Abortion Is for the Living
The state of Georgia is right about Adriana Smith
1. Background
This is a post about Adriana Smith.
Before I make my argument, I want to be clear: what’s happened to her is tragic, and her family has my sympathies. I harbor no ill will toward Smith, her family, or even any of those speaking in what they believe to be her interest online.
For those unaware, here’s Smith’s story as told by Emily Amick, who asks What If This Was Your Daughter?
Imagine your daughter is 30 years old. She’s a nurse. A mom. For three decades she’s been your own beating heart outside of your body. One day she gets a headache so bad she goes to the ER. They send her home. They don’t run the necessary tests. The next day, her boyfriend finds her unresponsive. A cascade of blood clots has killed her. She is brain dead. Legally, medically, irreversibly gone.
But she’s also nine weeks pregnant.
You are standing in an ICU room, holding the hand of your dead daughter, and being told you cannot take her off life support. Because of a heartbeat. Not her heartbeat, but the flicker of fetal cardiac activity that Georgia law recognizes as life. A law that even hospital officials say offers no gray area, no compassion, no context.
A law that treats your daughter’s body as an incubator. And you, her grieving family, as irrelevant.
Amick—alongside other progressive commentators like Matt Yglesias and Jessica Valenti—considers Smith’s case a gross injustice. It’s “dystopian,” more proof that “Republicans are bad,” and, of course, it’s conclusive evidence that “the cruelty is the point” of pro-life activism.
The Guardian is hand-wringing about “how desperate society is right now to reduce women to their reproductive capacity.” SisterSong, the “Women of Color Reproductive Justice Collective” leading a lawsuit against Georgia’s abortion ban, published a statement decrying the “90 days of retraumatization, expensive medical costs, and the cruelty of being unable to resolve and move toward healing” endured by Smith’s family. “Our bodies are not battlegrounds for political power plays,” they wrote.
Of course, these kinds of objections totally miss the point. Opponents of abortion rights—who are generally the people that think Adriana Smith should be kept alive—are not driven by a subconscious (or consciously political) desire to control women's bodies and reproduction. Broadly speaking, the pro-life movement is just what it says it is—dedicated to protecting the lives of millions of fetuses, whom they overwhelmingly view as people.
So a somewhat more interesting commentator has been UC Davis Law Professor Mary Ziegler—she describes herself as “one of the world’s leading authorities on the legal history of the American abortion debate,” and has been making the rounds, writing op-eds decrying Adriana Smith’s predicament all over the place. She wrote for MSNBC that Smith’s case demonstrates that “[t]he endgame for the anti-abortion movement has long been legal recognition of fetal personhood,” and in Slate that her “case isn’t an oversight. It’s just one example of what fetal personhood means.”
Unfortunately, Ziegler fails to be charitable beyond the barest minimum acknowledgment of her opponents’ stance. Sure, it has to do with fetal personhood—but, even though Ziegler’s written a whole book about it, in a Reddit Ask Me Anything she commented: “I have seen very little evidence that support for fetal personhood is pretextual. What I have seen instead is how strange and strangely punitive the American concept of personhood has become.”
This is silly, of course—there are good reasons to think that fetuses achieve all the important features of peopleness (perhaps in gradual increments) well before birth.1 They grow limbs and hearts and brains. They begin to experience their surroundings and to look like children. By the end of the pregnancy, they’re probably full-on thinking, to some degree.
And yet I believe that a moderate pro-choice stance makes the most sense. I’m going to explain why, and in doing so will also explain why there’s basically nothing wrong with keeping Adriana Smith on life support until her child is born.
2. The Right to Abort is Like the Right to Pollute
Let’s set aside late-term abortions, which probably simply consist of killing people, and should be heavily stigmatized (if not outlawed and prosecuted).
Somewhere between a 12-20 week limit, though, is quite probably not-murder. And the best strongly-pro-life case against it is based on the potential future life of a young fetus. This is a consequentialist argument, not a rights-based one, and I think it does mostly suck, even though consequentialist utilitarianism is almost certainly better than any rights-based ethical theories.
Mon0 has a couple of great articles which make, more or less, the point that consequentialism is super computationally expensive. In its place, we tend to rely on quick intuitive heuristics about the duties we owe and rights we have. The task of a moralist, then, is to notice when one heuristic has been extended too far, to the point that it violates other more important, more fundamental intuitions.2
The conflicting heuristics in the case of abortion are, basically:
We should seek to preserve potential future lives.
Women should have a right to choose what they do with their bodies.
In order to form a conclusion, it might help to look at more settled questions with fairly analogous battling heuristics. For example, if we’re considering whether to allow the construction and operation of a coal power plant, we should intuit that:
The pollution will take statistical lives, but
Entrepreneurs have a right to start businesses, and consumers have a right to buy energy.
Everybody basically agrees that heuristic (2) is more powerful. There are a number of (consequentialist) reasons to back this up, the most important being: freely given choices tend to result in better outcomes. New coal power plants demanded by market forces are likely to make lots of people better off—consider the fact that nearly all new coal power plants are being built in developing countries, where the new energy will surely save more lives than the new pollution will take. Similarly, abortions are disproportionately had by poor single women who don’t want (more) children—generally speaking, their kids probably weren’t going to have such nice lives!
There’s a second reason we decide in favor of heuristic (2) in the case of the coal power plant, and it’s got to do with slippery slopes. Even if a freely constructed plant actually will have more negative externalities than positive, it’s important to maintain a social norm which says “we like freedom and we like markets.” Similarly, even though some abortions will be fairly net-negative, it’s important to maintain a social norm that respects women’s bodily autonomy.
3. Adriana Smith’s Case Is of a Different Class
Imagine that you live in a very nice and wealthy suburb, and the whole grid’s been solarized for years. There’s an old coal power plant at the edge of town—the industrialist who built it is dead, but his children (who live on the other side of the country) still own the trust, and they like to fly in, watch the smoke billow up into the air, and reminisce every once in a while. Of course, all the energy the plant is generating simply goes right into the ground, and your neighbors are all complaining about the asthma its pollution gives their kids.
In this case, we have again two heuristics to worry about:
The pollution is taking statistical lives, but
The plant’s founder’s family has an emotional connection to its continued operation.
It seems pretty intuitive that (1) wins out completely, and you should do all you can to get the plant shut down. No one significantly benefits from its continued operation, and the norm it upholds is tangential to the important pro-market ones at best. Sure, the rights of families’ to do what they like with their deceased relatives’ property is important—but, especially in cases where the family acts in irrational, anti-market ways, not so important that people should die over it!
Adriana Smith’s case is much more like this than that typical of a woman seeking an abortion. She is, for all philosophical and legal purposes, dead. She has no conscious experience, and never will again. She has no personhood, and never will again. Crucially, this means she has no right to bodily autonomy, and never will again.
At the point of her admittance to the hospital, 9 weeks pregnant, there were exactly two moral considerations to deal with:
Our interest in the fetus’ potential future life, and
Smith’s family’s emotional desire to end her life.
This should not be a difficult question. It’s got nothing to do with a woman’s right to control her own body, and everything to do with the state’s obligation to protect (potential, future) lives from emotional shortsightedness. This isn’t statist overreach, it’s not a nationalization of rights over women’s bodies, it’s not part of an Ongoing Reckoning over the improper treatment of black women in maternal medicine—it’s about valuing (potential, future) life above the rights of families to treat relatives’ dead bodies how they choose.
4. What If This Was Your Daughter?
That’s the question Emily Amick asked.
It’s meant to activate and exaggerate our intuitive appreciation for familial emotional desires about dead bodies. But, quite frankly, it’s an awful question to ask alone! It totally ignores the other heuristic—the one that deals with our interest in the fetus’ survival—and so we end up with a terribly skewed picture of the moral landscape.
So let’s consider another, better scenario: imagine your granddaughter has been hit by a car, crushing her abdomen, and causing her liver to fail. The doctors have stabilized her, but she needs a transplant to survive. Somehow, on the same day, your daughter—her mother—had a terrible stroke which rendered her brain-dead. The doctors give you an option: you can end your daughter’s life, harvest her liver, and have it donated to your granddaughter. If you do this, however, there’s still only a 50% chance your granddaughter will survive—of course, it’s better than the 0% chance she has without it, but it’s no guarantee.
(Let’s also assume your daughter never got a driver’s license, so never consented nor refused to be an organ donor, and also never indicated any preference in either direction.)
Would you have the doctors perform the transplant?
As far as I can tell, the answer must be yes! Your daughter is gone, irrevocably. Her interests are irrelevant. You have the chance to preserve (potential, future) life at no cost to any conscious person’s rights—how could you not jump at the opportunity, as painful and emotional as it might be? From an outside view, I’d even say you were obligated to ask for the transplant operation. If you refused and let your granddaughter die without a fight, I’d certainly judge you quite harshly.3
Analogously, if Adriana Smith’s mother were allowed to have her grandchild aborted and daughter taken off life support, I would urge her not to. And if she did it anyway, I would consider the act totally morally reprehensible. I’m thankful that Emory Healthcare is afraid to let her, and, perversely, thankful that the Georgia LIFE Act stands in her way.
5. Possible Caveats
Some details of the Smith case might complicate the moral picture a bit. For one thing, in Amick’s article, we learn that:
Adriana’s mother April Newkirk told WXIA that doctors told the family that the fetus has fluid on the brain and that they’re concerned about his health.
“She’s pregnant with my grandson. But he may be blind, may not be able to walk, may not survive once he’s born,” Newkirk said.
This might tilt the balance of consequences a bit to the side of the family’s concerns, but I don’t think completely. Blind kids still generally live lives worth living, and we’ve already been dealing in the realm of the potential life. Any chance is better than none.
Secondly, it’s possible that Smith’s family has to pay for all this. I don’t remember seeing any sources which say this explicitly, but given the usual operation of the American healthcare system, it really wouldn’t shock me if this pregnancy was an extremely costly one to the Smith family. This seems like an unfair cost to impose, when the family has no legal ability to choose otherwise.
Even if the cost isn’t borne by the family, someone is certainly paying to keep Adriana Smith’s body alive and working as, basically, an incubator. This cost might be very high, and it’s quite plausible that the money could be better used elsewhere (e.g., fighting malaria in the Congo). Then again, it’s not like the money would be used anywhere more worthwhile—hospitals have set budgets, and if they want to allocate more toward bringing (hopefully) healthy babies into the world instead of dumping all their money into barely-worthwhile end-of-life care, I can totally get behind it.
The final potential caveat has to do with the norms we’re setting. Many on the left immediately rushed to associate the Adriana Smith case with abortion rights in general. I think, of course, this was tactically silly, given that the case for taking her off life support is far less defensible than that for abortion writ large—but now that the association’s been made, is there a danger to opposing the pro-choice side’s stance?
I think not. Agreeing with your political allies’ less-agreeable positions is part of what’s gotten the left in trouble in recent years. If you spinelessly go along with DEI and cancel culture just because you think the Republicans are worse, you’ll end up alienating more swing voters in the long run. Better to say obviously true things, and to try to convince the more radical wings of your party to be less insane.
We can also decide to shape our rhetoric around a different, more worthwhile norm. Supporting the state of Georgia doesn’t have to be a pro-life stance—it can be an anti-dead-people’s-rights stance instead! I think this is a very worthy cause—it’s insane to me that people can choose not to be organ donors, and it’d be good to push society toward the realization that this is morally despicable. Smith’s case could be such a catalyst.
So I think Emory Healthcare should keep Adriana Smith on life support. They should deliver her unborn child, and then let her body die peacefully, having created a new life. The alternative is unjustifiably cruel.
And deniers of this fact will probably find themselves committed to Peter Singer–style defense of infanticide!
Frankly, I would go even further: if your daughter had explicitly told you, before her death, that she never under any circumstances wanted to become an organ donor, I think you still would have good reason to ask for the transplant operation. I think you still would be obligated to—because dead people don’t have rights over their bodies! (Well, maybe they have a right to get their heads frozen, on the off-chance their consciousnesses could eventually be resurrected. [I’m being serious about this, to be clear.])
We like to pretend that wills have moral worth because people are more motivated to innovate if they can pass on their wealth how they wish to—but if someone’s will stipulated that their daughter be shot, obviously you wouldn’t comply! Similarly, if your daughter’s wishes implied the certain death of your granddaughter, you would have no good reason to honor them.
Wow! I was cynical about Yglesias et al before, but this is a mask off moment.
The choice here is: 1 death or 2 deaths
Thanks for the shout-out! Honestly surprised that Yglesias has strong feelings about this case, it strikes me as one of those borderline situations that mostly just leaves everyone feeling sad.