In 1980, former Surgeon General C. Everett Koop wrote, "In my thirty-six years in pediatric surgery, I have never known of one instance where the child had to be aborted to save the mother's life." Planned Parenthood's Dr. Alan Guttmacher stated, "Today it is possible for almost any patient to be brought through pregnancy alive, unless she suffers from a fatal illness such as cancer or leukemia, and, if so, abortion would be unlikely to prolong, much less save, life." Both quotes apply to the unfortunate circumstance where the mother's life is at risk due to pregnancy; in the abortion debate, this is often proposed.
To lay some context, I will first note that, as the above quotes demonstrate, this kind of situation is incredibly rare. But, because it is possible for a woman to face severe physical risks due to pregnancy, it is important to determine the ethical course of action in such a case.
I have found that this situation, probably more than any other "tough case," can seduce even the most passionate pro-lifer to make an exception. He may feel that to forbid abortion in such an instance would be to place the life of the child above the life of the mother; and this doesn't seem very pro-life at all— because it's not.
In reality, the pro-life position has never been that a child's life is more important than his mother's, but simply that they are equal. To allow harm toward the life of a mother for the sake of her child is just as morally reprehensible as to allow harm toward the life of a child for the sake of his mother. Indeed, the pro-life proclamation is clear: all human beings have the same value. The moment we begin ranking lives and saying who should live and who should die, we have stopped being pro-life and have started playing God.
Let me get straight to an answer: There are no situations in which the intentional killing of an unborn child is justified. That being said, we cannot sit back and allow women to die from risky pregnancies. This is why the life-of-the-mother-circumstance can appear to be a rather serious predicament for the ethicist.
What should we do? Broadly speaking, everything should be done to support both the life of the child and the life of the mother. One might think of the situation as he would a terrible car crash in which two passengers are trapped, and removing one may risk the life of the other. The emergency team is morally obligated to do all they can to safely remove both victims from the car, granting neither one greater favor.
But what does this kind of ethic look like in the case of abortion? If a pregnancy becomes threatening during the second or third trimesters, a doctor can ethically induce labor, deliver the child prematurely, and sustain the child outside of the womb with intensive neonatal care. During the first trimester, however, premature delivery is not an option. The question then becomes what to do when a pregnancy threatens a woman's life before her baby is strong enough to survive on his own.
The only real-world medical problem we are really talking about here is ectopic pregnancy. This occurs when the embryo implants somewhere other than inside the uterus— usually in the fallopian tube, or sometimes in the ovary, abdomen, or cervix. Such a pregnancy often ruptures the fallopian tube, and, alternatively, results in a successful birth only 5% of the time[1]. According to analyses of statistics provided by American Academy of Family Physicians, WebMD, and Centers for Disease Control, the risk of maternal death due to an untreated ectopic pregnancy lies somewhere between .05% and .119%[2]. While this risk is incredibly low, it is real, nonetheless. Therefore, in such an instance, a surgeon can ethically remove the expanding fallopian tube with the embryo inside, if the woman so desires— that's a medical problem, and he is addressing it[3].
In philosophy, there is a principle called double effect: a morally permissible action may have a foreseen but unintended side-effect. In the case of a tubal pregnancy, removing the fallopian tube may be necessary to preserve the life of the mother, and, tragically, will likely result in the death of the child[4]. Nonetheless, removing the tube is very different from abortion, which is intended to kill the child; in ethics, intent matters.
I would like to make just a few final notes.
First, neither the health-of-the-mother-circumstance nor the rape-circumstance, if maintained as legitimate reasons for abortion, would justify the current status of abortion in the United States. Under today's legal standing, a woman may undergo an abortion in all 50 states, through all 9 months of pregnancy, for nearly any reason she deems fit. Hence, when a person argues that abortion should be legal because of situations like life-risk and rape, even if he were to succeed in that argument, he would only be justifying the 4% of abortions that occur because of such circumstances; meanwhile, his argument does not support 96% of abortions in America. Indeed, to argue for legalized abortion from so-called "exceptions" is as silly as to argue for the abolishment of traffic laws due to the fact that a man might need to run a stop sign one evening to get his wife to the hospital[5].
Second, a closely related argument to the health-of-the-mother argument is the fairly common pro-choice contention that child-bearing is dangerous, and no woman should be forced to risk that danger against her will. This argument is silly for several reasons, but mostly because the alternative the pro-choicer is suggesting is abortion, and having an abortion is more physically dangerous than giving birth— the natural outcome of pregnancy. The most recent report from the Centers for Disease Control shows that the pregnancy-related mortality rate in the U.S., for instance, is .0118%, whereas, in some nations, as much as 55% of abortions are unsafe[2,6]. Which is better for women: delivery or abortion?
Being comprehensively pro-life is neither extreme nor uncompassionate. To insist on the right to life for everyone does not infringe on the right to life of anyone, and if we are to truly stand for the principles of human rights, we must do so without compromise or apology. No matter what emotional appeals a person makes, intentionally killing an innocent human being is still always wrong; atypical circumstances do not change that.
Let's love women and children. Let's be comprehensively pro-life.
Vita Pro Omni!
[1] BBC News
[2] Pregnancy-Related Mortality Surveillance (http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5202a1.htm)
[3] On the other hand, upon realizing that an ectopic pregnancy is actually far less life-threatening than many people believe, a woman may also choose to simply "wait, watch and pray."
[4] It is important to note here that removing the fallopian tube often does not kill the child at all, because he has already died well before the surgery became necessary.
[5] A point Francis J. Beckwith makes in his book Defending Life: A Moral and Legal Case Against Abortion Choice (p. 105)
[6] World Health Organization (http://www.who.int/reproductivehealth/topics/unsafe_abortion/en/index.html)
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