From nucleus - winter 2004 - Dodging the Elephant [pp2-5]
In April, the media wowed us with heartwarming reports about the latest medical technology: three dimensional fetal ultrasound. Large, colour pictures pioneered by Professor Stuart Campbell’s team at London’s Create Health Clinic, displayed the unborn babies in amazing detail. The new scanners demonstrated fetuses at twelve weeks stretching, kicking and making complex movements. At 14-15 weeks they were seen sucking their thumbs and yawning. By 18 weeks they were opening and shutting their eyes and by 26 weeks they were scratching their noses, smiling and frowning. Conventional ultrasound produces only 2D images of the developing fetus. These are useful for measuring the growth of the fetus and assessing abnormalities, but convey very little information about behaviour.
Writing in the Daily Telegraph, journalist Tom Utley said jokingly that he was sure he’d seen an elephant barging about the television studio during the report, but the newsreader had seemed intent on ignoring it. The ‘elephant’ Utley referred to was the question: ‘If fetuses behave in such a recognisably human way, even at 12 weeks, then how can it possibly be right for the present law to allow them to be destroyed, with few questions asked, when they are twice that age?’ I’d argue that the metaphorical elephant’s even-bigger brother, which everyone (Utley included) tries even harder to ignore, is the question: ‘Abortion is a reality, but are we really sure it’s right?’
The abortion debate is one of the oldest in bioethics, but it shows no signs of going away. It is also shrouded in emotion, from our instinctive reaction of ‘ahhh, how sweet’ on seeing the pictures produced by Stuart Campbell and his team, to the terribly private pain suffered years later by so many women who have had an abortion.
As Jacky Engel writes in her article on pp11-19, much of our abortion legislation in the UK is the result of case law drawn up like patchwork over decades. The pro-choice and pro-life camps alike draw on the hard, frequently tragic, cases that so often lie at the heart of lawmaking to gain support for their respective causes. But this detracts from the fact that so many ignore: 181,600 women underwent a termination procedure in England and Wales in 2003 – 3.2% more than in 2002 – and 13% of these took place at more than 13 weeks gestation when, according to Campbell’s pictures, the fetus is already well developed.
Over the years that the abortion debate has rumbled on unresolved, there have been enormous advances not just in the field of fetal imaging, but also fetal surgery (with anaesthetic) and neonatal care. The 24 week mark in pregnancy is traditionally regarded as the point of viability, the time in the pregnancy after which the unborn baby could theoretically live outside its mother’s womb if it was born early. However, some argue that this is more a measure of the sophistication of our neonatal care, and in many centres it is almost becoming routine for babies born pre-term at 24 weeks’ gestation - more than four months early - to survive with good clinical input. An electronic paper published in the journal Pediatrics earlier this year reported that 66% and 81% of those infants born at 23 and 24 weeks of gestation respectively survived to be discharged home. However, it is worth noting the significant burden of lasting neurodevelopmental difficulties in this group. Many thousands of pounds is invested in the intensive care of each of these children, as well as their clinical follow-up, and often their need for special education.
At the same time, late abortions are taking place in the UK, maybe even in the same building, and occasionally result in live births but, unlike pre-term births, these children receive no care or investment of any kind at present - they are simply left to die. The Human Fertilisation and Embryology Act (1990) permits abortion at any stage of pregnancy if there is a ‘substantial risk’ of serious handicap and a handful of such procedures take place each year after the traditional 24 week viability limit.
The British Medical Association’s (BMA) annual representative meeting (ARM) in July called on the NHS, the General Medical Council and other professional bodies to work together to ensure that babies born alive as a result of a termination receive the same full neonatal care as that available to other babies. Abortions carried out late in pregnancy, before or after the 24 week limit, usually involve an injection of potassium chloride to stop the fetus’s heart prior to an induced vaginal delivery, but even after doctors have checked using ultrasound that the fetal heart has stopped, there are anecdotal reports that it might start beating again.
Legislation exists in the USA stating that appropriate care should be given to aborted babies born alive. In contrast, in Britain we simply have guidelines suggesting that from birth all people have the right to expect care and treatment appropriate to their needs. Speaking to the British Medical Journal, Ib Adedugbe, deputy CMF representative on the BMA’s medical students’ committee, who proposed the motion at the ARM said, ‘What we need now is a policy that gives a distinctly clear code of practice for our members to follow.’ She went on: ‘It should not matter how a baby is born. We have a duty to protect the fundamental human rights of a baby once it is considered living.’
Why is it that we seem to think it’s right to spend thousands saving the life of a pre-term baby, even if this results in complex long-term problems, yet if that same child was still in the womb, in other circumstances, it would be a very different story? This paradox demonstrates the fundamental inconsistencies at the heart of the abortion debate and it seems to be finally coming to light. Prime Minister Tony Blair has hinted that he might consider re-examining limits for late-term abortions in light of medical advances such as 3D ultrasound. However, he merely said that it was sensible to watch new findings, and Downing Street stressed that he was not signalling any government law plan.
The ultrasound images showing a fetus looking remarkably like a baby at only twelve weeks gestation have provoked demands for the existing 24 week time limit on terminations for ‘social’ reasons to be halved. This appears unlikely to happen but, ironically, Lord Steel, the architect of Britain’s abortion laws, is leading calls for the limit to be reduced to 22 weeks. He said restricting a mother’s right to choose to terminate her pregnancy by reducing the 24 week upper limit needed to be balanced by the fact that some fetuses survive after being born at 22 weeks’ gestation. ‘I think people find it very repugnant to think you are getting close to the point where you are not dealing with a fetus but with the possibility of a baby,’ he told BBC News.
Steel’s words illustrate one of the principle reasons why dialogue in the abortion debate has always proved so fruitless. Pro-choice advocates hold that the fetus is not fully alive and is thus dispensable. This position is increasingly supported by influential philosophers such as Peter Singer. In contrast Christian ethics is built upon a biblical anthropology, which holds that God’s image in human beings imparts us with an extraordinary value: Genesis 9:6 forbids the killing of men because of this. This sanctity of life principle is at the heart of the Christian argument against abortion.
We are too easily preoccupied by the hard cases like late abortion that dominate the media but only really serve to fudge the central issues in the debate, forgetting the hundreds of fetuses aborted each week for social reasons. However, I cannot concur with Lord Steel’s ‘possibility of a baby’ at 24 weeks. The essential nature of the fetus does not change in any way at viability; as I’ve already mentioned, it is simply a measure of the current sophistication of our neonatal life-support systems. To take his argument to a logical extreme, a fetus seen on scans to be sucking its thumb and opening its eyes at 23 weeks, but then being aborted, is not a live baby; it is merely a potential life. In contrast, the wanted child born at the same stage in pregnancy, being given intensive resuscitation before being rushed down to the neonatal unit, is a live baby.
It is easy to get bogged down by academic arguments about personhood and forget that the women seeking abortions are real people, facing real pain. Our response as Christians should be one of compassion not judgment. However, philosophically and theologically, I am convinced that there is no point in development at which we can reliably conclude that a fetus ‘becomes’ a human being. It seems apparent that the embryo bears the image of God and thus has a moral claim from the moment of conception. We surely owe a duty of care to the embryo and early fetus as much as the newborn baby and the mature fetus. If this is true, we need to keep trying to drag the elephant out of the shadows.