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Abortion. THE hot button issue for today. My comments will probably include something to offend everyone, so be prepared with your rotten tomatoes. And before I get into the meat of the subject, bear with me as I go through my qualifications to comment on the subject.

I am a doctor — an anesthesiologist. Abortions come in multiple forms, and I’ve administered anesthetics for hundreds of abortions that nature started. These are called “spontaneous abortions” or “miscarriages.” They usually happen because of genetic abnormalities in the fetus. A few come from an incompetent cervix, and I’ve done anesthetics for placement of a “cerclage,” a special suture that prevents the cervix from dilating before the baby is ready for delivery.

I practiced in a hospital that did not allow abortion on demand, so I was not asked to do anesthetics for those. But I did participate in circumstances where an abortion would have been proper to save the mother’s life. The first was in 1980, while I was in Saudi Arabia with the Loma Linda University Overseas Heart Surgery Team.

A young woman who had had a mechanical heart valve placed several years before was admitted in extreme distress. She had gotten pregnant, stopped her blood thinners, and the valve was stuck due to a blood clot. We pulled out all the stops, but it was too late. We lost her on the table. She should never have gotten pregnant, but her Islamic religion did not allow that option.

After returning to Florida, a young female recruit from the Orlando Naval Training Center was admitted to my hospital with new onset shortness of breath every time she ran the obstacle course. We discovered that she was pregnant and starting her second trimester, but also had a rare disease called “primary pulmonary hypertension.” After extended consultation, we decided that the only way to save her life was to try to terminate her pregnancy. Unfortunately, we were again too late, and she died on the table.

The only other case I recall was a second-trimester abortion for non-survivable fetal anomalies. Ultrasound was just developing to the point where we could identify these problems before birth. Since carrying a child to term in a normal pregnancy is a non-trivial risk, the safer route for mom was to terminate the pregnancy. She could try again.

As you can see, there are occasions where an elective abortion is required for the mother’s health, but they are rare. I saw three in thirty-three years.

The second concern regarding abortion is moral, or in the common mind, religious. There again, I believe I am qualified to comment. My training began in medical school, where I had the rare opportunity to take an excellent course in medical ethics. It was taught by two professors I can best describe as saints. This training continued through my fellowship in Critical Care Medicine.

Since then, I have undertaken seminary training that includes biblical Greek, Hebrew, and Aramaic. I have written well reviewed books on theological topics and teach weekly in my local evangelical church. And a local seminary has asked me to teach biblical interpretation from time to time. So I can speak to the religious side of the issue.

Yesterday (May 16) Alabama Governor Kay Ivey signed a bill that makes performing an abortion a felony unless the mother’s health is at risk. When we place this against Virginia Governor Ralph Northam’s statement approving the killing of an infant after birth, we see the extremes of the possible opinions. The Alabama bill essentially declares that life begins at conception, while Northam’s statement would allow infanticide.

Most of us find the Virginia Governor’s comments repugnant. He would allow for the killing of a child born alive in Virginia. That raises a serious question about all laws banning murder. If it’s OK to kill an hours-old infant, what about a days-old infant, or a years-old no-longer-infant? There is no standard.

The trend toward various “heartbeat” standards does not suffer from this flaw. The Alabama and Georgia laws, while somewhat different, do create bright legal lines. This is important, but the two states illustrate a clear difference in approaches.

Georgia purports to ban abortion once a heartbeat is detected, unless a police report claiming rape or incest is filed. This raises a major ethical question that the Alabama law addresses head-on. If life begins at conception, and is clearly detectable with the presence of a heartbeat, why is it acceptable to kill it based on how it came to be created? Alabama clearly defined legal personhood as originating at the same time as a heartbeat. This defines the earliest time that a killer can be charged with two murders when he kills a pregnant mother. Alabama has chosen to defend all its citizens.

Georgia, on the other hand, has taken a politically popular but morally ambiguous position that ignores the “morning-after pill” option. Are all live pregnancies persons? Or are they persons only if they arrive in an approved manner? Biologically there is no difference. Biblically there appears to be no difference, either.

For evangelicals, who hold the Bible as the authority, it is necessary to actually open the Book and consider it carefully. Perhaps the most famous case of incest is that of Lot and his daughters in Genesis 19. They got him drunk in order to get pregnant by him. Their sons became the ancestors of enemies of Israel. The next is the case of Judah and Tamar in Genesis 38. There Judah’s daughter-in-law tricks Judah into getting her pregnant. When she is discovered, he calls for her to be executed (v. 24). Clearly, he has no concern that the baby is a person. But we don’t hear if that’s God’s opinion. Ultimately, she lives, and her son becomes one of Jesus’ direct ancestors (Matthew 1:3).

Rape is clearly condemned in the Bible, with the death penalty commonly declared. But in Deuteronomy 22:28-30, we find a variation. If a man rapes a virgin who is not related to him or betrothed, then he has to marry her and pay her father fifty shekels of silver. In this way, he will provide for her for life. It seems that biblical laws are generally defined in a way that protects women. But what about abortion?

Exodus 21:22-25 appears to be the only passage that addresses the issue, and that only peripherally. In it, if a woman suffers an injury in a fight, and that injury leads to a miscarriage, then the perpetrator must pay the husband an amount of money that the husband demands and the Court approves. If it were considered murder, then the death penalty would apply, but it doesn’t. Our only logical conclusion has to be that there appears to be no clear biblical instruction regarding abortion. That’s probably because children were highly desired, and that women were strongly protected from rape and incest. Thus, elective abortion did not happen, and the Bible doesn’t address it.

One final passage of importance is Jeremiah 1:5.

“Before I formed you in the womb I knew you, And before you were born I consecrated you; I have appointed you a prophet to the nations.” (Jer 1:5 NAS)

Many Pro-Life advocates use this text to advocate that life begins at conception. But does it really say that? The only clear statement is about God’s foreknowledge of Jeremiah’s birth and commissioning as a prophet. When we look at “I formed you in the womb,” we find ourselves in the position of trying to force our scientific rationalistic thinking into a text written to a pre-scientific audience. That is the error of anachronism. In Genesis 2:7, God “formed” Adam from the dust of the ground. But it wasn’t until God “breathed the breath of life into his nostrils” that he “became a living soul.” The verbs are the same, leaving us with a biblically unsolvable question. When does life begin? And that brings us to the early church.

Athenogoras (ca. 177 AD) says that the use of drugs to cause abortion is murder.

“How, then, when we do not even look on, lest we should contract guilt and pollution, can we put people to death? And when we say that those women who use drugs to bring on abortion commit murder, and will have to give an account to God for the abortion, on what principle should we commit murder? For it does not belong to the same person to regard the very fœtus in the womb as a created being, and therefore an object of God’s care, and when it has passed into life, to kill it; and not to expose an infant, because those who expose them are chargeable with child-murder, and on the other hand, when it has been reared to destroy it. But we are in all things always alike and the same, submitting ourselves to reason, and not ruling over it.” (emphasis added)

But his contemporary, Clement of Alexandria says (Miscellanies, Book V, Chapter 1, ca. 193 AD),

“Now we know that neither things which are clear are made subjects of investigation, such as if it is day, while it is day; nor things unknown, and never destined to become clear, as whether the stars are even or odd in number; nor things convertible; and those are so which can be said equally by those who take the opposite side, as if what is in the womb is a living creature or not.” (emphasis added)

In short, the Bible is not clear as to when life begins. That’s not surprising, since that was never a subject of discussion in the time and place when its relevant parts were written. In the second century after Christ, there was a difference of opinion as well. Athenogoras thought a fetus was a person, but Clement of Alexandria opined that we could not know because there were good arguments on both sides.

This is an accurate reflection of our knowledge even today. Some evangelicals make strong arguments for life beginning at conception. Pro-abortion advocates make strong arguments to the contrary. But it is almost inconceivable that anyone could make a rational argument that a living child born in whatever circumstance is not a person the way Ralph Northam (a pediatric neurologist!) does.

As a society, we have to protect the image of humanity. To that end, we provide institutional care for children born with horrible defects that prevent them from ever functioning as humans. But they look enough like us that we erect a wall against wanton execution of these “non-human humans.” We cannot allow any more Josef Mengeles to exist. That’s why Kermit Gosnell is in prison.

But we cannot allow law to be so emotional and unclear. It has to provide bright lines that clearly show what is unacceptable, so that anything not unacceptable is OK. Both Georgia and Alabama have done this. Whether their answers are “correct” cannot be distinguished either from scripture, history, or science. All we can properly say is that this is what we see as the best answer.

Alabama has the best legal position, because its law is constructed from the question of personhood that the state has an interest in protecting. Georgia’s law fails this test due to its feel-good exceptions for rape and incest that ignore the option of the morning-after pill that would prevent a heartbeat from ever occurring. New York has the worst legal position since its law functionally eliminates the crime of murder.

Ultimately the Supreme Court will have to wrestle with this again. We must wait to see if they are willing to deal with law instead of social engineering founded in the evils of mankind.

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