The abortion induced ( abortion : the Latin abortus or aborsus turn of aborior , ‘contrary to orior ‘, ‘contrary to birth’) or abortion ( IVE ) 1 is to cause the biological death of the embryo or fetus to Its subsequent elimination, with or without medical assistance and in any social or legal circumstance. It is distinguished from spontaneous abortion , since it occurs naturally or is caused by an accident.
Voluntary termination of pregnancy has been standard practice for millennia. 2 3 In the debate on abortion controversies exist very different character: scientific, health, socioeconomic, ethical and religious which is partly reflected in the different legal systems on abortion in each country where the practice of induced abortion can Be considered a right or a crime .
Induced abortion statistics
In a study published in 2007, it is estimated that between 42 and 46 million abortions are performed annually (between 20 and 22% of the world’s 210 million pregnancies annually). 4 Of the 190 countries in the world, only 22% of abortion is allowed. 5
With regard to unsafe abortions , there would have been 21.6 million worldwide in 2008, according to a study published by the World Health Organization in 2011. 6 According to this organization, unsafe abortion is “a procedure to end a unwanted pregnancy carried out by lacking the necessary skills or in an environment that does not conform to minimum medical standards, or both “people. 7 8 9 that is, abortions in which the woman’s life is in danger. In Latin America and the Caribbean in 2000, 29 unsafe abortions performed per 1,000 women aged between 13 and 44 years old, more than double the world average of 14 abortions per 1,000 women and 32 abortions per 1,000 births. Referring to Fig.
Unsafe abortion is estimated to be the third largest direct cause (13%), after hemorrhages (25%) and infections (15%) of the 536,000 maternal deaths occurring each year in the world, 10 although In Latin America the proportion of maternal deaths due to unsafe abortion reaches 17%. eleven
In Latin America and the Caribbean , of the 18 million pregnancies that occur each year, 52% are unplanned and 21% of them end in abortion. According to some studies, in Latin America, about 3.7 million unsafe abortions would be practiced annually. The risk of death from unsafe abortion in developing countries is 370 per 100,000 cases. The number of women dying from abortion annually is 68,000, equivalent to 13% of maternal mortality . In Latin America, unsafe abortion accounts for 17% of maternal deaths. 12 13 14 15
A demographic profile made in Cuba mentions an average of 4.7 children per mother in the 1960s , and an average of 1.5 children in 1992. This is due, among other factors, to contraceptives and induced abortions. Induced abortion is said to have reduced 60 per cent of maternal deaths between 1970 and 1990. 16
Procedures for induction of abortion
1st trimester (0-12 weeks of embryonic development):
* Manual vacuum aspiration (MVA-MVA).
* Suction or aspiration of electric vacuum AE or AVE (EVA).
* Dilatation and curettage – instrumental uterine curettage (LUI);
* Mifepristone and misoprostol ( medication abortion).
2nd trimester (12-28 weeks):
* Dilation and evacuation
* intact dilation and extraction
* Induction of preterm birth
3rd trimester (28-30 weeks):
* Hysterectomy , intact dilation and extraction and induction of premature labor .
Abortion can be induced in many ways, and the choice depends on the time of gestation or development of the embryo or fetus , the health of the mother, the socioeconomic context in which the decision is made and the act performed, especially access To medical services, and limits imposed by legislation, among other factors.
Procedures under sanitary control
Abortion with medication or chemical
The chemical or pharmacological abortion consists of the interruption of the development of the embryo and its elimination through the birth canal, all induced by what is usually a combination of drugs. It is only feasible in the first weeks of pregnancy. In the United States the percentage of abortions performed with drugs ( medical abortion ) of total abortions has increased since the approval of mifepristone : 1.0% in 2000, 2.9% in 2001, 5.2% in 2002, 7.9% in 2003, 9.3% in 2004, 9.9% in 2005, 10.6% in 2006, 13.1% in 2007. 17
In Europe the use is unequal, thus, in Portugal it supposes 67% of IVE ( voluntary interruption of pregnancy ), in France 49%; In England and Wales 40%, in Scotland and Finland 70%, in Spain only 4%, in Italy less than 4% since it began its sale in December 2009. 18
This type of procedure is usually preferred when it is possible, because it does not require anesthesia or surgical intervention (the use of instruments ), with the greatest inconvenience being bleeding and the woman being able to observe the process and the ejected embryo , which is Psychologically painful for those women who doubt the morality or convenience of the act.
The procedure has reduced its effectiveness after the seventh week of development. Despite its relative simplicity, the process requires continued medical monitoring to ensure success, to prevent possible complications, and also often because the evacuation is incomplete and requires the final intervention of a physician. The most common regimens are: 19
- Mifepristone with misoprostol . Mifepristone along with misoprostol is the most common chemical method, administered until the first 7 to 9 weeks of pregnancy (49 to 63 days). The method consists of administering mifepristone at high doses (600 mg according to FDA protocol ) and, at two days, a misoprostol tablet (400 μg) that causes labor contractions. Mifepristone is an antagonist of progesterone , a hormone necessary for the continuity of gestation. Misoprostol is used to ensure expulsion. The protocol presents various contraindications , for example with continued prior use of steroid-based therapies . 20 18
- Misoprostol alone. Up to 49 days of gestation: 800 mcg. (200 mcg every 24 h), and up to 3 times (when there is any contraindication or allergy to Mifepristone or access to it is absolutely impossible). Pregnancies from 49 days to 20 weeks: 2 or 3 Misive 200 vaginal tablets every 4 to 6 hours, respectively. In pregnancies greater than 20 weeks, a dose of 400 mcg will be used. 200 every 4 to 6 hours or even smaller according to response. twenty-one
- Methotrexate with misoprostol . Methotrexate is given with an injection and affects the proliferating cells of the embryo, causing the interruption of its development. A few days later, administration of misoprostol, a semisynthetic analogue of prostaglandin PGE1 that stimulates contraction of the uterus , causes expulsion of its remains. The procedure is contraindicated in different medical conditions, such as renal failure .
There are also very common methods used in South America that are considered as chemical, these being of origin of that same country, that were used for century XX. Among them is Hierbabuena which was the abortive most used in America, whose active principle, a ketone, the pulegón, had convulsive action and produced cardiovascular collapse, cardiac arrhythmia generalized cooling and loss of consciousness. 22
Another method is the wild rosemary , whose leaves were added to the beer to increase its intoxicating action; Contained an oil ( ledum camphor ) that acted locally as irritant and resortive and caused abortions. Its toxic action produced excitation and paralysis of the nervous centers, convulsions, congestion and edema of the face, vomiting, meteorism and stertorous breathing. 2. 3
1: Amniotic sac
5: Manual syringe
6: Connection to suction pump.
Surgical abortion is called the set of surgical techniques that have the purpose of provoking abortion, that is, voluntarily ending the gestational process .
The most commonly used surgical method before 7 weeks of pregnancy is aspiration abortion . It consists of removing the fetus or embryo by suction using a syringe manual or a pump electric suction . Manual aspiration is also called minisuction or menstrual extraction . It is applied only for the first few weeks and does not require cervical dilatation (see also cervix or cervix ). For these first weeks, there is talk of abortion , rather than abortion, although in fact both terms are synonymous. From the fifteenth week until the twenty-sixth, cervical dilatation and surgical manipulation, as well as suction , are required . This method was shown in detail in an ultrasound in the documentary titled The Silent Scream ( The Silent Scream ) , produced by Dr. Bernard N. Nathanson, who during the seventies was the owner of one of the largest abortion clinics in the EE. UU.
The method of dilation and curettage (see D & C ) is a general method that is also used during the medical examination to take samples or for the detection of certain cancers. It is also known by the name of partial birth , and is usually done between the sixth and the fourteenth weeks. The World Health Organization (WHO) recommends that this method is not used except when manual aspiration is not feasible, and in fact its use is infrequent. The curettage is used to clean the walls of the uterus with a curette . 24
In advanced stages of gestation , if an abortion is to be performed for therapeutic reasons, other appropriate procedures are used for the fetal developmental stage. It can induce premature labor using prostaglandins , while injected serum saline or urea in the amniotic fluid , which causes fatal burns in the fetus. In more advanced cases, exceptional techniques are used, such as the so-called “dilatation and intact extraction ” or “partial birth abortion”, which requires two or three days of preparation to ensure the necessary cervical dilation, and drugs that induce Birth. The doctor will manipulate the fetus, to make first leave its legs, until leaving only the head, if necessary. Finally, the brain is emptied by suctioning after making an incision at the base of the skull.
The choice of one technique or another depends on how advanced the pregnancy is and whether cervical dilatation is necessary or not.
From the 15th week to the 26th week of pregnancy , the dilation and evacuation method (D & E), which consists of the opening of the cervix , is emptied using surgical instruments and suction.
It is necessary to use other techniques to induce abortion from the third trimester. The premature birth can be caused by prostaglandin , which can be applied with an injection of amniotic fluid with caustic solutions (saline) or urea .
After the 16th week of gestation, abortion may be triggered by intra-uterine cranial compression, which requires decompression of the fetal head before its evacuation. Abortion by hysterotomy is a procedure similar to cesarean section , and is performed under general anesthesia , because it is considered a major abdominal surgery. 25
When the fetus is at an advanced gestational age of six to nine months, some countries apply the method of partial-birth abortion, a procedure that has led to several legal disputes. 26
From 20 to 23 weeks of pregnancy, an injection will be needed to stop the fetal heart . 27 Late techniques put at much greater risk the health of the mother.
Possible adverse medical consequences
Abortion, in addition to ending the pregnancy, and the existence of the embryo or fetus – according to the case -, is not a risk-free intervention for the mother. Even so, according to some studies, the risks are lower than those of a normal birth. 28 29 30 Some abortive methods, when dealing with non-invasive procedures, have a low risk of serious complications. 31 32 Even so, the risk may increase depending on how advanced the pregnancy is. 33 34 When abortion is induced by the same patient, complication rates will always be raised 80% or more. 2. 3
- The abortion by suction curettage or aspiration may cause: 35 36 37 38 39 40 infection, trauma of cervix, peritonitis, endometritis, laceration or uterine perforation, hemorrhage, renal trauma, pelvic inflammatory disease, embolism, thrombosis, sterility, etc. .
- Abortion due to dilatation and curettage presents the same risks as the previous method, in addition to uterine perforation, hemorrhage, genital tract infection, intestinal laceration, pelvic abscess and thromboembolism. 35 3637 38 39 40
- Abortion due to dilatation and evacuation has the risks described for all previous systems, in addition to pelvic, renal, cervical infection and peritoneal infection. In addition, it can cause the woman to have future ectopic pregnancies , or babies underweight , or even stillborn, or with serious malformations. 35 36 37 38 39 40
- A saline injection abortion has the possible consequences, rupture of the uterus, pulmonary embolism or intravascular clots 35 36 37 38 39 40
- The abortion by providing of prostaglandins can cause 41 42 rupture of the uterus, sepsis, bleeding, cardiac arrest, vomiting and aspiration of this, stroke and acute renal failure.
- Abortion through menstrual extraction, which is practiced only in the first seven weeks of pregnancy, is a method that does not discriminate between the patient being pregnant or not, acting in both cases. In addition, only incomplete aspiration can be performed, which will lead to subsequent infection. 42
- Abortion by delivery of mifeprex or mifepristone (RU-486) can lead to severe bacterial infection, blood sepsis, and prolonged and heavy bleeding, which may require surgery. The misoprostol , sometimes used with mifepristone, can cause bleeding and cramps. Sometimes the embryo or the fetus can survive the intake of medicines, in which case the fetuses suffer severe malformations. 43
- Partial-birth abortion carries with it serious risks of rupture or perforation of the uterus, which could cause bleeding and end in a hysterectomy – removal of the uterus. 44 45
- The morning after pill , or emergency contraceptive, due to the LNG ( Levonorgestrel ) it contains carries pathological vascular alterations: hemorrhages, microhemorrhages, spotting, and so on. Several studies also claim that this drug induces functional changes in blood vessels. 46
Other consequences have also been described:
- Damage to the fallopian tubes if an infection develops.
- Difficult births and increased number of miscarriages. 42
- Increase in the rate of birth by cesarean section , and premature birth (before 32 weeks of gestation).
- Placenta previa , which makes a cesarean section necessary to save the life of the mother and her child.
- Isoimmunization -immunization against the blood of another person- in Rh negative patients .
- Breast cancer has also been reported in women who aborted their first pregnancy in the first trimester. 47 48 49
However, other studies find no significant difference between women who have aborted and women who do not. 50 51 52 53 Melbye and researchers conducted a study that included 1.5 million Danish women without finding differences in the risk of getting breast cancer. fifty
The Royal College of Psychiatrists , the leading professional organization of psychiatrists in the UK , says that the issue of the relationship between induced abortion and the effects on the mental health of the mother is not entirely resolved. There are some studies that do not find negative consequences, and others that do. 54
Therefore, since voluntary abortion may pose a risk to the mental health of women, it recommends that those who wish to have an abortion should be adequately advised of these risks. 55
The National Federation of Abortion in the United States maintains that, scientifically, there is no evidence of long-term post- abortion stress , neither of depression nor anxiety nor of any other psychological illness , concluding that the highest stress is prior to the process, The vast majority of women claim to experience a later situation of relief . 56
In contrast, a study published in the Journal of Child Psychiatry and Psychology and funded by the New Zealand government found that 42 percent of women who were followed up who had an abortion before age 25 suffered from depression ; This figure is double those who were never pregnant, and 35 percent higher than those who decided to continue with their pregnancy. The same study found that those who had abortions were twice as likely to drink alcohol , to dangerous levels than those who did not, and three times more likely to depend on drugs illegal. 57
In 2008, the British Journal of Psychiatry published a study concluding that intentional abortion increases the likelihood of suffering psychic disorders. 58
In 2011, The British Journal of Psychiatry published a synthesis of publications on the subject between 1995 and 2009 by Priscilla K. Coleman in which it is concluded that abortion increases the risk of mental problems in women who practice it . 59
Some propose that the psychologically adverse effects of abortion should be referred to as a special condition called post-abortion syndrome. However, the existence of this syndrome has not been recognized by any medical or psychological organization, 60 and some pro-choice doctors and supporters have argued that the idea of popularizing this “post abortion syndrome” is a tactic used by pro-life supporters For political reasons. 61 62 63 64
Legal aspects Therapeutic abortion and voluntary abortion
Most regulatory laws, both permissive and restrictive, distinguish between therapeutic abortion and elective or voluntary abortion.
Therapeutic abortion consists of termination of pregnancy for medical reasons, 65 in order to:
- Save the life of the mother, when the continuation of pregnancy or childbirth mean a serious risk to his life;
- Protect the physical or mental health of the mother when they are threatened by pregnancy or childbirth;
- Prevent the birth of a child with a serious genetic or congenital disease, which is expected to result in a fatal outcome or severe illness or disability, or
- Reduce the number of fetuses in multiple pregnancies to a number that makes the risk acceptable.
From the bioethical point of view, there are questions about the application of the term “therapeutic” because it is considered, among other things, that this term is exclusively associated with that area of medicine that instructs the precepts for the treatment of diseases. 66
The one performed for other reasons. When the pregnancy is the result of a crime of a sexual nature ( rape ) or the application of an assisted reproduction technique not consented to by the mother.
Also included as reasons: the minority of the mother, the inability to care for a child for economic or social reasons and the desire to hide the stigma that represents in certain social contexts a pregnancy outside of marriage.
Abortion by medical-legal indication
Abortion is understood by medical-legal indication to the medical or surgical act that consists of the voluntary interruption of the gestation in cases in which the domestic law of each country provides for the non-imposition of a sentence for such reason, although abortion in general Is considered a crime.
The importance of abortion by medical-legal indication is that it facilitates that these interruptions are practiced within the institutional health field, eliminating unnecessary risks for women. 67
The abortion , understood as the intentional termination of pregnancy, is, depending on the law in force, conduct punishable or not punishable, according to the specific circumstances.
In this way, depending on the country that contemplates it, it is considered a criminal offense in any circumstance, or a right of the pregnant woman. In other countries, even though it is also a crime, it remains decriminalized in certain cases, whenever maternal consent is mediated.
At present, legislation in most parts of the world contemplates the decriminalization of abortion, following the United Nations recommendation , 68 for supposed intermediates, always taking the will of the pregnant woman as a sine qua non requirement for a possible non Punishment
The legal systems that decriminalize abortion in some or all cases, do so from the following perspectives:
- The Anglo- Saxon system develops the fundamental rights of women from the perspective of their right to privacy and in relation to the idea of ’viability’.
- The European-continental model , in turn, links abortion with the general right to freedom of women, whether it is specified as reproductive freedom (see reproductive rights ) or as a right to autonomy .
- In the Islamic system , abortion is only allowed for medical reasons in which the mother is in grave danger.
- The international system for the protection of human rights – international nongovernmental organizations such as Amnesty International , as well as universal human rights protection bodies, such as the United Nations Commission and Human Rights Committee United Nations or the World Health Organization – relates the problem of the decriminalization of abortion with the right of women not to be subjected to cruel, inhuman or degrading treatment; That is, with the general prohibition of torture .
Legislation on abortion is a highly controversial issue, since both proponents of a position and their detractors argue for a human right . Proponents of abortion wield the right to freedom, autonomy or intimacy of the pregnant woman, and detractors the right to life that they grant to the unborn child .
Abortion in the world
In countries like Russia , Canada , the United States , China , India , and most European countries, abortion is legal at the request or demand of women during a certain period of gestation. On the other hand, in most countries in Africa , Latin America , the Middle East , Oceania and Southeast Asia abortion is illegal and penalized in any of the cases. Six countries around the world prohibit termination of pregnancy under any circumstances and imply imprisonment for any woman and person who performs, attempts or facilitates abortion: Chile (although it is not penalized if it was an undesired consequence of medical procedures To save the life of the mother), 69 Vatican City , El Salvador , Malta , Nicaragua and the Dominican Republic . 70 In the latter, the right of the unborn to life is protected by the State.
Approximately 25 percent of the world’s population lives in 54 countries that completely prohibit abortion or allow it only to save a woman’s life. Sixty-two percent of the world’s population lives in 55 countries where induced abortion is allowed, either without restriction as to its cause; Whether for therapeutic, surgical, eugenic, sentimental reasons, and even for socioeconomic reasons. In addition, some legislation establishes prerequisites, such as waiting periods, provision of information, the opinion of several physicians, or notification to the spouse or parents of the pregnant or unrestricted admittance such as Canada .
In the Old Testament, voluntary abortion is not mentioned. 71 Only the abortion derived from a coup inferred to the woman ( Exodus 21: 22-23 ), 71 is penalized, within the framework of a law that refers to the prohibition of homicide. The demand that a fine be paid by a man who causes the death of an unborn child by negligence indicates that this act was considered as harmful to man and woman, rather than to the fetus. 72 At this point, Hittite law was similar. 71 On the other hand, the Assyrian laws penalized even self-induced abortion, perhaps because the state needed warriors for military purposes. 71
Under the late Greek influence, the version of the Septuagint the Book of Exodus 21: 22-23 made a distinction between a fetus and one formed not formed, the latter being treated as an independent person. 71 This distinction between an early and late fetal state was quite common in the ancient world, and was defended by Aristotle in distinguishing between human souls and subalms. Thus, the time of the entrance of a human soul was commented by Aristotle at 40 days after conception for a male and 90 for a female. Many Catholic theologians will later accept this Aristotelian heritage in a different way; Among them Tertullian , Origen , Augustine of Hippo and Thomas of Aquino .
For its part, the theory that the human soul does not enter the body until birth was defended by Plato and was decisive for Roman law , where the ‘Patria potestas’ existed, by which the head of the family could dispose of the Life of any of his offspring without having to give explanations or be accused of a crime. [ Citation needed ] Only rarely was abortion treated as a homicide, even when this was punishable. On the opposite side we have above all the Pythagoreans , who emphasized the cult of a notion of medicine-religion to outlaw abortion, something with which Hippocrates aligned . The text of the Hippocratic Oath , proposed today by some classicists who wish to practice medicine, contains a passage that makes explicit reference to abortion: who swears agree not to introduce pessary abortive any woman. 73
In early Christianity there is a private cult of Asia Minor, perhaps Pythagorean, which opposed abortion. [ Citation needed ] also some Greek and Roman thinkers opposed abortion for other reasons than the humanization but by assuming an interference in the right of the parent for the child. 74
The Catholic Church opposes abortion from the first centuries of Christianity to the present day. It considers the human being existing from the moment of conception , and for this he considers mainly, in addition to many other aspects such as the potentiality of the embryo (this means, as it is explained in the Aristotelian philosophy , that in theory the embryo, Insofar as it can be converted by its natural development into a full human being, is de facto a human being at all times, from the very moment the egg is fertilized) or the right to life of human beings ( Human right widely recognized), the argument of the immortality of the soul, which would be inflated at the moment of conception. This is stated, for example, in the encyclical Humanae vitae of Pope Paul VI . 75
- Threats to life occur in the relationship between parents and children, as with abortion.
- In addition, the current situation is even more disconcerting due to the proposals, made in several places, to legitimize, in the same line of the right to abortion, even infanticide, returning to an era of barbarism that was believed to have been overcome forever.
- “My eye saw you in my embryo” (Psalm 139, 138, 16): the abominable crime of abortion
- Among all the crimes that man can commit against life, the abortion sought has features that make it particularly serious and ignominious. The Second Vatican Council defines it, together with infanticide, as “nefarious crimes.”Paul VI, Evangelium vítae 76
Historically, there have been theological discussions about the moment of the infusion of the spiritual soul (see, for example, the article traducianismo ). However, both the Fathers of the Church as the doctors of the Church were unanimous in the condemnation of abortion:
Throughout history, the Church Fathers, their Pastors, their Doctors, have taught the same doctrine, without the various opinions about the moment of the infusion of the spiritual soul having raised doubts about the illegitimacy of abortion. It is true that when in the Middle Ages the general view was that the spiritual soul was present only after the first weeks, a distinction was made as to the kind of sin and the gravity of penal sanctions; Authors worthy of consideration admitted, for this first period, broader casuistic solutions, which they rejected for the following periods. But it was never denied that induced abortion, even in the early days, was objectively a serious offense. This conviction was in fact unanimous. 77Congregation for the Doctrine of the Faith
In the twelfth century , Pedro Lombardo commented on the reference to abortion that exists in the Bible : that which appears in the Book of Exodus (21.22), where two types of abortion are distinguished: one that suppresses an already formed human being And with a human soul – and in this case is homicide – and another in which a “report” and soulless human being is eliminated, for which reason a fine should be paid. [ Citation needed ]
Later, Thomas Aquinas 78 adheres to that thesis Aristotelian saying therefore a difference in sin. Thus, in his Commentaries on the Sentences of Peter Lombard (III) he joins the Aristotelian thesis that the soul enters the 40 days in the case of men and 90 in the case of females. 79 Saint Thomas also assumes a somewhat modern point of view by leaving to embryology a greater precision of time to correct these aspects more accurately. 80
- At first, the embryo has a soul that is only sensitive and is replaced by a more perfect soul, both sensitive and intellective, as we shall deal with exhaustively below ( Summa theologica I, q. 76).
- In the generation of man the first thing is the living, then the animal and finally man ( Summa theológica II-II, q. 64).
- We must observe a difference between the process of generation in man and the animals of the air or water. The generation of air is simple since only two substantial forms appear; One that is displaced and the other that is induced. And all this takes place in an instant at the same time, so that the form of the water remains throughout the period preceding the induction of the form of the air. On the other hand, in the generation of an animal appear several substantial forms: first the semen, soon the blood and so until we find the form of an animal or a man. ( On the power of God , q. 3, a. 9, ad 9. Cf. Summa against Gentiles , II, Ch. 89, 11; Summa theológicae , Ia, q.
- As a soul it is united to the body as its form, it is united to the body as its own action. The soul is “the action of an organic body” (Aristotle, II De Anima, 412b, 5-6). Therefore the soul does not exist in the semen as an act (as opposed to potential or potential) before the organization of the body. ( Summa v. Gentiles , II, ch. 89).
In the theology Neoscholasticism Thomist of the twentieth century it is considered that Thomas did not have at the time with the scientific data we have now, and including their own dynamics and knowledge of DNA. This argument is a point of support for the Catholic Church in the twentieth century to defend the position that at the time of fertilization appears a new being, with its own dynamics and complete genetic information even if its state is dependent on the mother .
The theses of St. Thomas explain when the soul is inflated by God in the human being. And while this is incompatible with the arguments that equate abortion with murder or murder, proponents of this other point of view often point out that one can not attribute to St. Thomas a favorable stance for abortion by citations such as the following:
We serve a greater and more significant purpose, the manifestation of the goodness of God, and in that great context we are simply means to the end of God. […] God wants his own goodness as an end, and wants all things to be a means to that end.Thomas Aquinas, Summa vs Gentiles I. 86. 718
Therefore, in spite of the official position of the Catholic Church, this debate must be pointed out in Catholic theology as regards the moment in which the human soul, a “human being”, can be considered Of its development as well as the type of related sin, or if it exists. The different currents of opinion can be summarized in:
- Supporters of immediate animation (from the moment of conception). Within this position, those who considered the origin of the human soul by a preexistence prior to its union with the body ( Christian Platonism ) or by a derivation of the soul of the parents ( traducianism ) stood out .
- Supporters of mediated or delayed animation (after some time). Among those who defended this position, they were part of those who accepted that souls are created by God , a creation that could take place a few days after fertilization ( according to Aristotle , for example).
The thesis of the “mediate animation” held by Saint Thomas Aquinas was that which was imposed and that which became official. As mentioned, Thomas maintained that it was not until the 40 days when God breathed the soul into men and 90 days in the case of women. 79 Consequently, the thesis of the delayed humanization was the view generally held during the Middle Ages , determining that the soul was breathed by God to 40 days in men and 90 in women.
One reason why the Catholic theologians in favor of immediate animation have maintained that the soul is inflated at the moment of conception lies in the fact that the new soul does not derive from that of its parents and is therefore a divine fact . Under this line we can mention, for example , Didaché , the oldest writing of the Apostolic Fathers , which equates in importance to abortion by killing an unborn child, 81 or Tertullian . 82
This point is undoubtedly the one that causes more problems of conciliation with scientific knowledge. Some authors point out that the theologians of this tendency are actually aligned with modern philosophers such as Immanuel Kant or Gottfried Leibniz , since the idea that the soul exists at the very moment of conception arises more strongly mainly in the nineteenth century. 83
If in the previous centuries the vision of Saint Thomas was pre-eminent, in the twentieth century the official position of the popes is against any kind of interruption of pregnancy. Pope John Paul II wrote in this sense unequivocally in various encyclicals 84 and a similar line is maintained by Benedict XVI. These encyclicals are discussed by proponents of different perspectives, both within the Catholic community 85 and beyond in intellectual circles 86 or theological. 87
Theologian Teresa Forcades noted the importance of not interfering with the decision of the mother and the special and distinctive relationship of dependency between them that has been designed by God and where the decision of motherhood is included.
God puts the life of the fetus while it is not viable in the hands of its mother (in the entrails of its mother) and has linked the biological life of this one to the spiritual life of her. We will do well to respect this primary link. While the fetus can not survive independently of the mother, it is her moral responsibility to decide on her future, which is also hers, since the mother does not gestate the child only biologically, but also spiritually, with her love, With his desire that this one live, with the joy of taking it to the world. Respecting the mother’s decision is to respect the integrity of her moral conscience, even accepting that objectively can be wrong. 88Teresa Forcades
In the magisterium
In the first Council of Mainz – a local council of the year 847 – canonical penalties confirmed by previous meetings are confirmed: the woman who has aborted will have to prescribe 10 years of penance. Pope Esteban V affirms, in his letter Consuluisti de infantibus , that committing an abortion is a homicide, since the conception requires the action of God. 89
On March 4, 1679 , a decree of the Holy Office condemned two proposals concerning abortion:
It is lawful to seek abortion before the animation of the fetus, for fear that the girl, caught pregnant, be dead or infamous.Denzinger, Enchiridion symbolorum , 2134
It seems probable that every fetus lacks a rational soul while it is in the womb, and that it only begins to have it when it is stopped; And consequently it must be said that in no abortion homicide is committed.Denzinger, Enchiridion symbolorum , 2135 90
The Code of Canon Law of 1917 established for abortion the penalty of excommunication . 91
Apart from this allusion, the teaching of the Church does not return to rule on the issue until the twentieth century [ citation needed ] , but since 1930 has done so continuously and increasingly broad. Pius XI , 92 Pius XII , in various speeches, such as that given to the Society of Italian Physicians of San Lucas (on November 12, 1944), or John XXIII , 93 have condemned abortion as a homicide. In the Second Vatican Council there is one of the most cited condemnations in the later magisterium, namely, in the pastoral constitution Gaudium et Spes . 94
In the encyclical Evangelium Vitae , Pope John Paul II recalls that those who knowingly incur or collaborate in an abortion (parents and accomplices without whose support abortion has not taken place) incur immediate excommunication (called latae sententiae in the Code of Canon Law ). 95
The Jewish tradition is prone to the sanctity of the fetus, and does not allow abortion on request. However, it allows abortion under certain circumstances, because it does not consider the fetus as an autonomous person. The Mishnah (Ohalot 7: 6) explicitly states the admissibility of abortion if continuity of pregnancy could endanger the life of the mother:
“If a woman suffers harsh labor, the child (fetus) must be cut in her womb and be gradually removed in pieces, because her life takes precedence over that of the one, but if most of it has already come out In birth, should not be touched, for the [demand for] one life can not go above [other] life. ”
The Orthodox Judaism does not support other cause danger to the mother ‘s life, while the Conservative Judaism also considers the possibility of serious damage to physical or mental health, or when the fetus is not viable or have serious flaws, according to expert medical opinion.
The Islamic law (sharia) part similar to those of the Christian canon law considerations. Although neither the Qur’an nor the Sunna deal with the subject, the medical knowledge provided by the medical expert, such as Averroes , or the Islamic-knowing physician, such as Avicenna , is given importance . According to these, the fetus acquires the legal status of person when he receives from God his personal soul, a moment for whose identification is also trusted in the science of the doctor and not only in the revelation . According to oral tradition , the time of the infusion of the soul is at 120 days or four months. 96
Most modern jurists consider accepting the non-viability of the fetus in its first 120 days. 97 In Islamism, it is assumed that the complexity of fetal life increases over time, thus maintaining a gradualist perspective that is grounded in Islamic theology. It states that the spirit (rub) enters the fetus about 120 days (4 months) after conception. Those who take a stricter position argue that once the sperm enters the womb, it is destined to produce life, and thus for them the abortion is outlawed. However, within those 120 days the majority of jurists consider abortion as morally less serious and therefore not punishable.
In the same way, it is generally observed that the mother can abort if her life is at risk regardless of the time of gestation, so that the life of the mother prevails over the rights of the unborn. There is some debate in the case of malformation and to what extent this is reason to extend the 120 days. Although in the Egyptian fatwa this is not contemplated. 97 It should therefore be noted that there is debate about shortening the period and its assumptions, and where science sometimes plays a prominent role.
There are two legal schools that value abortion in different ways. The Hanafi school allows abortion freely in the initial four months, even when the woman’s initiative does not have the husband’s permission. The Maliki school mostly prohibits abortion altogether, arguing that even if the fetus is not properly human, it should not interfere with its natural fate to acquire its soul once the semen has settled. Some members of the Maliki school find abortion permissible up to 40 days. The Hanbali school usually reduces the deadline to 40 days, strictly prohibiting it afterwards. 98
The other Islamic legal schools, both Sunnis and Shi’ites , hold positions similar to those of the Hanafi school. Of the five categories in which legally classified acts – compulsory, recommended, optional, guilty or discouraged and prohibited – abortion has generally been placed among the optional or tolerable, specifying cases in which abortion should be considered criminal and punishable . In general, health reasons are considered to justify abortion. 96
In general, Islam encourages reproduction and discourages abortion, which does not easily receive social approval, but it is not necessarily considered a crime either. It is seen rather as a resource that should be used only last. The expression of the mother’s will to carry it out is an indispensable requirement.
The Buddhism does not contemplate the existence of a soul blown or created by a deity, so that their doctrine does not set a specific time for advice or not abortion. Nevertheless, Buddhist doctrine does observe an evolution of embryonic development and its capacities, so it observes a graduation 99 in moral gravity in the act of aborting in function of the evolution of the consciousness in the unborn. In general, Buddhism does not condemn abortion with excessive gravity although it points out the possible serious consequences for the emotional stability of the mother. In practice some Buddhist communities such as the Japanese celebrate ritual ceremonies (Mizuko kuyo) of emotional repair for those women who have experienced an abortion and so request.
In an obligatory investigation of the causes of the actions demanded by Buddhism to its followers, in general the context of the situation that can push a woman to this decision can be observed. So that abortion, even if it is considered a very unfortunate situation or that may be the result of clinging to sensual desire, does not come to have the same serious consideration as other actions. For example, Buddhism mentions numerous examples of the gravity of ending the life of an adult animal such as a dog, an elephant, or a horse. But not about a five- or six-week abortion. There is therefore no general rule in Buddhism that teaches a prohibition or approval in any situation, but tends to observe each case and its circumstances.
Countries where the Buddhist religion is majority (such as Thailand, Cambodia, or Japan), time laws and assumptions that allow abortion apply. 100 Of all of them, the case of greater permissiveness and decriminalization is the Japanese.
The beliefs of the Hindu world are varied but derive most of them from their ancient sacred texts, from the doctrinal Upanishads to the legends of the Puranas . Hinduism considers abortion from its texts in a way perhaps more radical than other religions, when considering that the human soul is present from the same conception without a debate of weight. The religious notion of non-violence towards any manifestation of life was further emphasized in the modern era by Mahatma Gandhi , the father of the modern Indian nation. Beside this, various religious scriptures such as the Suetásuatara-upanishad affirm that the souls that must reincarnate fall from the clouds with the rain, they enter the legumes, that when they are consumed by a man they become semen and can be injected in a Maternal belly Abortion is considered bad karma, and the person who commits it, when dying, should be injected into a woman who is thinking about aborting. 101
According to a complex theological scheme that contemplates the reincarnation of souls , both the zygote and the embryo or the fetus have a soul – whether already developed or not – and must be protected. Socially this moral vision remains predominant and the different Hindu cults and their leaders 102 hold this view in the majority, while at the same time accepting resignation a certain conciliation with the programs of family planning as well as with abortion, above all by the social and Of existing population.
Some Hindu texts derived from traditional medicine ( áiur-veda ) , such as the Charaka-samjita , recommend giving preference to the life of the mother rather than that of the fetus. This has served as a point of support for the Indian government to allow, through the MTP (Medical Termination of Pregnancy Act), 1971, to legislate abortion in cases of rape, incest or threat to Mental health of the mother. It is through this latter assumption that most abortions in India are carried out, which are currently very numerous.
The morality of abortion in Hindu society is complex. Religious texts such as the Vedas and Puranas clearly prohibit it, although Hindu philosophy allows them to be practically dismissed; Especially through Ayurveda or traditional medicine. The caste system, the selection of sex for socio-economic reasons, overpopulation and other serious problems, forces a coexistence that is seen in a resigned but not satisfactory way by the Indian society.
From a standpoint of bioethical , there is a clear division of opinion:
- Those who hold pro-life positions based on arguments that qualify as scientists – hold that human life exists since fertilization. 103
- Those who hold pro- choice positions reject that the embryo is an individual or person from fertilization, and there are within this group diverse positions regarding the moment in which it can be considered that a human being begins to exist. 104
- Those who believe that the position on abortion, pro – choice or pro – life either belongs to the realm of personal, ideological or religious beliefs, because the moment a human being can be considered can not be established by scientific criteria 105
On the one hand, there are those who argue that the embryo is a human life from the moment of fertilization, regardless of the degree of development and viability of the fetus outside the uterus. 103
The bodies of the woman and the embryo are different, since the DNA of the fetus is different from that of the mother, so it is considered a different being, as defined by Genetics – to point out that fertilization is the moment in which Constitutes the unique genetic identity; the cell biology which explains that beings multicellular are formed from a single initial cell, the zygote , whose core genetic information (found genetic fingerprint ) that is conserved in all cells and that is what determines the differentiation Cellular , and Embryology – which describes embryonic development and reveals how it unfolds without a continuity solution. ” 103Manifesto of Madrid
Thus, they derive that regardless of what the development of the embryo, it must be protected.
On the other hand, there are those who reject that the embryo is an individual or person from the fertilization, existing within this group diverse postures regarding the moment in which it can be considered that a human being begins to exist. For example, some scientists say that “the 12-week embryo is not a biological individual, much less a person: it lacks independent life, since it is totally unviable outside the uterus. The development of the brain is only in its initial stages, and the nervous connections that characterize the human being have not been established. The embryo, therefore, experiences no pain or any other sensory perception. ” 104
There is also the position, within the scientific group, that denies the legal-philosophical debate, from the scientific point of view, and reject the “ideological and partisan use of science … presenting as scientific arguments what belongs to the field Of personal, ideological or religious beliefs “, since for them” the moment in which a being can be considered human can not be established by scientific criteria, since scientific knowledge can clarify certain functional characteristics, but can not affirm or deny whether those Characteristics confer on the embryo the condition of being human, just as it applies to the developed individuals of the human species. ” 105
According to GFW Hegel , in his Phenomenology of the Spirit , 106 “If it is true that the embryo is itself a human being, it is not, however, for itself , for the human being is only so in reason as cultivated Has made itself what it is in itself . ”
In recent years has joined the debate bioethical the concept of ” pre – embryo ” with intent to differentiate the first 14 days of development of the unborn child ( ‘which is to be born’) the rest (ie, during the first stage of prenatal development ). Accepting the concept of pre-embryo, assuming that it is not a biological individual other than the mother, would lead to a bioethical reassessment of interventions during the first 14 days, either by eliminating them in the micro-environment or by manipulating them during research on their stem cells or stem cells (stem cells) in laboratory genetic engineering . [ Citation needed ]
On the other hand, there are those who consider that “the term” pre-embryo “lacks scientific basis and seeks to justify different research in the embryo, without there being any ethical and legal obstacles. 107
The concept pre – embryo has its origins in research carried out with pigs by the embryologist Washington in 1927 , [ citation needed ] who studied the phenomenon of twinning observing the placenta of female pigs from slaughterhouses. After much work, he failed to distinguish the process before 20 days, and not to leave the research stopped, proposed a working hypothesis and drew a scheme, which have been re-elaborated several times, to complete them according to the image they offer The new discoveries, but have not been empirically contrasted since then. Analyses of DNA 108 would represent a test against, since DNA preembryo course, the embryo, and the same individual, once adult, are the same.
Induced abortion has been and is variously considered in different societies: for some it is another procedure for limiting progeny; For others, it is an attempt on the life of an unborn human being.
The argument put forward by those who reject abortion – self-styled Provida – is “that the embryo or fetus is a human being with human rights, including that of being born, growing up and having a family.” While advocates of women’s free choice – and self- styled Pro- Choice – argue that “Every woman has a right to privacy, health and physical integrity, so she must choose whether or not she has an abortion, even more In extreme situations, such as pregnancy after a rape, diagnosed malformation of the fetus or embryo or when life is in danger ”
It is estimated that every year 46 million women resort to induced abortion to end an unwanted pregnancy. Legislative treatment varies greatly from country to country, but currently 62% of the world’s population lives in 55 countries where induced abortion is permitted, while 25% of the world’s population lives in countries that prohibit and penalize it. The WHO estimates that each year there are 20 million induced abortions.
Mortandad due to abortion in unhealthy conditions
The World Health Organization ( WHO ) notes that unsafe abortions are a major cause of female mortality, with a total of approximately 68,000 deaths a year in the world, representing about 13% of the 527 deaths 000 maternal deaths, that is, for obstetric reasons. 109 Studies published in 2010 speak of a number of maternal deaths of about 343 000. 110 The percentage is very unequal by region, reaching up to 30% of maternal deaths in some countries. 111 The risk is statistically higher where abortion under safe clinical conditions is not accessible, whether for legal, social, economic or other reasons. 112 113 The clandestine abortions , thus generating a problem of public health , the rate of deaths and the consequences they have on the lives of women.
Clandestine abortion is unsafe because it is not given in conditions that can guarantee optimal intervention. Non-specialized personnel are used. The life of the woman is put at risk. Bleeding and other complications of incomplete abortion are one of the causes of maternal mortality. [ Citation needed ]
In Latin America and the Caribbean , approximately 5,000 women die each year from complications related to unsafe abortions (more than one- fifth of total maternal deaths). This corresponds to 21 percent of maternal deaths globally. [ Citation needed ]
In 1996 , PAHO indicated that abortion is the leading cause of maternal mortality in Chile , Guatemala , Panama , Paraguay and Peru , the second leading cause of death in Costa Rica, and the third leading cause of death in Bolivia , Brazil , Colombia , Ecuador , El Salvador , Honduras , Mexico and Nicaragua . [ Citation needed ]
Of all women who undergo an unsafe abortion, an estimated 10 to 50% need medical attention for the treatment of complications. Incomplete abortions, hemorrhages and infectious complications are some of the risks women face when they do not receive adequate medical treatment with the necessary conditions to guarantee life and health. [ Citation needed ]
The WHO estimates that 13% of the approximately 600,000 pregnancy – related deaths worldwide are the result of performing abortions in unsafe sanitation. Induced abortion mortality is 0.2 to 1.2 per 100,000 abortions in countries where abortion is permitted. In countries where abortion is penalized, there are 330 deaths per 100,000 abortions. [ Citation needed ]
Abortions carried out under conditions of risk endanger the lives of many women, which is a serious public health problem. Most of these deaths, health problems and injuries could be prevented through greater and better access to adequate health care services, including safe and effective methods of family planning and emergency obstetric care.Fourth World Conference on Women, 1995. 114
These data have served as an argument for the decriminalization of abortion , that is, in favor of abortion being no longer considered a crime and legislated with specific considerations for specific cases.
Selective abortion of female fetuses at present
At present, in the countries with the largest populations in the world ( China 115 and India , where abortion is legalized), the coincidence of three situations, namely the medical advances that determine the sex of the future child, the legalization situation Of abortion and a ‘cultural preference’ for men have made the number of women decrease and there are more abortions of female embryos and fetuses. Particularly in India, researchers estimate that from 1985 to 2005, 10 million potential future women have been selectively aborted. 116 117
The 2001 census in India revealed that “fifty million women were missing”, which was in contravention of the world trend, in which the number of women is slightly higher than that of men. On the other hand, the application of the single-child policy in China in 1979 increased the male population, since the parents tried to deceive and avoid the law through preferential abortion or the abandonment of unwanted daughters. 115 118
Consequently, India is prohibited to make sonograms or ultrasounds to determine the sex of the fetus, because, since abortion is legal, many women are forced to abort if the fetus is a girl because, supposedly, 119 “a daughter not Will be able to care for their parents when they grow old, because it will be the cause of the family’s impoverishment to have to pay a dowry in their wedding, because it will be considered a guest in their own house until the day in which it leaves to marry, because the prestige of The mother and her position in the family will only be consolidated if the one who is born is a male, or because it is believed that only males can perform funeral rites by their parents. ” The abortion and selective infanticide towards future women could have an influence on the relationship between men and women, which rose from 117: 100, according to data from 2002. 118
Christophe Z. Guilmoto , a French demographer , has conducted a study concluding that in Vietnam , as in much of Asia, the rate of girls born is significantly reduced compared to that of children as a result of abortions Selective. 120 According to the same author, the masculinity index , however, has also experienced notable rises in countries where birth control does not exist as State policy. This is the case of India (with an average of 113 and 125 in the Punjab ), Taiwan , Singapore , Pakistan or Bangladesh . Also in the South Caucasus , Armenia , Georgia , Azerbaijan . Weaker, the trend is also visible in Albania and Montenegro . 121
In March of 2010, The Economist described , on its cover, this situation as a generocide . 122
Abortion and human rights
From the point of view of human rights, there are several opposing ethical-philosophical approaches:
- The approach that defends the right to interrupt the vital process of the zygote, the embryo or the fetus at any point in that process , that is, the future baby. From this point of view, the pregnant woman is granted the right to her own child and therefore to the choice of maternity , which is the premium over any other that is intended to be given to gestation.
- The point of view that defends the right to interrupt the vital process only until some development of the same. This view is supported by a vision of “development by phases” of the gestated subject. In this view no rights are observed for the zygote or the embryo, but for the fetus from a certain point of development that may be variable. In addition, the right to terminate the pregnancy of the pregnant woman can be extended depending on additional circumstances, such as malformation of the fetus, rape or danger to the life of the mother.
- The position that defends the non interruption of the process of the zygote, the embryo or the fetus, regardless of its point of development . This view is based on the consideration that the subject of development is a “human life” deserving respect. In this view, the pregnant woman has no right to end gestation by interrupting the pregnancy process at any stage of development.
Those in favor of total decriminalization hold an interpretation of human rights where prohibiting it would violate women’s fundamental rights and against the principles of social justice . In addition, it is argued that the prohibition causes women to die victims of poorly performed clandestine abortion, especially those who have the least economic resources or belong to the most vulnerable socio-economic sectors.
Opponents of abortion support an interpretation of human rights where legalizing it would undermine the right to life of the unborn child, which should prevail over the right of choice of the mother. Therefore, legalizing abortion would violate the fundamental right of every human being that is affirmed to exist from the very fertilization of the ovum, and thus against the principles of social justice . In this interpretation, the mother’s right to choose the right to life of an already existing human being, who has no possibilities of defense, is placed before this interpretation. For them, who consider the embryo as human life, 103 abortion is the leading cause of death in the world. 123 124125 126
People who are in favor of graduation in the decriminalization attempt to achieve different degrees of reconciliation between the right of the mother and the fundamental right to life. Normally, they seek support in scientific arguments about human development, since they show legal limits on the interruption of the pregnancy process according to the number of weeks since conception.
In recent years, some human rights protection agencies have called for the decriminalization of abortion by considering that its ban violates women’s human rights. These include the Inter-American Commission on Human Rights (IACHR), the European Court of Human Rights , the United Nations Human Rights Committee ( UNHRC ), the World Health Organization ( WHO ) and Amnesty International .
The Anglo-Saxon system, the European-continental system and the international system for the protection of human rights consider that the fundamental rights of women are violated when abortion is absolutely prohibited. The first system develops the fundamental rights of women from the perspective of their right to privacy and in relation to the idea of ’viability’. The continental model, in turn, links abortion with the general right to freedom of women, whether it is specified as reproductive freedom or as a right to self-determination. Finally, important international NGOs, such as Amnesty International , the Inter-American Commission on Human Rights , the United Nations Human Rights Committee and the World Health Organization, relate the problem of abortion to the violation of women’s rights Subjected to cruel, inhuman or degrading treatment, that is to say, with the general prohibition of torture .
Among the institutions that oppose induced abortion as being considered to undermine the right to life of the unborn, the Catholic Church stands out.
Postures of diverse organisms
Amnesty International supports the decriminalization of abortion to ensure that women have access to health services when complications arise from abortion, and to defend women’s right to abortion – within the reasonable limits of pregnancy – when their life or Your health is in danger. [ Citation needed ]
Their position has been questioned by both individuals and organizations such as the Catholic Church , which argue that if Amnesty International opposes the death penalty, it is inconsistent to accept its application to what they understand as an innocent child .
The problem here is the debate that has been generated regarding the definition of ” minor ” and the precise definition of the beginning of life and the definitions of ” individual ” and ” person ” (see Biological aspects and Doctors and Religious aspects ).
Political and religious positions
One can not speak of a correlation between political or religious tendency and position against abortion, because there are supporters and opposers to abortion in all tendencies; take for example the above, the existence of Catholics in favor of decriminalization as the Latin American Network of Catholics for a Free Choice, 127 128 129 feminist groups and atheists prolife, as Feminists for Life (Feminists for Life), 130 Women Against Abortion 131 and Atheists for Life , 132 or the Movement for Parliamentarians and Rulers for Life, 133 which integrates people of diverse political, religious and cultural tendencies.
Help pregnant woman
Women who think about abortion are subjected to psychological stress before and after abortion, as it appears in the scientific literature. 134
There are networks of individuals and organizations that focus on helping pregnant women, who work to contact women at risk of abortion with resources at the local level through the use of new technologies to help women suffering from stress and Depression and are thinking about aborting. 135 This network has pages in Spanish and English . The places to which they are referred (refer) are not for profit or religious affiliation. Some of them are located in the United States as Option Line , Stand Up Girl , in Spain as Red Mother and Thinking about Abortar or in Latin America as Center for Women .
Abortion induced in literature
Induced abortion is the subject of several novels, as the event of Annie Ernaux 136 and Daniela Astor and the black box of Marta Sanz . 137
The Spanish writer Miguel Delibes published in 2007, an article entitled “Free Abortion and progressivism , ” which states that is part of progressivism also the defense of the weak, also of embryos and fetuses 138