COMMENTARY

Abortion Access: 'A Heartbeat Doesn't Make You a Person,' Says Bioethicist

Arthur L. Caplan, PhD

Disclosures

July 15, 2019

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm the head of the Division of Medical Ethics at the NYU School of Medicine. Abortion is in the news often and many states are passing laws to restrict access.

Some have passed laws, so-called heartbeat laws, that say once there is a detectable heartbeat in a fetus, that's the limit to permitting elective abortion. Other states are going in the direction of allowing more access to abortion by saying, for example, as they do in New Hampshire, Vermont, and soon Maine, that LPNs, physician assistants, and others could be trained and permitted to perform abortions.

 

Some parts of the country are trying to expand access to abortion for women; other parts are trying to restrict elective abortion. There hasn't been much said over the past 10-20 years that's new about the ethics of abortion, but I do want to offer a comment on the heartbeat idea, because I don't find that to be a persuasive line in terms of where we should say abortions are not permitted.

I fully understand that some people believe that abortion is wrong at any age, from conception all the way out to 8 months and counting. I think you still need to come up with a sound ethical argument to persuade others that you ought to restrict abortion.

Is the heartbeat the point of significance in fetal development? I would say no. It is true that a beating heart may indicate more independence on the part of the fetus from the woman's body, and it may be a landmark that says the fetus is starting to establish physiologic independence. However, fetuses cannot live outside the woman's body until they are 22-24 weeks of age. They don't have lungs. They require amniotic fluid and being inside the uterus in order to breathe.

A fetus cannot function at 6-8 weeks, which is when you start to be able to detect a fetal heartbeat. Moreover, many women don't even know they're pregnant at 6 weeks, so you're putting control over something that they might not want to do into a test or a determination that may come too late for them. They might have decided to end a pregnancy earlier than that.

What would be a significant landmark? Remember, we have two reasons to permit abortion in the United States. One is fetal viability. We say that if the fetus could live outside the woman's body, then she loses control over the fate of that fetus. Well, if that's true, then it's still a cut-off at week 23 or 24. That is where Roe v. Wade put fetal viability.

I'm aware that there are new technologies coming down the road, including artificial amniotic fluid and artificial wombs, which might change the age of fetal independence. As long as the fetus has to depend on the woman and her body to survive, that does, in my view, still give her control over whether she wants to support that fetus or not.

The other issue is when does the fetus become a person? I would say we have an answer here, but it's not consistent with heartbeat. A heartbeat doesn't make you a person. What makes you a person is when you have integrated brain function. When your brain is beginning to work is where we draw the line—not around life, but around personhood.

If I begin to see the brain develop in a fetus and it begins to control, organize, and integrate what's going on in the fetal body, that is an important, moral landmark. And guess what—that probably happens at about 24-25 weeks as well.

I know that many of you who are watching are not going to shift your views about abortion, thinking that it just shouldn't happen or it should simply be up to the woman.

However, if you're going to make a moral or an ethical argument to support either legislative restriction or expansion of abortion access, I think you have to pay attention both to the viability question and to the personhood question. I think they point to permitting abortions later in fetal development than what we see in the heartbeat bills.

I'm Art Caplan at the Division of Medical Ethics at the NYU School of Medicine. Thanks for watching.

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