Wednesday, 9 July 2008

More on abortion - what about disabilities

Cross posted on In a Strange Land

The third and final post in my series on objections to / issues with my original post on abortion - speaking up for abortion, in which I argued that abortion was morally permissible, and access to abortion is morally desirable. You will recall that three issues were raised and I have written about two of them - the infanticide objection, and the female foeticide issue.

This is the third, and I think most difficult issue.

What about babies with profound disabilities, who don’t fit your criteria of being fully human? Why is it generally held to be morally okay to abort a fetus with severe disabilities but not to allow a baby born with severe disabilities to die?

This was raised by Mikhela, in comments.

There's one rather simple issue here, and one very difficult one, which Mikhela didn't raise herself but which is part of the moral worries surrounding abortion and it would be intellectually dishonest of me to ignore. The simple one is the issue of moral parity between killing and letting die, and the difficult one, which she didn't mention, is what does it say about our thinking about disabled persons if we think it's okay to abort fetuses with severe disabilities. That's a very tricky issue, so I'll deal with it first. (There's some interesting research that I stumbled across recently, that the people who are world beaters, top of their fields, particularly with respect to sport, don't spend any more time practising than those who are nearly as good, but they do spend more time on the harder and more challenging things. I've taken it up as a heuristic for virtually anything. Bar bloody housework. Which is not difficult - just tedious.)

Generally, we think that there is good reason for abortion if a fetus is severely disabled, or even somewhat disabled. Older parents routinely use amniocentesis to test fetuses for Downs syndrome, and other genetic disorders, and terminate the pregnancy if they show that the fetus is disabled. And aside from the dyed-in-the-wool anti-abortion crowd, no one seems to think worse of them for doing so. Even late term abortions are accepted if the fetus is deformed.

There are some terrible cases where the fetus is so badly deformed that it is likely to die before term, or die during childbirth, or die shortly afterwards, or survive to endure only a short, pain filled life. I'm going to assume for the sake of getting to the real issue, that these are not the abortions we might worry about. It's the abortions where the fetus would be disabled, but would nevertheless live, and have at least an okay chance of a good enough life, that can be worrying. Downs Syndrome people are a case in point. As children, they are generally very happy and loving little souls, and as adults, they can live enjoyable and purposeful and giving lives, by which I mean lives that add to the net sum of human happiness - very vague, I know, but what I am trying to capture here is that they contribute and give back to society. So why is it okay to abort a fetus that has the markers for Downs Syndrome?

Of course, the abortion is morally permissible in the terms that I set out in my initial post - the fetus is not a full human being, so it is not morally impermissible to end its life.

Here's the thing. If disabled fetuses are aborted, because either we don't think their lives are worth living, or because we don't want to support them, then what does that say about our feelings towards the disabled people who are already part of our societies. Do we think that their lives should be terminated too?

Of course not. These are people, persons, full human beings, and their lives are their own to dispose of as they wish. More to the point, as full human beings, people with disabilities enjoy all the moral standing that any other full human being enjoys. And in any kind of Western liberal democracy, people with disabilities have the full rights and responsibilities of any citizen. (How that gets put into practice is something to talk about another day, but at this stage, FWIW, it seems abundantly clear to me that people with disabilities are routinely excluded from full citizenship in our societies. For just one example, take a look at Lauredhel's post on the difficulties of accessing playgrounds.)

Even so, when it comes to some, if not all, disabilities, it seems that if we abort a fetus with those disabilities, then we are saying that their lives are not worth living, even though there are full human beings, human persons, with those very disabilities, living among in our societies, and they say that their lives are worth living.

I think we need to turn the question around. It's not about whether the lives of people with disabilities are worth living; it's about whether we are prepared to support people with disabilities and their families. Why is it that when parents find that the fetus they are carrying is disabled, they choose to end the pregnancy, and perhaps try again? I guess that sadly, many parents want a "perfect" baby and they won't settle for anything else. Others might be happy enough to rear a child and support an adult with disabilities, but they know that they simply do not have the resources to do so, and that the societies in which we live will not help them.

The "perfection" idea is a dangerous one - after all, in some cultures, one gender is seen as less "perfect" than another, and people of that gender lead compromised lives. I think it's an idea we need to fight against, but again, it's a topic for another day. I think however, that in the same way that we can morally disapprove of someone who has repeated and repeated and repeated abortions, instead of having a vasectomy or just bloody well taking much greater care with contraception, that perhaps we can morally disapprove of someone who is hung up on the idea of perfection. It's an impossible standard for any child to meet.

At the same time however, I think that it is quite reasonable for parents to decide that they simply don't have the resources - emotional, physical, financial, social - to rear a child and support an adult with disabilities. When a fetus with disabilities is aborted because the parents feel they cannot rear it, then the failing is not in the fetus itself, but possibly in the parents (vide the perfection problem in the paragraph above) and probably in the society that leaves parents of disabled children to bear the load on their own.

You can see that I'm meandering through this topic a little - it's something I struggle with, in part because I simply haven't spent enough time thinking through some of the ethical issues surrounding people with disabilities, and the way that our societies do, or don't, look after our members who have disabilities. Nevertheless, I think that the point is that the problem when we abort fetuses with disabilities is not that we think that the lives of people with disabilities are not worth living. The problem is that our societies simply don't support people who have disabilities, nor their families. We close our eyes, cover our ears, clap our hands over our mouths, and try to wish our responsibilities away. I'm very happy to keep on talking this one over in comments.

As for the simple issue - why is it morally permissible to let a severely disabled infant die, but not to euthanase them?

I don't think it is. I know that's what we do, but that doesn't make it morally permissible.

I think it is cruel to allow infants to die. I think that if the decision has been taken that the infant should not live, then we are required to make their deaths as painless as possible. Simply refusing treatment, or food, so that the infant will die, means that the infant may well suffer pain, and possibly terrible pain, all because we are too squeamish. We wouldn't do that to a pet dog, so why would we do it to another animal, just because it is one of our our species.

And I'm happy to talk about that one in comments too.


Anonymous said...

Peter Singer's book "Rethinking Life & Death" is a must read for anyone struggling with the issues you raise. For a starter, see the coverage his Wikipedia article gives here.

Anna said...

Do you think Deborah (and this is a genuine question, not a stirring one - I agree with you!) that allowing a particular practice while reserving the right to disapprove of it might be a difficult position to sustain? I'm thinking from a sociological perspective about the effects of moral disapproval on people's actions - it can act as a big sanction influencing people's choices. IE, is allowing but disapproving of abortion of foetuses with disabilities the same as saying, 'We won't take your right away - but we'll morally bludgeon you til you give it up voluntarily'? Apologies if that makes no sense. I have a head full of snot and general misery.

Deborah said...

Hmm... the thing is, I don't disapprove of abortion per se, but I do disapprove of the some of the attitudes that cause abortion, such as ongoing indifference to contraception, or thinking that only a "perfect" baby, whatever that is, might do.

And yes, it's a bloody fine line to walk, and very hard to get it right. But I don't think we should necessarily be looking for simple answers anyway.

I take your point about the sociological consequences. It's all very well for someone like me, who is happy to be a bit of a social isolate, to go my own way and be comparatively indifferent to what most people say and do, but if I stop to think for a moment, I realise that there are plenty of people who are actually much more comfortable fitting in with their neighbours. And why shouldn't they? So the point you are making is a very good one - that fine line may result in very real pressure on at least some people. And there goes choice, just like that.

Anonymous said...

I think that's a perfectly consistent position. Take smoking for example, you can disapprove of it, but not want to make it illegal. Or you can think that wealthy people should donate to charity without thinking that they should be forced to do so.

I think abortion of fetus identified as having Downs Syndrome is hugely fraught. I wouldn't do it personally; I wouldn't even take the test. I don't want to condemn someone who decides otherwise. What I'm afraid of is that the inverse would happen: it would become the social norm to abort fetuses with disabilities, and parents who chose not to would be stigmatised for burdening society with people who need extra care.

Actually I think it's arguable that this already happens in stigmatising teen parents and solo mums, particularly beneficiaries. Some people seem to have the attitude that "no-one has to have children, so if you do, you should be prepared to look after them". This is NOT a pro-choice position. It does NOT value a woman's choice, which may be to go through with a pregnacy despite the fact that the timing is inconvenient and she's not well resourced to look after the child.