Medical Progress Shifts the Abortion Debate

Alta Charo, a professor of law and ethics, talks with Steve Inskeep about how medical progress has changed the abortion debate over the years.

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STEVE INSKEEP, host:

The Roe vs. Wade decision came in 1973. It may seem like the political battle lines had not moved much since then, but medical science has changed. Professor Alta Charo says some of those advances affect the debate. She's a medical ethicist at the University of Wisconsin. And she begins with a concept in the original ruling. The high court said a woman had a right to an abortion up to the moment when the fetus was viable.

Professor ALTA CHARO (Medical Ethicist, University of Wisconsin): 1973 Roe v. Wade said that prior to viability, the woman's interest in controlling her body and the privacy of her relationship with her doctor would be paramount. After viability, states were permitted to forbid abortions only if, however, they insured an exception for the preservation of a woman's life or health.

INSKEEP: So the dividing line is when the fetus was viable on its own, and when was that found to be?

Prof. CHARO: They estimated that it would be roughly around the end of the second trimester. But, of course, it was understood that the trimesters were a proxy only for the notion of viability. That question, really, is how we understand the idea of viability. Our technical ability to maintain neonates who are born extremely young has certainly advanced over the last 30 years. Many of those children wind up with extraordinary disabilities, but there is a percentage that are fortunate enough to survive with a manageable level of disability or even in perfectly good health.

INSKEEP: Does that complicate the abortion debate at all, that the Supreme Court drew this line and technology may be blurring it to some degree?

Prof. CHARO: I think it's a complication that has always existed that reflects a theory about why the state may manifest an interest in pre-born life. In essence, we're saying that the state's interest begins at the point at which even in theory we have a separate citizen of the state who is now entitled to the state's protection.

But in the most recent abortion cases the court has no longer focused on viability as the relevant question, and instead has focused on the existence of fetal life, which may be nonviable outside the womb but could possibly continue to develop to the point of viability. So it's actually abandoned that notion of separate citizenship as the trigger for state interest.

INSKEEP: Let's talk about technology that helps you see into the womb. Anti-abortion activists are now advocating measures that would require a woman to look at a sonogram of the baby before having an abortion. Can that kind of technology, as it improves, change the debate?

Prof. CHARO: Yes, it can. Historically in the United States, where we did have abortion regulation which came primarily in the 19th century, it was geared to the moment at which a woman had what they called quickening, which was the ability to perceive the fetus inside the body and which often was roughly comparable to the moment at which her pregnancy would begin to show and other members of the community might be aware of her pregnancy.

Prior to that, pregnancy was treated as an entirely private matter. But as we moved into the 20th century and we saw technologies that allowed the outside world to perceive a pregnancy even earlier, whether it was through ultrasound or it was through in-vitro fertilization, we began to see this notion of a communal interest in that pregnancy moving earlier and earlier, back toward the moment of fertilization.

And to the extent that our debate about abortion is about the degree to which outsiders feel some empathy that leads them to believe they have a valid interest in the pregnancy, we see a change in abortion politics in which there's more and more of a demand to allow the community to control that pregnancy and the decisions around it.

INSKEEP: Let's talk about another kind of technology, technology to protect the health of the mother. There's a lot of debate, of course, about whether abortion laws should include exceptions for the health of the mother. Has that become less of a concern over time as it has become easier for women to survive pregnancy?

Prof. CHARO: Making pregnancy safer than it has been has certainly reduced the support that one might otherwise have found for allowing women to take measures to avoid pregnancy. It simply doesn't seem as frightening as in earlier centuries in which it was understood that women were frequently at risk of dying in childbirth. But interestingly, it is still more dangerous to be pregnant than to have an abortion.

INSKEEP: Alta Charo is a professor of law and bioethics at the University of Wisconsin. Thanks for speaking with us.

Prof. CHARO: Thank you.

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