Science in Christian Perspective

Abortion:

An Exercise in Biomedical Ethics

D. GARETH JONES

Department of Anatomy and Human Biology
University of Western Australia
Nedlands, Australia

From: JASA 34 December 1982): 6-17.

Induced abortion is one of the most provocative ethical issues facing human beings. It elicits extreme responses,  engenders passionately emotional reactions, raises perplexing philosophical and biological questions, places upon the medical profession the mantle of social control, and presents many ordinary people with one of the most pressing and pervasive of human, dilemmas. The planned destruction of human life, for that is what the artificial termination of pregnancy amounts to, brings us face to face with the meaning and finiteness of human existence; it forces us to examine the control we exert over future human lives and the reasons for bringing yet-to-be-born beings into existence.  When used as a means of genetic control, induced abortion highlights the sometimes conflicting interests of biological quality and human concern, aspirations after ideal human traits and valiant struggles against appalling deficits.

Fetal Development: Biological Considerations

Following fertilization of the egg by a sperm in one of the embryo of this age as having unquestionably human
uterine tubes, cell division begins. After four or five days the fertilized egg is known as a blastocyst and arrives in the body of the uterus. Here it floats in the uterine cavity for a short time before implanting in the wall of the uterus. Im plantation begins at about six days and is completed by ten days. During this period the cells divide steadily so that by the completion of implantation the blastocyst consists of around 150 cells. 

Following implantation, the outer layer of the blastocyst 

mation of the placenta. A small proportion of the inner 
layer develops into the embryo, which is taken as the period 

of gestation between two and eight weeks after fertilization.



The first days of gestation are hazardous ones. Some 10% of fertilized ova fail to implant; of those which do so and become embryos, about 50% are spontaneously aborted, usually without the woman realizing what has happened. These early spontaneous abortions are generally  due to abnormalities of either the embryo or its protective and nutritive surrounding structures. For instance, 5 - 10% of fertilized ova have chromosomal abnormalities, as against 0.5% of newborn children. As a result, 90 -95% of all conceptions with these abnormalities are rejected as ear ly spontaneous abortions.¹

 Eight weeks marks the end of the embryonic and the  beginning of the fetal period. It corresponds to a stage of development when all essential internal and external struc tures are present in rudimentary form. The heart of the em bryo is beating and the nervous system shows the beginn ings of reflex responses to tactile stimuli. Fingers and toes are clearly defined; the head is fairly rounded and erect, but is still disproportionately large. The neck region has become established and the eyelids are becoming more obvious. The length of the embryo/fetus at eight weeks is ap proximately 3 cm, and embryologists usually describe an embryo of this age as having unquestionably human characteristics.²            

By the tenth week the face of the fetus has a human appearance, and the genitalia have incompletely formed male or female characteristics. Bone and cartilage are recognizable by the twelfth week and a heartbeat can be  detected. By the sixteenth week the eyelids, nose, mouth, Ups, ears, fingers and toes are fully formed, and the skeleton shows clearly on X-ray films. Between seventeen and twenty weeks growth slows down, and fetal movements undergoes a series of changes which culminate in the for- (quickening) are commonly recognized by the mother. Eye brows and head hair are visible at the end of this period. The period between twenty-one and twenty-five weeks is  characterized by a substantial weight gain, and the body is better proportioned than previously.

From twenty-six weeks onwards a fetus is considered potentially viable. This means a fetus can survive if born prematurely, although the mortality rate is high because of respiratory difficulties. Survival is possible at this age because the central nervous system has matured sufficiently to control rhythmic breathing and body temperature.

Fetal Development: Ethical Considerations

Basic to all arguments on abortion is the status of the fetus-as a human being or a person. These terms tend to be used more or less interchangeably, the presupposition being that once a fetus can be classed as a human being or person it is eligible to the protection normally afforded human beings or persons.

I shall assume that fetuses are human beings, in that they are genetically part of the species, Homo sapiens. The issue then becomes whether a fetus at a particular stage of development is a person, in the sense that it has as strong a claim to life as a normal adult human being. Such a claim to life entails the claim to be nurtured, as well as the claim not to be killed.³

A frequent framework within which this debate is carried out is to consider the options provided by prominent embryological landmarks. The question asked in this instance is: "When does the fetus become a person?" The possibilities opened up by this approach are: (1) conception; (2) implantation at six to ten days; (3) the transition from embryo to fetus at eight weeks; (4) quickening at approximately twenty weeks; (5) viability at around twenty-six weeks; (6) birth; (7) a year or so after birth.

Whichever of these options is adopted, the fetus is regarded as a non-person prior to a particular stage of development and fully personal following it. A line is drawn at some stage during development, this stage serving as a transition between two quite different preceding and subsequent states. This transitional stage, wherever it is drawn for whatever reasons, has enormous repercussions for ethical concepts as well as for legal and social attitudes. Taken together, these options constitute the critical stage approach to an assessment of fetal status.

Prior to the critical stage, the fetus has no claim to life. With its onset, however, it acquires a claim to life virtually as strong as that of an adult human. Regardless of when the critical stage is placed, therefore, considerable moral weight is placed on it. Consequently, the criteria used to determine the critical stage become central to the debate.

An alternative approach is to regard the fetus as a potential person. According to the potentiality principle: "If, in the normal course of its development, a being will acquire a person's claim to life, then by virtue of that fact it already has some claim to life.⁴ I In terms of this principle, a potential person is an existing being which, while not yet a person, will become an actual person during the normal course of its development. A human fetus is a potential person, in contradistinction to an actual person (a normal adult human being), or a being with a capacity for personhood (a temporarily unconscious person), or a possible person (a human sperm or egg) or a future person (a person in a future generation).

 I shall assume that fetuses are human beings, in that they are genetically part of the species, Homo sapiens. The issue then becomes whether a  fetus at a particular stage of development is a Person.

The potentiality principle asserts that potential persons, such as fetuses, have a claim to life, whereas possible persons cannot exercise such a claim. Furthermore, it accords full personhood to those with a capacity for personhood. On the other hand, the claim to life of a potential person may be weaker than that of an actual person.

The potentiality principle takes seriously the continuum of biological development, and refuses to draw an arbitrary line to denote the acquisition of personhood. At all stages of development the fetus is on its way to personhood and, if everything proceeds normally, it will one day attain in its own right full personhood. The fetus is regarded as part of a continuing process, the end-result of which is the emergence of an individual human being characterized by human personhood.

Inherent in a potential person is a high probability of future personhood. With this goes a claim to life and respect, a claim that in very general terms may be proportional to its stage of fetal development. The claim is always present but, just as the probability of an older fetus becoming an actual person is much greater than that of a zygote becoming a person, it becomes stronger with development until at birth "the potential person attains properties and relationships so close to those of actual persons that the consequences of killing at this point are practically the same as killing young persons."⁵

These approaches encompass all attitudes to induced abortion. However diverse attitudes may be, and regardless of whether they have a Christian base or not, they can be analyzed within the various critical stage and potentiality frameworks. The onus on Christian ethicists is to determine which framework (a) is the most compatible with a high view of the fetus; (b) allows the fetus to be viewed alongside the needs of actual persons also involved in decisions regarding the fetus, and (c) has sufficient flexibility be be applicable in a consistent manner in practice.

Of the options presented by a critical stage approach, the two most frequently-held critical stages are conception and birth. Dissimilar as these are, both entail absolutes. The view that the fetus has the status of full personhood from the moment of conception implies absolute protection for the fetus at every stage of its development. By contrast, when birth is equated with the attainment of personhood, the fetus is regarded as an integral part of the mother-entirely dependent upon her in status as well as function. On this view the mother is given an absolute right to decide whether or not she wants the pregnancy to continue; the fetus has no rights or claims of its own and is to be disposed of entirely as the mother pleases.

The purposes God may have for a fetus or adult are regarded as irrelevant 
to humanistic objectives This one-dimensional view of human existence falls far short of the multi-dimensional perspective of humans in the image 
and likeness of God.

The emphases placed upon conception and birth correspond, respectively, to the Roman Catholic and elective abortion positions, perhaps the most influential viewpoints on abortion in developed societies. It is to these I shall first turn.

While conceding that a human fetus is of the species, Homo sapiens, Fletcher contends that the fetus is not a person "since it lacks freedom, self-determination, rationality, the ability to choose either means or ends, and knowledge of its circumstances."⁶ He adopts this position because, in his eyes, the essence of a person is reason, and "humans without some minimum of intelligence or mental capacity are not persons."⁷ More specifically, he considers a score of twenty on the Binet I.Q. scale as a base line for personal status. A fetus cannot meet this test, and hence is not a person. Similarly, a fetus lacks the other traits considered by Fletcher as necessary components of the humanum, including curiosity, affection, self-awareness, self-control, memory, purpose and conscience.

The practical consequences of adopting a non-personal view of the fetus are far-reaching. Fletcher writes: "The ethical principle is that pregnancy when wanted is a healthy process, pregnancy when not wanted is a disease-in fact, a venereal disease. The truly ethical question is not whether we can justify abortion, but whether we can justify compulsory pregnancy."⁸

Somewhat similar arguments are used by Fletcher when discussing infanticide or, as he terms it, postnatal abortion.' Both can be justified if and when the good outweighs the evil, because neither abortion nor infanticide is, as such, immoral. From this it follows that competing values have to be considered, value being assigned to the quality of human life rather than the state of merely being alive.¹⁰ Unfortunately, judgements concerning what is good or evil, and whether continued existence of a deformed or unwanted infant is justified, are relative matters and, in turn, raise ethical dilemmas of untold dimensions.

Fletcher's absolute position blinds him to any appreciation of a fetus' potential for personhood. Since a potential person is not an actual person, it is a non-person. Hence, there is nothing in between a being with rights and a being without rights. For Fletcher, the only test of personhood is rationality; failure to meet up to this test indicates absence of personhood and, one imagines, the forfeiture of a claim to existence.

At no point does Fletcher seek to incorporate within his approach a supernatural dimension. The purposes God may have for a fetus or adult are regarded as irrelevant to his humanistic objectives. His deliberate effort to humanize decision-making is offset by a relative disregard for fetal life, and he fails to justify his fundamental postulate that the essence of a person is reason. This one-dimensional view of human existence falls far short of the multi-dimensional perspective of humans in the image and likeness of God.

Beyond this, it contravenes the essential Christian principles of the dignity and worth of all individuals and potential individuals, because it makes no attempt to balance the claims of different individuals and conflicting interests. It pays no regard to the need to work out what it means to be human in this situation, accepting that whatever the mother desires is automatically granted. Implicit in this response is a denial of the concept of wholeness in the mother's life, and a disregard for the integrity of the family unit and the reciprocity of its members. In claiming to free the mother to be herself, it shackles her to a self-centered existence in which she herself and her own interests become all important to the exclusion both of the legitimate interests of those around her and of the demands of God.

The Roman Catholic position on the inviolability of fetal life began to take definite doctrinal shape in the seventeenth century. Ideas prior to this time are important, however, many of the most influential ideas in Christian circles originating with the Church Fathers, whose concern was with the origin of the soul and its time of union with the body.

Four major ideas stem from the Church Fathers. Traducianism (generationism) is attributed to Tertullian. According to this the soul comes into existence with the body as a biological transmission from Adam via the parents. This fitted in well with the doctrine of inherited original sin. Creationism stemmed from Clement of Alexandria, who held that the soul was immediately and directly created by God in each fetus. A third alternative was that no soul is present in the fetus until the moment of quickening, and among the proponents of this view was Augustine of Hippo. A fourth possibility was put forward in an incidental manner by Gregory of Nyssa, who used the distinction between 'fully' and 'potentially' human; for him, the unformed embryo is a potential human being. A similar position was espoused in the fifth century by a set of writings, the Irish Penitentials. These graded the severity of their penances as follows: "The penance for the destruction of the embryo of a child in the mother's womb, three years on bread and water. The penance for the destruction of flesh and spirit (i.e. the animated fetus) in the womb; to do penance for fourteen years on bread and water."¹¹

This distinction between fetus animatus and fetus inanimatus persisted unbroken in the Roman Catholic tradition until the late nineteenth century. For instance, Thomas Aquinas in the Middle Ages proposed that the soul is created some time after conception. This was the predominant medieval view, which leaned heavily on the Aristotelian tradition of delayed animation. According to this, animation occurs at around forty days gestation in the case of a male fetus and eighty days in a female. For Thomas Aquinas, it is at these times that the soul is 'infused', respectively, into male and female fetuses.

Except for three years between 1588 and 1591, no major shift towards absolute protection for every stage of fetal development occurred in Roman Catholic thinking until 1679. In that year a decree by Pope Innocent XI condemned what he regarded as certain erroneous views on abortion, and in this we may have the seeds of an absolute protection position. However, it was only with decrees of 1884, 1889 and 1902 that absolute prohibitions against the destruction of fetal life under any circumstances were issued by the Roman Catholic hierarchy.

'More recently Pope Pius XI in a 1930 encyclical emphasized the inviolability of fetal life on the grounds that it is equally sacred with the life of the mother. Canon 747 is even more explicit. According to this: "every aborted fetus shall be baptized without any condition, if it is known with certainty that it is alive, no matter at what period of gestation it is aborted. . . The obligation imposed extends to even the smallest fetus, even though it be aborted immediately after conception."" For Roman Catholic moral theologians, to abort a fetus with full knowledge and free consent is to commit murder. This is consistent with the Roman Catholic view that an unborn child is a human person with all the rights of a human person, and this status applies from the moment of conception.

In spite of such assurance on the absolute prohibition of abortion, the Roman Catholic position is not always absolute. The inevitable practical dilemmas associated with abortion are bypassed by distinguishing between direct and indirect abortion. Of these, it is the direct variety that is prohibited, namely, any action having as its primary aim a deliberate attempt to kill the fetus. On the other hand, indirect abortion is allowed. This occurs when an action has the secondary effect of expelling or destroying a fetus, and is justified under the principle of double effect. If, therefore, an action has two effects, one of which is good and intended, and the other evil and unintended, it is justified. The result of this principle is that if an action has the saving of the mother's life as its primary effect, it may be justified even though the death of the fetus may be the secondary effect. In a similar way, Roman Catholic doctors and nurses may participate in abortions if they do so only for a serious reason, such as grave inconvenience to the surgical team or a threat to one's professional future.

The major attraction of the Roman Catholic position for Christians is its high view of human life. It has the strengths of all absolute positions and it places the unborn directly in God's will. In practice, however, issues are often not this simple, and while we may wish to believe that abortion is always morally wrong, dilemmas abound. These are inevitable, and the ethical principles we adopt should be able to accommodate them.

The Roman Catholic position bypasses the dilemmas, and in so doing contorts the absolute nature of its protection of the fetus. It does this, not by appealing to personal responsibility, but by insisting upon rightness or wrongness as intrinsic qualities of certain actions." This vitiates human judgement and makes God's will far more relative than its dogma suggests.

The purported rigidity of Roman Catholic reproductive ethics is based on natural law. A fetus, once conceived, has the right to develop; this is an expression of natural forces and is a duty allotted to the mother by nature. Taken to its logical conclusion, this leaves no room for human responsibility. Instead, the erratic and impersonal forces of the natural environment are allowed sway. This bears little resemblance to the biblical emphasis on the responsibility God has bestowed upon mankind to control his environment.

Inviolability of fetal life: Paul Ramsey

Paul Ramsey is an ethicist of considerable perception, whose views have exerted immense sway in many areas of biomedical ethics. His writings on abortion are scattered and are frequently critiques of the views of other ethicists. It is difficult, therefore, to gain an overall perspective of his position.

An underlying principle for Ramsey appears to be that it is relatively unimportant to establish at what point during gestation a fetus becomes human. The reason for this is that, in Ramsey's words:

The value of a human life is ultimately grounded in the value God 'Is placing on it . . . Human sacredness is not composed by observable degrees of relative worth ... No one is ever much more than a fellow fetus; and in order not to become confused about life's primary value it is best not to concentrate on degrees of relative worth we may later acquire ...¹⁴

Distinctions between humans, pre- and postnatal, are relative. God values all humans, no matter at what stage of development they are.

This argument leads to the inevitable conclusion that, when two lives are in conflict, both are of equal sanctity. Under most circumstances, therefore, Ramsey is driven to adopt the Roman Catholic distinction between direct and indirect abortion, only indirect abortion being permissible. The only exception is when both fetal and maternal lives are in danger. in this instance, he allows for the killing of the fetus. Even here, however, he reiterates that the motives towards both fetal and maternal lives should be identical. This being so, it is not clear what ethical principles he is using to decide in favor of saving the mother's life. Apparently, it is simply that the fetus is aggressing against the mother, and direct abortion is the only available means of saving this life. This argument does not circumvent the difficulty, however, that the fetus is innocent and an innocent life is being taken even if, according to Ramsey, the intention is only the incapacitation of the fetus. It is difficult to escape the conclusion that these are abstract semantics, of little value in practical decision-making in conflict situations.

In further writings Ramsey has been prepared to commit himself to a point at which fetal life should be given protection and accorded the sanctity and dignity of a human person. He opts for the blastocyst stage, arguing that this is the point at which the first origins of individual life can be established. This is the earliest point after conception and prior to birth when, in Ramsey's opinion, an individual human life begins to be inviolate. Before the blastocyst stage it is uncertain whether thee will be twinning, while by the late embryonic stage the major functioning organ systems are established.¹⁵

In taking this stance, Ramsey has much in common with the genetic school although, in practice, he refuses to accept conception as the starting-point of individual human life. In some respects he gives the impression that the precise point is not important. What is important is that the particular point represents the beginning of human life and hence the beginning of the dignity and sanctity of that life with its moral claim to respect and protectability. Ramsey's concern is with the intimate connection between human life and equal worth-the onset of the one inevitably entailing the onset of the other as well.¹⁶

It is significant that no biblical text forbids procuring an abortion ... The Old Testament does not equate the fetus with a living person; it does, however, place great value upon it.

In spite of this, Ramsey places considerable store by the significance of the blastocyst stage as the origin of human life. This enables him to class intrauterine devices and any ,morning after' pills that may be developed as legitimate contraceptives. In no sense are they abortifacients since the pre-blastocyst stages are 'prehuman organic matter'; they represent potential individual human life, thereby for Ramsey removing them from the realm of ethical dilemma.

Ramsey's aim is to define the outer limits of the human community. Having done this, his intent is to see that all members of that community are treated with equal justice; human beings must not be competitively evaluated. All are equal from the blastocyst stage throughout fetal and postnatal life and then through to old age. Against the background of this guiding principle he deprecates the developmental school, which assigns degrees of value to the fetus at different stages of development. For Ramsey there is not a gradation of values; there is equal value or none at all.

Ramsey espouses a form of genetic determinism." The genetic composition of a fetus is, according to his view, definitive of that life, rather than preconditional. for that life. Once a blastocyst is in existence, all considerations other than the survival of that life become irrelevant-with the one exception previously mentioned. That life must continue, because it is equal to all other human lives. No guidance is provided for dealing with the human and social conflicts that sometimes arise, even when those conflicts are of a genetic nature. The existence of a blastocyst predetermines all future actions, even when its effect is to mitigate reconciling therapeutic and compassionate actions. Unfortunately, irremediable conflicts do arise, and an intransigent emphasis on genetic existence may in some instances over-rule profoundly human considerations.

Helmut Thielicke appears to start, like Paul Ramsey, from the premise of the inviolability of fetal life. In The Ethics of Sex he writes: "The genesis of human life is a sacrosanct domain which dare not be invaded by human hands."¹⁸ This follows from the orders of creation and redemption. The 'alien dignity' bestowed upon human beings by God, that is, their value in his sight, commences at the fetal stage. An allied consideration, according to Thielicke, is that once conception has occurred the man and woman involved have become parents. This means that "the office of fatherhood and motherhood has been entrusted to the parents and that they are now enclosed in that circle of duties which obligates them to preserve that which has been committed to them."¹⁹ Parenthood is a gift of God and is not to be lightly spurned. 

Thielicke's emphasis on the inviolable nature of nascent life stems from a biological foundation. In rejecting the older Roman Catholic emphasis on animation, he considers that the fetus throughout its development has "its own autonomous life, which, despite all its reciprocal relationship to the maternal organism, is more than a mere part of this organism and possesses a certain independence."²⁰ This, however, is a precarious foundation on which to build an ethical system, as the fetus is not autonomous in any biological sense-even after viability. Neither, indeed, is the infant or young child autonomous, except in a highly relative sense. More specifically, Thielicke argues that it is the possession of a circulatory system and brain that establish the fetus as a human being. This, as Joseph Fletcher cogently argues, is hardly a satisfactory definition of a human being, and is of no value anyway for the first six weeks of development when they are present only in the most rudimentary of forms.

The fetus, throughout its development, is important. Its potential for personhood marks it off as an entity of significance and potential dignity.

Thielicke's position up to this point has much in common with contemporary Roman Catholic dogma. However, when confronted by the borderline situation of conflict between the lives of mother and fetus, he refuses to follow the inexorable logic of Roman Catholic casuistry. Instead of arguing that the mother's life is of greater value than that of the fetus and that the latter may be indirectly destroyed, Thielicke resorts to the notion that we live in a fallen world. Conflict between one life and another can occur only in a fallen world; it could not have occurred in the original order of creation. What this means is that it is illegitimate to use principles based on the original created order to resolve issues of conflict. What we see in the world as disorder does not reflect God's creatorhood or will, and so we must expect a conflict of values.

For Thielicke there is an incommensurability between God's perfect will and the options and alternatives available to us in decision-making crises in the real, fallen world. We cannot decide with precise theological exactitude what course of action to follow when maternal or fetal life is at stake. The order of creation would, according to Thielicke, demand that nature take its course, and that maternal and/or fetal life be lost. This, however, is inappropriate in a fallen world and a responsible choice has to be made. For Thielicke, theological ethics do not provide a right-wrong answer in such a borderline situation. There is no easy solution, and whatever course of action is takensacrifice of her own life on the mother's part or abortionwill incur guilt. We must live in the light of God's forgiveness and we must exercise our freedom. Thielicke rejects the arbitrary decisions of rigid dogma, contending instead that in these conflict situations we are forced to exercise the costly freedom that is imposed on us "in the twilight zone between creation and Fall."²¹

In the end, therefore, Thielicke allows for abortion in borderline situations admitting that, within his basic affirmation of the sacrosanctity of fetal life, quantitative differentiations have to be made between conflicting lives. Decisions have to be taken; responsible choices must be made. He realises the dangers inherent within such decisionmaking, and yet contends that where conflict exists onerous choices are obligatory.

Thielicke's yearning for maintaining the dignity of human life, including that of the fetus, shines through his writings on abortion. This, taken with his emphasis on the responsible use of decision-making, constitutes an essential base for any approach to therapeutic abortion. Unfortunately, Thielicke's task has been made harder by his somewhat arbitrary decision that all fetal life, irrespective of the stage of gestation, is equally human. Even he appears ultimately, although not explicitly, to soften this by introducing quantitative criteria for deciding on a course of action in conflict situations.

A predominant impression left by Thielicke's handling of abortion is its vagueness. This stems from his inability to come to terms, at a practical level, with the reality that fetal life cannot always be accorded sacrosanct status. Perhaps this, in turn, stems from a fundamental error, namely, that the fetus may not have the status he ascribes to it.

Biblical data directly relevant to abortion are scant, although no biblical passage either speaks of humans possessing personhood before birth or condemns abortion as murder. The passage most commonly quoted is Exodus 21:22-25. This reads:

If men who are fighting hit a pregnant woman and she gives birth prematurely (she has a miscarriage) but there is no serious injury, the offender must be fined whatever the woman's husband demands and the court allows. But if there is serious injury, you are to take life for fife, eye for eye, tooth for tooth, hand for hand, foot for foot, burn for burn, wound for wound, bruise for bruise. (N.I.V.)

According to most translations and most commentators, this passage explicitly distinguishes the killing of a fetus from murder, on the ground that the fetus is not equivalent to an adult human life. The destruction of the fetus is not a capital offence, whereas the death of the woman is regard,ed as such. In contrast to the mother, the fetus is not regarded as a soul (nephesh), and greater worth is placed on the mother as fully personal than on the fetus she carries. Loss of a fetus merited a fine, whereas the killing of a baby, child or adult, led to the death of the murderer (Exodus 21:12).

A few writers on abortion attempt to nullify the implications of this passage by suggesting that the translations we have are misleading. For instance, one re-translation reads: "If men strive and hurt a woman with child, so that her children come out of her, and yet no mischief follow, he shall be surely punished. . ."²² Calvin's views on abortion are sometimes mustered as support, as he also interpreted this passage as teaching that fetus and mother were regarded as equal. And yet a reading of Calvin's comments on the passage show that his conclusions were based on an emotional antipathy to abortion. He fails to put forward convincing exegetical reasons for his interpretation. It must be concluded, therefore, that equating the status of fetus and mother in this Exodus passage is an example of special pleading.

It is also significant that no biblical text forbids procuring an abortion. This is in striking contrast to Assyrian law between 1450 B.C. and 1250 B.C., prescribing death by torture in cases or induced abortion. The silence of the Old Testament is notable, particularly since the Mosaic Code is normally more extensive and severe than other Codes in sexual matters. From this negative evidence it is not unreasonable to infer that God does not invariably prohibit abortion.²³ Never in the Old Testament is a fetus exacted for a fetus. This stands in contrast to the Assyrian Code, and was probably a means of protecting the fetus. Then again, conception is repeatedly recognized as a gift of God, for example, Genesis 4:1, 16:2, 17:19, 29:31, 30:22; Ruth 4:13. It is an act of creation in which humans play an essential part. Even beyond this, we have indications in the Old Testament that God is actively involved in fashioning the fetus, for example, Psalm 139:13-18.²⁴

The Old Testament does not equate the fetus with a living person; it does, however, place great value upon it. It presents us with a delicate balance, and not with hard-and fast rules. The fetus cannot be equated with a living person, and yet it is being built into the image and likeness of God. At no point in this process is it ever an expendable tissue of a human body, because God is at work fashioning it into a being with God-like characteristics.  

If God is at work in the fetus, what clues does this provide in our search for an abortion ethic?

God is the creator of all human life and human beings are created in his image, with an abundance of God-like attributes and the capacity of responding to God and relating intimately with him. Human beings are like God in that they are persons, who relate to everything in personal ways. They are rational and moral beings, with moral responsibility and freedom of moral choice. They are responsible beings, responsible for their own actions and for the created order over which they have dominion.

To exercise authority over everything else created by God is a privilege and duty given only to God-like beings (Genesis 1:26). It involves intellectual ability, farsightedness, initiative, creativity, moral concern, freedom of action, knowledge of the ways of God, dependence upon God, loving kindness towards the weak and perhaps above everything else an acknowledgement that all these powers come from God and are to be utilized wisely in his service. Underlying all these traits is God's treatment of humans as beings capable of deciding issues morally and rationally (Genesis 2:16, 17). Human moral obligations, however, are always related to the dictates of God, so that in responding humans become more like God.

As we consider the fetus, therefore, we also have to consider those other human beings implicated in decisions concerning its welfare and future. The fetus is on its way to full personhood and that potential demands respect. Actual persons are also implicated, and their responses as persons cannot be overlooked. God is involved, and the purposes he may have for the fetus and those surrounding the fetus constitute an essential paradigm for any decision-making.

Authentic human life, is, in the words of Matthew 6:25, more than food and the body is more than clothing. To be a human person entails more than merely having a human body. It is. to be dependent upon the activity of God in establishing a relationship with himself and with fellow humans. These constant spheres of interaction lead to growth of personality, self-awareness and human relationships, through which we begin to perceive the meaning of personal existence.

Abortion, therefore, presents us with a dilemma. On the one hand, we do not have a biblical warrant to class it automatically as murder; and yet, alongside this, we must cling to the seriousness of abortion. Induced abortion is a man-initiated process by which a potential human life is destroyed. A developing person, or if you like, an undeveloped person is prevented from developing further and from becoming a human being in the fullest sense of this term.

And yet there is no way out of this dilemma. It is basic to personhood and to the responsibilities God has bestowed upon human beings. The dilemma is further compounded by the fallenness of the human condition. Our highest ideals are frequently shattered by self-centeredness, pride, arrogance, deception and lust, and the consequences for fetuses and children may be tragic.

The question of abortion confronts us with the grandeur and tragedy of the human situation. To expect trite answers in this realm is to demean the magnificence of God's creation and the vast ramifications of man's rebellion against God. Any approach to abortion that takes seriously the meaning of human existence must rely, in the words of Harmon L. Smith, on "human reason, compassion. . . understanding, and all else that constitutes our creaturely apparatus for making morally sensitive and discriminating and finite judgments."²⁵ The same writer comes to the following conclusions:

We repudiate tyranny in all human relationships; fetal tyranny, merely because it is fetal, is no exception. Moreover, we cannot hide behind the facade of impersonal nature or a Deus ex machina as - justification for indecision and inaction. Direct abortion, when it is unavoidable, is no more than honest confrontation with this fact of our creatureliness and the dilemma of limited alternatives. We might wish the alternatives were different, or that our choice-options were larger; but wishing does not make it So."²⁶

A Perspective on Abortion

Each fetus is a human life and represents a potential for personhood from very early in development-from about one week onwards. From this early stage it is a potential person, and from about eight weeks onwards it has a recognizable individuality as manifested by its circulation and brain activity. It is on the road to full personhood. Does this inevitably lead to a position of absolute protection for the fetus?

A fetus is part of a continuum, the end-result of which is the emergence of an individual human being manifesting, under normal circumstances, the myriad facets that go to make up personhood. The processes of this continuum, however, do not begin at conception; neither do they end at birth.

They commence prior to conception, either in the love of two people for each other or in the lust of one person for another. Not only this, but in a very real if profoundly mysterious sense these processes commenced in eternity, at least for God's servants and when considered in hindsight. It was the Lord himself who said to Jeremiah: "Before I formed you in the womb I knew you for my own; before you were born I consecrated you, I appointed you a prophet to the nations" (Jeremiah 1:4, 5). We dare not overlook the sovereign purposes of God, although the manner in which these purposes and human responsibility interact has not been elucidated and perhaps-by its very nature-is incapable of elucidation. From a human angle, we are to exercise responsibility in our decision-making and under no circumstances are we to procreate life irresponsibly" or selfishly for that is to pour scorn on one of God's most precious gifts to mankind. The beginning of the fetal continuum receives far too little serious moral thought, both inside and outside marriage.

The other end of the continuum is also somewhat nebulous. A new-born baby is a very incomplete human person, with an enormous amount of biological development, range of environmental influences and wealth of educational experiences still required for normal maturity and growth. These constitute some of the relationships so necessary for the developmental continuum to be brought to fruition. Birth may signify the end of fetal life, but in terms of overall development of a human being it fades into comparative insignificance. Neither a fetus nor a child is merely a biological organism; each has before it the goal of wholeness as a member of the human community, but for this to be achieved nurture and protection, care and guidance, love and discipline-both human and divine-are needed.

If our approach to the issue and to individuals involved in making decisions is to be a truly Christ-like approach, it must be characterized by compassion.

To contemplate a fetus, therefore, as if it had attained mature personhood, in the sense in which older children and adults have, is misleading. The fetus is on its way to becoming an actual person, but as a fetus it is a potential person. What this implies is that, as we consider the personhood of a fetus, we rely heavily on its future potential. As it develops, less weight is placed on future potential and more on actual status, and this continues until adulthood is reached. The fetus, therefore, is an integral part of the human endeavour, and yet we must beware placing greater value on it than on human life after birth.

A corollary of the continuum-potentiality argument is that there is no developmental point at which a line can be drawn between expendable and non-expendable fetuses, that is, between non-personal and personal fetuses. It may be preferable to carry out abortions earlier rather than later during gestation, but that is a biomedical and not an ethical decision.

The fetus, throughout its development, is important. Its potential for personhood marks it off as an entity of significance and potential dignity. There is a gap of profound dimensions between an unborn baby and an appendix; the former has the potential to become a fully developed, mature human being, whereas the latter under routine circumstances has not. Norman Geisler writes: "There is a vast difference between that which can develop into an Einstein or a Beethoven and an appendage of the human anatomy. The former has immortality in the image and likeness of God before it: the latter is merely an expendable tissue of a human body."²⁸ Or to phrase it rather differently, one cannot compare Beethoven's person and achievements with his appendix. From this it follows that elective abortion (abortion on request) cannot be used legitimately either as a form of birth control or as a routine way out of the consequences of irresponsible sexual activity. Once a fetus has been conceived, that fetus must be regarded with seriousness and concern. To dispose of it lightly is to demean humanity and God's purposes for that potential person. Under normal circumstances, a fetus has a right to full personhood, a right that is repeatedly refused it in today's society. To put it in another way, conception is a prima facie case in favour of giving the undeveloped person a chance to develop.²⁹

For a Christian couple in particular, it behooves them to regard the fetus and all that it represents as a gift of God; they do not have the option of wondering whether the gift be accepted or rejected, even if the conception was unplanned. They have already entered the incalculably momentous role of being parents and ancestors, as C.S. Lewis³⁰ wrote and, as Rex Gardner expresses it: "Its potentialities' are hers (the mother's) to protect and cherish, not to be bartered for a color televison or a holiday on the Costa Brava."³¹ Before rejecting a fetus, it has to be asked whether the decision is one that can be taken before God and in responsibility to him.

The fact that a mother does not want the fetus, for no better reason than that she does not want it, is not an ethically acceptable ground for abortion. The question is whether or not the fetus was willed, that is, whether or not sexual intercourse was freely undertaken. It it was, then as human beings we must accept the consequences of our actions. This is what human responsibility is all about. If, therefore, intercourse was freely undertaken by consenting parties, a fetus resulting from this intercourse has the right to live.³² To abort on the grounds of convenience is to abrogate the responsibility bestowed on human beings by God.

Gordon Scorer has argued very persuasively, that to destroy life for reasons of convenience is to devalue it. Once it is decided that life is no longer uniquely precious, relationships in society become less important and may ultimately become meaningless. Scorer writes:

. . Jife has no existence and meaning apart from relationship with other lives. When we debate the rights and wrongs of induced abortion, we are debating a problem of human relationships much broader and more significant than that of a woman with an unwanted fetus. We are concerned with society's attitude to human life.³³

Having stated this, however, it is necessary to concede that we do not place an absolute value on human life as, according to most moral codes including the biblical one, there are circumstances in which life may be taken or at least may not be unduly sustained. If this is the case, it is difficult to argue that the fetus has an unqualified right to protection. The fetus is an integral participant in the human endeavour, and must be viewed in the context of all the relationships of which it is a potential part.

We are left with a two-fold perspective: our view of the fetus should be a high one but it should not be an absolute one. The fetus, being weak and defenceless, should receive considerable protection, but that is not the same as guaranteeing absolute protection. Furthermore, even when absolute protection is guaranteed in theory, it cannot be sustained in practice. There is a continuity of life from conception to death, and so what we need is a moral formula applicable to fetal life as much as postnatal life. In other words, we must look seriously at extending the concept of justifiable homicide back to a concept of justifiable feticide.³⁴

In the light of this discussion, we must now ask whether there are any circumstances in which abortion is permissible. The fetus cannot decide and so this is a responsibility which falls on others.

Danger to the physical health of the mother

There are instances where the physical health of the mother is placed in jeopardy by the continuance of a pregnancy, although this is undoubtedly a declining reason for termination. It is, however, sometimes a legitimate reason because, according to most commentators, an actual person is of greater intrinsic value than a potential person, that is, the mother's life is of more intrinsic value than that of the fetus she is carrying. In other words, the mother's actual humanity is of more value than the unborn's potential for it.³⁵

Abortion in this instance is allowed by practically all ethicists, thereby converting all absolute stances into relative ones. This is the one exception to the rule of fetal inviolability that, in my opinion, is the downfall of fetal inviolability. An absolute anti-abortion stance cannot cope with direct conflict between maternal and fetal lives. Its ethical base is inappropriate, unlike that of the continuum-potentiality approach.

The mental health of the mother is a more difficult realm; the use to which this is put as a reason for abortions in our society demonstrates the ease with which the public and medical profession are abusing the concept. Nevertheless, there may well be extreme instances where this must be seriously considered. These are extreme and always exceptions to the rule. By their very nature, they are compromises because one is doing something that is far from ideal. And yet, there are undoubtedly family situations where inadequacy, marital breakdown, financial stringency, unemployment and a host of other adverse social conditions lead to the conclusion that abortion of an unwanted pregnancy is the least tragic of a number of tragic options.

The difficulty with this ground for abortion is the vagueness of the concept of mental health, and the ease with which in practice it can be made to mean what society wants it to mean. All too easily, it is equated with abortion on request where termination occurs for reasons of personal convenience. Nevertheless, there undoubtedly are tragic situations in which life has already been so devalued and personal relationships have become largely meaningless that yet another child would aggravate the tragedy-for itself as much as for the mother. What is so badly needed in such situations is that the abortion is accompanied by a determined effort to rebuild personal relationships, and to inject some form of meaningful humanity into that home. The abortion itself can be justified only as part of a wider therapeutic endeavour, and after the possibility of adoption has been discounted. It is unfortunate that in societies where liberal abortion laws operate, adoption has become an unacceptable alternative to abortion on request.

Rape raises the question of whether a woman should be forced to be a mother against her will, and this immediately raises the further issue of whether a woman should be allowed to be treated as anything other than a fully human person. In this instance, the confrontation is between the conflicting demands of the personhood of the woman and the right to be born of a child conceived in evil.

If conception has occurred without the consent of the woman, it would appear to follow that abortion is in order if the woman requests it. This is because a woman is more than just her body; she is a person created in the image of God. Rape, therefore, is a denial of her personhood and of what she is in the eyes of God.

A life generated by rape serves only to underline the manner in which the mother's rights to health and self-determination have been infringed. As such, the rights of an actual person, the mother, take precedence over the rights of a potential person, the fetus. As Norman Geisler has expressed it: "A potentially human person is not granted a birthright by violation of a fully human person unless her consent is subsequently given."³⁶

Similar arguments apply to incest, where both rape and eugenic considerations are relevant. To quote Geisler again:

Allowing an end to blossom in the name of a potential good (the embryo) seems to be a poor way of handling evil, especially when the potential good (the embryo) may itself turn out to be another form of evil. It is better to prevent the evil from coming to fruition than to perpetuate it.³⁷

Genetic reasons

These now constitute one of the most serious reasons for therapeutic abortion, including as they do genetic and chromosomal abnormalities such as found in Down's syndrome, haemophilia, Tay-Sachs disease, disorders following maternal German measles and many other mental and physical defects.³⁸

Ethical difficulties abound in the realm of genetic abortion, and the perplexities here are far greater than when considering abortion on other grounds. This is such a vast realm that in the present context my only intention is to introduce some of the major areas of debate.

Whose good is involved? Genetic abortion is carried out because, by preventing a genetically malformed baby from entering the world, it is of therapeutic benefit-but, to whom? Three answers are given to this question: it is to the good of the fetus, the parents or society.

Some genetic disorders are so severe that it is frequently argued abortion is for the good of the fetus. In other words, non-existence is a benefit to the fetus by preventing intolerable suffering, severe retardation or gross malformation. Would this be the case with Down's syndrome? Probably not, although it may be with much worse disorders such as Lesch-Nyhan syndrome with its concomitant mental retardation, compulsive self-mutilation and usually death in childhood.

Enormous care must be exercised in arguing this way, however, because it involves acting against abnormality and suffering by means of non-existence. A disease is cured, not by making the patient better, but by bringing the patient's existence to an end. Is it meaningful to argue in this way; can there be benefits without a beneficiary?³⁹

Very easily the good of the fetus becomes the good of the parents. Aborting a malformed fetus may be a prelude to the hope of conceiving a healthy, replacement one later. Understandable as this is, it is a step on the road to the making of human persons interchangeable. Once this is accepted, the uniqueness and irreplaceability of humans will come to assume less significance than their health or lack of it.⁴⁰

More generally, the care of a severely defective child can be an overwhelming financial and emotional burden on parents. It may well be that some families will be unable to cope, although predictions about this may be far from accurate in specific instances.

The good of society revolves, almost always, around financial issues. Cost-benefit analyses have been made of many genetic conditions, and the results invariably show that the medical expenditure on genetically abnormal children and adults far exceeds that of prenatal detection. No matter how valid these determinations, the assumption on which they are based is that normality is preferable to abnormality and should replace abnormality whenever possible. This assumption, if taken to extremes, questions the equality of all human beings and places the good of society above that of individuals.

The humanity of malformed humans. Genetically defective individuals are still human beings who, in many instances, have unmistakable marks of personhood. Indeed, sometimes very deformed children demonstrate human qualities in abundance. A deformity should be very major before an abortion is even considered, and it should somehow be demonstrated that the deformity is so great as to rob the fetus of any potentially personal qualities. After all, what is under discussion is the responsibility of one person to decide in advance for another person that this other person's future life will not be worth living. This is an onerous-perhaps an unreal-responsibility, which should not be lightly accepted.

The good of all who might be directly involved in the birth of a severely deformed child needs to be considered. In making the decision, a balance needs to be attained between the pursuit of biological quality and the potential that a deformed child within a family holds out for that family to be humanized and to grow as a loving, human unit. Unfortunately, some families cannot cope with such a challenge, and a compromise must be reluctantly adopted, namely, termination of the pregnancy. Christians must never acquiesce too easily in the replacement of a tradition of mutual care by a tradition of disposal .⁴¹

Allied with this is   God's love for the weak and fragile. This requires that we show a comparable concern for the abnormal and those likely to be rejected by society.⁴² Fetuses are not merely physico-chemical mechanisms to be eliminated at will, even though the intentions are good. They are to be viewed with concern because they are human and because all members of the human community are genetically imperfect. Genetic perfection is an unattainable ideal, and our actions in readily eliminating genetically defective fetuses are not to be guided by such an ideal.

Ours is a fallen world, and the genetically defective are one manifestation of that fallenness. However we cope with the genetically defective, therefore, it is to reflect concern for the weak and defenceless, whether these be fetuses, distraught parents, or even a bewildered society. In general, helping the handicapped, not taking their life in advance, is the way to improve the quality of human life.⁴³

People and diseases. Throughout discussions on genetic abnormality care needs to be taken in maintaining the distinction between the person and the disease. Otherwise_ the conclusion is reached that the afflicted person or fetus is, rather than has, a disease.⁴⁴ It is easy to slide from the language of possession to that of identity, so that "he has haemophilia" becomes "he is a haemophiliac". When this transition occurs, the impression is given that the goal of abortion is the elimination of persons rather than the treatment of diseases.

This lack of distinction between people and their disease is highlighted by the dilemma frequently encountered when contemplating genetic abortion. This is the statistical risk of defect, so that when abortion for a statistical risk is carried out more healthy fetuses than deformed ones will be killed. This equation confronts us with the ethics of destroying normal fetuses as opposed to the ethics of allowing into the world defective fetuses. Which then matters the fetus or the disease?

Last words. It is impossible to emerge with any concise conclusions regarding genetic abortion. The issues are too complex and unresolved at present. Two quotations may highlight the difficulties.

One doctor to another-" About the terminating of a pregnancy, I want your opinion. The father was a syphilitic. The mother tuberculous. Of the four children born the first was blind, the second died, the third was deaf and dumb, the fourth also tuberculous. What would you have done?" "I would have ended the pregnancy." "Then you would have murdered Beethoven."⁴⁵

I was conceived after antibiotics yet before amniocentesis, late enough to have benefited from medicine's ability to prevent and control fatal infectious diseases, yet early enough to have escaped from medicine's ability to prevent me from living to suffer from my genetic diseases. To be sure, my genetic vices are, as far as I know them, rather modest, taken individually-myopia, asthma and other allergies, bilateral forefoot adduction, bowleggedness, loquaciousness, and pessimism, plus some four to eight as yet undiagnosed recessive lethal genes in the heterozygous condition-but, taken together, and if diagnosable prenatally, I might never have made it.⁴⁶

Whatever directions our thinking on abortion may take, we must beware of becoming censorious. If our approach to the issue and to individuals involved in making decisions is to be a truly human approach, and by that I mean a Christ-like approach, it must be characterized by compassion. Any decision to proceed with an abortion should be an agonizing one-anything less than that shows little regard for either the fetus or mother. There may be situations where women seek abortions on what Christians consider inadequate grounds; if that is so, our attitude should be a compassionate one in which we seek to help them not merely over the immediate problem but in the long term as well. They, too, are human beings, in need of all that is truly human.

¹Tanner, J.M., Foetus into Man: Physical Growth from Conception to Maturity (Open Books, London 1978), pp. 37, 38.

²Moore, K.L., Before We Are Born (W.B. Saunders, Philadelphia 1977), pp. 51-55.

³Langerak, E.A., Abortion. Listening to the Middle, Hastings Center Report, 9, 24-28 (1979).

⁷Fletcher, J., Humanhood: Essays in Biomedical Ethics (Prometheus Books, Buffalo 1979), p. 135.

¹²Abbo, J.A. and Hannan, J.D., The Sacred Cannons (B . Herder Book Co., St' Louis 1952), vol. 1, pp. 752-753.

¹³Smith, H.L., Ethics and the New Medicine (Abingdon, Nashville 1970), p. 34.

¹⁵Ramsey, P., Reference points in deciding about abortion. In J.T. Noonan (ed.), The Morality of Abortion (Harvard University Press, Cambridge, Mass. 1970), pp. 69-79.

¹⁶Ramsey, P., Abortion: a review article, The Thomist 37, 174-226 (1973). Reprinted in Three on Abortion (Child and Family, Oak Park, Illinois 1978).

¹⁸Thielicke, H., TheEthics of Sex (James Clarke and Co., Cambridge 1964), p. 231.

²³Waltke, B.K., Old Testament texts bearing on the problem of the control of human reproduction. In W.O. Spitzer and C.L. Saylor (eds.), Birth Control and the Christian (Tyndale House Publishers, Wheaton 1969), pp. 7-23.

²⁸Geisler, N.L., Ethics: Alternatives and Issues (Zondervan, Grand Rapids 1971), p. 219.

³¹Gardner, R.F.R., Abortion: The Personal Dilemma (Paternoster Press), Exeter 1972), p. 127.

³⁶Geisler, ibid, pp. 222, 223.

³⁷Ibid, p. 223.

³⁸Jones, D.G., Genetic Engineering (Grove Books, Bramcote, Notts. 1978), pp. 4-7.

³⁹Camenisch, P.F., Abortion: for the fetus's own sake? Hastings Center Report 6, 38-41 (1976).

⁴⁰Ibid.

⁴¹Dunstan, op cit., p. 85.

⁴²Shinn, R.L., Foetal diagnosis and selective abortion: an ethical exploration. In C. Birch and P. Abrecht (eds.), Genetics and the Quality of Life (Pergamon Press, Potts Points, N.S.W. 1975), pp. 74-85.

⁴³Geisler, op cit., p. 227.

⁴⁴Kass, L.R., Implications of prenatal diagnosis for the human right to life. In J.M. and R.F. Almeder (eds.), Biomedical Ethics and the Law (Plenum Press, New York 1976), pp. 313-327.

⁴⁵St. John-Stevas, N., The Right to Life (Hodder and Stoughton, London 1963), p. 20.

⁴⁶Kass, op cit., p. 313.