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June 27, 2022, 1:56 p.m. EDT

Four ethical principles can help us reason about the morality of abortion, and the morality of denying women control over their own body

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By Nancy S. Jecker

On June 24, the U.S. Supreme Court  overruled Roe v. Wadethe landmark 1973 decision  that established the nationwide right to choose an abortion.

For decades, rancorous debate about the ruling has often been dominated by  politics . Ethics garners less attention, although it lies at the heart of the legal controversy.  As a philosopher and bioethicist , I study moral problems in medicine and health policy, including abortion.

Bioethical approaches to abortion often appeal to  four principles : respect patients’ autonomy; nonmaleficence, or “do no harm”; beneficence, or provide beneficial care; and justice.

These principles were first developed during the 1970s  to guide research  involving human subjects. Today, they are essential guides for many doctors and ethicists  in challenging medical cases .

Patient autonomy

The ethical principle of autonomy states that patients are entitled to make decisions about their own medical care when able. The American Medical Association’s Code of Medical Ethics recognizes a patient’s right to “ receive information and ask questions about recommended treatments ” in order to “make well-considered decisions about care.” Respect for autonomy is enshrined in  laws governing informed consent , which protect patients’ right to know the medical options available and make an informed voluntary decision.

Some bioethicists regard respect for autonomy as  lending firm support  to the right to choose abortion, arguing that if a pregnant person wishes to end their pregnancy, the state should not interfere. According to one interpretation of this view, the principle of autonomy means that a person owns their body  and should be free to decide what happens in and to it .

Abortion opponents do not necessarily challenge the soundness of respecting people’s autonomy, but may disagree about how to interpret this principle. Some regard a pregnant person as “ two patients ”—the pregnant person and the fetus.

One way to reconcile these views is to say that as an immature human being becomes “ increasingly self-conscious, rational and autonomous it is harmed to an increasing degree ,” as  philosopher Jeff McMahan  writes. In this view, a late-stage fetus has more interest in its future than a fertilized egg, and therefore the later in pregnancy an abortion takes place, the more it may hinder the fetus’s developing interests.

In the U.S., where  92.7% of abortions occur at or before 13 weeks’ gestation , a pregnant person’s rights may often outweigh those attributed to the fetus. Later in pregnancy, however, rights attributed to the fetus may assume greater weight. Balancing these competing claims remains contentious.

Nonmaleficence and beneficence

The ethical principle of “do no harm” forbids intentionally harming or injuring a patient. It demands medically competent care that minimizes risks. Nonmaleficence is often paired with a principle of beneficence, a duty to benefit patients. Together, these principles  emphasize doing more good than harm .

Minimizing the risk of harm figures prominently in  the World Health Organization’s opposition to bans on abortion  because people facing barriers to abortion often resort to unsafe methods, which represent a  leading cause of avoidable maternal deaths and morbidities world-wide .

Although  97% of unsafe abortions occur in developing countries , developed countries that have narrowed abortion access have produced unintended harms.  In Poland , for example, doctors fearing prosecution have hesitated to administer cancer treatments during pregnancy or remove a fetus after a pregnant person’s water breaks early in the pregnancy, before the fetus is viable.

In the U.S., restrictive abortion laws in some states, like Texas, have  complicated care for miscarriages  and  high-risk pregnancies , putting pregnant people’s lives at risk.

However, Americans who favor overturning Roe are primarily concerned about fetal harm.  Regardless of whether or not the fetus is considered a person , the fetus might have an interest in avoiding pain. Late in pregnancy,  some ethicists think that humane care for pregnant people should include minimizing fetal pain  irrespective of whether a pregnancy continues. Neuroscience teaches that the human  capacity to experience feeling or sensation  develops between 24 and 28 weeks’ gestation.

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