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Abortion and disability

Abortion for fetal abnormality: ethical issues
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.

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