Abortion for fetal abnormality:
By Ann Furedi
This addition to the site is based on a presentation given
at the conference 'Abortion, Ethics and the Law' held at
Kent University in 1998. In it, Ann Furedi, director of
communications for BPAS, discusses the issue of abortion
for fetal abnormality. This issue has become perhaps the
most contentious of those raised in debates about abortion
in recent times. Growing support for the rights of disabled
people has generated a discussion about the ethics of the
exemption of abortion for abnormality from the legal time
limit that applies to abortion on other grounds. The argument
now commonly made is that in allowing abortion without a
time limit where there is possible abnormality in the fetus,
but imposing a time limit of 24 weeks where there is not,
the law perhaps reflects and reinforces discrimination against
disabled people. In her comments, Furedi provides an account
of eugenics as a form of social policy, and explains why
it is illegitimate to see the provision of abortion for
abnormality today in these terms.
In Britain, abortions are unlawful after the 24th week of
gestation except in a few exceptional circumstances defined
in law. One of these is when there a risk of fetal abnormality.
This is currently a source of some controversy. I do not
intend to make an argument in support of the current system
of time limits, because I do not believe that gestational
time limits are an appropriate means to regulate abortion.
I believe that if a woman wishes to end her pregnancy, and
a doctor is prepared to carry out the necessary procedures,
it is not the business of the law to intervene. Women should
not be required to justify their need for abortion. It is
sufficient that a woman does not want to continue the pregnancy.
However, there are those who argue that the existing law
is, in respect of abortion on grounds of fetal abnormality,
eugenic. Women's request for antenatal screening to detect
such abnormalities has been presented as ethically problematic
and the funding of such services by the NHS has been condemned
as illegitimate. It has been suggested that such services
encourage discrimination against disabled people and that
in accepting such services society devalues disabled people.
This is an argument that has been promoted, rather disingenuously,
by those who oppose abortion in all circumstances. The anti-choice
organisation LIFE produces a leaflet called 'Pre-Birth Screening:
Something Wrong With Baby?' This argues that '...to destroy
a child because he or she is not perfect is especially unjust
and elitist. Of course it is not always easy to cope, but
eugenic abortion recreates and legitimises primitive phobias
against mental and physical illness just when society seems
to be making real progress in outgrowing them.' The leaflet
asks '...are we not really sending a message to the disabled:
you are inferior, you should never have been born?' The
Society for the Protection of Unborn Children makes the
point that '...abortion of the handicapped is both a reminder
of the inhumanity of abortion, attacking the most vulnerable,
those most in need of help, and an offence to the disabled,
sending them the message that they are inferior and of less
value than the able bodied.'
In response, I want to briefly address three issues: what
do we mean by eugenics, and is abortion on the grounds of
fetal abnormality eugenic? Does abortion for abnormality
encourage discrimination against disabled people?
What do we mean by eugenics? This term is used very loosely
and often wrongly in discussion today. I certainly think
that the two organisations I referred to earlier use it
wrongly. Defined properly, eugenics is the view that society
can be improved through the manipulation of genetic inheritance,
and that social problems can be resolved biologically, largely
through the control and shaping of human reproduction. It
is arguable that the abortion law in Britain, when first
introduced was motivated to some degree by a eugenic outlook.
This was not the case in particular with regard to the clause
in the law about abortion for fetal abnormality, which was
largely a response to the thalidomide tragedy—a response
to women who feared they were to give birth to a severely
disabled child and were unable to prevent it.
It could be argued however that the clauses in the 'social'
clauses in the Abortion Act were motivated by a desire to
tackle the social problems caused by poverty deprivation
and hardship by shaping people's reproductive patterns (i.e.
making easier for them to limit family size) rather than
to making greater social resources available to them. This
could be seen as a eugenic approach, in that rather than
addressing problems of poverty and bad housing which meant
mothers were unable to cope with the numbers of children
they were having, policy makers concentrated on limiting
the number of children people might have. The underlying
idea is that people were poor not because society did not
give them the resources they needed, but because they had
too many children. Parliamentary discussion of the Abortion
Act explicitly discussed its use in preventing unfit mothers
from having unsuitable families. Contemporary medical journals
discussed the validity of legal abortion alongside the need
for a birth control plan for Britain to limit the numbers
of the poor.
Regardless of the motivation of some of those who supported
the legalisation of abortion in 1967, today it is very definitely
the case that abortion is not seen by doctors, policy makers,
or women themselves, as within that tradition of social
engineering. The context for abortion today is one where
its provision meets the request of a woman who no longer
wants to be pregnant. That is the case when we are talking
about the ending of unwanted pregnancies that have been
conceived unintentionally, and is so where abortion for
abnormality is at issue. Abortion when there is evidence
of fetal abnormality is not part of a social strategy to
reduce or limit the number of disabled people in society.
Women are not forced to have an abortion when there is risk
of fetal abnormality; rather doctors meet the women's request
where she feels she wants to end that pregnancy.
The Nuffield Council Report on the ethics on genetic screening
provides a useful distinction between eugenic decisions
and decisions that are taken for the benefit of individual
women. It describes the difference between legitimate choices
and unacceptably eugenic decisions as '...the point at which
the decisions of individuals are subjugated to the aims
considered to be of benefit to the population or the State'.
Thus the issue is whether abortion for abnormality is being
carried out for the benefit of the population or the State,
or for the benefit of the women with those pregnancies.
In today's context, abortion for abnormality is carried
out for those individual women who request them. There are
those who might argue that it is of benefit to society if
a woman chooses to terminate an abnormal pregnancy because
the state is saved the costs of caring for such a child
are saved. But that is incidental. Antenatal screening is
provided at the request of the woman, and for her benefit.
The decision to proceed with or end the pregnancy is ultimately
hers—not her doctor's, nor a policy maker's.
It is sometimes argued that women are encouraged to abort
abnormal pregnancies by a medical profession that values
the lives of normal children above the lives of those with
disability and it is the case that some members of the medical
profession see abortion on grounds of fetal abnormality
in the context of preventing an illness. There is often
an assumption that it would be in the interests of public
health for there to be fewer babies born with conditions
such spina bifida or Down's syndrome. Some people find this
objectionable, but it could be argued that such objections
are irrational. In general, we can agree that it is better
for babies to be healthy than ill, without implying that
women should be forced to abort unhealthy fetuses or suggesting
that the lives of unhealthy babies are of less value than
their healthy brothers and sisters.
It is not difficult to understand why women choose to abort
abnormal pregnancies. Many women find that they feel differently
about their condition when they find their baby would be
born disabled. The discovery that the child is 'not normal'
may challenge a woman's hopes and expectations about what
her future family life will be. A woman whose attitude to
her pregnancy changes when she finds it is affected by an
abnormality is not making a social or political statement
about the abnormality, or about born people with that disability.
She is making a statement about herself; what she feels
she can cope with and what she wants. Society should accept
women's autonomy in decision making. Since women have to
live with the consequences of those decisions they must
be able to make the decisions they perceive to be moral.
Abortion on grounds of fetal abnormality is not a matter
of eugenics, it is a means to extend women's control over
their lives and futures.
Does abortion for abnormality encourage discrimination against
disabled people? No it does not, since it is possible to
make a judgement or express an attitude towards a particular
condition, without in any way imputing an attitude towards
the value of people who suffer from that condition. Most
people would say they thought malaria was a bad thing, and
that it would be better if people did not suffer from it.
This does not mean they take a negative attitude towards
people who suffer from that illness. The same applies with
abortion for fetal abnormality. There is no reason to assume
that a woman's choice not to bear a child which suffers
from spina bifida or Down's syndrome implies she believes
such people should not be born, or be supported. It simply
implies that she does not wish to be a mother to one. Why
should this be seen as objectionable? A growing number of
women are choosing not to be a mother to any child, but
there is no suggestion that in choosing to remain childless
they are guilty of perpetrating negative attitudes to the
children of others.
Issues relating to disability rights and those relating
to abortion are completely different. At the moment however,
the discussion about abortion for abnormality is informed
by some of the debates that preoccupy the disability rights
lobby. Of particular concern is a view that rejects an understanding
of disability as a form of illness. Instead, disability
is seen as an expression of identity. An extreme example
of this is the growth of a movement called the Deaf movement
in the US, which perceives Deafness (always with a capital
D) not as an illness to be cured, but as an identity akin
to gender identity or ethnicity. Attempts to cure deafness
in children are seen to be an affront to that identity and
are therefore to be opposed. There are elements of this
thinking seeping into the abortion debate, and resituating
abortion for abnormality not in the context of illness,
but instead in the context of identity. It is this logic
that allows a person with spina bifida to argue that to
allow abortion on the grounds of spina bifida devalues her
life, and is an attack on her identity. I believe this is
an illegitimate issue to bring to the abortion discussion.
Even if one accepts the premise of the social/identity definitions
of disability (which I do not) to accept it should influence
the abortion discourse is to privilege the views of those
who experience a condition over women who carry fetuses
affected by it. Why should the experience of, say, spina
bifida entitle someone to a voice in the most personal decision
a woman has to make.
The idea that abortion for abnormality represents discrimination
against the disabled also elides the difference between
fetal life, and our respect for persons. As the ethicist
John Harris has argued, it does not make sense to suggest
that we should take same approach to the destruction of
a fetus or embryo and living people who have self-awareness.
The moral issues are entirely different. I would support
the decision a woman takes to abort any fetus, regardless
of the gestation, but that does not necessarily mean I think
that women should have the right to kill unwanted children
or, for that matter, unwanted husbands. My approach to the
fetus in the womb and to born persons is different.
Abortion in any instance should be based on a right women
have to make decisions about their own lives. This is important
because it implies a respect for women's moral worth and
their moral autonomy. The principle that we should be allowed
to make decisions on the basis of our conscience and act
on them is an important one, to deny this to women in pregnancy
is to deny them an integral expression of their humanity.
Basic physical autonomy must be respected. We do not generally
oblige people to compromise their own physical integrity
for the benefit of another person. It is illegitimate to
compromise that principle with respect to the fetus in-utero.
It is very disturbing that an argument can be made for placing
an imperative on a pregnant woman to remain pregnant against
her will. This gives to the fetus a higher moral standing
than that of born children. If my three-year-old son was
suffering from a potentially fatal condition and his cured
relied on my willingness to donate an organ, there is no
law that could compel me to undergo a medical procedure
in order to keep him alive. Yet in the discussion of abortion,
it is assumed that a woman should undergo certain medical
procedures on the grounds that the fetus should be brought
to term and survive.
There are two principles we need to retain with respect
of abortion, whether it is an abortion of a pregnancy that
is unwanted because it is conceived at the wrong time or
with the wrong partner, or whether it is unwanted because
the woman has discovered something about the quality of
the pregnancy that makes it unwanted. In any case, we have
to uphold the principles of decisional autonomy, and of
personal privacy. For these reasons I believe abortion should
be removed from the criminal law.
In conclusion, abortion for fetal abnormality is not eugenic,
unethical or immoral. It is simply one form of abortion.
If we respect women's autonomy and their right to make decisions
according to their conscience then we can argue that the
abortion law should be amended to allow women to end pregnancies
at whatever stage they see fit, without having to provide
a reason for doing so. At no stage should we tolerate any
compromise on the limited access to abortion that is presently
legal, and we should reject any attempt to reduce women's
access to abortion for abnormality.