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Selecting children

26 November 2007
By Dr Helen Watt
Director, Linacre Centre for Healthcare Ethics
Appeared in BioNews 435
Prenatal tests, and selection of children, are deeply entrenched in our liberal culture:  it is hard to subject them to a radical critique without attracting heavy disapproval. While it is socially acceptable to refer to prejudice against disabled people - and even to link this with pressures to screen - to challenge the whole state-sponsored institution of screening and abortion is to go further than many like to go. The bizarreness of separating lives into post-birth 'protectable' and pre-birth 'non-protectable' is invisible to many, though a source of unease to many more. Those who would recoil from postnatal 'termination' on grounds of age, ability or physical location hesitate to question that one and the same individual has human rights the moment she emerges from the womb - but not a moment sooner.

True, it is socially acceptable to recognise in some way the pain and grief abortion causes women, and the difficulty so many women and couples experience in making the decision to abort. After undergoing an abortion for disability, a woman may be encouraged to grieve for the child, and to hold her in her arms. Faced with the reality of a dead or dying baby, and a mother who may be suffering deeply, there is often no pretence that a child is not involved.

However, this merely highlights the schizophrenic nature of selection, since it is unquestioned that the woman has absolute control over whether her child lives or dies. The foetus is a child for the purpose of being grieved for, if abortion is chosen by the woman, but not a child for the purpose of being protected from the abortion. The doctors and nurses see the woman's grief, but do nothing to prevent the root cause; on the contrary, the death of her child is precisely what they mean to bring about. Abortion is somehow both a 'difficult' and 'agonizing' choice, and a choice which cannot possibly be wrong: guilt is seen as, at most, a psychological fact, not as something potentially appropriate and even potentially healing. This does a disservice to the many women who know they have been harmed by their abortions in ways a simple grief narrative cannot begin to capture.

Does life have value for all living human beings, disabled and able-bodied alike? If so, what justifies us in depriving a child in utero of a life we admit would be worthwhile? If not, what do we say to born disabled people, who rightly object to the assumption that their own lives have no value? In this context, we should bear in mind that people can have objective interests in things in which they do not take an interest. Life itself, however long or short it may be, is in a child's objective interests, as are the other 'human goods' which life normally contains. Just like any baby, the child in utero has objective interests in her future life of a kind no less important for the fact she cannot yet assert or understand them.

Of course, pregnancy involves her mother's body; however, pregnancy is not, we should remember, the only form of bodily support. If a woman gives birth alone in an isolated area, her child may for weeks be dependent on her body - for example, on her choosing to breastfeed - just as she was dependent on her body in the prenatal phase. In neither case does the child's dependency mean that she has lower moral status;  on the contrary, such dependency creates a moral claim on the person on whom she is dependent. And yes, parenthood makes serious demands - and often more serious demands in the case of a child with disabilities. However, the response to these demands is not to take the child's life, but to support her and the family. Parenthood is not about selecting a child we decide we want - as we might want a possession - but about unconditional love and welcome of any child we have.

We should have the courage to question the institution of selection, not just its extension to ever-wider categories of unwanted human being. The emperor has no clothes: parents do not own their children, whether before or after birth. Unless we are to defend the killing of born disabled children at their parents' discretion, parental autonomy cannot be extended to powers of life and death over the child. The fact of dependency is no more a reason to 'control' or terminate a human life before than after birth. If we take seriously both human equality, and the bodily nature of the human subject, we must recognise the rights of younger, more dependent and less 'able' subjects than we may want to believe.

25 March 2013 - by Dr Colin Gavaghan 
Being a bioethicist in the Antipodes is becoming a dangerous business these days. Just over a year ago, the publication, by two Australian academics, of a paper exploring the acceptability of 'post-birth abortion' led to media furore, hate mail and even death threats to the authors...
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