There is no valid reason why a woman should not participate in her health decisions when a pregnancy is affecting her. Whether this translates into a right for an abortion depends, or ought to depend, on whether it infringes on the woman’s reproductive rights or valid medical reasons. This is something which is hardly ever mentioned and which people are being led to confuse. Many often use terms like pro-choice (the right to make a choice to have an abortion) and “reproductive rights” interchangeably. Sexual education, options for infertility, treatment for STDs, contraception, emergency contraception, in vitro fertilization, and so on are all reproductive rights. A woman who becomes pregnant through rape has had her reproductive rights violated if she is not given immediate access of emergency contraception. Having an abortion for other reasons, such as a defective baby, or simply an unwanted pregnancy, is a pro-choice-right argument, but hardly a reproductive-right. The fact one argues for a right to terminate during a phase of gestation does not make it a “reproductive” right. Reproduction has already occurred.
Reproductive rights are something which can be legitimately argued for, even if they may infringe on some normative values which others will fervently defend. Therefore, while it is very noble to defend the rights of the fetus in cases of rape, the woman has a right to defend herself against this violation of her person and indeed based on reproductive rights – she did not make a reproductive choice. It is not a matter of a choice as to when one gets pregnant but as to with whom and how it occurred. Foetuses may have a right to live, both from a moral and legal point of view. I would argue that the woman has a right to choose with whom she wants to have a baby. To argue and say that from a philosophical point of view, that baby still has a right to continue to grow in a woman who has been violated and had no choice in the matter and in no way was responsible, is an indelicate balancing act to say the least. It goes without saying that if she comes forward too late she may forfeit those rights which is why many countries put a limit – foetuses, after all, have rights too.
When it comes to IVF, there are indeed reproductive rights to expect from society once these are feasible and possible. Why should we not treat infertility using all the means we have at our disposal? True, there is the issue with freezing embryos, but to prohibit a couple from reproducing impinges on other rights. While society not always recognises the moral issue of freezing embryos, these have reduced in number considerably from the liberal fertilizing of a dozen eggs by those who ought to have been more prudent, to fertilizing a few, or simply freezing ova.
Conversely to argue that one has a right to abortion if the baby has genetic or congenital disorders impinges, in my opinion, on the right of that baby. Nobody has interfered with the reproductive rights of the woman. Just as people forcing women to remain pregnant even for rape and medical reasons is hegemony, so is this. Reproductive rights have been respected and the woman wanted to have a baby. That life sometimes gives us a disabled child may translate into an “unwanted” pregnancy but, although some legislations allow this, it does not really qualify as a “reproductive” right. It is not even a matter over a right over one’s body. In reproducing we know things can happen. We cannot control nature by eugenically eliminating disorders. The rights of disabled people are respected also by respecting disabled children.
I have written, in past columns, about the right to participate in one’s decision when there is a medical condition, especially one which is a danger to one’s life. These are not so much reproductive rights, but more general patients’ rights. We cannot treat people without their consent and for consent to be valid there must be no controlling influence, coercion or manipulation.
One may ask about general health reasons. Defining health is a much broader issue than defining a medical reason. A psychosocial or socio-economic reason may be defined as health. A woman who has a job, is single and has four children, is subjectively a health reason. But it ought to qualify for an abortion based on a “reproductive” right? There are many ways to prevent pregnancy, from contraception to emergency contraception; rights, that is, which the woman has access to. If one is pro-choice, so be it, but one ought not to misuse a term. Wanting to terminate your pregnancy for a personal reason is not a reproductive right. A right to an abortion therefore is not automatically always a reproductive right. Society ought to have an interest in children not yet born while at the same time find a balance between the right of the fetus and medical right, including those which can legitimately be conceived as rights to do with reproduction.
Many would say that there is always a reason for an abortion, and hopefully this is true. But society has a right to decide on what reasons are valid.
A comment ought to be mentioned about the principle of double effect which allows a woman to receive treatment for a severe condition, say, cancer or a psychiatric, even if it causes harm to the baby. Here I would go for a reproductive right. It is noble to sacrifice oneself to have that baby, perhaps even considered noble to have the baby even if the treatment causes harm to that baby. We are not really speaking about a “disabled” child yet. We may have to consider the right for a woman to participate in her medical care without the knowledge that she harmed her future baby. Many women choose not to receive treatment, but offering a moral alternative without inducing harm ought to be considered.
I would argue in favour of reproductive rights, including a right to make a decision about rape. I would certainly favour a pregnant woman having a right to participate in her medical well-being without hegemony and harassment by society. Otherwise, there are many ways to prevent pregnancy. Man is the only animal who performs abortions. I cannot sell an organ. A right over my body is not enough unless I have valid medical reasons. Not all other reasons fall under “reproductive” rights, especially eugenic ones. There will be issues of overlap and discussion, such as early teenage pregnancy, but with proper dialogue, unless we are to withstand an outright ban on fetal rights, one has to balance the rights of the fetus with what I would say are natural rights of the mother when her life is in danger or when she did not consent and was criminally violated in stances of rape. No just society would make a woman pay for this. I cannot forcefully be called to give up my life for someone unless I want willingly to do it myself altruistically.
Pierre Mallia is Professor of Family Medicine and Patients’ Rights and teaches at the University of Malta. He chairs the Bioethics Research Programme of the Faculty of Medicine and Surgery. He also chairs the Bioethics Consultative Committee.
This article is his personal opinion and does not represent the opinion of any committee or Board he serves on.
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