How to Solve The Abortion Debate Now, For Good (SCOTUS-Pocus – The DOBBS Decision)
Solving The Abortion Debate: Foreword
Solving the Abortion Debate: My friend and medical colleague Vince finishes this “SCOTUS-Pocus” series by outlining a proposed solution to one of the most divisive issues our country faces in recent decades.
It’s clear that since this debate has been raging unsolved for decades, great issues like this and the moral consequences they impart aren’t going to be solved by draconian legislation or edicts alone. They must start in the hearts and minds of the people, and they must, on the practical and legislative levels, require compromise on both sides.
Just like many of my Christian friends would express disappointment at the “normalization” of morally problematic issues like abortion, transgenderism, etc., I’d argue that’s it’s much better to change the person, one person at a time, than try to mandate only one side’s viewpoint through draconian legislation.
Many of Vince’s propositions below reflect the need for people to accept a particular position that they may not otherwise accept. But that’s the start of solutions to great debates.
I speak not only as a US citizen, but also as a doctor, a conservative, a Jew, and a human. It is my sincere hope that everyone, not just the casual reader who happens upon my blog by accident, but policymakers and government officials as well, will read Vince’s proposed solution and finally decide to open up a dialog that may at last, help us in solving the abortion debate.
– Chaim
While some great questions in our lives remain unanswered, humans have over the eons, put their minds and hearts toward the solution to a number of complex and troublesome problems.
I believe there is a solution to the abortion debate in this country, and I’m going to summarize it below. These points represent what I feel is a viable compromise between the pro-life and pro-choice positions. Some of them represent simple common-sense concepts that one side or the other has chosen to ignore, while others represent a position that requires a deliberate concession on the part of one side or the other.
Naturally, if we’re going to actually solve this issue to a point where everyone is at least satisfied with the solution if not entirely happy that they “got everything” they want, we need to actually demonstrate the will and the ability to give and take on the issues that surround the abortion issue, and that’s what the following list attempts to start.
This is unlikely to be any sort of “comprehensive” list of points needing to be addressed in order to reach a solution, but they represent what I believe is a concrete direction, which could lead at last to a compromise with which everyone, both pro-life and pro-choice, could agree.
Universal agreement that life begins at conception
Since the biological fact that life for any species begins at the moment of conception (fertilization), any fallacious arguments to the contrary must be abandoned. The universal agreement of when life begins for purposes of the abortion discussion, would then be consistent with biological fact. This point is not necessarily “championing” a “pro-life” stance, but rather allowing centuries of known biological fact to prevail, and establishing for purposes of the discussion, a concrete and biologically-accurate baseline. (Please see prior posts from Dr Chaim outlining this concept in more detail).
Universal agreement that abortion is both the termination of a individual life, and a choice of the individuals involved
Once it is accepted that a separate individual life begins at conception, it must also be universally agreed that any interruption of that life’s natural development process (typically involving a 9-month gestational period of growth inside the mother until the moment of birth) is in fact the termination of that life.
It makes no difference if the interruption of the process is due to natural processes (such as miscarriage) or external process (abortion or severe external trauma) – the life inside the mother’s uterus is nonetheless terminated.
To avoid the consideration of legal charges of murder, manslaughter, etc., in the specific case of an abortion, it must be universally agreed that a legitimately-performed abortion procedure by licensed medical personnel under agreed-upon clinical conditions, does not constitute murder, manslaughter, or any other criminal act.
It must also be universally accepted that despite any personal feelings of the mother or father of any pregnancy, the decision to proceed with an abortion procedure lies with the parents of the life being considered for abortion, not by any local, state, or federal government, nor with any non-governmental organization (with the exception of decisions in the case of criminal acts as a cause of pregnancy). Acceptance of this point clearly negates the role of any local, state, or federal government in the decision-making process by placing the onus of the decision and its consequences where it belongs: on the persons directly involved in the pregnancy in the first place.
It must also be universally accepted that the decision-makers (the parents) must be given a complete understanding of the consequences, the “risks and benefits”, and of the various ways each will be affected physically and emotionally by the termination of the life and expulsion of the fetus – before the final decision to proceed with any abortion procedure is undertaken.
Universal acceptance of the concept of personal responsibility
As it is an axiom in life that nothing happens without reason, likewise pregnancies do not occur without the specific action of a biological male and biological female engaging in sexual intercourse. (For purposes of this discussion, I am disregarding the so-called “test-tube baby” method of procreation, since that is a specific decision made by two people who wish to be parents, a method which by its nature is undertaken with specific personal responsibility in mind.)
Thus there must be agreement on a very wide-ranging and public education effort to restore the concept of personal responsibility in matters of sexual activity and its consequences.
It is no secret that over the last several decades, the overall sense of morality in our society has declined, and people these days do not feel restricted in their behavior nor do many feel that non-marital, extra-marital, or non-monogamous sexual behavior is in any way problematic. Likewise, modern society has tended to gravitate toward a blame-game, wherein some people refuse to take responsibility for their own actions, but find it more convenient to blame something or someone else.
When these overall societal behaviors are taken in context of the abortion debate, we see that lack of personal responsibility has unfortunately led to a high risk for unintended pregnancy when two sexual partners either deliberately or “accidentally” disregard personal responsibility for the health and safety of their own bodies, and engage in sexual actions without providing for actions or methods, including emotional restraint, abstinence, or contraceptive methods, to reduce the risk of unintended pregnancy in the first place.
Personal responsibility for one’s actions, while consistent with “religious” or “moral” principles, exists coincidental to religion and morality. Personal responsibility is the duty of every human, to ensure that we act with integrity, honesty, and openness towards each other. A return to this type of respect for others and for ourselves must be discussed on equal terms everywhere – in schools, offices, houses of religious worship, governmental agencies, etc.
In terms of the abortion debate, since both men and women as equally responsible for the creation of a life that either one may consider unwanted, must act with personal integrity and responsibility, taking it first upon themselves and second with their intended sexual partner, to ensure that all efforts are being made to be completely responsible in the sexual act so that the risk of unintended pregnancy, as well as other undesired consequences such as sexually-transmitted disease, it minimized as much as possible.
Universal acceptance of the use of contraceptive methods and encouragement of moral concepts including abstinence
This point needs to go hand-in-hand with personal responsibility. While it is impossible in our current society to assume that no one will engage in sexual activity until they are in a stable, monogamous, lifetime relationship, it needs to be universally accepted that to practice personal responsibility in sexual activity, the use of contraceptive methods must also be universally accepted and encouraged.
Thus, religious entities including the Roman Catholic Church among others, must abandon any consideration of outright bans of non-human methods of contraception (for clarification I consider the Roman Catholic Church’s dogma of “rhythm method” of contraception as a “human” method as it is inherent on the human to perform it, and not by any other chemical or material means).
It’s clear that many religions have not done a good job of instilling their concepts of holy living and godly behavior among their adherents – were that so, we all would be very likely practicing the same religion, worshiping the same god, and all behaving consistently by the same moral code, and there would very likely be no need for an “abortion debate” in the first instance.
The Call to All Religions
I directly call upon all religious organizations of every world religion, to abandon the practice of forcing their religion’s concepts on others and on society, and instead utilize the method that the Christian religion’s Yeshua (Jesus) himself used: passing down deep religious truth and encouragement of godly behavior by using one-by-one or small-group settings.
This type of interaction with others would be the best method in which to pass on guidance to practice the moral principles of abstaining from sexual intercourse until after the partners are in a monogamous marriage relationship, while realizing that as humans we may fail in this moral concept and engage in sexual activity outside of those moral principles.
Methods in practice
In such case, as in the case with those who do not choose to adhere to any set of religious principles, the use of effective contraception for both sexual partners – not just one – should be strongly encouraged. This would do several things.
First, it would thrust the concept of personal responsibility in sexual behavior directly on the participants, meaning that anyone who wishes to engage in sexual activity and minimize their risk of an undesired pregnancy should take it upon themselves to utilize an effective method of contraception specific to their biological sex. This type of personal responsibility would make it much less likely that one of the sex partners would defer contraception under the assumption that the other partner will do it.
Second, it could make relationships stronger if both partners feel they are sharing equal responsibility for avoiding an undesired pregnancy instead of one partner feeling that the other who chooses not to use contraception is only interested in the pleasure of the moment with little care for any consequences.
Third, it would allow the men in such relationships to feel that they are an equal part in the decision-making process of any consequences of their sexual activity.
Fourth, it would lower the rate of sexually-transmitted disease, as well as almost certainly reduce the need for non-emergent or problematic reason (rape, incest, threatened life of mother, etc.) abortion procedures in the first place.
Universal acceptance of the man’s role in consequential decision-making
Just as the male in a sexual relationship is as equally responsible for the creation of an unintended pregnancy, that male must be afforded just as much right as the female, to a decision on the disposition of the child. Here, the common phrase “my body, my choice” must be abandoned in its present understanding which includes the fallacious concept that the male in the issue has no rights or “no say” in what occurs after a pregnancy is confirmed.
Since the man involved in the sexual activity that results in a pregnancy has contributed his portion of genetic material to the life that is created in the woman, the man is equally responsible for the consequence of pregnancy (obviously humans don’t reproduce asexually).
Thus the man must be afforded an equal say in the disposition of the child. The life inside the womb is not the “property” or “burden” of the woman alone and must not be seen as such. Since the man is equally responsible for the pregnancy in the first place, he is thus equally responsible for the “burden”, the consequences of the pregnancy.
Whatever the disposition of the pregnancy, the male partner must be seen as having an equal voice in the process. To deny this to the man, is in fact a violation of his rights. The ability of both sexual partners to contribute to the decision-making process to either maintain a pregnancy or to obtain an abortion, is truly fair and equitable for both man and woman involved.
While it is an unfortunate reality that some men would choose to abandon their rights in decision-making, this should not be a blank excuse for denying men in toto their right to have a say in the disposition of the pregnancy that they had an equal role in creating. Obviously, if the man decides to abandon his decision-making rights, then the ultimate decision will fall on the woman.
The overarching concept here must be universally seen as this: since the actions of both man and woman have equally created a life, both man and woman have equal right to determine the course of action for that life.
Universal agreement that all options be given equal exposure and consideration
When faced with any pregnancy (assuming no internal abnormalities interfere with normal development), the parents of that child, once agreed that one or both will make a decision on the disposition of the pregnancy, must be given equal and non-preferential exposure to all available options. There must no longer be any attempt to silence or stifle any option other than abortion. It is clear that other options including adoption exist.
Every option must be “on the table” for consideration, and none must be allowed to be given more weight or “preference” than any other. Thus, those persons and entities which would seek to steer decision-makers away from any option that preserves the life of the child must be prevented from doing so.
Likewise, each option must be explained to the decision-makers in detail, including risks and benefits of each option, including all known actual and potential physical and psychological impacts of each option.
In this way, the decision-makers will truly have all potential options for the disposition of the pregnancy at their disposal, and must be permitted to make a decision on their own without any external coercion from any source.
Universal agreement of a “consultation period” prior to any abortion procedure
This goes hand-in-hand with the previous point regarding opportunity to consider all possible options for disposition of a pregnancy. In no case should any woman or man be pressured into making a particular decision. The percentage of times that an immediate, “can’t wait” abortion procedure is actually needed is extremely small; thus nearly all abortion procedures if wanted or needed, can be performed in a more relaxed time frame.
This time can and should be used by both sex partners to be informed of all possible options, and ample time to consider the pros and cons of each option for their particular situation, including being fully advised of the risks, benefits, and potential or actual ramifications both physically and psychologically of each option.
Universal acceptance of national specialized certification for all abortion providers
This is a concept that should be common sense, but has eluded national interest and debate.
As part of a physician’s training, education and practice in at least basic surgical practices is provided. But in order to become a specialized surgeon requires further training and certification.
While certainly many physicians currently providing abortion services may already be board-certified gynecologists or general surgeons, it must be universally agreed that the abortion procedures are specialized invasive procedures, and that as with any invasive procedure, abnormal or unintended consequences can occur. Because of this, physicians not specially certified to perform such procedures should not be permitted to perform them until they show proficiency in the procedures.
Also, in order to maintain a level of trust in the safety of the abortion procedures, particularly with those who would be otherwise opposed to abortion for any reason, the demonstration of specialized skill in the performance of such procedures to minimize abnormal consequences would prove beneficial. Here is what I propose:
1) A national certification specifically covering abortion procedures. This would be similar to board certification for other specialties, but those obtaining this type of certification will be required to demonstrate a minimum level of competence and proficiency specifically in abortion procedures. The certification may be managed under gynecology, but it must be nationwide and mandatory. No abortion will be able to be performed by any physician who is not specially certified in this field, evidenced by their passing the certification process. Providers of abortion services must be required to re-certify on a time frame and in a manner to be later determined.
2) A national certification for specifically covering facilities providing abortion procedure services. All facilities nationwide who intend to provide abortion procedure services, regardless of what they are – hospitals, ambulatory surgical centers (ASCs), or specialized outpatient clinics – must be required to meet a national minimal medical/surgical site standard, with the requirements mandated by law on a national level. This certification may be administered for example, under the auspices of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and must be subject to re-inspection and certification on a specific interval in order to maintain compliance with the standards. All hospitals, ASC’s and other specialized clinics performing any type of healthcare service must submit to such inspections and certifications, and it must be universally agreed that any facility, regardless of the type or the location, must be subject to the same certification requirements.
3) A national-level specialized certification process for Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives. According to a study published in 2013 by the American Journal of Public Health, and reported by the University of California-San Francisco, the medical authority granted to CRNP’s, PA-C’s, and CNM’s to perform abortion procedures is widely varied across the country. This is, of course, due in part to each profession’s board certifications being covered by various agencies, but certainly no less in part due to special interests in various states, as evidenced by the fact that “Full Practice Authority” for CRNPs is harder to pass in certain state legislatures than in others. I propose that a nationwide level of certification and authority be enacted for “non-physician providers” to perform certain abortion procedures (aspiration or chemical for example) at specific time frames during the pregnancy. This certification would be similar to that which I proposed for physicians, with re-certification on a time frame to be later determined.
Restrictions on abortion procedures and timing
While an abortion procedure can logistically be performed at any time during a pregnancy, I propose that certain restrictions must be imposed:
1) A restriction, but not a ban, of “on-demand” abortion procedures performed on minors without the knowledge and consent of at least one parent or guardian. This restriction is as much for the protection of the minor, as it is for the healthcare provider who intends to perform the procedure. Since it is impossible to completely eliminate the possibility of minors (or anyone for that matter) to engage in sexual intercourse, in the case of an unintended pregnancy occurring among this population (considering that contraceptive methods have been used and have failed), a minor requesting an abortion for an unintended pregnancy should be required to obtain the consent of at least one parent/guardian. It would make no difference which parent/guardian it is, so long as an adult is aware of and agrees with the request from the minor. This would give the minor and the parent (or parents) opportunity to consider all of the alternatives prior to any final decision.
2) A restriction on availability of so-called “Plan-B” contraceptives. This type of medication is a higher dose of the hormone levonorgestrel, which is commonly found in many oral contraceptives in lower doses. As such, use of high-dose levonorgestrel is in fact an effective method of reducing unintended pregnancy when used as directed. In various states (at the time of this writing) it is available over-the-counter with unrestricted access. However, I propose that while it should remain over-the-counter, it should be regulated by the FDA, as is the over-the-counter decongestant pseudoephedrine; the reason for this would be restricting its access to minors to limit potential adverse effects of taking high-dose levonorgestrel without the prior advice and guidance of a medical provider. I would strongly recommend that all minor females of menstruating age, be given advice by their pediatricians or primary care providers about their medical fitness to use levonorgestrel if needed. After receiving this advice, and assuming there are no specific medical contraindications of the minor female using such a medication, any woman over 18 should be freely permitted to obtain the medication for themselves or for a minor relative, without any other “restriction” than asking a pharmacist or pharmacy technician to obtain it for them behind the pharmacy counter – they should not be required (as is required with pseudoephedrine for other reasons) to prove age or have their state ID scanned. In deference to this more open access, it should be very strongly encouraged that woman who intend to have levonorgestrel on-hand for any as-needed use, first seek the advice of their gynecologist or primary care provider so that any potential medical contraindications could be addressed and a woman can feel confident that use of “Plan-B” is not likely to cause any harm to their health, and that such advice and consent be duly noted in the patient’s medical record as evidence that the medical fitness for using such a medication was cleared by a medical provider.
3) Restriction of “on-demand” abortion after fetal viability. In general, medical science considers a fetus “viable” (likely to survive outside the womb) at 24 weeks, though some doctors will use a different time frame, based on specific circumstances. While indeed the fetus prior to the point of viability is still biologically alive, a line needs to be drawn somewhere, and I propose that subject to consensus among medical professionals, that the 24-week mark be considered the general point of fetal viability, prior to which abortion “on-demand” may be performed, but after which the “on-demand” provision would no longer apply. After fetal viability, abortion would be permitted only in certain circumstances, and after thorough consultation with the woman’s board-certified obstetrician. There are a number of examples why a woman and/or her partner would wish to obtain an abortion after fetal viability, one example would be if it is found by fetal testing that the child has a congenital disorder such as Down syndrome. Any request for an abortion in such cases should be considered only after (as noted previously), all alternatives are presented to the parents with equal gravitas and none excluded or given more attention than any other, and after full consultation with a board-certified obstetrician including counseling on potential health implications, etc.
Universal ban on “live-birth” abortion procedures and universal agreement of the status of “born-alive” abortion infants
As of this writing, legislative action in the US Congress was being drafted in reference to this issue, and a debate remains as to the exact percentage of post-viability abortion procedures actually result in a viable fetus still being alive.
The implications of an abortion procedure “going wrong” and resulting in a live fetus being expelled are horrifying of course, considering the facts that biologically every fetus is actually “alive”, and an abortion procedure is intended to unquestionably terminate that life. If my other proposals are assumed as accepted, they would almost certainly minimize the instance of post-viability abortion in the first place, but what about the instances of post-viability abortions performed that do not go as expected, and the fetus is expelled, still alive?
I propose that there is national-level acceptance of the fact that in such a case, the status of the child surviving a failed abortion is considered exactly the same as a child born under normal circumstances, with all the same rights and privileges of life and medical care to maintain that life outside the womb.
Thus, any attempt to terminate the child’s life once outside the uterus must universally be considered a criminal act of murder regardless of who makes the attempt.
Basically, an abortion provider performing a post-viability abortion has “one chance to get it right”, and has a medical, ethical, and legal responsibility (under penalty and/or sanction) to ensure that the fetus is actually and completely dead, before full expulsion from the fetus. In the cases where the child is expelled from the uterus and is in fact still alive, immediate post-natal care must be afforded to the child surviving the failed abortion procedure, just as with any intended live “premature” birth, in order to make all medically reasonable efforts to maintain the life.
Any effort to deny the survivor the same level of post-natal care that is given to any normal birth, must be considered a legally and ethically criminal act with appropriate criminal or civil penalties and/or sanctions applying.
Concluding Thoughts
Let me conclude by talking openly here. Many of us have lived with this issue long enough to see how it has caused some fractures in our society. Currently, the “losers” appear to be those on the pro-life side of the argument, since even before the SCOTUS decision, abortions have been carried out daily with no signs of slowing down or stopping.
After the SCOTUS decision, many in the pro-choice camp tried to make it appear that they had suddenly become the victims, while everyone knew that was never going to be the case with the Federal government and many state governments firmly in the hands of a party very much agreed with open and unrestricted abortion access.
To The Pro-Life / Anti-Abortion Supporters
To the pro-life supporters, I say this:
I think you’re putting too much on yourselves, and fighting a battle with mudpies, when the opponent has sabers.
I certainly agree with the concept that all life is sacred, that abortion is the termination of a life, that G-d frowns on abortion, people should act responsibly and with morality. However, let’s be realistic and allow me to speak your language.
While we know G-d will win the war, Satan is certainly winning a few battles here. The horse of morality is out of the barn and has run away, there is absolutely no way we’re going to get it back by marching and chanting and trying to force our morality on a whole nation at once.
Morality by force was historically never successful, and it will never be successful. Let’s face it – abortion is here, it’s going to continue to happen whether we like it or not, just like our kids are going to continue to have sex outside of marriage, and we’re going to continue getting divorces, whether it’s moral or not. Satan is winning battles, because we forgot how to fight – he’s doing hand-to-hand combat, while we’re doing trench warfare.
We have to move away from this concept of “everyone has to be good because we say so”, and return to the concept that Yeshua showed us – small group and one-on-one discipleship. People are not going to come to G-d and live a moral life because some government edict says so, or because they’re forced into a large crusade and shamed into feeling like they have to approach the altar.
“Forced conversions” are not real conversions – they’re conversion of behavior, not conversion of the heart and soul.
If we want to win the “abortion war”, we have to allow the hearts and souls of the people – one person at a time – to be changed to a more responsible and moral behavior, which will ultimately result in a decrease in the need for “unwanted pregnancy” abortions in the first place.
Oh, and medically speaking, there actually are occasions where an abortion procedure is medically necessary to save the life of the mother, so stop trying to shame women into thinking they’re committing murder if they choose their life over the life of their child. Leave the choice up to the parents, because it’s their lives, not yours.
To The Pro-Choice / Pro-Abortion Supporters
To the pro-choice supporters, I say (you didn’t think you’d get away clean, did you?):
Well hurray for you, you’ve had your over 40-year time in the sun. You have a US president who doesn’t seem to care about the debate, as long as the outcome makes him look good.
But before you continue to gloat and try to force a “national abortion law” to override what the SCOTUS had properly decided by relegating the decision on abortion legality and specifics to the individual states, stop and think what you’re asking.
Free, open, unrestricted killing of life, for whatever reason or no reason, any time, anywhere, by anyone who claims to be qualified to do it, just because it is your body and you claim that you have the right to say what you do with your body, and the man involved has no say whatsoever.
Well, if it’s your body and you have the right to do with it whatever you want, why do you continue having promiscuous, unprotected sex, practically inviting an unwanted pregnancy? Why put yourself through that in the first place, when you can prove to everyone that you’re being responsible with the choice and not being so reckless in your behavior?
While it may be “no one else’s business” if you want to go off and have sex whenever you want with whomever you want, however you want, then for G-d’s sake at least be responsible and use protection. And if the man you’re intending to sleep with is so ignorant and self-absorbed that he refuses to use his own method of contraception with you, then let me tell you – he isn’t worth the time; find someone who at least respects you enough to use a condom.
Oh, and why not start working with pro-life supporters to try to solve this issue together, instead of using a self-righteous battering ram to force your way nationally without any thought of how it would affect those who don’t agree with everything you say. Haven’t we lived long enough with the “I don’t care about anyone else, it’s my way or the highway” attitude in our country?
SCOTUS has made us a roadmap to finally solving this – on a national level – without one side of the debate being completely shut out. I believe both sides can come together, cooler heads can prevail, and we can solve this to everyone’s satisfaction.
Come, Let Us Reason Together
Certainly each of the points I’ve raised above don’t represent a comprehensive list. But I believe that if everyone, pro-choice and pro-life, seriously sat down and contemplated these proposals, we could finally start a dialog that could solve the decades-old abortion debate. We could end a major source of sociopolitical division in our country by logic and cold reason, not by emotionalism and partisanship.
If we can truly come together and solve this issue, just think of what else we could accomplish when everyone puts aside their extremism and divisive dogmas and works together.
