Part IV
May 1984
A. Reflections for Those Giving Spiritual Care
The task of ethical reflection and the application of moral judgments to the life of the individual Christian falls not only to Christian pastors but also to Christian counselors, physicians, and--perhaps in some cases more so--to others closely associated with the person seeking help. With the promotion and growing acceptance of abortion as a matter of private choice and constitutional right, fewer women are seeking professional or ministerial counseling in their deliberations about abortion. Today, advice and guidance concerning abortion decisions come primarily from peers, friends, and family--if, indeed, the pregnant woman consults anyone at all. Certainly, any serious counseling that is done is likely to have been done before a woman goes to an abortion clinic. The remarks that follow, therefore, are addressed not only to pastors and to Christian physicians and counselors, but also to anyone who may suddenly be faced with the challenge and opportunity of counseling with a woman or a couple contemplating abortion.
1. The Contemporary Setting
a. Women are being conditioned to want and feel the need for abortions. Data from many countries indicates that a change from restrictive to permissive abortion laws gives rise to a group of women who seek abortions when they would not previously have done so. The subjectively felt stress which leads many women to seek an abortion can be understood correctly only if this social influence is recognized and taken into account.
b. Overlooked in the abortion dilemma is the distress often experienced by the father of the child to be aborted. Numerous studies have reported that men may have difficulties with an abortion experience and may suffer painful role conflict. Since abortion is legally the choice of the woman alone, she may, in effect, choose motherhood, while he may not choose fatherhood. Some men, thwarted in their desire and need to protect their offspring, report persistent dreams about the destroyed child and considerable guilt and sadness. [21]
c. A near constant which must be remembered in counseling women who are considering (or have had) an abortion is their low self- esteem. Many have difficulty appreciating the dignity and value of their own lives. They may have a poor self-image or may have experienced rejection at a crucial moment in their lives. It is understandable, then, that they may have difficulty affirming the dignity and value of the child within them. The pain they know takes precedence over the unseen child they do not know. For such women an abortion may only reinforce their negative feelings about themselves. [22]
2. Counseling Considerations
a. Abortion counseling should be crisis counseling. Abortion is an irreversible action often chosen at a time when careful, unhurried reflection is difficult. In such circumstances all of us may make decisions which are not best for us and which we may later regret. The distressed woman or frightened teenager facing pressures of time, economics, and even coercion from those with vested interests may be ill-suited to make a constructive and wise decision. It is imperative, therefore, that she be involved in an exploration of her situation and her alternatives.
b. It is important to identify accurately the real reason or reasons an abortion is being considered. For example, is it the condition of pregnancy or the result of pregnancy (the child) which is the source of anxiety? If the pregnancy itself is at issue, this may be because of lack of money for medical care, an existing health problem complicated by pregnancy, loss of employment, other inconveniences due to pregnancy, embarrassment, or rejection by one's spouse or partner when he becomes aware of the pregnancy. If the child to be born is the issue, this may be because of the woman's inability (financially, socially, or emotionally) to care for him, due to fear of single parenthood or fear of a child with mental or motor disabilities. Only by isolating the real problem, exploring its dimensions, and considering its possible resolutions will the woman's interests, as well as the child's, be fostered and protected.
c. Be aware of potential risks. Those who stand to benefit financially from an abortion are least likely to inform the distressed woman of possible physical problems which can result. Medical risks include more than immediate dangers. An abortion increases a woman's chances of having in the future an ectopic pregnancy, a spontaneous miscarriage, or a premature delivery. Hence, it is important to remember that more than a present crisis is at stake.
d. Know about available resources. Experiencing the limits to our ability to help women facing the stress of untimely pregnancy, we may be quickly drawn to assume that abortion is the only possible or reasonable solution. But a variety of agencies, organizations, and volunteer groups are available to offer a pregnant woman the support system needed to meet her personal, medical, and legal needs. These options can become possibilities for choice only as she is made aware of others who want to help her.
e. Be sensitive to the problem of guilt. Since abortion has become legally and socially acceptable, problems of guilt may be dismissed by some as part of an outmoded value system. Such dismissal is not likely to be a real service, however. When many women experience depression, nightmares, and difficulties in relationships following abortion, it will do little good to suggest that such guilt is irrational or unjustified because abortion was their legal right. [23] The problem is the guilt itself, and the verdict of conscience on these occasions is to be taken seriously. Such a woman needs counseling which will lead her to sincere confession and to the renewal of hope offered by the powerful word of the Gospel.
B. Response in the Political Sphere
We should not underestimate the depth of division on the issue of abortion which exists within our country, nor should we imagine that any quick and easy solution to that division is possible. While we may grieve over the drastic relaxation of legal restraints on abortion, we cannot, upon serious reflection, be surprised by it. We find in it yet one more example of the growing disposition of an increasingly secular society to resolve moral dilemmas through pragmatic considerations of public policy and one more instance of the perennial tendency of the strong to oppress the weak. The judgments courts make about legality or illegality do not settle moral issues and are not determinative for Christian conscience. If abortion was sinful before 1973, it continues to be sinful in the decade that has followed Roe v. Wade. And even if abortion were made illegal tomorrow, the divisions among our people would still need healing and the moral issues would need to be addressed. It is to the moral issues that Christians can and should speak.
We should not acquiesce in the notion that defenders of abortion are merely "pro-choice." There are some issues with respect to which it is not sufficient to be "pro-choice." Just as the Kansas-Nebraska Act of 1854-- permitting new states entering the Union the choice whether to be slave or free-- was not a tenable solution to the problem of slavery, so also a so-called "pro- choice" position on abortion is not adequate; for it does not recognize the justified claims of the unborn child upon us.
There is also no reason to acquiesce in the notion that abortion opponents are illegitimately attempting to foist a private, religiously grounded view upon the whole of a society which does not share these religious beliefs. Much Christian opposition to abortion is based upon (1) our increasing knowledge about the facts of fetal development, and (2) a commitment to justice and an unwillingness to make comparative judgments assessing the relative value of human lives. These aspects of our viewpoint are certainly held by many who do not share our religious commitments. Beyond this, however, we reject the prevailing view in our society that considers religion good only as long as it remains a purely private matter. This is a distorted notion of the function of religious faith in the believer's life, and we ought not permit others to define for us the nature and extent of our religious commitment. However one arrives at the view that the unborn are, in fact, human beings deserving of protection, it is difficult to see how such a view could possibly be responsibly held as a purely private opinion.
We do not, of course, imagine that all matters of morality are fit subjects for legislation. Lust and gluttony are among the seven deadly sins; yet we would not suppose that they should be prohibited by statute. But those matters of morality which impinge upon civic order, which touch the common good, are appropriate subjects of legislation. In such matters we can, do, and ought to legislate morality. Just as we believe that racial discrimination ought to be opposed not merely in private but also in the public sphere, even so we believe that laws to provide protection for all human lives are appropriate and necessary. When the common good is involved, law and morality must join hands.
For what should we labor in the public sphere? We have seen in our discussion of "The Legal Perspective" that court decisions following Roe v. Wade, although clarifying some questions in helpful ways, have left little room for limitation of abortion. It is probably true that any large gains will have to await either a different membership of the Supreme Court or a constitutional amendment. There have been within Congress attempts to settle the problem legislatively by passing a law which defines the legal meaning of "person." (The advantage of such an approach is that, as ordinary legislation, it would require only a simple majority.) The legality of this attempt is greatly disputed, however, and there is no doubt that a constitutional amendment would offer a more lasting resolution.
Proposals for such an amendment have come in several forms. Some propose amendments which specify when individual human life begins and thereby offer protection for the rights of the unborn. Others propose an amendment which states simply that the Constitution does not secure a right to an abortion--hereby returning us to the situation which prevailed prior to Roe v. Wade and permitting the several states to regulate abortion to whatever degree they wish. The advantage of the first kind of amendment is that it would provide a more uniform and sweeping solution. In our current political climate, however, it would likely be viewed by many as imposed rather than agreed upon, and might well be the source of new divisions. The second kind of proposed amendment, which would return the abortion issue to the states, would permit the people through their legislatures to debate at length what their policy with respect to abortion should be. Undoubtedly, however, it would make for a less uniform and less restrictive policy.
In truth, our greatest hope may lie in the possibility that the Supreme Court, perhaps with some new justices, perhaps impelled by medical advance, will find it necessary to extend greater protection to unborn human beings. The way in which this may occur was, in fact, suggested by Justice Sandra O'Connor in her dissenting opinion in the 1983 decision, Akron v. Akron Center for Reproduction Health. She noted that "the Roe framework ... is clearly on a collision course with itself." As abortion becomes a safer procedure, states will be less justified in claiming to limit abortion in ways that protect maternal health. But at the same time, medical progress will move farther back into pregnancy the time at which the fetus is viable, the point at which Roe v . Wade had permitted the states to legitimate interest in protecting fetal life. We can hope that the direction pointed to in Justice O'Connor's dissent, which takes seriously the need for more stringent protection of fetal life, will in the future be taken by a majority of the Court.
There is currently a "great debate" concerning whose good shall count in the common good. Shall the good of the unborn child count in the common life we share? Shall the rights and protections we all claim flow back evenly upon all, also upon the unborn child? We are, in fact, determining what the outer limits of the human community among us shall be. When such issues are being debated in our public life, Christians ought to be first to speak on behalf of those who are weak and unable to speak for themselves. We confess as a cardinal tenet of our faith that "God chose what is weak in the world to shame the strong" (1 Cor. 1:27). if that "religious" belief does not shape the whole of our life, including also our life in the political sphere, we have not begun to fathom either its power or its depth.
Notes:
[1] In the medical and legal sections of this report the biological terms "embryo" and "fetus" are often used in referring to the unborn child, while in the remaining sections care is exercised to speak of the unborn in terms more indicative of a new human being.
[2] For stylistic reasons the masculine pronoun will generally be used from this point when reference is made to the unborn child.
[3] Hymie Gordon, M.D., Mayo Clinic, Rochester, Minn., Personal Memorandum on file in CTCR office.
[4] Ibid.
[5] C. Everett Koop, now U.S. Surgeon General, has written the following regarding the IUD: "You should know that when the IUD first came on the market, it was known as the IUCD, which stood for 'Intrauterine contraceptive device.' However, it was recognized even then that the IUD was not a contraceptive device, but an abortifacient. It prevented the implantation of the already fertilized egg on the prepared wall of the womb (uterus).
Early in the use of the IUD, women were not mentally comfortable with it because many felt it was producing an abortion every time a fertilized egg attempted implantation on the wall of the uterus. Then one of the unthinkables happened: The American College of Obstetricians and Gynecologists changed the definition of pregnancy! Whereas formally all textbooks of obstetrics in this country properly defined pregnancy as 'that period of time between conception and delivery,' the definition was changed to 'that time from implantation to delivery.' You can see, therefore, that the effect of the IUD took place before pregnancy by the new definition, and this avoided any possible controversy. The IUD is not a contraceptive device; it is an abortifacient."--Francis A. Schaeffer, C. Everett Koop, John Buchfuehrer, and Franky Schaeffer V, Plan of Action - An Action Alternative Handbook for Whatever Happened to the Human Race (Old Tappan, N. J.: Fleming H. Revell Company, 1980), p. 80.
[6] John S. Robertson, "The Right to Procreate and in Utero Fetal Therapy," The Journal of Legal Medicine, 3 (1982), p. 352.
[7] Forziatti v. Board of Regulation. 12E 2d 789. This and the two following paragraphs follow closely the argument and language of David A. Frenkel (Ministry of Health, Jerusalem, Israel), in Journal of Medical Ethics (London), V (June 1979), pp. 53-56.
[8] The Hippocratic Oath reads in part: "I will give no deadly drug to any, though it be asked of me, nor will I counsel such, and especially I will not aid a woman to procure abortions" (Encyclopedia Britannica, 15th ed., s.v. "Medicine, History of," by John Walford Todd, Macropaedia, Vol. 11, p. 827). The "Declaration of Geneva," adopted by the General Assembly of the World Medical Association at Geneva, Switzerland, September 1948, states in part: "I will maintain the utmost respect for human life, from the time of conception; even under threat, I will not use any medical knowledge contrary to the laws of humanity." -- Ethics of Medicine, eds. Stanley Joel Keiser, Arthur J. Dyck, and William Curran (Cambridge and London: The MIT Press, 1977), p. 5.
[9] Fifteenth ed., Macropaedia, Vol. 11, p. 849.
[10] In 1859 the American Medical Association called abortion "the slaughter of countless children; no mere misdemeanor, no attempt upon the life of the mother, but the wanton and murderous destruction of her child; such unwarrantable destruction of human life ..." in 1871 the AMA said concerning doctors who performed abortions: "The members of the profession should shrink with horror from all intercourse with them, professionally or otherwise; these men should be marked as Cain was marked; they should be made the outcasts of society; it becomes the duty of every physician in the United States ... to resort to every honorable and legal means in his power to crush out from among us this pest of society."--Quoted in William Brennan's Medical Holocausts I: Exterminative Medicine in Nazi Germany and Con- temporary America, eds. Richard S. Haugh and Eva M. Hirsch (New York: Nordland Publishing International, Inc., 1980), pp. 331-32.
[11] Constance A. Nathanson and Marshall H. Becker, "The Influence of Physicians' Attitudes on Abortion Performance, Patient Management and Professional Fees," Family Planning Perspectives, lX (July/August, 1977), p. 158; cf. pp 158 and 163 for the brief quotations that follow from this source.
[12] The American College of Obstetricians and Gynecologists, the professional association of those physicians who are most frequently called upon to deal with questions relating to abortion, sends out to its membership an occasional newsletter release under the title "Statement of Policy as Issued by the Executive Board of ACOG." Perusal of these mailings more than suggests a cautious reticence on the part of ACOG in dealing directly and intensively with the ethics of abortion itself. For example, the statements dealing with abortion, even when labeled "ethical considerations," are characteristically devoted to matters many of which are only peripherally germane to ethics: due care in verifying diagnoses of pregnancy; adequate facilities, equipment, and personnel "to assure the highest standards of patient care"; problems of conflict between the pregnant woman's health interests and the welfare of the fetus; the special problem of unanticipated delivery of live infants by abortion; the careful consideration of alternatives to abortion, and the suggestion that the fetus has a qualitatively different nature and value from that of other human tissue and organs because of its potential for developing into "an obvious human being." The policy statements acknowledge that "prognoses often involve medical, social, and economic factors which impact adversely on the health of the woman; and while abortion may be one option ... other alternatives may, in fact, be equally or more appropriate in solving these problems." Alternative options which the policy statements recommend, without explicitly pronouncing upon the ethical considerations involved in abortion, include: education in family life, contraception, reproductive responsibility, and parenting skills; provision of supportive counsel; job protection for pregnant women; changes in employment practices whose present effect is to punish women for being or becoming pregnant; more supportive attitudes toward those who elect abortion or out-of-wedlock birth; improved adoption services; accumulation and evaluation of data concerning experience with abortion and its alternatives.
[13] As in its 1971 report on "Abortion: Theological, Legal, and Medical Aspects," the Commission has here limited its discussion to legal developments in the United States.
[14] See footnote 16.
[15] Recent evidence presents a serious challenge to the Court's premise and also raises questions about the validity of comparing two entirely different classes of pregnant women: healthy and diseased. The death of a healthy woman from a legal abortion is totally preventable simply by not aborting. The death from childbearing of a woman with a disorder is most often unpreventable because of medical inability to understand or control the disease process which takes her life.--M. J. Bulfin, "Deaths and Near Deaths with Legal Abortions," presented at the Oct. 28, 1975, convention of the American College of Obstetricians and Gynecologists. "Abortion and Maternal Deaths," British Medical Journal 2 (July 10, 1976), p. 70. "Most Mother, Child Mortality Seen in Small High-Risk Groups," O. B. Gyn News 16 (May 15, 1981), p. 13.
[16] The word "health" as defined by the Court was not limited to the usual understanding of the word (i.e., the absence of sickness or disease). Rather, the Court defined "health" in terms so broad as to encompass a woman's preferred life-style and social well-being. Factors which relate to health, said the Court, are "physical, emotional, psychological, familial, and the woman's age"--all of which are "relevant to the well- being of the patient" (Doe v. Bolton, IV-C). Health also includes "distress associated with the unwanted child," "continuing difficulties and stigma of unwed motherhood"; when pregnancy "will tax mental and physical health of child care" or will "force upon a woman a distressful life and future" (Roe v. Wade, VIII).
[17] We refer to the child in the womb as a human being but refrain from referring to that child as a person though we have no objection to the use of personal language in that context. We do this simply for the sake of clarity and to avoid unnecessary and futile disputes. In the contemporary meaning used by some, a person is a being aware of itself as a self-conscious self, capable of relating to other selves and envisioning for itself a future. On the basis of such an understanding, some would deny that the life of the unborn child is personal life. The more traditional sense given by Christian theologians to the term "person" would predicate it of any member of the human species, any individual sharing our common nature--whether or not that nature is at any moment developed to its fruition in the life of that individual. Human nature has a capacity to know, love, desire, and relate to others. We share in that human nature even though we do not exercise all the functions of which it is capable. Thus, the contemporary understanding adopted by some will designate as a person only one presently exercising certain characteristic human capacities; it understands personal life in functional terms. The more traditional understanding of Christian theologians regards personhood as an endowment which comes with our nature, even if at some stages of life we are unable to exercise characteristic human capacities. Obviously, some important philosophical disputes--chiefly, the debate between nominalists and realists--are involved here. We bypass these arguments and simply refer to the unborn child as a human being. Whatever we may say of personal qualities, human beings do not come into existence part by part as do the artifacts we make. Human beings come into existence and then gradually unfold what they already are. It is human beings who are made in God's image and valued by God--and whose inherent dignity ought also to be valued by us.[18] Cf. CTCR's 1976 "Report on Capital Punishment."
[19] Early Christian writers specifically condemned abortion as a violation of the Biblical prohibition against killing. The first century Epistle of Barnabas states: "You shall not murder a child by abortion, or kill it when it is born" (19:5 Goodspeed Translation). Similarly, the Didache (about A.D. 100-20) says: "Do not murder a child by abortion or kill a newborn infant" (2:2 LCC Translation). The ancient church father Tertullian (about A.D. 160-220) wrote in his Apologeticum (about 197): "For us, since homicide is forbidden, it is not even permitted while the blood is being formed into a man to dissolve the conceptus in the uterus. For to prevent its being born is an acceleration of homicide, and there is no difference whether one snuffs out a life already born or disturbs one that is in the process of being born" (IX, 8.)
[20] Here we have set aside the medical/legal designations "embryo/fetus" and emphasize the creation of a new human being within the womb of the mother.
[21] Vincent M. Rue, Testimony before Senate Subcommittee (November 4, 1981). Cf. "Sharing the Pain of Abortion," Time (Sept. 26, 1983), p. 78.
[22] David Mall and Walter F. Watts, M.D., eds., The Psychological Aspects of Abortion (Washington, D. C.: University Publications of America, 1979), p. 121.
[23] R. Illsey and M. Hall, "Psychosocial Research in Abortion: Selected Issues," in Abortion in Psychosocial Perspective: Trends in Transnational Research, ed. H. David et al. (New York: Springer,1978), pp.11-34.
The Christian response to the problem of abortion cannot be limited to public protest; Christians must also commit themselves to an ongoing ministry of supportive care for those who are faced with the kind of burdens that often prompt women to contemplate an abortion. Congregations and individuals interested in pursuing such commitment may wish to consider the following avenues of support for human life:
1. Designate a pro-life resource and contact person within the congregation to coordinate pro-life activity and education. Such a person may be responsible for informing the congregation on pro-life issues through bulletin inserts, a column in the congregational newsletter, pamphlets and tracts available, books for the church and/or school libraries.
2. Address the life issues from the pulpit and in Bible classes.
3. Make information available to all members of the congregation on the needs of pro-life organizations.
4. Organize a "care" group within the congregation to help mothers after the birth of the baby. Sensitize members to the plight of the woman who must try to raise a child in poverty, without a husband, often without help or support from family. Teenagers ostracized from peer groups need a listening ear from a friend. Some need parenting skills, assistance to obtain medical care, and other basic necessities. Provide infant and maternity clothes for mothers, as well as for organizations that provide supportive services for crisis pregnancies.
5. Discover ways to be supportive of parents whose teenage daughter becomes pregnant. Elders and spiritual care committees in particular need training for dealing with this situation.
6. Form prayer circles to pray for the unborn, mothers with a troubled conscience, children with handicaps and burdens in the home, the elderly and senile, and others whose value is viewed as diminished because they are unwanted or imperfect.
7. Conduct or sponsor youth workshops on life issues and sexuality for the community. Provide for sex education in the congregation for parents, youth, and children.
8. Establish a local "Lutherans for Life" chapter.
9. Celebrate a "Life Sunday" during the year to develop a Christian concern for mothers and unborn children.
10. Include a pro-life unit in confirmation classes and premarital counseling sessions.
11. Enlist the Christian day school in projects such as compositions, posters, poetry, and drama that convey a pro-life message.
12. Inquire about governmental and community sources of funding for the support of single mothers.
13. Establish contacts with pro-life leaders in your area and discuss ways of carrying out cooperative programs regarding pro-life issues.
14. Invite pro-life professionals (medical, legal, theological) to address groups within the congregation.
15. Provide home care for unwed mothers seeking temporary assistance during moments of crisis.
16. Write to congressmen and senators expressing the pro-life position on life issues.
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