THE MEDICAL ETHICS OF ABORTION
Warning- Long, rambling post that goes nowhere
Background info: In India, abortion used to be legal till 20 weeks of gestation for everyone. The parliament of India recently passed an amendment to the Medical Termination of Pregnancy Act, that essentially makes abortion legal up to 24 weeks of gestation for certain categories of women such as victims of rape, and also makes access to it easier by permitting it on the advice of only 1 doctor, changed from 2. (Side note- Yes, the same government that is called far-right Hindu nationalist by left wing American media passed this law, which shows how little predictive value is gained by sticking western labels onto a different culture)
More background info: I'm a doctor practicing in India, and my fiancee is training in neonatology. In med school, I was very pro-abortion, while she was against it. In a very rare occurrence, I actually managed to convince her that abortion should be a universal right- though she still said she would never get one herself. Today, I'm more ambivalent about it, while she supports it.
So a few days ago, in her hospital a young rape victim, 23 weeks into gestation, was posted for medical termination of pregnancy. The obs and the patient decided that inducing labour would be the safest option for her, and proceeded to do so. This was the first MTP being done in that hospital on a foetus older than 20 weeks without any abnormality, because it was legalized only recently. Normally the foetus dies during the delivery, and doesn't cry or have a heartbeat at birth.
In this case, they delivered the foetus- and it cried. It had a heartbeat. Now the obs were faced with a moral an legal problem- it was a living infant in front of them, and they could not let him die. So, after a very panicked call, my SO rushed there, resuscitated the baby and shifted it to the neonatal ICU. As a 700 gram neonate born at 23 weeks, she didn't expect him to survive long. He died the next morning.
It was a traumatizing experience for everyone involved. The mother, who was expecting a dead foetus, saw her firstborn son struggling to draw breath- and then lost him the next morning. The obstetricians, who swore a solemn oath to do no harm, blamed themselves for the death of a baby. There were many tears shed by all.
This incident brought into focus a contentious issue- what is the difference between a foetus and a baby, other than the location being inside or outside a womb? When it was a foetus, the obstetricians had a duty to the pregnant girl to abort it. When it was a live abortus, they had a duty to the baby to save it. It passing through the birth canal and separating from the mother seems like a very arbitrary boundary beyond which it is considered a living human. It was just as alive inside the womb.
Yet to the human mind, there does seem to be a difference. The mother, who was willing to abort her foetus, was horrified at the thought of her baby dying once it was alive and outside her. Now it was a baby, and she was morally culpable for it's death, as were the obstetricians.
I genuinely don't know what the morally correct action would be here (or, to my Indian mind- what is Dharma?) Forcing a 16 year old girl to bear the child of her rapist is unconscionable to me. The obstetrician could inject a drug into the amniotic sac to kill the foetus before inducing labour (she didn't do it because she didn't consider it safe in this case)- but what is the moral difference between killing it in the womb and smothering it a few hours later, after delivery? And the foetus/baby is as innocent as the mother- why should it's life be taken away? What should someone who has sworn an oath to do no harm, do? To my mind, the choice of inaction in order to escape culpability is a coward's choice, and doesn't absolve one of responsibility for the outcome.