Introduction to Ethics - Ethics at the start of life

Sean Doherty

- 13 minutes read - 2674 words

Aim: to equip students with an informed understanding of the prevalence and experience in contemporary life of abortion and fertility treatment, the pastoral needs of those who experience them, and to enable them to engage with the ethical questions they raise. Trigger warning. You may find some of the material in some of these items distressing.

Suggested preparatory reading

The question of personhood and when life begins:

See also the article by Lydia Jaegar above.

Further Reading: abortion

NB: As well as the specific discussions of abortion below, the question of when life begins is also very relevant here. For reading suggestions on this, see the list above.

Understanding the prevalence and reasons for abortion in the UK today:

Some thinkers in favour of abortion (in at least some circumstances):

A selection of theological discussions:

The books listed in the session above on Theological Foundations for Medical Ethics almost all also have sections or chapters on abortion.

Roman Catholic perspectives:

Pastoral, personal and even a bit political:

Further Reading: fertility treatments

NB: As well as the specific discussions of fertility treatment below, the question of when life begins is also very relevant here. For reading suggestions on this, see the list above. Many of the books listed above with respect to abortion and in the session above on Theological Foundations for Medical Ethics also have sections or chapters on fertility treatments.

Session 4 slides

Abortion:

Ensuring a safe environment for discussion

1) What causes the silence in the church and in our culture? 2) Why engage with this emotive and painful issue? 3) How can we break the silence well?

Key resource

Jonathan Jeffes, Abortion: Breaking the Silence in the Church (Chichester: Lean Press, 2013 – kindly available on Moodle). Jonathan is a post-abortion counsellor who has written a number of books and booklets including one on Talking to Teenagers about abortion. He is also part of the team at the Post Abortion Course.

Understanding abortion

Who has abortions and why?

Legal grounds under which one may obtain an abortion in the UK (Text of Abortion Act 1967: http://www.legislation.gov.uk/ukpga/1967/87.) If two medical practitioners certify that,

  • the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated;

  • the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman;

  • the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman;

  • the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman;

  • there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

Or in an emergency, certified by the operating practitioner as immediately necessary:

  • to save the life of the pregnant woman;

  • to prevent grave permanent injury to the physical or mental health of the pregnant woman.

Statistics from Abortion Statistics, England and Wales: 2021 (Office for Health Improvement and Disparities: June 2022, updated November 2022 and April 2023).

Why is abortion so prevalent?

Why do people get pregnant when they don’t intend to?

  • ? % of live births in the UK are from unintended pregnancies.

  • Proportion of women going for abortion who say they are using contraception at the time.

  • Effectiveness of contraception

Questioning the language of ‘choice’: some feminist voices

‘Unwanted by whom? Women who were having abortions in the 1970s were women who did not want to be pregnant. If you talked to people in those days, they said it was a relief. They said that it gave them something they would not otherwise have had. Today, by contrast, we are increasingly seeing a population of women who would rather be pregnant but cannot continue the pregnancies for reasons not having to do with their own volition.’ [1]

‘What women “won” was the “right” to undergo invasive procedures to terminate unwanted pregnancies - unwanted not just by them but by their parents, their sexual partners, the governments who would not support mothers, the employers who would not employ mothers, the landlords who would not accept tenants with children. …​ The goal was “every child a wanted child”; it should also have been “every abortion a wanted abortion.” A choice is only possible if there are genuine alternatives.’2 [2]

‘The abortion ‘choice’ is just one more arena in which men condition their love and respect on the basis of women’s obedience to their desires.’ What women want is to be supported in their reproductive choices, not offered the ‘cheap love of abortion as a substitute for honest care and commitment.’ [3]

Thinking through the ethical issues for yourself

Scripture and theology: recap from last week

  • Preciousness of human life (‘image of God’)

  • Goodness of physical human life (‘very good’; ‘from the dust of the earth’)

  • Created for community and relationship (‘not good’ to be alone’)

Specific texts often discussed:

  • Psalm 139:13-14 – God’s presence and involvement in the development of life in the womb

  • Jeremiah 1:4-5 – Prophet set apart before he had been ‘formed in the womb’

  • Job 3:3 – Job curses the night he was conceived

  • Psalm 51:5 – conception as the beginning of life

  • The Incarnation/conception of Jesus and the redemption of the whole of our bodily lives (Luke 1:31)

Tradition

  • Didache (late first/early second century), states that ‘you shall not kill the child in the womb or cause a new born infant to perish.’ (Cf. Hippocratic Oath.)

  • statement of the Church of England Board of Social Responsibility: ‘In the light of our conviction that the foetus has the right to live and develop as a member of the human family, we see abortion, the termination of that life by the act of man, as a great moral evil. We do not believe that the right to life, as a right pertaining to persons, admits no exceptions whatsoever; but the right of the innocent to life admits surely of few exceptions indeed.’

  • ‘few exceptions’ were stated in a 1983 General Synod resolution as: ‘situations where continuance of the pregnancy threatens the life of the mother.’ The 1983 Synod resolution concluded: ‘All life, including life developing in the womb, is created by God in his own image and is, therefore, to be nurtured, supported and protected.’

Reason: the question of the status of the embryo/fetus/baby:

  • What factor or point of development is it that confers the right to life?

    • lack of rationality, sentience (feeling), will

    • genetic uniqueness (cf. twinning, chimaeras, transplants)

    • but is this the same as being an independent person? – again cf. twinning, chimaeras

    • emergence of primitive streak lead some to suggest cut off at 14 days

  • the cautionary principle and the burden of proof:

  • ‘to be willing to kill what for all one knows is a person is to be willing to kill a person’.4

Possible ethical implications

  • Abortion because of fetal disability/quality of life

  • Tests such as amniocentesis which carry a risk and offer no medical benefit to the child

  • The use of embryos in scientific experimentation

  • Forms of contraception that function by inhibiting implantation (i.e. intrauterine devices and some forms of the pill)

What about…?

  • The morning after pill

  • Abortion to protect the life of the mother

    • the principle of ‘double effect’

  • Abortion of a child conceived as a result of rape

    • Judith Jarvis Thompson: does another’s right to life compromise a woman’s right to bodily independence?

Offering pastoral support

  • Check your background culture. Is it: ‘Don’t you dare show up here pregnant’ or ‘you must have the child’?

  • Immediate affirmation and encouragement are vital to a woman in an unplanned pregnancy.

  • What kind of support and acceptance will enable real choice?

  • Don’t get drawn into agreeing with OR judging someone’s decision but empower them to make their own.

  • Preserve relationship.

  • Sensitively break the silence (i.e. preach and speak about abortion). Always speak as if someone present has personal experience of an abortion (men as well as women).

  • Link with local unplanned pregnancy support and post-abortion counselling and support.

  • Relationships and sexual education (RSHE) with young people.

  • Equipping/encouraging parents to discuss with their children.

  • Marriage preparation.

  • Training for prayer ministry/pastoral care team members or equivalents.

Sooner or later as a minister/friend/parent/spouse/partner/ex, you will be asked: ‘I’m pregnant, what do you think I/we should do?’

What will you say?

Fertility Treatments

Theological framework

  • God’s concern in Scripture for those who cannot conceive children

  • The meaning of parenthood: why a child of ‘our own’?

    • In creation, parenthood is one of the purposes of marriage

      • children as expression and consummation of parental union (Genesis 1 & 2)

      • desire for a child of our own is legitimate and natural

    • In creation, children conceived through sexual union

      • passion not just decision

      • bodily integrity

Treatments

  • Prevalence of fertility difficulties (1 in 7 couples), yet unspoken

  • Growing numbers of same-sex couples and single women

  • Very fast moving science: IVF only since 1978, and many more developments since then

  • Treatments vary according to diagnosis:

    • CLOMID may be starting point, induces ovulation

    • IUI (intra-uterine insemination) natural – can use husband’s or donor’s sperm

    • IUI stimulated (stimulating ovulation, scans)

    • IVF (in vitro fertilisation) more invasive, expensive, complicated, takes longer

    • Natural cycle IVF

    • ICSI (intracytoplasmic sperm injection) with IVF

    • DONATION OF GAMETES (sperm and egg), EMBRYO DONATION

    • PGD (pre-implantation genetic diagnosis) enables checking for ‘defects’ and potentially selection e.g., gender, donor possibilities

    • SURROGACY can use combination of donated or parental gametes, implanted through IVF

Ethical issues

  • ‘Begotten or Made?’

    • To what extent can we abstract procreation from sexual union in marriage?

    • Begetting → Genesis → Procreation → Reproduction

    • Fruit of sexual union or satisfaction of parental desire/need?

  • Gamete donation

    • Whose is the child? What makes the child ‘belong’ to parent? Biology / intention / parenting function / will?

    • Anonymity

    • Analogy: step parenting, organ donation, adoption, or unfaithfulness?

  • Question of ‘surplus’ or unviable embryos

  • Embryo donation

  • ‘Slippery slope’ arguments:

    • PGD and ‘quality control’

    • commercialisation & the market

Some (tentative) conclusions:

  • The use of donated gametes in surrogacy and IVF seems to be ruled out:

    • subverts bodily structure of parenthood & marriage in creation

    • makes children a function of parental will

  • AIH and IVF using husband and wife’s gametes: legitimate but cautious

    • caution about technical and artificial intervention in sexual union

    • but enabling fruitful union, not ‘making’ a human being for own ends

    • question of ‘spare’ embryos

    • caution of slippery slopes (e.g., consumerism - PGD ruled out)

    • question of participation in an unjust system

Emotional impact and pastoral support

Approximately 90% of couples who have long term fertility issues will suffer from some form of depression. Unsurprisingly, it can be one of the hardest things to go through as a couple, and can lead to the breakdown of the relationship.

  • Personally: Sense of failure, anger, disappointment, confusion

  • As a couple: Isolation, anger, resentment. Fear of marital/relationship breakdown

  • Community: Isolation, inability to connect, bitterness, anger (esp. in church)

Good news:

  • Faith in God as support

  • Church can be a good support

  • Faith can grow and be strengthened

Bad news:

  • Faith in God can be shaken

  • Church still playing catch up with the issues

  • Church often unprepared with how to handle

  • ‘Christian’ platitudes can hurt

How to help:

  • Ask couple how you can best help them 

  • Persevere – long term support needed

  • Practical support  

1. Kristin Luker, ‘Why do people get pregnant (when they don’t want to be?)’ The 2010 Annual BPAS lecture.
2. Germaine Greer, The Whole Woman. (London: Anchor Books, 2000), p.109.
3. Nancyjo Mann in ‘Foreword’ to David Reardon, Aborted Women: Silent no More (Eliot Institute, 2002), p. xi.