A post about the UCC report into late abortion, and honesty about the ‘costs’ of our own positions.

It’s worth noting before you continue that this post will contain descriptions of violence and discussion of feticide and rape.

This week an article was published in BJOG, the journal of the Royal Society of the Obstetrics and Gynaecology. The study, authored by academics in UCC and CUMH was a qualitative study examining the experiences of Irish practitioners of abortion in the case of life-limiting conditions, or ‘fatal foetal abnormalities’. The article, written by a repeal campaigner and two other likely pro-choice authors, is one of the most direct examinations of the situation that Ireland’s new abortion law has actually created.

Some terminology before we proceed: the practitioners are referred to as ‘Fetal Medicine Specialists’ or FMSs. ‘Feticide’ refers to directly ending the life of the preborn child using a lethal injection. TOP is short for Termination Of Pregnancy, which refers to delivering the baby early with or without feticide. FFA refers to ‘fatal foetal abnormality’, or to use the term generally preferred by parents of babies who receive these diagnoses and carry to term, Life Limiting Condition (LLC).

The report makes for extremely upsetting reading. The practitioners extensively describe their own attitudes to and feelings about what they are doing. The quotes mostly speak for themselves – we’ve done our best to present them in context.

Over half of the FMSs expressed internal conflict about the provision of feticide and the need to ‘separate yourself from it completely’. They described feticide as ‘brutal’, ‘awful’ and ‘emotionally difficult’,  referring to it as ‘stabbing the baby in the heart’, and held themselves responsible for the death of the baby: ‘I caused the death’.

Almost all of the FMSs justified providing TOP for FFA or feticide because it was a ‘kindness in some cases’, and they would want someone to ‘step up and just be kind’. FMSs felt obliged to provide TOP for FFA as it is ‘the right thing to do’ and expressed the importance of being in a position to ‘provide full care for women’.

Providing TOP for FFA created a ‘psychological burden’ for over half of the FMSs. A couple of them referred to themselves as ‘doctor death’, dealing with death and dying or with opinions from others that they ‘are trying to terminate everything’. However, half of the participants expressed that this was their job, and that they have ‘chosen’ ‘to support (parents)’ and ‘it’s important to do it well’.

Another quote from the report:

Over half of the FMSs experienced conflict with neonatologists. Participants reported frustration that these colleagues would engage in decision making for TOP for FFA but would refuse to care for the woman and her baby ‘if the driving force was termination’. This generated concern for FMSs as they are ‘unclear as to who will look after those babies’ if a baby is born alive following TOP by induction of labour and without feticide, resulting in them ‘begging people to help’ them in providing palliative care.

From a list of direct quotes from interviews with the practitioners (it’s unclear from the way the report is formatted whether these quotes are from the same person or different people

“I remember getting sick out in the corridors afterwards because I thought it (feticide) was such an awful procedure and so dreadful.

You have to see the positive in it otherwise you would drive yourself mad.”

If you supported the repeal of the eighth amendment, it may be because you think that bodily autonomy is a great good, or because you think that people will no longer be forced to travel for abortions that they would have had anyway in the UK. But even if repeal achieved that, it’s not the whole picture. The honest, complete picture of repeal of the eighth includes the stories told in this article too.

A person who supported repeal who is prepared to look honestly at this article, rather than deliberately choosing to look away, will have to concede that there is a terrible cost to pay for their preferred situation. A situation where medical doctors get sick in corridors because they have given children lethal injections is not a thrilling human rights victory, even if those children were going to die soon anyway. It’s not the stuff of grand narratives about shaking off oppression. Even if it’s not what we think it is — a chilling, savage human rights violation — it’s at best a grim, violent price of achieving some great good.

Most people do not like thinking that their moral position might necessitate paying these kinds of prices. So the general move is just to ignore them. And thus really important information can be freely available but, through a sort of tacit agreement, almost never discussed. We won’t see any discussion of this article on RTÉ. It won’t be raised in Oireachtas committees, except by the usual suspects. What it depicts won’t be treated as any kind of national scandal – not because it’s not bad enough, but because it’s too bad. Looking straight at it risks burning your eyes.

Ignoring uncomfortable and distressing realities is something all human beings do, not just pro-choice ones. Pro-lifers weren’t rushing to talk about the Amnesty Report in 2018, which described horrific situations faced by women with terminally ill preborn children travelling to England to get an abortion. Nor do we tend to talk much about our own hard cases: about the trauma faced by pregnant rape victims for instance. When we do, we mostly want to emphasise stories in which victims talk about the joy brought into their lives by their children, and the goodness of those children’s existence. Don’t get us wrong, this is an important part of the story, and it’s one that’s underemphasised by the culture as a whole. You probably wouldn’t know, for instance, that most people who conceive through rape do not have an abortion, or that those who raise the child they conceived through rape often report feeling stigmatised and judged for their decision. But it’s not the whole story about pregnancy after rape.

The truth is that we mostly talk about the grim, sad parts of these cases when they are brought up by pro-choice people, or when we think that there was an angle on them that would bolster the pro-life position. This is a mistake.

Discussions are always best when they are honest. And honesty necessitates a frank look at the terrible costs of our own positions.

It’s not that we think the pro-life position necessitates doing anything morally wrong. In a just society, the families in the Amnesty report would have had access to the best perinatal hospice care available, and both they and their children would have been treated with dignity before and after their child’s death. We both know cases in which parents gave their children as much life as they could: we think this was unambiguously the right choice. 

But that doesn’t change the fact that in almost all cases of LLCs, the babies still died. Their parents still had to spend months carrying their children knowing that they would very likely not live long after birth. This was still one of the worst things that ever happened to these families, and unlike in the case of a miscarriage, it’s impossible to grieve in private, if that’s what the family wants. Your trauma and grief are exposed for all the world to see. It’s so easy to understand why a person would want to cut short that process, and requiring them not to is a huge burden.

In the imperfect, broken world that we live in, the pro-life position sometimes puts people in horribly traumatic and heartbreaking situations – rape victims, parents of babies with LLCs, people carrying pregnancies to term that they do not want. We want to do everything we possibly can for those people short of killing, because, if we are right, preborn children are our moral equals and killing an innocent person is always wrong. But even doing everything possible will not remove or even alleviate the trauma that these situations can cause.

We don’t think that the consequences of our position are horrible in the same way as the actions described in the UCC article are horrible. We think that an honest look at the terrible costs of both pro-life and pro-choice positions will reveal a fundamental asymmetry: that of requiring vulnerable people to go through immense trials in order to prevent other vulnerable people from being subject to violence, and subjecting vulnerable people to violence so that other vulnerable people can be spared immense trials.

But an honest look at the costs of our own position makes us more likely to take action to help those paying them. It makes us more able to understand those who disagree with us. And if we’re unwilling to square up and look directly at all the consequences of our positions, it would be a reason to doubt that in our heart of hearts we really believe what we say we do. We invite pro-choice readers of the UCC report to take that same honest look.

Ben and Muireann