Life is Complicated – part 03

A few weeks ago, we started a discussion stemming from Indiana’s new state law forbidding termination of pregancy based upon the disability status of the fetus (here, and here). I asked readers to write in, and tell me what they wanted in the way of a physician, if they were ever in that situation. A reader wrote in and offered her comments. Here, we will continue that dialog.

Dear Anne,

Thanks for your thoughtful response. Let me try to respond to your email point by point. I will use “>>” marks to set off my responses.

1. Oh, I’m famous! Hee!

>> Use your 15 minutes of fame  wisely!

I was conscious of skirting around the question at the time, in part because I still wrestle with my own thoughts around my own experiences.

>> Wrestling with one’s own thoughts and experiences is a useful process. Jacob wrestles  with an “Ish” (conventionally translated as “angel,” but the actual meaning in Hebrew is ambiguous). He fights the Ish to a draw. The Ish blesses Jacob, conferring upon him a new name – ”Israel” (literally, “I have struggled with God”), but at the same time wounds him in the groin, so that he walks with a limp forever afterwards. I see that as a metaphor: We struggle with our inner selves, and that struggle transforms us into something better – although we often bear the scars of our struggles, inwardly or outwardly. If you’re not a big fan of Scripture, then perhaps Hemmingway will resonate: “The world breaks every one and afterward many are strong at the broken places.”

Implicit in my response is a gentle, respectful admonishment to both of us– if people like Peter can’t depend on their own mothers or on their psychiatrists to defend, fiercely, their place in this world, then we’ve failed.

>> Here, you commit an error in logic. You combine two questions into one, when they are actually separate. Specifically, you talk about the child you have (Peter, a living, breathing person), and the child that might come into existence – nameless, formless, a child who may or may not ever exist – as if our obligations to both of them are the same. But that is a fallacy. What you may choose to do for Peter in the real world, and what you may do (in the present) about some future for some theoretical, nonexistent person are not the same thing. As an example: There is no ethical way for you to “not have” Peter. On the other hand, there are many ethical ways to not have future children. Even devout Catholics accept “natural family planning” (an updated version of the old rhythm method) as moral. Then there are the myriad of other means of averting pregnancy: condoms, foam, IUDs, vasectomy, etc, without even getting to the issue of termination of pregnancy. We cannot ethically kill our unwanted children, but we can ethically prevent the conception of unwanted children, because they belong in two different classes. Therefore, to say that if you contemplate termination of pregnancy because the child would have a disability somehow means that you would be failing Peter is the logical equivalent of mixing apples and oranges.

There is a lesson in Talmud, the Jewish commentary on Scripture, that goes as follows: “Whoever saves a life, it is considered as if he saved an entire world.” In other words, saving a single life also saves all of the potential future offspring of that person. But if we equate children not yet conceived with “lives”, then all forms of birth control – including abstinence within marriage – are sinful, because they preclude potential future children from coming into existence. As radical as this sounds, there is Biblical precedent for this position: There are 613 commandments from G-d in the Hebrew bible, and the very first of them, given on the 6th day of creation, is “Be fruitful and multiply.” We are commanded to reproduce, and – at least in theory – failure to do so is a violation of G-d’s law. There are fundamentalist religious groups who live by this belief (and have very large families). But I am going to take a more “modern” or secular view, and say that abstinence within marriage, and natural family planning, are OK. (Actually, I would go further than that, but let me stick with these two methods, to make my point.) Why? Because preventing future theoretical children from coming into existence is morally and ethically different from killing (or devaluing) children who already exist. Likewise, and by extension, we should not equate what we do vis-à-vis one class (existing children, including Peter) with what we do vis-à-vis the other class (children yet to exist). This is the flaw in your logic that undermines much of what you say thereafter. I am admittedly sidestepping the issue of when a “theoretical child-to-be” becomes an “actual child-in-fact.” At the time of intercourse? At the time of fertilization of the egg? Implantation of the egg? Viability outside the uterus? But first I want to separate the issue of “children in fact” from “children perhaps to be.”

I think I’ll stop here for today, and take up the rest of your letter next time! But first, a whimsical respite from all this heavy thinking.