If you think that abortion on-demand is morally wrong or at least morally dubious, there’s a question you must ask yourself: would you rather live in an egalitarian world where abortion on-demand is legal, or in an anti-egalitarian world where abortion on-demand is illegal? Some might call this a false dilemma, but I disagree: perverting prenatal justice to serve insidious political goals is worse than being indifferent to it.
In this sad era of the echo-chamber, people usually notice only the flaws of those they oppose. I’ve taken the opposite approach: deliberately immersing myself in the pro-choice mindset. Over the years I’ve cherished friendships with smart pro-choice women. I constantly read pro-choice books and papers, attempting to fully understand how they see this issue—and I can tell you straight away: they’re right. The pro-life movement as we know it does oppress women.
In the pro-choice imaginary, human personhood is defined by physical autonomy. It is an essential freedom, one that comes with a price unnamed but accepted. In the pro-life imaginary, fetal personhood is defended by its most fundamental right: not to be killed. It’s an obligation etched onto the pregnant individual, inscribing all kinds of other expectations enmeshed in traditional social values. The pro-choice and pro-life perspectives are customarily framed in liberal and illiberal terms, respectively. This cannot be helped, unless we uncover and reconsider the rules that govern how we conceptualize beings.
The Thing About Metaphysics
The metaphysics underlying Western science is historically influenced by Aristotelian thought. It revolves around distinct, individual substances with inherent qualities and purposes, arranged in a hierarchical order of reality. Standard biological models still reflect this influence: a pregnant woman is considered one substance, and the fetus another. For Aristotle, the rational man had a higher degree of completeness, embodied as the pater familias–the only legitimate decision-maker, and the owner of land, slaves, women, and children.
Christianity’s insight that the soul is ungendered, that ownership is unreal, that personhood is relational, and that the true human nature is supernatural is hardly compatible with this structure. Interestingly, the leading pro-life philosophy is neo-Thomism: an Aristotelian reading of Christianity. It turns human relationality back into a hierarchy, re-separates substances, and extracts moral norms from the physis of the fallen cosmos.
On the other hand, pro-choice autonomy is essentially an extension of Lockean self-ownership. It continues in the tradition of viewing humans as self-determining agents, applying it to women as full individuals and rightful participants in the pursuit of happiness, free from the constraints of metaphysical accidentals tied to their sex.
This is why the conservative opposition to the Enlightenment finds its natural apex in anti-abortion sentimentality: the mass killing of unborn babies is the best proof that modern egalitarianism is not true. This is wrong, and wickedly so. In fact, everyone is wrong here, except me. But let’s pause here and tune in to the news from America.
The Laws
It’s a beautiful day here in post-Dobbs dystopia: pregnant women are being denied a basic standard of care, OB-GYNs are threatened with prison time, pro-life institutions claim that abortion is never medically necessary, pro-life states challenge federal standards for emergency medical care, pro-natalist capitalists demand more workers born—all while eugenic reproduction and abortion are rampant. How did it come to this? Put simply, the right is incapable of understanding pregnancy either properly or justly. Now let’s deal with the complexity.
I’ve been in the pro-life movement for years. Before Dobbs, abortion to save the life of the mother was a standard part of our narrative—until the conservative-led movement came to power and started enacting legislation. Suddenly, there was an upsurge of activists and pro-life organizations claiming that “abortion is never medically necessary.” This is the key to understanding how bad things really are.
Ever since the late 1980s, when the religious right combined the Evangelical appetite for political power with secular-sounding Catholic bioethics, the theoretical underpinnings of the pro-life narrative began coalescing around neo-Thomism. It conceptually separates the mother and the unborn child to emphasize their equal moral status. In terms of arguing against abortion, the focus had to be shifted from termination of pregnancy to intentionally killing the fetus.
Accordingly, AAPLOG, a leading pro-life OB-GYN association, now defines abortion as intentional killing and publicly states that abortion is never medically necessary. This reflects a global trend: AAPLOG is following the 2012 Dublin Declaration, which makes a similar claim. Consequently, after the fall of Roe v. Wade, many U.S. pro-life laws redefined what constitutes abortion. Rather than simply banning abortion on request, these laws have a broader agenda.
For comparison, European laws usually refer to abortion as intentional termination of pregnancy. But the US laws define abortion as intentional killing of the fetus—they posit the presumption of malice.
This definition also conflicts with standard medical usage and official medical classifications. Many treatments still medically classified as abortions (such as certain miscarriage treatments) are now legally redefined as “not an abortion.” Likewise, some medically necessary abortions are now labeled as “intentional killing,” making their legality difficult to determine and even harder to defend. Why? Because these laws are based on the assumption that doctors are intentionally harming babies in abortion procedures.
In Texas, “abortion” is defined as any act intended to cause the death of an unborn child, using language nearly identical to a model law from Americans United for Life. This definition, also found in other pro-life states, excludes treatments for miscarriage and ectopic pregnancy.
However, these laws consider miscarriage treatment “not abortion” only if the miscarriage is spontaneous and the fetus is dead. Non-spontaneous miscarriages are complications from abortion pills. This wording provides a leeway for hindering the treatment if the pregnant person is guilty of taking abortion pills. It’s an insidious strategy: restrict abortion and then outlaw expeditive help to victims of illegal abortion. We’ve seen what this looks like in practice. AAPLOG even argued in court that providing life-saving treatment to patients who’ve taken abortion pills conflicts with pro-life doctors’ conscience.
Even besides the abortion pill issue, many types of miscarriages, like those in progress, do not present a dead fetus. But the official criteria for ascertaining fetal death implies weeks of diagnostics. Likewise, an untrained eye might not catch any issue with excluding ectopic pregnancy treatments from the definition of abortion. However, the law typically defines ectopic pregnancy as "occurring outside the uterus," while some ectopic pregnancies occur within the uterus, making this exception problematic and incoherent.
The typical pro-life response boils down to, "Well, this then falls under the definition of abortion for medical necessity.” Let’s see how that works: abortion for medical necessity is based on "reasonable medical judgment" to prevent "death or serious impairment to the mother's health." However, the law’s definition of abortion presumes malice, which contradicts both reasonable judgment and medical necessity. Since both are deliberately made open to interpretation, and the penalties are severe, this creates a strong incentive to delay treatment.
In addition, the laws draw from legal terminology related to self-defense. However, legal justification for killing in self-defense requires the imminence of serious injury or death. Some higher-level courts have already clarified that the imminence of the threat is not always required, but the legal wording still stands.
Any law focused on the intent to kill, rather than intent to terminate the pregnancy, will push doctors to take extra steps to cause fetal death indirectly or to delay treatment until maternal health indicators worsen, all to minimize the chances of prosecution. Before Dobbs, standard of care was provided before a life-threatening condition developed, as not all patients survive once that point is reached. With their presumption of malice that creates an affirmative defense, vague wording about necessity, and severe penalties, these laws now incentivize doctors to go below the standard of care when it comes to protecting maternal life and health.
The Metaphysical Politics of Pregnancy
I could provide numerous tragic examples to show how this strategy plays out in practice, but I’d rather focus on the deeper source of this misery. It is best exemplified in the words of John Finnis, one of the key architects of pro-life legal theory. While arguing against the phrase “abortion to save the life of the mother” in an essay on medical ethics, Finnis says, nota bene:
First, that sort of formulation implies that, in this case at least, killing may rightly be chosen as a means to an end. Second, by referring only to the mother, any such formulation implies that her life should always be preferred, which is unfair.
Both of these claims are wrong. The former forces an inadequate metaphysical framework onto pregnancy, while the latter blatantly denies any sort of primacy to the pregnant person.
And so we return to the points I made at the beginning of this essay.
It is surreal to me that the fundamental phenomenon for the material basis of our existence is persistently misconceptualized. The nature of this misconceptualization is political. The metaphysical is political, the political is metaphysical.
In pregnancy, one person's existence doesn’t just cause but constitutes the organic state of another. The interconnectedness of beings and life processes in pregnancy defies those attempts to separate substances, making intentions, actions, and consequences impossible to untangle. In addition, there are collective duties to pregnant persons that arise when we accept the existence of a pre-given burden and organic expenses of pregnancy. This is what the conservative mindset is up against. Accepting these burdens makes additional serious medical risks supererogatory. A truly just law would give the pregnant person freedom to decide on whether to accept these risks.
But according to the delineational, neo-Thomist view, the phenomenon of pregnancy does not exist: there are just mothers and children. No burdens, no organic care-labor, no cost whatsoever for the mother–therefore, no pre-given reasons for erring on the side of the mother. This is perfectly encapsulated in Finnis’ second claim in that quote. According to his view, there could be situations where, for instance, putting the pregnant person in a coma and using their body for gestation might be considered ethically acceptable.
This is what some justices on the Supreme Court believe. The state of Idaho recently challenged the federal Emergency Medical Treatment and Labor Act (EMTALA), which requires hospitals to provide stabilizing emergency care, including abortion when necessary. Justices Alito, Thomas, and Gorsuch argued that EMTALA can be flipped to protect the fetus. The case was left without a decision on the merits. Maternal primacy in pregnancy-related medical necessity does not stand a chance with conservatives. Their entire “mother-saving” rhetoric is purely consequentialist: the mother is saved only because her death would also mean the death of the fetus. They will never accept any special duty to the pregnant person as a standalone principle.
The repercussions of this view are very real. This means increasing the pregnant persons’ risk of death to achieve “proper” proportionality or to cause fetal death indirectly to be able to plausibly deny the intention to kill. There are an array of serious conditions where such an “indirect” approach can be lethal to the pregnant person.
The Problem Made Intractable
On the other hand, the axioms of self-ownership, when applied to pregnancy, yields similar results, but in the opposite direction: the pro-choice mindset is notoriously incapable of accepting any sort of maternal duty towards the fetus. The metaphysics of the pro-choice stance is equally substance-oriented and delineational, except that it revolves around self instead of Aristotelian nature. Since the fetus (and, according to some theorists, even a newborn) does not yet own a self, it cannot count as a full person.[1] In fact, an impregnable human doesn’t count as a full person if their self-ownership is deniable by enforced continuation of gestation.
The clash between pro-life and pro-choice is made intractable because both of these narratives are benign to the paradigm of autonomous, individual agents. Both are correct to a degree. Both are essentially anti-social.
There is no solution to be found by pitting absolute autonomy against organically dependent humans. Focusing on individual instances of human nature self-directing their growth against a blank backdrop won’t help. The solution is in the relational nature of personhood. The organic entanglement of pregnancy is reflected in social entanglement and interdependency of all us. The pregnant must be recognized as selves, rather than being reduced to bare biological life and stripped of subjectivity. This is relational autonomy: there is no self without the other. There has never been a delineated, non-relational person hovering over the waters. Our small enselfing bodies require other bodies and other selves. Those providing organic nurture to enselfing humans need others to recompense their labor and guarantee their safety. But even this minimum is unacceptable to conservative pro-lifers. Why?
Because to delineate and hierarchize genders, they need these burdens to be romanticized away as sacrificial motherhood without any collective duties to the pregnant person, and safely tucked into the privacy of the nuclear family. Within the borders of this privacy, female organic care and domestic labor must be sentimentalized instead of recompensed. The romanticization of women’s labor in the private sphere is historically and dialectically tied to the rise of individualist competitiveness among men in the nominally egalitarian public sphere. Standard conceptions of fetal personhood borrow from the male paradigm, erasing the female and the phenomenon of pregnancy: it’s all self-directed individual growth against the whitewashed backdrop of organic entanglement and female care. The moment this self-directedness applies to female selves, the entire structure falls apart. Good.
Is There a Solution?
To an extent, European welfare can mitigate the injustices of absolute autonomy and gender-based oppression. But it cannot provide a pro-life solution because its ultimate allegiance lies with liberal capitalism. Its “equality” requires abortion on demand as a superficial fix for the in-built injustices of the free market—such as income inequality, exploitation, and unpaid labor. Its technocratic “quality of life” function still requires the practices of liberal eugenics. Its machine paradigm, managing family and reproduction through capillary power, still depends on abortion.
Can this be amended while protecting nascent humans from abortion on-demand? Yes. Are we ready? I don’t know. Millennia of gender-based oppression still weigh heavily on our collective consciousness. We need a truly just social contract with those capable of pregnancy, one that fairly compensates the burdens of pregnancy and childcare while respecting relational autonomy.
Gender justice must be upheld, and gender de-normativized, because this is the only way to dismantle gender hierarchization. We must ensure free access to all forms of contraception. Abortion should be defined broadly, without presumption of malice, and provided exclusively as an in-hospital healthcare, legal when medically indicated. The laws must not borrow from the legal terminology for self-defense, because such laws require the threat to be imminent. Medical indications must encompass any serious physical health risks: whether underlying, developing, or imminent. All abortion-related laws must explicitly prioritize the maternal patient. Neither pregnant individuals nor medical practitioners involved in abortion should face criminal liability. Hospitals as institutions can be fined in case they breach the scope of medical indication.
Healthcare, including medically indicated abortion, must be free. Quality childcare and public education must also be free. Related social policies should be parent-focused. This means total financial support equivalent to two minimum wages during pregnancy and one year postpartum, interchangeable between parents, and five or more years for parents of medically complex or disabled children. Childcare allowances should be provided for every child up to age 18. Parent-specific rights in the workplace must be robust, with state-incentivized work-from-home options or, if impractical, more flexible schedules.
If a truly just pro-life movement may exist, it can only come from the left. Protecting nascent humans from abortion on demand requires an unbiased understanding of the phenomenon of pregnancy, a realistic and fair outlook on the burdens it implies, and a strong commitment to broader social and economic justice. The right’s monopoly on pro-life values must be dismantled. For decades, leftist pro-lifers have allied with the religious right and various socially conservative factions to advance a shared cause. But the right had its chance to articulate and implement its philosophy, and the result is nothing less than a spectacle of injustice. It has to be rejected in full.
Peter Singer, Practical Ethics, 3rd ed., Cambridge University Press, 2011; Michael Tooley, Abortion and Infanticide, Clarendon Press, 1983; Jeff McMahan, The Ethics of Killing: Problems at the Margins of Life, Oxford University Press, 2002. ↩︎