An interview with Ann Furedi, Chief Executive of BPAS, that’s really worth reading.

This interview is published in full on the Oxford Students for Life word press blog. It is really worth reading, and showing to friends who may be on the fence, or who hold a middle ground position. This is one example of what an intellectually honest defence of abortion looks like, and the challenges that it runs into. Again, it’s really worth reading in full, but here’s two extracts to draw you in.

The first is shorter, and includes a description of one reason why some women have late term abortions : “[v]ery often, the reason why you’ve got someone who’s presenting later is because they’ve been trying to make it possible for them to have the baby.” (A is Ann Furedi, and H. is Henry, the medical student interviewing her.)

A: […._I think that most women would rather prevent pregnancy than end one, and I think that is because we have a sense of when conception has happened, that that is something that is special and distinct. It may be something that we are abhorred by, or it may be something that we think, you know, the circumstances… Most women who come to BPAS are pregnant by someone who they actually liked! Most people are actually in a relationship with that person. In fact, overwhelmingly they come to the clinic with their partner, and it is a decision they have made together, that this is for the best. So many women will say “in different circumstances I would continue this pregnancy”.

H: It’s almost like they’re so close…

A: Yeah, and honestly, the way I look at it is there are a certain number of women who will basically say “get rid”. But for most women, there is a… if circumstances were different, they would make a different decision. Now, it may be that those circumstances are so wildly different that it’s not close at all. So it may be that “if I wasn’t 14”, “If I was 10 years older than I am now, I would make a different decision”, “If I wasn’t in the middle of my exams”, “If my boyfriend loved me”, “If my husband wanted the baby”.

In fact, one of the things that frustrates me enormously when we have discussion about legislation and so on, is people who have got a thing about wanting to reduce the time limit, because they can cope with the idea of early abortion, but not late abortion. Very often, the reason why you’ve got someone who’s presenting later is because they’ve been trying to make it possible for them to have the baby.

H: These difficult circumstances… Let’s make it worse: husband’s a drug addict, girl’s 14, they have no money. Whatever that might be, that’s really hard. It might be that they struggle. It might also be that 10/15 years later, they come out of that, and they have a son, or a daughter, who’s going to school, who they love. I would also say that when they’re in that situation, it’s really hard, but there isn’t an option to just passively undo it.

A: That’s right.

H: ‘Not continuing with the pregnancy’ is a euphemism that is used to create that illusion, but there isn’t an option to undo it. In order to get out of that, you have to kill someone.

A: Well in order to do that, you have to do one thing or the other.

H: You have to kill the foetus.

A: You have to kill the foetus, that’s right. You are ending that life that has started.

H: And it’s that woman who has to live with that. It’s nobody else, not the abortion provider, not the legislation, it’s that woman who has to live with that. I fully believe that you are somebody of compassion and caring, and that you are a truth-seeker who is really trying to work this out. I’m not sure if this has happened, but how would you feel about a woman coming to you 5 years later utterly distraught? Maybe they can’t have a baby now, maybe they say “I made the wrong decision, I was scared, I panicked, someone told me it was ok, I cannot live with myself.” How would you feel about that?

A: First of all, I would say that there will be women who make decisions they come to regret making. You know, we all do that, and you’re right – when you say the weight of that decision lies with that woman, I think that’s absolutely right, and I think it’s an incredible burden to place on her, it’s an enormous responsibility. But ultimately you can’t put the clock back. Every woman, and I’ve made this point publicly, there is no woman sitting in an abortion clinic who isn’t wishing she could put the clock back, because it’s a s*** place to be. You’re right, she has to do one thing or another.

But the point is that that is the responsibility that sits with us in the context of our lives and our position as mothers. We take responsibility for the lives that we create, and we take responsibility for the lives that we don’t. And there will be women who come back and say “I wish I had done something different.” But, you know, there will be women who will say “I wish I hadn’t had that child”, there are women who will say “We make mistakes in life”. But I agree with you – for you, because you take the view that you do, you find it almost unimaginable that someone can take that decision and live with it without being in some kind of complete denial.

The second is about a criterion she uses to distinguish between humans who have rights (like the right to life) and ones that do not, and which other humans, apart from human fetuses, this criterion excludes from full equality.

H: This brings me on really nicely to something that I wanted to ask you about. I’ve read your book, three times actually, ‘A moral case for abortion’. You devote a whole chapter to this, the question of personhood, called ‘Is it human? Do we care?’. I wanted to quote you, and then we can talk from this.

You say in this chapter: “Our ability to be aware of ourselves, and our self interests, to make decisions, to take responsibility for ourselves and others, to write the story of our lives, these are the things that define us as human.” and then you say “The presence of these qualities makes one life worthy of a kind of secular sanctity, and their absence subjects one life to the determination of others.”

So I’m a doctor, I work in an NHS hospital, and I currently work on a geriatrics ward. About half my patient have severe dementia. Progressive, irreversible cognitive decline. Many of them posses none of the qualities you list as defining us as human. My question is this: are they not human? Do they not deserve to be protected and cared for? Do they not have a right to life?

A: [long pause] My answer to that is.. Yes they definitely do. Yes they definitely do, and we should do all that we can to preserve their lives.

Let me ask you this, as a doctor. If one of those patients went into heart failure. You have your heart, and you’re deciding to give it to one of those patients, or to give it to a child at the beginning of their life. Doctors make these value judgements: where is it going to go.

For me, the end of life decisions I think society is going to struggle with enormously. Partly because it hasn’t recognised some of the issues that I would pull out as being important at the start of life. And I’m thinking this through almost as I’m saying it here. I’m going to a slightly new place on this. But what I was going to say is that we all make decisions, so we say these people’s lives matter. Would a doctor making a decision between giving a heart to a 20 year-old or an 80 year-old, would he be saying that 80 year-old’s life doesn’t matter.

H: No, because it’s a different situation.

A: He would say it’s a completely different situation. He would weigh that up. I was going to make the point that there is something we need to do as individuals, and therefore socially, in terms of working through what we do think is important and what matters about human life at its various stages of development, both absolutely and relatively. Because from the point of view of what I’m morally privileging, in terms of where I stand on abortion, It’s a privileging of somebody’s decision about their own body, and about their own private life and their own private existence.

H: I think we’ve acknowledged already that it’s not, because there’s at least another human involved, a member of the human species. That’s the difference between obesity and pregnancy.

In answer to your heart failure question, which I think is a good one: we make decisions frequently not to actively treat people. However, those decisions are made in that person’s best interests. That is fully caring for that person at the end of their life.
That is not for the decision of somebody else. So for example, those patients are a financial and emotional drain on their families. Some families come in and say “I wish they would just die”.

The 96 year-old with dementia, and I currently fight every day for 3 such people, those people, by your definition, and let’s just get it right, are not defined as human. By the exact wording of this, they do not have these qualities, and therefore are not defined as human, not worthy of secular sanctity, and because of these absences, they are subject to the determination of others. The people most affected by their lives are their families. I don’t think either of us would agree that their families get to decide that they should die. But this is the case you’re making with pregnancy.

A: It is the case I’m making with pregnancy.

The reason why I’m making the case in relation to pregnancy is because with pregnancy you have a situation you have with no other. You have a direct conflict between what one individual thinks is the right thing to do about my body, and my personal circumstances, and my family, and my family life. Somebody has to make a decision in relation to that situation. Either they are going to prioritise the biological life of the foetus inside me, or they are going to prioritise my ability to make that decision for myself. That’s basically the run of it.

To my mind, it’s profoundly immoral to deny that woman the control over herself that pregnancy involves. The reason why that is a very specific situation is because you can only mitigate and preserve that biological life by directly conflicting with her bodily autonomy and her moral sense of what’s right in terms of her family, her offspring, the fruit of her womb.

When you’re talking about elderly people at the end of their life, you’re really talking about something I think that is very very different. You’re talking about people who, you know, they may be in that state then, but we know that they’ve had a life, they’ve had experience. I believe there’s something going on there, I don’t believe they are empty shells. But even if you believe they are, then us, you as a doctor, me as a fellow member of humanity, can have hopes and desires about how those people are treated, and to want to do the absolute best to nurture and nourish and all that with these people. But it doesn’t impact on somebody else’s bodily autonomy and physical abilities. So I might want my mother to die. But ultimately if I want nothing to do with my mother any more, I can walk away from the hospital, and leave her in your very competent and capable care.

H: I think that’s a fair distinction. I think we’ve moved away though from personhood.

A: We have moved away from personhood.

H: I want to bring it back, and just ask you: This definition you make of personhood… To be clear, I don’t think my patients are not people. They bring value to my life in so many ways. Acts of kindness even when they don’t know their name, for example. Made my day on Sunday. They can have such enormous value. But they do not fit this definition of human. By this definition, they are not worthy of secular sanctity, and they are subject to the determination of others. Do you agree that this paragraph needs revising?

A: I would say that what I’m writing about there is I’m dealing with the embryo, and the personhood of the embryo, and the difference between embryonic life and life after birth. So I think I’d need to read that in context. But I think that it’s pretty clear in the context of a book about the morality of abortion what I am talking about.

H: But what you’re doing is generalising what makes us human and applying it to the foetus. And what I’m saying is that generalisation that you make is false.

A: And I think that if I was writing about the end of life, which I’ve been doing a lot of thinking about recently, then what I would be doing is developing that point, to make that point that the situation that the embryo is in, of one that has no sense, that can have no sense of life, because it has not developed the faculties..

H: Yet.

A: …Yet. But that ‘yet’ is a very important point. It has not yet developed the faculties to have that appreciation. It’s different to your old people, who may have lost faculties, but certainly…

H: Have had them at a different time.

A: …Had them at a different time, and who us of* know? As you say, the person who is no longer capable of remembering their name can be capable of a whole range of other human responses. We don’t revert back. What I’m saying is that I am not entirely convinced that in a kind of aged before death situation we revert to the simple state of an embryo. I don’t know enough about this, I know f*** all about this, but I would find it quite difficult.

H: [laughs] I agree.

A: One of the things that I find utterly compelling from people who have taught me about embryonic development is the inappropriateness of projecting backwards in time from the knowledge that we have of the world around us to the way that that is perceived.

H: In what way?

A: Well, one of the things that… actually if you get the chance to hear him talk he’s really worth listening to – Stuart Derbyshire, who I work quite a lot with, writes for spiked, who is a psychologist who tends towards the neuroscience end of it. His specialist area is pain. He spends a lot of time torturing students, trying to work out how people perceive pain and their understanding of it. His point is about how important the kind of total appreciation we have of our social context is in terms of how we appreciate even stuff that appears to be very very elementary, in terms of how we see things and hear things.

And therefore the stuff which I’m sure you wouldn’t necessarily buy into which some of your colleagues might is that the embryo in the womb is just that fully formed little thinking person who knows who his mummy is and listens to Mozart and appreciates things. It’s not really like that.

H: No, agreed.

A: And that’s why I think that there’s a huge distance… I don’t think there’s an inverted bell curve in terms of human…

H: Right, we don’t revert back. But I do think that when we are trying to work out when a human life becomes a person, we do assign certain attributes, and it’s worth thinking about other people.

A: Absolutely, I agree with you.

H: So is it the ability to feel pain, clearly not.

A: No.

H: Is it consciousness? No, because we all spend a third of our lives unconscious.

A: Yeah, but I think the thing is that there’s a certain thing we do – we can go through these exercises, and so on, we can try and put things down. It’s very interesting, even in writing this book, talk about going down the rabbit hole, and so much of it ends up on the cutting room floor.
It’s absolutely pitiful. I’ve got more stuff about the consciousness of animals than you’d ever want to know. Somebody said to me there are way too many cats in that book, and it’s really true.
There’s all kinds of things we can bring in, but ultimately what it comes back to is, and this is where we get into the scratched record thing – you are looking at it from the point of view of embryo to human and consistent moral commitments and a continual privileging of that human life above all else, yes?

Whereas for me, I think what I am privileging is the moral and bodily integrity of the existing conscious human being in that situation who contains that embryo to begin with, but then will give birth to her child. I’m saying that that human life matters to me, I think it has value and worth while it’s inside her, for what it will become.

For when it’s in early infancy, and people often say to me if you’ve got that approach to abortion how do you feel about infanticide and so-on, what’s magical about the passage through the birth canal – well actually it’s because it’s then outside of the woman, and good doctors like yourself can take responsibility for that.

I think it’s got a certain degree of moral worth when it’s inside the woman, it’s got a certain amount of moral worth as it’s growing up, and then it’s got moral worth at the end of it’s life, and it’s different. I’m not going to say that it’s more or it’s less, but what I’m going to say is that until it is born, you can only realise the status that you want to give it, if there is a conflict, by somehow taking away something from that woman. And that’s what I can’t bring myself to do. I cannot bring myself to say to a woman who is pregnant and feels that is wrong for her to be pregnant and that it is wrong for her to have this child…

H: Morally wrong?

A: Yeah. I cannot bring myself to see that it can be morally right to override her agency in that situation. What it comes down to for me is that somebody is going to have to make that decision, and so the only person who I think…

H: Well, if abortion is available, and we say “abortion is fine, carry on”.

A: Well, the point about is that, you know from medical history, people have been taking decisions about whether or not to have babies for probably as long as we have connected a swelling abdomen and absence of menses with having babies. Somebody decides, and the question is who. And that’s where it’s really hard.

When I was saying to you earlier about really needing to do more thinking about the end of life stuff. It’s because that’s why I have got a position perhaps, a moral positioning in terms of some of the end of life stuff, that’s probably quite different from somebody who would say there’s an absolute and complete equivalence, because it’s simply a matter of the nature of the entity that was once the embryo and is now the ancient demented useless person.

Whereas for me, the situation and the way that society can react, the way that we as other people can express our humanity towards that, and I do think there’s something that is, again, remarkable, in the way that we express our humanity in terms of our caring and love of other more vulnerable people, right the way through.

People say to me “isn’t this a remarkably, you know, selfish, dim view of humanity, are you only saying it’s only rational people etc.”. Absolutely god no, you know, because why would you not treat people well?

And that’s why I say I have a presumption in favour of life. It doesn’t concern me at all to say that, and I think that most women would rather prevent pregnancy than end one, and I think that is because we have a sense of when conception has happened, that that is something that is special and distinct. It may be something that we are abhorred by, or it may be something that we think, you know, the circumstances… Most women who come to BPAS are pregnant by someone who they actually liked! Most people are actually in a relationship with that person. In fact, overwhelmingly they come to the clinic with their partner, and it is a decision they have made together, that this is for the best. So many women will say “in different circumstances I would continue this pregnancy”.

H: It’s almost like they’re so close…

A: Yeah, and honestly, the way I look at it is there are a certain number of women who will basically say “get rid”. But for most women, there is a… if circumstances were different, they would make a different decision. Now, it may be that those circumstances are so wildly different that it’s not close at all. So it may be that “if I wasn’t 14”, “If I was 10 years older than I am now, I would make a different decision”, “If I wasn’t in the middle of my exams”, “If my boyfriend loved me”, “If my husband wanted the baby”.

In fact, one of the things that frustrates me enormously when we have discussion about legislation and so on, is people who have got a thing about wanting to reduce the time limit, because they can cope with the idea of early abortion, but not late abortion. Very often, the reason why you’ve got someone who’s presenting later is because they’ve been trying to make it possible for them to have the baby.

H: These difficult circumstances… Let’s make it worse: husband’s a drug addict, girl’s 14, they have no money. Whatever that might be, that’s really hard. It might be that they struggle. It might also be that 10/15 years later, they come out of that, and they have a son, or a daughter, who’s going to school, who they love. I would also say that when they’re in that situation, it’s really hard, but there isn’t an option to just passively undo it.

A: That’s right.

H: ‘Not continuing with the pregnancy’ is a euphemism that is used to create that illusion, but there isn’t an option to undo it. In order to get out of that, you have to kill someone.

A: Well in order to do that, you have to do one thing or the other.

H: You have to kill the foetus.

A: You have to kill the foetus, that’s right. You are ending that life that has started.

H: And it’s that woman who has to live with that. It’s nobody else, not the abortion provider, not the legislation, it’s that woman who has to live with that. I fully believe that you are somebody of compassion and caring, and that you are a truth-seeker who is really trying to work this out. I’m not sure if this has happened, but how would you feel about a woman coming to you 5 years later utterly distraught? Maybe they can’t have a baby now, maybe they say “I made the wrong decision, I was scared, I panicked, someone told me it was ok, I cannot live with myself.” How would you feel about that?

A: First of all, I would say that there will be women who make decisions they come to regret making. You know, we all do that, and you’re right – when you say the weight of that decision lies with that woman, I think that’s absolutely right, and I think it’s an incredible burden to place on her, it’s an enormous responsibility. But ultimately you can’t put the clock back. Every woman, and I’ve made this point publicly, there is no woman sitting in an abortion clinic who isn’t wishing she could put the clock back, because it’s a s*** place to be. You’re right, she has to do one thing or another.

But the point is that that is the responsibility that sits with us in the context of our lives and our position as mothers. We take responsibility for the lives that we create, and we take responsibility for the lives that we don’t. And there will be women who come back and say “I wish I had done something different.” But, you know, there will be women who will say “I wish I hadn’t had that child”, there are women who will say “We make mistakes in life”. But I agree with you – for you, because you take the view that you do, you find it almost unimaginable that someone can take that decision and live with it without being in some kind of complete denial.

And the only thing I can say is that it’s our job to, and I really mean it when I say that BPAS is an organisation that is driven by a very very very strong value based ethos, which is about putting women in the position where they are able to make the best decision for them in this situation, where it’s going.. You know, she’s there, she’s going to take one road or the other. And the best thing you can do is to ensure that in making that decision, women are able to genuinely weigh up all the possibilities, and all the help they can get, and that they understand exactly what it is that they are deciding.

When somebody comes as says “I have no choice”, it’s the job of our councillors to say “let’s talk about that, and let’s talk about the choices that you have”. “I haven’t got any money”, well have you thought about … The last thing that you want to do is to have someone going through a procedure and then saying “I wish I hadn’t done that because of …” Typically what will happen is that a young girl will come to you and say “My parents will kill me”. Your job really is to say “do you know what? They really won’t. Talk to your parents. They might be really cross with you, or they might not be”. It would not be a humane or good service to be in any way trivialising or downplaying or coaxing.

Ciara

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