In 1986 a group from the Royal Society of Medicine attended a conference in New York billed as: ‘Biomedical Ethics: Anglo-American dialogue.’ Despite the fact that there was clearly a sense in which the British had come to learn the new ‘bioethics’ from its American progenitors The Reverend Professor G.R. Dunstan discussed the strong tradition of ethical reflection found in the UK medical profession in his opening address. Indeed he claimed that with regard to "the involvement of churchmen and philosophers in medical ethics, we in the United Kingdom were about ten years ahead of you in the United States" (1988:5). For support, he draws on the work of the Church of England’s Moral Welfare Council and “its pioneering work on the ethics of sexual relationships in general to specific questions of contraception, sterilisation and abortion in particular, and thence into the prolongation of life and of dying” (1988:6).
It is easy to forget the fact that the Church of England played a positive role in much of the progressive legislation of the 1960s, perhaps most notably in the formation of the 1967 Abortion Act. There is little doubt that some of those involved with the development of the Act thought abortion was, at minimum, ethically questionable. However it was clear that the consequences of criminalisation – primarily backstreet abortions but also women having to continue with pregnancies that put their health at risk – were a sufficiently great moral concern that could no longer be ignored. Certainly the CoE (and, for that matter, the BMA) also had a conservative effect that can still be discerned in the fact that two doctors are required to certify the grounds for an abortion before it can take place. At the time this restriction on a woman’s ‘right to choose’ was sufficient for some feminist campaigners to become disillusioned with the development of the bill and to disengage from the process.
If we take a broader socio-historical view we can perceive a greater complexity to the morality of abortion than the simplistic supposition that it is either permissible or it is not. It would be nice to be able to say that the abortion debate differs in the UK and the USA precisely because here this complexity is recognised whilst in America it is not. Yet we only need look to the continuing lack of legislation or guidance in Northern Ireland to see that we are just as capable of being held hostage by determinant interpretations of, or demands for, right and wrong. Ironically the continued lack of abortion services in Northern Ireland is only tenable precisely because (some) women who live in Ireland’s north and, we might add, in Ireland as a whole are able to travel to England and elsewhere in Europe to avail themselves of the services they are denied in their home countries. It is thanks to those who do recognise the moral complexity of abortion that those who do not are able to maintain their opposition and prevent legislative action or guidance being issued.
In the past couple of weeks the new Secretary of State for Health, Jeremy Hunt, has expressed his backing for halving the current time-limit on abortion to 12 weeks whilst Marie Stopes announced it will open its first clinic in Belfast where it will provide abortion up nine weeks gestation. The law that will apply to the Marie Stopes clinic in Belfast is that which the 1967 abortion act replaced in the rest of the UK. It is unclear how this law should be interpreted. Whilst, having been directed to do so by the courts in 2004, the Department of Health NI issued guidance in 2009 this was subject to legal challenge on the basis of their clarity unclear (in relation to conscientious objection and counselling). The guidance was subsequently withdrawn and has not been reissued. The Northern Ireland Family Planning Association has been granted a Judicial Review for January 2013 where they will argue that the Health Minister should be compelled to comply with the 2004 order without delay. Consequently it remains unclear whether the interpretation the Marie Stopes clinic intends to adopt will be found to be correct even if it is defensible on the basis of continued lack of guidance. The 1967 Abortion Act sought to clarify the law that still applied in Northern Ireland, originally setting the limit at 28 weeks. The current limit of 24 weeks was introduced in 1990 as part of the Human Fertilisation and Embryological Act. Whilst there is room for legitimate debate about what, precisely, this limit should be we should also recognise that setting this limit is about managing the moral complexity of abortion and the provision of services. What it is not about is providing a determinate answer to the question of when, and when not, an abortion might be morally permissible.
Certainly the rights and wrongs of abortion per se is a question that arises in different contexts. Many women who seek abortions will struggle with it themselves, as will some healthcare professionals (hence the provision for conscientious objection). Indeed many continue to debate this and other matters of medical and bio- ethics and seem to do so endlessly. It is easy to find those who have an opinion on the matter but it is, perhaps, more interesting to consider who it is we do not hear from. The answer is, of course, the overwhelming majority. Regardless of what moral question is being posed the vast majority of those who will have to answer it, which is to say those who will actually face up to it in the course of their everyday lives, will not be involved in the public moral debates or in the formation of a political response. Furthermore the lack of abortion services in Northern Ireland impacts on those from lower income backgrounds more than those from middle or higher income backgrounds. Women from Northern Ireland can access abortion services in the rest of the UK but they cannot access NHS abortion services. As well as bearing the cost of travel, time-off and, possibly, childcare women who travel from Northern Ireland must pay for their abortions. This is not a problem that the Marie Stopes clinic will solve as, unavoidably, it will have to charge for its services. For an abortion this will run into the hundreds of pounds.
If we believe in the moral autonomy of individuals, the right of individuals to make moral decisions for themselves, then legislating to govern activities like abortion becomes process of constructing a framework within which such individuals can exercise their moral autonomy. There has been a failure to enact such legislation in Northern Ireland or to issue guidance on tyne existing legislation. Once again somewhat ironically the consequence of Marie Stopes opening a clinic in Belfast might be to decrease the pressure on the devolved government to do so. Most abortions take place in the early part of pregnancy meaning that the number of women that find themselves having to travel to another country to access abortion services will be greatly decreased. Equally ironically, were the UK government to pursue Jeremy Hunt’s proposal to half the abortion time limit the likely result would be an increased pressure on the Northern Ireland government to produce its guidance, if not actually legislate on the matter.
The CoE’s positive involvement in the early issues of ‘bioethics’ was made possible by its recognition of the complexity of the questions being asked and, therefore, the solutions that needed to be found. The reduction of ethical debates into dichotomous positions and attempts to answer moral questions for all is not tenable in modern liberal democracies. Abortion legislation and guidance should be seen as predicated on a social ethics that involves managing moral complexity and involving a consideration of what we owe to others under conditions of moral disagreement. Even those who do not agree that abortion is morally permissible should be encouraging the Northern Ireland’s devolved government to produce the promised guidance or to legislate on the issue. Indeed, as with many of those involved with the development of the 1967 Abortion Act, they might even adopt a positive role in the process.
References:
Dunstan, G.R. 1988. Two Branches from One Stem. In Biomedical Ethics: An Anglo-American Dialogue. Annals of the New York Academy of Sciences. 530. pp.4–6.