Why Is the US Still Hung Up on the Abortion Debate? A Bioethics Perspective

Unlike most countries in the developed world, the United States is still deeply mired in the abortion debate — a hotly contested issue that divides the nation and still holds the potential to tip the balance at election time. But while the Religious Right and elements of the Republican Party are undoubtedly the prime instigators in keeping the debate alive, there are other factors as well — including an unscientific notion of when life truly begins.

As an outside observer, I have to admit that the ongoing abortion debate in the United States seems odd — if not a bit anachronistic. Here in Canada, where abortion has been legal since 1969, conservative governments have tried to rekindle the issue at various times, but are quickly forced to back down after the inevitable public backlash; for most Canadians the abortion debate is over and done with.

This may have something to do with a well established sense of women's rights in this country — but it may also be on account of diminished religiosity. In Canada, politicians re-introduce the abortion issue at their own peril, due to our general distaste for politicians who openly espouse their religious views. This is clearly not the case in the US, of course — a factor that certainly helps to explain why the abortion debate can't seem to go away.

Religion, Access, Contraception

Abortion as an issue is remarkably complex and dynamic. It touches upon women's rights, politics, law, ethics, and many other areas — but one domain that's particularly sensitive to abortion is religion.

Why Is the US Still Hung Up on the Abortion Debate? A Bioethics PerspectiveS

Indeed, a quick scan of countries in which abortion is either prohibited or severely limited reveals a list of nations whose populations are still very pious. In Europe, for example, Catholic countries like Ireland, Poland, Portugal, and Spain still limit abortions to only those cases in which the mother's health is in question. And like the US, the abortion debate in these countries is still very much on the top of the political agenda.

Similarly, access to abortion is also constrained in a number of South American and African countries. In these regions, religion remains a contributing factor — but so too is access to contraceptives (whether it be on account of religious injunctions against their use or outright inaccessibility).

And indeed, it's important to note that abortions are declining globally, mostly on account of better access to contraceptives. The connection is near incontrovertible; a recent study published in Obstetrics and Gynecology revealed that abortion rates plummet in those regions where contraceptives are provided at no cost.

Conversely, the abortion debate has all but disappeared in countries like Canada, Sweden, the United Kingdom, and Japan. And in fact, a recent gallup poll ranked these countries as among the lowest 30 nations in world in terms of public religiosity. The United States, on the other hand, was ranked as the 44th most religious nation alongside such countries as Kosovo and Argentina.

What makes the US unique, however, is in how it compares to other rich-world populations. When considering developed nations exclusively, the median proportion of the population who say religion is important in their daily lives is at 38%. In America, this figure is as high as 65%. The US, when compared to other developed nations, is astonishingly devout.

Few would argue that there isn't some sort of connection between this religious sensibility and the ongoing abortion debate in the US.

And it's also no mystery as to why abortion and religion make for poor bedfellows. Christians in particular believe in the existence of the soul, and by virtue of this, insist that life begins at the point of conception. Abortion, as seen through the eyes of the devout, is nothing less than murder — an egregious usurpation of God's will — not to mention a capital offense. It's this fundamental conviction that has led to the wide scale mobilization and politicization of the pro-life movement in those countries where religion still matters.

From Political Religion to Political Science

Indeed, the abortion debate has become remarkably politicized in the US. As of late, the Republican Party has rekindled the issue, much to the chagrin of its more liberal and libertarian elements (not to mention a good portion of its female constituency). In addition, grassroots Tea Party activists have also worked aggressively in their attempts to knock down existing abortion laws.

Why Is the US Still Hung Up on the Abortion Debate? A Bioethics PerspectiveS

And interestingly, unlike the way politics is done in most other developed nations, American politicians are not afraid to wear their religiosity on their sleeve — and in fact, it's practically a requirement. A good example of this came recently when Indiana Republican Richard Mourdock argued that if a woman became pregnant from rape that it's what God intended. While there was certainly shock and outrage at the comment, it was by no means a career ending statement. And in fact, he may have even earned some accolades (and votes) from his religious supporters for being so forthright.

Try this in another country, however, and one risks political suicide. Canada provides another good example. Its Prime Minister, Stephen Harper, is a devout member of the Christian and Missionary Alliance — yet the realities of Canadian political life has largely forced him to remain tight-lipped about his religious views (not that it prevents him from tabling policies that are consistent with his spiritual convictions).

Now this being said, not all Republicans are willing to use the religion card in the struggle against abortion. In a country that has claimed to have separated church from state, it's often not wise to attack abortion by using religious arguments alone. So instead, some politicians have learned to use backdoor tactics and outright misinformation.

The efforts of Minnesota's Michelle Bachmann provide a good example. Bachmann has tried to undermine support for abortion laws by turning it into a money issue. She recently referred to Planned Parenthood as the "LensCrafters of big abortion" and slammed the federal government for injecting $363 million into the organization. But as a 2009 report indicates, none of this money can be used to fund abortions — of which only 3% of its total budget make up the organization's abortion services anyway.

Other backhanded attempts involve enacting laws that limit or regulate abortion, such as laws requiring parental consent for minors, parental notification laws, spousal mutual consent laws (which isn't necessarily a bad thing), laws that require abortions to be performed in hospitals exclusively (i.e. no clinics), laws that enforce waiting periods, and so on. Other attempts include limiting state funding, and forcing women to read pro-life literature prior to consenting to an abortion.

And most recently, some Republicans have tried to co-opt science itself. The latest trend along these lines is the suggestion that fetuses have what's called "pain sentience" — the psychological capacity for physical suffering. The basic argument is that the capacity for pain is the ultimate arbiter of things, and that the ability of a fetus to feel pain should be enough to prohibit abortions.

This idea has taken off in some districts, including Nebraska and Idaho where legislators have sketched out respective Pain-Capable Unborn Child Protection acts. And to bolster their case, these politicians are citing neuroscientific findings of pain sentience.

Mitt Romney is one such politician. Last year he wrote a piece for the National Review in which he said, "I will advocate for and support a Pain-Capable Unborn Child Protection Act to protect unborn children who are capable of feeling pain from abortion."

But as the misguided war against Darwinian evolution has shown, scientific "arguments" propped-up by religious interests are very rarely on point — and this issue is another good example. While the capacity for pain is a requirement for personhood (an issue we'll get to in just a bit), it is not sufficient. As William Egginton recently wrote in the New York Times, "As pain sentience does not serve as a basis for legal prohibitions in general (or else mousetraps and deer hunting would be prohibited), the statutes' real purpose is to use potential evidence of pain sentience in fetuses to indicate the presence of something far more compelling - namely, personhood."

But more to the point, (actual) scientific research has shown that a preterm fetus cannot experience pain. A 2005 study published in the Journal of the American Medical Association concluded that "Evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester."

It's Really About Personhood

Yet, setting aside religion, politics, and suspect science, there's also the issue of Roe v. Wade, the important precedent that makes abortion permissible in the US. Its specific wording states that abortions are allowable only up until the point of viability — that crucial point when a baby can survive on its own outside the womb.

While some might argue that this indirectly confers personhood status at the time of viability, further scrutiny reveals that it does not. As a thought experiment, suppose that medical technologies will continue to push back the limits of how early preterm births can happen. As it stands, some of the earliest preemies have survived as early as 24 weeks, with some documented cases as low as 21 weeks. So, does this mean that viability (or is that personhood?) should start at 21 weeks?

Moreover, because it's not unreasonable to assume that medical technologies will continue to improve the survival rates of premature births, it's possible that the age of viability could be reduced even further — what would thus require women to get abortions far earlier than the current standard maximum limit (20 weeks). The situation will get even more absurd if and when artificial wombs are developed in which the entire gestational period can take place outside of a biological womb.

This is why the abortion debate so desperately needs to settle around the personhood issue. Unless the dialogue switches from viability to personhood, Roe v. Wade may not stand the test of time.

Unfortunately, this is not going to be easy. As it stands, there is no agreed upon definition or criteria for personhood. And it's doubtful that consensus will ever be reached on the matter.

Why Is the US Still Hung Up on the Abortion Debate? A Bioethics Perspective

Christians will forever insist that ensoulment is the defining factor, and that an embryo is a person. Moreover, they will not be swayed by arguments from pro-lifers who raise completely separate issues, such as women's rights. And in fact, this points to a fundamental problem in the abortion debate; oftentimes, the opposing camps aren't actually engaging in conversation. Too many times they just talk past one another.

Another angle on personhood is the idea of potentiality — that it's the potential of an entity that confers moral status. But this doesn't work either. If a clump of embryonic cells can be considered a person because it has the potential to be a person, then logically speaking a clump of stem cells would also have to be considered a nascent human; recent studies have shown that pluripotent cells can be coaxed into reproductive cells. Moreover, the idea of confering personhood status to an abstract entity is deeply problematic unto itself.

Many bioethicists, on the other hand, consider physiological and cognitive attributes like cortical activity (an indication of conscious awareness), emotional response (like responding to a parent's movement or voice), and the startle reflex (a response to the environment).

So, for example, 53% of fetuses between 26 and 27 weeks display startle reaction, but none prior to that. By consequence, current laws which state (either explicitly or implicitly) that personhood begins at the third trimester may actually be spot on. Clearly, further work needs to be done to reach scientific consensus as to when personhood truly emerges.

In the meantime, Americans who are interested in upholding abortion laws should concentrate on these aspects of the debate. Logically sound arguments backed by science (and supported by the courts) will forever trump religious superstitions and opportunistic politicians.

Image: Allen Graham - PDImages / Shutterstock.com. Inset images via Guardian, BBC/UN, StemCells.