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Abortion

ABORTION

PRACTICE

Medically, abortion is defined as the termination of pregnancy by any means before the fetus is sufficiently developed to survive; it is divided into spontaneous ("miscarriage") and induced. Dictionaries, encyclopedias, and textbooks sometimes follow this definition. However, the practice of induced abortion requires a definition that is properly descriptive of the moral reality. In his landmark encyclical The Gospel of Life (Evangelium Vitae) (1995), John Paul II, citing the need to "call things by their proper name," defines abortionhe uses the term "procured abortion"as "the deliberate and direct killing, by whatever means it is carried out, of a human being in the initial phase of his or her existence, extending from conception to birth " (58) (emphasis in original). Approximately 15% of recognized pregnancies end in spontaneous abortions. However, the topic of procured abortion is part of an intense debate that John Paul II calls "an enormous and dramatic clash between good and evil, death and life, the 'culture of death' and the 'culture of life"' (EV 28). At the conclusion of his classical study on abortion, Connery notes that the trend in the 19th century of eradicating abortion has now been reversed and that "in our present society the frequency of abortion is far greater than anything the Roman or ancient world ever knew or dreamed of" (Connery, 313). Indeed, the practice of abortion is unprecedented not only in terms of numbers but in term of methods and motivations.

Procedures. The purpose of abortion is to produce a dead child. Techniques for performing abortion are divided into surgical and what are called medical (involving the use of chemicals).

In surgical abortions the unborn child is killed and removed either through the woman's cervix or, for some late-term abortions, through the abdomen (hysterotomy or hysterectomy). The most common abortion technique reported in the United States for 1997 was the surgical technique of dilation of the woman's cervix and curettage (D&C) (97.4% as reported to the Center for Disease Control for 1997), including sharp curettage but mainly suction curettage (vacuum aspiration). In suction curettage, the cervix is dilated, and a hollow curette tube is inserted through the cervix and into the uterus. Suction causes the baby's body to implode; the body parts are then suctioned through the tube. After 16 weeks, dilation and evacuation (D&E) is used. A variation on D&E is intact dilation and extraction (D&X or partial-birth abortion), used primarily at 20 to 24 weeks, but sometimes later, a technique in which the child is delivered feet-first all except for the head, an instrument is forced into the base of the living child's head, the brain is sucked out, and the delivery of the now-dead child is completed.

In medical abortions, various chemicalssuch as oxytocin, saline or urea solutions, prostaglandins, mifepristone (RU-486), misoprostal, or methotrexateare used in various combinations to kill the unborn child and/or to induce premature labor. Certain contraceptive drugs and devices can also act as abortifacients by preventing implantation of the newly conceived life. This also is one of the principle effects of "morning-after pills," high doses of ordinary birth control pills taken a couple of days after intercourse.

Statistics. The number of illegal or clandestine abortions performed is by definition difficult to determine. Estimates vary widely. Once abortion is made legal, the overall incidence of abortion increases. In the United States, the incidence of legal abortion is tracked by the Center for Disease Control (CDC) and by the Alan Guttmacher Institute (AGI), founded by Planned Parenthood. CDC data are derived primarily from central health agencies and are considered incomplete. To overcome this deficiency, AGI sends questionnaires to all known abortion providers. CDC reported 193,491 legal abortions in 1970. The number increased to a peak of 1,429,577 in 1990, then generally dropped throughout the 1990s to 1,186,039 in 1997 (with a slight increase from 1995 to 1996). AGI's peak number, also in 1990, was 1,608,600, that number dropping in 1996 to 1,365,700 (also with a slight increase from 1995 to 1996). Especially since the 1950s, laws regulating and restricting the practice of

abortion have been overturned in many countries. AGI estimates that the number of legal abortions worldwide in 1995 could have been as high as 25.6 million.

Reasons for Abortion. CDC's report on U.S. abortions for 1997 showed that women obtaining abortions were more likely to be under 25 years of age (51.8%), white (58.4%), and unmarried (81%). Forty-eight percent had repeat abortions. CDC or the AGI surveys do not track reasons for abortions. Specialized surveys indicate that most abortions are elective. In one U.S. study, women on average gave 3.7 reasons for obtaining an abortion, with 76% choosing concern about how having a baby could change their lives. Similar results are found worldwide.

However, reasons for promoting the legalization of abortion extend far beyond making life choices available. Major social forces consider abortion an essential part of an effort to control population growth and size. Others see abortion as a tool to solve a wide variety of social problems, for example, poverty and crime. In these and other cases, the inherent dignity of the unborn child is negated, reduced, or superceded for the sake of other values.

CHURCH TEACHING

Each person is created in the image and likeness of God and is called to a personal relationship with God that will last forever. The life of each person is sacred and must be respected absolutely from the moment of conception to natural death. No one can ever claim the right to directly destroy an innocent human being for any reason. Direct abortion is gravely contrary to the moral law. With respect to care for the mother and her child, the Church's social teaching embraces a deep commitment

to support for families, help for pregnant women in need, and healing after abortion.

Scripture. Neither the Old nor the New Testament explicitly addresses the question of procured abortion. This silence is not a sign of acceptance but of abhorrence. Life is a gift from God, who is the Lord of life and death. Shedding the blood of the innocent was forbidden (Gn 9:46; Ex 20:13; Dt 5:17). In some texts it is suggested that God works within the womb (Jb 10:812, 31:15; Is 44:24; Ps 139:1315; 2 Mc 7:2223) and that God has a personal relationship with the unborn child (Is 49:1, 5; Jer 1:5). In the New Testament, the infancy narratives in particular manifest great respect for fetal and infant life.

Early Church. Abortion was an accepted practice in the Greco-Roman culture. As the early Church moved into this world, an explicit teaching in opposition to abortion developed. The Didache or Teaching of the Twelve Apostles, an early book of Christian instruction with roots in the Jewish community (dating perhaps from the 1st century ad), begins with a teaching on the two Ways of Life and Death, and includes the admonition: "Thou shalt not procure abortion, nor commit infanticide" (II.2). In the early centuries, the condemnation of abortion was unequivocal.

The first Church legislation prescribing penitential discipline for abortion appears in the early 4th century, beginning a legal tradition that continues to this day. The distinction between the formed and unformed fetus, especially with regard to the time of animation, entered into patristic theological reflections. A primary influence in this regard was the Septuagint (Greek) translation of a text in the Old Testament. One man in the course of fighting with another strikes a woman and causes a miscarriage (Ex 21:2225). In the Hebrew version, a fine is levied for the miscarriage, but the principle of "life for life, eye for an eye" applies to any other injuries. The Greek text introduces a distinction between the unformed and formed child, the penalty for destroying the former being a fine, for the latter "life for life." Here abortion of the formed fetus was homicide. Not all Church Fathers thought the distinction between the formed and unformed fetus was significant. Even for those who did, the time of animation was not seen as a dividing line determining when abortion was permissible. Whether formed or unformed, a new human life was under way and abortion was rejected either as homicide or as anticipated homicide.

Transmission of the Tradition. In the Middle Ages, Aristotle's biology, in which the male was formed at 40

days, the female at 90 days, was reintroduced into the West. The distinction between the formed and unformed fetus became a part of Church discipline, law, and theology, but the condemnation of abortion at any stage continued. As Connery notes, "Even during the many centuries when Church penal and penitential practice was based on the theory of delayed animation, the condemnation of abortion was never affected by it" (Connery, 304). The distinction was used mainly for purposes of legal classification and the grading of penances.

Building on an unpublished work of John of Naples, Antoninus (13891459) for the first time introduced into theology a discussion of abortion of the unanimated fetus to save the life of the mother. Theologians debated this matter for the next three or four centuries. The issue became obsolete when the distinction between formed and unformed fetus was undercut by the findings of modern science and the theory of delayed animation was displaced by that of immediate animation. Connery argues that a consensus of theologians regarding immediate animation was reached in the second half of the 19th century. "This tended to make the whole question [lregarding abortion of the unanimated fetus] somewhat speculative" (Connery, 223). In 1869, Pius IX removed the distinction between animated and unanimated fetus as a basis for penalties in Church law.

In the course of the modern debate, Antonius de Corduba (14851578) introduced a distinction between acceptable medical therapies that are immediately, directly, and principally conducive to the health of the mother (de se salutifera ) and unacceptable therapies that are immediately, directly, and principally conducive to the death of fetus (de se mortifera ). Corduba's distinction met with general acceptance and eventually became known as the distinction between direct and indirect abortion.

Modern Developments. In the second half of the 19th century, an extended debate arose among theologians over craniotomy (collapsing the skull of the child to complete delivery) and medical abortion to save the mother's life. Those in favor argued that the fetus in these circumstances was an unjust aggressor, even if only in a material sense. The intention was to save the mother's life, while the death of the fetus was accidental and unintentional. Through decrees in 1884, 1889, and finally 1895 (DS 3258, 3298), the Holy Office rejected craniotomy and medical abortion. It stated that it cannot be taught that craniotomy is licit, and that the same applies to any

medical procedure directly lethal either to the fetus or to the mother. After devoting four chapters of his book to these controversies, Connery concluded: "It may be difficult in many cases to know where to draw the line between accidental and deliberate killing, but church authorities apparently felt that these theologians [arguing for the procedures] had gone over the line" (Connery, 312).

After the issuance of the encyclical Casti connubii by Pius XI (1930), in which abortions for the mother's life or health were addressed at some length, a discussion developed among theologians on the application of the distinction between direct and indirect abortion to the case of the removal of the cancerous uterus of a pregnant woman. Theologians generally came to accept the position that it was legitimate directly to remove the cancerous uterus to save the mother's life, with the indirect effect that the child may die.

In 1898 and 1902, the Holy Office responded to questions about ectopic pregnancies (DS 3338, 3358). It recognized the general permissibility of a laparotomy, as long as serious provision was made for the life of both the fetus and the mother, but it objected to the direct removal of the nonviable fetus. In a work published in 1933, T. Lincoln Bouscaren applied the distinction between direct and indirect abortion to ectopic pregnancies. He argued that a pathological tube could be directly removed to save the mother's life, with the indirect effect that the child may die. His position was generally accepted by theologians.

In his Oct. 25, 1951 "Allocution to Midwives," Pius XII affirmed that every human being, even the child in the womb, has the right to life directly from God. There is no justification for the direct, deliberate disposal of an innocent human life, whether as an end in itself or as a means. In a Nov. 26, 1951 "Address to the Family Front Congress," Pius XII again affirmed that innocent human life from the first moment of its existence is to be preserved from any direct voluntary attack. He further stated that this principle applies to mother and child; every means must be used to save the life of both. The Holy Father explicitly adopts the distinction between direct and indirect abortion. He notes that he is careful in the use of the expression "direct killing."

The reason is that if, for example, the safety of the life of the future mother, independently of her state of pregnancy, might call for an urgent surgical operation, or any other therapeutic application, which would have as an accessory consequence, in no way desired nor intended, but inevitable, the death of the fetus, such an act could not be called a direct attempt on the innocent life. In these conditions, the operation can be lawful, as can other similar medical interventions, provided that it be a matter of great importance, such as life, and that it is not possible to postpone it until the birth of the child, or to have recourse to any other efficacious remedy.

Vatican II to the Present. In its "Pastoral Constitution on the Church in the Modern World," the Second Vatican Council summed up the Church's teaching tradition on abortion: "God, the Lord of life, has entrusted to men the noble mission of safeguarding life, and men must carry it out in a manner worthy of themselves. Life must be protected with the utmost care from the moment of conception: abortion and infanticide are abominable crimes" (51). Thirty years later, John Paul II authoritatively set forth the teaching that the direct and voluntary killing of an innocent human being is always gravely immoral (EV 57) and then with an equal invocation of authority he applied this teaching to abortion:

Therefore, by the authority which Christ conferred upon Peter and his Successors, in communion with the Bishops I declare that direct abortion, that is, abortion willed as an end or as a means, always constitutes a grave moral disorder, since it is the deliberate killing of an innocent human being. This doctrine is based upon the natural law and upon the written Word of God, is transmitted by the Church's Tradition and taught by the ordinary and universal Magisterium (EV 62) (emphasis in original).

The worldwide practice and promotion of abortion on a scale unheard of in the history of human society prompted this unprecedented formulation of the Church's teaching. Just as the Church at the end of the 19th century could not be silent about the working classes who were oppressed in their fundamental rights, so today, "when another category of persons is being oppressed in the fundamental right to life, the Church feels in duty bound to speak out with the same courage on behalf of those who have no voice" (EV 5).

SPECIAL QUESTIONS

In the process of human generation, God creates and directly infuses the immaterial and eternal soul. The Magisterium has not definitively resolved the issue of when the soul is infused. However, today, as in the past, all direct abortion from fertilization forward is rejected. In The Gospel of Life, John Paul II sets forth two basic arguments. First, a new human individual begins at fertilization: "a life is begun which is neither that of the father nor the mother; it is rather the life of a new human being with his own growth. It would never be made human if it were not human already. Right from fertilization the adventure of a human life begins, and each of its capacities requires time, a rather lengthy time to find its place and to be in a position to act" (EV 60, quoting the Congregation for the Doctrine of the Faith, "Declaration on Procured Abortion" [1974]). John Paul II takes as his own the rhetorical question asked in the CDF's instruction Donum vitae, "How could a human individual not be a human person?" Second, when human life is at issue, the safer course is required: "The mere probability that a human person is involved would suffice to justify an absolutely clear prohibition of any intervention aimed at killing a human embryo." The Holy Father continues: "Precisely for this reason, over and above all scientific debates and those philosophical affirmations to which the Magisterium has not expressly committed itself, the Church has always taught and continues to teach that the result of human procreation, from the first moment of its existence, must be guaranteed that unconditional respect which is morally due to the human being in his or her totality and unity as body and spirit" (EV 60).

In the Middle Ages, Thomas Aquinas was a proponent of delayed animation. According to his biological theory, out of excess nourishment, the male produces semen, which serves as an active instrumental cause of the generative power of the father's soul, the elements, and the heavens (responsible for the species of the one generated). Also out of excess nourishment, the female produces menstrual blood, a passive material. At conception, the semen begins acting on the menstrual blood; through a series of many generations and corruptions, a new life is generated, at first vegetative, then animal, and finally, when the body is sufficiently organized, intellectual. With respect to the completion of the generative process, the parents only dispose the matter, while God directly creates the form. In the Summa Theologiae, Thomas espouses the classic Aristotelian view that once generation is complete, the semen dissolves. "The movement of an instrument ceases when the effect has been produced in being" (Summa Theologiae I, q. 118, a. 1, ad 4).

As noted earlier, with the establishment of the cell theory, the discovery of the female ovum, and a proper understanding of the male sperm and fertilization, the theory of immediate animation became generally accepted. The essential generative act takes place at fertilization. What happens thereafter is self-directed development and growth. From the single-celled zygote stage, the new life is an organized, complex, unique, human, individual person. The new life is not a potential human being but a human being with active potential to grow and develop in accord with the life cycle proper to the human person.

Those who seek to maintain the general theory of delayed hominizationthe commonly used term today for delayed animationin the context of the new biology have difficulties in explaining how a lower form of life is transformed into a higher. If the male semen is not the cause of the ever-evolving generative process, then a new efficient cause must be found. The most economical argument places the nucleus of the zygote as the efficient cause of the developmental process. Ashley and O'Rourke point out that for Aristotle the presence of a highly organized body is dependent on the appearance of a "primary organ" (which for him was the heart) through which the soul activated the organism. But today we know that "a sequence of primordial centers of organization in the embryo goes back continuously to the nucleus of the zygote, long before the brain appears as the final center" (Ashley and O'Rourke, 236). Only the minimal structure necessary for the active potentiality of self-development is required for an organism to be an actual human person.

Not all who favor some form of delayed hominization adopt the traditional general theory. Some argue that the new human life in its earliest days and even weeks is genetically human but is not a single unified individual. However, a careful look at what is known biologically sheds new light on early human development and casts aside the suggestion that in the early stages the cells of the new life are just an aggregate.

Serra and Columbo argue that the new genome, established at fertilization, is the basis of the structural and functional unity of the embryo developing in a constant direction. In fact, the regulation of the process of development is the result of the hierarchically ordered activity of three main classes of genes: the "coordinate," the "selector," and the "realizator" genes. After reviewing the biological data, Serra and Columbo conclude: "[A]part from fortuitous disturbances, at the fusion of two gametes, a new real human individual initiates its own existence, or life cycle, during whichgiven all the necessary and sufficient conditionsit will autonomously realize all the potentialities with which he is intrinsically endowed" (165).

Johnson examined the arguments that claim irreversible individuality does not occur at fertilization but perhaps 14 or so days later. He reduces the cases giving rise to this view to three: that of the hydatidiform mole, the role of the maternal contribution to human development, and the question of totipotentiality (including the issue of twinning). In the case of hydatidiform moles, no organism is actually present or the organism is profoundly defective and doomed to die. With respect to the maternal role in the developing new life, Johnson argues that any genetic information received from the mother would be subordinate to the dominant role played by the zygote's own directive structures. The most important of these three cases is that of totipotentiality. The cells of the early embryo, perhaps up to when the primitive streak appears, possess an ability to become separate organisms, as occurs in the case of monozygotic twinning (with the subcase the possibility that the twins subsequently recombine). Thus, some argue, until twinning is no longer possible, the new life is a genetic but not a developmental individual. Johnson observes that separated early cells can develop as new individuals (a form of asexual reproduction) but that excessive focus on this "plastic" character can give rise to the idea that the early cells when part of the developing new life have no more than an incidental unity. An examination of the cells as part of the early embryo shows complex ordering, communication, and regulation one in relation to the other. He suggests that "potentially totipotential" would be a better term for the cells that are a part of the developing new life. Serra and Colombo make a similar point when they state that the totipotency present in the zygote does not mean indeterminancy, but an actual capacity for executing a plan according to a given program. Twinning occurs when cells accidentally break off (due, for example, to an error in cell division) and is the exception to the rule. Johnson argues that the claims for delayed hominization that he has examined cannot be used as grounds to justify any proposed action.

CONCLUSION

On many occasions, John Paul II has addressed the question of abortion. In his Oct. 7, 1979 homily on the Mall in Washington, D.C., he poignantly summed up the Church's teaching: "I do not hesitate to proclaim before you and before the world that all human lifefrom the moment of conception and through all subsequent stagesis sacred, because human life is created in the image and likeness of God. Human life is precious because it is the gift of a God whose love is infinite; and when God gives life, it is forever."

Bibliography: "Law and the Incidence of Abortion," Documentation on Abortion and the Right to Life II (Washington, DC 1976), 511. a. torres and j. d. forrest, "Why Do Women Have Abortions?" Family Planning Perspectives 20 (1988) 6976. f. g. cunningham, et al., eds., Williams Obstetrics: 20th Edition (Stamford, Conn. 1997). k. l. moore and t. v. n. persaud, Before We Are Born: Essentials of Embryology and Birth Defects, 5th ed. (Philadelphia 1998). s. k. henshaw, "Abortion Incidence and Services in the United States, 19951996," Family Planning Perspectives 30 (1998) 26370, 287; Sharing Responsibility: Women, Society, and Abortion Worldwide (New York 1999); "Abortion Surveillance United States, 1997," Morbidity and Mortality Weekly Report: CDC Surveillance Summaries 40 (Dec. 8, 2000). Congregation for the Doctrine of the Faith, "Declaration on Procured Abortion," (1974); "Instructions on Respect for Human Life in Its Origins and on the Dignity of Procreation," (1987). Catechism of the Catholic Church 2258, 227075, 2319, 232223. john paul ii, The Gospel of Life (Evangelium Vitae) (1995). "The Didache, or Teaching of the Twelve Apostles," The Apostolic Fathers, v. 1, tr. k. lake (Cambridge, Mass. 1965). U.S. Catholic Bishops, Pastoral Plan for Pro-Life Activities: A Reaffirmation (1985); Faithful for Life: A Moral Reflection (1995); Living the Gospel of Life (1998). j. t. noonan, jr., "An Almost Absolute Value in History," in The Morality of Abortion: Legal and Historical Perspectives (Cambridge, Mass. 1970), 159. g. grisez, Abortion: The Myths, the Realities, and the Arguments (New York 1970); The Way of the Lord Jesus, v. 2: Living a Christian Life (Quincy, Ill. 1993). b. ashley, "A Critique of the Theory of Delayed Hominization," in An Ethical Evaluation of Fetal Experimentation: An Interdisciplinary Study, ed. d. g. mccarthy and a. s. moraczewski (St. Louis, Mo. 1976), 11333. b. ashley and k. d. o'rourke, Health Care Ethics: A Theological Analysis, 4th ed. (Washington, DC 1997). j. connery, Abortion: The Development of the Roman Catholic Perspective (Chicago, Ill. 1977). s. j. heaney, ed., Abortion: A New Generation of Catholic Responses (Braintree, Mass. 1992). m. johnson, "Delayed Hominization," Theological Studies 56 (1995) 74363. p. lee, Abortion and Unborn Human Life (Washington, DC 1996). t. j. o'donnell, Medicine and Christian Morality, 3d ed. (Staten Island, N.Y. 1996). i. c. de paula, "The Respect Due to the Human Embryo: A Historical and Doctrinal Perspective," in Identity and Statute of Human Embryo: Proceedings of Third Assembly of the Pontifical Academy for Life, ed. j. de dios vial correa and e. sgreccia (Vatican City 1998), 4873. a. serra and r. colombo, "Identity and Status of the Human Embryo: The Contribution of Biology," in ibid., 12877. w. e. may, Catholic Bioethics and the Gift of Human Life (Huntington, Ind. 2000). j. donceel, "Immediate Animation and Delayed Hominization," Theological Studies 31 (1970) 76105. n. ford, When Did I Begin? Conception of the Human Individual in History, Philosophy, and Science (Cambridge, Eng. 1988). t. a. shannon and a. b. wolter, "Reflections on the Moral Status of the Pre-Embryo," Theological Studies 51 (1990) 60326.

[m. a. taylor]

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