The central philosophical question posed in Fritz Oehschlaeger’s Procreative Ethics and Paul Hinlicky’s review of the work relates to the origin and the identity of the self and the moral responsibilities of that self to others. Both works lead their readers towards a conclusion that we have moral responsibilities to those in our communities. As Christians, both authors echo the familiar refrain that we are called to be “servants of all,” particularly servants to those who depend upon us for life itself. This writer’s refrain is similar, however, she finds that the conversations concerning the moral questions surrounding the beginnings of human life must center upon a relational understanding of the self.
 Oehschlaeger’s first chapter deals with contraception and, thus, the meaning of sexuality. This chapter is a necessary part of the discussion at hand. The question of contraception asks whether there is a meaning for sexuality other than procreation. Specifically Oehschlaeger wants to build an argument for contraception from natural law, thus claiming that there is natural meaning to sexuality beyond procreation. The issue is far from academic. Today, there are many who believe, with the world’s population over 7 billion, that access to contraception is a moral good. Simultaneously there are those who claim that contraception is a moral evil that promotes a culture of death.
 A utilitarian might point to the fact that many Americans cheered the lower teen pregnancy and abortion rates as well as lower STD and AIDS infections in these past two decades when substantial quality sexual education has existed in public schools along with better access to birth control. A utilitarian might argue that current politics have put these two factors in jeopardy. However, rather than discuss the practical implications of the discussion of contraception this author wishes to turn to the philosophical discussion of the meaning of sexuality.
 Oehlschlaeger rightly discusses the history of the philosophy of sex as linked to culture and medical technology. Certainly Augustine’s insistence that sex is at best a necessary evil needed for the procreation of children owes much to the 4th century’s Socratic, Stoic, and even Gnostic cultural repugnance for the flesh. Certainly Thomas’ and Luther’s insistence that healthy sexuality must be open to the production of children was tied to both a misunderstanding of the role of the sperm as homunculus and the real understanding of the fragility of human life in medieval Europe. But what is missing from Oehschlaeger’s history is a female perspective on sex. While there are far fewer female theologians and philosophers in this era than male, the ones that do write about sexuality have a radically different philosophical cast, one that Simone de Beauvoir rightly places as “mystical” and “holy”. Rather than speaking of “cruel lust”, Hildegard of Bingen discusses the necessity of the female orgasm for both the mother and the offspring’s good health. Rather than criticizing the sin of desire, Heloise claims that her love is more pure as Abelard’s whore than as his wife. Rather than denouncing the evils of the flesh, Venetian courtesan Veronica Franco extols the holiness of sex even when decrying the horrors of prostitution. These three medieval woman saw their bodies in relationship; in relationship to the earth, to their families, to their cloisters, to their cities, to the children they bore. Perhaps their relational understanding of their own selves caused them to see sexuality differently than their male counterparts. Hildegard saw poor women who were raped, Heloise certainly saw the consequences of her own affair, and Franco cautioned her friends to prevent their daughters from becoming courtesans. But despite this they did not see sin in sexuality per se. Moreover, the holiness they saw in sexuality did not come from the outcome of procreation. Hildegard extols virginity, but says plainly that many women cannot live full and healthy lives without regular sex. Although both Heloise and Franco loved the children they produced, clearly neither saw the meaning and purpose of their sexuality as procreative. Rather these three medieval women saw sexuality as part of the full human experience. In sex, a partner submits herself to the other and recognizes that the lines between selves are mostly illusion.
 In this view, sex does not need to have a set of narrow rules in order to make it holy—the holiness comes from the love of the relationship and the submission to the whole one becomes with one’s partner. Love, of course, is the guiding rule, which is why Franco ultimately denounces prostitution to a city that objectified its courtesans and Hildegard denounces rape to an aristocracy that believed peasants’ bodies were the property of the landowners. Contraception does not, however, violate love. And as Oehschlaeger rightly points out, contraception allows for many parents the ability for more full child- rearing. This view of sexuality as union between partners, symbolic of the greater unity that holds individuals in real community, is not opposed to the view that sexuality is linked to procreation. Rather it forms the necessary understanding of the self as relational that makes other parts of the discussion about procreative ethics sensible.
Conception and the origins of selfhood
 When sex is understood as a loving practice that brings a couple together in a fuller understanding of their mutual need, dependence, and love, there is less confusion between sex and violence and less possibility for casual or narcissistic sex. Thus, a healthier, more honest view of sexuality may be the first step to framing the origin of life questions.
 This author fully agrees with both Oehschlaeger and Hinlicky’s assessment that abortion is always a tragedy. Like Oehlschlaeger, she agrees that abortion needs to remain legal and safe in contemporary American society; but like Hinlicky she agrees that such society needs to be radically reformed in order to lower the number of abortions. In general, this is the position of the majority of pro-choice advocates. Former President Clinton’s desire to make abortion safe, legal and rare was echoed when President Obama said that pro-choice and pro-life advocates ultimately want the same outcome, far fewer abortions in the U.S. While the number of performed abortions did drop radically after 1992, abortion is still hardly rare in the U.S. One must wonder, as Oehlschlaeger does, what is happening in a nation that sees abortion so often as a solution to an unexpected pregnancy. This writer wishes to put forth the hypothesis that a main hindrance to real pro-life policies is the philosophical misunderstanding of the relational nature of the self in U.S. culture and politics.
 One of the most common arguments for an anti-abortion stance is that the fetus is a totally dependent but unique, irreplaceable, independent being. The inferred corollary is that all born humans are independent beings capable of self-reliance. While Oehschlaeger makes strong arguments for distinguishing between killing and letting die, he fails to assert strongly enough the more honest view of both the relational nature of the fetus and the relational nature of born members in society.
 Oehschlaeger makes the argument that the living self begins with conception. This view implies the need for a discussion of the moral questions surrounding IVF, embryonic stem cell research, and some forms of IUDs and hormone therapies. Neither Hinlicky nor Oehschlaeger discuss these issues specifically although both firmly assert their view that a unique irreplaceable self begins at conception. Importantly, the issues above all occur because the embryo is unique as a stage of human development. The embryo is not a homunculus. Rather the embryo can become any number of possibilities. The embryonic cells can become 1, 2, 3 or more complete individual human babies as Oehlschlaeger mentions. However, given certain stimulation, the cells can become therapeutic cells rather than fetuses. The majority of conceived embryos do not become fetuses but become tissue that is reabsorbed into the mother’s body or is discarded. Even embryos that securely implant do not always develop into fetuses, some become only placentas resulting in “empty sack pregnancies.” What the embryo will become depends completely on the embryo’s relationship to its environment. Some of that relationship can be manipulated by scientists; much of that relationship is still mysterious to doctors, parents, and researchers. What is known via empirical evidence is that the embryo has no chance of developing into a fetus without a relationship with a mother.
 Thus, the pregnant mother is in relationship with her embryo. If the embryo develops into a fetus, it does so by a process that turns her flesh into the substance of the fetus. The frequently considered concept of the pregnant woman as a unique self who is housing a unique self is simply false. The embryo or fetus and the mother are in a relationship so complete and complex that no mathematician can definitely state whether they are one or two. The pregnant woman is both. Everything she eats, every hormone she produces, every activity she does affects the fetus substantially. And the growth, hormone production, and movements of the fetus affect her substantially, both physically and psychologically. Her heart’s size, her brain’s chemical structure, and the whole of her body and psyche are affected by the fetus. In short, she is a different self because of the pregnancy, and some of those differences are irrevocable. Pregnancy is a relationship in which the woman and her embryo are both substantially created in relationship with each other.
 Oehlschlaeger suggests that the divisions between early abortions and later abortions are based on a “person like me argument”. Many doctors claim that the divisions are based on the safety of the procedure for the mother. Recognizing the relationship of pregnancy adds another dimension to the discussion. While the pregnant woman is paradoxically both one being and two for the whole of her pregnancy, there seems to be a time when nature seems to say the relationship looks more like one person and a time when nature suggests the relationship looks more like two people. Pre-fetal embryos that can become any cell in the human body, or a placenta, or a fetus depending on a complex system of relational causation, are rarely detectable even by the mother. Fetuses at the age of 6 weeks can be detected on transvaginal ultrasounds but are not formed fully. Indeed, their development radically depends on factors of their relationship with the mother’s body. Missing or extraneous limbs, malformed organs, phenotypical gender that differs from genotype, and other anomalies are still possible at this stage of development. In other words, the child this young fetus will become is still radically undetermined. However, fetuses after the age of 12 weeks have the foundation of their organs, genitals, and limbs. And overwhelmingly these fetuses survive if not aborted. After 25 weeks, the majority of fetuses are developed to such a point that they can survive even after being separated from their mothers if given extensive post-natal care. After 36 weeks, the vast majority of fetuses can survive being separated from their mothers without advanced technology. However, even a full term newborn will change and evolve throughout its lifetime. And even a full term newborn, or 5 year old child, cannot survive without significant human relationship.
 The reason for the discussion of fetal age is not to undermine the tragedy that all abortion is, but it is to reinforce the obvious reality that embryos and fetuses do not simply depend on the mother for life, they depend on the mother and the mother’s environment to determine the very shape of their selves. Oehschlaeger asks in his later chapters whether a fetus who has had genetic therapy is a different individual after the therapy. This author would argue that not only genetic change but any phenotypical change alters the evolving self. The mother’s prescription medication may cause a birth defect that will radically alter the self of the child. The contamination in the water the mother drinks will have a similar affect. Given the complexity of human fetal development, emotional, dietary, social and psychological conditions all factor into creating the self that will be born. Moreover, the relationships and environment the newborn encounters will also factor into that evolving self. Really, there is no moment in which the human being becomes its essential self, for the self is constantly substantially changing: physically, structurally, psychologically, and spiritually.
Society and a More Honest Understanding of the Self
 Thus, even the mother is not an essential, free, independent, and self-reliant self. She is, also, part of a relationship—a relationship with her embryo or fetus, but also a relationship with her sexual partner, her family, and her society. Most pro-life and pro-choice advocates falsely assert that the mother stands alone with the choice to keep or kill her fetus. If the frequently cited statistics published by the Guttmacher Institute are to be believed, the majority of women who have abortions live in poverty and claim that they wish they could change their circumstances so that they could keep their pregnancies.1 Thus, changing the circumstances of poverty in the U.S. could potentially prevent the majority of abortions in this country.
There are clearly two issues at stake. First is the issue of the prevention of unwanted pregnancy. Second is the issue of putting forth the conditions so that unplanned pregnancies do not end in abortion. Both issues are better framed with relational understandings of the self. Understanding the physical, psychological, and spiritual reasons for unplanned pregnancy is critical. These pregnancies, by definition, do not occur because of the choice of independent female selves. These pregnancies occur within relationships and environments which surround and form the women’s selves.
 The current author is not an expert on gender studies or cultural psychology and will limit her comments to a few anecdotal measures on the topic of preventing unplanned pregnancies. First, rape and incest are two causes of unwanted pregnancy that obviously demonstrate the way a woman’s self is shaped and violated by the relationships around her. The individuals in society must constantly advocate for healthy, consensual, loving relationships and constantly condemn violent or oppressive sex acts. The author cannot help but mourn that a leading 20th Century Catholic intellectual like G.E. Anscombe suggested publically that rape is less sinful than marital intercourse using contraceptives. Sadly, rape and incest are still overlooked and even condoned in certain segments of society. However, this can be changed; and a firm condemnation of rape along with a healthy understanding of sexuality can change our society’s sexual practices. Second, statistics show that there is a significant statistical correlation between sexual education in public schools and lower teen pregnancy rates.2 This author would argue that this is not simply because of the increased knowledge about contraceptives. As Mary Wollstonecraft claimed in the 18th century, girls and boys who are given accurate information about their bodies and their sexuality are less likely to be victimized or seduced and less likely to sexually objectify each other. Third, it stands to reason that quality education as a whole, including cultural enrichment, athletic competition, and optimism about the economic future, all encourage men and women to seek fulfillment in many avenues other than sexuality.
 While Oehschlaeger makes many quality arguments on the distinction between killing and letting die, this author would like to argue that responsibility for abortion (like the responsibility for killing civilians in war) lies not only with the mother (or the soldier) but with the members of the society that inform the conditions and policies that suggest that the abortion (or the “collatoral damage”) is necessary. Society is, of course, complex, and here too the author makes only a few select anecdotal points. First, as Hinlicky states at the beginning of his review, many political and social policies in the U.S. are debated solely in terms of economic merit. This view that human life’s worth is measurable in terms of dollars is the heart of the problem. This is not to say that women have abortions because they think pregnancy will hurt them economically. Rather, the majority of women report that they have abortions because they believe they have no economic alternative. Sadly, women in poverty who keep their babies often find themselves in dire straits. This author has watched many students make the decision to keep their pregnancies and have their babies even though this meant living in homeless shelters rather than dorm rooms. Further, in the state of Wisconsin, mothers cannot qualify for public assistance unless they seek outside employment. Thus, they cannot go to school full time or choose to stay home with their babies. Thus, many mothers must drop out of college to take minimum wage jobs. Universally, their babies are forced into daycare centers paid for by the state. While these women could have used their public assistance money to stay in college and obtain higher paying, more satisfying careers that best used their talents, the system rewards large corporations who employ these women at wages so low that tax payers must subsidize their salaries with health care and daycare benefits. The similarities to the way slave women were forced to leave their babies unattended while working for their masters cannot be ignored. While this author applauds those women who have taken on these burdens in order to nurture the children they conceived, she believes that the guilt of their poverty and the poverty of their children lies on us all who preserve the current system.
 It is this guilt, in the sense of debt, that betrays the fundamental error in a society that holds as axiomatic a belief in independent, essential, self-reliant selves. We are substantially altered by the relationships that surround us. For example, Milwaukee’s African American infant mortality rate is higher than that in most third world nations. The deaths of so many children affect the selves of all Milwaukee’s residents. The cost of poverty is not just the cost of taxpayer subsidized health care and public assistance. The cost of poverty affects our community, our air, our water, our education system, our democracy, our economy, our psychological fears and hopes, in short our very selves. We ought to care for the members of our community because they depend on us. But we also ought to recognize that we depend on them.
 Understanding ourselves as part of a relationship changes our understanding of our rights and responsibilities to others. Like the triune God in whose image we are made, we are both unique whole selves and evolving, relational beings. Recovering an understanding of our relational natures changes our understanding of our sexual and procreative practices for the better. Oehlschlaeger’s book is an intelligent and insightful beginning to a conversation that calls all of us to begin to take better care of each other.
Jennifer Hockenbery Dragseth is Professor of philosophy at Mount Mary College. She is the editor of The Devil’s Whore: Reason and Philosophy in the Lutheran Tradition (Fortress Press, 2011).
1. Many pro-life and pro-choice groups site the statistics given by the Guttmacher Institute that shows a strong statistical correlation between poverty and abortion rates (80% of U.S. abortions are performed on women whose income is below the poverty line in 2005.) as well as an articulated correlation. (75% of the women asked who had abortions said that they chose abortion because they could not afford the baby.) See www.guttmacher.com for the 2005 statistics and other reports. These statistics are in-line with other more informal surveys done by other groups around the U.S.
2. Several studies have shown a statistical correlation between comprehensive sexual education and lower abortion rates. See, for example, Stanger-Hall KF, Hall DW (2011) Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S. PLoS ONE 6(10): e24658. doi:10.1371/journal.pone.0024658.
Other studies have shown this correlation to be true internationally. Those countries with the lowest abortion rates are those countries with the most comprehensive sexual education in schools. See for example, Ketting, E. Visser AP. Contraception in The Netherlands: the low abortion rate explained. Patient Educ Couns. 1994 Jul;23(3):161-71.However, there are some groups that suggest that this correlation is due to other factors in the culture of states and countries that provide comprehensive sexual education.
© November/December 2012
Journal of Lutheran Ethics
Volume 12, Issue 6