Answer: The term abortion is highly charged, and rightfully so. Yet the word carries different meanings in different contexts. The word abortion, as it appears in medical literature, is much broader than the term as used in common conversation. Neither definition necessarily matches how statutory laws refer to “abortion.” The medical definition is “the removal of pregnancy tissue, products of conception or the fetus and placenta from the uterus” (www.health.harvard.edu/medical-tests-and-procedures/abortion-termination-of-pregnancy-a-to-z, accessed 4/10/23). Casual speech typically reserves the word abortion for procedures motivated by a desire not to have a child. This complicates discussions of determining the morality of “abortion”: two people might agree on what acts are permissible but label them differently.

What matters is not the term applied, but the action taken. To prematurely remove an unborn child from a woman’s body or take out embryonic tissue does not necessarily involve killing or an intent to kill. Scheduled C-sections, for instance, artificially “end a pregnancy,” but with positive intent. To end an unborn human life because it interferes with one’s economic stability, preferences, or lifestyle is a heinous sin. But in rare cases, difficulties in pregnancy present a genuine moral dilemma. When that happens, both lives involved should be considered. It is vitally important to remember, however, that instances in which the life of the mother is legitimately at risk are extremely rare, accounting for far less than 1% of all abortions.

When dealing with choices of life and death, ethicists consider the principle of double effect as developed by Thomas Aquinas. This means balancing the potential benefits and costs of various choices. Even if a choice results in a negative outcome, it may be more moral than the alternatives because it presents the least harm (Kockler, N., “The Principle of Double Effect and Proportionate Reason,” Virtual Mentor 2007;9(5):369–374).

In discussions about abortion, the double effect principle harmonizes with a biblical truth: the mother’s life and the unborn child’s life are equally valuable. Biblically, the death of the unborn should never be a goal. There is an important distinction between “killing the unborn” and “making a woman no longer pregnant.” To be ethical, ending the pregnancy must be done solely to preserve life, not to seek death. Efforts must also be taken to treat both mother and child with full human dignity and respect. This includes providing for the child’s comfort. Neither the parents nor the doctors should want the child to die.

In short, there may be ethically valid reasons to “end a pregnancy” by attempting to separate the woman and the unborn. Chief among these is when intervention is the only way to preserve one of their lives.

When medical intervention is the moral choice

It’s important to remember that, when treating a pregnant woman, doctors have two patients. The mother is not a gestational apparatus, like an appliance; her life is a doctor’s responsibility as much as the life of the baby. The moral difference is that the mother is the only one able to make decisions for both patients. With that in mind, deliberate removal of the unborn or related remains may be morally justified. Several situations fall into this category.

The first scenario is universally accepted as a healthy, moral medical procedure. This is when a baby does not form or stops forming very early, and related tissue needs to be removed. Some miscarriages—which medical literature refers to as “spontaneous abortions”—leave remnants behind that can harm the woman unless they are purposefully removed. In this case, there is no living unborn at all. In other cases, the tissue never matures into an embryo, but the mother does not miscarry. The mother should feel free to allow doctors to remove the tissue. In medical documents, this procedure is classified as a type of “abortion.”

The second scenario that should be uncontroversial is when a developed but unborn infant has died. There is no moral or biblical reason to force a mother’s body to contain a dead child any longer than necessary. In fact, if the baby is too large for the mother’s body to reabsorb, the mother’s life is at risk. Yet, so far as medical literature is concerned, intervention to remove those remains would also be labeled a type of “abortion.”

The third scenario is more difficult but logically sound. Sometimes, a pregnancy creates an immediate danger to the mother’s life, such that both she and the unborn will die without any hope of the baby surviving. This is true in almost all cases of ectopic pregnancy: when the embryo implants outside the uterus. Related are cases of acute, uncontrollable infection. If no action is taken, both mother and child will die. If the pregnancy is ended early, only the unborn will perish. In such a situation, it would be morally and biblically advisable to act to save a life—by removing the baby—rather than doing nothing while two lives are lost.

In tragic cases, medical personnel are forced to use a process called “triage,” where multiple patients are assessed and ranked according to their condition. That includes assessing what measures are needed to treat each. If resources are limited, emergency responders may choose not to treat an “un-savable” patient, so they can save one or more others who would die without immediate help. In cases of a difficult pregnancy, both mother and child are patients, and it is moral for doctors to consider both when weighing options.

When either decision may be justified

There are rare cases in which the mother could carry a baby to viability—enough development to survive outside the womb—but she will most certainly die as a result. Perhaps she develops an infection when the baby needs a few weeks more gestational growth. Or she needs immediate treatment for cancer, which would inevitably kill the unborn. In such cases, Christians must remember that both the mother’s and baby’s lives are equal in value. The two are likewise precious to God. Most ethicists would say either choice would be justifiable.

Biblically, the quandary is more complicated. Jesus said, "Greater love has no one than this: to lay down one’s life for one’s friends" (John 15:13). A mother may lean on this verse to justify continuing the pregnancy, knowing she will die. In the verse before it, Jesus said, “My command is this: Love each other as I have loved you” (John 15:12). A woman loves many people—such as other children and family—and she may lean on this verse to justify sparing her own life to continue filling her responsibilities to her loved ones.

Without question, being faced with such a choice is heartbreaking. Christians should mourn that such an awful situation occurred at all. We must approach women in such a terrible dilemma with support and without judgment, regardless of the decision they make. The Holy Spirit may lead either way; neither choice comes without lasting trauma.

A similar dilemma may occur when there is an option for premature delivery. Once again, medical terminology sometimes classifies inducing early labor as a form of “abortion.” Yet the intent in this case would be to preserve the mother’s life while doing as much as possible to rescue the unborn child. The age at which premature infants can survive outside the womb continues to decrease; even secular ethicists recommend lifesaving measures for unborn children of 23 weeks gestation and beyond. At 36 weeks—a full four weeks early—99 percent of babies survive. The induced delivery of a seriously premature baby should be treated as an early birth, and the child should be provided with all available medical care.

As with other situations, these scenarios evoke the “triage” concept: when it seems no good options exist, there is a genuine ethical struggle to decide what choice is best.

When intervention is dubious

There are scenarios in which a pregnancy causes no harm to the mother, but the doctors believe the baby will not survive long after birth. Some congenital defects limit the lifespan of a newborn. Examples include chromosome disorders trisomy 13 and 18, and anencephaly, where the baby is born without a brain.

In these situations, the parents are forced into a difficult decision. One option is to carry to term and soon lose their child. Some women choose this option, giving their children the longest life possible and using their wombs as palliative care. Other women cannot bear the thought of remaining pregnant for months knowing they will lose the baby shortly after birth. These cases are similar to those necessitating end-of-life decisions regarding a terminally ill adult.

Adding complexity is the fact that doctors and parents may not have accurate information. Many diagnoses of life-limiting conditions are wrong. One study found birth defects diagnosed by ultrasound were wrong 8.8 percent of the time (Danielsson, K., “Accuracy of Ultrasounds in Diagnosing Birth Defects,” Very Well Family, 3/28/21). For rare chromosome disorders, conditions that seriously limit the life span or quality of a child and often lead parents to abort, blood tests can give a false positive 85–90 percent of the time (Kliff, S., and Bhatia, A., “When They Warn of Rare Disorders These Prenatal Tests are Usually Wrong,” The New York Times, 1/1/22). There is more than a slim chance that children assumed to be hopeless will survive and even thrive if allowed to live.

It would appear the more ethical and more biblical course is for mothers to carry babies with a life-limiting diagnosis as long as possible. Friends, family, and churches should support parents facing such diagnoses, no matter if they decide not to carry to term. Each situation is different and requires discernment. And “life-limiting” sometimes isn’t days but, with proper medical treatment, could be years (Digitale, E., “Compatible with Life?” Stanford Medicine Magazine, 11/19/18).

When abortion is unjustified

It should go without saying that taking any action that could end a life is not justified unless the mother’s or baby’s life is in reasonable danger. Early delivery or C-sections are options that do not require the death of the unborn. Down syndrome is not a legitimate reason to terminate a pregnancy. Neither are limb defects, deafness, or handicaps easily treated with available medical care. Abortion should never be used for the purpose of eugenics.

Nor should a child be killed to avoid being an inconvenience. An ethical, moral, biblical approach to pregnancy acknowledges that, from the moment of conception, there are two human persons involved. Ending one of those lives for financial, preferential, or other non-terminal concerns is wholly unjustified. Sadly, the overwhelming majority of all elective abortions performed have no connection to birth defects, health risks, or even concerns such as rape and incest.

Post-intervention care

Ethically, the death of a child should never be the intent of any procedure. In no scenario is it moral to act on an unborn child with the express intent of ending that life, even when the child is expected to have life-limiting conditions. Further, children taken early from the womb should be given all reasonable care—regardless of how they came to be in that situation.

As with terminally ill or brain-damaged adults, there may be questions about the morality of sustaining life in extreme cases. The same basic concepts apply to neo-natal care. Subjective terms such as “quality of life” should be scrutinized and not used as simplistic arguments. Cases involving life-sustaining care should be handled with tenderness and humility, as with any other medical dilemma. Christians should be prepared to support those faced with such tragedies; any choice will bring pain.

Obviously, the practice of post-abortion termination is entirely immoral. Sometimes children survive late-term abortion attempts. Any child removed alive from a woman’s body should be given all reasonable medical care. Infants left to die or deliberately killed after an abortive procedure are not hovering on the edges of ethical nuance; they are murder victims.

Conclusions

It is important that church leaders understand these moral complexities to give good counsel and proper support.

Women should not feel pressured to maintain a pregnancy that will inevitably result in the deaths of both her and her baby. Nor should women feel pressured to terminate a pregnancy when the baby has been diagnosed with a life-limiting condition.

Patients should have access to good information and feel free to speak with their clergy and hospital ethics boards.

Christians should seek mature understanding of medical issues and their sometimes-confusing terminology when considering legislation to support. Careless phrasing in laws can provide loopholes leading to unnecessary deaths.