Late-Term Abortions Pose Dilemma Down Under

The abortion debate in Australia hasn't reached the fevered pitch of the controversy in the U.S., but the recent highly publicized abortion in Melbourne of a 32-week-old fetus diagnosed with dwarfism illuminates the troubling issue of choice.

Leslie Cannold

Abortion is a crime in most states in Australia. In the state of Victoria, where the capital is Melbourne, a 1969 judicial decision allowed doctors to grant a woman's request for termination if he formed an “honest belief” that the abortion was necessary to preserve the woman's physical or mental health.

While this judgment has meant that women in Victoria have relatively good access to safe termination services early in pregnancy, it clearly establishes abortion as a medical prerogative, not a woman's “choice,” or “right.”

Indeed, after the story of the 32-week abortion was leaked to the press by anti-abortion activists, the Royal Women's Hospital where it was performed rushed to reassure the public that the doctors' reasons for performing the termination would be assessed by an inquiry.

News reports of the complex case-the woman herself has not spoken publicly-have focused less on the legal aspects of the case, and more on the ethical issues usually seen to surround late-term abortions: the late gestational age of the fetus and the seriousness of its predicted disability. While only five per cent of terminations are performed after 14 weeks, about half of these are done because of potential damage to the fetus.

The woman who decided to terminate her pregnancy at 32 weeks carried a fetus diagnosed with dwarfism, a largely inherited disorder which causes disabilities that range from access issues and minor orthapedic problems to serious bone deformities and chronic breathing difficulties that in the worst cases lead to death shortly after birth. Details of this particular case are not known.

My research suggests that while most women see abortion as a moral issue, they nominate different ethical concerns than the male-centered ones that mainstream academics and journalists glibly presume to be at issue. Such views equate “viable” fetuses with babies born, and consequently reduce pregnancy to an issue of “fetal location.”

Women, not surprisingly, see the relationship between mother and fetus as meaningful and at the heart of the moral issues surrounding abortion. Many see the pregnant woman as morally obliged to commit as early as possible either to gestating the fetus and rearing the child that results, or to obtaining a termination.

The Royal Women's case demonstrates how social and medical attitudes and practices surrounding pregnancy may, by imposing alternative ethical requirements on pregnant women, alienate them from their own intuitive understanding of the range and limits of the moral obligations that arise from the “pregnant relationship:” the evolving relationship between the pregnant woman and her fetus.

During pregnancy a woman is becoming a mother, a process she completes when the child is born. At the center of this becoming is her evolving relationship with her fetus. For most women this relationship is initially only known because of tests, not felt (“The line on the box on the stick says I am pregnant, but I don't feel anything.”), but it becomes central to her thoughts, dreams, hopes and body by the time the baby is due.

Most women increasingly come to love the fetus inside them as it progressively makes its presence felt in their bodies and lives. As time goes on, they grow eager for the baby to emerge from their bodies, so that they can “consummate” the relationship begun in utero, through sight, smell, touch and nurture.

The existence and practice of prenatal screening imposes other ethical imperatives on women, while the limitations of the screens themselves may hinder the normal development of the relationship between mother and fetus.

Ethicist Paul Laurtizen believes the mere existence of medical technology can compel people to “choose” it. In other words, if a woman does not choose to have a prenatal screen and she gives birth to a disabled child, some will see her as having chosen to have a child with a disability (and therefore as solely responsible for the social and financial costs of its care).

The vast majority of doctors are enthusiastic supporters of prenatal screening. They assume women do and should choose these tests only when they are willing to terminate a fetus with a disability, and many expect and encourage women to choose termination when test results disclose abnormalities.

This enthusiasm occurs against a backdrop of social indifference-some would say antagonism-towards people with disabilities.

However, some prenatal tests, such as the one for dwarfism, only can be performed effectively very late in pregnancy.

These pressures put women in a bind. They are seen as morally irresponsible if they decide against screening, or refuse to terminate an anomalous fetus, but they are castigated as callous and unmaternal if they do decide to terminate a disabled fetus late in pregnancy. In addition, the pressure to screen and terminate runs counter to the attachment and commitment many women feel and believe they should feel to their fetus.

Some may seek to resolve these dilemmas by holding off coming to know, love and commit to the fetus inside them until they have been given the medical “all-clear.” Remaining “tentative” about their pregnancy, to use ethicist Barbara Rothman's phrase, may be a woman's best way of protecting herself emotionally as she tries to negotiate the contradictory moral demands imposed on her by the medical profession and society.

Some have argued that the Royal Women's Hospital case demonstrates the ethical burdens faced by the medical profession and the urgent need for law reform. I would argue that what this case mostly demonstrates is the untenable moral and practical burdens imposed on pregnant women in Australian society.

As the technological management of pregnancy increases and the tools in the medical armory expand, women are faced with increasingly difficult and intensely personal moral decisions, and increasingly harsh social judgments-no matter what they choose.

We desperately need greater respect for women's moral agency and support of their struggle to make moral choices that make practical sense in an increasingly complex and constraining world.

Reforming the law to put the choice in women's capable hands is only a start.

Leslie Cannold writes regularly for The Age of Melbourne and is the author of “The Abortion Myth: Feminism, Morality and the Hard Choices Women Make” (Allen & Unwin, 1998, Wesleyan University Press, 2000).