The Ethics of Pregnancy, Abortion and Childbirth

Exploring Moral Choices in Childbearing

Helen Watt

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781138188082
• eBook ISBN: 9781317283836
• Edition: 1
• Topic: Medicine
• Subtopic: Ethics in Medicine

The Ethics of Pregnancy, Abortion and Childbirth addresses the unique moral questions raised by pregnancy and its intimate bodily nature. From assisted reproduction to abortion and 'vital conflict' resolution to more everyday concerns of the pregnant woman, this book argues for pregnancy as a close human relationship with the woman as guardian or custodian. Four approaches to pregnancy are explored: 'uni-personal', 'neighborly', 'maternal' and 'spousal'. The author challenges not only the view that there is only one moral subject to consider in pregnancy, but also the idea that the location of the fetus lacks all inherent, unique significance. It is argued that the pregnant woman is not a mere 'neighbor' or helpful stranger to the fetus but is rather already in a real familial relationship bringing real familial rights and obligations. If the status of the fetus is conclusive for at least some moral questions raised by pregnancy, so too are facts about its bodily relationship with, and presence in, the woman who supports it. This lucid, accessible and original book explores fundamental ethical issues in a rich and often neglected area of philosophy in ways of interest also to those from other disciplines.

1 The Uni-Personal Pregnancy

The topic of this book is human pregnancy, not the moral status of the fetus—an issue which forms merely one important part of the wider whole of ‘pregnancy ethics’. This wider whole, which includes a range of questions raised by being or becoming pregnant, takes in the woman’s bodily connection with the fetus and the moral implications of that connection for the woman and for those about her. These issues will be the subject of later chapters; this opening chapter will examine the status of the fetus—though many will find my exposition frustratingly brief (or, indeed, otherwise frustrating). For only after some exploration, however summary, of the status of one half of the mother-fetus ‘dyad’, as the bonded pair is sometimes called, can the moral demands of the bond be explored in a bolder and less tentative way. Having come to a conclusion on the status of the fetus, we are then better placed to ask what follows morally from the fact that the bearer of this status is uniquely enclosed within the body of an adult individual.

Human Personal Status

The question for this chapter is whether the fetus is, morally speaking, ‘one of us’—a human moral subject or, as some would put it, a ‘person’, though this word has often further connotations. In this chapter, I will use the term ‘person’ or ‘human person’ not in the sense of ‘self-conscious individual’ (for example), but in the rather generic moral sense of ‘full human moral subject’. By that I will mean an individual whose welfare and survival have a special moral importance. I will not assume in advance either that human persons are the same as (or exist throughout the life of) individual human beings, or that anything specific in the way of self-consciousness or past or current experiences is required to have full ‘personal’ status. I will look at various approaches to the question of what might be required for personal status, including an approach which sees the response of the pregnant woman herself as determinative of the status of her own fetus, more than any characteristics it may have.

One immediate question we can ask about status is: Did we always have our current moral status? Or was this status something we acquired gradually, or at a certain point? Did our status begin when we began? A slightly different question, which we will look at first, is: What essentially are ‘we’? Are we (for example) our bodies (that is, our ‘animated’ bodies, not our corpses)? Or perhaps a part of our bodies—our brains or some part of our brains? Are we constituted by something bodily which precedes us, as a statue is constituted by a lump of bronze which exists before it constitutes a statue? Are we a phase in the existence of the human organism, so that ‘person’ names a stage in the life of that organism, rather like ‘parent’ or ‘adolescent’? Or are we rather something non- bodily—for example, minds, or series of experiences?

Are We Our Bodies?

It is common to think that we are our living bodies—not necessarily conceived in very mechanistic terms—though also common to think that we are not. Certainly our thoughts do seem closely embodied: often we consciously experience ourselves simultaneously as thinking, feeling beings and as bodily beings who relate physically to the people and things around us. It is the same being who breathes—consciously and unconsciously—and uses breath to speak, laugh or shout. It is the same being who hears the words of others and comes to understand what they mean. Even religious views which recognize survival after death sometimes speak of a ‘resurrection of the body’ which returns the disembodied remnant to its ‘proper’ role of animating some particular body. Whatever we might want to say about the (actual or conceivable) survival of disembodied minds, such entities do seem radically truncated when compared to a whole, bodily human being.

Are We Our Experiences?

Some of those who may concede the plausibility of a bodily identity for ourselves will nonetheless reply that it is our experiences—in principle, transferrable into other bodies and/or stored in computers—which make up the ‘real us’. Reference may be made to, for example, Science Fiction scenarios in which our bodies are emptied of our memories, which are then transferred to another body. Wouldn’t we think of ourselves as going where ‘our’ memories (or quasi-memories) go—rather than remaining ‘in’ the now-unconscious body with which we began?¹

However, those defending a human bodily identity will point out that—if we keep to Science Fiction—we can imagine ‘my’ memories being transferred simultaneously to two bodies, or (to move a bit closer to reality) we can imagine two people being ‘fed’ or ‘brainwashed’ with material from my biography until ‘they’ believe that they are ‘me’. I can’t be the same individual as both these people—so why think that I am either?² True, each of the individuals after ‘receiving’ my memories has (unlike the now-unconscious body we began with) experiences ultimately caused by my experiences—but does that make them me ? Why not see myself as the original, bodily individual who did once experience things (in between sleeping) but has now lost the memory of these experiences and, perhaps, the very ability to experience?

Moreover, we need to ask, more fundamentally, why we have the experiences we do. These experiences appear to be a function—closely coordinated with other functions—of the kind of bodily life we have. That bodily life surely involves experiences; it does not simply cause them ‘from without’ for some discrete entity, whether a soul, brain or brain part. In this respect, we are like nonhuman animals: a ‘dog subject’ is not something separate from a ‘dog organism’ (whether a single entity or a string of experiences) but an intermittently conscious bodily subject whose experiences, like its other activities, are those of the kind of being it is. A dog chases rabbits because dogs are carnivores and rabbits are prey:³ whatever psychological links there may be between the dog’s experiences, these are all experiences of the same dog subject because they are undergone by the same bodily being—the same living whole, or organism, which has needs, tendencies and so on connected with its bodily type. So too with humans: our experiences are very much a function of the specific kind of bodily entity that seems to undergo them. The very same entity prepares for these experiences, sleeps, wakes and integrates itself as an organism throughout. As mentioned above, we have at least the impression of unity on a daily basis: we feel, at least, as if we ourselves have at once a beating heart, the sensations that go with that, and the thoughts that go with both.

Turning to our search for an individual subject who might be the ‘carrier’ of our moral status, it is hard to see how rights or interests, for example, could be ascribed to, in particular, an experience or series of experiences: how could a thought (or thoughts) have rights of its (their) own? Such an account seems even less attractive than the view that we are persisting, nonphysical beings who merely interact with pre-existing and quite separate living bodies. It appears that we should, at very least, concede that the body is somehow internally involved in the human subject, even if we do not believe that the subject is present throughout the body’s life.

Interestingly, there are some strange implications in the sexual/reproductive area if we are not in any sense—not even in a partial sense—our own, entire living bodies. If we are not our bodies, then couples do not make love;⁴ only the ‘animal beings’ with which their minds are associated unite sexually. The idea seems ridiculous and demeaning: this is not how loving couples experience what they do. Similarly implausible and demeaning is the idea that a pregnant woman is a mind using a separate womb to gestate, in the way that she might use an incubator or some other ‘tool’ to bring a child to term.⁵ Surely a pregnant woman is her own, thinking, feeling and (currently) gestating body: her animated body is her, not just something her brain or soul makes use of.

Overlapping Subjects of Experience

Another problem for theories which separate the thinking or feeling subject from the bodily organism is that we risk finding ourselves with two subjects, filling exactly the same space and using exactly the same bodily parts and capacities to have these experiences. For any living organism of a sentient kind will, if all goes well, first acquire and then exercise the ability to experience. If we ascribe experiences also to a separate ‘person’ (or pre-personal subject) in the case of human experiences, then it seems that we have two subjects of experience, existing and experiencing simultaneously in the same location and using the same cerebral/bodily equipment: the animal and the (pre-)personal subject. Isn’t that one subject too many?⁶

If we carry this confusion over to the case of pregnancy, we risk suggesting that there are two spatially completely overlapping beings, both of a kind to have experiences: a person and that person’s ‘animal’⁷—the latter carrying an ‘animal’ fetus who is itself presumably overlapped by a psychological being of some kind, at least in the case of a fetus who is conscious. So: four subjects of experience here, where we would expect to find at most two—assuming there are no twins or triplets in the picture. Again, this seems quite unreal.⁸ The living body must be identified more closely with the experiencing subject.

But perhaps the pregnant woman is not exactly her living body (i.e., a living human animal), but is rather constituted by her living body, as a statue is constituted by bronze. The problem here is that the living human organism itself appears to acquire, as it develops, the ability to experience: not derivatively via some new (pre-)personal subject it comes to constitute, but in its own right—as part of its developmental plan. The organism does not ‘borrow’ its ability to experience,⁹ but, rather, progressively perfects its own capacities to the point where it can have experiences—although these capacities can of course be damaged later on. Why should we think of some totally new entity appearing¹⁰ when the organism acquires, as it does seem to acquire, the ability to experience? And what happens to that new entity when the organism loses the ability, whether temporarily or permanently? We will return to the question of brain damage shortly.

Moral Status and Desires

If a pregnant woman does not have, but is, in some fairly strong sense, a living body with high-level moral status, when did she acquire this moral status, and how should we think about status generally? (We are, again, referring to the full moral status known as ‘personhood,’ and not the lower, though quite genuine, status we attribute to, e.g., our pets.)

Some link ‘personal’ status very closely to a history of thoughts and feelings, perhaps of a highly individual kind associated with a ‘personality’. While accepting that the human individual is a bodily subject who began many months before birth, they associate the rights and status of this bodily individual very closely with his or her desires. Perhaps our rights and status begin sometime after we ourselves begin as living beings. Morality is, we might think, all about adjudicating between ‘interests’ formed in one way or another by the desires of those involved. Can’t we see a hierarchy of status between ‘pre-desire’ individuals such as embryos, those with primitive desires such as more developed fetuses and infants, and those with increasingly sophisticated desires like older children and their parents?¹¹

This may seem like an obvious way of looking at moral status, one which coheres with the importance we attach to some at least of our own desires and projects. In the context of homicide, in particular, the frustration of desires and projects can certainly make some cases of killing morally worse than some other cases—at least from that perspective. To kill me before I finish my great novel is worse in some ways than killing me after I finish my great novel, since in the one case, though not in the other, a morally relevant desire will be frustrated. At least as an aggravating feature of homicide, past desires of the victim can be morally relevant, as can desires of other people. Killing an aimless and friendless, though innocent, person, while still unambiguously murder, does not have the aggravating feature of thwarting the victim’s desires and those of friends. Such killing is, nonetheless, quite bad enough and can indeed have other¹² aggravating features: there may be an especially poignant deprivation if one is deprived of the very opportunity to form¹³—much less succeed in—long-term projects, as will be the case with infants, for example.

Even conceding that desires can be linked with genuine interests which can then be thwarted, it is not clear why we should think that the presence of desires or projects is always necessary for us to have interests to be thwarted or fulfilled. Certainly, desires do not seem to be sufficient for us to have interests in the satisfaction of precisely those desires. For one thing, not all desires are morally good: some not only may, but should, be thwarted—by ourselves and by other people. Spiteful desires are one example; grasping desires are another. We all recognize such desires in ourselves but also feel (at least in our better moments) that these desires and their satisfaction are not in our true best interests...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Acknowledgements
• Introduction
• 1 The Uni-Personal Pregnancy
• 2 The Neighborly Pregnancy
• 3 The Maternal Pregnancy
• 4 The Spousal Pregnancy
• Appendix: Pregnancy and Lethal Fetal Anomaly
• Bibliography
• Index