The Doctor's Dilemma

A pro-life physician's abortion story provokes and troubles.

What does a pro-life doctor do when confronted with a woman whose life is threatened by her pregnancy? Dr. Matthew Loftus, a missionary physician in East Africa, writes a harrowing essay for the New York Times about the day he had to answer this question for himself. The young mother on his table had suffered for days without prenatal care and was now slowly bleeding out, a process that would lead to certain death unless he emptied her uterus. He vividly conveys the stark dilemma to the reader: Kill one patient, or lose two.

It’s a terrifying read, one I don’t recommend for anyone who may be triggered by a graphic description of abortion. I will be as delicate as possible in referring to it in my analysis here. Suffice it to say, Loftus doesn’t spare us the brutality of the procedure, and that is precisely his final point: “Ending a child’s life before birth is so wrong that only saving another life could be worth it.” Yet he sees it as inextricably connected with his vocation as a Christian doctor who has always believed human bodies are sacred, including the body his own hands killed. He struggles to understand why God would have placed this choice before him. Still, in the end, he believes it was good, right, and life-giving. He clings to the hope that one day, he will meet the child in heaven, resurrected in a new body.

Before I get into why I am troubled by this story, its framing, and its timing, I want to extend my genuine sympathy and admiration to Dr. Loftus. His story begins with his passion to serve the poorest of the poor in the direst of straits. He would never have met this young mother in this desperate circumstance had he not sacrificially given himself to the cause of helping mothers like her. It is also clear that his choice profoundly wounded him, and his soul carries the scar to this day. Like Loftus, I am also a Christian who is also pro-life, also believes that human bodies are sacred, and also looks to the resurrection of the dead. My concerns proceed out of this shared faith, a faith from which I don’t intend to exclude Loftus simply because of the choice he made or the way he presents it.

With that out of the way, let me begin with an honest question: Why this story, and why this moment? Obviously, we stand on the verge of what increasingly looks like a stunning reversal of Roe vs. Wade, which will leave individual states to draft their own abortion legislation. But no pending legislation that I’m aware of would eliminate carve-outs for cases when a mother’s life was in imminent danger. Even staunch activists who oppose abortion in rape or incest cases have historically included a life of the mother “asterisk.” Loftus himself says he opposes all exceptions except this one. All of this leaves me genuinely wondering how his story—a story which takes place in a developing nation under highly unusual medical circumstances—is germane to the American post-Roe legal landscape as it appears to be actually opening up before us. What is his goal in sharing it? And further, what is the Times’s goal in platforming a story where, in his own words, a pro-life doctor’s once “simplistic” ethical ideals are shattered through the performing of an abortion? These are two different questions. It seems to me not implausible that they have different answers.

Loftus may have intended to offer his story as a kind of subversive pro-life argument—that the act as he recounts it is so horrific, so scarring, that it should not be an option under any circumstances except to save another life. Perhaps he hopes that someone with a more expansive view of abortion rights will be shocked by it, pause, and reconsider. Maybe such a reader would initially be drawn in by the headline, “When an Abortion is Pro-Life,” and get something they weren’t expecting. I presume Loftus himself didn’t compose that headline, though he may well have approved it.

I wonder, though, if his rhetoric might unintentionally enable the opposite argument. Though he is sorrowful and sober about the procedure, he believes his hand was, literally, forced. As gruesome as his task was, he had to steel himself and see it through, similar to the way a soldier must harden himself to kill. His training taught him to suppress his basic human instinct not to take an innocent life, in service of the best medical outcome he could engineer.

At this point, a doctor who didn’t share Loftus’s generally pro-life commitments might say, “Fair enough. You drew your line there. But I draw my line here. [Insert other circumstances around a woman’s health, mental state, well-being, security, etc., short of a life-or-death crisis.] I, like you, must train myself to push past the basic horror of taking a helpless human life. I, like you, must steady my mind and my hands to do what has to be done for the sake of a greater good. We simply differ on the necessary conditions for that greater good.”

This passage also gives me pause, as Loftus seeks to reconcile the violent act of abortion with his life and health-giving Christian vocation:

By caring for others now, Christian doctors seek to honor the goodness of our bodies and anticipate this future resurrection. Occasionally we have to amputate, give toxic chemotherapy or otherwise tear apart the body for the sake of healing. This power shouldn’t be used lightly, and in the case of a living human person in the womb it should be only the most extreme circumstances that permit its use. But the power is there, and sometimes we must use it in an irreversible, life-ending way.

Of course, it is also upsetting for the surgeon or the cancer doctor to cause short-term suffering, particularly for children with limited understanding of what’s happening. Yet this does not dishonor the body of the child with a dangerous infection, tumor, etc., because that short-term suffering is counted worth it for the child’s own long-term health and healing. And there’s the rub. When Loftus writes in this context that doctors must sometimes “tear apart the body for the sake of healing,” it must be asked, “Yes, but whose body? And whose healing?”

By now, readers may be thinking it’s all very well for me to sit in my armchair and opine about a situation I will never face, but what would I actually do, in Loftus’s shoes?

As he describes the situation, the mother had a massive blood clot under her uterus, and his tiny hospital had only one unit of blood on hand in their micro-fridge. It’s not made precisely clear what good that blood might or might not have done. Loftus says they needed to “save” it for a scenario where it was guaranteed to do good. My fairest reading of this is that he judged it would have little or no saving effect for this mother. Meanwhile, he doesn’t give any other details on why they chose not to perform a C-section or hysterectomy, saying only that the baby was a mere 18 weeks along and thus not viable. Not being a doctor, I can only guess why they didn’t remove the child by one of these non-violent means. Perhaps either operation would have been guaranteed to kill the mother in her precarious condition. However, as a pure point of ethics, I do believe a premature delivery is different in kind from a violent attack. True, a premature baby may be all but guaranteed not to survive outside the womb, but it doesn’t seem intrinsically unethical for doctors to make such a gamble when they are trying valiantly to care for both patients.

But, you might press, what if even those options were not on the table for Loftus and his team? What if there truly was nothing for it but to take the violent action he did? What then?

Here I’ll come clean: I still think it was wrong. Understandable, certainly. A choice and a soul wound for which I can extend sympathy, to be sure. But my spade is still turned on the fundamental moral axiom that it is intrinsically wrong to kill an innocent human being, regardless of whether the ending of that life is the ultimate intended effect. Here begins many an ethics back-and-forth over the principle of double effect, the active-passive distinction, etc., etc. Of course, these are all conversations I’ve had multiple times, all questions I’ve thought through and worked out in my own way. Without turning this into an ethics paper, as a point of social interest I will say I once saw a very articulate secular pro-lifer lay out this same reasoning, with the same conclusion. This is a piece unto itself, but the idea that pro-life logic hinges on a “religious” hang-up seems to sit in tension with the fact that a secular pro-lifer can land “to the right” of a Christian doctor on this question. Indeed, for Loftus, the Christian doctrine of the resurrection theologically contextualizes his choice, helping to ease the burden. As should be clear by now, that is a theological contextualization that sits uneasily with me.

That great debate looms over this intimate tragedy. Space only permitted me to scratch the surface of it here. But the coming weeks, months and years should provide ample opportunity for it to receive the depth it deserves. For now, I remain unsettled.

Addendum: If you appreciated this essay and would like to hear me dig a bit more into all this, here’s a long podcast I recorded with Jay Shapiro. Jay is a pro-choice atheist, but we had a civil dialogue nonetheless.