Drs Chervenak and McCullough have thoughtfully taken us through an ethical framework for abortions.

The authors rightly make the point of the “precision of terminology,” and yet fail to follow their own injunction when it comes to the important definition of the word “viability.” Viability is a point in time that keeps changing, but only in the direction, defined by the progression of our technology, toward earlier gestation in the life of the infant. This inexorable fact only serves to vitiate the authors’ use of the term as a point in time, and make it into what it truly is, a continuum of an individual’s life.

With the loss of the artificial point of viability, this would seem to make moot their ethical argument(s) for “viability” being a point of justification, given the forcefulness of their statement, that “it is ethically impermissible to offer feticide for viable fetuses… .”

As to the issue of multiple gestations from the introduction of multiple embryos requiring “selective reductions,” this should be a thing of the past and should be an ethical discussion of its own by our reproductive medicine colleagues. And, in the absence of anomalies incompatible with life, we are left with the same old conundrum of the issue of autonomy with the inherent tension being between the infant and the mother. The argument of the “continued pregnancy posing a risk to the pregnant woman’s health or life” falls under Thomas Aquinas’s doctrine of double effect. I have struggled with this issue in women with advanced cervical cancer in early gestation. I would, however, ask the authors to suggest what other medical situations they believe would be operative requiring “feticide” in a pregnancy that has reached 28 weeks’ gestation?

Finally, the authors have correctly noted the physician’s role in this dilemma, when he or she has conscience issues that do not allow them to “participate” directly or indirectly in an abortion. Clearly, those physicians who morally do not participate in abortions believe that the ethical principle of beneficence is operative for both the woman and her infant, given the data that address the long-term psychological impact of the abortion on the woman. It seems to me that the notion of one being able to schizophrenically separate a moral base into a professional conscience vs an individual conscience is not only artificial, but also incomprehensible as one’s moral base would logically compel one’s indivisible conscience.

Anonymous