Chapter 7: Abortion 2

Chapter 7: Abortion 2

The Difficult Cases

Abortion where there is no medical complication

The great majority of abortions are sought not because of danger or abnormality but because of circumstances: money, housing, work, relationships, timing, an absent or hostile partner, existing children, education, and fear. Verena’s case is the ordinary case.

The word usually applied to this category by opponents is "convenience", and I am not going to use it, because it is inaccurate and it poisons the conversation. Nothing about Verena’s situation is convenient. The word describes a woman deciding lightly, and while such decisions no doubt exist, they are not what most of the statistics are made of.

The Christian position is that circumstances, however genuinely hard, do not license the killing of a human being, because that is what moral absolutes mean. This is a demanding claim, and it should be stated as what it is: a demand, made of a specific woman, at a real cost to her. Anyone making it who does not feel the weight of it has not understood it.

What follows is not only "no". It is: what is the Church going to do? That question is taken up below, under Support.

Risk to the mother’s life

Where continuing a pregnancy will kill the mother, and where the child cannot survive in any case, intervention to save the mother’s life is morally permissible on the analysis given in Chapter 5. The act is directed at saving a life that can be saved; the death of the child is foreseen, unavoidable, and not the means by which the mother is saved.

Two points of great practical importance.

This must not be interpreted narrowly to the point of danger. Where laws or institutional policies have required doctors to wait until death is imminent or certain before acting, women have died. Ireland’s case of Savita Halappanavar in 2012, which contributed to that country’s change of law, is the best known. A moral framework that in practice delays treatment until a woman is dying is not protecting anyone.

Serious risk to health, short of death, is a genuinely harder question on which Christians differ, and the assessment depends heavily on medical facts that a book cannot supply.

Ectopic pregnancy

An embryo implants outside the uterus, most often in a fallopian tube, where it cannot develop and where continued growth will rupture the tube. Untreated, this kills women, and it kills them quickly.

Nothing can save the embryo. There is no available technique for relocating it. The choice is not between the child’s life and the mother’s; it is between one death and two.

The tradition’s analysis is that treatment directed at the damaged tube — its removal — is an act aimed at a pathological condition, with the death of the embryo foreseen and not intended. This satisfies the conditions in Chapter 5 and is accepted across the Christian traditions that use that analysis.

Where Catholic moral theologians have differed among themselves is over techniques that act more directly on the embryo or on the pregnancy itself rather than on the tube, some regarding these as direct killing and others not. Orthodox writers have generally been less restrictive. My own view is that all standard treatments for ectopic pregnancy are permissible, because the death is unavoidable in every scenario and the object of the act is the treatment of a lethal condition.

What matters far more than this dispute: a woman with a suspected ectopic pregnancy must be treated immediately and must not delay seeking care for religious reasons. If you are reading this and have severe one-sided abdominal pain, shoulder-tip pain, or unusual bleeding in early pregnancy, go to hospital now. No priest anywhere would tell you otherwise.

Serious foetal abnormality

Three distinct situations get confused under this heading, and they are not the same.

Conditions incompatible with life, where the child will die before or shortly after birth. Anencephaly is the clearest case. Here the option that is almost never offered, and should be, is perinatal palliative care: continuing the pregnancy with support, delivering the child, and allowing them to die held rather than removed. Parents who have taken this path frequently describe it as the most important thing they have done and equally frequently describe having had to fight to be told it existed. Where the tradition says no to abortion in these cases, it owes these families this alternative, in practice and not in theory.

Serious conditions with uncertain prognosis, where the child may die young or may live with substantial impairment, and where the medical picture is genuinely unclear. These are agonising and the parents are often making decisions on incomplete information under time pressure. Judgement here should be slow, well-informed, and accompanied.

Conditions compatible with life, of which Down’s syndrome is the most common. Here the ethical question is at its sharpest, because what is being ended is not a dying life but a disabled one.

Disability rights campaigners — many of them not religious — have made this argument with more force than the churches: that selective abortion for disability communicates a judgement about the value of disabled lives, and that it does so to disabled people who are already alive and listening. In the United Kingdom, the Abortion Act’s provision allowing termination for serious foetal abnormality has no upper time limit, unlike the general 24-week limit, and this asymmetry has been challenged in the courts on exactly these grounds. Whatever one concludes, a society that permits until birth what it prohibits after 24 weeks has said something, and disabled citizens are entitled to notice.

Parents receiving such a diagnosis should know that the information given at diagnosis is often out of date about outcomes and life expectancy; that screening tests carry false positive rates and a screening result is not a diagnosis; that families of children with Down’s syndrome report levels of satisfaction that consistently surprise those outside them; and that they are entitled to time, to a second opinion, and to speak to families who have made both choices.

Rape and incest

The hardest case in this chapter, and I am not going to make it sound easy.

The child conceived in rape is not guilty of the rape. That is the Christian argument in one sentence, and it is true. If the unborn child is a human being, then the child’s innocence is not diminished by the circumstances of conception, and no one may be killed for their father’s crime.

Now the other half, which Christians frequently refuse to say aloud. What that argument asks of a woman who has been raped is that she carry, for nine months, inside her own body, a daily physical reminder of the worst thing that has ever happened to her; that she undergo labour; and that she then either raise the child or give it up, having been given no choice about any of it by anyone at any stage. That is an enormous thing to ask. It is possibly the largest thing any moral tradition asks of anyone. Thomson’s argument has more force here than anywhere else, because the responsibility response does not apply: nothing this woman did contributed to the situation.

I hold the Church’s position. I hold it while acknowledging that a woman in this situation who cannot do it has not committed the same act, morally, as someone deciding freely, and that her culpability is affected by everything Chapter 3 said about coercion, trauma, and duress. And I hold that any Christian who states the principle to such a woman without first attending to what has been done to her should be removed from any position of pastoral responsibility.

Practically: the immediate needs after a sexual assault are safety, medical care, and support, and a woman should be encouraged to seek all three at once. Where emergency contraception is offered, Christians hold different views about its use, partly because the mechanism has been disputed — current evidence indicates that the commonly used medications act principally by delaying ovulation rather than by preventing implantation, though this has been argued over. A woman in this position should not be left to work through that literature by herself in an emergency department at three in the morning. She should be able to ring someone.

Incest carries the additional dimensions of ongoing abuse and, frequently, a minor. Here the safeguarding obligation is absolute and immediate: this is a crime in progress, the priority is the protection of the child, and it must be reported. Chapter 22 sets out how.

Reproductive coercion

Almost entirely missing from public debate and common in practice. Women are pressured into abortions they do not want — by partners, by parents, sometimes by employers or traffickers — and women are also pressured into continuing pregnancies against their will, and both are forms of abuse.

If someone is being coerced into an abortion, the Church’s obligation is not to congratulate itself on the outcome she has been forced towards. It is to help her, because the coercion is itself the sin in front of it. A woman who says “he told me he would leave if I didn’t” is describing something being done to her.

Law and What Christians Should Seek

The moral question and the legal question are distinct, and Christians who collapse them cause avoidable damage.

Almost everyone agrees that some things are wrong and should not be criminal — adultery, cruelty, and most lying. The question of what the law should do about abortion is a separate argument requiring its own reasoning about enforcement, evidence, effects, and the proper reach of the state. Christians who share a moral position can disagree in good faith about the law, and Chapter 30 sets out the framework.

Some observations that apply whatever one concludes.

Laws differ enormously and change. In England, Wales, and Scotland, the framework rests on the Abortion Act 1967 as amended, permitting abortion up to 24 weeks on specified grounds with the agreement of two doctors, and without a time limit where there is a substantial risk of serious foetal abnormality or risk to the woman’s life. Northern Ireland’s law was changed in 2019–20. Other jurisdictions differ radically, and the United States has been through major change since 2022. Anything a book says about the law is likely to be out of date, and readers must check current law where they live.

Criminal prosecution of women is opposed by most people who oppose abortion, including most pro-life organisations, and prosecutions of individual women — which have occurred in the United Kingdom in recent years under nineteenth-century legislation — strike many who share the underlying moral view as both cruel and counterproductive.

Conscientious objection for medical staff exists in law in the United Kingdom and in many other places, and its scope has been litigated. Chapter 14 addresses it.

Reducing abortion and restricting abortion are not the same project. The measures most strongly associated with lower rates — reliable contraception, economic security, housing, childcare, support for young mothers, action against sexual coercion — are available to Christians regardless of what the law says, and are within the reach of a parish in a way that legislation is not.

Support: What the Church Owes

If the Church says no to Verena, the Church has taken on an obligation. What does discharging it actually look like?

Before. A parish where a young unmarried woman can say she is pregnant without her life ending. This is the single most important variable and it is almost entirely about culture rather than programmes. If the first consequence of disclosure is gossip, humiliation, and the withdrawal of her role in the church, then the parish has built a machine for producing secret abortions, and it should not be surprised by the output.

Practical help, specifically. Money. Housing. A cot. Childcare while she works. Help with immigration or benefits paperwork. Someone to go with her to appointments. Someone to talk to her mother. A job. These are unglamorous and they are what the decision actually turns on. A parish that can raise fifty thousand pounds for a building can raise it for this.

The father. The Church has historically directed almost all its moral attention to the woman, and this is a scandal. The man who told Verena it was her decision and her responsibility has done something gravely wrong, and if he is a Copt he should hear that said to his face. Any parish that would discipline her and leave him serving at the altar has abandoned justice.

After birth. The child is three, and four, and eleven, and the mother is exhausted and alone. If the Church’s interest ended at delivery, it was never about the child.

Adoption, presented honestly. It is a genuine option and it is also a hard one, involving real and lasting grief for birth mothers, and it should not be offered as though it were a tidy solution. Where it is chosen, the Church’s obligation to the birth mother does not end.

Afterwards: Grief, Repentance, and Healing

A large number of women in your parish have had abortions. So have a number of men been party to them. Nearly all of them have never told anyone in the church, and many have not told anyone at all.

Some feel nothing much. Some feel relief. Many carry something they cannot name, sometimes for decades, and it surfaces at unexpected moments — a birthday that would have been, a later pregnancy, a grandchild.

Several things need saying to them, and they need saying without conditions attached.

Your child is not lost. Nobody should ever tell a woman that her child is in hell or in limbo or annihilated. The Church commends the departed to the mercy of God, and it has never taught that God is bound by our failures. If it helps you to name the child and to pray, name the child and pray.

Nothing you have done is outside forgiveness. This is not a slogan. It has been the deliberate teaching of the Church since the Council of Ancyra. Confession is available. A priest who hears this in confession is hearing something he has heard before and will hear again, and if he responds with horror he has failed at his job.

Forgiveness and grief are different. Being forgiven does not remove sorrow, and continuing sorrow is not evidence that you were not forgiven. It is bereavement, and bereavement takes the time it takes.

Self-punishment is not repentance. Chapter 3 distinguished godly sorrow from the worldly sorrow that produces death. If what you are carrying keeps you away from Communion, isolates you, and tells you that you are disgusting, that is not the Holy Spirit. Take it to a confessor. If it is severe, take it to a doctor too, because prolonged grief and depression are treatable and suffering silently for twenty years is not a penance God requires.

Men, this includes you. Fathers who pressured, fathers who paid, fathers who said nothing and let it happen, and fathers who were not told and found out later. There is almost no pastoral provision for you anywhere and the grief is real.

Pastoral Guidance

To a woman who is pregnant and frightened, right now. Do not decide today, if you have any time at all. Tell one person who will not repeat it and will not lecture you — that alone changes what is possible. Get accurate information about your actual options, including what support is genuinely available, which is usually more than you think and less than you need. Find out whether anyone is pressuring you, and name it if they are. And if you are a Copt who has stayed away from your priest because you are certain of what he will say, consider that you may be predicting the wrong man; and if you predict correctly, find another priest, because they are not all the same.

To parents who have just been told. Your daughter has told you something she has been terrified to say. What you do in the next ninety seconds will shape the rest of it. Whatever you feel, the first thing out of your mouth should be that you love her and you are not going anywhere. You can say everything else later. You cannot unsay the first thing.

To priests and servants. Almost everything about how this goes is decided before anyone comes to you: by what you have said from the front, by how the parish treated the last person, by whether you are known to be safe. If you have preached about abortion in a way that made it unsayable, you have made your own work impossible.

When someone does come, ask what she needs rather than announcing what she should do. Find out what is actually driving it — it is usually money, housing, or a person. Offer concrete help and be able to deliver it. Do not extract a decision as the price of support. And never, in any circumstance, discuss what you have been told with anyone.

To everyone else. The way your parish talks about this when nobody vulnerable is apparently present is what determines whether anyone vulnerable will ever speak. There is no such thing as a room with nobody in it who has been through this.

Practical Principles

1. The unborn child is a human being and deliberate abortion is the taking of an innocent human life. This is the Church’s teaching and it is not a matter of opinion within Coptic Orthodoxy.
2. The woman is also a person with her own life and obligations, and any argument that treats her as a vessel has already failed.
3. Distinguish carefully: deliberate abortion; treatment for miscarriage, which is not abortion; and interventions where fetal death is foreseen but not intended, which are analysed under double effect.
4. In an ectopic pregnancy, seek treatment immediately. The embryo cannot be saved by any means, and delay kills women.
5. Culpability varies enormously with coercion, trauma, age, and duress. The act does not change; the person’s guilt does.
6. Never use the word “convenience” for decisions made under real pressure, and never describe an abortion in terms designed to shock.
7. Where the Church says no, it incurs an obligation. Money, housing, childcare, and a place to stand in the parish are the shape of it.
8. Hold the father to the same standard as the mother, publicly.
9. Do not confuse the moral question with the legal one. Christians who agree about the first may differ in good faith about the second.
10. Nobody is beyond forgiveness for this, and any priest, servant, or parishioner who suggests otherwise is teaching something the Church has never taught.

Questions for Reflection or Discussion

1. What would have to be true about your parish for Verena to have walked in and told someone at five weeks?
2. Where does Thomson’s violinist argument seem strongest to you, and where does it break down? Try to state it fairly before answering it.
3. The charge of inconsistency — loud before birth, absent afterwards. Is it fair against your own church? What is the evidence either way?
4. What would perinatal palliative care actually require, practically, for a family in your congregation who received a lethal diagnosis next month? Does anyone know?
5. Why does the man in these situations so often escape moral attention, and what would change that?
6. Someone tells you, twenty years afterwards, that they had an abortion. What do you say first?

A Prayer

Lord Jesus Christ, who was carried in a womb and born to a frightened young woman in a country not her own: be near everyone caught in this. Be with the woman who does not know what to do, and give her someone to tell. Be with the one who decided long ago and has never spoken of it, and let her hear that she is forgiven and that You are holding her child. Be with the parents who have been given a diagnosis and cannot stop crying. Forgive us for the times we have been loud about the principle and absent about the person. Make Your Church a place where the truth can be told without anyone being destroyed by it. And receive the children we did not receive, into Your hands, where they are safe. Amen.

Notes

Note on medical, legal, and statistical material in this chapter. Figures on unsafe abortion, the mechanisms of emergency contraception, and outcomes following prenatal diagnosis are all areas of ongoing research and revision. Nothing in this chapter is medical or legal advice for any individual. Anyone facing an urgent medical situation in pregnancy should seek immediate clinical care and should not delay for any reason.

A note to the reader. This chapter deals with material that many readers will have lived through. If reading it has raised something painful, please consider speaking to your father of confession, your doctor, or someone you trust. Support for pregnancy loss, for post-abortion grief, and for sexual violence exists in most countries, and it is worth asking for.