It is extremely important to differentiate between being anti-abortion at an individual level and being anti-legalising-abortion (anti-choice), a distinction that is often overlooked. It is perfectly reasonable and respectable for individuals who would never have an abortion themselves to be pro-choice.
by Gilbert Gravino
Illustrations by the author
At the heart of every debate on abortion are its scientific, moral, social, psychological and medical aspects. They all play a crucial role in formulating an opinion and taking a stance on the issue.
On the Scientific Aspect of Abortion
Pregnancy is indeed a process. It starts with a man’s sperm fertilising a woman’s egg which forms a single-celled zygote, and then progresses through a sequence of stages to become a more complex embryo and then a foetus. These stages heavily rely on being nourished and supported by the woman, particularly in the early stages of a pregnancy. Eventually, if delivered successfully, this becomes an independent, biologically self-sustained body.
It is fair to say that the genetic composition of the cell in a fertilised-egg-stage is identical to the genetic composition of each cell in the adult-independent-human-stage. However, this does not mean that the entity as a whole remains unchanged along the entire spectrum of the process. Having the same genetic composition within each cell is not sufficient to regard these different stages as scientifically the same or equal—the anatomy is different, the physiology is different, the senses are different and the conscious state is different.
For example, we know that the brain cortex and the thalamo-cortical complex, which are crucial for human consciousness, are not intact before 24 weeks of gestation. Before this time, the developing foetus is incapable of any form of conscious awareness and unable to experience pain in any sense. Even then, the foetus remains in a continuous sleep-like state and unconscious partially due to in utero sedation and nerve inhibition (a result of the womb environment and chemicals secreted by the placenta). Such issues have a bearing on people’s opinion regarding up to which point abortion should be done, if at all. (Note: Over 90% of legally-induced abortions in U.K. and U.S. happen at ≤ 13 weeks gestation*. Foetal anomalies that are not detected before this gestational age contribute to later stage abortions.)
The brain cortex and the thalamo-cortical complex, which are crucial for human consciousness, are not intact before 24 weeks of gestation. Before this time, the developing foetus is incapable of any form of conscious awareness and unable to experience pain in any sense.
Many are opposed to abortion because they recognise the entity in utero as a living entity. However, we need to appreciate that there are different forms of life (as the entity in utero changes along the process) and a ‘killing’ needs to be put into the context of what sort of life is actually being terminated. For that matter, a sperm is also effectively a living entity that carries potential to form a mature human being. Therefore, a more important question to ask is whether the entity in utero constitutes a person or not. This remains ambiguous territory and there is no scientific answer to this question.
We must not pretend that this is a black and white issue. The divergent views on this conundrum completely rely on very personal moral beliefs which are in turn influenced by societal norms. This brings me to my next point…
On the Moral Aspect of Abortion
People consider abortion as morally right or wrong primarily on the basis of the value they attribute to the entity in utero and whether they regard this as a person or not. Importantly, this is completely based on the individual’s personal reasoning or moral beliefs developed in the context of social values and predominant attitudes. For this reason, arguing that all the major political parties and the majority of people in Malta have a certain set of moral beliefs against abortion, and we should therefore not discuss this agenda, is a very unfair argument.
There is no place for self-perceived moral superiority in a healthy society. It is quite arrogant, intolerant and undesirable for humanity at large for anyone to say that their moral values are definitely right and those of others are definitely wrong or that established values are necessarily right. This is because there is no indisputable reliable measure to determine who of us is right or wrong about what is morally right (‘good’) or morally wrong (‘bad’).
It is quite arrogant, intolerant and undesirable for humanity at large for anyone to say that their moral values are definitely right and those of others are definitely wrong or that established values are necessarily right.
Nonetheless, we aim for a society where we can all live together harmoniously and try to minimise any cause of social stress. This necessitates tolerance and respect for others’ moral values, and it is what being pro-choice is ultimately about.
I feel obliged at this point to make it clear that medical doctors are no more equipped than anyone else to decide what is morally right or wrong. Nobody is, and this is why nobody should decide for anyone else. It remains an individual personal matter, and therefore the patient’s choice should be autonomous and respected by all doctors in every circumstance. This includes a patient’s choice to have or not to have chemotherapy for cancer, a Jehovah’s witness’ choice to have or not to have a blood transfusion… and the choice to have or not to have an abortion.
The pro-choice stance respects the views of all conscious beings, allowing all individuals to decide for themselves. Conversely, the anti-choice stance (opposing the legalisation of abortion) simply disregards those who have no moral objection to having it done, and in so doing it does not respect or tolerate their moral values. Therefore, it is extremely important to differentiate between being anti-abortion at an individual level and being anti-legalising-abortion (anti-choice), a distinction that is often overlooked. It is perfectly reasonable and respectable for individuals who would never have an abortion themselves to be pro-choice.
On the Social Aspect of Abortion
Improving social services, ameliorating help in the community, providing education and giving access to contraceptives are all very important, but unfortunately do not stop the occurrence of all unwanted or complicated pregnancies. Just consider that contraceptives are not 100% effective, the circumstance of a rape victim, the occurrence of non-viable pregnancies and a pregnancy with a threat to the woman’s health or life.
The option of travelling abroad for an abortion is not sufficient as it discriminates against those who are unable to travel. This includes those with financial difficulties, sole guardians of children/dependents, victims of domestic abuse, and migrants lacking necessary documentation. When these factors are not an issue, there is still a problem in that the process is delayed and abortion may have to be carried out at a slightly later stage.
When it comes to travelling abroad for an abortion the process is delayed and the procedure may have to be carried out at a slightly later stage.
A woman who opts for an abortion is often labelled as selfish. Many suggest that the offspring could be given for adoption so that families who cannot have children of their own can be made happy and fulfilled. I deeply empathise with couples in this situation, but forcing someone through an unwanted pregnancy and making them give birth for this purpose is not the right solution—this is what I would regard as more truly selfish.
I can almost draw parallels between this idea and the dystopian world of The Handmaid’s Tale which is dominated by the subjugation of women. Women who are fertile but do not want children are in no way indebted to those who are biologically unable to have children. The other form of ‘selfishness’, where a person wants to have control over their own moral values and control over their own body is something that we should all encourage and support if we all want to be free individuals. This form of ‘selfishness’ does not mean that we do not help and support each other. However, we all need to take care of ourselves and be allowed to make decisions that are fair and make us happy before we are capable of pleasing and actively taking care of others.
Unfortunately, the anti-choice movement and the current law in Malta create a hostile social environment for those who hold different views, but primarily for the women who want to have or have had an abortion.
It is my personal view that a woman in this situation should be respected, regarded more highly and have her say on a matter that has an impact on her well-being. Especially when I consider a premature entity in utero that is incapable of consciousness and that is biologically directly dependent on the woman’s body (affecting her health). I also think that it is not sensible to fight for an unconscious unborn to be born, only to have the freedom of exerting their own moral beliefs and freethought taken away from them (whether this affects the right to access abortion or any other moral issue).
Criminalised abortion results in some women risking their lives by resorting to drastic and unsafe means to terminate unwanted pregnancies.
Lack of freedom in this regard has a very negative impact on the quality of life. Forcing women to carry unwanted or complicated pregnancies to term, or stigmatising them for having an abortion, is certainly not helping anyone in society or improving the quality of life of any sentient being. Not to mention the fact that criminalised abortion results in some women risking their lives by resorting to drastic and unsafe means to terminate unwanted pregnancies.
Women are by far the most affected in the debate on abortion as they are the ones experiencing the pregnancy, all the changes it brings with it and its delivery. However, it also affects men. Men are affected directly when, for example, part of a relationship that is not ready to have children (or more children), and indirectly by living in a society where women do not feel free and autonomous. This is stressful on women, which in turn impacts on the general well-being of society as a whole. Personally, I would rather live in a community where everyone, including all the women in our lives (partners, wives, siblings, mothers, daughters, female friends, etc.) feel free and content.
On the Psychological and Emotional Aspect of Abortion
Women can change their minds about abortion after experiencing an uninterrupted pregnancy or induced termination. Amongst the women who have an abortion, there are those who eventually regret it and those who never come to regret it (as with any other life choice). If you hear enough stories you realise that all of these scenarios exist.
Conducting large cohort studies to assess the psychological aspect of abortion is not yet possible in Malta due to the immense stigma and hostility which stops women from coming forward and being open about their experiences. Although not generalisable, small qualitative studies and portals like ‘Break the Taboo Malta’ remain crucial in that they tell stories which so far have been largely hidden by the media. If you juxtapose these stories with what is repeatedly told by many anti-choice organisations—that all women suffer mental problems as a result of abortion—you can tell that this is a very sensationalist and unrealistic sweeping statement. Needless to say, the exposure these organisations get is skewed and also not generalisable in that they are mainly approached by women who fit their views on abortion.
Another issue to consider is the fact that out of those who do experience regret, many could be the result of heavy stigmatisation and hostility by society, rather than the abortion itself.
Mental health problems correlated with abortion were not causally linked, i.e. not caused by the abortion itself but relate to substantial confounding social factors. Therefore, the false notion that abortions cause mental illness is unfounded and untrue.
Since we cannot rely on local data presented by either the pro-choice or the anti-choice movements, we must therefore look at international data. Three large meta-analyses and critical reviews investigating the association between abortion and mental health problems are those conducted by the Academy of Medical Royal Colleges, the American Psychological Association and Charles Reviews**, all of which concluded that there is no significant association. Mental health problems correlated with abortion were not causally linked, i.e. not caused by the abortion itself but relate to substantial confounding social factors. Therefore, the false notion that abortions cause mental illness is unfounded and untrue. Studies also reflect that a common sentiment after an abortion is relief.
On the Medical Aspect of Abortion
In any medical condition it is always best practice to avoid medications and surgery wherever possible, as these always have side effects and risks. However, in certain circumstances where their benefit outweighs the risk, it may be sensible to use these methods. The same applies for abortion.
Ideally, the scenario of an unwanted pregnancy and the need for abortion is avoided altogether. However, unwanted and complicated pregnancies continue to happen due to the unforeseen circumstances already mentioned. In these cases, given the woman is in favour of having a termination, the benefit of an abortion could outweigh the risks. When carried out in a professionally controlled manner (as is the case in countries where it is legal) these are generally very safe (although still carrying certain risks as with any other medical procedure or surgery). Needless to say, a pregnancy also has its own risks.
Ideally, the scenario of an unwanted pregnancy and the need for abortion is avoided altogether. However, unwanted and complicated pregnancies continue to happen due to the unforeseen circumstances already mentioned.
The current law in Malta does not allow abortion under any circumstance, even when the woman’s life is in danger.
The principle of double effect (PDE) can be applied to counter this limitation. This ethical principle stipulates that it is permissible to do something ‘morally good’ that has a ‘morally bad’ side-effect, providing the latter was not the intention, even if it was foreseen. By applying this principle (in the context of Maltese law which considers Catholic teaching as the normative value), doctors can only save the woman when the life of the foetus is terminated indirectly. In practice this is applied, for example, in the case of an ectopic pregnancy. This refers to an embryo that is growing outside the womb, usually in one of the fallopian tubes where it cannot survive. Through the PDE, the condition can be treated by surgically removing the tube containing the embryo.
With that said, illegalised abortion still limits the quality of care. Consider a woman who becomes pregnant and has a heart defect or other disease that is known to pose a great risk to her life. She would like to terminate early not to take any risks, but cannot do so as it is illegal. Doctors will try to save both the woman and the foetus by waiting for the latter to reach a stage where it can thrive outside the womb and get it delivered. In the meantime, the woman has to undergo the physiological and physical effects of the pregnancy and the delivery, which could severely compromise her health and her life. These effects can persist even after the baby has been delivered.
Consider then a pregnancy involving a non-viable foetus such as in the case of anencephaly. As the current law stands, a woman in Malta in this situation has to carry the pregnancy and deliver a stillborn, or deliver a baby that dies hours or days after being born. A pro-choice position allows women to choose, and if they would rather continue with the pregnancy they can opt for this. It also gives the option of terminating the pregnancy for those who feel that it poses a great deal of emotional anguish and practical difficulties.
Consider then a pregnancy involving a non-viable foetus such as in the case of anencephaly. As the current law stands, a woman in Malta in this situation has to carry the pregnancy and deliver a stillborn, or deliver a baby that dies hours or days after being born.
Some argue that we should always let nature take its course and not play god. This view is quite flawed and ironic, as it contradicts the current medical practice which is widely accepted by doctors and patients. In medicine, we constantly manipulate natural occurrences to try and improve our well-being and quality of life. This varies from relatively simple therapy like treating an infection with antibiotics to highly invasive procedures like a heart transplant. This, however, does not equate to us playing gods. It is simply a matter of doctors who have the necessary skills providing help to patients who are free to choose and decide for themselves their own treatment pathway.
P.S. I recognise that other people—including trans and non-binary people—can also be pregnant and need an abortion. I do not wish to exclude anyone.
Access to abortion is regarded as a human right by all the relevant major international organisations. This includes the Royal College of Obstetricians and Gynaecologists, the World Health Organisation, United Nations, Council of Europe, and Amnesty International.
* Statistics from the Centre of Disease Control and Prevention (U.S.) (2015), Department of Health and Social Care (England & Wales) (2017) and National Services Scotland (2017).
** The Academy of Medical Royal Colleges (2011) reviewed studies from 1990 to 2011; the Charles Reviews (2008) and the American Psychological Association (2009) reviewed studies from 1989 to 2008.
Gilbert Gravino is a Maltese medical doctor. He studied at the University of Malta, obtaining a bachelor of science degree in 2010 and a medical degree in 2015. Currently, he is undertaking further medical specialist training in the United Kingdom.
Supposing, in and of itself, termination is intrinsically wrong:
Is rape intrinsically right?
Is pregnancy as a result of an incestuous act, intrinsically right?
Is abusing a woman’s body, intrinsically right?
Is insisting on the completion of pregnancy when there is a risk to mental and physical health intrinsically right?
An unwanted pregnancy is more than unwanted pregnancy. It is a moral dilemma for the pregnant woman.
And it is a dilemma which only she has the right to resolve.
Personally, I would have understood my mother’s trauma had she found it extremely difficult and painful to carry me for the full term.
Dr. Gravino, thanks for your insight and hope that you are doing well the UK. I appreciate your arguments on a delicate matter that definitely warrants further discussion in Malta. However I am disturbed on your scientific premise on Abortion.
To Quote, you state that in the early stages in utero “the anatomy is different, the physiology is different, the senses are different and the conscious state is different”. You also state “However, we need to appreciate that there are different forms of life (as the entity in utero changes along the process) and a ‘killing’ needs to be put into the context of what sort of life is actually being terminated. For that matter, a sperm is also effectively a living entity that carries potential to form a mature human being. Therefore, a more important question to ask is whether the entity in utero constitutes a person or not. This remains ambiguous territory and there is no scientific answer to this question.”
The question that needs to be asked is whether a zygote (first fertilized cell) constitutes human life. Ask any Nobel Laureate in Medicine and Physiology and they will reply that life starts with a zygote. As you well know the cell is the fundamental unit of life. We have the means in the lab to nurture those cells and develop them into organs, even a multicellular organism. That same cell has a unique genetic code and may replicate independently to form the complexity of human life. Thus questions of consciousness, anatomy and physiology do not factor. Physiology and Anatomy are a gross manifestation of biochemistry which in turn constitute cell biology. Thus the basic cell functions do not change from the first cell stage. You may say that chemistry is a science of matter. The difference between the science of matter and the science of life include the following: Living cells divide independently, living organisms evolve, they obey the lays of physics and chemistry yet exhibit properties that atoms do not exhibit (emergence). All living organisms are each unique. The fertilized egg (zygote) meets the aforementioned criteria but sperm does not. Sperm cannot replicate and does not have a unique genetic blueprint as the first cell has. Further, biologists state that life of all organisms reaches an end: death (I will leave it at that).
Thus, we must be very clear. Any reputable scientist agrees that life starts at the zygote stage (whether they are religious, atheist or agnostic).
The argument as to whether the zygote is a potential person or a person with potential is philosophical and I will reserve it for another time.
What constitutes and defines ‘life’ as a general term can also be a long complex philosophical argument. Defining ‘life’ as you know can be ambiguous. There is no peer reviewed scientific textbook or literature explicitly stating when life begins, because that is a question not only of biology, but other matters, including philosophy. However, let’s not get lost in philosophical arguments.
Certainly, science proves that a zygote is the first human cell with full genetic complement capable of replication and self-development. A gamete and a zygote are certainly not the same and I do not think anyone is debating this. Nothing in my writing contradicts any of this (please do not misinterpret my writing – this is easy when you do not agree with my point of view). The general public is generally well informed and you do not need to be a scientist to know this. A single gamete certainly does not have a full genetic complement and is unable to direct self-development, unlike a zygote. The point that I tried to make is that two things can be made to look (or thought of being) the same through the use of words, when they are in fact not. For example, you can say that a gamete and a zygote both have potential (they do not have the same capabilities, but they both carry potential, as without them no human would form), but they are still scientifically very different – this seems to be very clear to everyone. Likewise, a zygote may also be portrayed as being the same as a human being like you and me (since they have the same genetic complement, etc.), but it is certainly not scientifically the same – this does not seem to be clear to everyone. Anti-abortion groups try to portray a zygote and a few week embryo as if it is a human being like you and me, just in smaller dimensions, which from a scientific point of view is ludicrous. At a moral level, you can certainly have the right to believe that these are equal. But not everyone has the same moral values and that is why what determines whether a woman can have an abortion or not should not be debated between you and me, but rather a debate with herself at an individual personal level, where she can decide for herself. Essentially, the value that is attributed differs and relies on moral differences. Even considering that this early stage of pregnancy involves human cells with a full genetic complement that is capable of self-development (this is clear without reserve), this should not impose and force women to carry a pregnancy (which at that early stage is not yet independently biologically viable outside the womb) and give birth (which directly affects her health) against her wishes.
I never expected anyone to change their opinion just by reading this essay, if anything I expected many to disagree with my point of view. But at least it needs to be discussed and everyone should be allowed to voice their perspective, rather than always hearing one side of the argument dictated by a majority culture.
Women have rights; Men have rights; Children have rights; Animals have rights; Who will be defending the rights of the unborn baby? …. u hallina habib!
I read the arguments to get rid of incoumberance od an unplanned pregrancy. The fact that the facto sperm enter a women depends of accidental sex not protected by either two. Yet the consequence is a prospective fetous like you and me was our beginning. . Our mentality is that that is concepttion on an indipendent person in the long rub which is tio open gates in law to abort it. They cannot abort it if it is in advance stage and involve a doctor so senseless to court pieces of flesh of supposed to save the premature babies. . Find some esqueses to open clink or pay from our taxes the abortionists ideal.
The doctor reveals his pro-abortion bias, even if he tries rto mask this.
He makes many assumptions which are incorrect, misleading in fact.
1. We are not human because we are concours or can feel. For example, Congenital insensitivity to pain (CIP), also known as congenital analgesia, is one or more rare conditions in which a person cannot feel (and has never felt) physical pain. we don;’t class these patients as lesser hmans with fw=ewer right do we?
2. Whwne someone is in a coma, induced or otherwise, such as in caes of oxic-metabolic Anoxic brain injury, we do not consider this patient to be a lesser human do we, so why would we use pain, consciousness as indicators for acceptable forms of abortion?
3. Just because a baby may be unwanted, does not mean that this disqualifies that life as a candidate for death. There are many unwanted persons in society, should they lose their human rights also?
4. He compares the killing of a human life in utero, with treating someone with antibiotics. How does one square that triangle and arrive at the conclusion that killing an innocent fragile life is on the same moral level?
5. The author invites us to consider a pregnancy involving a non-viable foetus such as in the case of anencephaly as a justification for abortion. In fact, he is probbly not aware of the deep therapeutic effects on both the mother, an the father, when even if there is no hope, they are permitted to cradle their child for a short while after birth.
6. Inferring that the value and the rights of human beings increase with progression and the stages of development is ludicrous. This gradualtistioc approach is very worrying. It implies that a doctor will give more or less wort to a patient throughout their lfe cycle. The ramifications for this flawed mentality are tremendous. Utalitariansim is a terrifying eugenic principle. Doctors ought to be very careful not to fall into this trap.
Most eloquently put! Prosit! Life is life from conception and there are no ifs and buts. So sad that this circumvention of when life actually begins should come from a doctor and a Maltese one at that. Abortion is simply murder and this touting it as a right is absolute bull. I am all for pro-choice such as when Divorce was introduced but the latter only goes against religious beliefs, does not take anyone’s life and you are free not to take it up should it be against your beliefs. Abortion however is a totally different kettle of fish. Arguments are not on religious grounds and do not need to be because murder is a universal moral tenet and not a prerogative of any religion. It is intrinsically wrong and therefore cannot feature as a choice. By the same yardstick why don’t we legalize theft too…. there are plenty of have nots who are going through very tough traumatic times when there are plenty of those who are have-all and more than needed!! The have nots have a right to choice no??
Supposing, in and of itself, termination is intrinsically wrong:
Is rape intrinsically right?
Is pregnancy as a result of an incestuous act, intrinsically right?
Is abusing a woman’s body, intrinsically right?
Is insisting on the completion of pregnancy when there is a serious risk to mental and physical health intrinsically right?
An unwanted pregnancy is more than unwanted pregnancy. It is a moral dilemma for the pregnant woman.
And it is a dilemma which only she has the right to resolve.
Personally, I would have understood my mother’s trauma had she found it extremely difficult and painful to carry me for the full term.
Dr Gravino, I look forward to the outcomes of your research. Try to remain as objective as possible in your analysis nonetheless, despite the very clear pro-choice opinion expressed above.
Thank you for this. With all political parties officially against abortion here in Malta, we who are pro-choice are left with noobe to vote for, at least in the upcoming MEP elections.
There are no national parties in the EU. While MEP candidates run on national party tickets, once elected, they join political groups in the European Parliament. PD candidates will join ALDE, PN candidates will join PPE (centre-right) and PL candidates will join S&D (centre-left). ALDE and S&D are more likely to protect reproductive rights, but you can check them out and compare them.