Abortion for disability past 24 weeks (Published: 7 July 2008)

Numbers aborted under ground E of the Act

In 2007 there were 1,939 abortions carried out under ground E of the Abortion Act, of which 135 were at over 24 weeks gestation. Of these 135, 59 were for abnormalities of the nervous system, 34 for abnormalities of other organ systems, 31 for chromosomal abnormalities and 11 for other conditions.

Between 1996 and 2004, 20 babies were aborted because of club foot, and a further four because of polydactyly. All of these took place at more than 20 weeks.[1] Between 1995 and 2001 there were 26 abortions for cleft lip and or palate.[2] Of these two were carried out at more than 24 weeks gestation.[3]

Arguments for abortion to term for disability

Reducing suffering of the individual:

Abortion for foetal handicap is often justified on the basis of alleviating suffering, either for the baby affected or for the family who will have to care for them. However, according to a press release on their website, 'The Down's Syndrome Association does not consider Down's syndrome a reason for termination. People with Down's syndrome can and do lead full and rewarding lives.'[4] The suicide rate in Down's syndrome sufferers is significantly lower than that in the general population.[5]

Reduce the pressure on families:

Caring for a disabled child is challenging for families. Common parental reactions to a diagnosis of long-term disability in their child include sadness, guilt and anger. However, research shows that the divorce rate amongst parents of disabled children is no higher than that in the general population.[6] Siblings of children with Down's syndrome generally get on well with their disabled brother or sister. They are fond of them, not embarrassed to introduce them to their friends, and often become more caring individuals than they were previously, according to their parents.[7]

Economics:

One argument (often left unspoken) in favour of the termination of seriously handicapped foetuses is essentially economic – that such individuals place considerable burdens on an already over-stretched health service (and often do not become financial contributors to society to repay these costs).

Even if there are no moral objections to financially-driven destruction of foetal life, there are still problems with abortion being used in this way to reduce burdens on services. Decisions about healthcare rationing are inevitable, but must be made in the public arena where all members of society can contribute to the debate. At the very least an evidence-based review must be undertaken, to assess the relative costs of caring for different types of congenital disability, against the costs of diagnosis and termination of affected foetuses.

Reasons why disability abortion to term should be scrapped

Possibility of cures for some congenital abnormalities:

Steady improvement in neonatal intensive care and paediatric surgery has led to many structural abnormalities that previously would have been fatal now being considered curable. Several years ago the media reported that a woman at 35 weeks gestation was recommended to have a selective termination of one of her twins because of a cardiac abnormality, which she was later advised could be corrected though an operation with an 85% success rate.[8]

Because of intensive surgical correction of cardiovascular abnormalities, only 10% of those with Down's syndrome now die below the age of 5. Of the 90% who survive, most now reach their 50s or 60s. Many phenotypic features of Klinefelter's syndrome can be reduced by testosterone therapy, and some trials have even shown success in using advanced fertility treatment to allow those affected to father children.[9]

Better quality of life for the disabled:

Mercifully, the days when 'imbeciles' were condemned to asylums and abandoned by society are in the past. The Disability Discrimination Acts of 1995 and 2005 commit society to promoting the civil rights of disabled people and fighting discrimination against them. It is now mandatory for disabled people to have barriers removed in accessing education, employment, public transport, public facilities and other services, and to have equal rights in buying land or property.[10] Such legislation, and the changes that follow in the provision of ramps, disabled toilets, large print documents or disabled parking spaces, all serve to reduce the level of handicap faced by those with a disability and to improve their quality of life.

Better support for families:

An increased awareness of the challenges of caring for children with disabilities means that families including such children receive considerable help from local authorities. The help may be financial, through social services, by the offer of child-minding, or it may involve the provision of respite care to allow parents time to recuperate. Many children with Down's syndrome are now catered for in mainstream schools, and can lead happy and fulfilled lives, achieving high levels of independence.[11]

To stop discrimination against those unable to defend themselves:

Tom Shakespeare is a research fellow at Newcastle University who was born with the genetic condition achondroplasia, leading to severe limb abnormalities. Although defending abortion in principle, he greatly opposes the special case made for abortion due to foetal handicap. Speaking about those with profound learning difficulties, he argues that 'just because a person is unable to articulate their views and concerns clearly does not mean that their life isn't worth living.'[12]

Effects of abortion for foetal handicap

Effects on the woman:

Abortion cannot wind back the clock. Instead of facing the problems of bringing up a disabled child, women may face long term psychological ill health. Disabled babies are often very much wanted – often conceived by older mothers for whom they may represent the last chance of having a child. Since the abortion is being considered not for 'social' reasons but solely because of the abnormality, conflicting maternal desires can make the decision very traumatic. These factors mean that abortions for disability are often 'high risk' for developing subsequent mental health problems. According to one study 77% of women aborting an abnormal baby experienced an acute grief reaction, and 46% were still symptomatic and requiring psychiatric support six months later.[13]

Personal anecdotes of those in this position, that were collected for another study, are harrowing: 'when we went to the parents' support group the other couples said they blamed themselves for not being strong enough to deal with an abnormal child. When they said this, it was like a dagger through my heart, because I knew it was true for me, too. I cried for two solid days, but I had to face my guilt. Those feelings are there, and if you don't get them out, they eat away at you.'[14]

Effects on society:

Abortion for handicap may also have larger impacts on society, with disabled people particularly sensitive to what they feel it says about their value. As Tom Shakespeare points out, 'it is very difficult to support a practice which would have prevented one's own existence'.[15] At a 1998 workshop on abortion, unexpected agreement was reached between Ann Furedi, now of Abortion Rights, the pro-choice charity; and Helen Watt of the Society for the Protection of the Unborn Child. Both were agreed that the law should not treat disabled and able-bodied foetuses differently – Watt arguing that abortion law should be greatly curtailed across the board, and Furedi that women should be able to abort up to term for any reason they choose.[16] The mere existence of section 1(1)d requires serious review since it seems to draw a line between the moral worth of foetuses based solely on their level of disability.

Conclusion

Scientific advances and advances in caring for the disabled mean that people born disabled today can reckon on a considerably higher life expectancy and quality of life than in previous years.

Discriminatory abortion of disabled babies cuts across all the attempts of society to help disabled people live normal lives. It suggests that they are of less value than the able-bodied and sends out the message that a disabled person is an accident that should have been averted.