The Nathaniel Centre

Reflections on Post Abortion Care

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Category: Bioethics at the Beginning of Life

Created on Monday, 12 June 2017 01:40

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Dawn de Witt

Beginnings

Around 2000 I joined a small group of women to explore the merits of the Victims of Choice post abortion recovery programme from the United States. At the time, it struck me that I had very little knowledge of abortion issues despite my professional studies. In New Zealand, a termination of pregnancy is available through the public health system and is promoted as a safe medical option for those who do not wish to continue a pregnancy to term. The experience of the group was that there existed a real need for healing and reconciliation after abortion - and we wanted to make that possible.

The literature confounds

My interest in the issue prompted me to do a literature survey. This opened a Pandora's box for me. There were conflicting findings, heated debate, fierce criticism of unsound methodologies, vehement argument and counter argument. I was disappointed. The scholarly articles and debates seemed to be immersed in the politics and polarities surrounding abortion that were prevalent in American society, unable to transcend them. The title of the 1998 monograph of the American Psychological Association, The New Civil War: The Psychology, Culture, and Politics of Abortion1 appears to confirm that.

There was no consensus on the impact of abortion. In some reports, it was construed as just another stressful event. For others, it was a significant trauma associated with mental health issues and symptoms similar to Post Traumatic Stress Disorder (PTSD). The notion of Post Abortion Syndrome (PAS) was raised and rejected.

The American Psychological Association (APA) consistently asserted that the incidence of negative responses after abortion was low (19902, 19923). In 2006, a task force was assigned to evaluate the evidence.

The American Psychological Association Report on Abortion and Mental Health
In 2009, in their Report on Abortion and Mental Health4, the APA concluded that:
1. Most adult women who terminate a pregnancy do not experience mental health problems. Some women do, however.
2. The evidence regarding the relative mental health risks associated with multiple abortions is more uncertain.
3. Some women experience sadness, grief and feelings of loss following an abortion, and some may experience "clinically significant disorders, including depression and anxiety." 5
4. No evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors." 6
The results related to the experience of a single abortion as opposed to multiple abortions. The Report noted factors that may be predictive of more negative psychological responses following first-trimester abortion among women in the United States:

• perceptions of stigma
• need for secrecy
• low or anticipated low social support for the abortion decision
• a prior history of mental health problems
• personality factors such as low self-esteem and the use of avoidance and denial coping strategies
• characteristics of the particular pregnancy, and the extent to which the woman wanted and felt committed to it.

Here was clear acknowledgement that some women were experiencing grief and mental health issues after an abortion. Yet, despite the report warning about the dangers of making globalising statements, the message disseminated was: Abortion Has No Impact On Women's Mental Health. This message persists today.

To better understand the impact of abortion, I undertook to listen to those who were seeking help after abortion.

Impressions from the field

The deepest of sorrows

The most poignant learning has been the depth of grief and sorrow I encountered. This is no ordinary grief. It is complex and complicated. There are multiple losses; complex personal and social narratives; intense emotions; and some level of responsibility in the death. The grief is disenfranchised. It is socially unrecognised, unacknowledged and unsanctioned. There are no socially accepted rituals for mourning. At its heart is a death of a baby.

In those seeking help, this sorrow seems universal. It has presented in men and women; in relationships that are secure or in more tenuous, uncommitted or even undesirable relationships; whether there had been full responsibility or coercion; where there is faith and where there is no faith; where there have been pre-existing mental health issues and where there has not; in cases of secure attachment histories and in those with histories of insecure attachments; whether the pregnancy was unwanted or wanted; and whether there was a sense of connection with the foetus or not.

Anger is a part of grieving. Coupled with bitterness and resentments, it can become intense. It may be directed towards God, oneself or others. At times, we see that anger directed at 'the State', the 'system', or society at large; this anger is about unrealistic societal expectations, mixed messages from society, insensitive processes and a lack of information about the risks.

Four areas of wounding have emerged from my own listening and reading: the wound to the child; the wound to self (primarily for being implicated in the termination, intentionally or by default); wounded relationships (with others involved in the abortion) and wounded spirituality. Healing entails reconciliation(s) in each of these areas.

The feminine face of coercion

The incidence of coercion is high, consistent with that reported by the Elliot Institute.7 The classic picture of threats, intimidation, ultimatums, stand-over tactics and/or violence is seldom reported. More prevalent is the subtle psychological pressure applied by others, usually female, to compel a woman to terminate a pregnancy against her will.

Younger women, not yet fully individuated, still dependent on their parents and lacking the confidence to challenge parental authority, tend to fall victim to the female face of coercion - a mother, sister, or grandmother may persuade, cajole or harass, the subtle use of a position of trust, power and influence in a close relationship. Youth, obedience to parents and respect for authority add to the pressure to comply.

The message 'I know what's best for you' masquerades as care and may go unnoticed by the professionals involved. Reports include not being listened to by medical personnel; not being given an opportunity to be seen alone; and being sidelined while the dominating figure conducts the conversation. Passivity is easily misconstrued as consent and the process quickly moves to completion. Powerlessness, isolation and a sense of abandonment ensue. Violated boundaries, betrayals of trust and the losses of abortion give rise to anger and rage which, if internalised, may trigger depression.

Family narratives

Family stories underpin decisions to terminate a pregnancy.

Fathers shape their daughters' perceptions and expectations of men. A daughter observes her father's care for her, for her mother and how he relates to his wife/partner in pregnancy. The absence of a father may prompt a daughter to exchange sex for love. In my experience father narratives have been less prominent than mother-daughter narratives.

A woman's relationship with her mother is seen as central and ambivalence in the mother-daughter relationship is significant. Themes and patterns of behaviour are noted over three generations of women as they respond to trauma, life events, societal and familial attitudes to women and sociocultural trends.

Narratives passed down inform womanhood and produce powerful, often subconscious, beliefs about motherhood, for example, 'Once you're a mother, your life is not your own'. Injunctions like 'be successful' and 'do something with your life' subtly undermine the value of motherhood. Mothers who have been disappointed or who have struggled with motherhood subtly communicate this to their daughters.

Presence of historical sexual abuse was not surprising and is well documented in the literature.8 What is surprising is the high incidence I've noticed in peer support groups with whom I have been involved – over 80% on one occasion.

Lack of information

It is surprising that reports of insufficient information are regularly heard. With some dismay, women say: 'Nobody told me'; 'I didn't know'; or 'I never expected this'.

The Code of Ethics for Psychologists 9 states that obtaining informed consent from those with whom they are working is "a fundamental expression of respect for the dignity of persons and peoples."

A psychologist needs to:

1. provide "as much information as a reasonable or prudent person, family, whānau, or community would want to know before making a decision or consenting to an activity" (para. 1.7.6)
2. take reasonable steps to ensure that the information is understood (1.7.7)
3. take all reasonable steps to ensure that consent is not given under conditions of coercion or undue pressure from them (1.7.4)
4. "have an increased responsibility to protect and promote the rights of those who were vulnerable because they have lesser power" (1.7.1)
5. give sufficient time for the recipients to respond to the information (1.7.7).

The omission of informed consent in the protocols around abortion may, in part, reflect the fact that the Contraception, Sterilisation, and Abortion Act 1977 was promulgated before there was any developed notion of informed consent.

The fact that other health care professionals operate under equivalent codes of ethics regarding information and consent is not borne out in the stories I have consistently heard from women.

Conclusion

Experience confirms that abortion is a significant life event that can cause considerable loss and grief. The circumstances of the decision and the factors that influence the decision are diverse and complex. Simplistic restatements of research findings, without elaboration, do women a disservice.

Full and accurate information about risks and effective screening for coercion by way of independent and neutral counselling, and enough time to consider her response to an unwanted pregnancy, is every woman's basic right. As psychologists and healthcare professionals, it is our responsibility to ensure that.

I am deeply grateful to those men and women who have shared their stories with me and I thank them for enabling me to grow in this field.

Dawn de Witt is a Counselling Psychologist with a background in general practice, relationship counselling and family therapy. She presently co-ordinates Project Rachel in the Catholic Diocese of Hamilton, New Zealand and is on the retreat team of Rachel's Vineyard Retreats.

Endnotes

1. http://www.apa.org/search.aspx?query=the new civil war retrieved on 2 February 2017
2. Adler, et al. 'Psychological responses after abortion'. Science 06 Apr 1990: Vol. 248, Issue 4951, pp. 41-44. http://science.sciencemag.org/content/248/4951/41 accessed on 21 March 2017
3. Adler, et al. 'Psychological factors in abortion: A review'. American Psychologist, Vol 47(10), Oct 1992, 1194-1204. http://dx.doi.org/10.1037/0003-066X.47.10.1194 accessed on 2 February 2017
4. http://www.apa.org/pi/wpo/mental-health-abortion-report.pdf accessed on 2 February 2017
5. APA Press Release. http://www.apa.org/news/press/releases/2008/08/single-abortion.aspx accessed on 20 March 2017
6. Ibid.
7. http://www.theunchoice.com/articles/howcommoniscoercion.htm accessed on 20 March 2017
8. Boden, Joseph M; Fergusson, David M; & Horwood, L. John. 'Experience of sexual abuse in childhood and abortion in adolescence and early adulthood'. Child Abuse & Neglect, Volume 33, Issue 12, December 2009, pp. 870–876
9. Code of Ethics for Psychologists. Para 1.7 http://psychologistsboard.org.nz/cms_show_download.php?id=235 accessed on 6 March 2017.

Richard Stith on the moral status of the human embryo and fetus

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Category: Bioethics at the Beginning of Life

Created on Tuesday, 22 November 2011 22:31

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Finally, in a very readable article, Richard Stith provides a philosophical framework for making sense of the different understandings people have regarding the moral status of the human embryo/fetus. The widespread vision of the embryo and fetus as "under construction" is the key to understanding why good people may find pro-life arguments to be non-rational or absurd. The construction versus development approach may also help to clarify mutual misunderstandings regarding the moral acceptability of euthanasia.

Review of the Abortion Laws in New Zealand: Submission to the Law Commission – May 2018

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Category: Bioethics at the Beginning of Life

Created on Thursday, 01 November 2018 03:10

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Joint submission by the New Zealand Catholic Bishops Conference & The Nathaniel Centre

The Status of Unborn Human Life: Our Position

The debate about when human life begins is uncontroversial. As reported by the Royal Commission on Contraception, Sterilisation and Abortion (1977): “From a biological point of view there is no argument as to when life begins. Evidence was given to us by eminent scientists from all over the world. None of them suggested that human life begins at any time other than conception.” 

The ethical questions around abortion and research on embryos centre on the sort of respect or protection we should accord human life; in particular, whether it is ethically consistent to accord a different level of respect to humans in the earliest stages of life, as well as whether there are ever factors that mitigate the respect due to human life at any stage of development. 

Most people, whatever their position on issues such as abortion or embryo research, agree that human life deserves a ‘special’ status even if they do not accord unborn human life the same moral status as human life post-birth. The belief held by some that the life of a human embryo matters less than other human life at a more developed stage may reflect the fact that it is largely unseen.  However, an embryo is not simply a collection of cells that happen to be contiguous. These cells are a human embryo, a new human individual and part of the human family. Embryos and foetuses become children just as children become adults, not by some addition to what they are, but simply by developing further as the kind of beings they already are.

The common understanding of ‘person’ in our culture has, latterly, been shaped by an emphasis on self-consciousness as the mark of personhood. A much older understanding of person, however, locates personhood in the dignity of a being's rational nature, irrespective of whether that being is even ‘conscious’ at a particular phase in his or her life. According to this traditional view, there is nothing problematic about saying that an unborn child or a persistently unconscious patient is a person, for they are truly our fellow human beings. 

Recognising that the status of the human embryo or fetus flows from their inherent connection to the human family is key to understanding why Catholic teaching holds they ought to be treated with unconditional respect whatever the stage of development – a life is begun which is neither that of the mother nor the father. It is already the human being it will always be and will only grow in size and complexity. Mothers instinctively recognise this by invariably referring to the embryo or foetus within the womb as their baby.

On that basis, embryos and foetuses are entitled to be granted a place in the human family and treated with the same respect as persons.  As the Royal Commission stated: “The unborn child, as one of the weakest, the most vulnerable, and most defenceless forms of humanity, should receive protection.”

Introductory Comments: 

1. There is a lack of clarity that has led to confusion in the community about the precise meaning of the brief that has been given to the Law Commission by the Minister of Justice. We are assuming that the wish to treat abortion as “a health issue that is a reproductive choice for women”¹ centres around a wish to provide for ‘abortion on demand’ in New Zealand – that is, a wish to make it a decision solely between a woman and a doctor as is the case for reproductive choices involving contraception. However, this is nowhere clearly spelled out, something which makes it difficult to comment on your brief in a truly informed way. 

2. If our assumption is correct, then what the Law Commission is being asked to do represents a significant policy change. As we understand it, the current law, as set out in the Contraception, Sterilisation, and Abortion (CS&A) Act 1977 and the Crimes Act 1961, sets up a ‘tension’ between the needs and desires of the woman and the rights of the foetus/unborn child and seeks to balance both. Making abortion solely “a health issue that is a reproductive choice” would ignore this tension, removing any requirement to consider the rights of the unborn child.

3. Meanwhile, we note that in public comments explaining your brief,² you state that the Law Commission will not be commenting on policy issues. 

4. In our minds there is a degree of incongruity between the brief and your public comments. In which case we interpret your comments about policy to mean that it is not part of your task to recommend that any changes be made to the eligibility criteria for abortion or to promote any alternative approaches as preferable to the existing policy approach.

5. The public and other interested parties have a right to be fully consulted on any changes to the current policy approach, including eligibility criteria. It concerns us that the Law Commission could potentially be cooperating in a policy change by stealth.

6. That your brief falls short of the “full review of the legislation” that Justice Minister Andrew Little was reported as saying “would first take place” adds to our concern about a lack of proper process on what is a critically important piece of legislation.³

7. In line with the Catholic position stated above, we are opposed to any change in the law which would either lessen or, worse, totally remove the (limited) rights the current law accords to the unborn child. The changes we would advocate for (and which would not constitute a policy change) are those which would (i) ensure continued consideration of the rights of the unborn child and (ii) promote the well-being of women, including better processes to ensure adequate informed consent. 

8. Indeed, along with the 65% of New Zealanders identified in the 2017 Curia Poll,⁴ we would like to see changes implemented that would further reduce the number of abortions occurring in New Zealand. 

9. We understand that under current law there is no ‘right’ to have an abortion in New Zealand and that administering (or supplying the means for procuring) an abortion is unlawful except when certain eligibility criteria are met as spelt out in Sec 187A of the Crimes Act 1961. The current situation is arguably well-described as providing for ‘abortion on request’ insofar as any discussion about abortion must be initiated by the woman but ultimately depends on two appointed doctors being satisfied that critical eligibility criteria are met.

10. We note that there are certain groups and individuals pushing for change who claim that the current law criminalises women. Sec. 183 of the Crimes Act 1961 specifically states that “a woman (or girl) shall not be charged as a party to an offence against this section” (the relevant section being that which describes “unlawful abortions”).  We therefore regard such claims as both inaccurate and mischievous – under current abortion legislation, women are not liable for prosecution except in situations where they attempt to procure their own abortion, something we comment on below. 

Our Key Arguments:

11. The ‘tension’ that we believe characterises the current regime (see above) is revealed in the legislation in several places: 

    1. It is spelt out in Section 30(5) of the CS&A Act which stipulates that the appointment of members to the Abortion Supervisory Committee should have regard to views ‘incompatible’ with the tenor of the CS&A Act. The views described as ‘incompatible’ are: 

       (a) that an abortion should not be performed in any circumstances:

       (b) that the question of whether an abortion should or should not be performed in any case is entirely a matter for the woman and a doctor to decide.

    2. It is also evident in the longer title of the CS&A Act: An Act … to provide for the circumstances and procedures under which abortions may be authorised after having full regard to the rights of the unborn child…

    3. That the unborn child has a status that gives it rights is also upheld in Section 182 of the Crimes Act (“Killing unborn child”) which, we note, you have been instructed need not be reviewed (Letter from Minister of Justice Hon Andrew Little to Hon Sir Justice White QC, 27 February 2018 – letter released under the Official Information Act). Logically speaking, the ongoing existence of Section 182 andthe existence of a parallel law making abortions solely a matter between the woman and her doctor, would set up an inherent contradiction between two laws. 

12. Making abortion solely a health issue, in the sense of making it merely a matter between a woman and her doctor, will deny many women the chance to manage the tension that lies at the heart of all abortion decisions. That is, it will deny women the chance to deal with abortion as a significant ‘moral issue’ involving the ending of a human life. This, we argue, would not be in women’s interests. As the feminist writer Naomi Wolf has stated: “I will maintain that we need to contextualise the fight to defend abortion rights within a moral framework that admits that the death of a foetus is a real death: that there are degrees of culpability, judgment and responsibility involved in the decision to abort a pregnancy; that the best understanding of feminism involves holding women as well as men to the responsibilities that are inseparable from their rights…”.⁵

13. Most women understand that an abortion, whatever the reason they are contemplating it, has significant moral implications. This is signified, among other things, by the way women who have had abortions commonly speak of their ‘child’ rather than using terms such as ‘the products of conception’. In a peer-reviewed qualitative exploration of women’s needs and preferences in clinical care during the process of having an abortion, one of the strong themes to emerge was that women want to be recognised as “grappling with a real-life moral decision”; to be affirmed as “moral decision-makers”, something that only occurs “when medical personnel recognized this conflict and affirmed the decision as moral …”⁶

14. Using language which either denies what is happening or which disguises the complexity and moral dimensions of abortion, is ultimately not in the interests of women. Equally, and even while it might be presented as empowering women to make their own decisions without interference from the State or others, creating an altered legal regime that frames abortion as being solely about the well-being of the mother will potentially undermine women’s sense that abortion is a serious moral issue and, consequently, their moral agency. Were that to eventuate, the State would be party to undermining the true ‘moral’ dimension of abortion and would be potentially contributing to poorer outcomes for many women. 

15. It is our considered and strongly held view that the tension that characterises the current legal approach must be retained. To be retained, it must be reflected in the legal framework governing access to abortion. 

16. There are three other important reasons for retaining certain provisions relating to abortion in the Crimes Act that we wish to highlight: 

    1. Under the current law, there is protection provided to women from unscrupulous abortion providers. This needs to remain and it is proper that the Crimes Act continue to spell out sanctions to prevent and/or punish such actions. 

    2. The increased use of medical abortifacients and their ready availability from other countries via the internet, means that some women may seek to import such drugs and take them without proper medical supervision. This is particularly a risk for young women who feel the need to keep their pregnancy and abortion decision secret. Whether they import the drugs directly or fall prey to unscrupulous providers, it is for the protection of these women that the importation of such drugs must be restricted in law.

    3. If treating abortion as a ‘health issue that is a reproductive choice’ means, as we suggested above, ‘abortion on demand’, then this allows for abortion for any reason, including gender selection and disability. These reasons for abortion are highly contentious. We note here the Curia poll of 1,000 New Zealand residentswhich found that only 9 percent of respondents supported sex selective abortions, and 90 percent were opposed. For females, only 1 percent supported sex selective abortion while 94 percent opposed it.

17. For all the reasons spelled out above, we argue that abortion needs to be treated as both a justice and a health issue. We argue this requires legislation which clearly and precisely specifies the circumstances under which abortion remains unlawful and under which abortion providers will be prosecuted for unlawful abortions.

18. In support of our position we note that the Abortion Supervisory Committee (ASC) has notbeen advocating for a significant change in the way that abortions are administered in New Zealand. In the 2017 Report to Parliament’s Justice Select Committee, the ASC stated that: “The ASC does not propose amendments that would change the original intent of the Act.”

19. Furthermore, and importantly, in the same 2017 Report it is written that “[T]he ASC recognises the merit in having a robust pathway in place, which requires certifying consultants to assess and certify patients and to ensure counselling is offered.” While there are some who argue that the current law disempowers women because it makes what should be a personal decision subject to external interference, to cumbersome and intrusive legal and procedural obstacles, we argue that choices are always limited by the constraints of knowledge and by context, including coercion^,.^8,9 As The Nathaniel Centre has previously stated: 

    Many women, after the event, report feeling that they had no other option at the time but to proceed, often because of pressure from parents, partner and/or peers. At times this pressure is also experienced as coming from staff at the Termination of Pregnancy Units. For other women, the pressure they feel is generated by employment or social factors. In the words of another commentator, in such situations, the decision for an abortion is best described as a tragic response to lack of choice.¹⁰

20. It is therefore in the interest of free and informed consent that all women should be offered independent counselling that (i) addresses the coercive realities surrounding many abortions and (ii) canvasses the other options that exist. The law has an important role in ensuring that women are given the opportunity to understand and work with the complex moral, personal, family and social contexts within which they find themselves contemplating an abortion. ‘Abortion on demand’ will not achieve this. In other words, it is important to keep in place carefully considered eligibility criteria as well as providing a robust pathway of options that is clearly laid out in law. 

21. Furthermore, reducing abortion decision-making to ‘a reproductive choice for women’ denies the fact that many others are involved in and/or impacted by the decision. As Germaine Greer has written: 

    
    Pregnancy is unlike other patient-doctor relations in that there are two other individuals involved - the father-to-be and the child-to-be … What women ‘won’ was the ‘right’ to undergo invasive procedures in order to terminate unwanted pregnancies - unwanted not just by them but by their parents, their sexual partners, the governments who would not support mothers, the employers who would not employ mothers, the landlords who would not accept tenants with children, the schools that would not accept students with children.¹¹

22. Women are reported in the literature as taking into account a range of persons and factors when contemplating an abortion including “the woman herself, the potential child, her sexual partner, existing children, the extended family, and financial matters.”¹² Women contemplating an abortion are well aware of the broader ramifications of such a decision and it would be a moral and social disservice to them if the language and regulatory frameworks around abortion conveyed something different. The legal model for regulating abortions in New Zealand must acknowledge and account for this broader reality. A narrow framework focussed solely on the mother will not achieve this.

23. If the law is to protect and promote genuine informed consent, then women contemplating abortion must be given the time and support required to make a genuine decision. A decision for an abortion can only be described as a truly ‘free’ choice if the woman knows there is tangible support (familial, financial, emotional, social) that enables her to choose to keep the child. This requires a parallel review of the social support structures that our society offers to women who are pregnant.

24. We note that the health risks associated with an abortion are widely acknowledged in the research literature. While there is some disagreement in the research literature about the extent of the negative health consequences of abortion for women, the negative effects on some women are incontestable. This provides a further reason in our minds for clearly laid out and robust processes, including the funding and availability of independent counselling provided by an individual or organisation otherthan the abortion provider.

25. Referring again to the 2017 ASC Report, as well as the 2016 Report, we do agree that some of the language used in the present CS&A Act is outdated and clumsy and needs to be reviewed.

26. Public awareness of the complexities of this issue is illustrated in the Curia Poll¹³ referred to above. Some of the findings of this poll include: 

    1. 52 percent of respondents ‘generally support abortion’ but 29 percent ‘oppose’ and 19 percent were ‘unsure/refuse’; 

    2. Of respondents aged 18 to 40 years, only 47 percent ‘support’ abortion, with 34 percent opposed and 19 percent ‘unsure/refuse’. 

    3. 65 percent of respondents agree that society should work together to reduce the number of abortions; only 17 percent disagree; 

    4. Of those who generally support abortion, 63 percent agree we should reduce the number of abortions. 

    5. Only 9 percent of respondents support a time limit of 20 weeks (the current legal limit); 4 percent support time limits over 20 weeks; 41 percent support time limits of 15 weeks or less. 

27. It is noteworthy that in New Zealand, abortion numbers and rates have been declining since 2007. That is, the numbers of abortions, the ratio of abortions (number of abortions per 1000 pregnancies) and the rate of abortion (number of abortions per 1000 women aged 15-44) have all declined. While the reasons for this are not understood, those on both sides of the divide can agree this is a good thing. We suggest that while the reasons for this decline are not understood, it is a precarious time to tamper with the law. Any proposed changes should be considered keeping this in mind.

Conclusion: ‘Abortion is both a health and a justice issue’

28. Human life begins at conception and is entitled to the full protections offered to human persons from that point forward. 

29. The inherent dignity of human life from conception means that the starting presumption should always be in favour of human life, whether born or unborn. It’s on this basis that we oppose establishing a ‘right’ to abortion. This being so, it is appropriate that the unborn enjoy the same fundamental protections the Crimes Act provides for all other human beings. Therefore, if the State is to continue providing abortions in certain situations, the law should only ever provide for abortion as an ‘exception’ to the fundamental right to life. 

30. Our considered view is that abortion is both a health and a justice issueand it should be treated by the law as such. 

31. There is much at stake in a review of the abortion laws; it is a deeply moral issue involving the future of a human life as well as the well-being of the woman and her family. The State has an essential responsibility to protect and care for allhuman life. It would abdicate this responsibility by making abortion solely a matter between a woman and her doctor. 

32. We need legislation which clearly specifies the circumstances under which abortions remain unlawful and under which abortion providers will be prosecuted for unlawful abortions.

33. We do not support changing the original intent of the Contraception, Sterilisation, and Abortion Act 1977. The current law acknowledges and upholds a ‘tension’ between the effect of the pregnancy on the woman and the rights of the unborn child. This must not be lost in any review of the current laws. 

34. The changes we would advocate for are those which would (i) further recognise the rights of the unborn child, (ii) promote the well-being of women, including better processes to ensure adequate informed consent and (iii) lead to fewer abortions occurring in New Zealand. 

35. We want to see the law provide a more “robust pathway” governing abortions in New Zealand, one that acknowledges women’s need for full and independent information and support in order that genuine informed consent can take place. To this end, we want to see the provision of independent and publicly funded counselling for all women considering an abortion. 

The abortion debate – an unhelpful dichotomy

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Created on Thursday, 05 September 2013 11:02

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The Catholic tradition holds that the right to human life is inviolable. It is based on a notion of human dignity that is ‘intrinsic’ – that is to say, not dependent on, or subject to, any calculation of ‘value’ or values based on values ‘extrinsic’ (or external) to the life in question. These extrinsic factors include human perceptions about the ‘quality’ of this or that life.

In Catholic teaching this approach is applied consistently from the moment a unique human life begins. “A life is begun [at fertilisation] which is neither that of the father nor the mother. It is already the human being it will always be and will only grow in size and complexity. On that basis, all embryos are entitled to be granted a place in the human family and treated with the same respect as persons.”(New Zealand Catholic Bishops, Submission on the use of gametes and embryos in human reproductive research, 2007.)

While this stance is rejected by many, it is arguably the most philosophically coherent of all approaches. When we consider that all human embryos are biologically and ontologically the same kind of being, it is actually illogical to accord greater or lesser respect based on their perceived status as routinely occurs within the IVF industry. The highest status, for example, is reserved for ‘wanted’ embryos by couples anxious to conceive a child. Over time the same embryo can become ‘unwanted’ if a couple no longer desire to have more children. Then again, in some countries, an 'unwanted frozen embryo' may, if the parents agree, be granted a certain (although much reduced) status as a potential object for donation or research – wanted by others on the basis of its usefulness as ‘experimental laboratory material'. In this scenario dignity for human life is directly linked to subjective human preference, i.e. to extrinsic factors.

It is of grave concern that there are moves afoot by some members of Young Labour to persuade the Labour Party to make the decriminalisation of abortion an active part of its 2014 policy platform. This move is derived from the view that the present law denies women their rightful autonomy; abortion is subject to the judgements and favour of others when it should, quite simply, be a woman’s choice. It is further argued that this reflects a lack of trust towards women; a woman’s own judgement is discounted in favour of ‘state mandated control over women’s bodies’ – seen as an unwarranted assault on women’s freedom.

The most vocal proponents of abortion decriminalisation advocate that access to abortion should be subject to nothing more than a woman’s choice, with no necessary consideration of the rights of any other party, including the father or the unborn child. For these people, the very existence of any law is seen as too restrictive and therefore unacceptable. Thus, Alison McCulloch writes of the “real freedom to choose.”[1] McCulloch and others hold this view even while they acknowledge that New Zealand women already have access to safe and legal abortion services – a situation described by persons on both sides of the debate as virtually ‘abortion on demand’.

While not considered as inviolable, the rights of the unborn child are nevertheless acknowledged in the current abortion law which, in its longer title, speaks of providing “for the circumstances and procedures under which abortions may be authorised after having full regard to the rights of the unborn child.”[2] As noted above, the right to life of the unborn child is a fundamental tenet of those opposed to abortion. It has led to what may be described as a ‘competing rights narrative’ in which the right of the woman to choose has been pitted against the right to life of the newly conceived human being.   

I would not want to disregard arguments centred on the embryo and its right to life. However, closer consideration of the facts reveals that the existence of a robust process requiring critical discernment by the woman and some form of external evaluation, far from restricting a woman’s choice, is in fact a necessary component for protecting women’s choice. Why? For a variety of reasons, including relationship stress, family and financial pressures and a real or perceived lack of support, many women make the ‘choice’ to have an abortion under real duress and even coercion. This figure is said to be as high as 64% - almost two out of every three women. In another survey of women who sought help after abortion, 83% said they would have carried to term if they had had greater support. In other words, pitting the ‘right to choose’ against the ‘right to life’ is an unhelpful dichotomy.

True freedom for women demands a transparent robust process that includes a high degree of professional and compassionate scrutiny in which women are provided with real alternatives and the support needed to carry a baby to term. Decriminalisation will not achieve this – it will only further undermine the authentic choices of women.

Dr John Kleinsman is director of The Nathaniel Centre