The Costs We Refuse to Count

Every position in the abortion debate, pursued to its logical conclusion and implemented as policy, produces consequences that are genuinely harmful – consequences its proponents must honestly confront. There are no cost-free answers. The refusal to acknowledge the costs of one’s own position is one of the primary obstacles to productive dialogue.

Elena’s position – unrestricted access at all stages – means that some late-term abortions will terminate lives that are, by any reasonable standard, viable human beings capable of feeling pain and surviving outside the womb. While such cases are rare and overwhelmingly involve severe medical complications, a legal framework that draws no lines sends a moral signal that many people across the spectrum find deeply disturbing. It also alienates the moderate majority, making coalition-building harder and potentially provoking backlash that results in policies more restrictive than would otherwise prevail. A position of zero restrictions does not command majority support. Insisting on it may come at the cost of securing the broad, stable protections that would serve most women most of the time.

Marcus’s position – legal abortion through viability with reasonable regulation – faces the problem that the viability standard is a moving target, shifting with advances in neonatal medicine rather than with any moral or philosophical development. More practically, the regulatory framework he envisions has proved, under Casey’s “undue burden” standard, extraordinarily difficult to implement without being weaponized. Regulations that appeared reasonable in the abstract were systematically used to close clinics, delay access, and impose costs falling disproportionately on poor women and women of color. His position depends on a regulatory system staffed by good-faith actors, and the American political system has repeatedly demonstrated that this assumption is unwarranted.

Sarah’s position – the centrist compromise – suffers from political impracticability and inherent instability. A 15-week standard satisfies no one deeply and energizes no one politically. It will be challenged from the left as an arbitrary restriction and from the right as an arbitrary license to kill. Its reliance on accompanying social programs depends on bipartisan cooperation the current environment cannot deliver. If those programs are not enacted – and they likely will not be – the compromise amounts to restriction without the investment that would make it tolerable. Both sides will charge moral cowardice: that by refusing to take a clear stance on the fundamental question, the centrist produces a framework principled about nothing except its own moderation.

James’s position – prohibition after a fetal heartbeat with exceptions – functionally eliminates most legal access, because many women do not know they are pregnant at six weeks. The exceptions for rape and incest, while morally important, are extraordinarily difficult to implement: they require police reports that many survivors cannot or will not file, or subjective “good faith” standards vulnerable to abuse. Women denied wanted abortions experience worse physical and mental health, greater economic hardship, and higher rates of remaining in abusive relationships. Their existing children suffer measurably worse outcomes. And in an era of medication abortion obtainable through the mail, criminal prohibition drives abortion underground without significantly reducing its incidence.

Ruth’s position – near-total prohibition from conception – carries consequences extensively documented by history and international comparison. Countries with near-total bans do not have lower abortion rates; they have higher rates of unsafe abortion and maternal mortality. The WHO estimates 23,000 women die annually from unsafe procedures, overwhelmingly in highly restrictive countries. A near-total American ban would create a two-tiered system: wealthy women traveling or accessing medication through informal channels, poor women resorting to dangerous methods. The refusal to make exceptions for rape and incest imposes extraordinary burdens on women who have already suffered the most intimate violence – burdens the majority of Americans, including the majority of self-identified pro-life Americans, regard as unjust. Enforcement would require unprecedented surveillance of women’s reproductive lives: monitoring pregnancies, investigating miscarriages, policing the mail. The carceral infrastructure necessary is fundamentally in tension with conservatism’s stated commitment to limited government.

The deepest truth about the abortion debate is that it is a genuine moral tragedy – not in the colloquial sense of something sad, but in the classical sense: a situation in which legitimate values are in irreconcilable conflict and every choice entails real loss. The woman who terminates a pregnancy loses something, even if she believes it was right. The society that compels a woman to carry an unwanted pregnancy loses something, even if it believes it is protecting life. There is no resolution that eliminates all of these losses. There is only the ongoing, painful, necessary work of a self-governing society trying to navigate moral complexity with as much wisdom, compassion, and honesty as it can summon – knowing it will never get the answer perfectly right, and that the attempt is itself an expression of the moral seriousness the question demands.

This debate will not resolve. Biology will not stop making pregnancy uniquely burdensome and uniquely miraculous. The question of personhood will not yield to science. Faith will not dissolve before secular argument. The gap between men’s and women’s reproductive experiences will not disappear. But what can change is the quality of the conversation: the willingness to acknowledge the costs of one’s own position, to recognize the humanity of those who disagree, and to seek the broadest possible zone of mutual tolerance in a society that must, somehow, hold together despite its deepest divisions.