Since the news broke of the leaked draft of the decision in Roe v. Wade, I have been pleasantly surprised that many pro-lifers are expressing the notion that “the real work starts now.” The authors of these articles and social media posts suggest that they understand that providing legal protection for the unborn is not the only goal of the pro-life movement. These pro-lifers know that we must also help struggling mothers and families, by promoting programs and policies that provide them with help, such as adequate healthcare, maternity leave, financial and material support, and housing and educational opportunities.

Unfortunately, I’ve also seen some self-described pro-lifers celebrating the news in a triumphalist and callous way. I would like to address these reactions in light of the bioethical principles at play.

As a Catholic doctor, I have studied Church teaching in the area of bioethics and apply its principles regularly in my work. At times, the moral questions are complex, with many decisions to be made among an array of competing values. Philosophers and ethicists have developed systems for discerning ethical questions in medical cases. Typically, these frameworks will rest on some foundational principles or “pillars.”  The four pillars of medical ethics that are most frequently cited are non-maleficence, beneficence, autonomy, and justice.

These same principles can be applied to other moral and ethical issues as well including the issue at hand. In the context of the debate over our moral responsibilities should Roe be overturned, I would like to focus on two of the four pillars: non-maleficence and autonomy.

How to approach a bioethical dilemma

When two bioethical values conflict, we have a bioethical dilemma.

Usually, the way to solve a bioethical dilemma is to establish a hierarchy of values. When two values conflict, our course of action is based on the one that is more important according to this hierarchy.

Classically, “non-maleficence” has been the supreme value in bioethics and medicine, trumping all others. Non-maleficence is another way to express the classical adage, “First, do no harm.” The expression, which comes from the Hippocratic oath, means that it’s better to do nothing than to perform an action that will result in harm.

Historically, pro-lifers have followed the classical bioethical hierarchy. However, as society became more individualistic and liberal, the value of autonomy became more prominent. Today, many believe—even without knowing it—that autonomy is the supreme value, trumping even non-maleficence. This is the paradigm applied in physician-assisted suicide, for instance.

But autonomy, or a right to self-determination, cannot be a supreme value. Many people were able to acknowledge this during the course of the pandemic, by following public health guidelines on masking, social distancing, and vaccination. Many people did these things, despite the mild inconvenience, in order to help prevent the spread of the virus to others. On the other hand, defiance against these precautions and protests against the vaccines and mask use were rightfully considered unreasonable in face of the situation, because they prioritized autonomy over non-maleficence (and also beneficence, which is doing good or acting in the best interests of another).

The opposition to public health guidelines during the pandemic demonstrate that the imbalanced approach to the principle of “autonomy” can be found across the political spectrum. We must recognize that autonomy is limited by other priorities, such as the common good. Even still, just because autonomy is not a supreme value, that doesn’t mean that it should not concern us. Unfortunately, the callousness on display from some pro-lifers has led to simplistic thinking.

Let’s be clear, just because I say that something is complex, I’m not saying that one side is not wrong or that both sides are correct. However, given the intimate biological and psychological bond uniting mother and unborn child, we should not downplay the hardships induced by this bioethical dilemma.

Doing what is right does not mean that it is easy. Quite the opposite actually. Doing what is right is usually very hard. Therefore, pro-lifers should act and speak with sobriety and sensitivity, aware of the gravity of the issue and the concerns of others. We cannot let activism present an idealized version of reality that will collapse when confronted with concrete situations in real life.

Certainly many pro-choice people also speak callously, as if performing an abortion is no big deal. They do not consider abortion as taking a human life. Their rhetoric has gone from saying that abortion should be “safe, legal, and rare” to “Shout your abortion!” Their strategy is effectively to deny that an ethical dilemma exists at all.

Pro-lifers should not mirror this behavior. We should not downplay any of the principles at play, even if they conflict and we must ultimately choose one of them. Here is where the pro-lifers saying “the real work starts now” are right.

Certainly one way to mitigate the conflict between “non-maleficence” and “autonomy” is to help women choose the non-maleficent option. When women exercise their autonomy and decide not to harm their unborn child, both values are pulling in the same direction, and the dilemma is solved.

This is the reason why, contrary to what some pro-life “purists” say, we need to address the causes of abortion. We need a whole-life approach. We need better healthcare (maternal and fetal), we need to create better socio-economic conditions for families, we need to prevent the sexual exploitation of women.

In other words, it is imperative that we need to eliminate the situations where women’s autonomy is reduced and they are convinced that abortion is the only option. In fact, we would need to do these things even apart from the abortion controversy, because they stand on their own as an infringement of other ethical goods.

Is this realistic? Of course, it is naive to think that there will be a time when complex situations will never occur. But we must recognize our moral duty to reduce these situations as much as possible.

The more successful we are at eliminating the conditions that make abortion seem like the only option, that will allow us to more directly address abortions that result from when autonomy is invoked disproportionately to the maleficence of the act (and yes, those do exist). It will also allow us to effectively respond to the false idea that abortion solves certain systemic problems, rather than burying them further. the situations where the bioethical conflict occurs.

We must be realistic and empathetic. We can’t be callous. We must take women’s concerns about autonomy. Those who attribute all abortion to hedonism or a thirst for “baby-killing” are incorrect and unhelpful. If we don’t advocate and work for the welfare of women and families, any legal “victories” for the pro-life movement will be short-lived, and any hope of providing legal protection for the unborn in the foreseeable future will be wiped away.

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Pedro Gabriel, MD, is a Catholic layman and physician, born and residing in Portugal. He is a medical oncologist, currently employed in a Portuguese public hospital. A published writer of Catholic novels with a Tolkienite flavor, he is also a parish reader and a former catechist. He seeks to better understand the relationship of God and Man by putting the lens on the frailty of the human condition, be it physical and spiritual. He also wishes to provide a fresh perspective of current Church and World affairs from the point of view of a small western European country, highly secularized but also highly Catholic by tradition.

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