How much is a fetus worth?

In a pluralistic society it is difficult to reach a legal consensus, much less an ethical one. People may never agree on what it is that gives value to the unborn. They may never agree on the precise moment tissue becomes human, or indeed on what it means to be human. But a collective concern cuts across these diverse positions. It is here that the author makes his contribution to the controversial abortion issue.

Jack W. Provonsha, M.D., Ph.D., is chairman of the Department of Christian Ethics, Lotna Linda University Division of Religion, Loma Linda, California.
The frequent association of the feminist movement and proabortion groups is neither illogical nor unexpected, in light of the fact that both involve resistance to the traditional male-dominated social model. Nor is it difficult for those males who support general feminist aims (as I do) to agree that because women run the risk and experience the discomfort of childbearing, they should have the most to say in the matter. But should that final say be absolute? Does no one else have a stake in the issue—the fetus, the father, the larger society? For example, we quite legitimately refuse a woman absolute rights over her newborn infant. She has no freedom to. destroy it or even to abuse it. The newborn has a say, even if the rest of us temporarily have to speak for it. So far I have heard no feminist organization advocating freedom to practice infanticide. Apparently, somewhere between the warm fluid darkness of the uterus and the light of day, a value transformation takes place.

A similar transformation is apparent in the thinking of those obstetricians who view the fetus, at least the early fetus, in objective tissue terms—"the commonest tumor in the female uterus." Such doctors would never allow purely medical or even preferential considerations to govern the care or lack of care given to the healthy newborn. Apparently, for them too something happens on the way to the delivery room.

Much of the abortion conflict, of course, has revolved around the question When does a fetus undergo this value metamorphosis? Does it happen at conception, "when supposedly it receives its human soul? (For centuries the church simply followed Aristotle's concept of soul-implantation at forty days for males and eighty days for females.) Does it happen when the embryo attaches itself to the wall of the uterus, giving it at least a creditable physiological future (a consideration, by the way, legitimizing abortifacient lUDs or "morning after" injections)? Does it occur at quickening, that mythical boundary between embryo and fetus when the fetus announces its nontumor presence (a concept that formed the basis for old English and early American law)? Does the change take place at viability, with its calendar arbitrariness? And what does viability mean when we compare the intensive-care differentials between Appalachia and a modern teaching hospital? Does it happen at delivery when most of the baby is out (as some of the older rabbis taught)? Or at respiration ("God ... breathed into his nostrils the breath of life; and man became a living soul")? When does the transformation take place—ethically, not just legally? Lawyers and ethicists do not always see eye to eye on such matters. Law by its nature has to be precise and well-defined even if arbitrary; ethicists lie awake nights.

The higher question behind all of this concerns humanness. We are trying to discover when, in the course of its development, does tissue come to make human claims upon us? But this question presupposes that we have first-decided what it means to be human, a question that haunts most of the bioethical issues modern technology has thrust upon us.

The field of inquiry is divided between those who draw a qualitative distinction between man and the lesser animals and those who do not. For those who do, such a distinction is usually defined either in terms of a unique human soul or in terms of functional capabilities such as making choices and being accountable.

Those who opt for an implanted immortal soul as that which gives humanness to tissue have at least one advantage when it comes to the abortion issue. Conception is the only occasion in the whole course of events when some thing happens in a brief moment of time that is truly momentous. Those shades of gradations represented by terms like implantation, embryo, fetus, quickening, and viability are difficult to nail to the wall. Even delivery and breathing represent not so much profound modifications in the fetus as changes in location and adjustments in physiology. Is the fetus, ten minutes before birth, different in a way that would affect its value from what the child is ten minutes after?

Those who view humanness primarily in terms of function, who maintain that it signifies the ability to do something more than the brutes do (reason, choose, become creatively accountable), are the ones in real trouble with the abortion issue. Surely embryos and fetuses do none of these things. But neither do newborns and there's the rub. Presumably it would be as acceptable on this basis to destroy newborns as to destroy fetuses, since both are in the same "prehuman" condition. Infanticide would be as permissible as feticide, and abortion would be ethically, if not medically, practicable in any trimester prior to birth. In this case the human question becomes When? When does one become accountable and thus human? At age 7 ? At age 12 ? (Surely not at 24 gestational weeks!)

The point is that in a pluralistic society, in which people's beliefs and value systems differ widely, it is difficult to achieve even legal, let alone ethical, consensus. We may pass laws based upon voting majorities and submit these laws to the scrutiny of an olympiad judiciary—which simply represents another level of voting majority—but we shall experience great difficulty making everybody happy with the results, as we have all learned by now.

It is difficult, but we must try. What follows in this article may be considered an attempt to bring a measure of rational tranquility into an intensifying ethical storm. It may even serve to promote more meaningful public practice.

I submit that the abortion issue cannot be resolved ethically by attempting to discover the precise moment when tissue becomes human. This is true,first, because a large segment of society does not accept the notion of an implanted immortal soul. In fact, I do not, in spite of the current rash of books and articles supposedly confirming the existence of such a soul after death. As an unabashedly Christian believer, I find that my conception of man's nature is conditioned more by the Hebraic, and thus Biblical, concept of man than the Platonic Greek dualism implied by the soul doctrine. But I must also be respectful of other people's points of view, as we all must be if we expect to live together on this troublesome planet.

Second, knowing the exact moment cannot solve the abortion issue, because all the moments after the first are moments only arbitrarily. Certainly the legal definition of viability as a precise number of weeks, however necessary for the convenience of jurisprudence, is nonetheless artificial.

And if one defines humanness only in terms of human function—or even the potential for such human functions as choice, accountability, et cetera—one opens up a Pandora's box and releases a host of other troubling questions. We readily recoil at the prospect of legitimizing infanticide, as such a definition might. And what of those individuals who by reason of brain defects occurring in genetic or intrautenne life can never, now or in the future, do any of these requisite human things? We have institutions overflowing with such blighted persons. What would happen to such individuals if we defined humanness in terms of certain functions? That readymade source of nonresisting experimental subjects and organ-transplant donations has already been eyed with some eagerness. And what of our responsibilities toward those who can do such human things no longer, our senile, demented elderly? They too are "cluttering up" our institutional and financial landscape.

It is possible, of course, to grant intrinsic worth to a fetus, at whatever stage—even an embryo—on other grounds than its soul. Embryos and fetuses are of greater value than mere tissue largely because of what they may become. They borrow at least a part of their value from that possible future. But they also possess another intrinsic value, to those of us who are sensitive to such things. They possess the marvel that is the genetic code. As soon as all of those genes and chromosomes have come together, it has happened! Those fantastic, incredible things that will-be taking place over the weeks, months, and possible years that follow are already established in that microscopic miracle of creation! Forgive the hyperbole, but one is almost tempted to bow one's head in awe and reverence at the vision. (I personally cannot understand how molecular and cellular biologists can avoid becoming deeply religious people.)

But even if, owing to a genetic or other defect, fetuses and embryos have no really human future, their value still transcends mere tissue value because of another quality that defines humanness. And this is my main contribution to the ongoing discussion.

Along with his ability to reason (homo sapiens) and to create (homo faber), man possesses another quality that is in a measure derived from these. He is homo symbolicus. (None of these qualities is possessed in absolute degree, of course, but their relative extent is so great, compared with other life forms, that we can almost speak of absolute distinctions between man and even those animals most similar to him.)

By homo symbolicus I refer to that quality in man that enables him: to posit representative values. The term symbol in this case indicates any entity, object, thing, or action that refers to, points to, or stands for something else. It is this gift in man that forms the basis of his human activities. It is the basis, for example, of his articulate speech. Sounds or inscriptions come to have meaning for those in on the secret. When one reads or listens to another talking, one does not merely see markings on the paper or hear sounds; one sees and hears ideas. The markings and sounds are thus symbolic. They refer.

The use of symbols is the foundation for most of our complex social interactions, including economic ones. With out the ability to attribute representative value to pieces of paper, bars or slugs of metal, or shiny pieces of mineral, some of which might be relatively worthless intrinsically, all of the "Wall Streets" of the world would grind to a screeching halt, and we would be reduced to a crude system of barter—a sack of wheat for a shirt.

Symbols are thus enormously useful to us humans at all levels of life. And they are not to be taken lightly—if humanness is to persist. Religious people have always understood their significance—in part because of another feature of symbols. Not only do they stand for, and thus communicate, attitudes, but they also condition attitudes, including value attitudes, toward the reality symbolized. The way one treats or regards the symbol may very greatly affect one's attitude toward that to which the symbol points. This is why religion has generally abounded with symbolic richness—rituals, liturgies, objects. Some religious structures almost overwhelm us with a sense of awe and reverence just by our stepping" inside them. A holy book becomes a holy object because it points to, that is, represents, what religion is about.

It is this symbolic quality in man that is too frequently overlooked in the abortion issue. To illustrate it most effectively, I ask you to take a brief look at the opposite end of life. May I illustrate from a patient of my own? She was an elderly lady in her late 70s who had suffered a number of small strokes, diminishing her capacity in a variety of ways. She had become something of a care problem but was still kept in the home of her daughter who loved and looked after her.

One night the daughter called in great distress. "Doctor, please come; some thing terrible has happened to Mother." I arrived at the home to find the old lady lying in bed in a profound coma; her respiration was labored and erratic, her pulse irregular and difficult to palpate. It took no special degree of medical acu men to recognize that she had suffered a serious cerebral accident and that her survival was in question.

She was taken by ambulance to the hospital, where further observation confirmed the seriousness of her condition. I tried to prepare the daughter for the obvious. Her thoughtful response after listening to me was "Doctor, I don't think I want you to do anything for Mother."

Now, of course she did not mean that to be taken literally. If she had, we could have wheeled her mother down to the morgue and laid her out to cool off on the slab table there. She was thinking of all those fancy gadgets, respirators, cardiac pacemakers, and the like, by which we can almost endlessly prolong the dying process these days.

Understanding this, I replied, "There really isn't very much we can do for your mother. [Which wasn't strictly true either. What I meant was "There is nothing we can do to bring her back to normal mental function."] But," I went on, "we will do all we can to keep her comfortable."

Now, whom was I treating? The daughter, of course. There was no reason for her decision to leave her with a residue of guilt. But I was also treating me, and the nurses, and others who were responsible for her mother's care. I obviously was not directing my remark to the patient, who by definition (deep coma) was about as "comfortable" as anyone can become.

I acted as I did because I care about my attitude toward people. I want to preserve my humanness, my compassion. The old lady was no longer "human" by any functional definition. She was already a "functional" corpse, although we probably could have kept her cadaver "alive" for a fairly long time if we had hooked her up to the gadgets. But the point is, she still meant humanness at this point in her life and thus retained human (if symbolic) claims upon us. And until the changes should take place in that symbol and be confirmed so that she could come to mean corpse—and we have fairly well-established, even ritualistic, ways of doing this—it was important that we honor the claims of that symbolic human life for our sakes.

I submit that what is true at the end of life also speaks to life at its beginnings.

The original claims that give birth to symbols come to us out of our traditions and collective experiences. Fetuses have always meant something special. One does not carry a fetus like one "carries" an appendix. One is with child, one is going to have a baby; and that's one of the things that has kept human life human since time immemorial. It is this attitude that provides the open arms at birth and thus a sense of acceptance and value on the part of children without which there can be tragic deprivation.

Symbols are usually not consciously created, though they may be consciously or even unconsciously destroyed. Symbolic values can be stripped of meaning as when, for example, we objectify and depersonalize individuals to whose human claims upon us we do not wish to listen. The horrors of war—the Mylai incident in Vietnam and the revelations of the Nuremberg trials in Germany—come easily to mind.

We can desymbolize fetuses, too. And we seem to be doing so in some segments of our society. But we ought to take a long look at the general consequences of this tendency if what I have been suggesting about the attitude-conditioning potential of symbols is true. To desymbolize may also be to devalue, and we have enough of that going in our society to keep us all awake nights.

What is a fetus worth? The fetus may gain its value from several directions, depending upon one's beliefs and personal value system. It can be of value as one possessing a human soul. (Not all share that belief, of course.) It can be of value as a miracle of creation with profound future potential (a position I hold, but I realize not everyone agrees). It can also be of value because of our collective concern with keeping human life human on this planet. And this is one concern that I do think all of us generally share. But to protect that concern means we must also be prepared to protect those supporting symbolic values that serve it. This includes looking after the marginal, even submarginal, individuals among us. It includes protecting our ability to feel compassion for our senile elderly. It also includes resisting fetal devaluation.

To be sure, sometimes values, even human values, compete, and ethics must also wrestle with these. Sometimes it is necessary to give priority to one value over another. What this means, in the present case, is that sometimes a fetus (as symbol) must be sacrificed because of its threat to the humanness (not merely life; humanness is a quality of life) of its mother. The thing symbolized always stakes a prior claim over the symbol but never unless the threat is severe enough to require it. And that is a judgment, I suggest, involving all of the persons directly concerned. An abortion must never become a trivial action. The decision must always be carefully considered by others even if it finally rests in the hands of the one most threatened. There should be counseling, and there should be wrestling. It ought always to pain our souls for the sake of all of us and our common humanity. We should all be prepared to share the burden and we ought to be prepared to pick up the tab. Providing viable alternatives to abortion could be a costly matter, but I submit that, on the above terms, a fetus is worth the cost.

Naturalist Edwin Way Teale once said, "It is those who have compassion for all life who will best safeguard the life of man. Those who become aroused only when man is endangered become aroused too late." Perhaps this applies also to symbolic man, as well as to endangered species. Actually, man, at least moral man, may be the most endangered species of all.


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Jack W. Provonsha, M.D., Ph.D., is chairman of the Department of Christian Ethics, Lotna Linda University Division of Religion, Loma Linda, California.

January 1984

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