Decision: a conclusion or resolution reached after consideration. Origin: late Middle English (‘bring to a settlement’): from French décider, from Latin decidere ‘determine’, from de- ‘off’’ + caedere ‘cut’. Webster’s.

In a sense, important decisions frequently cut-off options and at times, even life itself.

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One important issue as the 2022 American election approaches is the Solomon’s wisdom-requiring topic of abortion. The political, psychological, psycho-social, and spiritual domains are as consequential as the legal conundrums surrounding Roe v Wade.

Many contemporary independent, educated, and mindful women say, “It is my body and I decide what to do with it, my pregnancy, and my healthcare, period!”

In a basic legal and medical ethics sense of course, they are correct. Women in America have genuinely won the long battle against their early oppressed days as a man’s chattel. They have fought and triumphed to gain unquestioned potential legal equality and political power. America’s first female vice president Harris is a good example. No male or female can undo this evolved and evolving political reality in America.

But a woman’s choice to share her body with a man for pleasure, love, procreation, marriage, or all four, brings other complex issues into focus when a pregnancy occurs. Most ideally, a pregnancy involving a loving bond of shared intimacy between life-partners results in shared pleasure, responsibility, and two biological contributions, particularly two sets of DNA.

In this preferable context an abortion decision involves two responsible persons, not one! If the partners starkly disagree about an abortion after careful prayerful consideration, then the woman’s decision would of course in the end be determinative; even if major psychological, marital, or relationship conflicts occur over the serious disagreement. It is best of course if the partners could come to an agreement about not merely birth control but ending a potential life of a member of their family.

In too many instances the father or impregnating male is either unaware, indifferent, or absents himself from any role during or after the pregnancy or delivery. Such circumstances are profoundly sad for the mother, the man, and our American society. Absent fathers impose enormous psychological damage and consequences for children and a society.

A Relevant Study

Many years ago, a psychiatrist colleague and I did an unpublished study. We reviewed the labor and delivery records of mothers at a home for unwed mothers. The study group was comprised of mothers without the presence of the baby’s father during the pregnancy, delivery, or postpartum period. The other matched group had the significant presence of the baby’s father during the pregnancy, delivery and postpartum period. The group with present fathers had better APGAR scores, fewer infections, and fewer delivery and post-delivery complications for baby or mother.

Unfortunately, in many abortion decision situations, the male or partner may be gone from the situation for various reasons. In the absence of a supportive partner, a woman faces the abortion decision alone or perhaps with some vital support from friends, family, clergy, and her physician.

Part of what a woman faces in making the abortion decision in the twenty-first century is vast amounts of accumulated scientific knowledge about the tiny human embryo, fetus, and developing human infant in-utero. For example, the state of Utah has proposed a law requiring anesthesia of a fetus during abortion performed at or beyond twenty weeks out of concern for pain thought to be demonstrated in in the fetus. The subject is extremely complex as an important “Fact Check.org” 2015 article by Dave Levitan entitled ,“Does a Fetus Feel Pain at 20 Weeks?” summarizes thoroughly.

Levitan’s work highlights the truly Solomon-like dilemma a woman or couple face in the contemporary abortion decision. Levitan describes the scientific facts about the experience of pain in the fetus and developing human infant in-utero. The article concludes,

[T]he literature on fetal behavior, perception, organization, movement and responses focuses largely on fetuses above 28 weeks of gestation, with a relative lack of studies on the fetus between 20 and 24 weeks. This results in too much reliance on neuroscience, too much reference to animal work, too much extrapolation from both of these and too little real-world human investigation on which to base a realistic view. No one would deny that there are important issues to be confronted, but a sensible debate needs a solid base of rigorous empirical inquiry.

Regardless of one’s final conclusions, the very careful study of the emerging scientific information opens up ultimate questions and mysteries about human consciousness, morality, professional ethics, and the tiny world of a developing body, brain, mind, and spirit.

In the author’s opinion, abortion done in the last trimester is infanticide unless there are immediate medical emergency dangers to the life of the mother. After delivery abortion is in my opinion murder.

A 29 week fetus (YouTube screengrab)

Abortion done in the mid trimester is highly questionable unless there are highly traumatic psychiatric issues or severe immediate medical danger to the life of the mother. Rape and incest as a reason for an abortion at any phase of pregnancy raise complex issues for the obstetrician, psychiatric consultant, and the patient seeking an abortion. Often, ongoing psychiatric care is important after the abortion in those instances.

Selected Relevant Vignettes

(1) As a psychiatrist at a community mental health center I worked with a woman with severe mental illness who was raped by a fellow psychiatric patient at the state mental hospital. She was competent to decide and chose not to have an abortion. Her social worker and I helped her deal successfully with the traumatic issues and she became a good mother and worked to support herself and her baby boy with support from us and her friends and family.

(2) As a medical student I interviewed and examined a sixteen-year-old girl who had been impregnated by her father. He had come home very drunk from a Saturday night party. He and his wife had argued, and he said he thought he was going to sleep in a guest room. But, “by mistake”, he crawled into bed with his daughter where intercourse occurred resulting in her pregnancy. I assisted at her abortion. To my knowledge the girl or her parents were not referred for psychiatric care or follow-up. I look back to that event and feel shame and regret for my passivity as a student reluctant and feeling powerless to speak out to my superiors at the time.

(3) I once worked with an affluent couple in couples therapy. Early in their marriage and in the husband’s successful business career, his wife became pregnant. He insisted they seek an abortion for her because he was consumed with his postgraduate business education at a top school. She refused and was at term when a stillborn baby boy arrived. The husband felt relieved and plunged further in his studies. His wife without his knowledge buried the little boy, named him, and every year remembered their stillborn son alone by herself. Many years later, with two adolescent children in their home, significant marital problems arose. The issue of their lost son emerged in the treatment. They struggled for a long time with complicated, grief, loss and sadness. For an array of various reasons, including pain over the lost son, they agreed to divorce.

First trimester abortion in my opinion must always be approached seriously with counselling about all options including adoption. A competent abortion consultation must involve exploration of the woman’s feelings and thoughts about her decision. If there is an involved father/partner, he should best be included as well. In my clinical practice I found significant numbers of women and sometimes their life partners whose resolution of their feelings about the abortion decision had important on-going implications psychologically for themselves as individuals and their relationships.

A hopefully successful psychological processing of the abortion decision, pro or con, involves a candid, genuine exploration of the options, emotions, meanings, and circumstances, because the decision for abortion involves the ending of a life and the awesome responsibility involved. A casual, arrogant, violent, or militant attitude about the abortion decision seems ignorant, self-absorbed, and spiritually out of touch.

Some mental health professionals argue that babies born to a woman without partner support or ability for full commitment to motherhood result in a major population of unwanted children. Such children, they say, become a major problem to American society, the economy, social services, the courts, criminal justice system, and prison system. In my opinion, I think they are wrong and produce a simplistic, pejorative eugenic tone to the discussion about abortion. This view tends to infantilize, condescend, or take for granted a woman’s autonomy and prerogatives in her decision-making.

A decision to abort in my opinion is never a perfunctory, routine, or a sociologically described “healthcare decision.” An individual or couple’s abortion decision involves considerations that go far beyond a political or legal debate about Roe v Wade. It involves profound and poignant individual, relationship, moral, and spiritual decisions about the sanctity of life itself.