Salient. Victoria University Student Newspaper. Vol 35 no. 17. 19th July 1972
Abortion Law Time for Reform ?
Abortion Law Time for Reform ?
Extracts from 'A Case For Abortion Law Reform', a pamphlet by J.S.Werry, M.B.Ch.B., B.Med.Sc., Dip.Psychiat., F.R.C.P.(C). F. A. A.C.P.
Facts About Abortion
|1.||Abortion is practised universally whether legal or not. For example, in France, where it is illegal, abortions are estimated to equal live births.|
|2.||Though very few in number, some pregnant women do commit suicide as a direct consequence of their unwanted pregnancy.|
|3.||The health risk of illegal abortion is not borne equitably, the rich tending to get safe medical abortions in private clinics while the poor are forced to use the hack street non-medical abortionist.|
|4.||legal abortion can be simple, non-repugnant and in countries with high standards of medical care, such as Czechoslovakia, as safe as pregnancy.|
|5.||Psychiatric after-effects of legal abortion are in-frequent and minimal (4) and occur mostly in women whose psychiatric condition predated conception.|
|6.||Legalised abortion reduces both the rate of and mortality from criminal abortions. Note that the Swedish failure to find a reduction in criminal abortion rates as cited by Professor Liley reflects not a liberal abortion law as he suggested, but a law which tin the 1950s and early 1960s) in practice actually approximated to the present New Zealand law. This is reflected in the decline in abortions from 0.90 per 100,000 of population in 1951 to 0.37 in 1960 (11). Tietze claims that criminal abortion continues in countries like Hungary because it is secretive while legal abortion lacks privacy. Thus, if privacy could be achieved by allowing abortion as an outpatient procedure in a doctor's office, rather than by requiring the approval of a panel of doctors in a hospital, further declines in the number of illegal operations could be expected.|
|7.||Future fertility is not impaired by uncomplicated medical abortion.|
The Present New Zealand Law
The New Zealand law, embodied in the 1961 Crimes Act, permits abortion if done in 'good faith for the preservation of the life of the mother'. In practice, however, most abortions are done on the basis of the bourne decision (risk to physical or mental health of the mother) and many New Zealand doctors favour even more liberal abortion laws (3). It has been claimed with justification that, due to advances in medical science, indications to safeguard the life or physical health of the mother are now few in number and that most legal abortions in New Zealand are on 'psychiatric grounds'. As a psychiatrist I must point out that psychiatric grounds' are determined mostly by obstetricians not by psychiatrists, many of whom feel that the prediction of future psychiatric illness in the mother as a result of pregnancy is at best an inexact business and that the risk is low. There is little doubt that most therapeutic abortions in New Zealand are, in fact, done on compassionate grounds masquerading as psychiatric. The law assumes an exactitude in medical science which it does not possess and hence is open to variable interpretations dependent on the doctors own views and, undoubtedly, the social and financial status of the patient as well. The present law is what might be termed a 'cop out' by society which, while theoretically forbidding abortion, says to the medical profession, 'It's okay as long as you can pass it off as a medical rather than a moral question.'
Complete Prevention of Unwanted Pregnancy is Impossible
Many (including abortion law reformers I argue that abortion is a poor substitute for abstinence or birth control as a means of preventing unwanted pregnancy. It is no good, however, being naive about human nature and the complex psychological, emotional, cultural, and intellectual problems of sexual behaviour and birth control. The illegitimacy/pre-marital conception rate in New Zealand shows that it is time certain facts about sexual behaviour in un-married New Zealand girls were accepted and that one cannot argue Canute-like for universal premarital abstinence.
Neither can adoption take -care of all unwanted children. Many unwanted children are not available for adoption since their mothers feel tied to them by guilt, and there is a group of physically or racially handicapped children who are unadoptable. One effect of the new British abortion law has been actually to increase adoptions in this latter group.
The Sanctity of Life is Relative
When there is a conflict of values (such as the health of the mother versus the life of the foetus) a solution must be found which may be decided by quantitative (the greater good or the lesser evil) or qualitative (killing is always wrong) sets of values. It should be quite clear after a moment's thought that most English-speaking societies have very clearly opted for the quantitative position as attitudes on killing in self defence, war and the present New Zealand law on abortion illustrate. It is important to realise, however, that opponents of abortion law reform do not often adhere to a position of absolute sanctity of life, since most of them are not pacifists and many do not oppose the use of IUDs (intrauterine devices) as a form of birth control despite the fact that the IUD works not by preventing conception but by preventing implantation of the fertilised ovum. Moral purists might also claim that birth control by preventing life is a violation of the sanctity principle. Finally, the sanctity of life is in the end relative to what we are willing to pay for it. Our government for example, when allocating money for our hospitals, has in the end to say that certain roads are more important than, say, an artificial kidney machine for a particular hospital.
Is the Foetus a Person?
Until the beginning of the 19th century, the time of quickening (16-20th week) was taken as the point at which the foetus became a human being. Professor Liley (see Broadsheet A Case Against Abortion) has pointed out that this was in part due to medical ignorance about the exact moment of conception and how to determine it, but if we examine the current New Zealand abortion and inheritance laws to say nothing of the perceptions of pregnant women (Who often do not identify the tumour growing in their uterns as a baby until the point of quickening), it is obvious that in practice both the law and mam women draw a distinction between a foetus and a human being, Homunculus (or miniature man) arguments about the foetus are sentimental rather than real, since for many of us the foetus does not have the essential characteristics of visibility, viability, human shape and interpersonal responsiveness which enable us to feel that the foetus is a human being like us Finally, the state of development of the brain, at the time most abortions are carried out, is so rudimentary that any notion of foetal consciousness must be dismissed.
Hallmarks of Good Abortion Law and Practice
|1.||It does not ignore the facts and altitudes on abortion held by a majority of the public, particularly women.|
|2.||Private moral decisions are left to the individual woman and not delegated to doctors.|
|3.||Medical decisions are made by doctors (principals whether it is safe to do an abortion on a particular woman).|
|4.||Medical advice is freely and non moralistically available to the woman — principally appraisal of the risks of abortion or of continuing the pregnancy.|
|5.||The final decision (subject only to medical veto on grounds of high risk or unavailability of medical facilities) is made by the woman in private rather than by a panel of doctors.|
|6.||Participation by all medical and nursing stall is made voluntary.|
|7.||The privacy of the woman is respected.|
|8.||Illegal (that is, non-medical) abortion is made a serious crime for the abortionist.|
What Happens When Abortion is Legalised?
Professor Liley has correctly noted that there is an immediate escalation in abortions but his statement that 'there is no limit to the level that the abortion rate can reach' is not borne out by the experience of countries such as Czechoslovakia and Hungary where (unlike Sweden liberal laws have been in effect for more than ten years. In both these countries there was a sharp rise in the first three to five years of the law, followed by a flattening out, so that the rate is now fairly stable (11). Further, simultaneous public education on birth control can reduce the rise even more. Thus, in Japan, the rate of legal abortion per 1,000 live births has declined from 717 in 1957 to 387 in 1967 (1).
The strain on health services produced by the rise in abortions after legalisation is a potential problem, but the development of new, simple and safe techniques done on an outpatient basis has enabled cities like New York to cope without difficulty.
The debate over abortion is rather like the outcry in the 1920s and 1930s as women fought for the right for birth control. A substantial number of women see the abortion question as a private moral decision, not a favour to be dispensed arbitrarily by doctors (mostly male) in what is basically a demeaning adversary relationship — the woman implores, the doctor deplores, then occasionally relents. Many of us in the medical profession would like the responsibility for the decision taken from our shoulders and vested in the woman herself.
In this respect it would be a recognition of the right of the woman to control her own reproductive activity. But women's rights are not the only arguments for a more liberal attitude to abortion which, in contrast to what is often suggested by opponents of abortion, Is dictated by a basic and humane concern for the woman afflicted with an unwanted pregnancy, for her family, and for society as a whole. It is thus no paradox that, in sharp contrast to countries in which abortion is prohibited, the ones with liberal abortion laws are generally those in which the status of women is most equitable and the concern of society for all its members most marked.page 8