…and this is a 
Anencephaly and right-wing moralizers
Category: Development • Politics • Reproduction
Posted on: January 10, 2007 12:00 PM, by PZ Myers
There's an important phenomenon in development called neurulation. This is a process that starts with a flat sheet of ectodermal cells, folds them into a tube, and creates our dorsal nervous system. Here's a simple cross-section of the process in a salamander, but in general outline we humans do pretty much the same thing. Cells move up and inward, and then zipper together along the length of the animal to produce a closed tube.
It's a seemingly simple event with a great deal of underlying complexity. It requires coordinated changes in the shape of ectodermal cells to drive the changes in tissue shape, and invisible in simple diagrams to the right are all the inductive interactions going on that trigger the differentiation of the tube into a nervous system.
This is also a relatively early event in humans. It begins about 18 days after fertilization, with a thickening of the ectoderm to form the initial sheet, called the neural plate. By day 19, the edges of the plate thicken and rise, and the whole thing folds at the midline and looks something like an open hot dog bun. The photo below is of a pair of 20 day old human embryos; the midline seam is open and clearly visible.
By day 23, the edges have all fused together along the length of the embryo, leaving openings call neuropores at the rostral and caudal ends; the picture to the left is of a 23 day old human embryo, looking at its head end, and you can see right into its prospective brain. By days 26-28, both neuropores will close.
This is a crucial event that occurs very early, in the first month, of a pregnancy. What happens if the zipper gets stuck, and the tube fails to close completely?
It happens, and unfortunately it happens fairly frequently. About 0.1% of births in America have a serious neural tube defect caused by a stuck neural tube zipper.
The outcome is myelomeningocele—portions of the neural tube are left exposed, fail to develop properly, and are damaged and degenerate. It's variable in its consequences; when the posterior neuropore fails to close completely, it can result in nearly undetectable defects in the caudal spine to lower body paralysis and perturbations of cerebrospinal fluid flow that if untreated, can lead to hydrocephalus and severe brain damage.
Failure of the anterior neuropore to close is even more serious. The brain fails to form. This condition is called anencephaly, and it is untreatable and lethal. If they aren't dead at birth, they might last a few days before succumbing. They have no brain. At best, they have a mass of dying, relatively undifferentiated neural tissue smeared across the floor of their incompletely formed skulls. They can't think, they can't feel, they can't respond. The real tragedy is that development can proceed surprisingly far without a brain, and these fetuses are recognizably human (here is a photo for the strong of stomach), and they can be carried fully to term.
I can't imagine a clearer case to illustrate that humanity involves more than just the fusion of two gametes. We aren't defined by our complement of genes or a single instant of genetic combination, but are the result of many genetic and epigenetic processes working progressively through embryogenesis to assemble a functioning human being. When moral absolutists try to apply simple-minded, black-and-white reasoning to a complex situation (and defining a human being is certainly a complex problem), you get criminal travesties like this one:
A sailor's wife was pregnant with an anencephalic child, whose probability of surviving or of ever being conscious was zero. She, reasonably, wanted an abortion.
But the Congress had decided -- that no federal funds should be used to pay for abortions except where the life of the mother was at stake. As a result, Tricare (formerly CHAMPUS) the agency that covers military families, refused to pay the $3000 the abortion would cost.
The family sued, and a federal court ordered Tricare to pay, and the abortion went forward.
Then the Justice Department (with John Ashcroft as Attorney General) sued the family to recover the $3000, out of the sailor's pay of less than $20,000 a year.
The Justice Department just won. A panel of the Ninth Circuit ruled that, under a 1980 Supreme Court precedent upholding the Hyde Amendment -- a parallel provision to the one in question, but applying to Medicaid recipients rather than to military families -- the law was valid and the government didn't have to pay for the abortion. Consequently, the family has to pay the money back.
Our guardians of purity have magnified the pain of this family and willfully and vindictively punished them for the 'crime' of a biological imperfection. I call that evil, pure and simple. There should have been no question in this case that an abortion was necessary.
There are much more difficult cases. What if the fetus was diagnosed with 'merely' a case of myelomeningocele that meant it would be paralyzed, require extensive surgeries, and would be a crippling financial burden? The average cost per year of maintaining a child with myelomeningocele is approximately $70,000, and that drain never ends. People with severe spina bifida can be intellectually and socially capable, fully human, but a young family with limited resources ought to have the privilege of making a choice about whether to shoulder the responsibility before the fetus has acquired those mental capacities. I presume we now have a government that will force families to take on that burden, but will refuse to pay any part of the price.
Cohen MM (2002) Malformations of the craniofacial region: Evolutionary, embryonic, genetic, and clinical perspectives. American Journal of Medical Genetics 115(4):245-268.
Comments
Thought-provoking point: life isn't as discreet as brain vs. no brain, or even DNA vs. RNA. This is something I've thought about a lot lately. As primates, we deal with the world as a series of distinct objects, and this way of thinking has also defined the way we deal with abstract concepts, like "alive" or "human." Political implications aside, organic chemistry just isn't that simple.
Posted by: Poseidon | January 10, 2007 12:08 PM
Posted by: Steve LaBonne | January 10, 2007 12:10 PM
Poseidon, it's even tougher than you suggest. The world of biology is full of fine gradations, gradual developments, small differences barely detectable that later loom large, and all the messiness of reality. Inevitably, human societies have to draw lines around parts of biological reality, in the moral and legal spheres, if nowhere else. That means there inevitably is some judgment and choice and even arbitrariness in how we draw those lines. The right-wing moralizers don't want to admit that reality. More than anything, they want to believe that the correct location of those lines is somehow predetermined, somehow not a matter of human decision, somehow instead is soemthing Out There, if only we could find it. Their core understanding of morality is based on fantasy. They have no way to address hard issues except by retreat into fantasy. And because it is fantasy, they can't even address the questions that logically arise from it.
Posted by: Russell | January 10, 2007 12:28 PM
There are all sorts of wacky results that fall out of "life (ensoulment) begins at conception". What about chimeras; are they really two people? What about a parasitic twin? I noticed a distinct lack of pro-lifers picketing the hospital where the "pregnant man" had his twin removed (and presumably not placed on life support). What about identical twins; do they each get half a soul? Remember, any dithering about brains or minds or bodies is tantamount to admitting that a just-fertilized zygote doesn't have a soul!
It's pretty damned amazing that anyone can claim these things with a straight face.
Posted by: grendelkhan | January 10, 2007 1:05 PM
This has been made into a play called "Mitzi's Abortion":
http://www.acttheatre.org/plays_mainstage_mitzi.htm
Posted by: HCN | January 10, 2007 1:08 PM
I wouldn't say it's evil of them - rather, economically sound. And gals and boys in DC are just tagging along. I hear it's called capitalism.
Posted by: romunov | January 10, 2007 1:53 PM
Ebon Musings has a great article about all the absurdities one is led into by believing that there is such a thing as a soul. The article is called "A Ghost in the Machine."
http://www.ebonmusings.org/atheism/ghost.html
Posted by: Ric | January 10, 2007 2:11 PM
I am an obstetrician and a veteran. If the government or any insurer were required to cover the cost of abortions for malformations, there would be endless legalizing about the definition of "malformation." If the fetal karyotype is trisomy 21 or Down syndrome, is that mandated to be covered? How about Turner syndrome (45 chromosomes, missing one X chromosome, compatible with a normal but generally infertile female existence)? How about a 47XXX karyotype in the fetus (normal female life, generally fertile, but a stastically significant but maybe not clinically meaningful lowering of IQ compared to the normal 46XX female)? One could go on and on with these types of examples. Anencephaly is a horrible diagnosis to tell a pregnant woman. The insurer, in this case the taxpayers, in deciding to not cover any abortions has decided to not make judgements about the value of any particular fetus' life. In my opinion this is a wise decision. $3000 is a lot of money for a presumably 2nd trimester abortion. It is still much cheaper than the cost of raising a normal child, for which this couple was hoping and maybe even planning. I know I will get hate mail for my supposed insensitivity, but the clearest policy is not to cover abortion at all, rather than deal with the subjective worth of human life with all its variable phenotypes in deciding whether one woman deserves her abortion to be paid for and another woman doesn't.
Joe
Posted by: Joe | January 10, 2007 2:15 PM
There should have been no question in this case that an abortion was necessary.
The definition of "necessary" for the purposes of this law was whether the life of the mother was threatened. The family really had no case and the lower court badly screwed up IMO.
Doe claims that in her particular circumstances there is
no rational relationship between an interest in potential life and § 1093(a)'s funding restrictions because of her fetus' terminal condition. Rational basis review, however, "is not a license for courts to judge the wisdom, fairness, or logic of legislative choices."
Congress has a right to encourage people to have babies by means of refusing payment of abortions of choice -- which this was. Lower court seemed to buy the idea that because this abortion only technically breached the wishes of Congress but didn't really prevent a baby being born (because of it's terminal condition) that it was legal to pay for the abortion. Lower court also goofed in other areas. A poor ruling generally. Appeals court continues:
A statute "does not fail rational-basis review
because it is not made with mathematical nicety or because in practice it results in some inequality." Rather, the constitutional test requires only that the statute, as a general matter, serve a legitimate governmental purpose. Just as in Russell, Doe's contention that "we must consider [her] personal circumstances when judging the reasonableness of [1093(a)'s funding restrictions] is an impermissible attempt to ratchet up our standard of review from rational basis toward strict scrutiny." Id. Because the statute is rationally related to a legitimate government purpose, and because an "imperfect fit" does not render a statute invalid, we reject Doe's equal protection challenge under rational basis review.
Otherwise you have judges second guessing law makers too much. Since congress is the most democratic and the courts the least democratic part of a government that makes sense.
Posted by: DavidByron | January 10, 2007 2:32 PM
While I see the procedure in the OP as justifiable, I don't quite agree with 'necessary'. As stated, the fetus could be carried to term. At such time as the health of the mother is threatened, then the insurance should kick in. Were I faced with such a situation, I'd find the 3K$ somehow. Thanks Joe for your enlightening comments.
As also noted above, one can be inclined to wonder if some of the right wing moralizers might not have some defect of biology themselves. They appear to be able to lead a normal life, but are subject to oversimplifying complex issues into simple white/black ones.
Posted by: Sparrow | January 10, 2007 2:37 PM
The black and white morality mentioned isn't so much a morality, in my opinion, as the avoidance of a morality.
Morality is a tool to help us make choices, and is part of the society we live in. Choices are not easy - but they have to be made. Any morality that avoids dealing with hard issues is, at best, useless.
Posted by: DragonScholar | January 10, 2007 2:43 PM
Joe writes, "If the government or any insurer were required to cover the cost of abortions for malformations, there would be endless legalizing about the definition of "malformation."
The rather obvious alternative is for the insurer to cover the cost of any abortion. That removes the insurer completely from making any "judgements about the value of any particular fetus' life." It leaves such judgments entirely up to the woman, and simply has the insurer paying for a medical procedure.
Posted by: Russell | January 10, 2007 2:48 PM
I remember the first time this story came up, and it definitely made me think.
I have a devout Catholic friend. He's so anti-abortion that he would never even think of voting for any candidate who is not totally opposed to it. I can tell he even thinks bad of me because I support abortion rights. So I was kind of surprised when I asked him about anencephaly (I explained it first) and he said he didn't think abortion was really out of the question. Apparently, he doesn't think human beings without brains really do have souls. Somehow intelligence is related to having a soul.
I asked him a question regarding how anencephaly develops later than the embryo stage, and if he would support abortions before the period in which the brain even starts to develop, but he never made that logical leap.
Posted by: Cyde Weys | January 10, 2007 2:51 PM
Trying to use biology as an ethical foundation for determining the moral status of abortion leads one ask many utimately irrelevant questions. When is a conceptus 'viable'? What constitutes 'serious impairment' of either the conceptus or the health of the imparata? The important question is when does a conceptus become suffienctly a 'person' (a legal/political (theological?), not biological, status) that its right to survival trumps the imparta's competing right to autonomy? However determined, it must be recognized that equitably arbitrating the competing rights does not necessarily mean minimizing the aggregate harm. Sometimes even the best choice sucks.
Posted by: pluky | January 10, 2007 3:07 PM
DavidByron makes some excellent points of law above. I don't see this as a matter that should be decided by law though. I think that this should fall under a criticism of 'prosecutorial discretion'. I agree that "There should have been no question in this case that an abortion was necessary", I can hardly begin to imagine the trauma of carrying such a child to term in order to give birth to a corpse.
However, Tricare/CHAMPUS should have clearly given an exception to policy, and John Ashcroft clearly should have excercised prosecutorial discretion in declining to prosecute. I think this is why the 'reasonable man' standard has fallen into disuse - we are seriously lacking in reasonable men.
Posted by: Bulman | January 10, 2007 3:16 PM
Friends of ours adopted a baby. When she didn't hit some milestones she was tested and they decided she was deaf. When more milestones were missed they did a CAT scan and found that she had only enough brain to drive certain automatic functions like eating, heart, breathing, etc. To add to the family's pain their church keeps telling them that if their faith is strong enough God will give that baby a brain. So when that didn't happen they were left with the unspoken message that something is wrong with them. There is no telling how many years the child will live. She has lived three years so far which is longer than expected. If God does give the child a brain I will be sure to let you all know. Right after I get up off the floor.
Posted by: Ken | January 10, 2007 3:20 PM
I think Ambrose Bierce covered this one a while ago:
Posted by: NJ | January 10, 2007 3:23 PM
The rather obvious alternative is for the insurer to cover the cost of any abortion. That removes the insurer completely from making any "judgements about the value of any particular fetus' life." It leaves such judgments entirely up to the woman, and simply has the insurer paying for a medical procedure.
Well said, Russell.
Posted by: Bob | January 10, 2007 3:36 PM
Consider the reverse situation: Women who choose to continue their pregnancies, as these Pals of the Unborn claim to want, but lose their babies anyway.
As most Americans are vaguely aware, our infant mortality rate is a national disgrace. Our Black and Indian babies, no hyperbole, die so commonly it's as if they were born in some third-world country.
So exactly how much effort have you ever seen Ashcroft or any of those other anti-abortion dicks throw into helping these babies make it? (In particular, take a gander at the white-vs-black numbers in DC, and consider how much local control Congress has over the health delivery system there. Apparently the "right to life" only applies to white babies.)
Posted by: Molly, NYC | January 10, 2007 3:58 PM
Although I'm a long time supporter of the right of women to choose abortion, I also support the right of those who think abortion is immoral not to pay for abortions through taxes. I also think that whether an abortion is medically indicated is a relevant consideration, and I think "medical indications" should encompass a good deal more than "protecting the life of the pregnant woman."
In short, I think the issues, medical, moral and political, are a good deal more complicated that most people want to acknowledge.
Posted by: bob koepp | January 10, 2007 4:07 PM
Molly: Is it possible you're making this into an issue of race when it really isn't one? It seems to me it's more of an issue of economics. Especially in DC.
Posted by: Cyde Weys | January 10, 2007 4:08 PM
The family doesn't have to cover the cost if friends pay it for them. Is there a place I can donate to become one of those friends?
Posted by: Jud | January 10, 2007 4:09 PM
I think the problem is that people hew towards their subjective notions ("but is it human?") for moral decisions and responsibilities rather than objective realities, like suffering and sentience.
This lends itself to a wild tapestry of competing realities and moralities that are generally mutually incompatible and ignore objective real-world problems. The end result is inhumane, arbitrarily punitive outcomes as noted in the blog.
Posted by: Loren Michael | January 10, 2007 4:30 PM
I also support the right of those who think abortion is immoral not to pay for abortions through taxes.
I consider the killing of hundreds of thousands of people to stoke a leader's ego to be immoral. Can I refuse to pay for Bush's war? I consider subsidizing tobacco farming immoral (although I support the right of any adult to be a dumbass and smoke if they want to). Can I refuse to pay the part of my taxes that goes to tobacco farmers? And so on. We're talking about taxes, not charitable contributions. You can't pick and chose what you want to pay taxes on. Anyone who considers abortion so immoral that they'd rather a woman die under tortuous conditions (and if you think I'm exaggerating it's only because you haven't ever seen a death in pregnancy or labor) than let their taxes pay for an abortion then they can move to Saudi Arabia where they'll be very happy with the morality.
Posted by: Dianne | January 10, 2007 4:30 PM
Jud: I totally agree about friends paying for this. Wouldn't it be nice if atheists could show they have more morals than the Ashcroft types by helping to pay for this procedure.
If there is a donation place, let me know, I would be happy to help them.
Posted by: Lj | January 10, 2007 4:38 PM
When a woman desires an abortion, that abortion is necessary. End of story.
Posted by: Mooser | January 10, 2007 4:38 PM
Although I'm a long time supporter of the right of women to choose abortion, I also support the right of those who think abortion is immoral not to pay for abortions through taxes.
bob koepp - What makes these this view so special? My taxes pay for Bush's war and it's neurochemically impossible to view anything as more immoral than I feel this war is. And I'm not alone.
Moreover, they're lying about their motives. It's obvious that the vast majority of anti-abortioners couldn't care less about the welfare of fetuses; what they care about, and all they care about, is giving women a hard time about having sex. You may see that as a reasonable basis for public policy; I sure don't. And neither would they, or they wouldn't lie about it.
Posted by: Molly, NYC | January 10, 2007 4:45 PM
Both Mooser and Molly deserveth thine accolades, for yea they be-eth correct.
Posted by: stogoe | January 10, 2007 5:03 PM
Cyde Weys wrote:
Molly: Is it possible you're making this into an issue of race when it really isn't one? It seems to me it's more of an issue of economics. Especially in DC.
That, of course, raises the much broader question (totally unrelated to the thread at hand) of the extent to which one can separate issues of race and class in this country (and especially in DC). But, suppose one can, and that this is an issue of poverty rather than of race: if you make the appropriate substitutions in Molly's comment, does the end result suddenly become morally tolerable?
Posted by: JBL | January 10, 2007 5:16 PM
For those interested in helping women have access to abortion, consider the National Network of Abortion Funds (http://www.nnaf.org/); they provide information for more local organizations that help women gain access. Planned Parenthood is also a good way to help women have access to birth control and abortion services.
Posted by: Bardiac | January 10, 2007 5:17 PM
Molly: Is it possible you're making this into an issue of race when it really isn't one? It seems to me it's more of an issue of economics. Especially in DC.
Cyde Weys - That's a fair statement, and absolutely, fixing the IMR is complicated, and it's going to cost. And it's going to cost more, and be more complicated for people with worse IMRs. But:
1. If the anti-abortion crowd were actually concerned about life, why would the cost or the difficulty be an issue? They should be on this like white on rice. But it's not even a blip on their radar, because frankly, they couldn't care less about babies. They care about hassling pregnant women.
2. If you ever wanted a textbook example of institutionalized racism, this is it.
Posted by: Molly, NYC | January 10, 2007 5:21 PM
Congress has a right to encourage people to have babies by means of refusing payment of abortions of choice -- which this was.
How does making it harder to abort fetuses with severe deformities encourage people to have babies?
Posted by: windy | January 10, 2007 5:21 PM
To libertarians I think it does, which is one reason I left the libertarian camp decades ago.
Posted by: AndyS | January 10, 2007 6:04 PM
[blockquote]I know I will get hate mail for my supposed insensitivity, but the clearest policy is not to cover abortion at all, rather than deal with the subjective worth of human life with all its variable phenotypes in deciding whether one woman deserves her abortion to be paid for and another woman doesn't.[/blockquote]
Bullshit. By that critieria, the clearest policy is to cover ALL abortions. Then you're not dealing with the subjective value of anyone's life - the embryo's or the mom's.
But hey, I'm Canadian, and we don't even have abortion laws. It's just another medical procedure here (from a medical and legal perspective, anyway).
Posted by: Deanna | January 10, 2007 6:06 PM
Covering all abortions or covering no abortions would be equally nonambiguous policies to me. I have no problem with either one.
The insurance coverage for any patient is a business contract between the patient and insurer or employer and insurer. The contract in this case was that this abortion would not be paid for. The courts decided that this contract was valid and legal. The courts enforced the contract. End of story as far as who pays for what.
I think you have to separate out the right to abortion and the right to have it paid for. An employer has the right to negotiate covered benefits with an insurer. A mutual insurance company has the right to determine within legal bounds what is and isn't covered. A significant percentage of Americans seem not to want their tax dollars used to fund abortions. The legislature, recognizing this significant minority, has decided to not allow military employees or dependents to have this procedure covered. They can have the abortion (the Supreme Court has already narrowly affirmed that right), but the taxpayers don't have to pay for it. If anyone doesn't like the legislative decision, work for change through lobbying and voting. This also applies to tobacco subsidies and military fiascos.
Joe
Posted by: joe | January 10, 2007 6:32 PM
Sparrow,
You seem to be using a rather narrow definition of "health" here. There may be no physical threat to the mother (I wouldn't know), but I suspect that the majority of women would find the prospect of carrying such a fetus to term very distressing.
Posted by: Andrew Wade | January 10, 2007 7:00 PM
The clearest policy is not to cover any medical procedures whatsoever. That doesn't make it a good policy. Likewise for abortion. Avoiding complication is all well and good, but it shouldn't be the first goal of legislation.
Posted by: Andrew Wade | January 10, 2007 7:06 PM
Joe,
That doesn't make them right.
Agreed. Despite the fraud in the last election, the U.S. is still a democracy, and that should not be thrown out. But not just lobbying politicians; speaking out in public too. Public debate and criticism is very important too; and it's a shame that the media has confused commentators, journalists, and shills; they're not the same.
Posted by: Andrew Wade | January 10, 2007 7:26 PM
The insurance coverage for any patient is a business contract between the patient and insurer or employer and insurer. The contract in this case was that this abortion would not be paid for. The courts decided that this contract was valid and legal. The courts enforced the contract. End of story as far as who pays for what.
So if the contract was made to not cover cardiac bypass surgery that would also be legally okay, as long as the patient had the 'choice' to pay for it themselves should they find themselves in need of it.
Or maybe chemotherapy, or physical therapy, or vaccinations, that list COULD be made endless. I think the poster who commented on the lack of 'reasonable people' being in short supply was quite correct.
As for what our tax dollars go for - we get no say in it for the most part, so why should a few overly vocal, superstitious, god bothering idiots get a say in anyones medical care? Who do you want deciding what procedure you and your family can choose from and/or have paid for by the insurance company (who you are paying). The priest or the MD.
Posted by: flame821 | January 10, 2007 7:27 PM
The distinction between fetuses and people is not hard to make, but the world is full of idiots. I don't think people with severe spina bifida would be entirely unreasonable to fear that they might be next when fetuses are selectively aborted. But I don't think banning abortion would do anything to discourage bigotted idiots from being bigotted idiots.
Posted by: Andrew Wade | January 10, 2007 7:42 PM
I agree with what Bulman said: "I can hardly begin to imagine the trauma of carrying such a child to term in order to give birth to a corpse."
Forcing a mother to continue with a pregnancy (which remains medically risky, even in this country) in order to give birth to a maimed, terminal vegetable is not reasonable or rational, much less compassionate.
I see why the circuit court ruled as they did, when forced to it. The blame should be on those who approved the regulation, which appears to specifically exclude cases of anencephaly, to be implemented in the first place. It wasn't an oversight - someone writing the regulation really wanted women in exactly this position to experience exactly this nightmare! How incomprehensible.
Posted by: bioephemera | January 10, 2007 8:01 PM
Andrew says:
"The clearest policy is not to cover any medical procedures whatsoever. That doesn't make it a good policy. Likewise for abortion. Avoiding complication is all well and good, but it shouldn't be the first goal of legislation."
Some employers do decide to provide no health insurance benefits. That's fine by me. Some provide some coverage but exclude physical therapy, some chiropractic care, some prenatal care. Potential employees should look at medical coverage when applying for a job to see if the policy of the employer suits their needs. In this case, the employer's policy didn't cover the cost of abortion.
Who is "right" or who is "wrong" in the abortion and abortion funding debate is never going to be solved. The reality is that a significant percentage of the population equates abortion with murder, and therefore finds abhorent the thought of the their tax dollars funding such an activity. The policy of non-coverage for abortion for the military antedates all the characters central to the above court case. John Ashcroft as attorney general is a lawyer advocate for the Federal Government's interest, which here was in having the health care coverage policy honored. He is a total asshole, but he was doing his job. The woman received tragic news, had her abortion, ending up paying $3000, and ran up I suspect $20000 in court costs. Not a pretty picture all around.
Joe
Posted by: joe | January 10, 2007 8:15 PM
John Ashcroft clearly should have excercised prosecutorial discretion in declining to prosecute.
Agreed. Much lower ranking DOJ attorneys exercise such discretion. This wasn't a criminal matter, it was an employee benefit matter and the district court decision would not have been binding precedent for future cases.
Posted by: MTran | January 10, 2007 8:39 PM
Andrew says:
I don't think I specified a definition of 'health'. Physical, mental, emotional all qualify in my view. As someone said above, if the woman feels it necessary, it should be done. I only meant is was not medically necessary from the point of view that it is possible to carry such a fetus full term.
In a similar vein, my wife and I had friends in NYC 15 years ago faced with a similar problem. Their first pregnancy was found about 24 weeks in with a baby with only two chambers to its heart. I've at least forced a few righteous wingnuts to face the fact that abortion is not just a procrastinator's contraception through this personal story.
Posted by: Sparrow | January 10, 2007 8:55 PM
The reality is that a significant percentage of the population equates abortion with murder . . .
No. A significant percentage of the population pretends to equate abortion with murder.
But if you look at their behaviour, it's never been consistant with a concern for the welfare of pregnant women, neonates, toddlers, older kids or anyone else. (Clearly, any supporter of this war who claims to value human life is full of crap.)
What it has been consistant with is a really punitive view of sex, and a desire to stick their big fat noses into everyone's bedroom.
Posted by: Molly, NYC | January 10, 2007 8:57 PM
You wrote:
"There should have been no question in this case that an abortion was necessary."
I carried an anencephalic infant to term because I wanted to. Emily was my daughter and I was her mother, and that was that.
I was reassured by many doctors that an abortion was not "necessary" because there was no harm to me. In fact, the potential complications of an immediate delivery at 23 weeks were greater than the potential complications of a delivery at term. At the time, and possibly still, studies showed that anencephalic pregnancies had less risk of gestational diabetes, preeclampsia, and c-section.
Please do not refer to "desirable" procedures as "necessary." Some mothers do not desire the procedure and do just fine without it.
Emily was, we were told, blind and deaf. Yet not only did she respond to sound (she jumped at sudden loud noises) but she actually responded to *specific sounds* and after birth consistently turned toward the sound of my voice. She reacted to light.
Emily only lived for two hours, but I would not trade those two hours.
I run a website for parents who have already decided to go to term, and I moderate an anencephaly support forum for mothers who have decided to go to term. We have 400 members on the online group; I have helped hundreds of parents with the online guide for parents going full-term. I have never, after helping all these parents, encountered parents who regretted going to term. I have unfortunately encountered parents who regretted abortions their doctors pushed them into by saying they were "necessary" only to find out afterward that they, the parents, had a choice.
Emotional recovery tends to be faster for moms who went full-term because we have grieved ahead of the loss and are able to deal with the questions before the shock and can be fully prepared for the time we spend with our babies. We also don't have the questions about our own culpability in our child's (inevitable) death. Perinatal hospice programs are on the rise for exactly this kind of situation, and more parents are being helped every year.
The parents definitely have a choice to make. But then let them make it, and don't call it "necessary" the way you did in your post. Thank you.
Posted by: Jane lebak | January 10, 2007 8:59 PM
Joe:
I think most of the comments above were more directed at the policy, rather than at the players involved in this particular court case, after the policy had been set. Certainly for all I know, the judge was correct, most of those involved were just doing their job. That doesn't obviate the policy discussion.
Posted by: Russell | January 10, 2007 9:03 PM
I see an irony in this story that many of you probably wouldn't. I was serving in the US Air Force when Roe v Wade legalized abortion. (Prior to that it was legal in only a few states, as I recall.) Before Roe v Wade it was a not very well kept secret that women in the military were among the select few in the country who could actually get an abortion -- and Uncle Sam paid for it. Not sure whether "dependent wives" had the same access.
Posted by: Gerry L | January 10, 2007 9:06 PM
Sparrow,
My apologies; I misunderstood.
Posted by: Andrew Wade | January 10, 2007 9:06 PM
Please do not refer to "desirable" procedures as "necessary." Some mothers do not desire the procedure and do just fine without it.
as is often common in these debates, Jane forgets that there are more than somatic processes involved in the term "necessary".
As another in this thread brought up, just because the idea brought you no significant mental stress, does NOT mean that such stress is not to be found in others.
You are overgeneralizing your own experience by a long ways, to be sure.
Have you considered yet another possibility?
Maybe the parents in question would prefer to get on with their lives more quickly; give themselves another chance at having a child that would survive as quickly as possible.
Your gross generalizations about "emotional recovery" don't necessarily apply to others.
Posted by: Ichthyic | January 10, 2007 9:08 PM
You live on a different planet than I do. A good percentage of the population doesn't have the luxury of "seeing if the policy of the employer suits their needs." I am barely able to keep from adding expletives to that sentence, by the way. The breathtaking smugness and arrogance is beyond me.
Posted by: Shell Goddamnit | January 10, 2007 9:15 PM
Yo Joe,
News flash, I, (granted I do not represent a significant portion of the population), find the thought of my tax dollars funding the war in Iraq which has caused the deaths (murders) of thousands of innocent fully formed human beings, to be abhorent.
Would you please tell me where on my income tax return forms I can check off those items that I find abhorent so I can can make sure that my tax dollars are not used for those purposes.
BTW, This statement totally shattered my irony meter,
"The policy of non-coverage for abortion for the military antedates all the characters central to the above court case. John Ashcroft as attorney general is a lawyer advocate for the Federal Government's interest, which here was in having the health care coverage policy honored."
Wasn't this the same guy who had the bare breasts of the statue of justice covered for indecent exposure, I'm sure he was just doing his job then as well.
On January 28, 2002, Attorney General John Ashcroft, announced that he spent $8000 of taxpayer's money for drapes to cover up the exposed breast of The Spirit of Justice, an 18ft aluminum statue of a woman that stands in the Hall of Justice.
Just curious, Joe, was that taxpayer money well spent?
You may want to read, if you haven't already, the poem written by Claire Braz-Valentine with regards this particular incident.
Joe, you may be right but I think you probably deserve any hate mail you might get because your point of view is indefensible.
Posted by: Fernando Magyar | January 10, 2007 9:22 PM
Shell Doddamnit says:
"You live on a different planet than I do. A good percentage of the population doesn't have the luxury of "seeing if the policy of the employer suits their needs." I am barely able to keep from adding expletives to that sentence, by the way. The breathtaking smugness and arrogance is beyond me"
Boy oy boy, this is my first time commenting on this blog. I had thought it was read by open minded critical thinking types. God (sorry), Thor, forbid we deviate from the party line of the open minded. News flash, Shell, it's an all volunteer army. There are loads of $20000 a year jobs out there, and some where you don't have to be launching Tomahawk missiles onto civilians.
I think there are going to be many ideas beyond you, Shell. If my smugness and arrogance took your breath away, keep reading, but please, only until you pass out.
Joe
Posted by: joe | January 10, 2007 9:30 PM
Fernando,
I believe I said John Ashcroft was an asshole. I believe I said that we can vote out of office those with whom we disagree. And by the way, name the Senators and Representatives that had the gonads to vote against the megalomaniacal president on his way to this war? Difficult task?
Exactly what part of what I have said is indefensible?
Joe
Posted by: joe | January 10, 2007 9:38 PM
Poseidon, most primates are a little smarter than homo sapiens sapiens. We are well aware that the world is not a bewildering collection of disjoint objects. You tie your own selves in knots with your psychotic hallucinations.
Get yourselves some treatment. You can come home when you are no longer a danger to yourselves and others.
Posted by: Primate indeed! | January 10, 2007 9:38 PM
News flash, Shell, it's an all volunteer army. There are loads of $20000 a year jobs out there, and some where you don't have to be launching Tomahawk missiles onto civilians.
And the number of $20,000/year jobs that offer health insurance the way the armed forces do is probably pretty close to zero. That's less than $11.00 an hour.
I think I'm starting to recognize Joe from when he was Joe Schmoe over at Kevin Drum's place. Same smug insistence that libertarianism really does work, same conviction that the people currently working at Wal-Mart have only to walk through the door of a Fortune 500 company to be offered a $100,000/year salary.
Posted by: Mnemosyne | January 10, 2007 10:17 PM
Personally, if it had been me, I might have said, "Fine, don't pay teh $3,000 for the abortion, you can pay the $20,000 it will cost for me to bring this fetus to term and have it die within a couple of hours." But I'm a bitch that way.
Posted by: Mnemosyne | January 10, 2007 10:18 PM
Joe,
You said "The insurer, in this case the taxpayers, in deciding to not cover any abortions has decided to not make judgements about the value of any particular fetus' life. In my opinion this is a wise decision. $3000 is a lot of money for a presumably 2nd trimester abortion. It is still much cheaper than the cost of raising a normal child, for which this couple was hoping and maybe even planning."
Unless I missed something this couple was seeking an abortion because the woman was pregnant with an anencephalic child, that had no chance of survival. They already had that knowledge.
It was Ashcroft's job to defend the interest of his client, The Federal Government, and asshole or not he had to do his job, no argument here. However I do expect that the Attorney General of the United States of America should have the wisdom to exercise his powers of discretion in certain cases.
What I find very hard to defend is your viewpoint that not making a value judgement about a fetus without a brain can be considered a "WISE" decision. More importantly I as a taxpayer don't remember having been asked to make that decision one way or another. Maybe I missed that memo.
My apologies if I have I possibly misunderstood your viewpoint.
Posted by: Fernando | January 10, 2007 10:45 PM
"Although I'm a long time supporter of the right of women to choose abortion, I also support the right of those who think abortion is immoral not to pay for abortions through taxes."
What if I don't want to have to pay for cancer treatment for people who chose to smoke? What if I don't want to pay for surgery to staple someone's stomach? What if I thought black people shouldn't be able to get treatment?
Can I choose not pay taxes to support war? Choose not to pay taxes to support national ID cards? Government subsidies of tobacco farmers? Choose not to pay for oil subsidies rather than mass transit subsidies? No taxes to go to the D.E.A.?
There are an infinite number of things government does that some person could consider immoral. There are an infinite number of things a person could see as immoral NOT to do that government doesn't do.
Of all of those things, why is abortion the only one that its "reasonable" to allow people to opt out of paying taxes for?
Posted by: craig | January 11, 2007 12:12 AM
Thanks for the biological explanation, PZ. It helps to get those facts right.
Posted by: Russell Blackford | January 11, 2007 2:40 AM
Add me to the list of those willing to help the Does meet this unforeseen expense. If anyone knows of a way to do so, please let me know.
Posted by: Pieter B | January 11, 2007 3:49 AM
This is where the European countries are well ahead.
Here, an abortion is given if the mother wants it.
Yes, there are christian goups (RC & Evangelical) making LOTS of noise, and occasionally protesting.
We've even had a couple of cases of doctors/pharmacists trying to stop it, but the bad publicity shuts them down, except among their own little faith-groups.
But, that's what they want - they WANT to be hated by the "irreligious", because it makes them feel so good and smug.
You have the same problem, except these creeps are still in charge.
Oh dear.
Posted by: G. Tingey | January 11, 2007 3:56 AM
Fusion of the two sides of the invaginated neural plate cannot occur without properly orchestrated apoptosis (programmed cell death). Too much, or too little, apoptosis during neurulation results in a failure of the tube to close properly. If this happens at the caudal (tail) end of the neural tube, the spina bifida occurs as a result.
Posted by: The neurophilosopher | January 11, 2007 6:41 AM
An example of what Dawkins calls "the tyranny of the discontinuous mind".
Posted by: ben | January 11, 2007 7:19 AM
Thanks ben, re: neurophilosopher's deep insight, I was just about to ask for the punch line.
Posted by: Fernando Magyar | January 11, 2007 7:39 AM
Jane, thank you for sharing your story. You obviously are much stronger mentally that I, because I would have had an abortion if any of my children had been found to be anencephalic. There's no way I could hold it together mentally if I had to prepare for both a birth and a death at the same time.
This was your choice, though. No one forced you to carry Emily to term. The problem with our current "pro-life" lunatics is that they want to force women to "pay" for having sex. Getting rid of abortion rights is just the first step. The real goal of groups like Operation Rescue and the men at Concerned Women for America is making birth control illegal. In their world sex has to have "consequences", and if that means bringing more unwanted babies into the world so be it. They don't care what happens to these babies after they're born, only that they get born.
Oh, this is my first comment ever on this blog, in the spirit of Delurking Week :)
Posted by: Kimmer | January 11, 2007 11:21 AM
How brainless can Emily really have been, if she really reacted to light? The eyes, and even the optic lobes, are rather far away from the brainstem... ~:-| For movements other than reflexes, the region on top of the head is needed... and so on... can someone explain all that?
And the two-chambered heart: What would that lead to? A baby with the metabolism of a toad? Or was there no connection to the lungs or something?
Now to neoliberal politics ( = a lack of both knowledge and empathy at the same time):
Bullshit. The USA should at long last become a First World country, or at least a Second World country. It's about time. Healthcare by an inefficient bureaucracy is vastly preferable over healthcare by employers, especially in a world where there aren't any jobs anymore except maybe in Malaysia.
About the US "volunteer army"... that's a draft on the poor, pure and simple. I propose the following experiment: Raise the minimum wage to First World levels (10 $ per hour upwards), stop rewarding immigrants with the citizenship if they serve and survive, and watch where all the volunteers go.
Posted by: David Marjanović | January 11, 2007 12:46 PM
David,
I agree whole-heartedly that there should be universal single payer medical care. I also agree that the present volunteer army is especially attractive to the disadvantaged (no John Kerry references here please!). I personally favor universal conscription with everyone serving 2 years in national service. This would decrease the chance of silly military actions like Iraq. The wealthy and privileged congresspersons will think twice about military action when their kids might be put in harm's way. However, we can't make an "ought" out of an "is." I was addressing the present realities in the discussion at hand.
So far I have been called "neoliberal," whatever that might mean, and "libertarian." I personally consider myself a non-evangelical rationalist. I'm non-evangelical because I want to continue to remain an optimist.
Joe
Joe
Posted by: joe | January 11, 2007 1:03 PM
I rarely post here, but I think I'm entitled this time. My son was born in 2002 and appeared to develop normally at first, but started showing obvious delays after about 6 months. It took until he was 16 months old for him to be diagnosed with porencephaly. He is missing most of the right hemisphere of his brain. Moreover, I'm no expert, but I believe it is visible on his 20-wk ultrasound. However, when I investigated the possibility of a malpractice suit, I was told by attorneys that my case would involve arguing that I would have chosen an abortion had I known what was wrong, and they were unwilling to make this argument in a Florida court! Now, please do not get me wrong. I love my son with all my heart, but if I had to do it all over again, and I had known, I would have had an abortion. In fact, when I was pregnant again, 3 years later, I had ultrasounds done every 2 weeks, scheduling on at exactly 23 weeks, to have the option of a legal abortion before 24 weeks. Afer that, even with severe brain malformations, no legal abortion would have been possible.
My son is a sweet kid, and he laughs, and appears to have some level of consiousness, but he is and always will be severely disabled. It is unfair to him, it is unfair to us, and frankly, it is unfair to society, which bears most of the costs of his medical care.
How inhumane that the mother should have gone on and have a full-term pregnancy, knowing full well that the child would have died. Would the birth, the funeral, and everything else not have cost more than $3000? Not to mention the heartache and suffering of the family. How cruel!
Posted by: makita | January 11, 2007 2:52 PM