Hard cases and political footballs

This excellent piece by Melanie McDonagh in the Spectator about the perceived BBC bias with regards to Northern Ireland’s abortion law, alerted me to the tragic case of Sarah Ewart, who discovered at her 20-week scan that her unborn baby had the severest form of spina bifida and was anencephalic as a result, namely the baby did not have any skull bones. This meant that her baby would die following a traumatic birth in which labour would need to be induced, the lack of skull would mean that there would be no pressure to cause natural labour.

Sincere sympathies to Ms Ewart. Any pro-lifer who rushes in to condemn her as a result of her decision to travel to England for an abortion should hang their head in shame and reconsider whether or not they ought to be a part of the pro-life movement.

This is one of those cases that stretches all of us to our limits where the pro-life lobby needs to be exceptionally cautious before throwing around cold, hard, legalistic definitions of moral theology, which can seem lacking in empathy, in order to justify the best course of action in such a terrible situation.

While Melanie McDonagh is right to identify the underlying agenda of Jim Naughtie, her point that “most people would accept that a baby without a head is, to all intents and purposes, not a baby” requires further analysis.

Firstly the definition of personhood is not dependent on the presence of any one part of the body. A person who is missing a limb is no less of a person than an able-bodied person. In this distressing case, it is not that there is no head whatsoever, but that no bones have formed in the head. Without wishing to dwell upon the gruesome detail, there will be a brain and presumably a face, but no bone to support the mass. So it isn’t accurate to say that the baby was not a person, or not alive or even lacked a head, but that he or she would not have been able to live outside of the womb.

Personhood is not defined by location, or the eight inches of the birth canal. A person does not suddenly become more human or more alive, by virtue of their passage down the birth canal, or through the walls of the abdomen, in the case of a cesarian.  Location does not determine a human’s worth or value. The process of birth does not render a baby any more human or alive. Neither does mental capacity. A six week old baby is not less of a person because they lack mental reasoning skills,  in the same way that someone suffering from Alzheimer’s is no less of a person, nor someone in a temporary coma for example.

The law in Northern Ireland  rightly does not allow foetal abnormality as grounds for abortion, which should not be controversial. A civilised society should not approve the principle that people should be terminated on the grounds that they are not able-bodied and therefore their lives of lesser value.

Awful situations such as these are precisely where we must carefully apply principles of moral theology . We cannot commit an intrinsically  evil action in order to bring about a good.

The problem is that the abstract often seems cold, hard, unfeeling and dogmatic when applied to real people and real situations. We cannot forget that there is a real person involved at the centre of such suffering. It’s a difficult balance between not allowing sentiment or empathy to determine what is the correct course of action and yet abandoning all empathy in the process of applying a general principle. Hard cases do make bad law, the heartbreaking situation faced by Sarah Ewart does not justify killing humans in utero en masse as a result of their disability.  Cases such as those of Sarah Ewart are thankfully exceptionally rare, which is another reason, why the law should not be changed, especially not when one considers that a similar law in the UK allows for babies with completely correctable and reversible conditions such as cleft palate, to be aborted up until birth.

I would like to think that were in Sarah Ewart’s position, I would carry the baby to term, the key part of that sentence being “I would like to think that”. It’s a huge ask, even as someone who counts themselves an absolutist in pro-life terms, one of those hardcore extremist nutters, I would be lying if I tried to claim that continuing a pregnancy in such circumstances would be easy. No doubt there would be times that I would scream, rage and rail about the injustice and cruelty of it all and hand on heart I cannot state in any certainty that if I were in Sarah Ewart’s position and carrying the baby til term, I would not have a physical and nervous collapse. And that’s speaking from the position of a pro-lifer who knows that to take the life of an unborn baby is innately wrong and unjustifiable.

I would have the comfort of my faith and unlike many people, the support of a religious community to sustain me, alongside the innate knowledge that morally, I was doing the right thing. But it would not be, by any means easy. When my  unborn baby passed away in utero, I only had to live with that knowledge for ten days, which felt like an interminable and unbearable period of time. I cannot begin to image what it must be like for someone in Sarah Ewart’s position, I have previously posted the joyful and courageous  witness of the parents of an anencephalic baby, but even Colin did not suffer from the condition with such severity. We cannot forget the nature of the condition of the baby, would mean that the birth would be infinitely more traumatic than in other circumstances of stillbirth or neo-natal death due to disability.

Even for a pro-lifer there is a dichotomy between not taking direct action to kill one’s own unborn child and taking action to save one’s own health and sanity, which would in my case have an impact on my existing children.

Knowing that I would struggle, is it therefore fair to impose my moral values upon Sarah Ewart and dictate what her course of action should be?

No-one could or should blame Sarah Ewart for her decision to travel to England for an abortion and neither should the law be so lacking in compassion that any doctors who assisted her in abortion in this terribly rare and upsetting case be prosecuted, for wanting to spare her a horrific ordeal. We should not be ordering or compelling her to be brave, insisting that there is no way that the termination of her pregnancy should be tolerated.  This is a far cry from the situation we have in the UK whereby doctors pre-sign batches of forms authorising the abortion of babies on the grounds that they are female.

This is one of those genuinely hard cases and limited circumstances in which doctors should be able to use their discretion in terms of treating a mother without fear of consequences. Was there  really no way that the process of double effect, whereby action could be taken to treat the mother which would indirectly result in the death of the child, could be applied?  I suspect an easier solution may have been to have performed a cesarian at the point of viability, say 24 weeks, so that the baby could pass away naturally and swiftly and to spare her the ordeal of late-stage abortion and a traumatic birth experience, a decision which could well in time, have rendered the process of grieving easier.

That’s only my personal opinion however in the absence of more detailed medical evidence about this  particular case. It seems to me that what was at fault here was not the abortion law in Northern Ireland, but rather its application. One has to wonder why the medics involved in this case, could not bring themselves to be a little more creative and more compassionate in their interpretation of the law? Why could no-one be brave enough to put their neck on the line for a woman in terrible and desperate circumstances, caring more for a rigid interpretation of the law, that could then be exploited for political purposes,  than the overall welfare of Mrs Ewart. Or was it that abortion was not the only option in this case?

In any event, surely she deserved better than to be used as a political football and unfortunate poster-girl for a law that could potentially cause the deaths of those with wholly treatable conditions? Or are pro-choicers guilty of projection when they accuse the pro-life lobby of putting dogmatic belief before the best interests of the individual?

Whatever the answer, our thoughts, prayers and sympathies should be with Sarah Ewart and her child.

UPDATE

Dr Peter Saunders, of the Christian Medical Fellowship has written a compelling, sensitive and scientific piece on the realities of an anencephalic baby. It puts an entirely new spin on events, detailing what an anencephalic baby would look like. Though I thought I had understood the condition, the way Mrs Ewart’s case was reported was incredibly misleading.

Had I been in possession of this information, then the post would have been written along similar lines to that of Dr Saunders. I guess there’s a lesson for us all in there somewhere.

18 thoughts on “Hard cases and political footballs

  1. The point about being pro choice is that is must be about real choice. If she wanted to carry the baby to its natural end, she should have been supported to do so. But as to your point about making her a political football – these types of cases are deeply tragic and, as you say, don’t represent the norm in the abortion debate. Yet I have read on pro life sites cases of women who have carried the baby to term and watched it die and they believe, wholeheartedly – as do the organisations behind the sites – that their personal fortitude should be the norm for other parents. They are harshly and callously critical when it isn’t. So, like it or not, these cases are absolutely political footballs – certainly on the pro life side.

    Where I also disagree is with Northern Ireland not allowing abortion even in cases of foetal abnormalities. This should absolutely be a controversial stance. Conditions like anencephaly, Potter’s Syndrome and Mermaid Syndrome may be rare, but they do happen. Forcing women to carry these babies to term for no other reason than religious ideology is absolute cruelty. Your solution about a caesarian being better is just angels dancing on the head of a pin – the result will still be the baby’s death.

    1. I’m inclined to agree on the cruelty of forcing women in these hard cases to take a particular course of action and also when it comes to harsh criticism though to be fair, I’ve not seen any from the pro-lifers with whom I associate.

      Believing that life begins at fertilisation and that all life is of equal value and worth flows holistically from many religions, but is not in and of itself religious ideology.

      1. I have to be fair as well and say that the sorts of pro life sites I have been reading have tended to be radical American sites where the arguments are not – ahem- as well argued and thoughtful as yours.

        Regarding your point about abortions because of cleft palates etc. Surely some of the responsibility for this has to come down to the medical profession for either not explaining cleft palate properly or failing to discuss the fairly minor surgery that can correct it.

      2. Yes I think so. Cleft palate can admittedly sometimes be a marker for other conditions but the medical profession tend to treat things such as Downs as pathologies, giving a worse case scenario.

        Whatever side of the divide we stand on I think we all have to bear in mind that these are real individuals.

        Had Sarah Ewart been given an abortion in Ireland there would have been a very strong reason to state that prosecution would not have been in the public interest.

        It’s a very delicately balanced issue.

  2. “Any pro-lifer who rushes in to condemn her as a result of her decision to travel to England for an abortion should hang their head in shame and reconsider whether or not they ought to be a part of the pro-life movement.”

    The pro-life movement simply wants mother and child both to be treated as patients. If a child suffers a severe head trauma, is the solution to hack the child the pieces? Of course not, but leaving the child to suffer and die in the womb is unlikely to be the solution either.

    My point is that I think you missed something here by casting it as an either/or false choice here: ‘agree to an abortion or leave the pro-life movement.’

  3. Not meaning to overstay my welcome, I’ll make one more remark (or so) as a follow-up to my previous.

    “It seems to me that what was at fault here was not the abortion law in Northern Ireland, but rather its application.”

    The pro-life movement rejects any law that pits mother against child or child against mother or treats one as human and the other as less than human. The obligation to make sure that is not the case is entirely on the lawmakers. So it is on them to identify any deficiencies in that regard and make corrections as necessary.

    Once the facts are in, we may yet determine that the abortion law is at fault, but I agree we should hold off on that decision.

  4. I’m afraid I have to respectfully disagree. No-one needs to condemn anyone. The lady in this case hasn’t asked for your opinion. But the Catechism is crystal clear:

    2271 Since the first century the Church has affirmed the moral evil of every procured abortion. This teaching has not changed and remains unchangeable. Direct abortion, that is to say, abortion willed either as an end or a means, is gravely contrary to the moral law.

  5. http://onedaymorefamilies.blogspot.ie/p/why-one-day-more.html This organisation, One Day More, has been set up to help women come to terms with a diagnosis that their baby has a life limiting condition. I find it particularly interesting that the woman quoted above moved in her emotional state from one of wanting the baby to die quickly to wanting the baby to life for as long as possible.

    Also, I am very wary of stretching the concept of treatment of the mother even if it results in the loss of the child, to covering possible psychological distress…surely that’s the very loophole (Ground C) that accounts for 98% of abortions in the UK, and the basis of our recently passed unjust law in the Rep of Ireland.

    1. I’m not arguing for the law to be changed on the basis of this case, but while pro-lifers do need to defend the status quo, this is one of those utterly heartbreaking cases in which an application of the catechism seems cold, clinical and lacking in all empathy particularly if the woman is not a Catholic.

      There’s a very difficult balance to be drawn in terms of not doing anything that could send a signal that aborting disabled children is acceptable, but on the other accepting that in such a terrible and unusual case such as this one, to compel a woman to carry her child to term can seem exceptionally cruel.

      Which is why I wonder whether or not an abortion was really the answer, whether the condition was as reported and if so why no doctor would be prepared to help her. It’s one of those cases which would make me think that were she to have had an abortion, it would not have been in the public interest to prosecute on the basis of the reported facts.

  6. Caroline, my understanding of the aetiology of anencephaly is that it is the lack of formation of the brain, not necessarily lack of skull bones, although these can be affected by the condition. Prenatal scanning is notoriously poor at giving accurate details about such things and often scanners are wrong in their diagnoses. It is entirely possible to have a natural spontaneous delivery with an anencephalic baby. I am not clear as to the point you are making here; the correct thing to do as far as the Catholic teaching is concerned is to allow the baby to be delivered as naturally as possible and not to deliver him or her early simply for ‘ convenience’, although the mother’s health must be taken account of. Often there is excess amniotic fluid with these abnormalities which is a risk to the Mum. And there is no question of the fact that to deliberately harm the child is a sin and a crime, whatever his disability. It is not ” exceptionally cruel” to “compel a woman to carry her child to term”. This is the natural order of things. Where on earth have you/we got the idea that to carry a child who will die shortly before or after birth is a cruel imposition? Those precious days when the child is protected in utero from an external world it cannot survive in are priceless. Yes, there is a bitter sweetness to this process, but we do not have charge over our lifespan, that is God’s prerogative.

    1. Rachel, according to the BBC report, the baby had no skull bones. Other reports stated that the baby had “no head”.

      Clearly the baby would have had some head, but the lack of skull would have meant that she would not have gone into labour naturally.

      Usually I would agree 100% with what you have expressed here, but this case, from what has been reported seems extraordinary.

      A baby with no skull would be tremendously traumatic to deliver naturally, we all know that induced births are never the easiest and it does admittedly seem cruel to the mother.

      Of course we cannot condone terminating the life of the child, which is why I would favour a delivery ASAP post viability.

      Not everyone has the comfort of faith and to effectively compel a woman to deliver a baby (which if reports are correct) physically has no skull, at 40 weeks, does seem uncompromisingly cold & cruel.

      Were an abortionist to have helped her in this rare situation, I would not have condoned them, but neither would I have been pushing for prosecution.

      If the facts are going to term with a headless baby as reported by Melanie McDonagh (a Catholic journalist) then all of us should exercise compassion and allow for a compromise wherein the baby is not killed but neither is the mother forced to go to term if she cannot endure it.

  7. Caroline, in my experience there is always some “poetic licence” ( to put it kindly) used by journalists in the field of abnormality and abortion. Usually thre is some part of the skull present although it is possible to be missing most of th brain, although the brainstem is always there. It is not the case that anencephalic babies cannot be delivered naturally, although not always. Delivery requires careful management for the health of both mother and baby. I highly recommend that you and your readers look at a fantastic website http://www.anencephalie-info.org where you will learn facts about this condition rather than the fictionalised account of secular journalists. There is a lot of ignorance about such abnormalities, fear-mongering always serves those who favour abortion as a “solution” to the “problem” of a child who will not live long. Amazingly, if you wiki the term you will also see that at least three children with this condition have lived for 2, 3 and 6 years respectively. By all means give us your opinion, but don’t take as gospel the “facts” quoted in the press.
    I also highly recommend the following current article by the excellent Peter Saunders http://www.lifenews.com/2013/10/14/twenty-reasons-to-think-twice-about-aborting-a-baby-with-anencephaly/ where he gives a reasoned critique of the case you discuss.

    1. Thanks so much for that Rachel. I saw the piece by Peter Saunders earlier today and if you look at my twitter feed, you’ll see I tweeted it earlier.

      I did understand anencephaly previously, but fell for what you call the fictionalised accounts in the media, my understanding of the description of no skull bones, was something entirely different to what Peter properly explained. From what had been described it seemed like the head would be its usual shape, only unsupported. I certainly didn’t believe the “entirely without a head” narrative of Melanie McDonagh.

      Mea Culpa, but yes, it does put a whole different spin on the story. I had an entirely different and more gruesome idea of what the condition was in this particular case.

      But thank you for pointing this out for everyone, I had been planning to blog it later.

  8. I also congratulate Peter Saunders for reminding us that these are human persons. We only need a soul to be a human being, not a whole brain

    1. Which is also what I pointed out in my initial piece. Personhood does not hinge upon mental capacity or having a particular appendage.

      My understanding from what had been reported in this specific case was entirely different to the reality. I know the condition is not that rare, but it was being described as if this really was a particularly severe case.

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