The numbers response

Ord contends that if fetuses have the same moral status as adult humans, spontaneous abortion is ‘the greatest killer of all’, and ‘leads to more regrettable human death than all other causes put together’.18 One strategy of responding to the problem of spontaneous abortion is to argue that the number of morally problematic spontaneous abortions are far less than what they initially appear to be.

Substance view theorists Robert George, Christopher Tollefsen and Henrick Friberg-Fernros argue that many early spontaneous abortions result from chromosomal defects ‘so significant that a human embryo probably failed to form’.4 10 According to the substance view, humans are essentially rational substances; if a biologically human embryo possesses severe chromosomal defects, then it is unviable, and lacks the capacity to become a fully rational substance, and thus while such things may be biologically human, they are not human substances.

Rob Lovering contends this response is a red herring; citing Carlson that at best 50% of spontaneous abortions are caused by such defects.16 28 He says ‘that still leaves roughly 3,000,000 spontaneously aborted human fetuses in the United States alone, more than 200 times the number of people who die each year from AIDS in the United States’.

If we take George and Tollefsen’s response seriously, a couple of things become apparent: first, a significant number of human biologically fetuses—roughly 30%, or about 1 in 3—are not truly human. This is surely at odds with the common-sense moral intuitions held by most antiabortion theorists. Second, this would still mean that 42% of all true human beings die from spontaneous abortion—a staggering, morally significant amount. Third, as I’ve argued in an earlier work, for proponents of the substance view there would be no reason to bother saving the lives of chromosomally deficient biologically human embryos.19 According to the substance view, whether or not something possesses rationality is an essential trait, so any intervention that would correct the chromosomal defects of these embryos would destroy them and replace them with a different substance—a full rational substance with comparable moral status with you or I. Thus, even if there was an inexpensive pill with no medical risk that could easily correct these chromosomal defects, according to the substance view, using such a pill would be optional and non-obligatory; this is to say that a woman with a chromosomally deficient embryo is morally permitted to refrain from taking such a pill, while a woman with a non-chromosomally deficient embryo facing a different medical risk would not be morally permitted to refrain from taking steps to save that embryo’s life. This consclusion is certainly  inconsistent with the intuitions of most antiabortion advocates.

A more compelling set of numbers comes from Don Marquis.12 He argues that our moral intuitions about early pregnancy are unreliable and contends that a human organism does not come into existence until after cell totipotency ends at about 2 weeks. Most spontaneous abortions occur before 2 weeks—approximately 5 out of every 6.18 If human embryos do not become human organisms until the end of this 2-week period, then only 20% of human organisms die from spontaneous abortion, compared with the substance view’s 42% of human substances. This number is still quite large and substantively higher than other deaths by a wide margin, and thus, on its own, is insufficient to address the problem of spontaneous abortion, but the margin is much smaller than competing anti-abortion views.

The problem with Marquis’s view is that it shifts the debate; it is no longer a question of if abortion is morally acceptable, but when. Abortion is always morally acceptable within the first 2 weeks of pregnancy. Rather than oppose abortion, if Marquis is correct, we ought to advocate that those considering abortions act swiftly to secure an abortion in the first 2 weeks. Education, vigilance and easy access to abortion would prevent the vast majority of unwanted pregnancies.

The control principle response

In response to the problem of spontaneous abortion, Friberg-Fernros says, ‘… the existence of obligations is dependent on our capacity to fulfill these obligations.4 We cannot reasonably be obligated to do something which we cannot do – as the famous Kantian maxim ‘ought implies can’ stresses. … it is not immoral per se to fail to do something about the embryo loss if we were subject to conditions which precluded attempts to prevent spontaneous abortions’.

Roughly the argument is as follows:

1. The control principle—moral responsibility requires control.

2. At present, we have no control over whether many spontaneous abortions occur.

3. Therefore, we are not morally responsible for failing to prevent many spontaneous abortions.

There are three substantive problems with this argument. First, just because we cannot prevent all spontaneous abortions does not mean that we should not prevent any. Friberg-Fernros notes that even with current medical technology, we do have the possibility to ‘do something about embryo loss’ (214). However, preventing such losses would be difficult, he says, because the majority of spontaneous abortions occur before the woman is even aware that she is pregnant. He says this is ‘a fact which also makes it hard to see how one ‘can’ do anything about it’.

Marianne Burda takes a similar stance:

Since 60% of early pregnancy losses occur in the first 2 weeks before a woman may realise she is pregnant, treatment directed towards preventing these losses must be initiated prior to the woman possibly being able to detect that she is pregnant.23

Elsehwere I have argued if one was serious about preventing spontaneous abortions, one ought to recommend that women that have engaged in sexual activities err on the side of caution and assume that they are pregnant until medical testing shows otherwise.19

Burda notes the difficulties and expense that such vigilance would require:

Therapies to prevent these possible losses may require a woman and her partner to undergo testing before she is pregnant to identify any factors that may possibly contribute to pregnancy loss. Testing and prophylactic treatment may be required each month before or around the time of conception. This type of testing and treatment is unnecessary for women who will have no problems with their pregnancies and subjects them to risks and side effects from the testing and treatment. This approach also wastes limited resources that can be directed to other areas of medical care and research, including helping women who have a history of recurrent losses.23

However, this response is unsatisfying for two reasons:

1. The burden to undergo regular, rigorous testing after sexual activity is not all that different from the burden the antiabortion position argues women have to carry fetuses to term.

2. Burda contends that such an approach is a waste of limited resources,not because it will not save lives, but because it is a less efficient means of saving lives than had we allocated resources differently. This is an empirical matter that antiabortion advocates need to stay abreast on, but if this empirical fact requires us to allow fetuses to spontaneously abort, it seems it would just as easily obligate allowing voluntary induced abortions if we expect that we can save more lives by other methods. Since there is compelling reason to think we can do just this, the antiabortion theorist’s focus on induced abortion is misguided at best.

Second, even if we cannot currently prevent most spontaneous abortions and ought to refrain from preventing some of the preventable early spontaneous abortions because it would be an inefficient use of scarce medical resources, we might still have a strong moral obligation to dedicate resources to medical research on spontaneous abortion, doing so would likely result in more efficient practices and treatments that could be used to significantly reduce the number of spontaneous abortions in the future.

Third, and I think most importantly, the control principle response seems to miss the point: spontaneous abortions result in an overwhelming number of lost lives. Even if we do not have control over whether such loss of life occurs, we certainly have control over how we respond to this loss of life. Contemporary antiabortion theorists mourn the loss of human fetuses killed in voluntary, induced abortions that they could not prevent, yet refrain from mourning the far greater loss of human fetuses killed by spontaneous abortions they could not prevent. In other words, they show more reverence—more respect—for some human fetus lives than others.

The visibility response

Thomas A. Marino notes that many pregnancies end in spontaneous abortion before anyone suspects there was even a pregnancy.27 In some such cases, had a woman received currently available medical treatment, she might have been able to prevent the spontaneous abortion, but if she was not aware of the need to secure such treatment, it would not make sense to hold her morally accountable for failing to secure it. Furthermore, if she remains unaware of her spontaneous abortion, it does not make sense to hold her blameworthy for failing to mourn the loss of her fetus’s life.

Marino says the spontaneous abortion problem can be understood as a ‘missed opportunity’ to educate women about prenatal health and that such education ‘ought to be further promoted’. Marino undersells the obligations here—those that believe fetuses, from conception, are comparable with adult human beings have a strong moral obligation to educate about the fact that women might be pregnant before they realise it and promote vigilance regarding the moral obligation to secure prenatal care immediately following any kind of behaviour that one believes might lead to pregnancy. However, these obligations do not end there; one would also be morally obligated to educate people about the rate of spontaneous abortion and about the potential value of medical research that might lead to less abortions—either spontaneous or induced. There is good reason to think that this should include education about contraception and alternative sexual behaviour that would not result in pregnancy. Indeed, given the high rate of spontaneous abortion, would-be parents ought to be educated about adoption, as a successful adoption satisfies their goal to become pregnant without bringing into existence a human fetus that is more likely to die of spontaneous abortion than be born.

It does not make sense to hold a woman morally accountable for failing to mourn the loss of a child she never knew she had, but this lack of awareness does not stop her from mourning the faceless masses lost because of spontaneous abortion. It is not uncommon to pay one’s respect to groups of deceased people—those who died in war, in terrorist attacks, in school shooting, of disease or the like. Spontaneous abortion culls more living things than all of these things combined, yet few antiabortion theorists express any regret or concern.

Sarah-Vaughan Brakman offers an explanation for the antiabortion theorist’s lack of grief towards spontaneously aborted fetuses: ‘it is a normal human response to feel more deeply the loss of life of those one knows or with whom one is in immediate community than a loss of human life that is unknown, or more distant or otherwise not as present or visible’.24 She continues, ‘Therefore, the fact that there is NOT presently a concerted effort to limit [spontaneous abortion] as there is to limit deaths by cars, cancer and cyclones speaks in part more to the power of visibility and degree of personal connection to others than to any moral status claim or to a weighing of number of lives lost’.

Although both Marino and Brakman contend the fetus’s lack of visibility helps to explain why one has diminished responsibility to prevent its death, for Marino, one’s diminished responsibility is a matter of ignorance that can, and should, be overcome through education; in contrast, Brakman seems to suggest visibility is tied to personal connection and the greater our personal connection to the subject, the greater our moral obligations towards them.

For much of human history, our moral obligations have largely been local because there was little we could do for those both literally far away, such as those on the opposite side of the world—and figuratively far away—in this case, undetectable fetuses. We did not have moral obligations towards far away people because there would be no way of satisfying such moral obligations. Today, things are different; we can help those both literally and figuratively far away. Many philosophers have argued that distance is not, by itself, morally relevant.29 30

Although many philosophers agree that we may have stronger moral obligations towards our family, friends and community than towards strangers, this does not mean that we have no obligations towards strangers. In light of the sheer number of spontaneous abortions, then, our relative lack of interest in prevention spontaneous abortions compared with deaths by car accident is morally wrong.

Still, Brakman’s contention that personal connection is morally relevant is somewhat compelling, but it seems to be a reverse-edged sword for the antiabortion theorist. This stance seems to be inconsistent with those that oppose abortion on the grounds of the fetus’s moral status. If our moral obligations are tempered by visibility and personal connection, then the belief that fetuses are morally comparable with adult human persons is not sufficient to show that abortion is morally wrong. Either one can have a personal connection with a fetus that does not yet exhibit signs of personhood or one cannot. If one cannot, then all abortions are morally acceptable on this view regardless of the fetus’s moral status. However, if one can have a personal connection with a fetus, then causing or allowing abortion is only seriously morally wrong for those with a sufficiently close personal connection to the fetus regardless of the fetus’s moral status. This is to say that individuals can have a strong moral obligation to refrain from causing or allowing abortions to occur to their fetuses, but they cannot have a strong moral obligation to act to prevent others from causing or allowing abortions to occur to the fetuses of others.

Consider the antiabortion theorist that opposes abortion but contingently lacks any personal connection to a fetus at risk of induced abortion. Such a theorist seems to stand in the same (lack of) relationship to fetuses at risk of induced abortion as they do to fetuses at risk of spontaneous abortion; this is to say that they are strangers, largely invisible and most likely thought of as abstract statistics. On Brakman’s view, either one can have a moral obligation to such things or one cannot. If one cannot, then for most people, there is no moral obligation to oppose either induced or spontaneous abortion. This is inconsistent with contemporary antiabortion views. If one can, then the lack of a personal connection to spontaneously aborted fetuses does not excuse the antiabortion theorist’s relative lack of interest in preserving their lives.

The causing/allowing distinction response

Many philosophers believe there is a morally relevant difference between acting and refraining, such that in some cases acting to bring about a harm can be morally worse than merely allowing that harm to occur. Christopher Dodsworth, Tihamer Toth-Fejel and Zach Stangebye take this stance:

Ord ignores the distinction between doing evil and failing to do good. We are always responsible for the former (absent excusing conditions), but we are not always responsible for the latter. Moreover, the former is usually morally worse than the latter.

It is wrong to ignore drowning children, but it is an entirely different type of evil to drown them yourself and consider it a ‘right’ to hold them underwater as they thrash frantically for air, until their young collapsing lungs bleed into the water.25

Is the difference between acting and refraining—in this case killing and letting die—morally relevant? James Rachels employs a thought experiment to gauge our moral intuitions on the matter; we consider two parallel cases that are identical except for one thing—the first involves a killing, the second a letting die.31 Consider the following two cases:

Smith Kills: Smith stands to make a significant amount of money from future fertility treatments if something should happen to his patient’s fetus during pregnancy. During the birth, he wraps the umbilical cord around the fetus’s neck, causing it to suffocate to death and be stillborn. He acts to bring about the fetus’s death for financial gain.

Jones Lets Die: Jones stands to make a significant amount of money from future fertility treatments if something should happen to his patient’s fetus during pregnancy. During the birth, he notices that the umbilical cord is wrapped around the fetus’s neck and does nothing, allowing the fetus to die and be stillborn. He refrains from acting to bring about the fetus’s death for financial gain.

If you have the moral intuition that Smith and Jones have acted equally wrongfully, this is evidence that there is no morally relevant difference between killing and letting die. Rachels contends the rightness or wrongness of an action depends on the reasons for or against that action; in these cases, Smith and Jones have the same reasons to do what they do: they act or refrain from acting to bring about the fetus’s death for financial gain despite compelling reasons to do otherwise.2

Suppose that you have the intuition that Smith acts more wrongly than Jones, this would be evidence of what Dodsworth and colleagues believe: that killing is worse than letting die. Even if this is the case, it strikes me that most of us would conclude that what Jones does is still seriously morally wrong. Similarly, a person that freely ignores drowning children they could otherwise easily save is a moral monster. Even if acting to cause a death is more morally wrong than merely allowing death to befall someone, the latter is still uncontroversially morally significant.

There are two significant problems with this reply to the problem of spontaneous abortion. First, even if allowing abortions is less bad than causing them, the antiabortion theorist would have to hold that there is a wide gulf between the two—that causing the abortion of a human fetus is morally equivalent to causing the death of an adult human person, while allowing the abortion of a human fetus is not morally problematic at all—such that allowing spontaneous abortions to occur is not problematic at all. Note, of course, this would mean that allowing others to perform induced human abortions, too, would not be morally problematic at all, completely undermining most contemporary antiabortion efforts to restrict access to abortion.

Amy Berg takes a similar stance, contending that contemporary ‘person at conception’ opposition to abortion is not typically restricted to individuals pursing their own abortions but includes opposition to ‘other people’s abortions’ as well.14

Second, in all likelihood many spontaneous abortions may be inadvertently caused by the actions of others—whether the pregnant woman, or those around her; in other words, many spontaneous abortions are probably accidentally induced abortions as well. Thus, the contrary to Dodsworth and colleague’s assumption, the distinction between acting and refraining cannot explain the different stances antiabortion theorists take towards intentional induced human abortion and spontaneous human abortion.

Finally, the appeal to a distinction between acting and refraining seems to miss the point; for most antiabortion theorists, what makes abortion seriously morally wrong is the fetus’s loss of life, not the means that it loses its life. Don Marquis says ‘The loss of one’s life is one of the greatest losses one can suffer. The loss of one’s life deprives one of all the experiences, activities, projects, and enjoyments that would otherwise have constituted one’s future’.10 The reason most antiabortion theorists oppose abortion is to prevent this kind of loss, and this loss is experienced by both killed fetuses and fetuses merely allowed to die. Cursed Lamp demonstrates this clearly: the djinn explains that his actions do not cause harm to others, they merely allow harm to befall others; but I suspect most of us would find this distinction completely irrelevant to determining whether or not Allison should make more wishes.

The weak obligations response

According to Ord, if human fetuses are morally comparable with adult human beings, we are currently failing our moral obligation to do something about spontaneous abortion because spontaneous abortion kills far more human beings than induced abortion, cancer, AIDS and so on.18 Similarly, Rob Lovering says of spontaneous abortion ‘Now, if a natural epidemic were killing the same number of, say, standard adult human beings annually, we would at least be talking about if not doing all that we could to eliminate the epidemic’.16

One response to the problem of spontaneous abortion is to argue that our obligations in the face of spontaneous abortion are significantly weaker than Ord believes they would be. Thomas Marino says:

Ord also suggests no one is doing anything about pregnancy loss. There are three points to be made here. First, for women who do not have repeated pregnancy loss, there is nothing to do. They try again and get pregnant. Second, there are numerous scientific and clinical studies designed to help those women who do have documented pregnancy loss that is affecting their ability to get pregnant. Third, if anything, this is a missed opportunity because more needs to be done to educate women about the importance of prenatal health, which ought to be promoted further.27

Marino’s response is rather unsatisfying. First, it is not clear why Marino would think that women who have yet to become pregnant have nothing to do; after all, his third point just is that there ought to be more done to educate women, so surely women have a moral obligation to educate themselves long before pregnancy loss—reported or otherwise. Furthermore, if women can take steps to reduce the chance of future spontaneous abortions, it seems they would have a strong obligation to do so. Second, although there are some studies to this effect, Ord’s contention is that given the sheer size of the problem of spontaneous abortion, if fetus lives are morally significant, there should be many more.

Robert Card proposes a different set of obligations one has in face of the possible scourge of spontaneous abortion, contending that those who believe fetuses are morally comparable with adult human persons ought to ‘change their sexual behaviours to avoid undesired procreation and/or alter their methods of contraception when engaging in sexual intercourse’.26 He goes on to say, ‘The cost of an educational campaign that promoted non-procreative sexual behaviors or advocated, for example, combining methods of contraception to substantially reduce the chance of unwanted fertilizations would be relatively low, and it certainly would not entail eliminating the funding of cancer research’.

There are three substantive problems with this. First, it seems that even relatively minor advances concerning conception and spontaneous abortion would lead to far more lives saved than major advances in other areas that we currently devote substantive scarce medical resources to investigating, such as cancer research. More importantly, if our goal is to save fetal lives, we ought to devote far more resources to fighting spontaneous abortion than fighting induced abortion.

Second, suppose that one agrees with Marino or Card, that our moral obligations with regards to spontaneous abortion are relatively minor, involving mostly inexpensive, minor changes in education and sexual behaviour. It is important to note that contemporary antiabortion theorists fail to emphasise even this! Whereas the control principle, visibility and causing/allowing distinction responses have attempted to show that one’s moral responsibility for allowing spontaneous abortion is not as morally significant as critics say it is, the weak obligations response takes it for granted that spontaneous abortion is a serious moral problem, but one that is easily addressed. Thus, failure of contemporary antiabortion theorists to address the issue of spontaneous abortion seems all the more egregious. Even if you believe that it you have a strong moral obligation to save the lives of others, it is somewhat understandable to refrain from donating a kidney to save the life of a stranger, but it is far less understandable to refrain from donating an aspirin to save the life of a stranger when one has hundreds of aspirin at hand.

Finally, even if one disagrees with Ord regarding the extent of our moral obligations towards preventing spontaneous abortion, Lovering’s point still stands: at the very least, if you believe that fetuses are morally comparable to adult human persons, you ought to talk about the threat of spontaneous abortion. Yet, it seems that contemporary discussion with regards to noticing, let alone caring about, spontaneous abortion seems to come exclusively from the prochoice side of the debate, chastising antiabortion theorists for treating like things differently, and spending their efforts to prevent what they believe is a relatively minor harm, while leaving a far greater harm unmentioned. If Marino and Card are correct, and our moral obligations with regards to preventing spontaneous abortion are relatively minor and easily satisfied, this is all the worse for those antiabortion theorists. Imagine a parent chooses to spend her life’s savings—let’s say a million dollars—treating one of her children, while letting her other 11 children die of starvation. It is hard to imagine one making such a bizarre choice, yet it seems this is what many antiabortion theorists choose when they focus on the comparably small evils of induced human abortion, rather than the overwhelming evils of spontaneous abortions.

The asymmetrical response

Roughly, the problem of spontaneous abortion is that many antiabortion theorists treat like things differently, as they contend that all human fetuses, from conception, are comparable with adult human persons, yet while they take active steps to prevent the deaths of human fetuses from induced abortion, they do not take similar steps to prevent the death of human fetuses from spontaneous abortion, where spontaneous abortion kills more human fetuses than induced human abortion, and prevention of deaths from spontaneous abortion may very well be far easier to achieve in both the short and long term with relatively little investment—whether the major shift of priority Ord suggests, or the relatively minor shift of resources suggested by Marino and Card.2 6 18 27 Dodsworth and colleagues and Friberg-Fernros offer another possible response to the problem of spontaneous abortion, contending that there is an asymmetry between human fetuses and adult human persons that makes the loss of many human fetuses morally insignificant compared with loss of even one adult human person.4 25

Dodsworth and colleagues say, ‘In several ways, embryos may have much less to lose by death than adult humans do: they do not have life plans, desires, responsibilities, or intentions that are thwarted; early embryos do not feel pain, and they are not yet participating members of any personal relationships’.25 Friberg-Fernros takes a similar stance, contending that the life of one adult, human person might outweigh the lives of many human fetuses because while normal adult human persons have strong time-relative interests, or a psychological connection to their future and past selves, human fetuses lack time-relative interests.4

The problem with this response is that it rejects the common antiabortion stance that human fetuses, from conception, are morally comparable with adult human persons; on this view, they are significantly less valuable, and thus abortion is nowhere near morally equivalent to the killing of an adult human person. This is, of course, the very thing Ord sees himself arguing for.

Furthermore, elsewhere I’ve argued that if Friberg-Fernros’s appeal to time-relative interests is correct, his view is best described as a proabortion stance, as in many situations a woman’s time-relative interests make it morally obligatory to perform an abortion for relatively minor gain, even in cases where that woman takes a strong time-relative interest in having children.19 Consider the following case:

Vacation: Janine is young and has strong time-relative interests in both her career and having children. She becomes pregnant with donor sperm, but shortly thereafter she learns of a tremendous job opportunity that will require her to travel for a year, but will pay extremely well and will allow her to take an extended period of time off following that year of travel.

For Friberg-Fernros, it seems that Janine’s strong time-relative interests in her career advancement obligate her to have an induced abortion, as she can have a replacement child using donor sperm in the future.

Although the asymmetry response is able to explain why spontaneous abortion is not comparable to the deaths of adult human persons, it seems this response throws the baby out with the bathwater, rejecting the commonsense moral claim that so many antiabortion theorists believe—that human fetuses have a moral status comparable with that of adult human persons—the belief that most contemporary opposition to abortion rests on in both academic and non-academic circles.