Foetuses and Eggs
Sunday, October 19, 2008
When Australia became federated in 1901, Abortion was illegal. In the last hundred or so years, as with many things, this law has changed. So too have attitudes to things like womens' rights, termination of pregnancy, and the notion of autonomy. Today's post scratches the surface of Termination of Pregnancy (ToP), in an attempt to examine some aspects of this challenging topic.
This morning there were about a twenty Anti-abortion protesters outside my medical school. Now, I'm used to seeing protesters on my way to PBL. There's usually one or two camped outside the local clinic, a few blocks away, holding their signs and getting cars to honk. Not many cars honk. But protesters outside Uni was something entirely different; they were coordinated, and chanting and really waving those signs with enthusiasm. Ironically, we were learning about STIs, hydatiform moles and the like. These protesters annoyed me, not just because their loud chanting disturbed my learning, but also because they're pushing their views onto other people.
Of the women I know who've undergone a ToP, none of them did it lightly. They are aware of their choices, and the options available aren't ideal. There is much guilt. They don't talk about it freely. Each week when I drive past the old, stagnant men, shoving their placards at the women who've made their choice, I get cranky. These blokes have no idea about the woman's circumstances. They're simply hurling abuse and idealistic viewpoints at a vulnerable young women. It's always good to kick someone when they're down.
What winds me up is that is that the people harranguing the patients are invariably men. They haven't been in this situation; they don't live with the consequences of their point and shoot activities. If they have endured some semblance of the emotional turmoil involved, they'd sure as hell have some sympathy.
I appreciate that abortion is not an operation that should be performed 'on demand'. It's not a form of contraception, it's not the 'morning after' pill. ToP is morally serious. The moral debate centres on the rights (if any) of a foetus vs the rights of the woman.
There is currently public debate about the issue in Victoria. Pending a vote in the Upper House, abortion will be removed from the Crimes Act. Currently, as with most Australian states, in Victoria "unlawful" abortion is illegal. However, "The “Menhennitt ruling” (as mentioned by de Crespingy and Salvulescu,) stipulates that an abortion is not “unlawful” if a doctor believes that the abortion is necessary to preserve the woman’s life or her physical or mental health. The upper limit of gestation is undefined."
Some doctors and academics have vociferously opposed the changes; One doctor has placed the a sign at the door of her surgery announcing that she will not be complying with the new laws. How does the new law effect doctors? Two main points; firstly, that abortions may be legally procured before 24 weeks. The opposing doctors argue that the cut-off should be twenty weeks. I don't consider myself informed enough to argue one way or t'other on this point.
Secondly, the opponents argue that the bill does not adequately deal with doctors whom object to abortion on moral grounds. In medical school, we are taught that the patient has a right to be made aware of all their options, and if a doctor is unwilling to refer a patient for a ToP, they should refer the patient to a doctor who is willing to explain all possible options. In this way, the patient's autonomy can be fully exercised. The opponents of this Bill appear to not currently do this. So, do they believe paternalism or patient autonomy, or even womens' rights? Hmph. Isn't it good to see how times have changed.
As far as those protester blokes at the clinic go, I enjoy imagining someone lobbing eggs their way in a drive-by. I doubt they'd get the irony.
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Some other resources:
Abortion: time to clarify Australia's confusing laws, Lachlan J de Crespigny and Julian Savulescu, MJA 2004; 181 (4): 201-203 http://www.mja.com.au/public/issues/181_04_160804/dec10242_fm.html
Abortion laws in Australia, E Kennedy, O&G Magazine; 9 (4): 36-37 http://www.ranzcog.edu.au/publications/o-g_pdfs/O&G-Summer-2007/Abortion%20laws%20in%20Australia%20-%20Elizabeth%20Kennedy.pdf
I'm maternalistic, matronizing occasionally. And you sound/read as though you haven't had many conversations about the subject of abortion. You should inform yourself, as the same rules apply to euthanasia, "assisted death," the death penalty, and our upcoming debates on genetic manipulation of future generations.
I'm sure that you understand the difference between the embryo or fetus and a body part or end stage cell line. There's no doubt that what we are discussing is a human being.
The nature of this individual human being is underscored by in vitro fertilization. Just as a neonate may be cared for by other people, that embryo in the lab can be nurtured by others and even adopted for implantation into a woman other than his or her biological oocyte- mother. What we do to that embryo affects the later toddler and adult, and even his or her own children.
Once the individual human being is acknowledged, we have to discuss whether or not to afford him or her the protection from intentional killing by others - what some call "personhood." This is the dangerous point of our conversation. How do we justify intentional, interventional and elective killing of that embryo or fetus in such a way that does not put other human beings that we acknowledge are "persons" at risk?
Autonomy should not be your first consideration in this deliberation. Instead non-maleficence, then beneficence and justice should be weighed with autonomy. Your own note about the decision to act or not act according to rules and laws by you future colleagues points out that these other values come into play when you are discussing the interaction of the mother, the unborn child, and the doctor and nurse, and the law.
Beverly B. Nuckols, MD, from Texas. (Posting this discussion at my blog, Lifeethics.org.
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