By Dr Emma Wood
The Sydney Morning Herald recently published one of the saddest abortion stories I’ve ever read. It is the kind of story that unsettles you, whether you regard yourself as “pro-choice” or “pro-life”. If you are pro-choice, the story forces you to come to grips with the humanity of the foetus. If you are pro-life, the story might cause you to wonder, even if momentarily, whether the principles by which you stand are sufficiently nuanced or compassionate.
A woman, Louise* tells the story of expecting her second child. The pregnancy goes well in the early stages, and the baby, “Toby” shows all the signs of being a healthy little boy. The family joyfully awaits his arrival until a late-stage scan shows that Toby has suffered a severe brain bleed at some point in the last few months. The news is tragic:
“If he survived birth, he would be in immediate, significant pain from the pressure in his head, which could start to push his brain stem into his spine. An emergency shunt would be needed, followed by multiple further surgeries. Should he survive, he would be paralysed down his left side; complete quadriplegia was also a real possibility. He would be blind and cognitively impaired. He would never walk or live independently. He would likely never leave a care facility.”
Soon enough, the doctors start discussing abortion with Louise and her husband.
“The foetal medicine specialists were concerned about my impending due date. Feticide could occur legally at any point before I went into labour but, once I did, Toby would have to be born. Once he was here, they’d be obligated to do everything they could to keep him alive – regardless of his levels of pain, or of the horrendous way in which he might die, or of the profound disabilities he’d certainly live with.”
Eventually, at 37 weeks, the decision is made. Foeticide – a decision Louise describes as an act of maternal love – is performed via an injection of potassium chloride into the heart, which, (according to Louise’s obstetrician) would be painless for Toby.
As I read this story, multiple reactions rushed into my mind: “This is as much about the ethics of euthanasia as it is about the ethics of abortion”; “Was this family offered the option of neonatal end-of-life care?” “No one can tell me ever again that slippery-slope arguments are mere scare tactics.”; “This poor woman. I would not wish the grief she now feels on anybody.” There is nothing quite like a woman’s description of the physical reminders of a baby’s unnatural absence post-abortion.
With trepidation, I would like to offer a response to this abortion story. For there are ethical issues it raises which need to be disentangled. The questions this story raises have implications for the wellbeing of us all and for the health of our shared life as humans.
One of the first things we need to remind ourselves of in the wake of stories like these is the limits of diagnostic technology. It is not uncommon to meet women who have been recommended abortion in response to a grim diagnosis, who then go on to give birth to healthy infants. Generally, one can gain a more accurate understanding of a baby’s prospects once they have been born, than while they are in utero.
But how, then, to respond to the fear: “Once [Toby] was here, they’d be obligated to do everything they could to keep him alive.”?
Quite simply, I am not sure that this is true. Often, we can reasonably decide that we will not do everything to keep ourselves, or a loved one, alive, if an aggressive disease or serious injury has put a human body into decline.
Suppose, for instance, that your father is diagnosed with serious heart problems at age 80. The doctors tell him that he can expect to live for another two years at best if his condition remains untreated. If he will undergo multiple rounds of surgery, long recovery times in hospital, and a course of ongoing medication, the doctors tell you, he may live another five to fifteen years. Your father may choose, after much reflection and consultation with the family, not to undergo the treatment for his condition. He may decide simply to live out the rest of his time, enjoying what he can, and, when it becomes necessary, go into end-of-life care. Your father may, in other words, make the decision not to do everything he can to keep himself alive. Both morally and legally, such decisions can be acceptable.
For babies who suffer life-limiting injuries or diseases in the womb, the same logic may apply. When either a disease or injury threatens the life expectancy of a baby, it may then be decided that it is not worthwhile, even for the baby, to take all possible measures to extend life if the burdens of the treatment are great enough, and the expected benefit from them negligible.
But – and this is crucial – there is a difference between making a decision not to do everything one possibly can to stand in the way of another person’s impending death, and becoming an agent of another person’s death oneself. This is a distinction commonly discussed in the ethics of euthanasia.
One can think of the distinction in the following way, bringing to mind again our hypothetical elderly father. You could support the decision not to put your father through treatment for his heart condition, without having to think of yourself as complicit in his death. His killer is the disease, not you or anyone else: there was already an underlying condition threatening the biological functioning of your father. Though you provide him with end-of-life medical care, you and he are no longer attempting to fight that condition to the greatest extent you possibly could. But you can still rightly say that it is the condition that ultimately ends your father’s life, not your own actions or his.
But suppose, instead, that rather than providing your father end-of-life care, you were to give your father a lethal injection. In this scenario, you contributed something to the fatal impairment of his biological functioning. You became an agent in his death.
The same is true when abortion is performed on a baby with a life-threatening disease. It is true – a baby may already be on a path to death. His biological functioning may already be under threat. But to add something to that biological impairment (in Toby’s case, via the injection of a poison) is to cross the line between letting die and killing.
To add something to a human being’s biological impairment via one’s own action cannot, by definition, be a medicinal or therapeutic action. Writes T.A. Cavanaugh:
“Death always injures the person who dies. Indeed, it constitutes the terminus of all diseases and what all injuries intimate, the final, last assault one can suffer… The sick labour under a burden; medicine attempts to alleviate that burden. To undo the subject by killing him does not lift the burden. Rather, to do so is to take the side of illness against the patient by unwinding him. The death-dealer does the disease’s last work.”
Now, many supporters of euthanasia out there deny that this distinction between killing and letting die is morally important. “If someone is going to die anyway, what is wrong with doing something to bring forward the inevitable?” is a statement one often encounters. It is worth noting that such reasoning, strictly speaking, might support murder or assisted suicide in any circumstance – for we are all “on the path to death” by virtue of being mortal (it is just that some of us, thanks to disease, are on the path faster than others). I submit that it is in everyone’s best interests to steer clear of lines of reasoning like this, and hold instead to Cavanaugh’s insistence that all medicinal treatment, properly defined, excludes killing.
But even if we leave such arguments aside, one can still see another possible reason for objecting to the abortions of babies with life-threatening or life-shortening sickness: absence of consent. If it ever is ethical to actively take the life of an innocent human, surely, one may not do so without that human’s consent. Unborn babies, of course, are in no position to consent to their life and future being taken away. If it would be more loving and dignifying to place that elderly father into end-of-life care than it would to actively kill him (assuming, for argument’s sake, that he gives no consent for the latter), then we must conclude that it is more loving and dignifying to plan for neonatal end-of-life care for a foetus in a parallel situation.
So far, everything I’ve discussed centres around cases of babies who have a short life expectancy absent burdensome treatments that may add little benefit. What do we say of babies with foetal abnormalities or injuries that are not life-limiting, but may result in disabilities? With quadriplegia, or cognitive impairment, even? As experience shows, people with profound disabilities do, far more often than not, find meaning and enjoyment in their own lives. We must never assume that, just because disabled people cannot exhibit all the hallmarks of human biological flourishing, that their lives are doomed to be unbearably miserable. Thus, the question of whether we view disability itself as a reason for killing is a different question from how we are to make a cost-benefit analysis about how far to prolong life when a sick human’s suffering is the main question.
This brings me to the key question of this piece. What does it mean to love a disabled human baby? To deem, on their behalf, that their life is not worth living, because of the fact that they will be disabled? (Are we prepared to make such judgments about other disabled people we know, whose lives are full of joy and inspiration?) Or to care for them, invest in them, and cherish them, even if they turn out to be a person who is other than how we’d originally hoped they would be? Surely, love would compel one to do exactly this for one’s newborn who had suffered an injury that left him disabled. Is there any non-arbitrary reason why love, properly understood, does not also treat a foetus the same way (a full-term foetus, no less)?
Really, the question at the bottom of all this, as always, is whether foetuses are persons. Whether they are the kind of beings who are entitled to the same treatment we’d ordinarily give to other humans in parallel situations. If our answer is “yes” – foetuses are persons or bearers of full human rights – then foeticide on the basis of disability is not, and cannot be, an act of maternal love. If our answer is “no”; if foetuses have a less-than-full right to life, then discovery of a foetus’s disability arguably does not add all that much else to the moral calculation in favour of abortion. For we have the right to end their lives anyway, whether “selflessly” or selfishly.
As I read the recently published abortion story, I had to wonder: was the option of neo-natal end-of-life care even presented to the parents by the doctors? Perhaps it was. Or perhaps, as for many other parents who go through this kind of experience, abortion was held up as the only solution, and other paths left unexplored. To me, this story was a sad reminder of a larger problem: when one lives in a world in which pro-abortion rhetoric and slogans dominate public discussion – when activists’ single-minded aims of normalising abortion permeates our own thinking, our ability to consider other possibilities when we ourselves are in vulnerable situations can be blunted. People’s difficult circumstances – though they require imaginative and nuanced ethical thinking – become battlegrounds for the normalisation of abortion, that all-consuming priority.
As I read the story, I was also reminded of something else: the words “abortive eugenics”. A Western Australian medical professor had introduced me to the phrase two years ago, as he had become concerned about a growing trend he had observed in tertiary education. Increasingly, medical students he’d had conversations with had been encouraged by their teachers to view abortion as a legitimate way of ‘treating’ diseases and disabilities.
I remember this professor remarking that this attitude, indicative of throw-away culture, threatened to undermine the very logic underpinning the practice of medicine since the advent of Christianity. While, in ancient times, a common approach to the sick and the weak was to abandon them, to cast them out, to effectively erase them from our lives, the aim of medicine since the advent of Christianity has been, overwhelmingly, to embrace the weak, the sick, and the suffering. The latter approach to the sick is exactly what incentivised so many medical advances, so much creativity in treating disease, and so much interest in understanding its causes. Once this drive to embrace the sick is abandoned in favour of aborting them before they are born, my professor friend remarked, might this do damage to the creative, pioneering spirit of medical advancement?
These two different approaches to medicine – the ancient one (which casts out of sight the faulty specimens of humanity, lest the peace of mind of the strong and powerful be disturbed by reminders of human frailty) and what, until recently, we might have called a Christian approach – represent deep worldview differences, and different loves.
To illustrate just how different they are, indulge me in one last hypothetical. Imagine you have been invested with great powers, and have been given a mandate to make sure everybody on earth is healthy. Conceivably, there are two ways you might go about this. One way would be to take every person who is currently unhealthy, and attempt to make them as healthy as possible. But another way to achieve this goal would be to simply eliminate all the unhealthy people so that the earth is now only full of healthy people.
Perversely, both approaches are consistent with a love for flourishing human life. But the second approach to creating a world of healthy people only evinces love for human flourishing in the abstract; it does not evince love for human beings themselves. While the second approach values human beings because – and only insofar as – they are bearers of human flourishing, the first approach puts things the other way round: human flourishing is valuable because actual humans are valuable. To take this attitude: that a given human being himself is valuable, rather than human flourishing in the abstract, is what it means to love that human.
Anyone who loves human beings will, of course, love and seek human flourishing, which is exactly what medicine, traditionally understood, is in the business of doing. To love someone is to seek their good. But it is not consistent with real love for real humans to eliminate an actual human being on the basis that they cannot be a bearer of full human flourishing in every way, which is exactly what one does if one eliminates disabled humans in order to eliminate human disability. To do this is to place a love of human flourishing in the abstract over love for actual humans themselves. It is all too easy, it seems, for many people out there to confuse one with the other and, as a result, to experience a grief that resists being processed.
But it is worth ending with a reminder that there are other stories out there – stories which defy the Nietzschean glorification of human-flourishing-in-the-abstract over true love for real humans. One is the story of the academic, Sarah Williams, whose baby, Cerian, was diagnosed with lethal skeletal dysplasia in utero. Though birth would be fatal, Sarah brought the baby to term in the face of pressure from doctors to abort, and went on to write a book about her nine months with Cerian. Another is the story of a woman I used to work with, whose baby was diagnosed with Edwards Syndrome. After giving birth (and also having had to resist the pressure from doctors to abort) this woman and her family spent seventy precious days with the baby. This woman told me that, for the baby’s older siblings, those days were a lesson on the value of human life that they would never forget. Another is the story of a man I know, who lost all his limbs a few years ago to a sudden illness. He still has his life, his loving and devoted wife, his beautiful children, and has since taken up sailing!
This is not to deny the very real suffering in these stories. But these, nevertheless, are the stories that show us what love truly is. Love embraces and bears with another, as they are, in all their imperfection.
The final words I want to close with are to all women out there who have chosen abortion after discovering injury, disease, or disability of a little one. To those who still live with inner conflict, grief, disappointed hopes, or cognitive dissonance. I do not want you to hear condemnation. We live in a very confusing world. When faced with a choice between devastating alternatives, we don’t always receive the help and clarity we need, and even the wisest amongst us live with regrets that weigh heavily.
Your pro-life sisters are for you. Some of us have been in your shoes. And we hope for your sake that the path to healing and peace reveals itself.
 T.A. Cavanaugh, Hippocrates’ Oath and Asclepius’ Snake. Oxford University Press 2017: p 84.
Dr Emma Wood is a Research Fellow with Women's Forum Australia.