Editor’s Note: Read with care, as abortion details are recounted in this commentary.

Arkansas is facing a ballot initiative that aims to enshrine abortion in its state Constitution. The proposed Arkansas Abortion Amendment of 2024, which is supported by Arkansans for Limited Government, was approved by Attorney General Tim Griffin in January of this year. Now, the signatures of 90,704 registered voters are all that is needed to include this amendment on the Nov. 5 ballot.

With Ohio’s Issue 1 passing last November, the Arkansas ballot initiative, and others like it, whether in Florida, Nebraska or elsewhere, must be taken very seriously. Protecting the life of the unborn, health of the mother, and well-formed conscience of health-care professionals is paramount, and must be done, state by state.

The ballot language of Arkansas’ proposed abortion amendment shares some similarities with Ohio’s abortion amendment, also known as the Right to Make Reproductive Decisions Including Abortion Initiative.

For example, Arkansas’ proposal authorizes access to abortion through the first 18 weeks of fetal life (the 20th gestational week) for any reason, and throughout the entirety of pregnancy for cases of rape, incest and fatal fetal anomaly or to protect the life or health of the mother.

Ohio’s abortion amendment mandates access to abortion up to the point of fetal viability for any reason. It allows for limits to be placed after fetal viability, except in cases when abortion is performed to protect the life or health of the mother.

It should be noted that there is no consensus on when precisely a fetal human being is viable, but viability is generally understood to begin between the 23rd and 25th gestational weeks.

According to the American College of Obstetricians and Gynecologists, the chance of survival outside the womb increases from 23% to 76% during that time frame. Before the 23rd week, the chance of extrauterine survival is only 5% to 6%.

The 20th gestational week is the lowest common denominator for abortion access for any reason between Arkansas’ proposed abortion amendment and Ohio’s abortion amendment. By that gestational age, the Mayo Clinic reports the average child in the womb is more than 6 inches long and weighs about 11 ounces. Her sex can be observed by way of ultrasound imaging. Her heart is beating faster than 100 times per minute and pumps nearly 100 pints of blood each day. She rolls and flips in the womb, moves her eyes slowly, and can hear sounds. There is even evidence that suggests a child at this gestational age is able to feel pain.

Juxtapose the humanity of the child in the womb as just described with the way in which her life is taken through abortion.

The typical abortion in the second trimester (13th through the 27th gestational week) is dilation and evacuation (D&E). D&E at the 20th gestational week requires both a cannula and forceps to kill the child and remove her corpse from the mother’s womb. The cannula will pierce the amniotic sac and suction the life-sustaining fluid contained therein. It will also start tearing away at the child. The parts of the child’s body that remain after suctioning will be dismembered with forceps and removed. Access to this series of lethal procedures is what Ohio’s constitutional amendment allows — and what Arkansas’ would allow if passed.

Now, recounting the appalling nature of second-trimester abortions is not to diminish the humanity of human beings who have not yet reached the 20th gestational week. Abortion at any stage of embryonic or fetal development is morally reprehensible. But it is important to put into words the consequences of a “Yes” vote on Arkansas’ proposal. It is unacceptable simply to concede, “Well, at least abortion is limited in the third trimester.” Our youngest brothers and sisters demand the same right to life due to every man, woman and child.

Embryonic and fetal children are not the only victims of abortion. Mothers face serious risks to their health during and after abortion. These risks are both physical and psychological.

For example, the Louisiana Department of Health identifies the following risks that have been associated with abortion: “pelvic infection, incomplete abortion [where fetal body parts remain in the uterus after the abortion is performed], blood clots in the uterus, heavy bleeding, cut or torn cervix, perforation of the uterus wall, anesthesia-related complications.”

Moreover, the health department reports that some women experience “depression, grief, anxiety, lowered self-esteem, regret, attachment, flashbacks, and substance abuse” after abortion. Proponents may want women to “Shout Their Abortion,” but untold numbers of women regret theirs every day.

John Donne famously exclaimed, “No man is an island.” We live in community with one another. Our actions, for better or worse, affect our neighbor. Each abortion requires medical participation — a physician to prescribe and a pharmacist to fill the prescription; a physician to operate the cannula or forceps, a nurse to assist, and an ultrasound technician to visualize the child in the womb, and so on. Yet abortion is an act that is entirely antithetical to the very nature of medicine, which aims to heal, not harm; to care for, not kill.

The Hippocratic Oath unequivocally declares, “… I will not give a woman a pessary to cause an abortion.” There are countless doctors who refuse to participate in an act that harms their patients and kills their patients’ children. They realize that abortion is morally reprehensible and medically indefensible.

Even when confronted with the often-used argument that abortion must be accessible when a mother’s life is in peril, many physicians and specialists reject the supposed medical legitimacy of abortion, when properly understood. For example, to date, more than 1,000 professionals in the fields of obstetrics and gynecology signed a document titled the “Dublin Declaration.” It states, “[W]e affirm that direct abortion — the purposeful destruction of the unborn child — is not medically necessary to save the life of a woman.”

Ohio’s abortion amendment is a bellwether on how a constitutional amendment will affect the conscience rights of health professionals who refuse to participate in this fundamentally anti-life, anti-woman and anti-medicine act. Its passage raises many important questions that have yet to be answered.

How will institutions, professional organizations, licensing bodies and state governments respond to an employee who refuses to accede to a patient’s request to exercise her so-called “constitutional right to abortion”? Will these life-affirming health-care professionals be softly or overtly coerced to participate? Will a concession be made where physicians won’t be forced to participate directly, but will be mandated to write a referral, which is in and of itself morally unacceptable?

Consider the implications on health care if the so-called “constitutional right to abortion” is broadly understood to oblige Catholic physicians either to participate in an abortion or write a referral for a doctor who would do so in their place. The U.S. Conference of Catholic Bishops promulgated rules that bind Catholic health-care institutions and the professionals they employ. The following directives are worth quoting at length:

“Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. Catholic health care institutions are not to provide abortion services, even based upon the principle of material cooperation …” (“Ethical and Religious Directives,” ERDs, 45).

“Catholic health care services must adopt these Directives as policy, require adherence to them within the institution as a condition for medical privileges and employment, and provide appropriate instruction regarding the Directives for administration, medical and nursing staff, and other personnel” (ERDs, 5).

The Catholic Health Care Association of the U.S. reports that there are 665 Catholic hospitals in the United States, including 294 that provide obstetric services. Those hospitals employ more than 700,000 people full or part time and care for nearly 15% of patients across the country. There are also 1,573 Catholic continuing-care facilities, most of which are in urban areas.

And while those numbers are astonishing, they only account for Catholic health care. There are many other faith-based health-care institutions and individuals who will not participate in, or otherwise cooperate in, providing abortion.

If the federal or state governments in America take a heavy-handed approach to Catholic and other faith-based hospitals and health-care professionals that refuse to provide or refer for abortion, what will be the outcome? Can an already-overtaxed U.S. public-health-care system afford the impending influx of patients who would otherwise be treated by faith-based institutions and individuals?

As ballot initiatives press forward in states like Arkansas, voters must see through abortion proponents’ fearmongering and provocations. Voters should confess the truth that there has never been, nor can there ever be, a constitutional right to kill an innocent human being, including those in the womb. Pretending otherwise denigrates the humanity of our youngest brothers and sisters, imperils the health of women, and will be exploited to undermine the conscience rights of health-care professionals and institutions that affirm life and resolve to do no harm.

The inherent dignity of human life and the fundamental right of religious freedom, together, provide an urgent basis for action. Voters must stand firm, state by state, and protect life, health and conscience on the ballot.

Andrew Kubick is deputy director of the National Center for Religious Freedom Education and research fellow in bioethics and medical conscience at the Religious Freedom Institute. He also serves as personal consultations ethicist at the National Catholic Bioethics Center.