This post is a part of our Bioethics in the News series
By Parker Crutchfield, PhD, and Emily Carroll
The Texas legislature recently passed a law prohibiting abortion of a fetus older than six weeks. The law allows abortions after six weeks in life-threatening emergencies, but not when the pregnancy results from rape or incest. The law is extraordinarily restrictive and additionally deputizes citizens to enforce the law, providing a $10,000 bounty for successful civil suits of people involved in the “aiding and abetting” of abortion. The Supreme Court of the United States recently neglected to halt the law, which meant it went into effect.
We can’t be sure of the exact thoughts of those who enact or support the bill. However, there are some claims that such people often hold. In an article set to appear in Cambridge Quarterly of Healthcare Ethics, we argue that these claims imply that if one supports restrictions on abortion, one must also support compulsory organ donation. In other words, if you support restrictions on abortion, to remain intellectually consistent you must also support a corresponding degree of compulsory organ donation.
The Duty to Protect
Our argument starts with a claim common to those who oppose a woman’s right to choose to have an abortion. This claim is that a mother has a duty to protect her fetus.
The duty to protect is supposed to be a special obligation that holds between mother and fetus. Special obligations are those that hold between people in virtue of some relation between them. We have many obligations to other people; most apply regardless of how we are related to them. But special obligations arise only in the context of certain relationships, such as those that hold between parent and child. Most people agree that a mother or father’s obligations to their child are different from those that they have to strangers. Here’s one example: a parent has a duty to protect their child, but no such duty to protect a stranger who lives in a distant locale. There are other ways to explain the duty to protect, but the one we prefer is that special obligations kick in when one person’s life is vulnerable to another person’s actions (Goodin, 1986). The more one person’s well-being is vulnerable to another person’s actions, the more the second person must protect the first. Thus, on this view the mother has such a strong duty to protect the fetus that she must allow it to use her body, willing or not.
From Prohibited Abortion to Compulsory Organ Donation
But there are other implications of this line of argument. What’s true of the mother-fetus relationship is also true of the parent-child relationship. If a fetus has full moral status, then so does a child. And children are highly vulnerable to their parents. Their well-being is significantly affected by their parents’ actions. This is true not only of their social and emotional well-being, but also of their physical well-being. This is especially true of children who need organ or tissue donation.
Children who need blood products or a kidney, liver, heart, lung, or any other organ are highly vulnerable to their parents’ actions. At a minimum, the child is vulnerable to the parent’s cooperation with the healthcare team’s treatment plan. But the child who needs an organ or tissue donation is also vulnerable to the parent’s biology. In particular, a parent may be the most biologically compatible potential donor. For parents who are a compatible donor for their child, the child’s well-being is extremely vulnerable to their parent’s actions. In a society where organs and tissues are a scarce resource, the child’s vulnerability to a biologically compatible parent is a matter of life and death.
Children who need organ or tissue donation to survive are about as vulnerable to their biologically compatible parents as a fetus is to its mother. If a mother must donate her body to her fetus unless doing so emergently threatens her life, then a parent must donate organs and tissues unless doing so emergently threatens their life. This obligation would hold for both mothers and fathers. If a child needs a kidney and their father is a match, he must donate his kidney to his child, even if he doesn’t want to. Donating a kidney is not emergently life-threatening, nor is donating a variety of other organs and tissues. If mothers shouldn’t have a choice to terminate a fetus, parents should not have a choice about whether to donate organs and tissues.
A Policy Proposal
To be clear: we are not arguing that abortion is wrong or that it should be allowed. Nor are we arguing that tissue and organ donation should be compulsory. Rather, we are drawing out the implications of the anti-choice position. There are ways out of this implication, but they are unfriendly to the anti-choice position. For example, they may wish to accept that mothers have a duty to protect the fetus, but deny that they do so in virtue of the vulnerability of the fetus to the mother. Such a strategy is not likely to help their position, as other available accounts of special obligations are even less supportive (such as the view that special obligations only arise when someone voluntarily takes them on (Brake, 2010), which clearly isn’t the case when someone seeks an abortion).
For people who support the Texas law, intellectual consistency demands they also support compulsory organ donation. Thus, supporters should also consider legislation compelling parents to donate organs and tissues to their children, even if they don’t want to, and even if doing so presents a significant risk to the parent. Indeed, they should also want to deputize citizens to enforce the law, such that there is a $10,000 bounty on biologically compatible parents who fail to donate.
But if such a policy is unacceptable, so is the Texas law.
Parker Crutchfield, PhD, is Associate Professor in the Department of Medical Ethics, Humanities, and Law at Western Michigan University Homer Stryker M.D. School of Medicine. His research interests include biomedical and public health ethics, moral psychology, and epistemology. His book, Moral Enhancement and the Public Good, was released by Routledge in 2021.
Emily Carroll is a third-year medical student at Western Michigan University Homer Stryker M.D. School of Medicine. She completed her undergraduate studies in psychology and biology at McGill University. Her research interests in medical school include bioethics and public health.
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References
- Brake, E. (2010). Willing Parents: A Voluntarist Account of Parental Role Obligations. In D. Archard & D. Benatar (Eds.), Procreation and Parenthood: The Ethics of Bearing and Rearing Children. Oxford University Press.
- Goodin, R. E. (1986). Protecting the vulnerable: A re-analysis of our social responsibilities. University of Chicago Press.
- Jeske, D. Special Obligations, The Stanford Encyclopedia of Philosophy (Fall 2019 Edition), Edward N. Zalta (ed.), https://plato.stanford.edu/archives/fall2019/entries/special-obligations/.
- Lentine, K. L., & Patel, A. (2012). Risks and Outcomes of Living Donation. Advances in Chronic Kidney Disease, 19(4), 220–228. https:/doi.org/10.1053/j.ackd.2011.09.005.
- Liptak, A., Goodman, J.D., Tavernise, S. Supreme Court, Breaking Silence, Won’t Block Texas Abortion Law. The New York Times. September 1, 2021. https://www.nytimes.com/2021/09/01/us/supreme-court-texas-abortion.html.
- McCammon, S. What The Texas Abortion Ban Does — And What It Means For Other States. NPR. September 1, 2021. https://www.npr.org/2021/09/01/1033202132/texas-abortion-ban-what-happens-next.
- National Kidney Foundation. General Information on Living Donation. https://www.kidney.org/transplantation/livingdonors/general-information-living-donation.
MSU Bioethics 
Thanks for this post! As I thought about your argument, I found myself wondering if it depends on rejecting that there’s a moral distinction between killing and letting die. (Just to clarify, I’m not taking a stand on that distinction; I just want to explore its implications for your argument.) Suppose a defender of the Texas law responded to you by saying that in the case of an abortion, the fetus is actually being killed, whereas in the case of failing to provide a kidney, the parent is just letting the child die and so it’s not the same moral scenario. With that in mind, do you need to reject the notion that the killing/letting die distinction is morally significant in order for your argument to go through? (I suppose another way for you to respond might be to say that at least some cases of abortion wouldn’t have to involve killing; perhaps the abortion could be performed in such a way that the mother just stops providing support to the fetus but the fetus isn’t actually killed.) Anyway, I just wanted to clarify your thoughts on this. Thanks again for a nice accessible introduction to your article!
Excellent question, Prof. Elliott!
The short answer is, no, our argument doesn’t depend on denying the distinction between killing and allowing to die.
But your question highlights the importance of the duty to protect in our argument. We need the duty to protect, because this special obligation obviously prohibits killing, but it also prohibits allowing to die, at least for those that one must protect. The special obligation requires a “shielding” that ordinary obligations between strangers don’t require. I must not only refrain from killing my children, I must also refrain from allowing them to die. To allow them to die, when it is in my power to shield them from death (or suffering), is to violate my special obligation to them. While I must, in most cases, not kill other people, in most cases I don’t have the obligation to shield them from harm.
This line of thinking tracks pretty well, I think, with how society treats the duty to protect. We regard child abuse and child neglect as equivalently immoral. Indeed, some times neglect is significantly worse–neglecting to feed one’s infant for two weeks is worse than hitting them once a day. The latter may not kill them; the former likely will. But the wrongness of neglect only arises in the context of the duty to protect: no one else is obligated to feed the infant, though everyone is obligated to not hit them.
So, we can recognize the moral distinction between killing and allowing to die, so long as we are granted that a duty to protect holds between mother and fetus and parent and child. But it would be additionally unwise, I think, of the supporter of the Texas law to fall back on the killing/allowing to die distinction. The reason is that there are *lots* of circumstances in which killing is morally justifiable. One of these, arguably, is when one invades your life to a significant degree. “Stand Your Ground” laws, which Texas has passed, are presumably based on this reasoning. However, the Texas abortion law doesn’t allow abortion when the fetus results from rape. Or, to take Thomson’s violinst case as a reference point, falling back on the killing/allowing permits the removal of the violinist. But falling back on the duty to protect doesn’t.