Monday, May 5, 2008

A Middle Ground on Abortion Rights: An Answer in Fetal Viability

No issue in American politics generates as much controversy as the question of abortion rights. Faith based arguments are often found at the core of the debate, and conservatives point to their understanding of Christian thought as an essential aspect of their arguments. As Christians, we all believe that human life is precious and a gift from our creator. Therefore, we must all do our utmost to nurture and improve every human life, whether old or young, rich or poor, American or foreign.
The first question to evaluate is when does an individual's life begin? This is not an easy question to answer, and, as such, there are many landmarks that currently define this answer within the medical community. At conception, the union of sperm and egg produce a new cell, the zygote, with a new, unique set of DNA inherited from both mother and father. Within the current debate, this is the moment that most anti-abortion or pro-life advocates consider the start of a new human life, and, indeed, if all goes well, 9 months or so from this point, a new baby, with all of the unique gifts that make each of us special, will be born.
As the zygote travels within the mother's reproductive tract, it begins to divide into more and more cells and will need to implant itself into the mother's uterus to live and grow. This implantation is the next landmark in the life of an embryo, and its success is far from routine. While the exact numbers can never be known, current medical research supports a miscarriage rate of up to 50% due to failure of implantation. The embryo does not attach itself to the mother's uterus and passes out of her body without her ever knowing of the potentially momentous events that have taken place within her. Implantation, then, is the current medical moment when a woman is deemed to be pregnant, and the medical terminology changes. Prior to this, methods of preventing a pregnancy are termed birth control. Plan B and IUDs, for instance, are examples of birth control methods that act by helping to prevent implantation. After implantation, methods of ending a pregnancy are termed abortion.
At about 8 weeks of gestation, the developing life is given the name of fetus, and all major organ systems are developing. The baby continues to grow, and the next milestone is fetal viability. This is the time in a baby's development when he or she could live with currently available medical technology independent of his or her mother. This is now at 22 to 24 weeks of gestation. A bay who undergoes the trauma of a premature birth at this time does have a chance at life. This is at approximately the end of the second trimester and, therefore, near the end of the time frame of legal abortion in this country. Finally, the baby continues to grow and will become a full term infant by 36 to 40 weeks of gestation. a pregnancy at this time will result in a fully developed infant.

It is a woman's relationship with the new life within her that is the focus of the abortion fight. Before implantation, a woman currently has the right to various forms of birth control to prevent an unwanted pregnancy. Occasionally, fundamentalists have attempted to deny a woman this right due to their belief that pregnancy starts with conception; for example, recently, Illinois has enacted legislation designed to preserve every woman's right to access to birth control, and CVS Pharmacy has suspended three pharmacists for violating this law by refusing to fill prescriptions for Plan B. Furthermore, despite overwhelming support from its own scientific advisory panels, the Bush FDA has restricted the over-the-counter availability of Plan B to women 18 and older, essentially limiting access to younger women to a potential form of birth control.
At the opposite end of the question, some women's rights advocates believe that a woman has complete sovereignty over her own body until the delivery of the baby. While they acknowledge that the fetus is becoming more and more viable, they believe that each individual should have complete control over their body at all times. Currently, our society does grant late term pregnant women most rights over their own bodies, but not the right to an abortion. A woman may use tobacco or alcohol at any time and in any amount over the length of her pregnancy despite well known health risks to the developing fetus. A woman is not required to participate in exercise programs despite evidence that this could improve a baby's health. A woman is not required to receive medical care for the developing fetus; once born, similar care is often mandated by the state. Finally, current law does give women full sovereignty over their own bodies through the second trimester, including the right to an abortion. As a practical matter, women rarely choose to terminate a mid to late second trimester pregnancy, and physicians routinely caution against them due to emotional and health considerations for the mother.

What then is the best position for the contemporary Christian in this debate? As in many difficult questions of this nature, two compelling Christian ideals are in focus here. The first is our belief that we need to advocate for and help the needy. This takes many forms from our working to end world hunger and poverty to speaking out for the voiceless in any debate. The second ideal is our belief that our own bodies are our most fundamental gift from our creator, and, as such, are our own to control. We are given the ability to be our own moral agents and make our own decisions regarding the use of our own bodies, whether this is an end of life decision, pregnancy decision, or medical decision regarding our own body.
It is obvious that a fetus or what many would call an unborn child is voiceless. Therefore, I submit that as Christians, we have an obligation to consider the consequences of our actions as a society on these individuals. This idea is so often pushed by many Christians, that is needs no further explanation here. What is rarely discussed is the gift from God of our own bodies and what rights Christians see emanating from this gift. Our society grants wide latitude in decisions we make regarding our own bodies. We are allowed to engage in very high risk and potentially deadly activities such as smoking, mountain climbing, or chronic overeating. Americans routinely exercise their right to elective surgery despite a very real risk of death. For instance, elective lower extremity joint replacement surgery has a widely accepted mortality rate of 1%, and this rate is much higher for certain patients. However, in numerous discussions that I have had with patients contemplating the surgery and its risks, I have repeatedly been told that a patient's pain makes his life unbearable, and he or she is willing to risk death to improve it.
I know of no large scale religious tradition that advocates repealing this right that we all have to make decisions, even potentially life ending decisions, regarding our own bodies. God has given us our bodies and a moral compass, and we believe as Christians that we can make our own decisions. It is in the question of abortion that this God given right confronts our need to speak for the speechless. With all due sensitivity to individual rights advocates who believe a woman should be allowed her God given right to control her own body for the length of her pregnancy, I do not believe that this is the optimal Christian position. Furthermore, with all needed respect to those who believe that the potential embodied in the unicellular life that may one day become a newborn child always supersedes a mother's needs or desires, I do not believe a woman loses her right to determine that fate of her own body on the day that conception occurs.
When then does the tipping point occur that implies that the needs of the unborn child should supersede the needs of its mother? I believe that the answer to this question is the time of fetal viability. Prior to this time, the fetus is a part of its mother in every sense but the genetic. It cannot survive without the nourishment from its mother and the environment that her uterus creates. It could not survive implanted in another woman or with our best medical technologies. It is, without doubt, not an individual apart from its mother and is not an entity separate from her. Therefore, it is best defined as part of her body, and she has a right to make the choices that she feels are best for her most fundamental gift from God, her own body. After the time of fetal viability, the fetus can be seen as an individual apart from his or her mother. Not only does he or she have his own unique genetic makeup, he could survive in the world apart from his mother. His life is not necessarily dependent on hers. Due to this circumstance, the needs of the unborn child to its chance at life supersede the very real rights of his mother to determine the fate of her body. It is at this time that we as Christians need to defend the rights of the unborn as ardently as we would defend the rights of the mother prior to this time.
Finally, the concept of fetal viability is crucial to a Christian understanding of the abortion issue. It allows us to navigate between the God given rights of an unborn child and the God given rights of his or her mother in a way that is reasonable and considers both sides of the abortion decision

On a Withdrawal from Iraq

Many claim that a withdrawal from Iraq would be a mistake--that we should stay until we have achieved "success" or can claim some sort of victory. This victory is often defined as our ability to achieve a stable democracy where the Kurds, and Sunni and Shiite Arabs coexist in harmony, and the country becomes a U.S. ally. However, is this achievable in any realistic time frame?
Let's first look at Northern Ireland; it has taken nearly 100 years for the opposing populations, Catholic and Protestant, to approach a period of cooperation and mutual respect, and this is in a situation where one of the contestants did not view Britain as an occupying power, and everyone spoke the same language and had a common heritage.
Now, let's look at Iraq. Sunni and Shiite Muslims split apart in the seventh century after Christ over the question of kingship. In other words, there has been division and violence for some 1400 years now between the current warring factions in Iraq. Furthermore, unfortunately, these enemies have not infrequently used terrorist tactics against each other. In 1090 AD, a fanatic group of Shiites named themselves the Assassins of Alamut, and made a name for themselves by the unstinting use of assassination as a weapon against their Shiite enemies. This is the origination of the English word assassinate or assassin.
Now are we supposed to believe that our military forces, as marvelous as they are at jobs within their scope, can somehow magically bring Sunnis and Shiites together within a few years--that 1400 years of violence, extremism and, sometimes, fanaticism can be completely resolved by our military within such a short time frame? This is what President Bush has been promising for 5 years now and John McCain continues to promise. However, no occupying power, no matter how professional and well-trained, can make friends out of bitter enemies.
No one can predict for sure how our leaving Iraq will affect that country. Hoards of conservatives warned of dire consequences of our leaving Vietnam; it would be another falling domino in the unstoppable wave of communism. Despite such warnings, our leaders summoned the will to leave, and nothing happened. Communism was stopped; we are currently at peace with Vietnam. Again, no one can say exactly what the cost of leaving Iraq will be, but I can tell you what the war is costing the country right now: over 4000 American dead--that's 800 a year and counting, an all volunteer military that its own generals state is cracking under the weight of continual deployments, and $400,000,000 per day in expenses to this country. What could we not do with that money right here.
If we were to stay in Iraq for as long as many American military planners estimate it might take to possibly achieve some sort of success, this war would become the single biggest expense in the history of the republic. An expense, I might add, that we are currently passing on entirely to our children due to President bush's tax cuts for the wealthy. Our current definition of success in this war is utterly at odds with the history of the region. The cost of continuing it indefinitely, as Mr. McCain would have us do, is far too high in terms of American lives, American finances and the strains that it places on the best military on the planet.

Renaming the Estate Tax

Republicans in recent years have been successful in reducing and even raising the question of eliminating the estate tax. They couch their arguments in terms of loss of family farms or businesses and have renamed the tax as the death tax. This is one tax where progressives can easily change the terms of the debate.
A permanent estate tax was introduced in 1916 as a societal reaction to the accumulation of vast fortunes by the robber-barons of the time. It is one tax that helps separate America, the land of opportunity, from the old world of Europe from which many of us escaped. Many of our ancestors fled the class and property bound countries of Europe where a few families controlled all the available resources and emigrated to America where these resources--most notably land--were available to anyone willing to work hard enough to use them. This opportunity is what has built America into the modern wonder of the world.
For this reason, a better name for the estate tax should be the Landed Aristocracy Tax. It prevents the old world from descending into the new and taking away our common opportunities and placing them in the hands of just a few families who over time would come to control more and more of our resources. It helps in a small way to level the playing field across generational lines and preserve our country as the land of opportunity.
It also keeps our economy strong by helping to require those who would be successful to begin each generation anew with hard work and innovation. One can't entirely rely on inherited wealth for success in this country; one must earn it, and that's as it should be. So the estate or Landed Aristocracy Tax benefits us all; it provides needed money for the treasury and ensures that future generations will have the same opportunities that we enjoy today.