‘Disability cleansing’ – or a reasonable choice?

Britain’s most influential anti-choice group, Life, is having a rare celebratory moment, after successfully extracting a condemnation of the Abortion Act from the Disability Rights Commission (DRC).

Life had asked the commission for its view on Section 1(1)(d) of the Act. This is the clause that permits abortion without time limit when there is substantial risk of a serious fetal abnormality. In 1999 (the most recent year for which figures are available), 1702 abortions in England and Wales were carried out solely for this reason, 114 of them after 24 weeks.

Following a consultation (that involved disability organisations, but not abortion providers), the DRC concluded that Section 1(1)(d) was not, as Life had claimed, inconsistent with the Disability Discrimination Act, ‘since the latter is concerned with the rights of living persons’. So far so good. Unfortunately, the DRC went on to give this official statement:

‘However, the section is offensive to many people; it reinforces negative stereotypes of disability; and there is substantial support for the view that to permit terminations at any point during a pregnancy on the ground of risk of disability, while time limits apply to other grounds set out in the Abortion Act, is incompatible with valuing disability and non-disability equality.’

This is an interesting perspective – and it indicates that the DRC may well find itself with a difficult dilemma. Throughout its programme of work on ethical issues the DRC is supposed to be guided by two principles: ‘valuing disability and non-disability equally, and the right of individuals to make informed autonomous choices.’ In this particular instance, it is arguable that these two principles are mutually exclusive.

If we are to allow individuals (living persons) the right to make ‘informed autonomous choices’, we need to accept their right to ‘value disability and non-disability’ differently because, if we are honest, most of us do. We would rather be able to hear than be deaf; we would rather be able to see than be blind.

I find it difficult to believe that the actor Christopher Reeve, for example, values his condition as a paraplegic as much as he values his former ability to ride horses and act in Superman films. This is not to say that he values himself as a person less, or that he values his life less. It simply means that most people in these circumstances would surely choose to return to health if they could.

Which of us could honestly say that, when we are planning a child, we are indifferent as to whether or not it is healthy? We value health above ill-health. This does not mean that we accord less value to blind, deaf, paraplegic or ill people. Most people who approve of women’s decisions to end abnormal pregnancies would be horrified if anybody suggested that people’s lives be ended because of their disabled condition.

Life has been smart to focus on the issue of abortion for fetal abnormality. These campaigners have clearly lost their argument that abortion per se is a problem: society broadly accepts abortion as a possible solution to an unwanted pregnancy. But once the issue of fetal disability is raised, it seems to complicate things.

Many pro-choice activists who defend women’s right to end accidental unwanted pregnancies gag when asked if a woman should be able to terminate a pregnancy, not because she does not wish to have a child, but because she does not want to have a disabled child. Indeed, even many of those who lobby for abortion on request in early pregnancy see late abortion for fetal disability as a form of discrimination against disabled people – ‘disability cleansing’.

This makes it a perfect issue for the anti-abortion lobby to take up. There is little ground for them to gain arguing against early abortion, which is acceptable to the overwhelming majority of people – but when they take the argument into territory of late abortion, they find even pro-choice activists prepared to make concessions.

Abortion on the grounds of fetal disability smacks of a number of things that many liberals find unacceptable. It is judgemental and value-laden because, in opting to end the pregnancy, the woman says that while she was prepared to raise an able child she is not prepared to raise a disabled one. In opting to abort an abnormal fetus a woman is clearly saying that although she wanted a child, she does not want one on the terms that nature has offered. There are many who find it difficult to accept that some women should take control of their own destiny in this way.

Yet that women should have this kind of control over their destiny is exactly how it should be. It is the woman, after all, who has to take responsibility for the child after it has been born, and so only she is in a position to determine whether or not she is able or prepared to take the strain involved in rearing a severely disabled child. That the overwhelming majority of women who discover they are carrying a fetus affected by Down’s Syndrome currently choose to have an abortion is not surprising.

When a woman decides to have a child, she has an image of what motherhood will be like and what her child will be like. A severely disabled child is not usually what she anticipated or wanted. Access to antenatal testing and the option of abortion allows a woman to make an informed decision about the future of her pregnancy – and about her own future. Unfortunately, many of these tests can only be carried out when the pregnancy is fairly advanced.

Why should a woman in this situation be denied the option of ending the pregnancy in abortion? Nobody, at least in the UK, argues that women who wish to have disabled children should be forcibly aborted. The argument centres on whether a woman should be allowed to decide whether to continue a pregnancy that she now finds unacceptable.

Some disability rights activists argue that women’s choice should be denied because the acceptance of abortion for fetal disability has a corrosive effect on society. They argue that termination for fetal disability is a slippery slope to euthanasia for the living disabled, and that by condoning abortion on these grounds society condones discrimination against disabled people.

But this inexorable logic rests on the assumption that we are incapable of differentiating between our actions in respect of potential people and people themselves. After all, those who believe that abortion is a legitimate end to unwanted pregnancy do not accept infanticide as a way of dealing with unwanted babies or murder as a way of disposing of an unwanted partner.

Those who oppose abortion for fetal abnormality have been allowed to assume the moral high ground in the discussion. It is assumed that in an ideal world no woman would want to abort an abnormal fetus – we would accept the diversity they bring. Even many of those who accept abortion on grounds of disability often concede a moral superiority to those who accept the birth of a child with Down’s Syndrome or spina bifida with the same joy as a ‘normal’ baby. Abortion is accepted as an appropriate option for those who are ‘unable to meet the challenge of disability’ or accept their special talents.

Yet why should those who opt for abortion be made to feel that their decision is a symptom of their weakness and lack of moral fibre? Abortion of a previously wanted pregnancy on grounds of abnormality can be a difficult and brave decision. Many women opting to terminate pregnancies in these circumstances might have found it easier to let nature take its course, but cannot bear to bring a child into a life of pain. Others may be concerned about how such a birth will impact upon their obligations to existing family. Others may feel that they can make a more worthwhile contribution to society without the greater commitment to a child that lifelong disability would imply.

Those who argue that the current abortion law is riddled with eugenic assumptions undeniably have a point, but not for the reasons they suggest. The law was constructed on the assumption that abortion should be available for circumstances when doctors believe that a woman’s capacity for good motherhood is undermined by her health or her circumstances, or that it would be better for society if her child were not born. But the solution is the liberalisation of the law to allow women more control, not the opposite.

The current abortion law is not the kind of law that women need. We need access to abortion on request – for whatever reason we think is appropriate. If the DRC wants to make a sensible suggestion about the ‘discriminatory’ time limit that applies to Section 1(1)(d) it could usefully suggest that the limit be removed for all other grounds, too.

But until we have won such a law it is important to defend the access to abortion that current legislation gives us – including access to late abortion for fetal disability – and to celebrate rather than condemn the use of medical technology that allows women the chance to make a choice.

Ann Furedi is director of communications for British Pregnancy Advisory Service. She writes here in a personal capacity.

Read on:

spiked-proposals: Abortion, by Dr Ellie Lee

Defending abortion – in law and in practice, by Ann Furedi and Dr Ellie Lee