Justice Harry Blackmun, who delivered the majority opinion of the US Supreme Court in Roe v. Wade in 1973, humbly stated, “We need not resolve the difficult question of when (human) life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man’s knowledge, is not in a position to speculate as to the answer.”
It is unfortunate that the issue of abortion has become so polarized. We would all be better served if we could turn down the rhetoric. We need to do away with the sound bites that populate these discussions: “Stop killing babies,” is a well-known phrase. Well, how do we define babies? “It’s my right to have an abortion.” Are any rights absolute?
Justice Blackmun went directly to the heart of this debate: How do we define personhood? Who gets to define personhood?
As a physician, I contend that personhood cannot be defined medically, but there are appropriate medical terms that we can use to describe the formation of a person. Science is able to determine what is living and what is not. One can analyze a sperm cell or an egg cell and determine if it is genetically human material. At the point of fertilization, “it” would be considered, a human organism, a “zygote.” After the zygote starts to divide and forms organs it would be a human organism, an embryo. After eight weeks gestational age, it becomes a human fetus. Today, although medical support probably will be required at 24 weeks gestation, the fetus is capable of living outside the mother’s womb. At the time of delivery, and with the first breath, it is a human infant, a child, a baby.
American citizens live in a religiously pluralistic society: Christians, Muslims, Jews, Buddhists, Atheists, etc. None of these religious traditions is monolithic. No religious perspective speaks for all of its adherents; and no religion has a monopoly on morality.
I will give an example of two religious perspectives on personhood, looking at the two extremes of human development: conception and birth. I will be assuming that no one would attribute human personhood to a sperm and/or an egg.
The official Roman Catholic doctrinal statement, although not an infallible teaching, states that “ensoulment” occurs at the time of conception, with the union of the sperm and the egg; in the Catholic tradition, this organism becomes a person. This is relatively recent teaching, appearing in Pope Pius XI’s 1930 marriage encyclical Casti Connubii; which stated that abortion is a sin against life. In the early church, before the 1930 statement, because of a lack of modern medical knowledge, “quickening,” the perception of fetal movement, which usually occurs at approximately the fifth month, was thought by some to be the time when the fetus was considered a person.
St. Thomas Aquinas, an early Roman Catholic theologian (in the 1300s), recognized the physical and spiritual dimensions of all living things: plants, animals, and humans. He thought of the spiritual dimension as the “soul” of an entity. He also proposed a hierarchy whereby human life would demand more respect. He wrote that human life proceeds through developmental stages (hominization).
Under such a scenario, the early embryo at the time of fertilization would have a “vegetative” soul and draw its nutrition from the mother. As the embryo continues to develop, it attains a “sensory, or an animate,” soul. At some time in the developmental process, when God deems it appropriate, the organism is invested with a “human/individual/rational/personal” soul.
A Jewish perspective would be at the other end of the spectrum of religious beliefs. For the practicing Jew, the debate to have or not have an abortion is rooted in the context of the situation, as well as the temporal point of the pregnancy. If the mother’s health is at risk (or a fetus has a life-threatening birth defect), not only would abortion be permitted, but it may also be encouraged. The embryo, and the fetus, is considered a part of the mother’s body. The moral status of the fetus is based on the proximity to its own independent viability; it does not have an equal moral status with the mother until the baby is delivered and takes its first breath.
The beliefs of the other religions may lie between these two perspectives. So, to summarize, Catholics believe that the zygote is a person, while Jews don’t attribute personhood until the fetus takes its first breath. So where do we go from here?
Well conversely, at the other end of life’s journey, we can see an individual progressing through various degenerative stages or “de-hominization.” A person, who for whatever reason, may be existing in a persistent vegetative state or coma, is incapable of expressing their health care choices. These individuals, because they lack the capacity to make health care decisions for themselves, may need to rely on a surrogate decision maker; someone they have designated, or if necessary, someone assigned by the court.
Fortunately, the original signers of our Constitution, in adding the Bill of Rights, wrote the First Amendment to assure that we all enjoy the ability to practice our own spiritual and religious beliefs. “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof….” If we as individuals don’t wish to undergo an abortion, we should not be forced to have one, as what happened in China, in 1979, with its “One Child Policy.” On the flip side, if a woman decides that it is in her best interest to terminate the pregnancy, Constitutionally, she should not be prohibited from obtaining a medical abortion.
From a practical standpoint, whether we personally agree, the mother should be deemed to be the person capable of making such difficult medical decisions. She would be the best designated (surrogate) decision maker for a specific pregnancy, since she is fully aware of the context of her current pregnancy.
Paul Manganiello is emeritus professor of obstetrics and gynecology, at Dartmouth’s Geisel School of Medicine at Dartmouth. He lives in Norwich.