Focus: Where are the Women in the Abortion Debate?

ETHICS IN THE NEWS - FOCUS

One news story brought into focus through a Q & A session with an expert at the Center for Ethics

Today's Focus is with Dr. Toby Schonfeld who talks about the abortion debate as it is informed by bioethical inquiry.

The past few months have been marked by controversial bills across the country attempting to regulate abortion. For example, Virginia legislators proposed a bill that required women to have a vaginal ultrasound prior to obtaining an abortion. Legislators in Georgia passed a bill this spring that significantly restricts abortion past 20 weeks gestation. And the federal government recently considered (but rejected) a ban on abortions for sex selection. These legislative efforts aren’t new, but are rather the latest example of ways that the right-to-life lobby has tried to limit the provision of abortion since Roe v. Wade in 1973.

Below is an excerpt from a conversation with Dr. Toby Schonfeld, the Director of the Master of Arts in Bioethics Program at the Center for Ethics. Dr. Schonfeld’s research interests are in research ethics and the ethics of women’s healthcare. She shares her opinions about how the abortion debate relates to women’s rights and the role of bioethical research.

How has the pervasiveness of pictures of fetuses informed the abortion debate and women’s choices?

In regards to the famous LIFE magazine photos, we must wonder - why are we looking at pictures of fetuses? Why are there big vans with photos of fetuses on them driving through the street? Is our moral system based on aesthetic sense?  Some of Virginia’s new legislation requires women to look at pictures of fetuses before deciding about abortion, which seems to indicate that they think women don’t know what fetuses look like, and the visual image alone will be enough to dissuade her from terminating the pregnancy.

These practices infringe on the rights and welfare of women. Why assume women aren’t making a rational decision and can’t understand what they’re doing? Instead, we are re-entering an era of paternalism and protectionism. The concern is that someone has to look out for the best interest of the fetus because the woman (obviously) isn’t doing so (say the critics). In other words, the interests of the fetus must be preserved and the woman can’t be trusted. But it is not clear why the fetus’s interests ought to trump the interests of the woman, and that’s a debate that does not happen in the popular press.

What are your opinions on new laws that require a woman to have a trans-vaginal ultrasound before terminating a pregnancy?

The trans-vaginal ultrasound laws are particularly troubling because what they are literally requiring is battery:  a woman is required to be touched – in this case, penetrated by a foreign object! -- without her consent. With unconsented ultrasounds or other procedures, what we’re really talking about is invading a woman’s body. There is no other precedent for performing such actions without the express consent of the patient EXCEPT when the patient lacks decisional capacity.  The implication here is that the woman seeking abortion has as little to say to what happens to her own body as someone who has no decisional capacity. Does she loose the ability to make decisions because she’s pregnant? In fact, quite the opposite is true: a woman knows her body better than anyone else.

How can one begin to understand the nature of this debate?

There are two fundamental errors in arguments that are vehemently anti-abortion and hold that pregnancies should be maintained no matter what the cause. The first is in clinging to the myth of the “zero risk pregnancy” – the notion that if  a woman does everything “right,” then her child will be perfect and healthy. Unfortunately, the world doesn’t work that way; for one thing, the base rate of genetic mutations is 3-4% without taking into consideration external factors like environment. Research continues into factors that affect fetuses.

The second error follows the recognition that if we want all pregnancies continued, it makes sense to allocate resources to women who can’t afford prenatal care or post delivery costs. Many women seeking abortion do not have the economic, social, or psychological resources to care for those children. Those who claim to be against abortion ought to have correlative responsibilities to these women. That is, there should be systems in place to help care for the child who results from an unwanted pregnancy. Instead, anti-abortion rhetoric stems from those who don’t suffer the consequences. I worry about a social and political system that’s happy to be involved in overtaking women’s rights when it comes to the health of a fetus but has no interest in helping to care for children.

What is the role of a bioethicist?

The role of bioethics is threefold. A bioethicist should assess critically any policy proposals like those of Virginia and Georgia. Legislators are not physicians or ethicists and don’t always fully understand the broad implications of policies they’re suggesting. For this, it is important to help educate policy makers about questions raised. Of course, this doesn’t always work. In Nebraska, I testified in front of the state legislature about embryonic stem cell research. I only had three minutes to outline the ethical arguments supporting such efforts. The first question from a Senator was: “What are stem cells?” I was floored: if the legislators didn’t understand basic biology, how could we expect them to understand the nuances of the ethical argument?

Something similar happened in the discussion about HB 954 in the Georgia legislature recently. Despite physician testimony and a preponderance of medical evidence about embryology, legislators refused to believe the experts (see: this article). It is our job as bioethicists to bring these dichotomies to light in order to promote a more educated citizenry. The second role of a bioethicist is that once the question is identified, the processes by which to answer the question must also be identified. Sometimes we will need to do an empirical study, which may require a  change in regulation. Sometimes this will require careful articulation of the logical implications of a position. Sometimes this will require policy analysis. Regardless, a bioethicist can help to identify various ways to answer a set of questions.  

 The third component for a bioethicist is to conduct research. The research could be theoretical, clinical, social, or behavioral. Research helps answer some of these fundamental questions. In my work now I’m looking at how we view women, especially pregnant women, as vulnerable. This vulnerability is a category of the research regulations, yet I argue that what happens is that applying the regulations in fact makes women vulnerable, especially in the context of pregnancy. The category is a self-fulfilling prophecy that inhibits important research about how the pregnant body works. Our current regulations prohibit investigators from conducting studies that will inform us about how to care for pregnant women in an evidence-based, rather than anecdotally-based, manner. We don’t tolerate this research approach in other areas, for example in environmental health policy, particularly in attaining data about climate change. Why not ask for the same approach to gathering data about pregnant women?