohen has a BA in Bioethics
- 20:07and psychology from the University
- 20:09of Toronto and a JD from Harvard,
- 20:12and we are honored and grateful
- 20:13that you've joined us tonight.
- 20:14Glenn, take it away.
- 20:16The honor is all mine.
- 20:17Thank you so much for having me.
- 20:19My disclosures.
- 20:20So in the ones that are relevant,
- 20:21I currently sit on the ethics
- 20:24advisory boards for Lumina and Bayer.
- 20:26I've also served in the past
- 20:27on the ACOG Ethics Committee,
- 20:29although I don't sit on it now.
- 20:31So the day after the Dobbs opinion leaked,
- 20:33many wondered what Wright was
- 20:35next on the chopping block.
- 20:36Justice Alito's opinion,
- 20:37but not Justice Thomas,
- 20:39explicitly said that they're not revisiting
- 20:42today cases protecting contraception,
- 20:44same-sex sexual intimacy.
- 20:46Same sex marriage and says quote,
- 20:48what sharply distinguishes the
- 20:50abortion right from the rights
- 20:52recognized the cases on which Roe
- 20:54and Casey rely is something that
- 20:55both those decisions acknowledge.
- 20:57Abortion to strides with destroys
- 20:59with those decisions called
- 21:00potential life with the law at issue
- 21:02in this case regards the life of
- 21:04an unborn human being UN quote.
- 21:06And then said quote,
- 21:07none of the other decisions cited by
- 21:10Rowan Casey involved the critical
- 21:12moral question posed by abortion UN quote.
- 21:14So those of us in the
- 21:16bioethics community thought.
- 21:16Almost immediately,
- 21:17well, yes,
- 21:18that might distinguish same sex marriage,
- 21:20but clearly not embryo destruction,
- 21:22a key part of stem cell research,
- 21:24and how in vitro fertilization that's
- 21:26IVF is practiced at the moment.
- 21:28It also raises questions about
- 21:30what whether some forms of
- 21:32contraception would be regarded,
- 21:34by the court at least, as involving
- 21:36the destruction of an unborn life.
- 21:38When it comes to IVF,
- 21:40embryo destruction is extremely common.
- 21:42Data collected by the CDC reveals that
- 21:45virtually every IVF clinic in this country.
- 21:47Provides embryo cryopreservation services,
- 21:49which is necessary when there's
- 21:51more than one or two embryos
- 21:53produced in a single cycle.
- 21:55While most IVF cycles do produce
- 21:56more than two eggs for fertilization,
- 21:59the current standard of care is to
- 22:01implant no more than two to avoid
- 22:03the risk of multiple pregnancies.
- 22:04Those remaining embryos are often
- 22:06destroyed when the parties die,
- 22:08when they divorce,
- 22:09when they're going to decide they
- 22:11just don't want to have any more
- 22:13children and want to stop paying prior
- 22:15preservation fees about half of all IVF.
- 22:18Cycles in the US involve pre implantation,
- 22:20genetic testing and which sells our
- 22:22biopsy from a developing embryo to
- 22:23determine the health of resulting
- 22:25child and those test results when
- 22:27they reveal genetic abnormalities
- 22:29potentially associated with negative
- 22:30health outcomes are often destroyed
- 22:32or discarded to use the preferred
- 22:35term in the community.
- 22:36So what would happen if a state tried
- 22:39to restrict, directly or indirectly,
- 22:41IVF?
- 22:41In fact,
- 22:42Louisiana already has a statute doing so,
- 22:45dating all the way back to 1986,
- 22:47and it says,
- 22:48quote,
- 22:49a viable in vitro fertilized
- 22:50human ovum is a juridical person,
- 22:53which shall not be intentionally
- 22:54destroyed by any natural or other
- 22:56juridical person or through the
- 22:58actions of any other such person,
- 23:00UN quote.
- 23:00Kentucky also has a similar law,
- 23:02but it only applies to public institutions.
- 23:05There are vanishingly few cases
- 23:07that have ever discussed.
- 23:09Whether there are any constitutional
- 23:11rights to use IVF and in what way?
- 23:13Outside the US, we see models
- 23:15of restrictions that some states
- 23:17might be interested in adopting.
- 23:19In Italy, there's a 2004 law that
- 23:22prohibited creating more than
- 23:243 embryos in an IVF cycle and
- 23:27prohibited Carisoprodol preservation,
- 23:28the idea that all would be implanted
- 23:30and none would be cryopreserved.
- 23:32That law was ultimately struck down in 2009,
- 23:35but in Germany there's a prohibition
- 23:37on the creation of more than
- 23:39three embryos per IVF cycle.
- 23:41One could imagine a pro-life
- 23:43state passing a similar law.
- 23:45In the US, or less likely,
- 23:47but also possible,
- 23:48requiring any unused embryos to be
- 23:51available for quote UN quote embryo
- 23:53adoption by other individuals as
- 23:55a constitutional matter post dogs,
- 23:58those laws seem to me to be constitutional.
- 24:01That is Justice Alito's opinion,
- 24:03for the majority of the court
- 24:04seems to suggest that there is no
- 24:06constitutional problem with that role.
- 24:08Even pre Dobbs there were
- 24:10vanishingly few decisions suggesting
- 24:11such a constitutional right.
- 24:13The biggest constraint on
- 24:14this happening is politics.
- 24:16When we look at the polling done
- 24:18about abortion and about IVF,
- 24:20we find that many people who are anti
- 24:23abortion are nonetheless pro IVF.
- 24:25Nonetheless,
- 24:25there is a risk that some of
- 24:27these laws might come into being
- 24:30through more inadvertence.
- 24:31Adoption of personhood language
- 24:32aimed at abortion might sideswipe,
- 24:34in some instances, IVF and other processes.
- 24:38Because this is a bioethics colloquium,
- 24:40I'm going to spend the remainder of
- 24:41the time on a normative question.
- 24:43Should those who seek to prohibit
- 24:45abortion also seek to prohibit
- 24:47embryo destruction as part of IVF or
- 24:50other reproductive technology use?
- 24:52My answer is going to be a maybe.
- 24:54I'm a lawyer,
- 24:55so it's very common to answer without maybe,
- 24:57and it may depend a lot on your theory
- 24:59of embryonic or fetal personhood.
- 25:01At the start,
- 25:02let me just say I'm focused on
- 25:04reasons to prohibit IVF that are
- 25:06connected to embryo destruction.
- 25:08There are other reasons I think of
- 25:10Leon Cassas the wisdom of repugnance
- 25:12issues about gender roles that
- 25:14some conservatives might want to
- 25:16ban IVF or restrict IVF,
- 25:17but I'm focusing on embryo destruction.
- 25:20As I've put it elsewhere,
- 25:22most individuals who want to prohibit
- 25:24abortion subscribe to something
- 25:26like the two following premises,
- 25:28premise 1.
- 25:30Fetuses are persons and or get
- 25:32some of the rights of persons from
- 25:34early on in their development,
- 25:36particularly a right of inviability,
- 25:38that is the right not to be destroyed.
- 25:39That overwhelmingly good reason.
- 25:422nd premise,
- 25:43whatever interest the mother has
- 25:45in protecting her bodily integrity,
- 25:47protecting her reproductive autonomy,
- 25:49etcetera,
- 25:50that doesn't outweigh her fetus
- 25:52is right of inviolability.
- 25:53So I want to suggest those are the
- 25:55two main premises behind attempts to
- 25:57criminalize abortion and prohibit abortion.
- 26:00Now, what happens though,
- 26:01when replaces the word fetuses in
- 26:03those premise with the word early embryos?
- 26:05Or if you preferred fertilized eggs?
- 26:08Well,
- 26:08the exact same argument would seem
- 26:11to justify prohibiting.
- 26:12Embryo destruction,
- 26:13just as it does in abortion.
- 26:15That's just that.
- 26:16If you're against abortion,
- 26:17you have a very strong reason to be
- 26:19against embryo destruction as well.
- 26:21But I want to push further on this
- 26:23and look at those two premises and
- 26:25discuss why I think it's a maybe.
- 26:27Let's start with the second promise,
- 26:29the premise.
- 26:30That's the idea of bodily integrity.
- 26:32So many people are surprised when I tell
- 26:34them that the arguments are prohibiting
- 26:37embryo destruction are stronger,
- 26:39or, if you prefer,
- 26:40easier than the arguments
- 26:41for prohibiting abortion.
- 26:43Why you I say this because the second
- 26:45premise about women's autonomy,
- 26:47about bodily integrity,
- 26:48about reproductive autonomy,
- 26:50is less relevant,
- 26:51or in some accounts,
- 26:52irrelevant,
- 26:52in the case of early embryos
- 26:54that have not yet been implanted.
- 26:56While prohibiting abortion requires favoring
- 26:58the right of a fetus over the right not to
- 27:02gestate of the woman seeking an abortion,
- 27:04that's a bodily autonomy right.
- 27:06There's no controversy countervailing
- 27:07right to control one's body at issue,
- 27:10and we're talking about prohibiting
- 27:11embryos that have been.
- 27:13Produced extra corporally,
- 27:14that is,
- 27:15that our sitting outside the body
- 27:17that is prohibiting abortion
- 27:18directly restricts the right
- 27:20not to be a gestational parent,
- 27:22whereas prohibiting embryo
- 27:23destruction does not.
- 27:25One more way of putting it is to say
- 27:27the second premise is a very strong
- 27:29reason to support abortion rights,
- 27:31but it is weaker when it comes to
- 27:34opposing embryo destruction because
- 27:35prohibitions on embryo destruction
- 27:38don't involve force gestation.
- 27:40The most famous philosophical
- 27:41defense of abortion,
- 27:43based on the second premise,
- 27:44comes from Judith Jarvis Thompson's
- 27:46famous article a defense of abortion
- 27:48and her thought experiment about
- 27:50waking up as a human dialysis machine
- 27:52to the world's most famous violinist.
- 27:55Her argument is aimed at showing that
- 27:57even if you believe a fetus is a person.
- 28:01The abortion rights should persist.
- 28:03That is the exact argument that's
- 28:06unavailable for embryo destruction,
- 28:07which doesn't involve forced gestation,
- 28:10a kind of slavery in an indirect way.
- 28:13And that's not to say that a party
- 28:14that is aggrieved has no potential
- 28:16rights claim to make against a policy
- 28:19that prohibits embryo destruction.
- 28:21It's just to say that there's a
- 28:23harder to characterize argument,
- 28:24and maybe less persuasive if individuals
- 28:26were required to make their excess
- 28:29embryos available for adoption.
- 28:31Agreed,
- 28:31individuals might argue for a violation
- 28:33or right not to be a genetic parent.
- 28:35That is,
- 28:36the state is forcing them to allow other
- 28:38people to rear their genetic children.
- 28:40Here,
- 28:41the state could respond that the
- 28:43individuals could have avoided
- 28:44this dilemma by only fertilizing
- 28:46the embryos one or two at a time.
- 28:48The individual might say, well,
- 28:50yeah, that sounds great,
- 28:51but it would not be economically
- 28:53feasible for me.
- 28:54But when we get to that point
- 28:55in the argument,
- 28:56you might say we're really
- 28:57arguing about now is more in
- 28:59the style of positive liberty,
- 29:00a right to become a genetic parent.
- 29:02That is stymied by the background
- 29:04rule on the fate
- 29:05of cryopreserved embryos rather than a
- 29:08straightforward negative liberty restriction.
- 29:10If a state tried to prohibit the
- 29:12creation of more than three embryos
- 29:15per cycle and forbade cryopreservation,
- 29:17that's the German approach.
- 29:18In that case too, it seems as though
- 29:21the aggrieved party is really arguing
- 29:22about a right to be a genetic parent.
- 29:24Their argument might either be of
- 29:26this approach is too expensive,
- 29:28or that it will stop them from succeeding
- 29:30in IVF before they run out of money.
- 29:32That will prevent them from having a child,
- 29:34or the number of children they want to
- 29:37have via IVF before they run out of money,
- 29:39or in the extreme.
- 29:41Space before they age out of
- 29:43having viable eggs.
- 29:44It's not that these claims
- 29:46are not worth anything.
- 29:47I'm saying that they're worthy claims,
- 29:49just that they're much less
- 29:50clean and in my opinion,
- 29:51less forceful arguments for
- 29:53countervailing rights claims,
- 29:55the classic one regarding forced
- 29:57gestation in the abortion context.
- 29:59So that's why I think on the second premise,
- 30:01embryo destruction is different.
- 30:02What about the first premise?
- 30:04So once again, that first premise,
- 30:06I'm sorry,
- 30:06but a little quickly here,
- 30:08is that fetuses are persons and or
- 30:10get some of the rights of persons.
- 30:12From early on in their development,
- 30:13particularly a right of inviability.
- 30:16One could argue for prohibiting
- 30:18abortion but not prohibiting embryo
- 30:20destruction if one believes there
- 30:22are morally relevant differences
- 30:24as to personhood claims for early
- 30:26embryos as opposed to fetus.
- 30:28So here the argument for a restriction
- 30:30on embryo destruction is weaker than
- 30:32the one for restricting abortion.
- 30:34See how the two premises move together.
- 30:36One premise is stronger on abortion,
- 30:39the other premise is stronger
- 30:40on embryo destruction,
- 30:42which is quite interesting.
- 30:43All of this, though,
- 30:44is going to depend when it comes
- 30:46to this premise of personhood,
- 30:47on the criteria you want to
- 30:49adopt for personhood.
- 30:50So I'm going to say a few things now,
- 30:52but we can talk more about it during the Q&A.
- 30:54What are the different views about when
- 30:56personhood begins in less than 5 minutes?
- 30:58OK,
- 30:59here we go.
- 31:00First one is a view,
- 31:02and it's associated with the Catholic Church,
- 31:03for example,
- 31:04that personhood begins and indeed is
- 31:07completed at the point of fertilization.
- 31:10There's lots of critiques we
- 31:11can discuss about this view,
- 31:12but here all I want to say is that.
- 31:14That's your view.
- 31:15There should be no difference
- 31:17between destruction of embryos
- 31:18and destruction of fetuses.
- 31:20That is,
- 31:20embryo destruction and abortion
- 31:22are equivalent.
- 31:23Arrival view is sometimes called
- 31:25the 14 days of development fee,
- 31:27as Cynthia Cohen puts it quote.
- 31:29Several developments at this
- 31:31point are especially significant.
- 31:32The first of the cells of the early
- 31:34embryo begin to function either
- 31:36as part of the embryo proper or as
- 31:38extra embryonic supporting materials
- 31:40that will be discarded later.
- 31:41The second is that it is
- 31:43irrevocably settled by this time.
- 31:45An embryo proper that is distinct from
- 31:47the mandarins that nourish it is present.
- 31:491/3 is that twinning can no longer occur,
- 31:52UN quote, since embryos
- 31:54used for IVF are never allowed
- 31:56to develop anywhere near 14 days.
- 31:59If this is the marker of
- 32:00personhood you develop and adopt,
- 32:02you justifiably can draw a distinction
- 32:04between abortion and embryo destruction.
- 32:06For research, though,
- 32:07there's been much more pressure
- 32:09to go beyond the 14 day mark,
- 32:11and this might problematize that
- 32:13kind of research, to be sure,
- 32:14even those who are in favor of the.
- 32:1614 day approach still believe in early
- 32:19embryo deserves special respect,
- 32:21but I think most of them would say that
- 32:23special respect is satisfied in the
- 32:24case when the embryo is made a good
- 32:26faith effort to use it for reproduction.
- 32:28But we can talk a little bit
- 32:30more about that during the Q&A.
- 32:31Next, there are what are
- 32:33called capacity X fees.
- 32:35These split between views that
- 32:37require that an embryo attain an
- 32:39actual capacity X versus having
- 32:42the potentiality for capacity XI.
- 32:45Keep saying word X because
- 32:47there are different candidates
- 32:47for what you might adopt.
- 32:49Philosophically speaking,
- 32:49it could be their capacity.
- 32:51X is the ability to feel pain,
- 32:53embodied consciousness,
- 32:54to have awareness over the self of time,
- 32:57to communicate, to experience emotion,
- 33:00to solve new and complex problems.
- 33:02Some combination of these and a lot will
- 33:05depend on what version of that X you fill in.
- 33:08On some views of actual attainment,
- 33:10does the embryo actually have it?
- 33:12On some views of capacity X, there is a
- 33:15difference between fetuses and embryos.
- 33:16On the flip side,
- 33:18on potentiality views the contrast,
- 33:20and by contrast the pictures
- 33:22a lot less clear.
- 33:23As Cohen puts it,
- 33:24an early embryo is on this view,
- 33:26a potential human being.
- 33:27And will the normal course of
- 33:29events grow into an actional 1?
- 33:31And that's why we give it a rights claim.
- 33:34That puts a lot of pressure
- 33:35on what we mean by the quote,
- 33:37UN quote normal course of events.
- 33:39It also puts pressure on the
- 33:41question of whether the early
- 33:43embryo becomes the person it
- 33:46ultimately develops into or produces.
- 33:48That is,
- 33:49the potential to become versus
- 33:50the potential to produce.
- 33:52Is it more like hydrogen and oxygen that
- 33:55produce water but don't become water?
- 33:58Or is it more like me yesterday and me today?
- 34:01The me yesterday became the me today.
- 34:04Notice this depends on both
- 34:06metaphysical premises,
- 34:07but also factual questions
- 34:08like the polarity of the.
- 34:10Embryo and directions in which it develops.
- 34:12There's a ton more to say about this,
- 34:14but I want to make sure
- 34:15to be respectful at time,
- 34:16so I'm going to stop here
- 34:17just with the idea as to why,
- 34:19as a normative matter,
- 34:20questions about embryo destruction and
- 34:22their relation to abortion are very complex.
- 34:24Thank you very much.
- 34:27Thank you so much, Glenn.
- 34:29And and I apologize to everybody
- 34:31involved in this talk that I've
- 34:32brought together these four wonderful
- 34:34scholars and then limited them so
- 34:36significantly in the time that they had.
- 34:38But I do appreciate the the
- 34:41efforts to stick with the time
- 34:43and the conversation thus far.
- 34:44Now the third speaker this evening
- 34:46will be Doctor Sarah Hull.
- 34:48Sarah is a board certified cardiologist
- 34:50and echocardiographer here at Yale
- 34:51and a well known educator here.
- 34:53Yeah, she's also an associate director
- 34:55of our program for biomedical.
- 34:57Ethics Sarah, guys on AB from Harvard
- 35:00University and Biochemical Sciences,
- 35:02a masters degree in bioethics from
- 35:04the University of Pennsylvania,
- 35:05where she also received her MD and
- 35:08did her internship and residency,
- 35:09and Sarah did her fellowship in
- 35:11Cardiology here at Yale and Seller.
- 35:13Sarah is a highly respected and beloved
- 35:16educator here at the medical school,
- 35:18and we're very pleased to hear
- 35:19your take on this doctor hall.
- 35:23Thank you so much, Mark,
- 35:24and thank you as well to Katie and Glenn
- 35:27for your really insightful comments.
- 35:30I'm the the last comments about the
- 35:32the potential personhood claims
- 35:34of the fetus are are going to be
- 35:36a really nice launching point I
- 35:38think as as I shift gears to talking
- 35:40more about medical ethics and also
- 35:43delve into a little bit of of moral
- 35:46philosophy and anthropology with
- 35:48respect to moral claims that that on
- 35:51personhood that the fetus may have.
- 35:54I don't have any.
- 35:57Conflicts of interest to disclose.
- 35:59But I will start by outlining pretty
- 36:02clearly what I I intend to argue
- 36:05with my portion of this panel.
- 36:07Which is to say that political or
- 36:10governmental restriction of access to
- 36:12evidence based reproductive healthcare,
- 36:14including abortion,
- 36:15is unethical for several reasons.
- 36:17Because it violates the autonomy
- 36:19of pregnant persons,
- 36:20because it exposes women to harm,
- 36:22and because it exacerbates
- 36:25systemic inequity and injustice.
- 36:27So, but before I go there,
- 36:29I I do think it's really important
- 36:31for us to discuss the moral status
- 36:33of the fetus because that that is for
- 36:35many a salient considerations in this debate,
- 36:37although I will argue that it actually is,
- 36:40it should not be the central consideration.
- 36:42But I think we we need to address
- 36:44it because it is very important
- 36:46with respect to how we think about
- 36:48ethical health policy.
- 36:49So.
- 36:50While it is of course the easiest
- 36:54to argue that personhood begins
- 36:57at a clearly demarcated line,
- 36:59such as conception or fertilization,
- 37:01or at the moment of birth,
- 37:04I think this really oversimplifies
- 37:06what for many people is a much
- 37:08more complex reality,
- 37:09which is to say that there's a
- 37:11lot of Gray zone and continuum
- 37:14in between those two points,
- 37:16and and many people don't necessarily
- 37:18ascribe to one of those two moments.
- 37:21As a moment where there's a clear line
- 37:24between complete absence of personhood
- 37:26and full conferral of personhood,
- 37:29and I think if we interrogate
- 37:31our moral intuition,
- 37:31we can really help to to put put words
- 37:34and and a more concrete understanding
- 37:36of of what I'm trying to say.
- 37:38So let's say that that you
- 37:40are on a sinking ship,
- 37:41it's sinking very fast and it's a long ship,
- 37:44and at one end you have a frozen test
- 37:47tube with five fertilized embryos in it,
- 37:50and at the other end you have
- 37:52a one month old.
- 37:53Baby,
- 37:53I think I would be hard pressed to
- 37:56believe that anybody on this call
- 37:58would hesitate to save the baby if if
- 38:00you only have time to save one of them,
- 38:03you don't have time to save both
- 38:04and get on that on a lifeboat
- 38:06before the ship sinks.
- 38:07I think,
- 38:07I think everybody would save the
- 38:09one month old baby before they
- 38:10saved the fertilized embryos.
- 38:11Because we intuitively we know that
- 38:14that that baby has more of a claim
- 38:18to personhood than those embryos do.
- 38:20Although at the same time
- 38:22I think that if there
- 38:23were no baby. There and there were
- 38:24just a test tube full of embryos.
- 38:26I don't think many people would would say,
- 38:29Oh well that's just, that's just debris.
- 38:32Just like you know this this flag on the
- 38:34ship and you can just let it go down.
- 38:36I I think that that many people
- 38:38would make a good faith effort to
- 38:40to to take that test tube if it
- 38:43were possible to do so and not,
- 38:45not compromise the survival of
- 38:48for example that that hypothetical
- 38:51one month old baby and so again.
- 38:53I I think that if we interrogate
- 38:55our moral intuition,
- 38:56we can understand that there there's
- 38:58some sort of middle ground between
- 39:00absence of personhood and full
- 39:02personhood for many that that an embryo
- 39:04or a fetus can can lay claim to.
- 39:07And I actually find the concept
- 39:10of liminality,
- 39:11as described by the anthropologist
- 39:13Victor Turner,
- 39:13is really helpful to sort of understand
- 39:16how how we might think about this,
- 39:19this sort of Gray zone or this
- 39:21in between state, or,
- 39:21as Victor Turner would say,
- 39:22a liminal state or transitional.
- 39:24State between absence of personhood
- 39:26and full personhood,
- 39:27the concept of liminality is
- 39:29often applied to rights of passage
- 39:31during adolescence.
- 39:32So, for example,
- 39:33an adolescent is really neither
- 39:36a child nor an adult,
- 39:38and while we legally decide that
- 39:41at age 18 we confer a legal status
- 39:44of adulthood onto people,
- 39:47we know that it's that.
- 39:48Actually, it's not a neat,
- 39:49discrete line before which someone is
- 39:51not an adult and after which someone.
- 39:54Someone is an adult.
- 39:55But in fact that the the status of
- 40:00adulthood is is really something
- 40:02that's achieved gradually over time.
- 40:03And there's no one discrete time
- 40:05point at which you can say someone
- 40:07is or is not an adult.
- 40:08And I think the same is true for many
- 40:11individuals when they think about
- 40:13how normatively they would approach
- 40:15the question of of fetal personhood.
- 40:19I think, again,
- 40:20we can look at our moral intuition to
- 40:23to sort of confirm this by considering.
- 40:26How?
- 40:26How?
- 40:27The loss of an intended pregnancy
- 40:30would affect people at different stages.
- 40:33So for example,
- 40:34the loss of a the miscarriage of a
- 40:38seven week embryo is certainly very sad.
- 40:41Whereas the miscarriage of a 5
- 40:43month old fetus for whom many
- 40:45people may have chosen a name,
- 40:47started decorating of a babies room,
- 40:50that's really a tragedy.
- 40:51And then if you compare that
- 40:53to the death of a 2 year old.
- 40:55Child who has a name,
- 40:57who has relationships with other people?
- 40:59That's a devastating life changing event,
- 41:02and I think it's really disingenuous
- 41:04to pretend that all of those things
- 41:06are morally equivalent because
- 41:08all of them have the same claim to
- 41:10personhood I I think that's not
- 41:12actually what what most most or
- 41:15certainly many people would believe.
- 41:17I would also note that we typically
- 41:19place very high symbolic value on
- 41:21a person's date of birth rather
- 41:23than a person's date of conception.
- 41:26And that's really a defining
- 41:27aspect of our personhood.
- 41:28You know, if you look someone
- 41:29up in their Wikipedia article,
- 41:31it says when they were born,
- 41:32the date of birth is what
- 41:33we use on legal documents.
- 41:35We celebrate each other's
- 41:37birthdays culturally.
- 41:38And so it it at least again seems
- 41:41reasonable that in in many ways we sort
- 41:44of tacitly understand that that full
- 41:46personhood is conferred upon birth.
- 41:49But that's not to negate the
- 41:50fact that there may be some
- 41:52partial or incomplete claims,
- 41:54or or liminal.
- 41:55Names, as it were to to personhood
- 41:59after conception but before birth.
- 42:01I I think more importantly,
- 42:04as has been stated earlier,
- 42:06this is really a metaphysical
- 42:08question that that is predicated on
- 42:11individual values and belief systems,
- 42:13and science alone cannot actually
- 42:16decide what the personhood
- 42:17of an embryo or a fetus is.
- 42:19And furthermore,
- 42:20it's unlikely that we will ever
- 42:22really achieve a robust consensus
- 42:24in our pluralistic society and.
- 42:26If we really need to draw a line,
- 42:28then we should leave that to the
- 42:31individual pregnant person who
- 42:32is carrying that embryo or fetus,
- 42:34and leave it to that person to
- 42:36decide when when full personhood
- 42:39is conferred upon that fetus.
- 42:42I will also just note from a just to
- 42:45provide some data that 93% of abortions,
- 42:49according to the CDC this is from 2019.
- 42:5293% of abortions occur at
- 42:53less than 13 weeks gestation,
- 42:55and only and under 1% occur after 20 weeks.
- 42:58So for for people who do
- 43:01ascribe or agree with,
- 43:03ascribe to,
- 43:03or agree with this concept of sort of
- 43:06a gradual accumulation of personhood
- 43:08claims as the embryo and fetus develops,
- 43:11it's worth noting that the vast majority of.
- 43:13Of elective terminations of pregnancy
- 43:16or or abortions occur in the embryonic
- 43:20or very early fetal stages of development.
- 43:23So if I'm arguing that we really
- 43:25shouldn't use the moral claims of a
- 43:28fetus to personhood as a basis for
- 43:30public policy in a pluralistic society,
- 43:33because it's a metaphysical
- 43:34and very personal question,
- 43:36what should we base ethical
- 43:38public health policy on?
- 43:40And the first concept is,
- 43:42is of course the concept of autonomy,
- 43:43which has been mentioned by by my
- 43:46colleagues or alternate or as I would
- 43:48define that and as many would define
- 43:50it as an individual moral agents,
- 43:52right?
- 43:53To self-determination or self governance
- 43:56and as autonomous moral agents,
- 43:58women should maintain the right
- 44:00to determine how their bodies
- 44:02may or may not be used.
- 44:04Full stop.
- 44:06Similarly if if again we take an
- 44:08example to to help illustrate this,
- 44:10if if I am a bone marrow match
- 44:13for my sister who has a terrible
- 44:16hematologic malignancy that
- 44:17is severely limiting her life
- 44:19expectancy and she's not expected
- 44:22to live more than a few months.
- 44:24Unless I donate my bone marrow and
- 44:26there are no other matches out there,
- 44:28it's me or it's no one.
- 44:30I don't think anybody would argue
- 44:33that I should be compelled by the
- 44:35law to donate my bone marrow to
- 44:38her. Now, many people would argue that
- 44:39that would be the right thing to do,
- 44:40that the most ethical thing to do
- 44:42would be to to donate my bone marrow,
- 44:45and that it would be to use to use
- 44:47some moral philosophy terminology.
- 44:49It would be supererogatory,
- 44:50or it would be a good thing to do,
- 44:52but it would not be obligatory.
- 44:54Or my legal or ethical duty
- 44:56to do that no matter what.
- 44:59And certainly, even if you think
- 45:01that ethically it should be my duty,
- 45:02most people would not argue that legally
- 45:04we should compel people to donate their
- 45:06bone marrow or to donate a kidney,
- 45:07for example,
- 45:08to individuals who who may need them,
- 45:11even if there's no other no other
- 45:14available donor that can be identified.
- 45:16And similarly,
- 45:17we can no more compel women to carry an
- 45:20unwanted pregnancy by the same reasoning.
- 45:24Another important ethical consideration
- 45:25upon which I think we should base sound
- 45:28and ethical public health policy is,
- 45:30of course the concept of of beneficence
- 45:33and the and the and the similar
- 45:35concept of of harm reduction.
- 45:38And again, it's it's worth noting that
- 45:40abortion is an essential component of
- 45:43evidence based reproductive healthcare.
- 45:45And in fact I I really take
- 45:47issue with the term pro-life,
- 45:49as it's often used as a euphemism
- 45:52for pro forced birth.
- 45:54Because if your policy actually
- 45:56is forcing gestation and birth,
- 45:58that's actually an often an
- 45:59anti life policy with respect
- 46:01to the pregnant person herself.
- 46:02Pregnancy carries several non negligible
- 46:05risks of morbidity and mortality
- 46:07even in otherwise healthy women,
- 46:09and these include massive hemorrhage,
- 46:11gestational diabetes,
- 46:12eclampsia,
- 46:12which is a condition characterized by
- 46:15dangerously high blood pressure and seizures,
- 46:17stroke, sepsis and pulmonary embolism
- 46:19which is a blood clot in the lungs,
- 46:22the risk of domestic violence.
- 46:24Also escalates during pregnancy,
- 46:25so it can be a safety concern
- 46:28even beyond a medical concern.
- 46:29And according to the CDC,
- 46:32in 2020 the maternal mortality rate was
- 46:3524 deaths per per 100,000 live births,
- 46:39compared with only .4 deaths
- 46:41per 100,000 abortions.
- 46:43So that's a 60 fold difference in the
- 46:46mortality risk between an abortion and
- 46:49carrying a pregnancy to term and and
- 46:52delivering that that pregnancy and so.
- 46:55Again,
- 46:55forcing women to stay pregnant and to
- 46:59deliver a child is is most certainly
- 47:03putting her at the risk of additional harm.
- 47:06In addition,
- 47:07there are certain pre-existing
- 47:09conditions that increase the
- 47:10risk of pregnancy substantially,
- 47:12in particular cardiac disease.
- 47:13The American College of Cardiology
- 47:15states that cardiovascular disease is
- 47:17the leading cause of maternal mortality
- 47:20and there are certain conditions such
- 47:22as severe pulmonary hypertension that
- 47:24can carry a combined maternal and
- 47:26fetal mortality rate approaching 50%.
- 47:28And actually it's recommended
- 47:30as part of the standard of care
- 47:34to Council consideration of
- 47:35pregnancy termination for patients.
- 47:37With these conditions,
- 47:39who who become pregnant?
- 47:40Furthermore,
- 47:41the development of certain conditions
- 47:43can pit the survival of the fetus
- 47:46against the survival of the mother.
- 47:48So,
- 47:48for example,
- 47:49let's take a young woman who
- 47:51recently discovers that she's
- 47:53pregnant and also is at the same
- 47:55time diagnosed with an aggressive
- 47:57form of breast cancer for which
- 48:00chemotherapy is recommended without
- 48:02undue delay in order to maximize
- 48:05their chances of survival without.
- 48:07Which she would likely have a
- 48:10much higher chance of of death.
- 48:12Most chemotherapy is absolutely
- 48:13incompatible with the development of
- 48:15a fetus because it's very cytotoxic,
- 48:17particularly deadly to dividing cells,
- 48:20which is of course exactly what
- 48:21an embryo and fetus do.
- 48:23And so by by restricting access
- 48:26to pregnancy termination you're
- 48:28basically telling this patient
- 48:30that she cannot undergo the the
- 48:32evidence based treatment she needs
- 48:34for her life threatening condition,
- 48:36but instead she must.
- 48:38Serve as a vessel for for the
- 48:41fetus that she is carrying,
- 48:43even though it may very well be that
- 48:45that child will grow up without a mother,
- 48:47and not to mention other
- 48:49children and other people,
- 48:51other dependents that this person might have.
- 48:54And accordingly, many medical societies
- 48:57have made statements either expressing
- 49:00concern about the Dobbs decision or very
- 49:02explicit support of abortion rights,
- 49:04underscoring the primacy of
- 49:06the health of pregnant persons.
- 49:08And these include the
- 49:09American Medical Association,
- 49:10the American College of Physicians,
- 49:12the American College of
- 49:14Obstetricians and Gynecologists,
- 49:15the American Academy of Family Physicians,
- 49:17the American Academy of Pediatrics,
- 49:19the American Psychiatric Association,
- 49:21the American College of Cardiology,
- 49:23and the American Society
- 49:24of Clinical Oncology.
- 49:25So while the moral status of a fetus
- 49:27may be a metaphysical question upon
- 49:29which we may never achieve consensus,
- 49:32there's a very clear consensus
- 49:33in the medical profession that
- 49:35pregnancy is a potentially high
- 49:37risk condition and restricting
- 49:39access to evidence based healthcare,
- 49:41including abortion,
- 49:42is unethical and because it is
- 49:44harmful to women.
- 49:49I'm going to quote from the American
- 49:51Medical Association statement because it
- 49:53provides a very nice segue to the last
- 49:55consideration that I'd like to discuss,
- 49:57which is the consideration of of justice.
- 49:59So I quote from the AMA statement.
- 50:02From June 24th, access to legal
- 50:03reproductive care will be limited to
- 50:05those with the sufficient resources,
- 50:07circumstances, and financial means to do so,
- 50:10exacerbating health inequities by placing
- 50:12the heaviest burden on patients from Black,
- 50:14Latinx, indigenous, low income, rural.
- 50:17And other historically disadvantaged
- 50:19communities who already face
- 50:21numerous structural and systemic
- 50:23barriers to accessing healthcare.
- 50:24So again, to be clear,
- 50:26women we know that women of color
- 50:28and low socioeconomic status are
- 50:30disproportionately affected by
- 50:31restrictions on abortion access,
- 50:32and they also already face higher
- 50:34risks of pregnancy related morbidity
- 50:36and mortality due to structural racism
- 50:38and social determinants of health.
- 50:40For example,
- 50:41the risk of pregnancy related death
- 50:42is 3 to four times higher for black
- 50:44women than it is for white women
- 50:46in the United States and in 2020,
- 50:49the CDC estimated the maternal
- 50:51mortality rate for black women
- 50:53at 55 deaths per 100,000.
- 50:56Live births.
- 50:57Interestingly,
- 50:58this is because,
- 51:00again,
- 51:01I think in recent years we've begun
- 51:03to understand that differences
- 51:04in socioeconomic status do not
- 51:07explain away racial inequities,
- 51:08and that structural racism persists
- 51:11regardless of socioeconomic status.
- 51:13Even when that's corrected.
- 51:14And many may remember when Serena Williams
- 51:17was pregnant and delivered her child,
- 51:20she had a pulmonary embolism and
- 51:22she knew something was wrong.
- 51:24She urged her healthcare providers.
- 51:28To look into this further because she was
- 51:30concerned she had a pulmonary embolism
- 51:32and she was dismissed as as a quote crazy.
- 51:35And so even for someone as as famous
- 51:38and well respected as Serena Williams,
- 51:41this is still a problem if black
- 51:43women are are not believed and are
- 51:45are taken less seriously when they
- 51:46express concerns about their health.
- 51:50Furthermore, restrictions on abortion
- 51:52access again don't eliminate abortion,
- 51:55they just eliminate safe abortions
- 51:58for already vulnerable populations.
- 52:00Again, according to the American College
- 52:03of Obstetricians and Gynecologists I quote,
- 52:05approximately 21 million women
- 52:06around the world obtain unsafe,
- 52:08illegal abortions each year,
- 52:10and complications from these unsafe
- 52:12procedures account for approximately
- 52:1313% of all maternal deaths,
- 52:15nearly 50,000 annually.
- 52:17Now, I will note that there are some
- 52:20concerns from disability advocates.
- 52:23I apologize for the scratching of my dog.
- 52:24In the background,
- 52:26there are some legitimate concerns
- 52:28from disability advocates that overly
- 52:30permissive abortion laws promote a
- 52:31form may promote a form of eugenics by
- 52:35selectively terminating pregnancies
- 52:36with significant fetal abnormalities.
- 52:37But I should note that this criticism
- 52:40actually ignores the fact that
- 52:42some people with disabilities,
- 52:44when they are adults themselves,
- 52:46may be at increased risk of pregnancy.
- 52:48Related morbidity or mortality if
- 52:49they were to be forced to carry
- 52:52a pregnancy to turn,
- 52:53and limiting abortion access may
- 52:55therefore actually harm these disabled
- 52:57people disproportionately as adults as well.
- 53:00And so,
- 53:00while I understand that there
- 53:02there is a legitimate concern from
- 53:05these disability advocates,
- 53:06I would argue that the answer is not
- 53:08to force women to carry to term and
- 53:10deliver pregnancies when they do not
- 53:11believe that they and their families
- 53:13can adequately care for the baby,
- 53:15but rather to reshape policy
- 53:16such that families.
- 53:18Feel that they can better care for children,
- 53:20and some of this might look like
- 53:22universal maternity and paternity leave,
- 53:24universally available childcare that's
- 53:25commensurate with the needs of children,
- 53:28particularly when these
- 53:29children have disabilities.
- 53:31Better investment in infrastructure such
- 53:33as public schools and public safety.
- 53:37And so, in summary,
- 53:38the moral status of the fetus
- 53:40cannot be resolved by science,
- 53:42and it may not be reasonable to expect
- 53:44a consensus in a pluralistic society.
- 53:46So we should allow individuals to
- 53:48to decide for themselves rather than
- 53:50force our personal beliefs onto others.
- 53:52Women are autonomous moral agents,
- 53:54and decisions about healthcare and
- 53:56their bodies should be between them
- 53:58and their healthcare providers.
- 53:59Pregnancy and childbirth may
- 54:00expose women to harm.
- 54:02The can sometimes only be mitigated
- 54:04by the termination of pregnancy
- 54:06restrictions to access to evidence.
- 54:08Excuse me?
- 54:09Restrictions on access to evidence
- 54:11based reproductive healthcare,
- 54:12including abortion,
- 54:14exacerbate already unjust health disparities.
- 54:17And finally,
- 54:17ethical health policy should have
- 54:19the dual aims of ensuring patient
- 54:21autonomy and access to evidence.
- 54:23These standards of care,
- 54:25including abortion,
- 54:25and also to improving health systems
- 54:28to reduce unintended pregnancies
- 54:29and to reduce barriers to providing
- 54:31adequate care to children.
- 54:33Thank you.
- 54:36Thank you very much, Doctor Hall.
- 54:39And to remind you folks,
- 54:41we will have some time at the end to
- 54:43if you'd like to add some questions
- 54:45through the Q&A function on on zoom.
- 54:47But we have one more speaker this evening
- 54:49who is a Professor Jennifer Hurt.
- 54:51Jennifer Hurd is the Gilbert L
- 54:53Stark professor of Christian ethics
- 54:55at the Yale Divinity School.
- 54:56She's also a former president of
- 54:58the Society of Christian Ethics
- 54:59and she serves on the editorial
- 55:01boards of the Journal of Religion,
- 55:02Journal of Religious Ethics and Studies.
- 55:05In Christian ethics,
- 55:07professor Hurt received her
- 55:10bachelor's degree from Oberlin
- 55:11College in Religion and Biology,
- 55:14a master's degree from Princeton University,
- 55:16and a PhD in religion from
- 55:19Princeton University.
- 55:20Welcome, doctor herdon.
- 55:21Thank you so much for joining us.
- 55:23Thank you very much, Mark.
- 55:24And it's really a pleasure
- 55:26to join this panel.
- 55:27But I'd like to add this afternoon
- 55:29is a religious ethical lens on
- 55:30this conversation with the view
- 55:32of shedding light on how Christian
- 55:34stances and to a lesser extent.
- 55:36Jewish stances on abortion
- 55:38have become so polarized.
- 55:40Why pay attention to this history?
- 55:42Well, for one thing,
- 55:44because Jewish and Christian perspectives
- 55:45have been central to the formation
- 55:47of the Western legal tradition,
- 55:49and also because self identified Christians
- 55:51still make up 63% of the US population.
- 55:55Furthermore,
- 55:55the decades long activism of
- 55:57certain Christian groups,
- 55:59notably Roman Catholics in a
- 56:01coalition with evangelicals powered
- 56:03the overturning of Roe V Wade,
- 56:05and often this anti abortion stance
- 56:07is regarded as the Christian view.
- 56:10But in fact Christians and official
- 56:12church bodies today have widely varying
- 56:14views on the ethics of abortion,
- 56:17ranging from the United Church
- 56:18of Christ on the on one end of
- 56:20the spectrum with a full throated
- 56:22support for abortion rights through
- 56:24total condemnation of abortion.
- 56:26And among Jews as well, views are divided.
- 56:28There are some Orthodox Jews today who
- 56:30do regard abortion as tantamount to murder.
- 56:33But many Orthodox Jews
- 56:35support abortion rights,
- 56:37and overall,
- 56:3888% of American Jews support
- 56:40strong abortion rights.
- 56:41And in fact have brought recently
- 56:44and groups have brought religious
- 56:46liberty lawsuits claiming that a
- 56:48right to abortion is necessary to
- 56:51protect their religious free exercise.
- 56:53But overall,
- 56:54there's a greater polarization of views,
- 56:56and particularly here among Christians,
- 56:58than it perhaps at any other
- 57:00time in the past.
- 57:02From early on in their history,
- 57:03Judaism and Christianity have
- 57:05had a pronatalist stance,
- 57:07and is rooted in Genesis,
- 57:09in the command to be fruitful and multiply.
- 57:12So large families were associated
- 57:14with prosperity and blessing,
- 57:16and this was joined together with a strong
- 57:19concern for the lives of the vulnerable.
- 57:22So the Hebrew prophets proclaiming the
- 57:26the call made on persons by widows,
- 57:31orphans,
- 57:31the poor.
- 57:32And we see that being extended
- 57:34to other vulnerable life,
- 57:36for example in early Christian efforts
- 57:39to save inference from infanticide,
- 57:41which was legal under Roman law,
- 57:43and Christian efforts to set up
- 57:46orphanages for abandoned children.
- 57:48So how did these views as concern
- 57:51for and vulnerable life play out
- 57:55in relationship to abortion?
- 57:57Well, in the Hebrew Bible,
- 57:58the penalty for injuring a pregnant woman
- 58:01and causing a stillbirth was a fine.
- 58:04But if the woman died,
- 58:06the penalty was a life for a life.
- 58:08In other words,
- 58:09abortion was an offense,
- 58:11but it wasn't an offense that was
- 58:13seen as on the order of murder and
- 58:16only ever seen as acquiring the full
- 58:19moral standing of a born human being.
- 58:22It was common among Jewish thinkers
- 58:25to distinguish different stages based
- 58:27on how fully formed the fetus was,
- 58:29with moral standing increasing
- 58:32as pregnancy progressed.
- 58:34Abortion was not considered more
- 58:36ethically insignificant at any stage though,
- 58:38and rabbinic Judaism prohibited
- 58:40most abortions except to save the
- 58:43life and health of the mother.
- 58:45Within pre modern Christianity,
- 58:47fetal life was similarly it was
- 58:49widely taken to have moral standing
- 58:51comparable to a born human being,
- 58:53but only after a particular stage,
- 58:56and typically this was associated
- 58:58with quickening quickening usually
- 58:59in the 4th or 5th month when the
- 59:02woman can first feel the movement.
- 59:04Of the fetus.
- 59:05In medieval theology this was
- 59:07associated with ensoulment.
- 59:09That meant that it was associated with
- 59:12the dualistic metaphysics in which
- 59:14the soul was implanted in the body at
- 59:16that particular moment of development.
- 59:18And prior to this,
- 59:19the fetus was seen as part of the mother,
- 59:21not seen as a separate human being.
- 59:24So penalties for abortions that that were
- 59:27procured after quickening were more severe,
- 59:30and we can see very similar things in most
- 59:33of them thinkers with different stages.
- 59:35That had to do with perception
- 59:37of how developed the fetus was.
- 59:40Abortion to save the life of the
- 59:42mother was accepted at whatever stage,
- 59:44and there were both pharmaceutical
- 59:46and surgical procedures that were
- 59:49discussed in medical and theological
- 59:51texts as necessary and as justified
- 59:54under such circumstances.
- 59:56But that raises a question,
- 59:57of course.
- 59:57If a P, if if a fetus post quickening has
- 01:00:01the moral standing of a born human being,
- 01:00:03how could its killing be justified?
- 01:00:06Well, killing in war was justified
- 01:00:09within the tradition,
- 01:00:11so the prohibition on killing was a
- 01:00:14prohibition of killing of innocent life.
- 01:00:16Of course,
- 01:00:16a fetus would seem to be innocent life,
- 01:00:19but the argument is that a fetus
- 01:00:22whose existence threatens the life
- 01:00:23of the mother is akin to an insane
- 01:00:26person charging with a lethal weapon.
- 01:00:28That is,
- 01:00:29the fetus or the insane person
- 01:00:31attacking is subjectively innocent,
- 01:00:34but is objectively an aggressor.
- 01:00:36And the aggressor may be killed if
- 01:00:38that's the only way to protect the
- 01:00:40life of the one being threatened.
- 01:00:42And that is the traditional ground
- 01:00:43for the argument for abortion,
- 01:00:45to save the life of the mother and is
- 01:00:47found across multiple religious traditions.
- 01:00:50So there was concern for
- 01:00:52vulnerable fetal life,
- 01:00:53particularly after quickening or
- 01:00:55after some stage of development.
- 01:00:58But concern for fetal life was never only,
- 01:01:00never.
- 01:01:01The whole picture,
- 01:01:02just as significant in shaping
- 01:01:04attitudes to abortion, was a concern.
- 01:01:07The control over women's sexuality and a
- 01:01:09concern for assurance of male lineage.
- 01:01:12Women were thought to seek
- 01:01:14abortions in order to conceal non
- 01:01:16or extramarital sexual activity.
- 01:01:18And of course that was true given
- 01:01:20to the harsh treatment of women
- 01:01:21who engaged in such activity,
- 01:01:23whether or not it was by choice.
- 01:01:26So condemnation of abortion by
- 01:01:29these religious traditions was
- 01:01:31part of a patriarchal system of
- 01:01:34male control over women's bodies.
- 01:01:36Speciality.
- 01:01:39Now,
- 01:01:39there are several important
- 01:01:40shifts in attitudes to abortion
- 01:01:42and illegal status of abortion
- 01:01:43or the over the course of U.S.
- 01:01:44history.
- 01:01:45And I have to skip over all of that
- 01:01:48except to note that as fetal under
- 01:01:50fetal development was understood,
- 01:01:52more and more quickening
- 01:01:54was no longer seen as a
- 01:01:55particularly relevant ethical,
- 01:01:57ethical dividing line.
- 01:02:00So if we go to the mid 1960s and we see that,
- 01:02:04well, in the early 1960s abortion
- 01:02:06was prohibited in those states except
- 01:02:08to save the life of the mother.
- 01:02:10But in the mid 1960s this starts to change.
- 01:02:12In tandem with the women's movement and
- 01:02:15changing attitudes towards towards sexuality.
- 01:02:17Women were of course seeking
- 01:02:19social and legal equality,
- 01:02:21seeking autonomy, making decisions.
- 01:02:23And what decisions were more intimate and
- 01:02:26weighty than those concerning pregnancy?
- 01:02:28Who was better situated to
- 01:02:30determine whether a pregnancy?
- 01:02:31Posed a threat to a woman's life and health
- 01:02:34that the pregnant persons themselves,
- 01:02:37and this allowed for the consideration
- 01:02:40of all of the circumstances
- 01:02:42involved as casuistry in these
- 01:02:45religious traditions required.
- 01:02:47Well, what really sparked the Roman
- 01:02:50Catholic movement against these liberalized
- 01:02:52abortion laws was contraception.
- 01:02:54The birth control pill was introduced
- 01:02:56in 1960, it was extremely popular,
- 01:02:58and it generated fears among Catholic
- 01:03:00authorities that it would encourage.
- 01:03:02Sexual activity outside of wedlock.
- 01:03:05Mainline Protestants,
- 01:03:05in the other hand,
- 01:03:07embraced it as enabling family planning.
- 01:03:10In this social context of
- 01:03:12liberalizing attitudes towards
- 01:03:13sexual activity and expression,
- 01:03:14Catholic activists had much greater
- 01:03:17success mobilizing the faithful against
- 01:03:20abortion than against contraception.
- 01:03:23Sensitized concern for vulnerable
- 01:03:25and dependent fetal life,
- 01:03:26deeply embedded in the tradition proved to
- 01:03:29be a strong force for mobilization mainline.
- 01:03:32Partisans,
- 01:03:33in contrast,
- 01:03:34deeply committed to women's equality and
- 01:03:37autonomy and embracing contraception,
- 01:03:39focus their attention on these goods.
- 01:03:41And we're increasingly inclined to downplay
- 01:03:43the moral significance of fetal life,
- 01:03:45regardless of its point of development.
- 01:03:48Catholic leaders focus very heavily
- 01:03:50on the rural claim of fetal life,
- 01:03:52and we're increasingly inclined to down.
- 01:03:56Play the anguish and justice is
- 01:03:58produced by a system in which
- 01:03:59abortions were safe and available
- 01:04:01only for the wealthy and educated.
- 01:04:03Evangelical Protestants,
- 01:04:04meanwhile,
- 01:04:04were initially immobilized by
- 01:04:06a completely different issue,
- 01:04:08the issue of the freedom of Christian
- 01:04:10schools from governmental interference,
- 01:04:12which we are now recognizing to have
- 01:04:14been linked with a racist desire
- 01:04:17to preserve whites only education.
- 01:04:19But evangelicals, too,
- 01:04:21became eager to defend fetal life,
- 01:04:25and this was.
- 01:04:26Tightly yoked to their anxiety
- 01:04:29over sexuality.
- 01:04:30So on both sides I think we can
- 01:04:32see that there was a failure to
- 01:04:34address in a concerted way the
- 01:04:36primary reasons that women seek
- 01:04:38and have throughout human history.
- 01:04:42Lack of better affordable,
- 01:04:44readily available means of
- 01:04:46avoiding pregnancy and lack of
- 01:04:49resources and social support for
- 01:04:51giving birth and raising a child.
- 01:04:54Talk of choice hides the fact
- 01:04:55that for many poor women,
- 01:04:57choices are extraordinarily
- 01:04:58burdened and constrained.
- 01:05:00Given the lack of support for bringing
- 01:05:02a pregnancy to term and raising a child.
- 01:05:05This is true around the world.
- 01:05:07According to the Guttmacher Institute,
- 01:05:08abortion rates are actually highest
- 01:05:10in countries where access to
- 01:05:12abortion is restricted.
- 01:05:14In countries that restrict abortion,
- 01:05:16the percentage of unintended
- 01:05:17pregnancies and ending an abortion has
- 01:05:20increased during the past 30 years,
- 01:05:22from 36% in 1990 to 94 to
- 01:05:2550% in 2015 to 2019.
- 01:05:29Here in the US, the states in which
- 01:05:31abortion is now illegal are the states in
- 01:05:34which care for maternal health is weakest,
- 01:05:36and this should be a scandal for those
- 01:05:39promoting a consistent ethic of life.
- 01:05:42As Catholic ethicist Christina
- 01:05:44Traina has recently written,
- 01:05:45neither making abortion legal nor
- 01:05:48making it illegal addresses the
- 01:05:50conditions that create the desire
- 01:05:52for abortion in the 1st place.
- 01:05:55Bans will worsen those conditions.
- 01:05:58What of the rights that never materialized
- 01:06:01for robust maternal healthcare,
- 01:06:02indeed for universal and comprehensive
- 01:06:04healthcare and adequate social support,
- 01:06:07including decent wages, childcare,
- 01:06:09housing and job training?
- 01:06:12Talk of choice is cheap,
- 01:06:13and the kind of support that
- 01:06:16would truly support substantial
- 01:06:17freedom of choice for all,
- 01:06:18regardless of income level and
- 01:06:21racialization may be costly,
- 01:06:22but it enables a society worth living in.
- 01:06:26And this is, I think,
- 01:06:27what those loyal to biblical traditions
- 01:06:30of concern for the most vulnerable
- 01:06:32ought to be focusing on right now.
- 01:06:34Thank you.
- 01:06:39Thank you so much, Professor Hurton.
- 01:06:41Thanks to all our speakers.
- 01:06:42So I'm going to open it up now
- 01:06:45to questions through the Q&A.
- 01:06:47Please type them in.
- 01:06:48I'm going to take the prerogative of of
- 01:06:50the moderators prerogative asking the
- 01:06:52first question and I'll open this up to,
- 01:06:54to any of our speakers.
- 01:06:55So these were wonderful presentations
- 01:06:57and and I'm truly grateful.
- 01:06:59One of the things about the presentation
- 01:07:02that interested me was the question
- 01:07:03of whether one should seek to
- 01:07:05draw the line and how that line
- 01:07:07should be drawn in the whole first.
- 01:07:08It starts right with Katie's.
- 01:07:10The very first thing about Justice
- 01:07:12Roberts question about do we have
- 01:07:13something other than viability to go for.
- 01:07:15So an interesting detail which
- 01:07:17which I think a lot of folks on the
- 01:07:20call may know but many may not,
- 01:07:21is that the age of viability,
- 01:07:25if you will,
- 01:07:26has been often referred to it 20 as 24 weeks,
- 01:07:29even now as as recently as a few years ago,
- 01:07:31two or three years ago,
- 01:07:32I taught a class and a colleague that
- 01:07:34told the students that viability is
- 01:07:3624 weeks to which I had to attend say,
- 01:07:38well, the legislature.
- 01:07:39Just to decide when abortion is legal
- 01:07:42or when abortion becomes illegal,
- 01:07:44but they don't.
- 01:07:44The legislation doesn't really
- 01:07:46decide when viability occurs.
- 01:07:47And the reality is that that for
- 01:07:49there are places that are very
- 01:07:50aggressive at trying to save a
- 01:07:52child at 22 weeks or a fetus at
- 01:07:5422 weeks or newborn at 22 weeks.
- 01:07:56I should stay and and somewhere
- 01:07:58between 1/3 to 1/2 of those newborns
- 01:08:00that weren't at 22 completed weeks
- 01:08:03survive and and certain centers.
- 01:08:06And there are certainly many
- 01:08:07survivors at 22 weeks here and
- 01:08:09and at least half or more.
- 01:08:10And half of those born at 23
- 01:08:12weeks if active resuscitation
- 01:08:14is attempted can survive.
- 01:08:16So viability and Katie you pointed
- 01:08:17this out early on is that that of
- 01:08:19course you know Roe V Wade was a
- 01:08:21long time ago and and so that that
- 01:08:23the technology has changed but
- 01:08:25where to draw the line and how to
- 01:08:27draw the line is an interesting
- 01:08:28one and if we if we look at the
- 01:08:31gradualist approach to this in terms
- 01:08:32of a moral status and if moral
- 01:08:33status increases over the course
- 01:08:35of gestation nevertheless and Glenn
- 01:08:37I think it was you forgive me if I
- 01:08:39if it was someone else who raised.
- 01:08:41Judith Jarvis Thompson's argument
- 01:08:42about the violinist on her scenario
- 01:08:45about the violinist.
- 01:08:46And the point being that even the
- 01:08:48violinist who we would all agree
- 01:08:50has full moral status.
- 01:08:51Nevertheless,
- 01:08:51it seems wrong to require that
- 01:08:54person who finds himself tethered
- 01:08:55to the violinist to remain in bed
- 01:08:58for however long it needs to keep
- 01:09:00the violinist alive.
- 01:09:01And it's an interesting thought experiment,
- 01:09:03and one that's obviously caught the
- 01:09:05imagination of people who study
- 01:09:07these things for decades now.
- 01:09:09So I guess my question to the group.
- 01:09:11What I'm leading up to is at what point
- 01:09:15do you feel abortion should be permitted?
- 01:09:19And this is one of the questions that
- 01:09:22actually came came through to me.
- 01:09:24From a colleague from my cell phone is that.
- 01:09:28Is it? Should abortion be
- 01:09:29permitted at 38 weeks? At 22 weeks?
- 01:09:32Is there is can any of you see a
- 01:09:35line where it should in fact be
- 01:09:37permitted legally or or ethically?
- 01:09:40Or should it be permitted
- 01:09:41throughout gestation?
- 01:09:45I'll open up to anybody who wants to jump in.
- 01:09:47Does someone want to say where the
- 01:09:49line we used to say the lines at
- 01:09:5124 weeks and and I think that is
- 01:09:53still the case in Connecticut and
- 01:09:55maybe I'll start.
- 01:09:56So I'll start by saying that you'll
- 01:09:57find very few bioethics and lawyers
- 01:09:59that like the viability line.
- 01:10:00They they liked it since that all their
- 01:10:02lines might have been worse in terms of
- 01:10:04what was likely to be replaced by it.
- 01:10:05And I think Justice Alito's opinion,
- 01:10:07you know, has some choice words
- 01:10:08for it and there's lots of parts of
- 01:10:10his opinion that I disagree with.
- 01:10:11But this is one place where I think
- 01:10:13he's being somewhat fair myself.
- 01:10:15Like viability,
- 01:10:15I think one of the questions is whether
- 01:10:18the line ought to be one about time at all.
- 01:10:20Right.
- 01:10:20There are multiple lines you
- 01:10:21could think about when we look
- 01:10:23comparatively across the world, right.
- 01:10:25There are places where instead of shoot,
- 01:10:27you know, it's a combination of timing,
- 01:10:29but it's also about reasons, right?
- 01:10:32That and review and procedures.
- 01:10:34This idea that if we had a very
- 01:10:37expansive conception of the health of
- 01:10:39the mother that included mental health,
- 01:10:41one might be willing to kind of
- 01:10:43consider a line that's different.
- 01:10:45The absolutist position,
- 01:10:46which I do associate with Judith
- 01:10:48Jarvis Thompson, you know,
- 01:10:50essentially the idea that while
- 01:10:52you have a right to,
- 01:10:54an absolute right to unplug
- 01:10:55at any point of development,
- 01:10:56because the development is irrelevant
- 01:10:58in terms of the personhood of
- 01:11:00the individual or conceding the
- 01:11:02person or the individual,
- 01:11:03and we're talking about unplugging.
- 01:11:05I tend to think of that particular view,
- 01:11:08while kind of very principled,
- 01:11:09is not one that you find of very,
- 01:11:12very many people pushing forward,
- 01:11:14whether that's a political judgment.
- 01:11:16Ethical judgment, I think,
- 01:11:17is an open question,
- 01:11:18but I'm curious other people.
- 01:11:21Thank you. Let me share some of the
- 01:11:24questions that have come through here
- 01:11:25and some of these are, oh, please,
- 01:11:27I just want to piggyback on that, if I may.
- 01:11:29You know, I think I think that's
- 01:11:31a an issue that's raised a lot to
- 01:11:34sort of make abortion perhaps much
- 01:11:36murkier than than it usually is.
- 01:11:39And that's why I actually cited the
- 01:11:41statistics the the fact that under 1% of
- 01:11:44abortions happen beyond 20 weeks gestation.
- 01:11:48And so, you know,
- 01:11:50we talking about viability, you know,
- 01:11:52the the vast majority are going to be.
- 01:11:54Almost certainly pre viable and
- 01:11:57it's it's my understanding.
- 01:11:59Although you know,
- 01:12:00I would love input from our our our
- 01:12:04gynecology and obstetrician colleagues.
- 01:12:07My understanding is that most of
- 01:12:09the abortions that happen after that
- 01:12:12point are not just oopsie Daisy,
- 01:12:14I changed my mind.
- 01:12:15I don't want to have a baby anymore.
- 01:12:17These these are these happen
- 01:12:19because of really devastating fetal
- 01:12:21abnormalities that are discovered that
- 01:12:23are either incompatible with life.
- 01:12:25Or incompatible with any life other
- 01:12:28than a short life of of certain
- 01:12:31suffering and not not extended
- 01:12:34viability after birth or again,
- 01:12:37like a significant threat to
- 01:12:38the health of the mother.
- 01:12:40But of note,
- 01:12:41if if a pregnancy is desired and the
- 01:12:43health of the mother is compromised.
- 01:12:45And again, I I want to be clear.
- 01:12:47I'm not an obstetrician or gynecologist,
- 01:12:48so I I would love clarification
- 01:12:50from my colleagues,
- 01:12:51but my understanding is that if if a
- 01:12:52fetus is clearly beyond the point of
- 01:12:54viability and the pregnancy is very
- 01:12:56threatening to the health of the mother.
- 01:12:58Then the then the choice doesn't
- 01:13:00become either abortion or carry the
- 01:13:02pregnancy the term that the choices
- 01:13:04well do do we undergo expectant
- 01:13:06management or do we deliver early
- 01:13:08and manage because you know the fetus
- 01:13:11is is viable and even though we we
- 01:13:14we would love to keep in in utero
- 01:13:16for longer to ensure development
- 01:13:18we're going to give steroids and
- 01:13:20surfactant for lung development.
- 01:13:21And again Mark you probably can speak
- 01:13:23more intelligently about this than I
- 01:13:25can as a neonatologist but you know
- 01:13:27we're we're going to do the best we can.
- 01:13:28And so it's so just this idea that
- 01:13:31there again we we love to hear
- 01:13:33about this from abortion opponents,
- 01:13:35all these stories of, you know,
- 01:13:37again, partial birth abortion,
- 01:13:38which is not a medical term,
- 01:13:39that's not clear what that even means.
- 01:13:41But the fact is that the vast majority
- 01:13:44of abortions happen well before that
- 01:13:46that that blur of viability because
- 01:13:49it isn't a line, as you pointed out.
- 01:13:52And the ones that do happen late
- 01:13:54usually are because that that fetus
- 01:13:57is is not going to have.
- 01:13:59A very good chance at at anything
- 01:14:01resembling what most people would would
- 01:14:03call a a life without abject suffering.
- 01:14:06Or again,
- 01:14:06the pregnancy is terminated early
- 01:14:08because of severe threat to the mother.
- 01:14:10But usually in those cases they try
- 01:14:11to save the the fetus if if possible.
- 01:14:14So I, I, I,
- 01:14:15I welcome input from neonatology
- 01:14:16and guinot colleagues,
- 01:14:18but I just think that's a
- 01:14:19really important distinction.
- 01:14:20It's not that people are,
- 01:14:21you know, at 8 months pregnant
- 01:14:22all the time just deciding, oops.
- 01:14:23I yeah. I don't want to kid.
- 01:14:24I'm just going to,
- 01:14:25I'm just going to have an abortion.
- 01:14:26That's I don't think that
- 01:14:27really reflects reality.
- 01:14:30Thank you. Thank you.
- 01:14:30Let me see if I can get you a couple
- 01:14:32of questions in here if I could.
- 01:14:34And some of them are specifically legal
- 01:14:36questions and I because I wanted us to
- 01:14:39focus more on the ethical issues here.
- 01:14:41But there is one legal question
- 01:14:42that I will ask here because I
- 01:14:44think it's worth asking here.
- 01:14:46What's directed for to attorney Kraschel?
- 01:14:50Does Connecticut's law protecting
- 01:14:53physicians also explicitly protect APRN,
- 01:14:55PA's and midwives?
- 01:14:58Yes, it protects the licensed medical
- 01:15:00professionals providing healthcare
- 01:15:02that's legal in Connecticut.
- 01:15:05I will just say, however,
- 01:15:07that it is the shield laws that are in place.
- 01:15:11There's a lot to play out in
- 01:15:13the legal landscape to see how
- 01:15:15strong those Shields will be.
- 01:15:16I would not advise that.
- 01:15:17I think that the shield laws are bulletproof.
- 01:15:20They are states doing the best to
- 01:15:22protect the providers and the people
- 01:15:24seeking abortion care in those states.
- 01:15:26I think they're important.
- 01:15:28Laws that have been passed and put in place.
- 01:15:31And I'm proud of the fact that
- 01:15:33Connecticut was the first to do it.
- 01:15:35But I would just caution that there is.
- 01:15:38There are a lot of unknown legal questions
- 01:15:40that are probably going to arise when states,
- 01:15:43for example,
- 01:15:44start to refuse to honor us.
- 01:15:47You know,
- 01:15:48a request from another state to issue
- 01:15:50a subpoena through their usual legal
- 01:15:53infrastructure in a given state.
- 01:15:55Thank you. Thanks, Katie.
- 01:15:57Here's the question, please.
- 01:15:58Thinking about forced gestation,
- 01:16:00embryo destruction,
- 01:16:01abortion from a rights perspective,
- 01:16:03while some views more strongly
- 01:16:06favored some and more weakly others,
- 01:16:08can't we argue that all of these are
- 01:16:10rooted in the right to decide the
- 01:16:12number and spacing of your offspring?
- 01:16:14Admittedly, this neglects the argument
- 01:16:16of bioethical issue of life of the fetus.
- 01:16:19But we can currently.
- 01:16:21We can currently take Thompson's
- 01:16:23argument that the life of
- 01:16:25the fetus does not matter.
- 01:16:27Additionally,
- 01:16:27this right is still separate
- 01:16:29from the legal right.
- 01:16:31Umm.
- 01:16:34Maybe I'll say a word or two about
- 01:16:35about that right, which this is a
- 01:16:37little bit where I said about the
- 01:16:38second premise of the argument, right,
- 01:16:40that the idea of abortion is gestation,
- 01:16:43the right not to gestate is a
- 01:16:45very strong right we all have.
- 01:16:47And Professor Hall,
- 01:16:49Dr Hall mentioned this with the
- 01:16:51example of force bone marrow
- 01:16:53transplant or blood transfusion.
- 01:16:55We tend to think we have very strong
- 01:16:58rights over our body and in some ways
- 01:17:00the rights being asserted by people
- 01:17:02who are who want to restrict abortion.
- 01:17:04Is kind of on the same terrain.
- 01:17:06And one can say,
- 01:17:07even if I believe that fetuses have a
- 01:17:09very strong rights claim to be protected,
- 01:17:12here's this other rights claim that
- 01:17:13also sounds in bodily autonomy,
- 01:17:15and thus the conflict is kind
- 01:17:16of you have to choose one.
- 01:17:18By contrast,
- 01:17:18when you talk about something like
- 01:17:20a right to control the number of
- 01:17:22offspring and spacing ones offspring,
- 01:17:23for example,
- 01:17:24these are also real rights claim.
- 01:17:26It just seems to me they're
- 01:17:28defeasibility conditions,
- 01:17:28so when they get trumped and when they
- 01:17:31get overwhelmed comes much sooner than
- 01:17:33when we're talking about a right to control.
- 01:17:35One's body,
- 01:17:36and I think this is most apparent
- 01:17:37from people who've analogized,
- 01:17:39writes about abortion to 13th Amendment,
- 01:17:42anti slavery, rights of to say,
- 01:17:43to describe what it is to be a gestating
- 01:17:46person against one's will as akin to slavery.
- 01:17:49It's just a much stronger, in my view,
- 01:17:51rights claim to say that I have a right.
- 01:17:53If I have any rights in the world,
- 01:17:55it is the right not to
- 01:17:56have that happen to me.
- 01:17:58Whereas a right to space out your children.
- 01:18:00There's all sorts of ways in which
- 01:18:01the law does restrict that or at
- 01:18:04least doesn't support that right.
- 01:18:05Whether it's the weak coverage we
- 01:18:07have for in vitro fertilization,
- 01:18:08whether it's social support for parents,
- 01:18:11those are all positive liberty
- 01:18:12versions of the right.
- 01:18:13But just to say,
- 01:18:14even if that's a real right,
- 01:18:15it's not clear that's a right
- 01:18:17that's good enough to overcome,
- 01:18:18a right to protect the fetus for somebody
- 01:18:20who believes the fetus is a person.
- 01:18:22Thank you. Thank you.
- 01:18:23And if I, if I might also just add
- 01:18:25on top of that too is that to the
- 01:18:27extent there is a constitutionally
- 01:18:28protected right to parenting decisions
- 01:18:30found in the US Constitution,
- 01:18:32it's also, you know,
- 01:18:34I think most scholars would agree and.
- 01:18:36Their Supreme Court is that it's
- 01:18:38in the substantive due process
- 01:18:39of the 14th amendment.
- 01:18:40So that's in that sort of bundle of
- 01:18:44rights that I would say, you know,
- 01:18:46it becomes sort of disfavored rights
- 01:18:49perhaps as in the wake of the decision in
- 01:18:53which the court took apart one of them.
- 01:18:56And as Professor Cohen mentioned,
- 01:18:59Justice Thomas would suggest we
- 01:19:00should apply that same reasoning to
- 01:19:03other substantive due process rights.
- 01:19:05So even if we found.
- 01:19:07That that right existed under
- 01:19:09the US Constitution.
- 01:19:10Today,
- 01:19:11I would query whether or not it would
- 01:19:14withstand a similar analysis by this court.
- 01:19:19Thank you. Here's a note from one
- 01:19:20of our our maternal fetal medicine
- 01:19:22colleagues which is worth mentioning.
- 01:19:24Please just want to clarify the
- 01:19:27chemotherapy point we give chemotherapy
- 01:19:29and pregnancy and many cancer
- 01:19:31chemotherapies are not considered
- 01:19:33incompatible with supporting the pregnancy.
- 01:19:35We need to make sure we get
- 01:19:37that point correct.
- 01:19:37So Sarah, I I think the point you
- 01:19:39were making stands but but this
- 01:19:41nevertheless is we we don't we we
- 01:19:43want to make sure that people for
- 01:19:45example might be pregnant and also
- 01:19:47have cancer understand that that
- 01:19:49chemotherapy is not incompatible.
- 01:19:50Necessarily with pregnancy,
- 01:19:52with supporting a pregnancy and.
- 01:19:55For that clarification.
- 01:19:57This question is directed to you,
- 01:20:00Professor Cohen's parent's parents
- 01:20:01have a legal responsibility
- 01:20:03to care for their children.
- 01:20:05Does that responsibly extend
- 01:20:06to a fetus and why or why not?
- 01:20:10Yeah, so let me say two
- 01:20:12things that one is to say,
- 01:20:13and this is now an interesting
- 01:20:15discourse within people who who do this,
- 01:20:17who are philosophically interested.
- 01:20:18One of the big critiques of Judith
- 01:20:21Jarvis Thompson is that it posits
- 01:20:23the relationship of a stranger to
- 01:20:25another stranger as opposed to the
- 01:20:27relationship of a person to a life
- 01:20:29that they have fostered and created.
- 01:20:30So there's definitely a strand of
- 01:20:32critique of the Thompson style argument
- 01:20:34that says it's not just a random
- 01:20:36person who's your human dialysis
- 01:20:38machine or a long lost relative.
- 01:20:40Who needs a blood transfusion?
- 01:20:42It is a life that you brought into being
- 01:20:44and put in this potential to be harmed,
- 01:20:47and maybe that increases it.
- 01:20:49As a second thing I want to
- 01:20:50say is that the legal matter,
- 01:20:51one of things very interesting
- 01:20:52is that states that have adopted
- 01:20:54personhood language are now facing
- 01:20:55all sorts of interesting questions.
- 01:20:57So Georgia, for example,
- 01:20:59is giving a tax credit for dependencies
- 01:21:01for state law purposes to fetuses.
- 01:21:04And in Texas,
- 01:21:05I believe there was somebody
- 01:21:06that sounds silly to say it,
- 01:21:07but there was somebody who basically
- 01:21:09claimed that they had a right to be in the.
- 01:21:10High occupancy vehicle lane because
- 01:21:13they were pregnant, right.
- 01:21:15So there were two people in the car.
- 01:21:16So once you start recognizing the
- 01:21:18personhood of of embryos or fetuses for the
- 01:21:21purpose of trying to get out of abortion,
- 01:21:23restrict abortion,
- 01:21:24suddenly you have a long list of laws.
- 01:21:27You have to ask how does it apply here?
- 01:21:29And the one that I think is the most
- 01:21:30kind of potent and this is something
- 01:21:32that show good one among others have
- 01:21:34written about is child endangerment
- 01:21:35laws and how ingesting drugs,
- 01:21:37for example, relates to that.
- 01:21:38So that's an area that we've
- 01:21:39had a lot of conflict.
- 01:21:40Already,
- 01:21:41and I imagine we'll see more
- 01:21:42conflict going forward.
- 01:21:44Thank you. Thank you, Glenn.
- 01:21:45It's worth pointing out,
- 01:21:46which I think is is known to most
- 01:21:48or all people, just to remind us
- 01:21:50that that in terms of the analogy,
- 01:21:53no doubts the special relationships
- 01:21:55carry with them special obligations.
- 01:21:57But but it's also known,
- 01:21:58I think that everybody on this
- 01:22:00call that not every pregnancy is
- 01:22:02the result of a voluntary act.
- 01:22:04And that's probably perhaps relevant
- 01:22:06to the conversation as well.
- 01:22:07Another one of my maternal fetal
- 01:22:09medicine colleagues wants you to know,
- 01:22:10Sarah, that you are correct.
- 01:22:13Most late abortions are due to fetal
- 01:22:15abnormality. From maternal risk.
- 01:22:17Umm.
- 01:22:21And another OB colleague wants us to
- 01:22:23know that the majority of abortions
- 01:22:25are done for social reasons,
- 01:22:26not due to severe fetal anomalies or threat
- 01:22:29to the mother, even those after 20 weeks.
- 01:22:32So there appears to be a difference
- 01:22:35of opinion perhaps on that. Here is a.
- 01:22:42Can you discuss the ethical dilemmas
- 01:22:44of physicians in restrictive
- 01:22:45states where they cannot practice
- 01:22:47medicine the way they were trained?
- 01:22:49Now being unable to refer or
- 01:22:51perform abortions in women
- 01:22:53who need one for physical,
- 01:22:54mental or psychosocial reasons?
- 01:22:56Does anybody want to address?
- 01:22:59Obviously this is a I mean,
- 01:23:01this is a huge question,
- 01:23:02but the ethical dilemmas faced by physicians
- 01:23:04where there are legal restrictions?
- 01:23:06That prevent them from practicing in
- 01:23:08a way that they feel is appropriate.
- 01:23:11So I I can take that.
- 01:23:13Umm so you know, I I I think it's it's a
- 01:23:17it's a huge ethical dilemma because as
- 01:23:19as I've hopefully persuaded most people,
- 01:23:22restricting access to evidence
- 01:23:25based healthcare causes patient
- 01:23:27harm and violates patient autonomy.
- 01:23:29And so telling physicians that or
- 01:23:33other healthcare providers that
- 01:23:34they cannot provide evidence based
- 01:23:36healthcare that honors their patients
- 01:23:38wishes with respect to what they
- 01:23:40will or will not do with their own.
- 01:23:42Bodies is is really a violation of of
- 01:23:44some of our core duties as physicians
- 01:23:47and other healthcare providers.
- 01:23:49And there have been some calls for civil
- 01:23:53disobedience on an organized scale.
- 01:23:56Actually.
- 01:23:56That is to say that medical
- 01:23:59societies should work to provide
- 01:24:01legal cover for physicians in those
- 01:24:04states to provide services that are
- 01:24:07medically and ethically warranted
- 01:24:09even though they are illegal and.
- 01:24:12And to provide a robust enough
- 01:24:16protection with the idea being that if
- 01:24:19there's organized civil disobedience
- 01:24:22amongst an entire profession that
- 01:24:24it's really going to be impossible to
- 01:24:26operationalize laws because you can't put,
- 01:24:28you know,
- 01:24:29you can't put half of your state
- 01:24:31physicians in jail for half of your
- 01:24:33states OBGYN's in jail, for example.
- 01:24:35It's it's not as applicable
- 01:24:36to all physicians, obviously.
- 01:24:37You know, I as a cardiologist,
- 01:24:40I do not know how to provide
- 01:24:41that kind of care.
- 01:24:42Although there are,
- 01:24:43there are many cardiologists,
- 01:24:45particularly those who who specialize
- 01:24:46in the in the care of in the
- 01:24:49cardiac care of pregnant women,
- 01:24:50who who do often find themselves in the
- 01:24:52role of needing to counsel patients.
- 01:24:53And so maybe it's even, you know,
- 01:24:56if it's illegal to even counsel
- 01:24:58patients about pregnancy termination.
- 01:25:00Maybe that's an act of civil
- 01:25:01disobedience that they have to undergo,
- 01:25:03that they have to undertake.
- 01:25:04Excuse me,
- 01:25:05but I think it's also important
- 01:25:06to understand that, of course,
- 01:25:08these duties don't exist in a vacuum,
- 01:25:09and physicians are often the primary
- 01:25:11breadwinners for their families.
- 01:25:12And, you know, it's it's easy to just say,
- 01:25:15yeah, well,
- 01:25:15you just have to do the right thing.
- 01:25:16And and you know,
- 01:25:18if that means that you're fined or or
- 01:25:20you go to jail, well, then so be it.
- 01:25:22That's that's what you have to do.
- 01:25:24Well, you know,
- 01:25:24if you're the primary provider
- 01:25:26for your family as well,
- 01:25:27you also have very important obligations to,
- 01:25:29to your children and to your family and
- 01:25:30to other people dependent upon you.
- 01:25:32So.
- 01:25:32So I don't think that gives us carte
- 01:25:34blanche necessarily to tell physicians
- 01:25:36that they they have to disobey the law.
- 01:25:38But I do think there is a strong
- 01:25:40argument to be made for that.
- 01:25:41I think it does have to be done systemically.
- 01:25:43An organized way rather than than
- 01:25:46rogue individuals necessarily making
- 01:25:48making decisions because I think it
- 01:25:50will be much more powerful that way there.
- 01:25:53There's also,
- 01:25:53there have also been interesting calls
- 01:25:56for we talk about conscientious objection,
- 01:25:58but sort of the the OR basically
- 01:26:01saying I'm not going to provide this
- 01:26:03service because it goes
- 01:26:05against my conscience.
- 01:26:06The idea of conscientious
- 01:26:07provision or to say actually it is,
- 01:26:09it goes against my conscience not to provide
- 01:26:11this care and even though it's illegal.
- 01:26:13I want to be protected under a
- 01:26:15conscientious provision clause,
- 01:26:16much like they're conscientious
- 01:26:17objection clauses,
- 01:26:18so that those are, I think,
- 01:26:20some of the salient ethical dilemmas for
- 01:26:22physicians and other healthcare providers.
- 01:26:25And I I'm interested to see how
- 01:26:27that evolves as as we see these,
- 01:26:30these laws become implemented.
- 01:26:35Professor hurt, one for you.
- 01:26:38How would you respond to someone who said,
- 01:26:43for religious reasons, I believe,
- 01:26:46that a fetus is absolutely the moral
- 01:26:50equivalent to whether it's in solomont,
- 01:26:53whether it's a you know?
- 01:26:56Whether whether it's from scripture
- 01:26:58based or otherwise or or tradition based,
- 01:27:02I believe that this fetus.
- 01:27:05Is the same thing as a 2 month old baby.
- 01:27:09And therefore, not only would I not have
- 01:27:13an abortion myself because it would be
- 01:27:15the same as killing my 2 month old child,
- 01:27:18but I also think that it's my duty,
- 01:27:20my religious duty.
- 01:27:23To fight those who would make that happen.
- 01:27:27Umm.
- 01:27:28If if you were confronted by that
- 01:27:30question by someone,
- 01:27:31how would might you respond?
- 01:27:35You're muted. You're muted, gentlemen.
- 01:27:37Thank you. It's not a
- 01:27:38theoretical question. Obviously.
- 01:27:39That's a view that's pretty widely held.
- 01:27:43So I think in part I want to under
- 01:27:48score that that the traditions that
- 01:27:50they themselves are are embracing has
- 01:27:53always left room for regarding the
- 01:27:56fetus as an subjectively innocent,
- 01:27:59but objectively.
- 01:28:02Guilty aggressor whose life can be
- 01:28:05ended just like any other aggressor.
- 01:28:08When when life is under threat,
- 01:28:10and in that sense,
- 01:28:12even consistent with regarding
- 01:28:13the fetus as a full person there,
- 01:28:16there is room for there ought to be room
- 01:28:19for legal abortion in certain circumstances.
- 01:28:22Now that, of course,
- 01:28:24would provide a very limited justification,
- 01:28:27but I'm also inviting people of
- 01:28:29faith to delve deeper into their
- 01:28:32traditions and to recognize that.
- 01:28:34There's been shifts in views
- 01:28:36over time in terms of when we
- 01:28:39understand what what sort of moral,
- 01:28:42moral stratus we give to
- 01:28:44developing human life.
- 01:28:46And it's not that there is
- 01:28:48a traditional view on this,
- 01:28:49which is the current absolutist position,
- 01:28:52but it's much more complicated.
- 01:28:54And in fact,
- 01:28:55it may be much closer to something
- 01:28:57like some of the other views that
- 01:29:00were put out today about, say,
- 01:29:02something like a the the 14 day.
- 01:29:04View, perhaps,
- 01:29:05of where we say that there are
- 01:29:08points at which we could say
- 01:29:10it's not clear that what we have
- 01:29:12here is a human individual,
- 01:29:14and that we might want to say
- 01:29:17that either the notion that you
- 01:29:18want is either a person or not
- 01:29:21a person is too crude a moral
- 01:29:22distinction for us to be working by.
- 01:29:26Thank you very much professor
- 01:29:28Hurt and Doctor Hall and Attorney
- 01:29:31Kraschel and Professor Cohen.
- 01:29:33I thank the four of you very
- 01:29:35much for your time tonight.
- 01:29:36This was I've gotten so many
- 01:29:38compliments in my through my my
- 01:29:39texts on my phone and on the Q&A
- 01:29:41that that this was a wonderful
- 01:29:43presentation by all four of you.
- 01:29:45I thank you so much.
- 01:29:46I thank you all for joining us and we
- 01:29:48have another session coming up in a
- 01:29:50couple weeks with a crew from Saint
- 01:29:52Justine and Montreal talking about
- 01:29:54how we follow pre term babies so.
- 01:29:57Something different to him.
- 01:29:58We'll be reaching out to you about that soon.
- 01:30:00Again, thank you to our speakers
- 01:30:01and thank you all for joining us.
- 01:30:03And I wish you all a good night.