Plan B and the moment of conception

[mmcirvin]

I should put my own biases on the table here: Personally, I believe, for involved, more or less consequentialist reasons, that abortion should be legal, free of statutory encumbrances, and easy to get under all circumstances, up to the moment of birth. But I know that this isn't a popular position in America, even among people who generally support reproductive rights; I recognize that it is a difficult issue and I can sympathize with people who have moral qualms about late abortions.

Objections to abortion are sometimes phrased in terms of slippery slopes: if you support abortion under circumstance X then it's not a big stretch to support infanticide under circumstance Y, and where should we draw the line? (Most extravagantly, Philip K. Dick once wrote a misogynistic short story in which abortion had been extended to an option to kill your children up to the point where they learn algebra.)

In practice, though, nobody of consequence is advocating infanticide, and the true political slippery slope in the US slips the other way. Anti-abortion activists are turning their attention to bans and restrictions on various methods of contraception. This is logically perverse even from a hardline anti-abortion point of view, since a likely consequence of restricting contraception is to increase the rate of abortion, but it's happening.



The emergency contraceptive known as Plan B has at long last been approved for over-the-counter dispensation, which is important since time is of the essence when taking it. Unfortunately there are still a lot of restrictions—it can't be given over the counter to minors, and I don't think it's going to be distributed at ordinary pharmacies (mild correction: the FDA says that it will be distributed at pharmacies, but not at stores lacking a pharmacist, so the "pharmacists' rights" dodge to restrict it will probably still be a problem). Reactions to the decision seem to indicate that people still don't understand what it is or how it works, largely because of a concerted campaign to muddy the issue. News articles regularly fail to counter the impression that it's an abortifacient, which it is not.

PZ Myers explained it all in a well-written article months ago, and some more details appear here: Plan B is a larger dose of progesterone (correction) a synthetic hormone that mimics the action of progesterone; it is a substance also used in ordinary birth-control pills. A function of progesterone is to prevent ovulation. If a woman takes it within 72 hours of having sex, Plan B has a chance of preventing an egg from being released by her ovaries, and therefore preventing a zygote from being conceived.

An elevated level of progesterone naturally occurs in a pregnant woman, so it's not fatal to embryos or fetuses; Plan B is distinct from the abortifacient drug RU-486 (mifepristone). I also believe that RU-486 should be legal and easy to get, though it should remain a prescription drug because administering it properly requires medical supervision. But RU-486 is not Plan B, and I think part of what anti-Plan B activists are trying to do is sow confusion on this point.



The manufacturer of Plan B states that it may also cause changes in the endometrial lining that prevent implantation. This is the thin reed upon which any logical anti-abortion argument against Plan B hangs: the possibility that Plan B may actually sometimes prevent implantation of an already-fertilized embryo. Though, technically, abortion is defined as the termination of a pregnancy after implantation, the most doctrinaire of anti-abortion activists believe that a human life with full human rights begins the moment a zygote is conceived, and that doing something to prevent implantation is tantamount to murder.

However, as various comments to those posts, and linked resources, explain, there is no good evidence that Plan B really does prevent implantation, and in fact some evidence that it doesn't. For one thing, implantation typically occurs days later than Plan B's time window of effectiveness. The manufacturer's statement is likely an attempt to cover all bases in case Plan B is someday discovered to prevent implantation, and seems to be based on old theoretical arguments about birth-control pills that are not strongly supported by the evidence.

Besides, as I and many others have said before, more than half of all fertilized zygotes either naturally fail to implant or spontaneously abort afterward. If what you care about is preventing zygote death, Plan B ought to reduce the overall level by preventing conceptions even if it causes an occasional implantation failure. Given this, of course, one can get into delicate moral arguments about accidental vs. intentional implantation failure, God's will (if one believes in that) and the doctrine of double effect. But the important thing to understand is that if Plan B does prevent implantation, this is probably rare enough that it should be regarded as an accidental side effect rather than the drug's primary means of operation. Plan B is not an abortifacient, but a contraceptive that works by preventing ovulation.



Some of the remarks I've heard, though, such as the ones quoted in the comments to Bitch Ph.D.'s post, have clued me in to a realization that something else is going on here: I think people are defining "the moment of conception" not as the moment the sperm goes into the egg, but as the moment the man ejaculates, which can be many hours earlier.

When people say that a human life with full human rights exists from the moment of conception onward, what they often mean is not that this new being exists from the moment the sperm enters the egg. What they often mean is that it exists from the moment the sperm enters the woman. It's a prescientific notion of how babies are made that is built into the way we use the verb "to conceive" in its reproductive sense: "Son, you were conceived to the tune of 'Any Way You Want It' by Journey," etc.

It makes some sense if you realize that, prior to modern genetics, it was sometimes believed that some sort of complete homunculus or life-essence existed in the sperm itself, with the woman providing, so to speak, only the soil in which the seed was grown. Even the word "sperm" means "seed", a misleading analogy since it's the pollen that contains a plant's sperm. But the analogy colors the way we talk about sex and reproduction.

I know that just knowing the correct details of where babies come from is not going to dissuade some people. If your real cultural or religious problem is with dissociating sexual intercourse from reproduction, or with giving a woman the ability to veto a man's reproductive power after he comes inside her, no amount of science is going to change your mind. But I do have some hope that a correct understanding of what's going on will keep some undecided people from getting confused.

Comments

[manfire.livejournal.com]

I like when people mention the homunculus thing because it reminds me of that bit at the beginning of Tristram Shandy.

That is all.

also

[vardissakheli.livejournal.com]

Ted Chiang's wonderful story about defeating the extinction of humanity by discovering a self-replicating code, "72 Letters."

[mskala.livejournal.com]

Defining "conception" as "ejaculation" would neatly explain the prohibition on male masturbation, which is otherwise hard to justify on biblical grounds (the verses normally cited for it pretty clearly are talking about something else entirely) or "sperm are human lives" grounds (given that the overwhelming majority of them die whether they go anywhere interesting or not).

[kerri9494.livejournal.com]

Ah, the old "masturbation is murder" saw.

*sigh*

[mmcirvin.livejournal.com]

Some of the comments on Myers' blog even mention that a progesterone analog is used to enhance the possibility of implantation with in vitro fertilization. If it's taken after ovulation has happened, Plan B may be more likely to encourage implantation than to prevent it.

[partiallyclips.livejournal.com]

Number One on the Billboard charts the week I was conceived was almost certainly "Honey (http://en.wikipedia.org/wiki/Honey_%28Bobby_Goldsboro_song%29) by Bobby Goldsboro. I dearly hope it was not playing at the time of coitus. Anything else, please. Green Tambourine. To Sir, With Love. Anything.

And Matt, as for the rest of the post, you continue to be my hero.

[mmcirvin.livejournal.com]

In my case Number One was probably either "All You Need Is Love" or "Ode to Billy Joe". Hoping for the first alternative but I guess I don't mind either way.

(I discovered earlier that I was born under the sign of Simon and Garfunkel's "Mrs. Robinson", which is awesome.)

Whoa.

[vardissakheli.livejournal.com]

I never looked this up before: "Monster Mash"! Of course, for my parents, I have to look at the country charts, where odd coincidence leads to "Devil Woman."

Appropriate

[indyresolve.livejournal.com]

"Tonight's The Night", Rod Stewart

Well - the man was correct!

[mmcirvin.livejournal.com]

...OK, it might have been "Light My Fire."

[mmcirvin.livejournal.com]

By the way, as you can probably guess from the chemical similarity, much of what I've said about Plan B also applies to ordinary birth-control pills. They're more effective since they're taken regularly, so there's no issue of whether ovulation has already happened before they are taken. But there's also a popular folk belief, supported by no evidence, that birth-control pills secretly work through "silent abortion" of already-conceived fetuses, and there are people who want them banned or restricted on those grounds.

[spasmsproject.livejournal.com]

In Pale Blue Dot, Carl Sagan suggests that -- if one has to draw a line as to when abortion is unethical -- five or six months is a good cutoff. His reasoning, if I recally correctly, was that it is at this point that the fetal brain develops to the point where it can have primitive thoughts and some something approximating an awareness or consciousness. Since self-awareness and a capacity for reason are what define us as human, the fetus is not human until that point (sayeth Sagan). I like his idea, and it's what I eprsonally believe in, although I guess technically the fetus isn't really human until it can exist outside its mother without an incubator.

[mmcirvin.livejournal.com]

I'd be more comfortable with that kind of cutoff if all pregnancies were the same. As mskala pointed out at the time, I personally thought of Marjorie as my daughter even earlier in term than that.

But I don't think it should be a point of law, because in practice, late-term abortions usually result from wanted pregnancies which have gone very wrong in some way or other: the fetus is severely malformed or the pregnancy has become dangerous to the mother.

It's possible in principle to draft exceptions to work around all these cases, and only cover the vanishingly rare case of elective abortion of relatively viable fetuses late in pregnancy. But in practice that's not what legal late-abortion restrictions tend to be like—you instead get messes like the "partial-birth abortion" ban, which was passed on the basis of dishonest claims of what it was about, banned a particular procedure in a manner that made very little sense, and, by stigmatizing the procedure and discouraging training of physicians, created a chilling effect that makes it hard to use even in situations where the law permits it (e.g. the fetus is dead). Even a sensible ban would apply to so few cases in reality that its bad penumbral effects could outweigh the effect of its direct application.

Given that political situation, I think NARAL-level pro-choice extremism is actually a better policy position to take.

[spasmsproject.livejournal.com]

Fair enough.

[mmcirvin.livejournal.com]

...There's also the question of whether it's all right to legally compel a woman to continue the pregnancy even if the fetus is a human being. Pregnancy and childbirth are debilitating, painful and somewhat dangerous even under the best of circumstances; the law usually doesn't demand this degree of bodily invasion and sacrifice from one person to support the life of another—the usual example is that we don't force people to donate kidneys, and bearing a child is a lot worse than donating a kidney.

[eb-oesch.livejournal.com]

If you grant (which I don't) that fetuses are human beings with the same rights as others, the debate is over. The analogy between failing to donate your kidney and smashing a person's head open (the fetus is assumed to be a person) is weak. The better model is murdering your Siamese twin, which you're not allowed to do, even if he is inconvenient and a small threat to your health, and even if you discover a way to kill him by injecting a drug into yourself instead.

Many people would acknowledge a right to kill innocents to save yourself in the very rare cases where it is necessary, but only when the scales are tilted in that direction. One Siamese twin may be killed to save the other, but only if the outlook otherwise would be even more gloomy. For pregnancy, the scales tilt towards life: no society has ever been decimated by a pregnancy epidemic. So no killing. To suggest that a small danger to oneself justifies killing others is to embrace the morality of the villains of a dozen disaster movies. Even if you could get away with it, it is and always has been the state's role to try to prevent such behavior.

You say it's dangerous to concede that the argument is about when life begins, but it's better than starting an argument you can't win. (Maybe I'm assuming the conclusion here. Well, if after futher consideration you still believe that the pro-choice side of this debate is tenable even after conceding the key point, I wouldn't mind taking the opposite side of the argument once or twice more.) Nonetheless, this is an argument that bland pro-choice debaters slide into almost mechanically: instead of engaging the assertion "A fetus is a human being, and it should have the usual human rights", they stay "on message" with "A woman should be able to control her own body", even though the former statement (if true) trumps the latter. Even the names "pro-life" and "pro-choice" are abbreviations of the same lopsided argument -- it's a kind of verbal jujitsu where the pro-choice side slips its shoulders against the mat and surrenders the three-count without even having to touch its opponent. (Not that I have any better suggestion than "pro-choice" -- the vanilla "abortion rights" is no improvement.)

On the other hand, I thought the discussion how Plan B works, and of the strangeness of the idea that a baby exists even before fertilization occurs (as I understand it, even Catholics don't think the baby exists before fertilization -- it's too bad they oppose birth control also), were well targeted. And I have to admit that I forgot that Plan B wasn't just another trade name for RU-486.

[mmcirvin.livejournal.com]

I don't actually grant that they are people. My intuition there's definitely not any human being there in the first few months, and there's something that at least behaves like a baby in the last trimester, if the fetus is healthy.

I think I do agree that if the fetus is granted to be a human being, the bar for morally justifiable killing of the fetus should be set very high. But I still have the fallback position that the state could be doing damage by trying to enforce the distinction, since the really hard-to-justify case that anti-abortion arguments want you to think about (elective abortion of a late-term, healthy pregnancy) is actually fairly rare, and too much meddling can interfere with the treatment of people for whom the abortion is justifiable on medical grounds.

[mmcirvin.livejournal.com]

...I think one reason the Plan B controversy is so interesting is that in a sense it does engage the argument "the fetus is a human being with human rights"; not in the sense of providing a refutation, but in the sense of suggesting that much of the anti-abortion side is not really arguing honestly from that premise. No reasonable person could possibly believe that there is a human being with human rights before there's even a fertilized egg.

I suppose what I'm leery of, getting into an argument over when humanity-with-rights begins (not "when life begins", since life doesn't begin anywhere), is that since this isn't entirely a scientific debate over measurable things, it's liable to degenerate into "is not", "is too" with no way of resolving the matter. But people do manage to debate other moral issues that are not entirely scientific, so maybe there's a way forward; staking out positions of the form "no reasonable person could possibly believe this" might be a good place to start.

On the other hand, that was what the anti-abortion side seemed to be doing with the "partial-birth abortion" ban, only they were completely dishonest about it: it was phrased as "no reasonable person could possibly believe that it's OK to start to deliver a viable full-term baby then puncture its skull", but that wasn't what the ban actually banned. Get burned on these issues often enough and it becomes hard to pretend you're having a moral argument in good faith, which I suppose is part of the reason for my own degree of extremism.

[eb-oesch.livejournal.com]

I'm not afraid of the debate degenerating into "is not", "is too", if that's what the debate is fundamentally about. To me that's progress, because at least the nature of the impasse has been acknowledged. Besides, it's possible to nibble at the edges of the "is not"/"is too" argument in meaningful ways, which indeed you have done. In contrast, arguing for wide abortion rights even if a fetus should have human rights isn't just silly; it's hazardous. It's possible to reconcile a belief in liberal abortion rights with a belief that the fetus is fully human, but the moral synthesis of the two beliefs is ugly and brutal, so if you intimate, in an attempt to sidestep the religious aspect of the abortion debate, that some pro-choicers have reconciled them (which I expect really almost never happens), then people will probably just be revolted if they take the message seriously.

I didn't follow the partial-birth abortion debate very closely, although maybe I should have. I'd readily believe that many from the pro-life crowd engaged in shady and misleading debate tactics. Attempts by some pro-choicers to paint all pro-lifers as misogynists are also very distasteful, of course, as well as coming as close as you'll find to the godawful "How dare those people inconvenience women by trying to save babies' lives!" argument that I keep harping on.

[mmcirvin.livejournal.com]

Yeah, "partial-birth abortion" turns out to be a procedure not exclusively used on full-term fetuses, but usually used on, as I mentioned below, fetuses that are severely hydrocephalic, can't be delivered normally and may have a slim-to-zero chance of living in any event. And the only sense in which it's "partial-birth" is that the obstetrician pulls the feet out through the cervix before puncturing the fetus's head; complete birth in that manner could never happen. It's revolting, no doubt about it, but when it's done it's usually deemed the safest thing for the mother, which is why the ban couldn't have an exception for the health of the mother, just for the mother's life: a health exception would render it null and void.

I think that most people with anti-abortion attitudes are sincerely trying to protect what they think of as babies who are being murdered. I also think that they're often led astray by bad information, sometimes promulgated maliciously. I think that many of the leaders of the movement have a different motivation that is not so much misogynistic per se as just very conservative: they believe that people have essential roles they are born into, that the essential role women are born into is to be wives and mothers, that the sex act has an essential role of making babies and that disturbing this order is wrong.

Philip K. Dick, though, he had some serious woman issues.

[mmcirvin.livejournal.com]

Also, while it may not affect your argument, having seen childbirth recently, I'd really use a much stronger word than "inconvenience".

[mmcirvin.livejournal.com]

...Actually, I would also argue that there are some cases in which the forced-kidney-donation analogue is not weak but fairly precisely applicable. For instance, many late abortions happen in cases where the fetus is severely hydrocephalic and normal labor will kill the mother. In that case, the only other choices are abortion or delivery by Caesarian section. If the state chooses to give the fetus an outside chance at living in that case, it means legally forcing a person to undergo major abdominal surgery.

[eb-oesch.livejournal.com]

A strong analogy involves things that are superficially different but structurally similar, but the one you present tends in the opposite direction. If there is a good legal analogy between forbidding abortion and requiring a kidney donation, then the legal status of the alternatives must be similar. The alternative to donating a kidney is watching the Brady Bunch. The alternative to not getting an abortion is crushing a person's head. (If you don't assume the fetus is a person, then the analogy is weak for a different reason -- a kidney transplant involves two people, but if the fetus is not a person, then the abortion involves just one.)

Also, a C-section protects the health of two people, while a kidney transplant harms the health of one to benefit another. If a doctor applies the "do no harm" principle on a per-patient basis, believes the fetus to be a grade-A human, and does not believe in euthanasia, then he can perform C-sections, but he cannot ever perform abortions or perform a transplant on an unwilling live donor.

Even the least harm principle offers little to the pro-choice side of the debate. According to Wikipedia, the probability that a C-section will kill the mother is less than 1 in 2500. It's probably higher with a hydrocephalic infant, but still very low. It arguably changes the picture completely to consider quality of life, but counting quality of life in a way that cheapens one compared to another is controversial. (The dogma is that all lives have equal value, but I might guess that the decisions of doctors and parents in Siamese twin separation operations indicate a more nuanced view, with expected lifetime and mental development also being taken into account. As a wild guess, I wouldn't be shocked if such problems have all been resolved outside the court, so it might have established an opinion on the issue.) It changes the picture somewhat to consider nonfatal harms to the mother, but again, setting exchange rates between pain or infirmity and lives is controversial, not only in the exact rate of exchange but even whether the two harms are comparable at all. (Exchange rates of all kinds are set in liability lawsuits, but they are not accepted without modification in other circumstances -- the life of a rich person has more value in civil court, but not in criminal court, and in theory not to the Red Cross during disaster relief either.) So if the mother and fetus are presumed to have equal value, then even a tiny chance of saving the fetus justifies making the attempt.

I doubt many pro-lifers really value fetuses' lives as much as their mothers'. I doubt there's any country on Earth where the doctors generally do. I think there are many more people who might say they value a hydrocephalic fetus as much as a regular person, but really they just think the fetus should have some rights, even if they would never bet one mother's life against two fetuses'. The pro-life platform doesn't exactly accommodate that view, but neither does the pro-choice side, which seems to be based upon the notion that the fetus has no value, or at least none that the legal system should play a part in protecting.

Just to pick on a comment you made elsewhere, any legislation that is passed will be abused by biases parties on both sides, although, come to think of it, I can't blame abortion doctors for "exploiting" blank medical exception clauses in anti-abortion legislation. If the legislators cannot agree to a meaningful (not just "anything greater than zero", which would justify almost all abortions) risk threshold, then there is inadequate support for a real anti-abortion law, so it is only appropriate if they don't get one. (Although if -- as I now get the impression may be the case -- the courts insisted on the presence of medical exceptions, then the laws' internal inconsistency becomes easier to understand.)

IANAL, etc.

The nature of the "discussion"

[indyresolve.livejournal.com]

Posner, on the Becker-Posner blog, puts it pretty well in the discussion the related issue of stem-cell research.

"A number of the comments debate what seem to me purely metaphysical questions concerning when life begins, whether five-day embryos should be treated as full-fledged human beings, etc. By "metaphysical" I mean can't be resolved by reference to logic or evidence. They are matters of opinion and endless contestation, strongly influenced by religious views that cannot be verified or refuted (modern religions are careful to avoid proposing falsifiable hypotheses, such as that the world will end on September 1, 2006). I get no nourishment from such debates. I believe that upbringing, temperament, experience, emotion, and certain brute facts determine one's answers to such questions, not truth or falsity..."

My concern is that people, in their fear of social isolation or ostracism, don't want to be labelled fanatics or told that their deeply-held views, in the final analysis, are not much more than a matter of personal taste, so they try and put the cart before the horse. They decide what they want to believe from a moral dimension, and then turn back and selectively interpret existing science or blatantly fabricate and create the pseudoscience necessary to "justify" their views.

I would submit that it's better for the progress of human thinking and winning the public mind to contend with those who admit they dismiss scientific thought (who are largely discounted), than to contend with those who, through magical thinking, strange logic, and confusion of semantics, make an equal claim to the scientific throne and use that ill-gained perceived legitimacy to persuade and undermine the healthy self-skepticism of a rational person.

Re: The nature of the "discussion"

[mmcirvin.livejournal.com]

Yeah, that's why it's probably dangerous to even make the concession that the whole debate is about some objectively determinable question of when a human life begins. Though science can inform it, it's not fundamentally a scientific question.

Still, when people make scientific claims that are demonstrably false, such as calling some contraceptive an abortion drug when it's not, I personally feel compelled to call them on it.