The New York Times recently drew attention to a perhaps surprisingly vexed issue in the post-Dobbs landscape surrounding abortion: Just what is an abortion? And which procedures should not be considered or called an “abortion”? According to the Times:
During the five decades that Roe v. Wade established a constitutional right to abortion, this was mostly a semantic dispute. But in the aftermath of the Supreme Court’s decision to overturn Roe, simply defining the word abortion has taken on new political, legal, and medical consequences.
Indeed, the trouble arises because in the three different contexts identified—political, legal, and medical—the term is used in somewhat different ways. Yet, as I will show, none of these differences in usage affects the substantive moral questions surrounding abortion.
Consider the medical use of the term, which the Times characterizes in this way:
Major medical societies, and medical billing codes, define abortion as any procedure that terminates a pregnancy—whether that pregnancy is wanted or unwanted, whether a woman is seeking the procedure to clean out her uterus after a miscarriage, or because of a dire fetal diagnosis, or to terminate a pregnancy that she had not expected.
This use clearly does not track what we could call the ordinary meaning of the term: removal of a deceased fetus from the womb of a mother who has miscarried is simply not called “abortion” in everyday language.
But so what? “Abortion” is a medical term of art, and is largely used to identify a particular set of procedures that could be used for a variety of different reasons, some good, some bad. It does not really matter to any substantive debate about the morality of abortion that physicians use the term in a way that is maximally morally neutral. If the word was replaced simply by the names of the particular procedures or chemicals that are widely used to terminate a pregnancy, society would still be left to ask under which circumstances and for which reasons such procedures and chemicals might be morally permissible or not.
Legal vs. Medical Contexts
Or consider the use of the term in legal contexts after Dobbs. Many states want to limit the use of these medical procedures and chemicals to circumstances under which maternal life is at stake. Texas, for example, defines abortion as “the act of using or prescribing an instrument, a drug, a medicine, or any other substance, device, or means with the intent to cause the death of an unborn child of a woman known to be pregnant.” Texas allows this procedure only when the mother has “a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that places [her] at risk of death or poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced.”
At the same time, Texas stipulates that an “act is not an abortion if the act is done with the intent to: (A) save the life or preserve the health of an unborn child; (B) remove a dead, unborn child whose death was caused by spontaneous abortion; or (C) remove an ectopic pregnancy.”
Texas is not using the medical definition, and it is not bound to. Rather, it is bound to identify clearly what can and cannot be done in accordance with a law that is intended both to protect unborn human life and to allow medical interventions on behalf of a mother whose life is in jeopardy. In doing so, it departs to some extent from the medical definition, insofar as the latter considers removal of a miscarried child an abortion; and it overlaps with the medical definition insofar as it considers a life-saving medical procedure an “abortion” when that procedure brings about the death of an unborn child.
But again, where is the problem? The Texas law appears clear, and the conflict between that law and medical terminology is merely nominal: a physician could make full use of the medically accepted language while recognizing that much, though not all, of what physicians call “abortion” is legally impermissible in Texas. Certainly, to use the medical definition as a way of arguing that the Texas law was somehow unclear would be intellectually dishonest.
Moral Uses of the Term
If there is some genuine confusion, it might be in the different ways some pro-life advocates restrict their use of the word “abortion” to identify the moral contours of the issue. Are these advocates willfully creating confusion? No: they are both committed and principled in their defense of unborn human life.
Such advocates desire, with reason, that unborn human beings be given precisely the same legal protections that born human beings are afforded against both intended harms and also unintended but unjust harms. They use “abortion” as a kind of moral term of art to identify acts directed against the unborn that would not be legally tolerated were the victims already born.
This means their use is certainly not convergent with that within medicine: they will hardly consider cleaning out a uterus after miscarriage to be an abortion and are likely to think that, outside the medical context, such language is willfully obfuscating. They will see claims by celebrities who have miscarried that they have “had an abortion” to be a linguistic sleight of hand that is politically motivated.
But neither will they, as Texas law does, call a medical procedure used to save the life of the mother an “abortion.” Thus the Times report quotes pro-life lawyers, activists, and physicians, all resisting the language of abortion in discussing procedures done with the intention to save the life of the mother, even when they result in the death of an unborn child.
The entire tenor of the Times article suggests that this parsing of the linguistic landscape is done merely for a rhetorical advantage that is morally unprincipled. Dr. Louise King of Harvard Medical School is quoted as saying “An abortion is an abortion is an abortion,” and, a bit later in the article says that “weaponizing and politicizing language is highly inappropriate and unethical.”
Could such linguistic rigorism be unprincipled? Well yes, it could, and would, if advocates of the rigorist approach used or declined to use the language of “abortion” in ways that deviated from their core principle: unborn children should be legally protected in the same way that born children are. That does not seem on the surface a very plausible worry: principled pro-lifers believe that innocent human beings, born and unborn, should be legally protected from both intentional killing and unfair non-intentional killing.
And, importantly, this principle is common to pro-lifers who are not linguistic rigorists. So a pro-life lawyer, doctor, or activist might use the word “abortion” more in keeping with ordinary usage than the rigorist might, recognizing that in ordinary language the expression “life-saving abortion” raises few eyebrows. Such pro-lifers will speak of such abortions as justified, in the same way that homicide in self-defense can be called justified. And they will speak of unjustified abortions, often describing them as “elective” precisely because the killing is carried out, as it were, by choice, and not as part of an effort to save the life of the mother.
Tough Cases Remain
These different uses of the term “abortion” in no way paper over the existence of genuinely difficult medical scenarios. Hard cases sometimes arise, and pro-lifers must wrestle with them. For example: if it is morally permissible to accept the death of an unborn child in order to save the mother’s life, can it also be permissible to accept the child’s death if one is preventing some significant compromise to the mother’s health short of loss of life?
Or again, here is a complicated moral question, prompted also by the Times coverage in the aftermath of Dobbs:
A study from two Dallas hospitals reported on twenty-eight patients whose water broke or who had other serious complications before twenty-two weeks’ gestation, and who, because of Texas laws, didn’t receive medical intervention until there was an “immediate threat” to their lives or fetal cardiac activity stopped. On average, the patients waited nine days, and 57 percent ended up with serious infections, bleeding or other medical problems, the report said.
Is it permissible to slightly hasten the child’s death by aggressively addressing the risk of infection for the mother when she is in the process of miscarrying? The Times quotes a physician from Texas Right to Life who characterizes the intervention in this way: The “doctor [is] saying ‘I want to cause the death of the child today because I believe that they’re going to pass away eventually.’”
This does not seem obviously correct to me; and sound moral thinking allows hastening of death in other contexts when death is near, such as the removal of life-sustaining technologies. Pro-life thinkers need to address hard cases such as this for the sake of just laws and humane clinical approaches that are guided by genuine medical professionalism.
The moral questions in such cases are complicated, but whether one adopts the linguistically rigorous approach or not makes no difference whatsoever to their moral consideration. Nor does any particular terminology adopted in medicine or law, or found in ordinary usage, determine the morality of abortion. Pro-life and pro-choice advocates alike are capable of recognizing that a range of medical interventions can end an unborn human being’s life. They differ, often radically, about the justice of most such interventions.