Ethics and abortion for fetal abnormality
By Agnes Fletcher, Peter Garrett, Raanan Gillon, Hilary Rose and Ann Furedi

Introduction

What follows is a transcript of an event held at the Oxford Union in February 1998. At this event, titled Ethics and abortion for fetal abnormality, a number of individuals with influence in the discussions about abortion and disability put forward their different views on the subject. We felt that since what we perceive to be the key themes in the debate about abortion and abnormality were all raised in one place, it was worth publishing the proceedings of the event, to give a wider audience access to what was said. Thanks are due to Maxine Lattimer for her work in transcribing the event.

Ellie Lee:

This discussion has been organised jointly by the Oxford University Pro-Choice Forum and the Oxford Union. It is positive that the Union decided to host such an event, because it is important that there are forums made available where those of us with an interest in ethics and abortion can thrash out some of the issues. I would like to emphasise before we go into the discussion that this is a roundtable discussion rather than a debate. We have people contributing to the discussion who hold a variety of different points of view. The point of this event was to have all those different opinions raised here, and for us to then work through some of the issues. So we do not really have 'sides' as such, rather a range of opinions.

Our first speaker is Agnes Fletcher who is a disability rights activist and worked until very recently for Disability Awareness in Action which is an international disability and human rights organisation. She is now a lobbyist for a different disability rights organisation. Our second speaker is Peter Garrett who is the LIFE research director. Our third speaker is Professor Raanan Gillon who is professor of medical ethics at Imperial College, the editor of the Journal of Medical Ethics and part-time practising GP. Our fourth speaker is Hilary Rose who is a feminist writer on medical technology and reproduction, and is also a visiting research professor in sociology at City University. Our final speaker is Ann Furedi who is the director of Birth Control Trust.

Agnes Fletcher:

Thank you very much for that introduction and for the invitation to speak tonight. My central point is that the rhetoric of choice about selective terminations on the grounds of fetal abnormality only becomes a reality when all choices are adequately supported and when medical and other information and advice is as non-directive as it can be. I do not believe that this is the reality in reproductive services today and I do not believe that this bodes well for the future, as more and more genetic markers for particular characteristics become available.

My approach can be defined as a disability equality perspective. This perspective derives from a definition of disability as a form of social oppression experienced by people with impairments, or people perceived to differ from an idealised norm of what it is to be human. It is a perspective which is related directly to my own experiences as a disabled person with several impairments at least one of which I know to be inheritable, and to my involvement with national, international and grassroots disabled people's organisations.

I want to try to explain to you why many disabled people, including those like myself who are feminists, and who support safe and accessible abortion facilities, feel uncomfortable about selective termination on the grounds of what is called fetal abnormality. Many indeed feel more than uncomfortable. They feel angry and anxious, and those feelings, however unfounded some might believe them to be, deserve to be recognised. Disabled people's anxieties spring from past abuses of medical science and from current practice within reproductive policy, both of which can be defined as eugenic. Some people argue that talk of eugenics is unhelpfully alarmist, and I am not suggesting that we are on the brink of state atrocities. Nevertheless just as geneticists look at our family histories to make predictions about the future, a look at disabled people's collective history can inform us of why people without power and frequently without a voice in policy making may fear developments in medical science.

What I have to say next will be quite familiar to most people so I will be brief. The early part of this century saw sterilisation programmes in Europe and the US principally for 'mental defectives' as they were called. These people were seen as a drain on society and perceived as posing a threat on the grounds that they could contaminate pure breeding stocks. There were strong racial and class undertones to this eugenic ideology but a fear of idiots contaminating the race was central to policy certainly here in the UK. In Germany in the early 1930s the Nazis sterilised about 400 000 disabled people.

Next a list of genetic and psychiatric conditions was drawn up for which killing was permitted. Classed as 'genetic criminals', thousands of disabled people were murdered and the sophisticated methods of mass killing developed were later used to destroy other groups with characteristics seen as hereditary and undesirable. Eugenic ideas continue today at the level of enforced state policy only in China.

In countries like Britain, many disabled people see a lack of support for their rights and dignity expressed most recently in attacks on disability benefits. They live in a culture of oppression that devalues and dehumanises them, and that sees racial, sexual, physical and intellectual differences as a threat to individual and state integrity. Disabled people see pre-natal screening programmes as both part of and contributing to that culture. Globally, more than 80 per cent of impairments are caused by environmental factors relating to poverty and inequality, such as malnutrition, unsafe work practices and polluted water. Yet the holy grail of the human genome is presented as the answer to disability at a population level.

Tests during pregnancy are offered to the majority of women. There is evidence from the National Childbirth Trust of strong pressures on parents to test and to terminate in the case of a positive result. Some of the pressures to abort are related to directiveness in counselling and prejudice on the part of some medical professionals. Others are indirect financial and cultural pressures. Many people who strongly support the existence of abortion services feel less sanguine about widespread attempts to screen out particular characteristics.

Sex selection is objected to in part because it relates to a social statement about the quality or value of a female fetus. There was outcry last year at the possibility of screening to predict future sexual behaviour and the prospect of terminations as a result. Yet if abortion is morally acceptable why should such selective termination be unacceptable? I see the logic behind that question even as I feel for gay friends whose experience of living in a heterosexist culture and of discrimination is exacerbated by such Brave New World prospects.

In parallel to the sense that technology may be used to endorse prejudice, many disabled people are concerned because the current UK law allows termination of pregnancy on the basis of impairment up to the moment of birth, while abortion for other reasons must take place before 24 weeks. Surely as the range of characteristics detectable through genetic technology increases we must at least define 'serious handicap', the term used in the 1990 abortion law, more carefully.

Disabled people feel these dilemmas very strongly. They believe that the ever increasing allocation of resources to predict more and more characteristics in-utero sends a strong message about our worth, and that this is reinforced by the cost benefit analyses that often follow. When you hear that a test for a particular condition has been developed, and you have that condition or you know someone with it that can evoke a feeling of persecution, which may be unwarranted, but is nevertheless genuine.

The message is that such a person is automatically undesirable, that life with that impairment is not worth living. Dan Quayle once said that prediction was difficult, especially about the future, but the widespread terminations of pregnancies affected by Down's Syndrome and Spina Bifida surely provide some evidence of the likely future course of prenatal genetic screening. I read yesterday that more evidence had just been found of the genetic marker of dyslexia. The report referred several times to 'sufferers' but what we in the disability movement would say is that suffering for someone with dyslexia is to a large degree a question of social stigma. The problem is located in the social context in which people find themselves and not within the individual. This holds true for all impairments to a greater or lesser extent. Biology need not be destiny but all too often for those who are sent away to special schools, teased about their appearance, sacked from jobs without redress, turned away from cinemas and restaurants as a fire risk, or because they are seen as upsetting to customers, biology is destiny.

I am not anti-science and I am not anti-abortion but choice should mean choice. Full information should be available within the context of equality. We are far from achieving human rights for disabled people, we are still a relatively young movement. It has been part of that fight for rights that allows me to adopt a pragmatic approach to selective termination. Yet I remain concerned about the wholesale screening out of people who share particular characteristics and that the language of choice will be rhetoric, not reflective of reality until disabled people are afforded dignity and independence. It is difficult to articulate but there are positive aspects to the experience of impairment, to living with the reality of human frailty and the inevitability of death. To be impaired is the fate of all of us at some point in our lives, it is quintessentially human. The drive for bodily perfection and to slay death and disease may be important human impulses but stamping out differences is damaging to us all. In common with others I have found that the pain and fatigue that result from my impairments bring an intensity to other aspects of my life, allow me to focus on my priorities and appreciate the good things.

So, it is time to nail my colours to the mast. What do I believe? I believe that a woman's right to choose to terminate a pregnancy or to continue it is absolute, and her reproductive choices should be supported whether or not she is disabled herself. Impairment is one of the grounds for termination, others are timing, finances, partner status, age, size of family and career. However choices about whether or not to parent a disabled child are not adequately supported and termination should not be advocated by medical professionals as a routine solution to any of these problems without adequate exploration of the alternatives. I believe that although a fetus has no rights in law, in a sense the current law can be said to discriminate against the fetus suspected of having an impairment. A fetus whose actual or potential impairment status is unknown becomes a person at 24 weeks and cannot therefore be terminated unless this is warranted by considerable physical risk to its mother. The fetus thought to be impaired can be terminated at any point up to term even if it is capable of being born alive.

Disabled people are angry about this anomaly. I believe that information available to prospective parents, the context of decision making, the pressure to test and to abort make the notion of free choice less obvious. The lack of access to society and support for disabled children and adults mean that in fact many parents feel they have no choice at all. I believe that disabled people need to provide information about living with impairments and being disabled, to separate out the medical aspects from the social experience and to promote the idea of disabled people as whole and real, not walking or wheeling diseases.

I believe that we need to listen to what the people themselves say about living with impairment and not rely solely on doctors or media images, both of which may be misleading. I believe that we have to recognise that impairment is a continuum and that everyone will make a personal decision about what they find acceptable but we must challenge the automatic equation of impairment with misery. We must actively support the right of people to choose to continue affected pregnancies, much more actively than at present, while upholding women's right to early safe terminations without stigma. I believe we must oppose social and cultural pressure to screen and to terminate routinely while defending individual decisions to do so. And I believe that while striving for good medical care for all and remembering that the majority of impairments are preventable with good nutrition and health care and the alleviation of poverty, we must advocate a society which accepts and respects that differences of appearance and ability are part of being human, that illness and impairment are part of life, that independence and dignity are achievable for all.

I want to stress that I am not seeking to undermine abortion rights. But as a disabled woman with an impairment which is inheritable who is proud and happy to be just who I am, I must raise my concerns and the fears and anxieties of other disabled people even less articulate than myself and certainly without the privilege of my education and upbringing: people who are confined to institutions, people without any educational qualifications or job prospects, people written off at birth as half human to be pitied and locked away. The last 30 years have begun the process of unlocking disabled people, quite literally in many cases, and unlocking their potential. Many disabled people do feel that we need to create an accessible environment and equality for all first, but it will not be long before tests are used to seek out and destroy characteristics such as predicted undesirable height, weight, skin colour or sexuality as well as what we now define as disease. Some disabled people believe that the battle for disability equality is more important.

I accept that may be as a result of their particular and terrible experiences of social oppression. I acknowledge their feelings. For myself I believe that it is wrong to force women to undergo medical interventions against their will: that is why I am against the sterilisation and coerced abortion that is many disabled women's experience, and that is why I have no wish to force any woman to endure an unwanted pregnancy. However, more and more wanted pregnancies may become unwanted as prediction of quality of life on the basis of genetics alone gains increased currency and the impact of social and economic factors on well-being is ignored, and as long as the choice to parent a disabled child in comfort and dignity is not available to the majority. Current threats to disability benefits leave me with little optimism on that score.

Thank you for listening today. I ask you to ensure that other disabled people's voices are heard, those who live in institutions, those who live without the benefit of the education I have had, those whose fear and sense of being devalued makes them less polite and more militant that this Oxford graduate is compelled by her own experiences to be. As a movement we are only just beginning to debate issues of medical ethics. We have been busy trying to secure freedom from discrimination and basic civil rights, busy raising the consciousness and self esteem of ourselves and those even further down the status scale. We need to have the space to debate these issues and so I ask you to value the perspective that disabled people can bring to debates on ethics and to value the perspectives they can share on what it is to be human.

Raanan Gillon:

I want to make a few points before I get substantive as it were. The first is that in ten minutes what I can say is going to be a sketch, so we can hammer out some of the issues after that. The second point is that it is not a debate. I want to reiterate that we are trying to analyse and assess some of the issues.

I am coming to this discussion from the perspective of medical ethics, but also from a perspective of a practising GP, and the question we are discussing is one that arises in my everyday work quite often. The third thing I want to say is that abortion is not necessarily a tremendous tragedy in my experience. I have never had an abortion, but in my experience of dealing with people who want abortions early on, very often it is not the great tragedy that anti-abortion people often make it out. In contrast, when it is a question of aborting for handicap or disability later on in the pregnancy, and when the woman has actually wanted to have that baby then it usually is a pretty tragic experience. So what I say when I start to get more analytical about this issue does not imply that I am ignorant of the fact that in practice it is not just the logical discourse that we should be looking at, but also the very deeply powerful emotions that often go with it.

Finally, by way of introduction I want to say is that it seems to me that in the analysis of the abortion debate it is much more profitable to look at it not actually as a disagreement about morality. It is actually I think a disagreement about scope of morality. We all agree that we should not kill each other or we should not unjustly kill each other. What we disagree about quite radically is what we mean by 'each other', that is to say the scope of this 'right to life' as it is often claimed. It is the right not to be unjustly killed that is radically disagreed about. I will suggest to you that the disagreement turns not primarily on moral grounds but on metaphysical, on philosophical and on theological grounds, and on some mixture of the three. So if we can detach ourselves from the implications, which of course are very moral, and realise that it is actually a very complex philosophical and theological issue it may make it easier not to assume that because somebody disagrees with us therefore they are wicked, which tends to be the assumption.

There is a huge range of positions about the abortion debate, I am not going to go through them but just to remind you that at one level there are people who think that we are a person from the moment of our conception and that we should be treated equally in that respect, as people with all the rights that people have and afford each other. At the other end of the spectrum there is the notion that you do not become a person until after you are born and I will nail my colours to the mast straight away. I am at that end of the spectrum. I think that you need to have a capacity to be self aware to be a person and I do not believe you have a capacity to be self aware even when you are born. It is at least several months after birth that one develops this capacity.

There are a huge range of positions however, and in between the law actually specifies that legally speaking you are a person when you are born, but it gives you certain rights before you are born, as was pointed out. Those rights could be overturned not just because of severe handicap but also because of severe danger to the life of the pregnant woman. That is the position I am going to be starting from and I expect we will be hearing a contrary position fairly soon.

What about some counter arguments to that position? The first one I would like to consider is this notion that to abort in the context of disability or handicap is actually eugenics. I see eugenics as a social decision to produce some sort of social change across the whole of society with some sort of implementation of laws to achieve that. That is a very different matter as I see it, from individuals deciding that they want to bring into the world a certain sort of person and not other sorts of people. I will argue in a minute that this is quite an important distinction, and my own preference is essentially a libertarian one that allow individuals where possible to choose for themselves the sort of reproduction they want.

Set against that will also be a gradualist developmental approach, which reduces that choice the more developed the embryo, fetus and young, new-born baby becomes. Roughly speaking, the position is that very early on in its development when it is newly fertilised, an ovum is not anywhere near a person because it is nowhere near having the capacity to be able to be self-aware. As it gradually develops, it becomes more and more like that, and the abortion law, taking into account the development of that individual fetus, should represent an ever increasing concern to treat it more and more like a person. The rights inherent in this developing human being, are to be set against the libertarian approach that I was arguing for, where the woman has her own choice about whether or not to continue with the pregnancy.

The second counter argument that one hears often is about 'potential'. It is not yet a person some people will say, but it has the potential to be a person. I will just briefly say that I do not think this is sufficient to justify treating whatever has the potential to be a person, as though it already was a person. We simply do not do that in all sorts of other circumstances, as John Harris points out, we all have a potential to be corpses. That certainly does not justify treating each other as though we already were.

The next sort of argument that one hears is 'slippery slope' arguments and I think that is partly what we were hearing in the first contribution. There are two sorts of slippery slope. There is a logical slippery slope which means that if you accept X then you are logically committed to accepting Y. Then there is what they call the empirical slippery slope where it does not necessarily follow, but as a matter of fact it probably will follow, that even if X is okay nevertheless Y which is horrible will happen. Let us look at the logical slippery slope first because quite often you hear this argument.

This argument says, for example we were all embryos, and we were all fetuses and we are all jolly glad that we were not bumped off when we were embryos and fetuses because here we are having a nice life. Therefore it is very unreasonable to bump off any other embryo or fetus. We hear another version of the same thing, giving the example of Beethoven. You get the story of Beethoven who apparently had all sorts of disabilities, and if you had abortion for disabilities in Beethoven's time you would not have had Beethoven, and all the wonders that Beethoven produced. Then there is the same sort of variant which says I am a disabled person, I am very pleased that I was not aborted and therefore let us extend the same sort of concern to all fetuses with disabilities.

The first thing to note about this argument is that it applies equally well to contraception. So if you are going to run along with that line you had better realise it has some pretty important implications because it is just as strong against contraception as it is against abortion. The second point is that actually there is a logical asymmetry which I think is very important to recognise. If you believe that abortion is sometimes justified because the fetus does not yet have the rights that you and I have, and it does not have full moral equivalence, then it is quite possible to accept that the fetus although developing towards being a person, is not yet a person even though it is quite accepted that it is a human being. There is no doubt I think that is a human being.

If that is the case it is quite consistent to say I am very pleased that I who was once an embryo and fetus was not aborted, while at the same time saying it is not the case that all embryos and fetuses will become persons. So there is simply no logical symmetry between the argument of looking back, yes we were all fetuses, and the argument of in imagination looking forward on behalf of a fetus or an embryo and saying if it is allowed to develop then it will become a disabled person, and then it will be jolly pleased to be alive. It is perfectly true but we are only talking about possible people or potential people not about real people.

Therefore there is no logical connection between the two claims that firstly we are here and are pleased not to have been aborted, and secondly therefore all embryos and fetuses should not be aborted. That is pretty important to understand. It is particularly important for people who have disabilities to understand. Now I need to come to the second part of the argument which is the empirical slippery slope.

We have heard a convincing account of the fact that in practice people do not accept this argument. They feel quite passionately that they are being discriminated against. My response to that is try and understand that there is no need to feel discriminated against. There is no logical obligation to feel that, just because somebody decides not to have a baby because it has a disability when it is a fetus. There is no reason to think that therefore it follows that this person will have hostile intent and hostile attitudes towards people who have got disabilities.

On the contrary, in the view that I am proposing if you are a person then you have the rights of a person and indeed the respect of a person regardless of whether you have disabilities or not. There is simply no connection between the earlier position when you are not yet a person and the moral respect that should be accorded to you when you are.

The last part of what I will say is that when it comes to deciding to have a baby, and here I would like to agree with a pro-life argument that I have come across, do not kid yourself that you are going to have an abortion in the interests of that child. That is something that you quite often hear: we have to have an abortion because the fetus has got a disability or handicap and therefore it is in the fetus's interest to be aborted. If you are really genuinely concerned with the interests of the fetus as a child and as a person to be, then do it properly. Put yourself into the mind of this person in your imagination when he or she has been born and has grown up and has thought about it. Then say to yourself 'What would this person decide in terms of the disability concerned, and the alternative for that person not to exist at all?' I think we have got plenty of evidence that people when confronted with that alternative are jolly pleased that they are alive, disabilities or not.

There may be some disabilities that are so awful, like Lesch Nyhan syndrome where people are in constant pain all the time, that everyone would agree potential sufferers would prefer not to exist or to be dead rather than have constant torture. Examples like these are very few and far between. For the vast majority of disabilities, if you are really interested in the interests of the person you must let that person decide. That is usually the best way of finding out what people think. That is in no way to be against making decisions for abortion on the grounds of disability, just to realise, as I am claiming, that you are doing it because that is the sort of choice that you wish to make as a potential parent. You do not want to bring into the world a new person with these sorts of disabilities. It is your own autonomous decision based on your own autonomous views that are driving you, and not I would plead a spurious assumption that you are actually acting on behalf of this person who is not to be.

Peter Garrett:

I would like to paint a picture with three parts. In the first part I would like to set out my stall and tell you something about the perspective I am coming from. Then after that I would like to go back to fundamentals, and address the question of what is the status of the human embryo, because that will automatically encapsulate the status of the embryo with special needs. In the third part I would like to lay before you some objections to the view propounded by Professor Gillon, that we can separate society's attitude to the already born special needs person from the attitude of society to the not yet born special needs person. I would like to suggest to you a fairly bleak picture of the future, some of you may recognise it as already being present with us today, and that bleak picture I think collapses the attempt to distinguish the attitude of society to the already born and the not yet born.

I am a member of the Labour Party and I regard women who are pregnant in difficult circumstances as being somewhat between a rock and a hard place. My great hope on May 1st 1997 was that the champions of socialism, the champions of the downtrodden and the oppressed would march into office and they would immediately start to improve the conditions for women and children in society. I hoped they would immediately start to improve the provision for women during pregnancy and after the birth of their children. I felt that there was some merit in the argument of a friend of mine who said, although she is an Emily's List candidate, that the number of abortions will be reduced under the Labour administration because their social policies will be fantastic. For those of you who do not know an Emily's List candidate is somebody who is female and is committed to a pro-choice stance, or you might term it a pro-abortion stance.

Tragically, one of the things that Labour has contrived to do is to reduce benefits to single mothers. This makes a nonsense of the suggestion that under Labour social policy will move in such a direction that it will be easier to have one's child. In fact it is now easier to go for abortion. If Frank Dobson the Health Secretary has his way then it will be even easier. I would argue that the Labour Government is creating a force which pushes women in the direction of abortion.

As we have already heard from Agnes Fletcher we need to give real choice. Total choice depends upon making sufficient financial wherewithal available, and it also depends upon full disclosure of information. It depends upon allowing young people making the decision between abortion or life the opportunity to listen with a stethoscope to the heartbeat of their unborn child. It means letting young people making decisions about abortion or life see their child on an ultrasound monitor. My confession is that I am still a member of the Labour Party. The tragedy I believe is that we as a society are not moving in a direction of freeing people up for total choice, rather we are confining and reducing choice and we are forcing many women into having abortions because of straightened financial circumstances. I think that is something for which we, as a so-called modern and enlightened society, should be thoroughly ashamed.

Let me come on to the notion of the status of the human embryo. We were told that we should not be cajoled into believing that just because we are all sitting here having a nice life, we should also wish to continue to support the rights of those that have not made it thus far. I feel that we have to regard intellectual analysis in this area as being not purely analytic. If you closed your eyes and reflected on the nine months you spent in your own mother's womb and then answered honestly the question how much of that nine months do I want to disown, as not being a continuum as part of my life, most of you would come up with the conclusion that your life did indeed begin at conception.

The situation regarding the status of the human embryo is of considerable importance because the issue is purportedly addressed in 1983 by the Warnock Commission. In fact the Warnock Commission found that the question was far too difficult. Rather than trying to deal with the hoary ontological decisions that needed to be dealt, with the Warnock Commission said instead let us proceed straight to an analysis of the moral status of the embryo and how it should be treated. As a result we now have this amazing hodgepodge in British law. It says that you can destroy the human embryo up to 14 days in order to gather scientific information, although during that time it has some special designated status and if anybody is found to be keeping human embryos beyond 14 days then the police have the right to impound and destroy them on the grounds that they have now become fully human. This to me seems to be analytically ridiculous, and we should perhaps go back to the Warnock Report and the more recent documents looking at the status of cloned human embryos etc. We should ask for that ontological question to be readdressed.

Professor Gillon's tenet that we should believe that those who are persons are only those who are conscious, is for me extremely difficult because I believe that would lead rapidly to a society which acknowledges infanticide. I would also be very worried about going to sleep at night because if I am not currently expressing my consciousness perhaps I am vulnerable. Maybe he would come back later and explain just how wide his libertarianism would extend. Would it in fact be the case that babies in their cradles sleeping or otherwise would be open to some kind of application of Spartan law where they could be done to death if they did not pass muster in some libertarian lottery.

Let me come onto the central point, to discuss the position not of embryos in general but of those embryos that have special needs. It is the case in British law as Agnes pointed out, that they are discriminated against already. You can abort a child which is less than perfect right up to the moment of birth. The tragedy of the votes that were taken in 1990 is that the House was completely divided and the speaker had to cast a deciding vote in favour of not producing a list of those disabilities and special needs which would warrant abortion. So we have a situation in which you can in fact be aborted up to birth for a harelip or a congenitally displaced hip.

That itself is a scandal to our society and we need to go back and address that. Let me tell you of a recurring dream I have. In the dream I am getting onto a train and my 13 year old son who is currently three, is saying to me: 'What is that strange baby doing sitting on that woman's knee at the back of the train carriage?' I say to him be quiet, be quiet because it is self evident to me that the baby sitting at the back is affected by Down's syndrome. Just after we sit down a woman gets onto the train with her 8 year old daughter, and her daughter says: 'What is that funny looking woman doing with that baby at the back? What is that baby doing, it looks so strange?' And the mother says to the daughter, let us find out. She then says to the woman at the back of the train: 'What do you think you are doing with that thing? Have you not heard about pre-natal diagnosis? Not only am I affronted as a tax payer but my daughter has to look at that monstrosity. You have a duty not to bring people like that into the world because they will not be able to cope with the taunts in the playground. You have affronted me, you have affronted my child, you have affronted your own child.'

It is deeply unpleasant to be involved in that even as a role play, but I believe that we can not simultaneously go down the track of cooing in a politically correct fashion about the special needs people who are already born and at the same time seeking out and destroying those with the same special needs as they live inside the womb of their mothers. The British Set-Cookie: WEBTRENDS_ID=137.222.252.61-3505116880.29271345; expires=Fri, 31-Dec-2010 00:00:00 GMT; path=/ Medical Journal in 1992 declared that a new method of seeking out and destroying babies with Down's syndrome had been found and they proudly announced that the lifetime care costs for a baby with Down's syndrome would be £72 000. Then they announced that the search and destroy costs would be £24 000. So the bottom line is that you, ladies and gentlemen and society at large, save £48 000 every time we kill a baby with Down's syndrome in-utero. Currently 19 couples out of 20 choose to abort babies who have been found to have been suffering from Down's syndrome in the womb. 89 per cent of those who find that their children unborn are affected by Spinda Bifida choose, as Bianca did in EastEnders, to abort the child.

I do not believe in the hermetic separation of our societal attitudes to the already born special needs child and to the not yet born. I do believe that 10 or 15 years from now when people from our generation and the generation that follows us look upon children with special needs in society they will ask why these people are still with us in the wake of technological advance.

There is much more that could be said but ten minutes is all that has been allocated to me. I ask you to choose between a philosophical system which regards only those who are conscious as being worthy of life and a philosophical system which instead looks at the ontological problem of the human embryo and says yes, in the light of modern genetics we can see something which is like ourselves, we can see something which has a self directed genetic mechanism with 90 000 interacting genes which, if left alone, will develop as you or I are developing. I would leave you with one final thought. I believe that the 'not yet' argument fails completely and we should examine the 'not yet' argument. The unborn child is not yet a person but even if it is not yet a person the fact that it is on its way with its self directed mechanism to becoming a person means that we as a moral agent should not take the risk of becoming murderers by killing it.

If you find a building and you wish to demolish it how carefully must you check to make sure it is empty of persons before you do so and if there is any doubt left in your mind when you begin to swing the very heavy concrete blocks that will demolish that building does that doubt not indict you of murder, for as Petulian said to be prepared to kill what may be a man is to be prepared to kill a man.

Hilary Rose:

I have spent quite a lot of time in Scandinavia and also I am a sociologist and a feminist and this means that I live in complexity. Therefore the kind of fundamentalist purity offered by our last speaker is something I can not deal with. Let me tell you why. If you are in Scandinavia and you go into a supermarket around 11 o'clock in the morning it is full of juvenile delinquent disabled teenagers in the care of able bodied teenagers and they tear around the shops in classical teenager way. What I am taking about is a society which actually acknowledges disability in people, acknowledges impairment, and actually builds a society physically and socially which makes place for the diversity of human beings. Having said that let us try and get a grip on things.

Only three per cent of all disabled people are genetically disabled. So the big worry is should be about not just the three per cent, but the whole 100 per cent. As was beautifully pointed out by the Americans, at best we are all TAB's, which means Temporarily Able Bodied people. Most us end up as very dependent people, and some of us are dependent in the middle of life. So that is the background to this discussion.

What I think has happened, which I am very interested in, is that we have shifted from what I call 'state eugenics' to 'consumer eugenics'. Everybody uses the Nazis as the example, but of course as has been very properly pointed out state eugenics was everywhere, certainly in Britain. In Britain it happened by keeping people who were then called mentally handicapped locked up, and worse than that for those described as 'cretins' and so forth, keeping them apart sexually so they could not breed. This was the classical British solution proposed by the son of Charles Darwin, and there was a long history of Social Darwinism everywhere. What we had a that point was the state moving in and forcefully sterilising people.

I think that historic period has gone. There were pluses and minuses about that dreadful historic period. Part of it was the deep relationship between the early welfare state and eugenic thinking. There are great difficulties for us here. The doyen of welfare states, Sweden, was also the home of eugenicism and is also the home of the most brilliant provision for disabled people: that is what complexity is about.

What I am worried about at the moment is what I call a culture of consumer eugenicism and that is what leads me to have curious sympathies with Peter. What I think has happened is that in our culture we now have a very high tide of libertarianism: the ideology of the market has won out. We have lost state eugenicism, I do not think anyone would now tolerate it, only poor China suffers. State eugenicism has historically gone for the moment, although nothing is forever. What we have instead is consumer eugenicism in which people are promised, particularly by the media, that whatever you want you can have if you can pay for it - perfect partner, perfect house, perfect job, an Armani suit, a designer baby: you can have anything.

I think what we have got to look at is what the geneticists, or rather what the molecular biologists, have offered us. I think they have actually done an enormous amount of harm. One of the things that fascinated me in listening to the previous speakers is the assumption that these tests work. For a lot of conditions they are not clear, and do not show for sure if there is a genetic fault. What we have got is an ideology of certainty coming up from the culture of the new genetics. In fact there is not the certainty this ideology claims, and actually things are a bit more complicated. Instead, as genetics advances it shows a picture of increasing complexity.

The third thing I want to look at, and I have very much enjoyed some of the reflections on the moral status of the embryo, is how we culturally construct our understandings of who we are. In doing so, we take bits from religion, and religion of course shifts. In early Christianity abortion in the early weeks was absolutely fine because the fetus had no soul. What we get now from fundamentalist Christianity is the idea that the fetus has a soul from the moment of conception, so we cannot abort. But if you look at the history of Christianity the theory of the development of the embryo has changed and it changes in accordance with the best science available at the time.

As a result, you get this wonderful movement between the scientific constructions of who we are, the religious constructions of who we are, and what I would call in many ways the everyday morality. The picture Raanan describes is what I would call fudge and that is actually how culture often works. It is a fudge between religion and scientific constructions, and constructions of the moral status of the embryo. I think one has to consider that as really a rather wonderful 'fast one' that the embryologists have pulled over the philosophers and the stacks of religious people who were all on the Warnock Committee.

We also have to accept that we live in cultures, but we do not live in them passively, we can act on them. One of the things that we have done, particularly with the power of the women's movement is to insist that women, not men, women have the right to control our own bodies. This is a very peculiar longing at the moment because we also know that unless you are in a supportive society, notions of choice do not really exist. You have to do what is necessary. If the society is completely unsupportive then maybe the only thing to do is to have an abortion.

It may be that you want to have an abortion because you did not want to have a baby anyway. It may be that you took one look at yourself and realised that you were no more fit to have a baby than, I hate to say it, most men, in that men still largely escape their parenting responsibilities massively and dump them on the women. So we have got this very peculiar world going on.

To conclude, as I see it what we have got to recognise is the shift towards consumer eugenics which is deeply associated with the rise of individualism, the rise of libertarianism and the retreat of the welfare state. That is one of our very deep problems and that is happening all over the industrialised countries. The second point is that we need to get a very clear-eyed view that science is not something neutral in giving an account of human development as if science was like the eye of God looking on the world. Science is itself deeply implicated in cultural values, so when it tells us that the fetus is this, or the fetus is that, these are values inside the science, and we have got to understand that. It does mean, and this is one of the things that I have learnt in this discussion, that it is actually enormously difficult.

I want to finish with a little personal piece because I think it is very expressive of the difficulties of being involved in these debates. I happen to have a really rather discrete genetic disorder. I inherited it from my father who died rather early from it. He was an absolutely lovely man and I never felt anything other than love for him and I never felt any sense of anger that he had given this nasty little number to me. I am also a mother and when I learnt that I had given this nasty little number to one of my beloved sons I felt totally anguished. So I think you have to understand that being inside a situation is actually very complicated. Nothing other than love and generosity to my father, and guilt and anguish which it has taken me some time to resolve as a mother to my son.

I say this not because I want to claim some higher moral ground. I say it because as a person within a culture (even a sociologist) I am just part of the culture too. I do not actually feel that way now. My son and I laugh over it, and he challenges me quite sharply over these sorts of feelings as being morally entirely inappropriate. Yet I am being quite honest when I report them to you because they are what people feel when they are inside situations, which is why I say it is not something that is easy.

I want to say one last thing and that is what worries me above everything else is the growth of genetic testing. I have an enormous respect for clinical geneticists, and for people who go and see clinical geneticists because their family is carrying one of the real horror stories, like Tay Sachs or Lesch Nyhan syndrome. Then you are in a world of counselling, support and autonomy. What I am worried about is mass genetic testing in the ante-natal clinic because there it does not come with counselling and support. It comes with deeply held assumptions on the part of the medical profession that we know what is normal, we also know that you want normality.

That is the worry because who is in charge of the construction of normality in our culture is a very deep problem. Could you actually have done Peter's role play if there had been a person with Down's syndrome in the room? I do not think you could have, and I think there would have been an immediate tough challenge at least if the Down's syndrome person was anything like those people who I know.

Any woman, hopefully with the support of her partner, who faces those sorts of situations has to be very aware of the cultural pressures, the social and economic pressures which push her to go one way and she has to try and think about where she actually wants to go. Yes at the last analysis these things come to us privately and personally and they are very deep and they are very difficult, but at the same time we have to be aware that we belong to a society and there are all sorts of currents lying around.

Ann Furedi:

I think to begin with it might be useful to look at what we mean when we talk about eugenics and how the discussion of abortion for abnormality interacts with this. There is absolutely no question that the 1967 Abortion Act, which frames the regulations in which abortion is provided, was an Act fuelled by a desire to practice social engineering and by an assumption that fit mothers should raise healthy children.

To give some background to the current law, it is worth remembering that one of the reasons why the 1967 Act became law when it did, was the influence of people's perceptions of the thalidomide crisis. Suddenly you had a large number of babies being born with severe limb abnormalities and this changed the perception of abortion enormously. The context was no longer one of backstreet abortions, which middle class women never thought would happen to them. Abortion was suddenly placed very much in a framework of discussions about disability, with people wondering how they would be able to cope if they knew that they had taken a drug that would lead to a very severely disabled infant. There was a very heightened concern about this, which transformed the level of support for legal abortion.

If you look at the other clauses in the Act, you can see that abortion law in Britain was framed by a sense of the importance of a certain degree of social engineering. The Abortion Act does not allow women to choose whether or not they have an abortion simply because they do not want to be pregnant. It makes sure the woman fits certain criteria. These are basically criteria actually about whether she can be a 'fit mother', either fit in the sense of being physically healthy, or fit in the sense of being economically able to look after a child. I think that when abortion was legalised it was within those terms, and I think in fact when ante-natal screening began it was very much the 'search and destroy' exercise that people have characterised it as.

I do not think that is the framework in which abortion is provided today. We are stuck with the old law, and lots of us are working to try to change that old law. However, I do not think that attitudes towards abortion, and what happens when women seek abortion now, are now the same as in the past, and I want to go on to discuss how I think abortion is now perceived, especially with regard to abnormality. First I want to make clear my views on the law as it stands, to indicate my overall approach to the abortion issue.

I have very profound ethical problems with the way that the 1967 Act works at the moment. I have very profound problems with it from the point of view of the woman with a pregnancy that she does not want to continue. It is completely intolerable that the law can say to a woman who is 24 or 25 weeks pregnant that she cannot have a termination at that stage, yet it would permit her to have a termination for the same reasons at 18, 19 or 20 weeks pregnant. What happens in between? What is it that happens between 23 weeks pregnancy and 24 weeks pregnancy that means that suddenly there is a cut off point?

I very much agree with the perspective that was put forward by Raanan Gillon, that what you have throughout pregnancy is actually a continuity. I suppose you could say that there are certain defining moments. Whether or not we give them moral significance is very much up to us. There is the point of conception when you can say that from that point onwards you have something that is genetically distinct, but whether or not we choose to give that any moral significance is really up to us. Actually we do not, and in law a woman is not seen as being officially pregnant until the point of implantation which is some time after the fertilisation of an egg.

Some people will give moral weight to the differentiation of cells, when the cells that are to become the fetus become differentiated from the cells that will become the placenta. Some women will perhaps feel differently about the pregnancy form the first time that they perceive fetal movement, and in fact this is traditionally a way in which a defining moment in pregnancy has been identified. Before we became very good at clinically testing pregnancy, that was the time when the pregnancy was given some kind of significance. Other people will see birth as being the morally significant point.

I like the idea of birth as being a point at which you can at least say that something different has happened. It is only really from the time that the child has emerged from the womb that it is possible for society to intervene and to act and to do something to deal with the life of that child without potentially interfering with the life of the mother. That is in fact why I think that you can draw a distinction between life before birth and life after birth. It is possible for a woman's bodily autonomy not to be infringed by action on a child that has been born, where it is no way possible for that to happen from the moment beforehand.

Now to look at some of the issues that have been raised about fetal abnormality. I think that there is a real danger in the current reaction against the old approach of 'search and destroy' tests, and against the past situation where people with disabilities were treated in a subhuman way. There is a dangerous tendency for us to move very much in the other direction, with a kind of peculiar political correctness that really forgets some important truths about the reality of the situation.

I would argue very strongly regarding a point that has been touched on by some of the other speakers. I believe it is very possible to differentiate the attitude that one has to a pregnancy or to a fetus that is affected by abnormality, compared with born people, including those with disabilities. I think it is perfectly possible to have one attitude in relation to the fetus, and to have a completely different attitude to people who are born and who have a particular condition. I have no hesitation whatsoever in saying, though of course my attitude may well change if I found myself pregnant in these circumstances, that if I found I was carrying a pregnancy that was affected by Down's syndrome I would have that pregnancy terminated. I do not want to bear a child with Down's syndrome and I do not want to raise a child with Down's syndrome. That does not mean that I think that other women who are faced with that choice should take that same decision necessarily, and it certainly does not mean that I think that people with Down's syndrome should be eliminated.

What I believe, as a principle, is that any woman who found themselves pregnant with an unwanted pregnancy for any reason, should be allowed to end that pregnancy. Now that does not mean that I think that somebody who has a child that they find is an inconvenience should be allowed to kill that child because it is unwanted. That idea does not really follow through, and I think that it need not follow through in relation to our attitudes to fetal abnormality.

I think actually our attitudes to fetal abnormality more reflect our attitudes to illness and are more related to the way that we feel about other diseases and medical problems. I do not think that there is any one in this room who would hesitate about the fact that they think that it is a good idea for cystic fibrosis for example to be eliminated. Most people think the world would be a far better place if people did not suffer from cystic fibrosis, in exactly the same way that they think the world would be a far better place if people did not suffer from measles or smallpox or influenza. That does not mean that we feel that we want to kill people who suffer from those diseases.

I think that most people perhaps who are supportive of pre-natal screening see it very much as being a way of dealing with medical problems. They look at it in the same way as they look at other forms of medical treatment. As a result, I very much oppose the idea that pre-natal screening can be characterised as consumer eugenics. The reason why is that because I think that when we talk about eugenics, we are really talking about it ways in which in the past, there have been attempts to shape society by altering the gene pool, and to try to resolve social problems through policies that would affect who was born and who was not born.

I do not think that is at all related to the spirit in which individual women ask for pre-natal screening, and in fact asked for their pregnancies to be terminated on the ground of fetal abnormality. A previous speaker was absolutely right when they said that termination for fetal abnormality is done entirely in the interests of the woman. It takes place because the woman requests it, it is not something that is imposed on her, and it is carried out because she feels that she does not want to raise that particular child at that particular time in her life.

I do not think that women will stop deciding to abort for abnormality if they are given more resources. It may be the case that it would make it easier for women to raise disabled children if more resources were provided for them, but there are many women who will feel that they do not want raise a child with a particular disability. Now you may think that that is a terrible attitude for a woman to have, for her to be to be that judgmental. In reality however, when we think about the way in which women and couples think about pregnancy, and we consider why they become pregnant, we have to admit that people approach pregnancy with an idea of the child that they will have in their mind.

When a woman is pregnant she is dreaming of what her child will be and what that child will become. If a woman finds out that her fetus is affected by an abnormality which means that the child that she is carrying can never be that child that she has wanted, it is very understandable that her attitude towards the pregnancy may change. You might not approve of it and you may wish that the world worked in other ways and that people were not quite so judgmental. But in truth, it is that particular woman who has to live with that decision. It is that particular woman who at a stage in her pregnancy where an abortion involves a labour like birth, when she has already felt strong fetal movements inside her, and when she has maybe named the child, decides to terminate the pregnancy, and this is not something that she does lightly. It is because she feels very strongly about it and I think that we have to understand a woman's reasons for that. We then have to ask ourselves what kind of society we would be and really what people are asking of a woman, when they say that women's ability to terminate pregnancies in those circumstances should somehow be restricted.

Somebody will no doubt raise the point about what I mean when I talk about 'normal', what I mean when I say that women do not want perfect babies they want normal babies, and that often they will wish to terminate a pregnancy because they perceive that their child would not be normal, it would be disabled. I actually think that at the end of the day there is only one person who can make that decision and that it the woman who is pregnant and who will be responsible for the rearing of that child. That is why I am very opposed to the idea of lists being drawn up about what represents a serious abnormality and what is not a serious abnormality. In practice, it is a very subjective decision, and with regard to any particular abnormality, only the woman and her family know whether or not they can cope with it.

Peter I think raised a notion that a fetus could be aborted because it had a harelip. Well that is not really the question. It is really a question of turning to the woman with that pregnancy and saying to her: 'You cannot abort this pregnancy because I do not think you have a good enough reason'. It perturbs me very much when people who identify themselves as feminists can put that argument forward to a woman: you cannot abort this pregnancy because I do not think that this abnormality is serious enough.

Those of us who have campaigned for women's rights have spent a very long time arguing against doctors who disapproved, on other grounds, of women's reasons for having abortion. I think that it is as inappropriate for feminists or disability rights activists to be as judgmental with regard to abnormality, as it is for doctors to have disapproved of our reasons for having abortions because they thought that we should be eternal earth mothers and produce children every time that we have sex.

I think that these days we have moved away from an idea of 'search and destroy'. I think that women are now provided with far more information and choice. It is not perfect and we need to make it much better, but at the end of the day women are not dupes. They are capable of asking questions if they want to find out information. Women who find out that they have a problem pregnancy, because the fetus has a form of abnormality, do not rush into the abortion clinic to end to pregnancy, because as Raanan said the pregnancy is very often a wanted pregnancy. It is a decision that is agonised over and we should represent and understand it as that, and not trivialise the choices that those women make. We should to allow them to act in accordance with their conscience and their value system, and argue for a framework around abortion that allows for this. We should therefore allow women the right to make the decision to terminate on the grounds of fetal abnormality just as we would support their right to terminate on the grounds that the child was unwanted for any other reason.

Ellie Lee:

Thank you very much. I am now going to take questions and brief comments, and then let our speakers come back to them. I would imagine also that our speakers may have comments they want to make about what other speakers have said.

Question:

How accurate are the pre-natal tests that are done? Are they 100 per cent accurate or does it happen that after the abortion there was nothing wrong?

Raanan Gillon:

I can not give you the figures but it is certainly the case that sometimes there are false positives and false negatives, and I think that is part of the counselling process or discussion process to get people to understand that the risks involved are probabilistic risks not absolute certainty.

Question:

Some of the speakers have focused on the woman's experience, but the experience of carrying a Down's syndrome child is the same as carrying a normal child and it only becomes different if the child is born. Once it is born it is in the child's interests to have been born.

Question:

I feel that the abortion debate has been hijacked by pro-abortion feminists. It is not fair to say that any feminist must be pro-choice, or that any one who is not pro-choice is anti-feminist. It is no good to say that in the past men have abandoned children, so now women can be just as bad. I think feminism should keep out of the discussion as it is a moral question. If it was not for feminists, it would be a lot easier to decide about abortion.

Question:

This is directed at all the speakers. My experience has been that there is now much more concern about the needs of disabled people and an increasing attempt to help disabled people in society. Yet at the same time there is more ante-natal screening and abortion for abnormality. So how can anyone think that improvements in society's attitudes to the disabled and abortion for abnormality are incompatible?

Ann Furedi:

I think that the first point that was raised relates to point I was trying to explain about how a woman's attitude to pregnancy may change. What happens it that when a woman has an ante-natal test that detects a particular abnormality, she is then in a situation whereby the reality of the child that she will have is very different to what she imagined it would be like. That may very well change her attitude to the pregnancy. It may not, and there are some women for whom it does not, but there are many women for whom it will.

The point that I am really making is that if a woman feels strongly that she does not want to bear that child then I think that that is a decision which comes down to her and her alone, because she is the person who is carrying the child. If there is a conflict of interests it is all very well for a man to say, 'Well I will help you look after this child', or for someone from Peter's organisation to say that LIFE will provide you with resources, or for someone to say that the woman should have the particular child adopted. What these views do not take into account is that abortion is actually about ending a pregnancy. The woman is not simply saying she does not want to look after this child, she is also saying I do not want to continue with the pregnancy and that is a different matter. I think that at the end of the day that is something that she has to be accountable for and responsible for. I think it is very wrong for someone to try to veto that decision.

In relation to the point that was raised about the awareness of disability, I think there is a far greater awareness of disability issues and I think that it is right and appropriate that there should be much more concern about developing resources that are needed to help people with particular disabilities. What I find problematic is a carry over into the attitude towards a pregnancy situation. I think it is symptomatic of something that is going on much more broadly which I think is the way that pregnancy issues are looked at with more attention on the fetus, with the fetus right the way back through pregnancy being seen as the equivalent of a person. It is talked of as a kind of little person in the womb, as if it has all of the sensibilities that people actually do not develop until they are quite advanced into childhood. You can see that discussion taking place in relation to the question of fetal sentience and of fetal experience of pain, where the fetus is discussed as being like born people. This I think is happening in a particular form in relation to the disability debate.

Agnes Fletcher:

I think it is true that largely as a result of disabled people's own efforts and demands, and quite strident demands at times, that things have shifted with regard to attitudes to disability. Yet this building remains largely inaccessible to disabled people: if I were deaf rather than physically disabled I would have had no access to this debate and that is still the reality for large numbers of disabled people today. We are still waiting for discrimination to be properly outlawed in the same way as it is for women and people from racial minorities. So yes we have come a long way, but I think it would be wrong to say that we had got there and that there is no discrimination against disabled people and that disabled people are not for the most part the poorest in society with the least access to political process, to debate, to policy making.

If you look at the various commissions which consider medical ethics on genetics and other issues you will not find disabled people directly representing other disabled people. So until disabled people really have a strong voice in those debates it is very difficult to feel that our views are being properly considered and the particular perspective of disabled people is being considered.

To respond very briefly to some of the points Ann was making. I cannot be happy about the inequality in the law either. I feel uncomfortable with the situation because of its inequality. Ann might well want a society where terminations could be acceptable for any reason including sex selection, potential height of the person, if it is going to be a male and it is under 5'2", because of particular skin colour that that child is going to be. Actually I agree with her. Until there is that kind of equality and that yes, it is truly the woman's individual decision to decide to terminate on whatever grounds she wants, I cannot feel very happy. I cannot feel, and it may be very difficult for people here to understand, but I cannot feel fully valued as a person, as a live person, while that inequality exists in the abortion law. That may be irrational but it is a feeling that is shared very strongly by disabled people who do not consider the fetus as a person. We see a negative attitude to abnormality, encouraged through the idea that someone with Down's syndrome is not normal. Disabled people are normal, disabled people are part of the human race, we are not freaks, we are normal. We cannot feel part of society while inequality is there, as it is in abortion law.

Hilary Rose:

I am interested that the example that has been picked up of Down's syndrome which is of course not a genetic disorder, it is a congenital disorder. There is a world of a difference between being part of a family where you know perfectly well that people die a bit young, or they tend to behave in a particular way, or there is Huntingdon's disease every now and again, and a woman discovering she has a Down's syndrome affected fetus. The discovery of abnormality is a very different event for somebody who is part of a family who carries a genetic disorder.

One of the things that is happening is the increasing expansion of the numbers of genetic disorders: I think it is around 4000 that are classified now. That is actually worrying because the problem is which of those genetic disorders justifies abortion? I accept the common-sense point that some are so terrible that you cannot imagine anyone wanting to continue the pregnancy. In some of those families, for example Jews with the problem of Tay Sachs, they have developed community support for women who need to have an abortion because the situation that would result for the woman and child is so unbelievably dreadful. Even those women suffer. There is a huge empirical research literature showing that women suffer enormously from having terminated an affected fetuses and that they are suffering up to a couple of years later and feeling full of anxiety.

I think Ann has a slightly consumerist, unfeeling approach to it. I think actually it is a much tougher decision than those of us who have not actually been challenged by it have to come to terms with. I do not think one should diminish the difficulty of that. For example suppose one were 35, the biological clock was ticking and they told you, you have got a Down's syndrome fetus. I can think of quite a lot of good reasons, thinking of the disabled people I know, for keeping that pregnancy. It just depends who you know, and one of the things about this culture is that we shut disabled people away so you do not really know all sorts of interesting people who just happen to look a little bit strange. I think it is one of the things we cannot judge, until we are in a culture where disabled people can get into a building like this.

Ellie Lee:

We have run out of time, so can I ask our any of speakers who want to say anything else for final comments.

Raanan Gillon:

I just want to get back to the two strands of the issue here. I think it is quite important to keep them apart before actually then making a decision that links them together. The first one is: does the fetus have an independent moral equivalence to us? I think what we heard from Peter is that yes it does from conception onwards. Now if that is the case I think it radically reduces the right of women to do things to it, so that is a very important issue. If Peter is right, abortion is not just an independent choice that the individual can make.

The way to look at that is to say well suppose a mother decides of her 3 year old, that she would like bump it off because it is inconvenient, or because it is ruining her life, or it is producing problems with the other children in the family. No-one would suggest for a minute that she should be able to do that, and go and kill that child under some state accepted law.

So it seems to me that the fact that we do have an abortion law, and of course there are radical difference in thought on this, but in general we think that that is not the case that fetuses are morally equivalent to us. If you do believe that they are morally equivalent to us then I think you have a very important duty to do what you are doing, like Peter, which is to go on arguing with us and tell us why we are wrong. That is why this debate will never disappear because there are passionate beliefs in the two opposing views, so debate should go on.

The second problem is that when you have conscientious disagreement about these philosophical and theological issues then you have got another moral question. This is about how to organise society in a way that tries to recognise as much as possible the conscientiously and thought out positions of these different positions. I think it is quite different when it has been thought out very carefully and where it is then reasonable. They we have to try to acknowledge as much as we can the different positions and not insist that one lot of people have to do what the other lot of people believe is wrong on either side.

The second point I wanted to make was the role of emotion. Now we have talked about it, I have talked about it and it is a very important fact of real life. People's emotions are tremendously important in real life, but they are not the last word about what ought to be the case and sometimes one's emotions may be wrong. I think Hilary you were hinting at that when you said your son told you the guilt that you have is morally inappropriate. I think he was right, and if we recognise this, we can start tutoring our emotions and changing them.

The fact that we have strong emotions is a flag that says watch out carefully here, but then we need to think about them and it may be that our emotions are wrong. The example I give is from medicine. Sticking a finger up somebody's bottom to do a rectal examination is a repugnant, disgusting idea, and most people think it is a revolting thing to do. You learn in medicine that sometimes it is the right thing to do and you have to then tutor your emotions to make them match what you ought to do. I think a lot of that sort of attitude is important to bear in mind with all the emotions including the so-called moral emotions.

Peter Garrett:

I would agree that in a sense society is becoming more schizophrenic with regard to the way we view people with special needs. I think Ann is right as well that we do have an increasing cult of 'fetal personality'. There are some brilliant feminist books written complaining about the cult of fetal personality. Those responsible for this cult are often not just pro-life people like myself, but they are commercial companies like Peugeot and Korean Airlines who will constantly show you pictures of the baby in the womb and they wish to anthropomorphise the baby.

They want to pretend, to take Ann's position for a moment, that the baby is a person and they want to argue that the Peugeot no matter how good and how much they want to sell it to you, would only be the second most comfortable place you have ever been. Now I think that increases the rapidity with which schizophrenia is arising because we are going to now enter the 21st century. 'Window on the womb' technology and fetoscopy is going to treat us to manifold insights into the symphonic process by which the baby develops in the womb. At the same time we are seeing our society in some sections arguing for almost unlimited reproductive autonomy.

I would really like to throw a question back to Ann that relates to the question that was asked about feminism and the current of feminism running or bifurcating from the pro-life, pro-abortion debate. The question I would like to put to Ann is just how far would you go? I am surprised that Agnes seemed to be lining up with you on this but if a woman says to you I am having a baby girl, and I have decided I just do not want a baby girl, what would you say? Is it not the logic of your position and perhaps also the logic of Agnes' position to try to remove the stigma that currently attaches itself to people in the groups that you are representing? Yet is not the logic that you must automatically say yes, abortion because it is a baby girl is acceptable?

Ann Furedi:

Yes, that is very much the logic of what I am arguing, and I do not think there is any conflict between that position, and women's rights. The principle through which I would look at the issue of abortion is in terms of allowing a woman to maintain her bodily autonomy and to make a reproductive decision for herself, because she is the person who is primarily affected by it.

I think in some ways that the absurdity is that society places on women almost an obligation, in restricting abortion, for a woman to treat a fetus in some ways in a more privileged way than the way she is expected to treat a child once it is born. To give you an example of what I am talking about, I have a 2 year old. If my 2 year old was dying from a complaint and I could save him by giving a bone marrow transplant or a kidney transplant, I would regard myself as being morally heinous if I did not accede to that. Yet there is actually no law which could compel me to take something from my own body to save the life of my born, living, emergingly conscious child. Ironically there is a law that would compel me, after 24 weeks pregnancy, to endure the hardships and the health risks of late pregnancy and labour, to bring that child into existence. I think that is a rather bizarre way to frame the law, as it compels women to have a relationship to the fetus which is actually a legally privileged one over the way in which it forces a woman to relate to born people. It is my resistance to the idea of forcing women to relate to a pregnancy in that way which would make me say that a woman should have the absolute right to make decisions about the nature of that pregnancy.

Agnes Fletcher:

I understand from that what Ann would be advocating is termination on any grounds up to point of birth, is that correct?

Ann Furedi:

It is and I do not have any particular problem with saying this. Although I know that very often people get upset about it and it tends to get caricatured as abortion on the way to the delivery room. Get real! We are talking about real women here. When you think about what the process of an abortion involves, do we think a woman undertakes a late abortion without searching her conscience and without really thinking through the implications of what she is doing?

We do not actually need laws to tell women when they can and when they cannot have abortion late in pregnancy as a way of regulating it. The reason why women do not in general have abortions late in pregnancy is not because there is a law telling them that they cannot, but because they do not want to have an abortion late in pregnancy. This is because it is a deeply unpleasant, deeply distressing procedure and because women's attitudes to pregnancy change.

When you look at abortions for fetal abnormality that are post 24 week pregnancies and you look at the gestation at which some of these pregnancies are ended, it tears your heart out. In 1996 there were two pregnancies that were terminated at 37 weeks, that is three weeks before the child is due. My baby was born at 38 weeks and it was not even regarded as being premature. In 1995 an abortion took place at 38 weeks. Now you can either decide that those women who had those abortions are the most morally reprehensible women in the world or alternatively you can say what was it that put those women in that situation where they felt compelled to make that decision? I think we need to understand the reasons why those women choose that path, and then we will see the immorality of restricting their right to do so.