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Abortion: Time to Reconsider? |
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Abortion is rapidly rising back up the CMF agenda. The recent spate of correspondence on the issue in the CMF Journal[1] as underlined the Executive Committee's recent decision that we must have the debate again. Other developments have also contributed.
Part of the success[2] of our recent affirmation on euthanasia to the House of Lords Select Committee on Medical Ethics was that we could state consistently that 'intentional medical killing is always wrong'.[3] This must lead us to ask whether this principle applies equally before birth. The fact that the falling number of babies available for adoption is in large part a consequence of easy abortion has confirmed our strong opposition to the use of ova from aborted female foetuses in infertility treatment and research.[4] Our newsletter has highlighted some encouraging recent Christian initiatives to provide compassionate alternatives to abortion[5] and a Commission of Inquiry into the operation and Consequences of the Abortion Act has drawn attention again to the physical and psycho-social effects of abortion on women.[6]
CMF has never had a consensus opinion on abortion. Instead it has been maintained in the past that 'among Christian doctors opinions differ... from those who believe that such a procedure should never be entertained to those who regard the termination of an unwanted pregnancy as merely a logical extension of a responsible family planning programme'.[7] Our last official monograph on the subject was published in 1979 and is now out of print.[8]
Many are now asking whether as a fellowship of professing Christians who 'accept the Bible as the supreme authority in matters of faith and conduct'[9] we are right to maintain our previous low public profile on abortion.
The aim of this paper is to stimulate further debate toward the end of establishing an informed biblical consensus.
Before we start, however it will be useful to remind ourselves of the historical context of the current debate.
Recent History
Although abortion has been practised at some level by most societies, legal abortion on a massive scale is a relatively recent phenomenon. Since the Soviet Union first legalised abortion in 1920, much of the rest of the world has followed suit: Scandinavia in the 30s, Asia beginning in the 40s and Western Europe from the late 60s. By 1982 only 28% of the world's population lived in countries where abortion was largely illegal - mostly in Muslim countries, parts of Africa and Latin America.
There are now estimated to be 55 million legal abortions performed each year worldwide.[10] Britain was the first non-Scandinavian Western country to liberalise its abortion laws in 1967. Since then almost 4 million abortions have been performed in England, Wales and Scotland and there is currently one 'legal' abortion for every four live births. The typical woman having an abortion in the UK today is single, under 25, in her first pregnancy and having the procedure performed in a private institution for reasons of 'risk of injury to the physical or mental health of the mother'.[11]
This dramatic shift in practice has run counter to historically accepted codes of medical ethics. The Hippocratic Oath includes the resolution 'I will not give to a woman a pessary to produce abortion'.[12] The Declaration of Geneva (1948) states 'I will maintain the utmost respect for human life from the time of conception even against threat...'[13] and the International Code of Medical Ethics (1949) affirms that 'a doctor must always bear in mind the importance of preserving human life from the time of conception until death'.[14] In the same spirit the UN Declaration of Human Life (1948) asserts that 'everyone has the right to life'[15] and the UN Declaration of the Rights of the Child that the child deserves 'legal protection before as well as after birth'.[16]
When the legal abortion rate soared world-wide in the second half of this century the World Medical Association responded in 1970 by adopting the Declaration of Oslo.[17] This allowed doctors to perform 'therapeutic abortion' if their 'individual conviction and conscience' allowed it and the law and national medical situation were not in disagreement. In 1983 the words 'from the time of conception' were officially deleted from both the Declaration of Geneva and the International Code of Medical Ethics.[18]
No-one can deny that over the last century we have seen a reversal of attitudes toward abortion. From being traditionally opposed to it, the medical profession is now one of its major facilitators - either through willing complicity or passive indifference.
It is clear that the rise in the incidence of unwanted pregnancy is a symptom of the disregard of the Christian ethics of sexual purity and parental responsibility (both male and female). On this all Bible-believing Christians will agree. However there is disagreement among Christian doctors in five other areas which I will discuss in turn:
* The status of life before birth
* The meaning of the sixth commandment
* The lesser of two evils
* Imposing our standards
* Tolerance of mutually exclusive views
The status of life before birth
Is the fetus fully human?'
The fundamental issue in the whole debate is whether life before birth has the same status in the eyes of God as life after birth. If it does, then we must be obliged to treat human life in the womb with the same respect with which we would treat human life at any other stage of development. If it doesn't then we could argue that we are justified in employing some sort of sliding scale of value.[19] What does the Bible say?
Fundamental to the Bible's teaching on the status of human life is the principle that God himself is completely just and impartial (2 Ch 19:7). It is therefore not surprising that Jesus and the apostles warned against partiality on the basis of wealth (Jas 2:3,4), sex, race, social standing (Gal 3:28) and age (Mt 19:14). Furthermore Old Testament teaching enjoined special respect and protection for easily exploited groups such as the poor (Pr 22:22-23), widows and orphans (Ex 22:22-24), aliens (Ex 22:21), the handicapped (Lv 19:14), slaves (Ex 21:2-6) and the elderly (Lv 19:32). It must follow that devaluing any human life, let alone vulnerable human life, is inconsistent with God's justice. The heart of Christian ethical teaching is that we must love as Christ himself loved (Jn 13:34), that the strong should lay down their lives for the weak (Phil 2:5-8, Rom 5:6-8). To suggest that the weak may be sacrificed in the interests of the strong is not biblical morality.
Furthermore there are many specific references to life before birth in Scripture. Psalm 139:13-16 affirms God's creation of, and communion with, the unborn child as well as implying the continuity between life before and after birth. God calls Isaiah and Jeremiah before birth (Is 49:1, Je 1:5) and forms Job 'in the womb' as well as bringing him out of it (Jb 10:8-9, 18-19). Many other references to life before birth in the Bible reinforce these principles (eg. Gn 25:22-23, Ps 22:9,10, 51:5, 71:6, 119:73, Ec 11:5, Is 44:2,24, 49:5, Ho 12:3, Mt 1:18, Lk 1:15, 41-44) and there are over 60 references which mention conception explicitly.
In the face of the weight of this biblical testimony however, many Christians have justified attributing a lesser value to life before birth on the basis of Exodus 21:22-25. This argument has dominated CMF literature for several decades[20], [21],[22],[23],[24],[25],[26] and the impression gained is that it is the final word on the subject. In fact the exegesis is flawed. Let us consider it in some detail.
'If two men who are fighting hit a pregnant woman and she gives birth prematurely but there is no serious injury, the offender must be fined whatever the woman's husband demands and the court allows. But if there is serious injury, you are to take life for life, eye for eye ... bruise for bruise.' (Ex 21:22-25)
The argument put forward is that fetal life must be of less value to God or 'miscarriage' would have been punishable by the death penalty. It is easier to understand how people come to this conclusion when the RSV version of the translation is considered:
'...If men strive together, and hurt a woman with child, so that there is a miscarriage, and yet no harm follows...'
It is essential to stress first that this cannot be construed as a reference to abortion. There is no intention to hurt the unborn child and the woman is an innocent bystander to a fight who suffers accidental injury. However there are three key questions raised by the passage which have a bearing on the status of life before birth: Is this a premature live birth or a miscarriage? Does the fine apply to causing the death or the premature delivery of the baby? Does the set of punishments apply to injury of the child or mother or both?
The varied interpretations made by English translators virtually all add to the meaning of the original Hebrew text. Whereas the NIV reading implies a premature live birth, the RSV suggests that the baby is dead. The Hebrew doesn't rule out either possibility but simply states that 'her child' (yeled)- or more correctly her offspring since the form of the noun is a generic plural-'goes out'(yatsa). Yeled in most biblical contexts means simply child (see for example Gn 21:8, Ru 4:16, 1 Ki 3:25) and yatsa elsewhere simply describes going forth (Gn 12:4, Ex 35:20). Because there is no indication in the Hebrew text that death of the baby has necessarily occurred it is therefore not justified to assume (as many authors do) that causing a miscarriage was punishable only by a fine. Equally, the Hebrew does not specify whether the 'serious injury' referred to is suffered by the mother or the child. Both readings are possible. If, as some commentators have argued,[27] the lex talionis (life for life etc) applies equally to the child, causing a stillbirth or miscarriage would have been punishable by death. This reading would be far more consistent with the rest of the biblical testimony about the status of life before birth. If the Hebrew leaves room for doubt then surely we are obliged to give the fetus the benefit of that doubt. It is extremely dangerous in any area of biblical interpretation to base our whole practice on an unwarranted deduction from a single verse.
If God himself does not discriminate between individuals and affirms the humanity of life before birth recognising conception as a strategic event, dare we act differently? How can we justifiably claim that unborn children are not neighbours to whom we owe responsibility? The burden of proof must certainly be with those who are trying to justify abortion.
Most arguments that have been put forward to devalue life before birth are based more on human feeling and intuition than divine revelation. For example some[28] assume that being made in God's image involves possessing a certain level of rationality, consciousness or capacity for relationship and then argue that this is impossible without a certain level of neurological function. Scripture simply tells us that man is made in God's image(Gn 1:27; 9:6). A human being not yet born has value not because she knows God but because God knows her! (Ps 139:13-16) Human status is bestowed from above rather than being earned.
Others[29] assign human value on the basis of how we feel. It is argued that because we mourn miscarriages less than stillbirths, early life is less important. However to imagine that our status depends on how much we are valued by other people is again to undermine the Bible's teaching that it is ultimately what God thinks of us that really matters.
Some[30] presuppose lack of value by repeatedly referring to the fetus as 'a potential human being'. Isn't it more correct to call it a potential infant or adult or even a human being with potential? Speculation about whether or not the fetus possesses a soul also involves presuppositions. Whilst we must admit to some sort of dualism at the time of death (something after all survives death to be judged) the Bible gives no support to the notion that 'the soul enters the body' at some point after conception. To argue from the special case of Christ[31] using Hebrews 10:5 'a body you prepared for me' is not justified. Christ was pre-existent. We are not. If we want to argue from the special case of Christ then we have the Holy Spirit's own testimony (Lk 1:42) that Christ was present in Mary's womb at about 14 days' gestation (see vv 36,56-8). Can we really support with any conviction that he wasn't present at conception given Gabriel's visit and prophecy at this time? (Lk 1:26:36)
Arguments about the high mortality of the early fetus, the 'inconceivability' of heaven being filled with 'tiny blobs' and the impossibility of two 'souls' residing together in the embryo which twins[32] all similarly subject divine mystery to human judgement. The status of the human embryo has been more fully debated elsewhere.[33],[34],[35]
In Bishop Ryle's words, 'If the thing is not in the Bible, cannot be deduced from the Bible, or is not in manifest harmony with the Bible, we should have none of it.' There is no biblical basis whatsoever for assuming that human life before birth has any less status in the eyes of God than life after birth. The Scriptures rather support the conclusion that God values both equally.
The sixth commandment
Is abortion murder
If we accept that life before birth is as valuable to God as life after might we then defend abortion on the basis that it is not murder? We must not become confused here with legal, psychological or social definitions of murder. The Bible does not support the conclusions of previous authors that murder is 'the killing of a human being unlawfully with malice aforethought'[36]or killing with 'a feeling of ill-will' [37],[38] or 'illegal killing inimical to the community'.[39] What then does it say?
The sixth commandment 'You shall not murder' (Ex 20:13, Dt 5:17) which is restated in the New Testament (Mt 19:18; Rom 13:9) is not a blanket prohibition of all killing. It is apparent from those texts which expound it (Ex 21:12-14; Lv 24:17-21; Nu 35:16-31; Dt 19:4-13) that the biblical meaning of the word translated 'murder' (Hb ratsach, Gk phoneuo) is the 'intentional killing of an innocent human being'. Killing that is unintentional, what we call manslaughter, is not covered by the commandment, nor is the killing of guilty as opposed to innocent human beings. Old Testament Law recognised three situations in which killing was thereby justified: Holy War (Dt 20:10-18), capital punishment (over 20 offences) and self-defence (Ex 22:2,3). By contrast the shedding of innocent blood is universally condemned throughout Scripture (Ex 23:7).
Abortion is undoubtedly 'intentional'. It is also 'killing' in the sense that the fetus is alive before and dead after the event. The fetus is 'innocent', not being guilty of any capital offence. Killing in self-defence (of an intruder intending to commit a crime) was only ever excusable as an emergency and certainly never as a planned procedure in broad daylight. Furthermore as outlined above what is being killed is a 'human being'in the eyes of God. Abortion is then the 'intentional killing of an innocent human being' and thus falls within the biblical definition of murder. What else could it be? It is certainly not manslaughter (as has been suggested[40]) because manslaughter is unintentional. Nor is it 'justifiable homicide',[41],[42] because homicide was only ever justifiable for guilty human beings. The Scriptures support the conclusion that abortion is murder.
The Lesser of two evils
Is there any alternative?
If we accept that abortion falls within the biblical definition of murder, it might well ask whether it is ever acceptable to commit murder as the lesser of two evils. The answer is not as simple as it may appear at first sight.
The Bible teaches for example that it is wrong to tell lies, right to relieve the suffering of others and wrong to disobey the governing authorities - yet there are many examples of godly men and women with the apparent approval of God deliberately acting counter to these divine directives on certain occasions. It seems that deceiving an evil person is justified to protect innocent lives (Ex 1:15-21; Jos 2:2-7), causing suffering through a word of rebuke or act of discipline is justified to save a person from greater evil (Pr 27:5,6; 2 Cor 7:8-11) and disobeying the governing authorities is justified if it is to honour a direct command of God (Dan 3:13-18; 6:10-12; Acts 5:27-29). In each case, where two commands of God conflict, the higher one takes precedence.
Is there any instance in the Bible where God approved the taking of innocent human life to fulfil some higher end? I can't find any, unless we wish to argue that the cross itself in some way involved this. In this case God took the suffering upon himself, but are there any instances in Scripture where God commended the shedding of innocent blood to fulfil some higher law. Moses offered his own life for the people (Ex 32:31-34) and Elijah asked God to kill him (1 Ki 19:3-5) but God honoured neither request. Instead by his grace he provided some way out of the dilemma, by giving extra strength to those involved.
How does this apply to abortion? Some people attempt to justify abortion in hard cases such as fetal abnormality, rape and young maternal age by arguing that the suffering resulting from allowing the pregnancy to continue is a greater evil than the intentional killing of an innocent human being. Does this make sense? If, as we have argued, life before birth has the same status as life after birth in the eyes of God, it must follow that if we wouldn't approve of infanticide in a given situation, neither should we approve of abortion.
Would we sanction the destruction of a newborn baby who was grossly deformed, or conceived as a result of rape or the child of a minor? Wouldn't we rather look for some way to make the best of a bad situation, to work the evil for good - by using our medical skills, or helping practically or financially or perhaps by arranging adoption? Wouldn't it be better to try and strengthen those involved in some way to help them cope with the situation? Isn't this what Christ himself would have done. I'm simply saying that the same argument applies for abortion. Part of the problem has been that we as a Christian community have been slow to develop compassionate alternatives to abortion. However over the last few years organisations such as LIFE and Christians Caring For Life (a division of CARE) have worked hard at reversing this. They would benefit well from our support and encouragement.
In my own view, abortion is only ever justified as the lesser of two evils in an emergency to save the life of the mother. Here we are not saying that the baby is less important than the mother but simply that (since the baby will die regardless) it is better to intervene to save one life rather than stand by and watch two die.
Thankfully these situations are rare, and almost always occur at a gestation advanced enough to make delivering the baby alive quite feasible. As a general surgeon I have operated in an emergency for ectopic pregnancy and have delivered a premature baby by caesarean section in order to resect infarcted bowel. It has taught me a great respect for those who have to cope with these difficult dilemmas.
Imposing our standards
Do we have a right?
If abortion can only be justified as the lesser of two evils when the greater evil is letting both mother and child die - how should we handle the patient who is determined to have an abortion and won't be persuaded otherwise? If we refuse to help her are we simply imposing our morality on her? Do we have a right to refuse?
It is important to be clear what we are really asking here. If we help a mother to procure an abortion then we are being an accessory to that abortion. We are helping someone else to do what the Bible teaches is wrong. Would we assist our patients to steal or to commit adultery if their minds were set on it? How is abortion any different? If we agree that it is wrong to help patients kill their mothers or fathers after birth on the grounds that they are unwanted then surely it must be equally wrong to help them kill their children before birth.
Under the Abortion Act we do have the right conscientiously to object to involvement - but even if this ceases to be the case in the future, then surely isn't it better to risk our careers, reputations or lives rather than to disobey God? (Mt 10:28; Lk 14:26,27) This is what the great men and women of faith, who are given to us as examples did (Hb 11). Shouldn't we follow their example?
We cannot force our patients to continue their pregnancies. God himself never does this. The Gospel is an invitation, not an imposition. We must do what we can to help them cope if they decide to keep their babies, and welcome them back later even if they don't - but this does not mean that we should assist them to do what is wrong. This is allowing them to impose their morality on us, and as Christians we must obey God first of all.
Tolerating mutually exclusive views
Can we judge each other?
Christians who have been involved in performing abortions will generally try to justify the practice to themselves and others in some way. Some manage to do so quite successfully, and seemingly have no feelings of guilt or remorse. What should be our response to this? Should each person simply be allowed to do as they see fit provided their conscience is 'right before God'?
This is a difficult question. The Lord himself warns us not to judge one another or think ourselves better than each other (Mt 7:1-5;Lk 18:9-14). Paul teaches that it is wrong to 'judge another man's servant' (Rom 14:4). However the context in this latter case is with regard to disputes over 'externals'- the examples given are those of holy days and unclean foods. Whereas Paul makes it quite clear what he believes about both issues, he believes such differences of opinion should be tolerated in the spirit of love.
However he does seem to take quite a different approach when the issue is immorality among believers (eg. Eph 5:3-7). His approach to a specific instance of immorality in Corinth was to instruct the church to deal with the problem, and if necessary expel the unrepentant person (1 Cor 5:9-13). Jesus also taught that as his disciples we have a responsibility to rebuke one another (Luke 17:3,4) and gave specific directions about how this was to be done (Mt 18:15-17). Indeed the Old Testament context of the command to love our neighbours as ourselves suggests that this involves challenging each others' wrong behaviour (Lv 19:17-18). If we fail to exercise this responsibility how can we claim that we are acting in love?
If abortion falls within the biblical definition of murder, and if unrepentant murderers are to be excluded from God's presence (Hb 10:26-31; Rev 21:8), then it is most important that we do not allow fellow believers simply to go on doing abortions without being challenged. Would it be right to allow fellow believers to persist in adultery or theft simply because they claimed to have a clear conscience before God? Wouldn't we rather suspect that their consciences were not functioning correctly- that they had become blunted, or perhaps never been properly educated? (Pr 14:12; 16:2; Je 17:9). Love involves having the courage to confront. If our love does not lead us to challenge each other's wrong behaviour, then we are not loving each other enough.
Conclusions
I am convinced on the basis of the weight of the biblical evidence outlined that God accords equal status to life before and after birth, that intentional medical killing is wrong before as well as after birth, that the lesser of two evils argument does not hold for abortion, that assisting our patients to procure abortions is wrong and that as Christian doctors we must in love challenge each other's wrong behaviour.
I long to see CMF being as opposed to abortion as it is to euthanasia, and equally committed to the provision of compassionate alternatives to both. I believe this is the way of the cross: being prepared to pay the price of our obedience to Christ, and being prepared to be part of the solution. This will mean different things for each of us depending on the gifts God has given us and the position God has placed us in.
To make a firm stand on abortion inevitably involves personal cost. I have seen close friends and colleagues suffer discrimination at all levels from personal smears, to the denial of appointments for which they were well qualified, to being fined and censured by professional bodies for being unwilling to participate in abortion.
CMF, as a Fellowship of 4,500 Bible-believing doctors is unique. If we had a strong consensus on this issue it would help turn the tide on many others. There is no other organisation in the UK which is in as good a position to do it. Will we take up the challenge? (Es 4:13-14; Ezk 22:30)
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