National Right to Life, Family Research Council, and other anti-abortion organizations have been enthusiastically spreading the word about a study published in the New England Medical Journal showing that a fetus can be viable if born at 22 weeks gestation with advanced medical intervention. A New York Times article about the study was very clear that survival was for a “tiny minority” and that 24 weeks remains the medically and scientifically accepted point of viability. Nonetheless, as all sides in politically polarized issues tend to do, abortion opponents have focused on sharing the headline of the study and not the details. Although coincidental, the publication of the study is perfectly timed with the U.S. House of Representatives passing the 20-week abortion ban, which the Senate will now consider.
Predictably, those who oppose abortion see the study as the proof needed to ban late term abortions, also suggesting that viability age should be lowered. They are appealing to our hearts through survival babies, giving the false impression that at 22 weeks most fetuses can survive outside of the womb. Many who believe that late term abortions must be legally available might even agree with them if the study was conclusive. It is not.
There are important medical-scientific limitations to babies born before 24 weeks. When pregnant women either go into labor early or a medical complication otherwise comrpomises the pregnancy, doctors discuss available medical interventions and the prospective outcomes of each on the fetus. Not all hospitals have the technology or equipment most able to produce a live birth and not all parents choose to have those interventions. Indeed, it is those very women who may choose a late term abortion to save their own lives or spare their wanted child a life of poor health. Much as they felt joy at being pregnant, life offered them a heartbreaking complication. No one has the right to judge the decision they make, certainly not Congress or political opponents of abortion.
In a column for the Daily Beast, Cornell Professor of Pediatrics Jeffrey Perlman noted in more eloquent terms that the study had serious biases and design flaws and should not lead to lowering the age of viability. For that to make sense, a randomized study with and without medical intervention would be necessary. Perlman also pointed out that the research would have to account for a range of factors, such as gender differences in fetal development and accurate estimates of the age of the fetus to name a couple.
I am personally very grateful for the medical advances that have made it possible for premature babies to survive and live healthy, productive lives. I have significant reservations about the use of technology to force life too early to ensure health and quality, just as I do with sustaining life too long when people are confined to a bed with no consciousness and only technology allowing them to breathe. All of us know of children born with disabilities or conditions that require lifelong care. That happens and to full term as well as premature babies. Families accept and embrace the children, adjusting and growing with the child. The acceptance that society places on these children and the value they place on supporting them and their families is evident through public policies, including the Americans with Disabilities Act and various educational reforms.
If a 22-week-old fetus can receive medical assistance and survive, how should medical experts and ethicists respond in the future, if at all, to the prospect of lowering the stage of viability if technology continues to advance? Are we concerned about the financial and social/personal costs associated with using the technology? There are high costs for the medical technology and there are high costs to care for babies born so early that they must receive medical care throughout life however long or short. What about 22-week gestational stage babies born addicted to drugs? Are we going to complain about the public assistance their moms receive? Will Congress thwart programs that support the care for these babies?
For pregnant women in the wrenching situation of unexpectedly delivering a 22-week-old fetus, this study might offer hope if they happen to be at a hospital with the technology and expertise to offer medical intervention that might allow survival of the fetus. For other pregnant women, if this study is improperly used for political gain, and it already is**, instead of hope, it will further erode their options to make decisions they consider best for them and the baby they wanted and may even allow a physician to place priority on the life of the fetus over the woman. Which life is more important?
Instead of having implications for late term abortions and viability, the real issues to come from the study involve ethics and social support. A 22-week-old fetus is not naturally viable. An abortion at 20-22 weeks gestation may well save a woman’s life or spare a baby a life of pain. Nothing has changed in that regard.
** 5/15-15 update: Political misuse of the study has begun. See http://black.house.gov/press-release/rep-black-lauds-upcoming-house-vote-pain-capable-unborn-child-protection-act and http://www.nytimes.com/2015/05/15/opinion/an-abortion-bans-bogus-arguments.html?_r=0