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.


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.