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Abortion, Euthanasia, and The Value of Life

A number of ethical questions cluster around both ends of the human life span. Whether abortion is morally justifiable has popularly been seen as depending on our answer to the question “When does a human life begin?” Many philosophers believe this to be the wrong question to ask because it suggests that there might be a factual answer that we can somehow discover through advances in science. Instead, these philosophers think we need to ask what it is that makes killing a human being wrong and then consider whether these characteristics, whatever they might be, apply to the fetus in an abortion. There is no generally agreed upon answer, yet some philosophers have presented surprisingly strong arguments to the effect that not only the fetus but even the newborn infant has no right to life. This position has been defended by Jonathan Glover in Causing Death and Saving Lives (1977) and in more detail by Michael Tooley in Abortion and Infanticide (1984).

Such views have been hotly contested, especially by those who claim that all human life, irrespective of its characteristics, must be regarded as sacrosanct. The task for those who defend the sanctity of human life is to explain why human life, no matter what its characteristics, is specially worthy of protection. Explanation could no doubt be provided in terms of such traditional Christian doctrines as that all humans are made in the image of God or that all humans have an immortal soul. In the current debate, however, the opponents of abortion have eschewed religious arguments of this kind without finding a convincing secular alternative.

Somewhat similar issues are raised by euthanasia when it is nonvoluntary, as, for example, in the case of severely disabled newborn infants. Euthanasia, however, can be voluntary, and this has brought it support from some who hold that the state should not interfere with the free, informed choices of its citizens in matters that do not cause others harm. (The same argument is often invoked in defense of the pro-choice position in the abortion controversy; but it is on much weaker ground in this case because it presupposes what it needs to prove–namely, that the fetus does not count as an “other.”) Opposition to voluntary euthanasia has centred on practical matters such as the difficulty of adequate safeguards and on the argument that it would lead to a “slippery slope” that would take us to nonvoluntary euthanasia and eventually to the compulsory involuntary killing of those the state considers to be socially undesirable.

Philosophers have also canvassed the moral significance of the distinction between killing and allowing to die, which is reflected in the fact that many physicians will allow a patient with an incurable condition to die when life could still be prolonged, but they will not take active steps to end the patient’s life. Consequentialist philosophers, among them both Glover and Tooley, have denied that this distinction possesses any intrinsic moral significance. For those who uphold a system of absolute rules, on the other hand, a distinction between acts and omissions is essential if they are to render plausible the claim that we must never breach a valid moral rule.

ABORTION

Abortion is the termination of a pregnancy before the infant can survive outside the uterus. The age at which a fetus is considered viable has not been completely agreed upon. Many obstetricians use either 21 weeks or 400-500 grams (0.9-1.1 pounds) birth weight as the baseline between abortion and premature delivery, because few infants have survived when they weighed less than 500 grams at birth or when the pregnancy was of less than 21 weeks’ duration. Generally speaking, the fetus has almost no chance of living if it weighs less than 1,000 grams (2.2 pounds) and if the pregnancy is of less than 24 weeks’ duration. In one effort to resolve the matter, the American College of Obstetricians and Gynecologists has defined abortion as the expulsion or extraction of all (complete) or any part (incomplete) of the placenta or membranes, with or without an abortus, before the 20th week (before 134 days) of gestation. Early abortion is an abortion that occurs before the 12th completed week of gestation (84 days); late abortion is an abortion that occurs after the 12th completed week but before the beginning of the 20th week of gestation (85-134 days).

In the past the word abortion usually meant to nonmedical persons the elective interruption of a pregnancy, whereas “miscarriage” indicated a spontaneous expulsion of the uterine contents. The term miscarriage is seldom used medically. Abortion is generally permitted within Islam unless it is to save the mother’s life.

* The later the abortion takes place the worse it is thought to be.

* Some Muslims believe that for the first four months of pregnancy the woman has greater rights than the foetus but that after this time they are equal.

* Before the time of Prophet Muhammad (Peace Be Upon Him), unwanted female children were often buried alive in Arabia. Islam is opposed to abortion because the Qu’ran teaches:

“Kill not your offspring for fear of poverty, it is We who provide for them and for you. Surely, killing them is a great sin. (Surah 17:32)”

Islam teaches that children are a gift from Allah:

“He bestows children, male or female according to His will, or He bestows both males and females; and He leaves barren whom He wills. (Surah 42:49-50)”

Spontaneous abortion is the expulsion of the products of conception before the 20th week of gestation without deliberate interference. As a general rule, natural causes are responsible for loss of the pregnancy. An induced abortion is the deliberate interruption of a pregnancy by any means before the 20th week of gestation. In medical terminology an abortion may be therapeutic or elective (voluntary). A therapeutic abortion is the interruption of a pregnancy before the 20th week of gestation because it endangers the mother’s life or health or because the baby presumably would not be normal. An elective abortion is the interruption of a pregnancy before the 20th week of gestation at the woman’s request for reasons other than maternal health or fetal disease. Most abortions in the United States are performed for this reason.

A spontaneous abortion usually passes through several progressive stages. The first stage is a threatened abortion in which a woman, known to be less than 20 weeks pregnant, notices a small amount of bloody discharge from her vagina and, perhaps, a few cramping pains in her uterus. By pelvic examination it is determined that her cervix has not started to open or dilate. Either the symptoms subside or the matter progresses to an inevitable abortion, in which there is increased bleeding, the uterine cramps become more severe, and the cervix, or mouth of the uterus, opens for the expulsion of the uterine contents. An inevitable abortion terminates either as a complete or an incomplete abortion, depending on whether or not all the products of gestation are expelled. The process may start abruptly with pain and profuse bleeding and be over in a few hours, or it may go on for days with only a modest loss of blood. Spontaneous abortions early in pregnancy tend to be complete. When the pregnancy is further advanced, it is more likely to be incomplete. Usually the physician removes the retained tissue in the uterus surgically when there is an incomplete abortion.

If the fetus dies and is retained in the uterus for eight weeks or longer, the condition is referred to as a missed abortion. Women who lose three or more consecutive pregnancies of less than 20 weeks’ duration are said to suffer from recurrent abortion. An infected abortion is an abortion associated with infection of the genital organs.

Approximately 15 percent of all clinically evident pregnancies terminate in spontaneous abortion. A much higher rate of early pregnancy loss–more than 40 percent–is believed to occur. Some are lost so early that the woman and her physician are not sure whether she aborted or had a menstrual period that was slightly delayed, particularly heavy, and more painful than usual. The majority occur between the 6th and the 12th week after conception. Modifications in the abortion laws in several countries, including the United States, have greatly increased the number of requested abortions; it is believed that in some areas the number of abortions exceeds that of babies delivered alive.

At least half of all spontaneous first-trimester abortions have been found by karyotyping (examination of chromosome characteristics) to have a chromosomal abnormality. Some of these genetic mistakes are caused by abnormal characteristics carried in the egg or sperm or by the failure of normal rearrangement of the chromosomes to occur after the egg and sperm unite. It has been shown in animals that disturbances in the transportation of the fertilized egg to the uterus may cause premature or delayed implantation of the conceptus; fertilized eggs that are too young or too old tend to abort. Inadequate secretion of the ovarian hormones estrogen and progesterone, needed for the development of the newly fertilized egg, may cause failure of the lining of the uterus and its secretions to sustain the young embryo. Later, failure of the placenta to take over the hormone-producing function of the ovary may adversely affect the growth of the uterus and its contractility. X rays in large doses, radium, and certain drugs may cause abortion because they damage embryonic tissues. Abnormal development of the mother’s uterus may make it impossible for it to retain the pregnancy.

Late abortion is sometimes caused by the weakness of the cervix or by fetal death following knotting of the umbilical cord. Uterine tumours may cause abortion because they increase uterine irritability or create an unfavourable environment for embryonic growth. In most instances in which psychological factors allegedly caused an abortion, examination of the baby and of the afterbirth have shown defects in one or both that had occurred before the mother had suffered her emotional disturbance. Physical injury to the mother is a causative factor in only one in a thousand abortions. Abortions thought to be caused by automobile accidents, falls, kicks, and so forth are often the result of deleterious changes in the fetus and sac that occurred before the injury. Systemic diseases may play a role in causing an abortion. This is particularly true of acute infectious diseases with high fever and bacteria in the bloodstream, or of diseases such as pneumonia, in which there is a marked reduction in the supply of oxygen to the fetus. Heart disease, kidney disease, diabetes, high blood pressure, and other chronic diseases may be associated with premature birth and fetal death after the 21st week but do not ordinarily cause abortions.

Perhaps 3 percent of threatened abortions are prevented by rest and hormonal therapy. Most abortions are inevitable because the fertilized egg is abnormal; these cannot be controlled medically. Many women who suffer from recurrent abortion respond well to treatment; in some of these cases corrective surgery is necessary. An early spontaneous abortion without infection is rarely followed by ill health when the affected person receives proper medical treatment. Infected abortions, many the result of elective interruptions of pregnancy, have caused chronic pelvic distress and, in some cases, sterility.

EUTHANASIA

Euthanasia also called MERCY KILLING, act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder. Because there is no specific provision for it in most legal systems, it is accounted either suicide (if performed by the patient himself) or murder (if performed by another). A physician may, however, lawfully decide not to prolong life where there is extreme suffering; and he may administer drugs to relieve pain, even though he knows that this may shorten the patient’s life. In the late 20th century, several European countries had special provisions in their criminal codes for lenient sentencing and the consideration of extenuating circumstances in prosecutions for euthanasia. Islam is totally opposed to euthanasia and suicide. The Qu’ran says that Allah created all life and everything belongs to him:

“To Allah belongs the kingdom of the heavens and the earth. He creates what He pleases. (Surah 42:49)”

Life is sacred and people are forbidden to kill themselves:

“Destroy not yourselves. Surely Allah is ever merciful to you. (Surah 4:29)”

Muhammad (Peace Be Upon Him) said that people who committed suicide would go to hell.

If people are suffering badly they should ask Allah for help:

“O ye who believe, seek help with patient perseverance and Prayer; surely Allah is with those who patiently persevere. (Surah 4:29)”

“We will surely test you with something of fear and hunger, some loss of wealth and lives and the fruits of your work; but give glad tidings to those who patiently persevere, who, when a misfortune overtakes them do not lose heart, but say: To Allah we belong and to Him is our return. (Surah 2:155-156)”

No one has the right to decide when they will die:

“When their time, arrives they cannot tarry for a single hour nor can they go ahead. (Surah 16:61)”

The opinion that euthanasia is morally permissible goes back to Socrates, Plato, and the Stoics. It is rejected in traditional Christian belief, chiefly because it is thought to come within the prohibition of murder in the Ten Commandments. The organized movement for legalization commenced in England in 1935, when C. Killick Millard founded the Voluntary Euthanasia Legalisation Society (later called the Euthanasia Society). The society’s bill was defeated in the House of Lords in 1936, and so also was a motion on the same subject in the House of Lords in 1950. In the United States, the Euthanasia Society of America was founded in 1938.

The potential of modern medical practice to prolong life through technological means has provoked the question of what must be decided by the physician and the family in cases of extreme physical or emotional suffering, especially if the patient is incapable of choice. Passively doing nothing to prolong life or withdrawing life-support measures has resulted in criminal charges being brought against physicians; on the other hand, the families of comatose and apparently terminal patients have instituted legal action against the medical establishment to make them stop the use of extraordinary life support.