The Horrible Dilemma of the Pregnant Woman

She is pushed to have all the tests, then damned if she terminate late

Abortion is in the criminal code in many states in Australia, including the state of Victoria, of which Melbourne is the capital. However, in 1969 the state court ruled that abortion was defensible if the doctor honestly believed on reasonable grounds that it was necessary to preserve the woman’s physical or mental health. While this judgements has resulted in Victorian women having good access to safe termination services early in pregnancy, it also clearly established 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, the Royal Women’s quickly established an inquiry to reassure the public that they would be assessing the reasons doctors had for performing the termination.

News reports of the complex case at the Royal Women’s – about which nothing has been heard from the woman herself – 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 5 per cent of terminations are performed after 14 weeks, around half of these are done because of potential damage to the fetus.

My research suggests that while most women see abortion as a moral issue, they nominate different ethical concerns to the masculinist ones 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 that surround abortion. Many see the pregnant woman as morally obliged to commit as early as possible either to gestating the fetus and raising 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, not felt (“The line in the box on the stick says I am pregnant but I don’t feel anything.”), but it comes to occupy the center of 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 her body and life. As time goes on, they grow eager for the baby to emerge from their bodies, where they will “consummate” the relationship begun in-utero, through sight, smell, touch and nurture.

The existence and practice of antenatal screening imposes other ethical imperatives on women, while the limitations of the screens 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 pre-natal 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 antenatal 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 are “negative.”

This enthusiasm takes place against a backdrop of social indifference~~~~some would say antagonism~~~~towards people with disabilities.

However, some antenatal tests, such as the one for dwarfism, can only be performed 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 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 of the way they make them—no matter what they choose.

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 are desperately needed.

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