Correspondence

Women's Decisions about Abortion

N Engl J Med 1993; 329:1579-1580November 18, 1993

Article

To the Editor:

As one of the dissenting members of the Human Fetal Tissue Transplantation Research Panel, I believe that Kassirer and Angell (Nov. 26, 1992, issue)1 too easily dismissed our concern that transplantation therapy using tissue from induced abortion would encourage abortion.

Many women are ambivalent about abortion, and many find the decision difficult to make2,3. About one third change their mind at least once3,4. Women may vacillate because the decision is normally based on more than one factor4,5. For these women, “the pros and cons of the decision [are] somewhat evenly balanced,”4 and abortion is only a marginal good. For some women, knowledge that their fetal tissue could save someone's life can only tip the balance toward having the abortion.

Kassirer and Angell make two other critical errors. First, they claim that the National Institutes of Health guidelines would ensure that a woman's decision about abortion would be “totally independent” of her decision about tissue donation. In fact, if fetal-tissue transplantation became successful, it would be common knowledge that fetal tissue could be used to save someone's life. That abortion clinics do not mention this does not prevent women from considering it in their abortion decision.

Second, Kassirer and Angell claim that, even if women knew about the therapeutic use of fetal tissue, they would not be swayed, because they would be considering only “powerful personal factors, not abstract generosity toward anonymous patients with Parkinson's disease.” In fact, women considering abortion are motivated not only by self-interest but also by concern for others. In one study more than 20 percent of women had abortions because their husbands or partners wanted them to,5 and more than 25 percent of minors were influenced by their parents' wishes5.

James Bopp, Jr.
Bopp, Coleson & Bostrom, Terre Haute, IN 47808-8100

5 References

1. 1

   Kassirer JP, Angell M. The use of fetal tissue in research on Parkinson's disease. N Engl J Med 1992;327:1591-1592
   Full Text | Web of Science | Medline

2. 2

   Kerenyi TD, Glascock EL, Horowitz ML. Reasons for delayed abortion: results of four hundred interviews. Am J Obstet Gynecol 1973;117:299-311
   Web of Science | Medline

3. 3

   Bracken MB. The stability of the decision to seek induced abortion. In: The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Research on the fetus: appendix. Washington, D.C.: Department of Health, Education, and Welfare, 1975:16-1-16-23. (DHEW publication no. (OS) 76-128.)
   

4. 4

   Bracken MB, Klerman LV, Bracken M. Abortion, adoption, or motherhood: an empirical study of decision-making during pregnancy. Am J Obstet Gynecol 1978;130:251-262
   Web of Science | Medline

5. 5

   Torres A, Forrest JD. Why do women have abortions? Fam Plann Perspect 1988;20:169-176
   CrossRef | Medline

Author/Editor Response

The editors reply:

Mr. Bopp's own references make it clear that women decide whether to have an abortion on the basis of personal factors, not abstract altruism. Torres and Forrest (Bopp's reference 5) list 12 reasons given by the women in their sample, and all of them are personal. As examples, the first three reasons were “woman is concerned about how having a baby could change her life,” “woman can't afford baby now,” and “woman has problems with relationship or wants to avoid single parenthood.” Only 1 percent said that their partner's wish was the most important reason, and less than 0.5 percent said that their parents' wish was most important. Even these reasons have to do with personal relationships, and they are quite different from a desire to benefit an anonymous patient with Parkinson's disease. In our view, Mr. Bopp is stretching things.

Jerome P. Kassirer, M.D.
Marcia Angell, M.D.