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Letters & Op-Eds - 2000

Choices

The Ethics of Prochoice Advocacy

Frances Kissling

2000

With increasing opposition to family planning from various conservative forces, it is clear that those of us who are committed to reproductive health must become more thoughtful and engaged advocates. This commitment to advocacy will involve us in many new partnerships. Just as we have moved from a family planning model to a reproductive health model we will need to frame reproductive health in increasingly larger areas -- taking into consideration poverty, women's rights, religious freedom and the environment -- and seeking to engage those who have made a commitment to those issues in our issues.

As part of that expansion of our understanding of reproductive rights and in response to the inroads conservatives opposed to reproductive health and rights have made, it is critical that we deepen our ethical framework and conceptualization of reproductive health. No issue has been more difficult or more a taboo within reproductive health than abortion. No issue is more ethically challenging, although I believe entirely morally and ethically defensible.

I participated in a conference recently on the ethics of abortion. A key question was: Is there a new ethic of abortion. To a substantial extent, I have concluded that there is no new ethic of abortion. The core principles or values that have led most of us to favor legal and safe abortions and others to oppose it remain the same. What has changed are some of the medical and scientific advances. More aspects of pregnancy have become visible and more possibilities exist in terms of pregnancy treatment and outcomes. The ability to save younger neonates, to select sex, to treat fetuses in utero. The question before us in these instances is whether or not we are prepared or able to re-examine our core values and see if these new realities in any way alter those values.

While we are facing the same core ethical questions that we have faced for the last 30 years, they are more nuanced. At the same time that we are willing to subject our values to the test of new realities, we need not give up our values. Both commitment and the capacity to change are values we need to balance in this complex arena of abortion. This discussion of values is not just a Catholic thing; it is not just a religious thing. The desire to live a good life, to do the right thing is a concern of most of humanity.

We need not be afraid to bring values to the abortion debate. It has been said that those opposed to abortion have morals and those in favour have rights. This construction of the abortion debate as one characterized by polar opposites is common. What I want to explore here are the dichotomies and opposing values that have become part of our discourse as advocates of abortion. Some have characterised abortion as the lesser of two evils. In fact it is a conflict of goods . Unfortunately, not all goods can be honoured at the same time. The value of choice and the value of life, for example. The question of whose life - woman's or fetus? One side talks about women, the other about fetuses. One side talks about rights, the other about responsibility. Some of us value health more and some of us value rights. Do we advocate for abortion because it is a human right, or a women's right, or because it's a public health necessity? Another dichotomy that is frequently posed is individualism versus communitarianism. Which is dominant? Which wins in the abortion debate?

Then there are ethical questions related to our advocacy. Do we take an incremental approach, a step-by-step approach, to make abortion available, or do we have a somewhat absolutist perspective. Is abortion on request the only ethical framework for abortion? Are regulations or involvement by the state acceptable? Do we move towards what we want, or do we only accept laws and positions that fully reflect everything we want right now?

A very important question to ask is whether we are part of the establishment - or whether we are revolutionary. Where are we positioned in this debate, in terms of how we wish to see ourselves?

  • do we have passion, or are we prudent?
  • do we provide services or are we advocates ? Can we be both? What does providing services do to one's ability to advocate?

The future is our ability to combine and balance many of these dualities and see them as positive goods and values that need to be weighed and brought into the discourse.

The ethical and the advocacy debate over the past twenty to thirty years has been characterised by the adage "two ships passing in the night". There has been one set of people concentrating almost exclusively on one side of these dualities, another set on the other side of these dualities. But in American public opinion, for instance, a majority is in the middle. When you listen to people, to the radio, the television, the debate between the anti-abortionist and the pro-choicer, you know already what everybody is going to say. It is very boring for the people who listen, unless they are themselves deeply engaged in the debate.

When we talk about the advocacy side of the discourse about abortion, the person or group that shapes the question determines the answer. Most of us have not been shaping the question for a while. There may have been a period in history when advocates for safe and legal abortion shaped the question. The question then was: will women die? Or will women's health (mental and physical) be destroyed because they are forced to continue pregnancies or hide into a back street to have an abortion? This was the question that brought us success in making abortion legal.

Once legal abortion became a reality, and once women stopped suffering as a result of illegal abortion, our question became meaningless. A new question then arose and a discourse was shaped by those who opposed the right to choose abortion. This speaks to the dichotomy between the woman and the fetus mentioned above. Women were central in the advocacy discourse and in the ethical concerns of people in the early stage of legalizing abortion.It is not ethical to have legal conditions under which a group of people of one gender suffer. Things changed when women had legal abortion.

Many things changed when women could have abortions:

  • we have experienced an enormous backlash against women, and women's rights -- women have too many rights, it's enough!
  • we then saw the rise of concern over fetuses, for many reasons. Medical technology increased the concern and the attention on the fetus--the fetus became more real.
  • perception of rise in infertility -- babies became valuable commodities.
  • children have become a sign of our material wealth -- they are another consumer good. Fetuses become more valuable, and as there is no real evidence that women are suffering in this debate or conflict between who is worth more, women and fetuses, we are back to a point in time when the fetus is seen in many quarters as more valuable than the woman. Women do not need to be protected because we are empowered, achieving, having all of those things.

This discourse, this polarized, caricature of life that dominates the media is important for us to understand as we determine how we will frame and how we will talk about these issues in the future. It is very difficult to maintain a discourse in the future that does not respond to questions regarding the value of the fetus. This is very hard for most of us to confront, but we need to find ways to confront that. And I believe that the weight of medical, sociological and philosophical thought and knowledge easily leads to a conclusion that fetuses are not persons. As such they are not the moral or physical equivalents of the women in whose bodies they are located.

In linking two of the other dichotomies, the rights and responsibilities dichotomy, and the individualism versus the community dichotomy, one can say that we also live in a time, in terms of ethical discourse, where there is a reaction, a kind of fundamentalism that has taken hold against the modern enlightenment. We are in a post-enlightenment, post-modern era where there is much discussion about the individual and about rights. Many would say that this has got to go. They point to the poor people, saying that poor people do not live their lives, people in the South do not live their lives on a me-me-me basis, which is what they reduce individualism to. They live their lives and make their decisions in the context of community. How can we have all these rights out there, without calling people to responsibility?

The ability to combine these elements is critical to our success in the future. We need to acknowledge that responsibility is important. But so are rights - they do go together. One element of the rights discourse is the right to be responsible, but this is a very difficult concept to bring out in the modern discourse. We should be recognised as people who care about the community as much as the individual. This is critical to our success as advocates.

Another debate that goes on, and this is one that goes on mainly within our movement, is the debate about which is the winning strategy: rights or health. Do we advocate for and do we justify abortion on the grounds of health (of women, of children, of the community), or do we continue, even in the face of the assault on rights, to articulate abortion as part of the human rights of people, especially women? In the moral sphere, there is no right to abortion but there is a strong right to choose, and this includes the right to choose abortion. There is a right to autonomy, and the right to bodily integrity, and these are broad enough to include the right to abortion.

How do we shape these debates? This raises the question of how change is made in our society. Change is made in different ways. Each of us decides as a group and as an individual, based upon our own personality (of groups or individuals), what kind of approach we will take on the issue, based upon what we like. It is, no matter what we would like to think, primarily based on high-minded principles. It is based upon where we are comfortable. Change is made at the margins, not at the centre. Change is made by people who are on the outside, not by popes or presidents. For an insider the dynamic might be different. It all comes from where you are comfortable.

To be a good advocate you need to know who you are and to play to your strengths. Within our movement, we need to respect each other's strengths. One thing that happens -- within Family Planning Associations (FPAs) and within a country where there are all kinds of groups working on these issues -- is the tendency to concentrate an inappropriate amount of energy on criticising each other. Yes, we face an opposition movement that has developed increasingly complex arguments - a very well organised, highly articulate and emotionally attractive, anti-choice movement. The discourse of anti-abortion is richer than 20 years ago, more diversified than us, in the way it approaches the issue. It has groups and arguments on how abortion does harm to women. There is less talk of fetuses - they are only interested in protecting women's health and rights.

The challenge for the future, considering that good advocacy is ethical and based on fact, is for us to develop an increasingly richer discourse about abortion and about abortion rights. The challenge also is to train and educate ourselves to be able to conduct this discourse. In some cases the challenge is to do some deep, personal soul searching. Some FPAs resist being strong public advocates of the right to choose abortion. Since this right to choose abortion is part of the core principles and values of IPPF, there is work to be done. It is not to develop a culture of complaint. The responsibility is to solve the problem, not to complain about it. Part of the solving of that problem is to find ways to help people come to terms with their own feelings about abortion. One dynamic in the movement is that there are some of us that are so committed to the right to choose abortion, who have no doubts at any time, that we do not make the space for those people who have some doubt. And if we do not make that space for doubt within our movement and work through those doubts respectfully, then we cannot have large numbers of people going out and advocating for a right that they are a little uncertain of. The most interesting space in the human being is where doubt lives. Let us celebrate, welcome and learn from it. Let us use it to build a stronger and richer movement and to achieve the rights, the health and the wellbeing that all women deserve.

This article appeared in Vol. 28, No. 2, 2000 of Choices.