From Prenatal screening to “After birth abortion”

Róisín Dermody, independent researcher and disability activist, Dublin, Ireland

Abortion is a highly contentious issue when the debate focuses on a woman’s right to choose and the right to life of the unborn child.  However, when the decision to abort is based on the detection of an impairment during prenatal screening, the debate takes on a whole new perspective. And now, we are asked to consider the case of “After birth Abortion”.

On the 23^rd February 2012, the Journal of Medical Ethics published an article by  Alberto Giubilini and Francesca Minerva which advocates for “after birth abortion” on the basis that:

1. Neither foetuses nor newborns have the same moral status as actual persons,

2. The fact that both are potential persons is morally irrelevant and

3. Adoption is not always in the best interest of actual people.

They argue that infanticide or “After birth abortion” as they term it, should be permissible for the same reasons that abortions are permissible.

A serious philosophical problem arises when the same conditions that would have justified abortion become known after birth. In such cases, we need to assess facts in order to decide whether the same arguments that apply to killing a human fetus can also be consistently applied to killing a new-born human. (Giublini and Minerva, 2012)

As a disabled feminist, I have struggled to reconcile my pro-choice position with my reservations around prenatal screening and subsequent termination on the grounds of impairment.  However, I think, “After birth Abortion” is taking things a step too far.

Traditionally, within the abortion debate (i.e. pro-life v Pro-choice) the point at which life begins has been the issue, however, now we have  a question that is even harder to answer: When does a new born human become an “actual person”?

So what impact does this issue have for disability studies and the wider disability movement?  Given that the issue of prenatal screening and the termination of impaired foetuses is still so contentious, I would see the arguments surrounding the issue of “After birth abortion” as an extension of these arguments.

Several authors, including Hubbard, Shakespeare and Sheldon have drawn attention to the tension that exists between the feminist principle that a woman’s right to control her own body must entail the right to terminate an unwanted pregnancy, and the concerns of the disability movement that to permit the abortion of foetuses on the grounds of suspected impairment is tantamount to endorsing an anti-disability eugenics. (Sharp and Earle, 2002)

The legalisation of selective abortion on grounds of impairment has negative connotations for the lives of disabled people.  It promotes the notion that disability is something to be avoided and is seen as tragic. This, in essence, justifies discrimination on grounds of impairment. “Research and experience clearly reveal a tendency to assume the desirability of preventing the birth of foetuses with certain conditions” (Fletcher, 2001) which attributes a negative value to people living with those conditions. I agree with Tom Shakespeare when he says:

I support a woman’s right to choose whether to get pregnant or continue a pregnancy, but I am concerned about the context in which choices are made.  Social information about what it is like to be disabled – particularly information from disabled people themselves and their families – is as important in making these choices as genetic or clinical information. (Shakespeare, 2001)

In countries that have legal abortion and prenatal screening, it is becoming increasingly common for women who choose to continue a pregnancy after the detection of an impairment to be seen as irresponsible.  This broaches the subject of how parents should be supported and what information they should be given in order to make a decision following a diagnosis.  Such decisions cannot be made in a moral and social vacuum.

The decision to terminate a pregnancy in such circumstances is painful and difficult.  While parents carry the responsibility for making these decisions, society carries the responsibility for setting the social context in which these decisions are made. (Russell, 2001)

In the majority of countries where abortion is legal, the law specifies a cut-off point after which most abortions are prohibited, commonly set at the point of viability. However, in most of these jurisdictions it is possible to abort a foetus on the ground of impairment after the designated cut off point. Shakespeare criticises this practice stating “The law should not discriminate between impaired and non-impaired foetuses: a common time limit should be adopted for all pregnancies” (Shakespeare, 1998). Morally, there is no difference between the abortion of a non-impaired foetus and an impaired foetus; therefore, the law should not distinguish between the two.

Such late-term or post-viability abortions are the most controversial as the foetus is viable outside the uterus. These late-term abortions are often referred to as partial-birth abortions (PBA). Many anti-PBA activists consider late-term abortions as infanticide or murder. So how can “After birth abortions” not be described as infanticide?

The Authors use the term “After birth abortion” to demonstrate that it only applies to situations where an abortion would have been permissible. They also distinguish it from Euthanasia on the basis that Euthanasia is in the best interest of the euthanized whereas “after birth abortion” is in the best interest of the mother and wider family.

In the same way that using prenatal screening to identify foetuses with impairments in order to (ex)terminate them, we are witnessing not only a return to the medical model but also to a strong eugenic position:

“tests like amniocentesis are performed because a value judgment had been made that there is merit in identifying a foetus that if brought to term would become a person with disability.” (Blumberg, 1994)

Women’s choices are limited by the lack of supports in place for disabled people.  If such support structures were put in place to enable disabled people to realise their full potential and contribute fully to society, women might be more inclined to stand firm and exercise their ‘choice’.  Every disabled person should have the same rights to realise their potential in whatever areas as they see fit, on an equal basis with their non-disabled counterpart and without discrimination.

References

Blumberg, L. (1994) “The politics of prenatal testing and selective abortion” Sexuality and Disability Vol 12, Issue 2, pp. 135–153.

Giubilini, A. and Minerva, F. (2012) “After-birth abortion: why should the baby live?” in Journal of Medical Ethics, online 23/02/2012

Oliver. (2001) “Supporting Families to make informed decisions: how can we safeguard genetic diversity while respecting parents’ ‘right to choose’?” in Ward, L. Considered Choices: The new genetics, prenatal testing and people with learning disabilities. BILD Publications

Sharp, K. & Earle, S. (2002) “Feminism, Abortion and Disability: irreconcilable differences?”  Disability & Society, Vol. 17, No. 2,  pp. 137–145

Shakespeare, Tom. (1998) “Choices and Rights: eugenics, genetics and disability” Disability &  Society 13 pp. 665-691

Shakespeare, T. (2001) Forward in Ward, L. Considered Choices: The new genetics, prenatal testing and people with learning disabilities. BILD Publications