Freedom of Choice is not enough to make abortion ethical
A statement in opposition to the motion that abortion should be legalised in Ireland
Literary & Historical Society, University College Dublin, 25 September 2013
Members of the society, my fellow debaters, and members of the audience.
Thank you for the opportunity to make my case before you tonight.
The issue of abortion is wide-ranging. I am not going to try to address all of the issues, nor will what I say apply to every instance of abortion. I am a lecturer in ethics, and I am going to focus on one of the central ethical arguments made in relation to abortion: the role of choice and the claim that Freedom of Choice justifies abortion. In more ethical terminology, I will discuss how the ethical principle of autonomy should apply in abortion decisions.
The ethical principle of autonomy states that people should be free to make their own informed decisions about their healthcare.
My talk tonight addresses situations where women are free to make their own choices about abortion. What I will say will not apply as directly to abortion arising after rape. I believe my argument still applies in those situations, though I would need to elaborate on a few additional points. However, since the vast majority of abortions do not arise in the context of rape, I will focus tonight on all the other situations where abortion is considered when a woman finds herself pregnant after consensual sex, whether that pregnancy was planned or not.
In discussions about abortion, freedom of choice is taken as central. If a woman finds herself pregnant, and she does not want to have a baby, the argument is that she should have access to safe means to terminate her pregnancy. Given our Irish way of not dealing with tough ethical issues, people add that this also means a pregnant woman should not have to travel abroad to get an abortion. Legalising abortion is thus proposed as a way to promote choice and autonomy.
This approach to the ethics of abortion misses the whole point of what ethics is about. Some of this confusion has been caused by the way healthcare ethics itself has addressed autonomy. Medical ethics, and to a lesser degree, nursing ethics has become very focused on Principlism. This approach claims that most if not all ethical dilemmas can be settled by identifying which of four ethical principles are in conflict in a situation. This approach is best known from Beauchamp and Childress, two ethicists from Georgetown University in the US. Their textbook is by far the best-selling bioethics text, now in its 7th edition.(1) Their approach is widely used and quoted: basically, it in.
To put their method very simply, someone in an ethical dilemma should figure out which ethical principles are clashing and then it will become clear which one should have higher priority. In the case of abortion, a woman seeking abortion can claim that this upholds the principle of autonomy and respects her right to self-determination. Those opposed to abortion may point out that abortion harms the unborn and thus violates the principle of nonmaleficence (the ethical principle to do no harm). Thus, autonomy is in conflict with nonmaleficence. Only one principle can win. Which will it be?
Today, western societies generally hold that autonomy trumps all other ethical principles.
As I mentioned, we have come to this belief particularly within healthcare ethics.(2) When people are admitted to hospital, they are asked for their consent to various treatments and interventions. We believe that people are the ones who should make decisions about their bodies and lives. Gone (or going) are the days when doctors tell patients what is best. That is a good thing in lots of ways. It has corrected an imbalance where doctors inappropriately made decisions for patients.
So is abortion not a similar situation? A pregnant woman comes to hospital and says she wants an abortion. The hospital says this is not legal in Ireland, and therefore this woman’s autonomy is being violated. Who are we, the people of Ireland, to restrict this woman’s freedom?
But the situation is very different. When a person comes to the hospital with a medical problem or disease, the patient should be helped to understand the various treatment options. To promote autonomy, the patient should be allowed to decide which treatment to pursue.
But autonomy is only a means to an end. If the patient said he wanted morphine (or cyanide), and was making an autonomous decision, this would not be granted. Autonomy is only a means to an end.(3) Hospitals should promote autonomy in order to promote patients’ health.
When a pregnant woman seeks an abortion, pregnancy is not a disease. The hospital should provide information on how best to promote her health through caring for herself and the unborn during pregnancy. If her pregnancy was like a disease, where her life was being threatened by the pregnancy, then you have a different situation. Now two lives are intimately interconnected and are in conflict with one another. If only one can live, then there is an ethical justification to save one of the two. As tragic as such situations are, I do believe it is ethical to save one life when two cannot live. Such tragic decisions have been legal in Ireland for many years, and with the new legalisation they have a regulatory framework.
But the majority of abortions do not involve such situations. They involve decisions where a pregnant woman does not want to give birth. There may be many different reasons for this, some tragic, some highly complicated, some less weighty. All of them are difficult, and I believe such decisions usually are not made lightly. Autonomy does not settle the matter ethically because this only tells us who has the responsibility to make the decision.
Ethics is not just about who gets to choose; it is about which choices are ethical. Healthcare ethics has focused on autonomy to establish who chooses. Having established that patients are the ones to choose, this does not resolve many ethical issues. It is not as simple as claiming that we have the right to decide what will be done to our bodies.
We may believe that we have the right to do what we want with our bodies, but we do not. It is not legal for people to sell their bodies as prostitutes, nor even as organ donors. If I chose to put certain illegal substances into my body, I can be arrested. The whole basis of society is that certain autonomous acts are neither ethical nor legal. I may freely choose to steal, lie, cheat, or hurt others, but that does not justify my choice. In fact, we even make it a requirement that people be competent and freely choose to make decisions before we hold them morally responsible for them. Autonomy establishes moral responsibility as well as moral freedom.
We may choose autonomously, but that does not make the choice ethical. In the same way, a pregnant woman may freely choose to have an abortion, but that does not make this ethical. That determination must be made on some other basis.
One such basis is the so-called harm principle: that people have the freedom to do what they want, so long as they do not harm others. This is precisely where the whole freedom of choice argument breaks down in abortion. There is always an other where abortion is concerned. And by definition, that other ends up dead. The unborn has all of its rights and potential rights terminated totally.
This is why the nature of the unborn arises. Is the unborn a person to be harmed? This is a big topic itself, and I do not have time to address it here. However, this issue also does not settle the matter. We claim that it is unethical to treat animals and the environment in certain ways, even without believing that they are persons. Whether or not the unborn are persons, we have ethical responsibilities towards them on the basis of our relationship with them.
To determine whether autonomous actions are ethical, we need a view of what the good life entails. Autonomy can be used to promote an individualistic life, one focused only on the good of the individual. This can lead to a view of persons and society that is self-centred: “It is my life, and I will do with it what I want.” The one who has more power gets to decide what happens around him or her.
On the other hand, autonomy can be used to promote a society where our strengths and powers are used for the good of others. This is a view where the weakest and most vulnerable are given preferential consideration. During an unwanted pregnancy, the woman may be strong and assertive, or she may be under the thumb of some man or social pressure. In all cases, the unborn is totally dependent on the woman’s decisions. The unborn is the most vulnerable of humans because she cannot survive without the care of another, her mother. What is good is to care for the vulnerable unborn and allow him or her to develop and grow, to reach whatever his or her potential may be. This is what our mothers did and which gave everyone one of us the opportunity to be here today.
This raises one last point. Why should the woman have such responsibility? What if she did not want or look for that responsibility? What if her pregnancy was not planned? Here is where I mentioned at the beginning that my argument does not fully cover situations of rape. Outside of those situations, the responsibility to take care of the unborn begins with the decision to be sexually active. This in part is why this is such a momentous decision and has traditionally been viewed as something to be reserved until a committed, permanent relationship exists which is ready to welcome a child into society and protect and nurture the child during its formative years.
Autonomy means that our choices matter ethically. Ethics is about making ethical decisions when faced with significant choices. Our choice to have sexual intercourse brings ethical responsibilities. When we get into a car and drive, we take on certain responsibilities. If certain things happen, we are obliged to accept the consequences, good and bad. When we get into bed and choose to be sexual active, we take on certain responsibilities, intended or not. No contraceptive is 100% effective. There is always a chance of pregnancy. When pregnancy occurs, we have new responsibilities. This applies to both the man and the woman.
It is our very autonomy that makes abortion unethical. To respect our own autony, we must be willing to allow our actions to have consequences and to accept the ensuing responsibilities.
If we are to be autonomous agents, we should strive to act ethically. We have created a new, weak, vulnerable being who is entirely dependent on us. To promote the good of that life, and our own lives, we should choose the good of promoting life. This puts obligations on those around the couple, to help them choose life. Irish families have sometimes failed to do this, by rejecting daughters and sons. But in other cases, they have made brave, ethical choices: people parenting their unplanned grandchildren, or other families opening their homes to girls and babies. Such a society promotes true autonomy: people making choices to serve others and help promote the well-being of all, especially when people find themselves vulnerable and dependent.
If we legalise abortion, we will undermine these values and ethical principles. We will promote a society where people choose to do what suits them best, rather than make the hard and challenging choices to fulfil the relational commitments that arise from our autonomous choices.
I therefore urge you to reject the House’s motion.
- Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 7th ed. (Oxford University Press, 2012).
- Anna-Marie Greaney, Dónal P. O’Mathúna and P. Anne Scott, “Autonomy and Choice in Healthcare: Self-testing Devices as a Case in Point.” Medicine, Health Care and Philosophy 15.4 (2012): 383-395.
- John P. Safranek, “Autonomy and assisted suicide. The execution of freedom.” Hastings Center Report 28.4 (1998): 32-36