Abortion and the Transition of Morality in Modern Society

Abortion is defined by Merriam Webster dictionary as: "the termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus." Statistically, the incidence of abortion is a sobering reality in the United States, yet the trend is declining.

Almost half of pregnancies among American women are unintended, and 40 percent of these are ended in abortion. Twenty-two percent of all pregnancies except miscarriages are terminated by abortion. Each year, two percent of women aged 15-44 have an abortion, and for 47 percent of those women, it will not be their first. Fifty percent of women who will have abortions in the United States are under the age of 25. About 60 percent of all abortions are obtained by women who have one or more children.The occurrence of abortion with women age 15-44 is declining, at about two percent every four years since 1997. From 1973 until 2005, 45 million legal abortions occurred.The reason most women give for having an abortion has to do with their concern over responsibility to other people. Three fourths say that they cannot afford a child; three-fourths say that having a baby would interfere with work or school; and half say that they do not want to be a single parent or are having problems with their husband or partner. (guttmacher.org)

Most women who get abortions report using a contraceptive the month that they became pregnant. Over three-fourths of them report inconsistent use of contraceptive method as the reason for pregnancy. Lack of contraception as the reason for pregnancy is highest among poor, black, Hispanic, or less educated. (Jones Henshaw)

Up until 1973, States had enacted their own laws, outlawing abortion. Starting after the Civil War, states began to render abortion a criminal act punishable with severe penalties. This evolution of abortion criminality could be explained for several reasons, certainly not the least of which was the fact that medical technology had advanced due to the staggering casualty rates of the war. Doctors became more plentiful, having organized the American Medical Association in 1847, and the profession began to grow as an industry post-war, alongside the manufacture of drugs.

Historically midwives had performed most birth and obstetric procedures before the Civil War, and doctors began to overshadow the midwife's role in women's lives. This wave of legality coincided (possibly not by accident) with the "first wave" of modern feminism in America. Suffrage was the heart of the first wave, and the opportunity to vote empowered women to change the status quo.

As the feminist movement continued to evolve into the first decade of the twentieth century, abortion law became even more prevalent across the nation, almost as if the trend were a government response to American women's increasing desire for individual freedom.

The Nineteenth Amendment to the United States Constitution was ratified on August 18, 1920, allowing women to vote in the November 1920 election. However, abortion criminal statutes continued to evolve. In order to fully understand the legal precedent for abortion, it is necessary to explore the evolution of abortion law in the United States, because it is this history that much of the effort to legalize abortion has been based. Had there not been case law to support a legal appeal, it is doubtful that the effort would have been successful.

The laws of the United States were based on English common law where the concept of fetal "quickening," the point at which there is detectable movement of the fetus established the existence of a person. Aborting a "quickened" fetus, i.e. a person, was tantamount to murder, thereby creating a crime. Unborn embryos that had not "quickened" were not as closely scrutinized.

Common law governed issues like abortion until legislative action at the state level established code. The tide was turning though. By 1849, eighteen of the thirty states had enacted statutes restricting abortion, and by the end of the Civil War, twenty-seven of the thirty-six states had law on the books criminalizing abortion for the attending physician. By 1868, twenty-seven of thirty-seven states considered abortion at any stage of pregnancy a crime.

It is interesting to note that in every state women were considered "victims," and not perpetrators of abortion, regardless of intent or circumstance, largely because their testimony against the doctor would be difficult, if not impossible to procure if they were considered accomplices. (Linton) Women in early abortion criminal cases were not the culprits, in essence because they had no real recognition as citizens. A woman in the nineteenth century lingered legally somewhere between being property (a slave) and an extension of her husband's or father's persona.

In 1866, the Fourteenth Amendment to the United States Constitution established a broad definition of citizenship. After the Civil War, it was important to enable former slaves and their progeny to pursue opportunities granted to ordinary people. With this legislation a clearer picture of civil rights began to take shape in the nation. It was from this picture that the feminist movement gained new strength.

The Ninth Amendment to the United States Constitution; "the enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people" spelled out the existence of non-enumerated rights that existed tacitly by virtue of the formation of rights enumerated in the previous eight amendments. It has been interpreted, especially in combination with the Fourteenth Amendment, to infer basic human rights, such as the right to privacy, are guaranteed by the Constitution regardless if they are not literally included in the text.

It is the evolution of constitutional law in the United States that illuminates the nature of the issue of abortion and its governance. From the standpoint of a consequentialist argument, abortion can be valued from three different approaches; that of the notion that personhood begins at conception, or; human existence begins at "quickening;" or via birth. If any law applies to the unborn fetus as a human being upon conception then abortion is murder. Conversely, if the law considers only an individual who is born as a citizen, then the outcome of the abortion is the affair of the mother, and not within jurisdiction of any law. As stated by the prominent pro-life attorney Paul Benjamin Linton, "the issue is not whether the unborn are human beings, but whether the unborn are constitutional persons."(LeaderU.com)

On January 22, 1973, the Roe vs. Wade opinion written by Chief Justice Harry Blackmun, was handed down by the United States Supreme Court. This action launched a firestorm of political controversy and invalidated a Texas statute that made procuring an abortion a crime absent a threat to the life of the mother, as well as nullifying any statute in the country that criminalized abortion. Part of Blackmun's opinion was based on the tenets of the 14th and 9th amendments to the United States Constitution that guaranteed the right to privacy. Once again women in the United States were able to obtain safe, legal, and professional abortion services through the qualified caregiver of their choice.

While legal abortions and associated services began to occur, two powerful separate movements sprang up out of the controversy. "Pro-life" proponents maintained that the Supreme Court ruling was unlawful and not a true representation of the majority of Americans. "Pro-choice" advocates insisted that abortion was an issue that was best left for discussion between a woman and her doctor, and that it was imperative that abortion remain legal.

After the decision, the Pro-life movement almost immediately began to assault the judicial with myriad cases and appeals. A key aspect of the Pro-life position is that personhood begins at conception, and that any other interpretation is morally wrong. One major organization associated with the Pro-life movement is the national Right to Life Committee. "Formed in 1973, in response to a United States Supreme Court decision released on January 22 of that year, legalizing the practice of human abortion in all 50 states, throughout the entire nine months of pregnancy," the organization claims to support a "non-sectarian" and "non-partisan" effort to overturn the Roe vs. Wade ruling. The NRLC considers that the decision made by the Supreme Court in 1973 was erroneous, in the words of dissenting Justice William Rehnquist, in essence declares a "constitutional right to an abortion,"

The Pro-choice movement is interested in keeping abortion safe and legal. Pro-choice has many feminist roots, and is based in the philosophy of abortion being a private matter between a woman and her caregiver, a philosophy that is at least as old as the practice of midwifery. Many feminists believe that the transformation or "medicalization" of birth was a tactic to circumvent one of the few woman-controlled services a female in the nineteenth century could experience. Historically, midwives have been around longer than doctors, and in many cases up until the nineteenth century, midwives were the only healthcare women had. (Toler, Bramall) In addition to shifting the responsibility of childbirth to doctors, eliminating midwives meant all but eliminating abortion and birth control care giving. However, in modern time, the Pro-choice movement does enlist the assistance of the American Medical Association who by policy "recognizes and supports physician autonomy and discretion in medical situations concerning abortion." (AMA.org) Organizations like Planned Parenthood also favor the Pro-choice movement.

Cases were brought before courts to challenge the decision and in many instances the statutory relief provided by Roe vs. Wade was eroded by federal and state law. Among the issues brought forth by the challenges, federal funding for abortion services has all but vanished leaving poor or indigent women with little or no alternative to unwanted pregnancies. A recent proposed federal law sponsored by Republican Senator Sam Brownback from Kansas, the Unborn Child Pain Awareness Act of 2005 provided for a mandated script supplied during an abortion procedure that required doctors to advise women of the potential for "fetal pain" that could be experienced by the unborn child beyond 20 weeks of gestation. The AMA adamantly opposed this legislation because of the violation of the doctor-patient privilege, the intrusion of government into the doctor-patient relationship, as well as the questionable validity of the "research" performed at the behest of the sponsors of the bill. The law did not pass, but many in Congress seek to derail Roe vs. Wade through similar draconian measures.

If the United States Constitution is a collection of principles and thought based in consequentialist philosophy, that is, acts are judged by the outcome and effect on other people and property, then the notion that abortion should be illegal is not valid. If and when the United States considers the unborn as citizens, it is at that moment that abortion can be legally outlawed. However, this presents the nation with an important unavoidable dilemma; who or what has the authority, based on the United States Constitution, to deem when human existence begins? If the country is to continue to adhere to the Establishment Clause of the First Amendment of the Bill of Rights, then assigning a biblical or religious source to answer this question would violate the ethical framework on which the entire system of government rests. Justice Harry Blackmun addressed the question with unmistakable humility: "We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man's knowledge, is not in a position to speculate as to the answer."

“Utilitarian Feminism” Shaping and Advancing American Culture?

Introduction

When examining the state of inequality in the healthcare system of the United States, a number of ethical shortfalls surface for review. Often when a system with so many problems is investigated, the tendency to be overwhelmed with details can obstruct understanding of the real issues. For purposes related to this discussion, distilling some of the essential philosophies out of the confusion is not only helpful, but integral to the solution. In a nutshell, the US health care market has become the most inflated in the world because of escalating drug costs, profit-driven HMO's, baby-boomers approaching retirement, and consumption of unhealthy food. In the future, only the wealthy will be able to afford health care insurance coverage. Breaking down a description of the American health care system components and affected populations enables a clear vantage point from which to view the philosophy involved, the ethical considerations therein, and ultimately a solution for many of the problems.

The Players

To start with the largest player in the game by far in terms of dollars, the Pharmaceutical industry in America has attained an economic zenith of size and scope. (Sellers, 2002) Even though there are token programs by drug companies to offer prescriptions to American low income patients for free, pharmaceutical corporate profits are at an all time high, reporting in 2004 an average of 17.5 percent for the top three. Generally speaking, profit levels for "Big Pharma" are in the billions. (Sellers, 2002) This profit is often protected from tax by off-shore tax shelter schemes (Brittain-Catlin, 2005). As Big Pharma banks the proceeds from bumper years, another player, more actively involved with the business of managing the complex administration of the medical industry, has recently been politically demonized by stories of filthy-rich CEO's and hidden money stashes, all under the guise of a "non-profit HMO" corporate identity.

HMO's (health maintenance organizations) are healthier than ever. (Gerencher, 2004) Because of the intricacies of federal and state law governing HMO's non-profit tax status, HMO's often exploit, and maneuver around statutes barring large accumulations of profit that are not rebated back to policy holders in the form of lower premiums. Harold S. Luft, in his book Health Maintenance Organizations: Dimensions of Performance, describes some of the legal acrobatics:

"The question of non-profit orientation is clouded by the absence of a clear relationship between the legal status of an organization and its true orientation. In fact, the profit-nonprofit distinction is largely a legal fiction. For many HMO's the decision to have for-profit or not-for-profit is primarily dependent on (1) state laws concerning for-profit medical groups, (2) federal restrictions on grants to for-profit organizations, and (3) the trade-off between the tax advantages of the not-for-profit model and access to capital markets of the for-profit model." (Luft, 1987)

In short, HMO's in this country are an industry, complete with corporate infrastructure, legal consultants, lobbyists, and all the other paraphernalia that traditional insurance companies possess to conduct their day-to-day business both with consumers and the government. If HMO's were to take note of their primary source of revenue, their policy holders, they would probably endeavor to prioritize the health and financial well-being of those revenue generators.

As it is, according to the World Health Organization, Americans are some of the least healthy people in Western culture. (WHO, 2007) In spite of the seemingly bleak outlook, people are living longer in the United States, but it is possible that they aren't living any better. In America 12.4 percent of the population are over 65 with projections for this age group to increase by at least 2.4 percent a year until 2020. Average people over 65 have many more health issues than the rest of the population. (U.S. Census Bureau, 2004) These overall increases drive up the cost of premiums due to increased critical-care caseload consisting mainly of obesity and diabetes-related disorders, heart disease, and cancer. (NCHS, 2006)

For the rest of the population, it is no secret that Americans like to eat fatty foods. In Seattle there was a measure before the City Council to ban all trans-fat-containing foods from restaurant menus. A similar measure was passed in New York City last year. In the past nine years, obesity in America has increased by a startling 17 percent. Obese and overweight people statistically have more health problems. (CDC, 2008)

Solutions

In essence, inequality for healthcare options in the United States is driven by market forces and the overall lack of health in the society. Since the current health care system is a market and profit is the goal, healthy people are not necessarily the measure of success; hence the downward spiral of the state of health for the average American. It is a vicious cycle. In a strictly utilitarian political landscape, analysis of the problem and possible solutions can be brought to light. Bentham and Mill, by way of Pence, have illustrated a set of criteria to assign utilitarian value to a system:

Consequences: the consequences of a flawed healthcare system are unhealthy people, high cost, and deteriorating ethical standards of care. Changing the system for the good of society includes improving the health of the members of that society and in turn improving the efficiency of the system.

Maximization: the consequences of the flaws are widespread, and pervading the American demographic into previously considered "safe" economic strata. Implementing change for the better will impact the members of all economic classes via numerous improvements, not the least of which is lower health care costs for all.

A theory of value: the value of health is intrinsic to the fundamental rights granted by the United States Constitution. Healthy Americans are better citizens.

A scope-of-morality premise: the suffering of one individual can affect the happiness of all, either directly or indirectly via market forces (higher premiums) or diminished capacity to utilize resources. One person's health is no more important than another, regardless of economic situation.

Utilitarianism, in combination with constitutionalism, is one of the philosophical models from which much of the current United States judicial, executive, and representative government is based. (Ryn, 1992) Integrating the four Bentham and Mill ethical concepts with a nationalized healthcare improvement effort, along with propagandizing health awareness and prevention are a natural fit when attempting to alter the current healthcare industry status quo. But unfortunately, traditional means of change most likely will not suffice. Shifting the American opinion about healthcare will require a totally egalitarian concept that is more in line with the way most Americans think and act in their homes, and not so much in line with the way policy-makers think and act in government buildings. Women have been saying this for over 200 years. The words of Mary Wollstonecraft seem to foreshadow an impending revolution in social systems, "If the abstract rights of man will bear discussion and explanation, those of women, by a parity of reasoning, will not shrink from the same test. " (Wollstonecraft, 1792)

As feminism gains more momentum into the mainstream of American culture and progressive ethical attitudes begin to take hold in the medical profession, an entirely different way of looking at the problem of inequality in the healthcare system presents itself. The Ethics of Care approach sheds light on particularly compelling issues regarding equality and human interconnectivity, especially for children and families of patients. In her landmark reference text, The Ethics of Care, Virginia Held has outlined feminist-based philosophy criteria for determining how a social system measures up to progressive notions of patient welfare:

The interdependence of all individuals, specifically medical professionals, patients, and their families: Ethics of Care requires an assessment of all concerned in the healthcare picture. Women, children, and the elderly are all more vulnerable to the negative effects of the absence of basic healthcare. Relationships between doctors and patients, and the patients' friends and families are adversely affected by a healthcare system when there is iniquity. When this system is profit driven, those considerations lose vital recognition.

The most vulnerable affected by outcomes of choices made by others deserve special consideration: In a traditional marketplace when a profit-driven model of business begins to harm the customer base, market forces adjust the model to be more consumer-friendly. This has not been the case in the American healthcare business model. In fact, a profit-driven healthcare marketplace has nudged the most vulnerable into harm's way due to the lower profitability statistics for their categories.

The need to provide service and care, minding the contextual details of the patient's overall situation: Care-giving originated in the family or home, so much can attributed to a care-giving model that integrates the patient's total experience. To take the approach a step further, many feminists believe most of the world's ills can be solved by a similar approach: "…if we are to develop truly effective social policies about matters such as homelessness, mental illness, and education, we have much to learn by "starting at home" where the origins of care have their roots."(Noddings, 1984) Every person and family has a different story to tell when it comes to illness, disease, or well-health. It is vital that an accurate picture of the patient family and community is considered in all healthcare decisions.

Surprisingly, feminist ethics applied to biomedical issues is a revolutionary concept in traditional biomedical academic circles. Historically, feminist bioethics was limited to "women's concerns" and did not correlate with a more general application of mainstream bioethics. (Tong and Williams, 2008) In 1996, Susan Wolf published the anthology: Feminism and Bioethics: Beyond Reproduction, a ruthless expose of the bioethical status quo. (Donchin, 2008) In the decades up to this shift in ethical thinking, limiting an important "second" voice could possibly have hastened the contemporary American healthcare system meltdown.

Conclusions

Now, after reflection on the schools of thought in the light of the current American healthcare system, it becomes apparent that the two philosophies have (1) already at least summarily been introduced into the medical profession culture, and (2) can, in combination, provide a vehicle by which to resolve many of the problems inherent in the for-profit care model.

The outcome-oriented practices inherent in a consequentialist model have already been tested with a questionably successful re-vamping of the US primary and secondary public education system in the form of the No Child Left behind Act of 2001. It is yet to be seen if such utilitarian practices are successful in a large-scale public effort. However, the shift in thinking about a system focused on a result as opposed to a means was successful, and the nation has rallied around the cause of education reform.

Changing the way Americans think about healthcare as a national cause, not a profit-oriented business, with the ultimate goal of producing healthy citizens, instead of healthy bank accounts, will be incumbent upon those that undertake the mammoth task of changing, and ultimately solving, the national healthcare crisis. Incorporating a holistically-oriented coverage policy, emphasizing children and family basic health, and implementing well-health and preventative treatment initiatives will utilize and expound upon accomplishments from the Feminist movement. Perhaps with a focus on issues traditionally overlooked by the medical establishment, such as breast cancer, contraception, and the exclusion of women in clinical trials, a feminist approach to the healthcare crisis would be more attractive to larger cross-sections of the population. (Donchin, 2008) As women are becoming a larger segment of the medical profession, income disparity is still a controversial issue. (AMA, 1993) Regulating or capitation of fee structures, while controversial, will achieve equality and eliminate discriminatory barriers.

Several politicians along with their respective political parties have introduced healthcare reform without much success. The country could be in the throes of a collapsing system, or on the brink of a new wave of healthcare culture. Some experts consider the current dilemma a little of both. It would benefit America if the next measure of effort on a government scale be tempered with the knowledge and understanding from utilitarian and feminist ethics principles.

Not So "Equal" Equality

I think when we attempt to define "equality," we can bang our heads together and crank out a decent general definition. On the other hand, I propose that we tackle equality as it relates to various aspects of our culture. I suggest (mind you, no one needs to take me up on this) that we undertake an approach within the context of the framers of our nation. (Far be it from my intention to appear over-zealous in my patriotic spirit) Specifically, equality as presented in the "inalienable rights" part of the Declaration of Independence; "life, liberty, and the pursuit of happiness." In the words of the Founding Fathers, "to secure these rights, governments are instituted among men." "All men are created equal," that is a given, or "self evident." For me, in the purest sense of our vision of liberty as Americans, equality is granted by a higher power, and it is up to us to define equality through the means by which we govern ourselves, hence my argument that we present the definition through our cultural mandate as indicated by the original institute of our government. Does that make sense?

Life is a simple notion with complex underpinnings. Equality of life means that everyone, that is everyone has a right to exist. We are born, we thrive, we grow up, and in America, we live. All the other stuff, like education, opportunity, and justice are covered by the other rights, as far as I can see. This one says we all deserve to be alive. It could also be construed as a right to health because health is directly connected to existence. We conduct ourselves based on our well-being, and affect others' well-being in the process. With that said, our government, and our equality of life all depend on our health individually, and collectively (Bezruchka ).

Liberty on the other hand, is a complex notion with simple underpinnings. Liberty is another "natural" human right and government or law is restrictive of that right, even if only in a small sense. "Every law imposes some restriction on the natural liberty of mankind, which restriction is an injustice, unless legitimated by tending to their good." (Mill 31) Everyone has a personal sense of liberty, and protest when they feel it is compromised. Ultimately, we are all equal when it comes to the fact that government will set a boundary for us at some point in our lives. One boundary set by our government is taxation. How far those boundaries will limit our freedom, and how often the government moves to restrict us in comparison with another individual's government-set limits is what defines equality of liberty in America.

The pursuit of happiness is what probably gets the most discussion. Offering Americans an equal opportunity to exercise this right has been the overarching theme for most American political campaigns throughout history. The "pursuit of happiness," at least in the US, involves property. This emphasis on economy and consumerism is a hallmark of the character of Americans, at least as seen through the eyes of many in other countries. (Pursuing Happiness 32) This "inalienable right" is a summary of sorts, for the other rights secured by our government. However, the opportunity to pursue happiness in our country does not necessarily involve an equal playing field. The deck seems to be stacked in favor of those who have more property. In spite of claiming the title of richest country in the world, the poor of our country have only about half of what the poor in Norway and Japan have. (Pogge 68) The American mean household income is $45,072 (Webster). Considering that 7,605,303 families meet the US Census Bureau's definition of poverty, that does not leave much room for prosperity in our nation (Webster). However controversial that the concept may seem, health (see "inalienable right" 1, above) is directly related to the economies of nations and the US is not an exception by far. The spending on health care in the United States makes up nearly one half of all monies paid for health care worldwide (Bezruchka ). Considering the national debt, this can't be good for government.

So, from what I have discovered, equality is directly related to health, legal, and economic boundaries set forth by our government if we consider it all from the standpoint of the Founding Fathers.

References:

Bezruchka, Stephen. Economic Equality is Best Medicine." Seattle Post Intelligencer 26 Jun 2006, Sunday ed.: Opinion.

Mill, John Stuart. Utilitarianism. 7th. London: Longmans, Green, and Co., 1879.

Pogge, Thomas. "Growth and Inequality." Dissent 02 Jan 2008: 66-75.

"Pursuing Happiness." The Economist 01 July 2006: 32.

Webster, Bruce H.. "Income, Earnings, and Poverty from the 2006 ACS." US Census Bureau. Aug 2007. US Census Bureau. 8 Feb 2008 .