Doctor Science Knows

Friday, June 12, 2009

Abortion and quickening

OMG, I spent too much time today in the continued discussion at Erin's post All or Nothing:
my latest:

abortion stops a beating heart
I've often wondered about this slogan -- I used to drive by a billboard displaying it. Two things went through my head every single time:

a) so does a heart transplant

b) you're saying before there's a heartbeat it's OK, then?

When your billboard makes me think these things I'm not sure it was a successful slogan.

Let's see what sources I have to hand. In A Historical Summary of Abortion from Antiquity through Legalization (1973), Excerpted from A Christian View of Abortion By John W. Klotz (Concordia):
One interesting and oft cited distinction made in the early church was that abortion in the early stages of a pregnancy was not considered wrong. The reason for this can be traced back to Aristotle who held that the soul entered the body of a male fetus at 40 days and the body of a female fetus at 80 days. He believed that at conception the individual received a vegetable soul which gradually was replaced with an animal soul and finally by a rational soul. It was only after the appearance of the rational soul that abortion was to be considered murder. Sixtus V issued a bull in 1588, Effraenatum, wiping out the 40- and 80-day rule and punishing all abortion as murder; the punishment was to be excommunication. Subsequently Gregory XIV returned to the 40- and 80-day rule. However in 1869 Pius IX returned to the sanctions of Sixtus V.
Note that he says not just "not murder", but "not wrong". From The History of Birth Control, by Kathleen London:
The majority of women before the 19th century and many in the 19th century did not consider abortion a sin. Until the early part of the [19th] century, there were no laws against abortions done in the first few months of pregnancy [in the US]. Prior to the 19th century, Protestants and Catholics held abortion permissible until ‘quickening’—the moment the fetus was believed to gain life.

The issue was always killing, not a husband's rights, or else the act would not have been condemned had it been taken at the father's behest, which was not he case at all.Here I am relying more on my memory (it's been a long time since I read the primary sources, and the books I have to hand aren't the ones I need). In the 19thC, at least, doctors and clerics were very conflicted when husbands wanted their wives' pregnancies terminated when the wife did not. On the one hand, abortion (ew ew); on the other, undermining husbandly authority. I do not recall hearing about male authority figures advising wives to resist their husband's wishes on this issue, nor, frankly, does it seem plausible given the general emphasis on wifely submission and the extremely broad rights a husband had to his wife's body.

I do seem to recall that clerics (who tended to be more distant from the realities than doctors were) had a hard time believing that a husband truly *would* want his wife to abort -- and the situation where a wife wanted a child despite her personal danger[1] but the husband did *not* would not have been common.

The situation with unmarried couples was different, of course, and the rhetoric often stressed how aborting illegitimate pregnancy was covering up "the crime" -- the crime being illicit sex. In George Eliot's "Adam Bede", Hetty Sorrel is guilty of infanticide by abandonment, but her sentence of hanging is commuted to transportation (to Australia) when her well-born lover confesses. It's not clear how realistic this is, of course, and how much her life is spared because her boyfriend turns out to be the Squire's son. Within the novel, it's clear that Hetty's unwillingness to "name the father" is considered an aggravating circumstance.

Update #2 (multiple comments):

You don't do that when people's elderly parents die, do you, even though it is *possible* that euthanasia was involved?

My experience is that there *is* an investigation when an elderly person dies alone and unexpectedly. It's also my experience that the issue is far more likely to be suicide than euthanasia.

do you really think that when people hold strong to a moral principle, that means they are absolutely incapable of any nuance when it comes to law?

"All or nothing" is what it says.

Here's a primary source quote for you:
To the dismay of medical leaders, the public still believed that quickening marked the beginning of life. The practice of abortion persisted nationwide. "Many otherwise good and exemplary women," Dr. Joseph Taber Johnson reported in 1895, thought "that prior to quickening it is no more harm to cause the evacuation of the contents of their wombs than it is that of their bladders or their bowels."

[quoted in "When Abortion Was a Crime", from Joseph Taber Johnson, "Abortion and its Effects," American Journal of Obstetrics and Diseases of Women and Children 33 (January 1896): 86-97]

As for how reasonable people would be in practice, here's a Boston Globe article on the abortion ban in Nicaragua, El Salvador, and Chile. In those countries, poor women may find it difficult or impossible to be treated in a timely way for ectopic pregnancy or miscarriage, due to doctors' fear of prosecution. As you probably know, a D&C is both a method of abortion and frequently necessary to treat miscarriage -- doctors in public hospitals in these countries will wait as long as possible before performing one, lest they be charged with murder.

At present, do people hold inquests for every death that occurs? I was unaware of this practice.

AFAIK all "unattended deaths" are investigated, yes. I don't think they all go to the legal level of a formal inquest, but they're definitely treated as police matters.

Another citation:
While Aquinas had opposed abortion — as a form of
contraception and a sin against marriage — he had maintained that the
sin in abortion was not homicide unless the fetus was ensouled, and thus,
a human being. Aquinas had said the fetus is first endowed with a
vegetative soul, then an animal soul, and then — when its body is
developed — a rational soul. This theory of "delayed hominization" is
the most consistent thread throughout church history on abortion.

from Joseph F. Donceel, S.J., "Immediate Animation and Delayed Hominization,"
Theological Studies, vols. 1 & 2 (New York: Columbia University Press,
1970), pp. 86-88; cited here.


I don't get it. How would abortions continue without any problem? How would doctors go around performing surgical abortions for a living? Attempting to self-inflict abortion is dangerous and I doubt many women would go for it.

I'm going to assume that this an honest question, and that you were born after 1960 or so. I have a post in moderation with links, but briefly: there would be a network of discrete, well-paid doctors performing safe, expensive abortions for well-to-do women. *Lots* of women who couldn't afford such doctors would try all kinds of things to induce abortion, and many, many of them would die.

When pro-choice activists say "No More Coat Hangers!" they're talking about a historical reality.

I don't get it. How would abortions continue without any problem? How would doctors go around performing surgical abortions for a living? Attempting to self-inflict abortion is dangerous and I doubt many women would go for it.

I'm going to assume that this an honest question, and that you were born after 1960 or so. Alas, this comment will go to moderation, but I hope the links will be worth it.

Some doctors would still make a living performing abortions for well-to-do women, as is the case in most of Latin America (as reported in the Boston Globe article I linked to previously). When Barry Goldwater's daughter became pregnant out-of-wedlock in 1955, he arranged a safe, though illegal, abortion for her in New York. Networks of safe, expensive, discrete abortion doctors were *everywhere* in those days, with referrals through an intense network of word-of-mouth, mostly woman-to-woman, and ads using the words like "full gynecological services" and "complete privacy and discretion". Women would go out-of-town if they could -- a "spa weekend" to "restore one's health" was a *euphemism* in my youth. I don't know what this kind of service cost in today's dollars, but I'd guess that if a legal abortion costs $400 today, a safe illegal one one would cost $1000 or more, if you follow me.

As for women who couldn't afford a good doctor, yes they did take awful risks. Here's one doctor's report:
The first month of my internship [in 1962] was spent on Ward 41, the septic obstetrics ward. Yes, it's hard to believe now, but in those days, they had one ward dedicated exclusively to septic complications of pregnancy.

About 90% of the patients were there with complications of septic abortion. The ward had about 40 beds, in addition to extra beds which lined the halls. Each day we admitted between 10-30 septic abortion patients. We had about one death a month, usually from septic shock associated with hemorrhage.
Right now, complications from illegal abortions are a leading cause of death for women of child-bearing age in South America. In Peru alone, an estimated 50,000 women a year either die or suffer serious complications after an illegal abortion. More women in Ethiopia die from complications from illegal abortions than from any other medical reason save tuberculosis, the World Health Organization reports.


I have the impression that Rebecca thinks making abortion illegal would eliminate almost all of them, and that's what I was addressing.

Yes, making it illegal would reduce the rate -- but it would also severely *increase* the death rate for women, and abortions that did occur would be at a later stage because the finances and logistics would be more difficult.

Another cite from "When Abortion Was a Crime": The year after abortion was legalized in New York State, the maternal-mortality rate there dropped by 45 percent.


It's true that I never heard first-hand of anyone using a coat hanger. I did hear first-hand stories about crochet hooks. Is that scary enough for you? You've said that "I doubt many women would go for [self-inflicted abortion]", but the historical record and what's going on in Latin America proves that many *will*. Shocking, dangerous, horrifying -- yes, but it's a *fact*.

[1] How many of your great or great-great-grandmothers died in childbirth? Of my four great-grandmothers (born in various countries between 1865 and 1880), half died in or shortly after childbirth.

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