Bioethical Aspects of Abortion and Abortion Law
September 08, 2022Bioethical Aspects of Abortion and Abortion Law
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Information
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.