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'Don't mention the 'A'-Word: Why can't the truth be told about abortion?'
By Ellie Lee, John Parsons, Frances Kissling and Ann Furedi

Introduction

What follows is a transcript of a discussion convened by Pro-Choice Forum, titled 'Don't mention the 'A'-Word: Why can't the truth be told about abortion?' held at the Institute for Contemporary Arts on 28 February 1998. The aim of the discussion was to provide a forum for those with pro-choice outlook to discuss openly and honestly the problems that exist in making a clear case for a woman's right to abortion today.

Ellie Lee

I would like to welcome everybody to 'Don't mention the 'A' word: why can't the truth be told about abortion?' There are lots of different approaches we can take to discussing abortion, and today we are looking at abortion from the point of view of free speech. We will primarily concern ourselves with discussing what it is that can be said and cannot be said about abortion. In particular we will be discussing this with regard to pro-choice opinion. What aspects of the abortion issue remain taboo? What aspects of the issue do we retreat from discussing through? To consider this with me I have John Parsons who is a consultant in obstetrics and gynaecology at King's College Hospital. He practices both abortion and infertility treatment; Frances Kissling who is the President of the US-based organisation, Catholics for a Free Choice; and Ann Furedi who is the Director of Birth Control Trust and who I am sure is well known to many people here as a commentator on pro-choice issues in Britain.

The way that I am going to organise this morning is to take some opinions from our speakers to begin with and then open up to the floor for any questions or comments to our speakers. I also hope that to a certain degree they are going to engage in a dialogue with each other. I would like to begin with some comments from John Parsons.

John you have gained quite a reputation as probably one of the most outspoken gynaecologists in Britain today. Why do you think it is that you are fairly unique in that respect? Why are so few doctors who practice abortion prepared to speak out on the issue?

John Parsons

To answer that question, you probably need to look at the way in which medicine functions in this country. Most senior consultants work in the National Health Service but the majority of them also have some form of private practice. I would imagine that standing up and speaking about their abortion practice would, to them, not seem like a particularly good way of promoting themselves. There is a significant number of the population who are not enthusiastic about abortion or frankly against it. These doctors feel they may therefore put themselves in a poor light and get themselves a reputation as somebody who does abortion rather than perhaps as somebody who has a more general gynaecological practice, and therefore lose business. So there are probably practical reasons for it rather than any ethical or religious reasons.

Ellie Lee

To pursue this a little further, it does strike me as quite interesting to compare the situation today to that of 30 years ago when abortion was first legalised. It did seem to be the case then that a larger number of doctors, especially those who pioneered setting up an abortion service in Britain, were prepared to get involved in arguing for change. They argued for a change in the law, and wanted to promote the idea in society that women needed access to legal abortion, and to deny this to women was inhumane and barbaric. They would therefore present what they were doing in advocating abortion in a very positive way. In contrast, now it is 30 years down the line and we actually have legal abortion, there seem to be less doctors who are prepared to speak out about it, although the issue is far less controversial than in the past. Why do you think there has been that change over those 30 years?

John Parsons

Certainly 30 years ago the need for legal abortion was apparent to gynaecologists. All gynaecologists would have come across women who had suffered from illegal abortions and the complications it can entail, which meant there was a lot of reason and day to day pressure, to develop the vocation and to change the law.

If you go to developing countries where it is illegal to perform abortions you do not have to be there long as a gynaecologist to see women who have been damaged by illegal abortion, which fires you up. There is no need to be fired up in Britain any more now. There is legal abortion in this country and a woman can get an abortion if she wants one. It may not be the best law in the world but women can get an abortion, so there is not any reason to be activist about it.

You may ask why I am activist about it. I suppose it is because I am older and I can remember 30 years ago. Experiences both in my own personal life and also abroad in developing countries have made it seem an important issue to me. By default I inherited an abortion service at King's College Hospital where I work. I did not say I wanted to do abortion. I saw a service which was being run badly and took the opportunity to improve it, and having improved it of course I cannot lose it now, so I am stuck with it! Therefore I find myself talking about it.

Ellie Lee

I have noticed both in America and in this country a situation where younger doctors that are going into obstetrics and gynaecology are now more frequently exercising their right to conscientiously object and therefore do not practice abortion as part of their job. It is not clear whether or not this is because they have real religious and moral objections to abortion, or whether they see it as something that they would simply rather not do. It seems to me that more likely the latter is going on. Young gynaecologists today do not feel a sense of importance about performing abortion. It is not seen as a very worthwhile activity that can give them a sense of performing a useful role in society. Therefore there is no motivation to get involved. Do you have any ideas about how we might think about changing that? How can we encourage a situation where more young gynaecologists see abortion as a useful part of their job which they would like to be involved with?

John Parsons

I don't think that you are going to manage to do that and I think you are going to need a radical change in attitude towards the way forward in the pro-choice lobby. I actually believe that abortion should be taken away from doctors and we should use paramedics who are recruited specifically for doing it. You cannot train a doctor for six years, put them through obstetrics and gynaecology, and expect them to want to spent their time doing abortions. There is no getting away from it, it is an unpleasant procedure and you are not going to get people enthusiastic about doing it. Given the option, in a ethics neutral situation you will always opt for not doing abortion, which seems quite reasonable to me.

Because I knew I was going to be talking at this I asked the last group of medical students who went through our teaching at King's College Hospital what they thought about abortion. Actually I came away feeling very positive about it. There were 20 medical students and I asked them to tell me whether they were male or female. One did not. Medical students are like that! So we had 19 respondents, 12 male and seven female. Out of the 19, 18 agreed with women having the right to choose so that was jolly good. The only one who did not was a woman, which was interesting. The last questions I asked was 'Would you be willing to perform an abortion?' Seven of them said yes. I think that seven out of 19 is jolly good, because these are not gynaecologists, these are people who have not yet decided what they want to do. I do not therefore actually think that you are dealing with medical students who have got any major religious or ethical problems about abortion. However, to actually improve the service to women, to get a more vocationally orientated group of people treating women, I really believe you need to make it a paramedic job and I can see no reason in the world why you should not.

Ellie Lee

The last question I wanted to put to you concerns abortion for fetal abnormality. One of the things that struck me recently from the point of view of the medical profession is a sense that many want there to be tighter regulation or tighter guidance about that aspect of providing abortion. specifically, I am thinking about calls for a list of abnormalities for which it is legal to abort a pregnancy, and on the other hand a list where it is not. There does seem to be a certain sense amongst some of those involved in the medical profession the government should lay down clear guidelines about this. I was wondering what you thought about that demand? Why it is being looked at in that way compared to 1967 when doctors seemed to want to have a free reign and wanted to be given as much control as possible over what takes place in abortion? What do you think yourself about the idea of having a list of abnormalities to guide you?

John Parsons

The problem I think is that doctors, believe it or not, do not like being asked to play God. We get accused of it but it is certainly something that we do not enjoy doing. Inevitably there are situations where you think 'If I was this woman I would have this pregnancy, I would continue'.

Sometimes this response overrides your feelings that you should be helping this woman and it is hard not to feel resentful that you are having to destroy a baby which you feel does not deserve to be destroyed. You are being asked to kill a baby that you wish you were not killing. In comparison, if you had a list about what was acceptable and what was not, at least you would not have to have that sort of argument or you would find somebody who was willing to do it. All of the time, something that you battle with when you are doing abortions is between one's own feelings and the service you are supplying to the woman who is going to have this pregnancy or not have this pregnancy depending on what she decides. I have not myself had to face terminating late pregnancies. I think it is the later ones that are the major problem. If you get beyond 24 weeks or 28 weeks and there is an abnormality that you feel is not that serious, then I think that must be very stressful. I have not had to do it myself but I can see that it could be very difficult, and to have some guidance which had been agreed by some ethical group somewhere that everybody recognised might seem helpful. Whether it is the right thing to do is a different matter. I am not arguing that this is the right way, rather I am saying why that I think some doctors have been asking for it.

Ellie Lee

Of course we do then have the issue, which we can perhaps come back in the discussion, of where that leaves the woman: her ethical perception of her pregnancy and what she wants to do, and whether or not it is reasonable to have doctors overriding her preference.

John Parsons

They would not be doctors you see. This would have to be decided by a broad spectrum of society. We would like to pass on the responsibility thank you very much, we do not want it!

Ellie Lee

I would now like to put some questions to Frances Kissling. In Britain it is striking that it tends to be the case that the anti-abortion movement, in the minds of many people, is synonymous with the Catholic Church. Certainly whenever the abortion issue appears in the news the first people who are called on to argue the anti-abortion point of view are the Catholic Cardinals. At the same time of course we know that many if not the majority of Catholics do not oppose abortion and in fact think that abortion should be legal. I wonder what you think about that situation: first why the Catholic Church maintains a hard-line stance on abortion when that stance is in fact out of line with Catholic opinion, and second what you are trying to do to encourage more Catholic people to speak out and oppose what the Church hierarchy says about abortion.

Frances Kissling

Why the Catholic Church takes such a hard-line position on abortion is a question that occupies whole books and requires a much longer speech than I have time for today, but I can give a very abbreviated answer. Most people presented with the question would probably point to what the Bishops offer as their reason for being so vehemently committed to an anti-abortion posture, and that is the assertion that the fetus has an absolute right to life from conception. However, once you look more closely at Catholic teaching on abortion, you discover that this whole question is actually much more complex and nuanced than is usually presented. Official church opposition has a lot more to do with governance and authority than it has to do with theology and belief. Most mainline establishment institutions have tried to control fertility and particularly to control women throughout the ages, and the Catholic Church is no exception. In this sense the basic reason why, in my opinion, the Catholic Church is so vehement on this issue, is because it involves Church authority. Furthermore, it reflects the Church's viewpoint on women. In the minds of the Church, women cannot be trusted to make complex, moral decisions and therefore the Church and the State should make these decisions for each and every woman. So it is essentially it is a 'woman question' not a 'fetus question' or a 'life question'.

Ellie Lee

I also wanted raise with you, which perhaps links in with the matter of how we think about changing opinion on abortion today, issues from the material that you have been writing recently. I think you very accurately describe a change which has taken place since the legalisation of abortion in America in 1973, where there seems to be a greater sense amongst people that abortion is a very morally troubling issue. The fetus seems to be more at the centre stage of the abortion debate today, which is clear when we consider the prominence of issues like whether a fetus feels pain, or is in some way sentient. The concern has shifted over 25 years in the US from support for a woman's right to abortion to a questioning of that right on the grounds that more attention needs to be paid to the ethical and moral issues involved with destroying a fetus. How do you account for this change in opinion, and how should pro-choice opinion respond to the current concern with the 'interests' of the fetus?

Frances Kissling

There are two issues there, first what I think has changed, and second what results from these changes. I think it is much more complex than to say that the change is a greater focus on the fetus. That is a piece of it but there is more to it.

We live in a very different world today than that of 1967 to 1975. The massive changes in society between then and now are reflected in all of our discourse over cultural issues, including abortion. To briefly describe some of those differences, using the United States as my point of focus: the sixties and the early seventies was an era of an expanding economy and in that climate people tend to be socially generous. If the economy is going well and people feel comfortable, they are not afraid about the future, they are generally more expansive in their views toward other people and other people's behaviour. Furthermore, it was a time in which there was some promise of sexual freedom and sexual liberation the pill had been introduced and was really beginning to be widely used, and the HIV virus did not yet exist. So we had very different attitudes towards sex in the sixties and seventies than we do now. We were still part of a great civil rights era and believed that individual rights were prominent and that those individual rights extended not only to people of colour but also to women. That was the moral character of the country that led to the Supreme Court decision that included the right to choose abortion. We also, as John mentioned, were very much aware of the negative consequences of illegal abortion.

We now live in a very conservative world. We are coming off economic downturns in the States, people are much more afraid about their futures, and thus they have become socially more conservative. The promise of sexual freedom and sexual liberation is gone. There are so many things you do not talk about if you are a pro-choice advocate. You do not talk about what is good about teenagers having sex, you only talk about abstinence. We no longer even talk about sex outside of marriage, everything is done within the context of heterosexual marriage. We talk a bit about homosexuality because it has been more visible in this time but we are still not comfortable with this. Overall these changes influence the discourse about abortion.

The other change that influences the discourse about abortion is the fact that now it is legal, not illegal. When abortion was illegal, the push to make it legal was part of a much larger agenda reflecting core values that were important to us, particularly core values related to women, to freedom, to sexuality, to religious freedom, the rights of the individual and so on. That is what the debate was about as well as saving women's lives. Once abortion became legal we moved from being an avant guard movement to a rear guard movement. Now we are responding to what others say to protect what we already have. So the discourse about abortion is much more conservative than liberal. In that context what do you do about the fetus?

Those who are opposed to abortion talk about the fetus all the time. The fetus has also been made more visible by medical technology. Thanks to the sonogram, everybody has a picture of their baby from six weeks in utero: the fetus is more 'real' and more present than it was before. As a result our movement needs to include in our discourse what we think, feel, believe, and know about the fetus. There is an enormous reluctance in our movement to engage on this issue. We talk about women and they talk about fetuses. This is very tough and in a conservative environment if you pit women and fetuses against each other, fetuses are going to win, because women's rights are very unpopular today. So while not abandoning our support for women's rights, we do have to talk about the fetus which is complicated for us. I wonder how people reacted when John said 'well you know abortion is really very unpleasant'. What did they think he was talking about? Or what about when he said 'kill a baby'? These are words and language we in the pro-choice movement do not use. Whether we should or should not use them is a question we can and should talk about, because how that language effects the discourse and how it shapes people's attitudes is important for us.

Ellie Lee

What is your own view on that in relation to this issue? Do you think that we should be much more sensitive to concerns about the fetus and perhaps concede some ground, in particularly around later term abortion? Should we concede that this kind of abortion is very difficult and problematic? Or do you think that we should take the other approach and brazen it out, and maintain that women are people with rights, and fetuses are not, so there is no real issue to confront?

Frances Kissling

First of all I think we should say what we believe, which is very important. One of the difficulties with this issue at least in the States is that is has been so massaged by communications experts and by people who take polls and tell us what we should say and what we should not say. For example, we had the 25th anniversary of legal abortion this year and our pollsters and people who do focus groups told us we should not talk about celebrating the 25 years we should commemorate the 25 years. They said these words really made a difference in terms of how people see us. But for me, there was an element of celebration about it, and I think it is good to talk about that. So first we have to say what we think and believe.

Second, I think a lot of us in the pro-choice movement have not confronted what we think and believe about the fetus. The first step is really internal to our movement. People in the pro-choice movement have got to figure this out. People did not go crazy in the pro-choice movement about 'The Silent Scream' (a graphic film of an abortion seen through sonography), because it was a difficult film to counter. They went crazy with it because they were shocked at this graphic depiction of abortion. A lot of people in the pro-choice movement have never really thought about what they think about the fetus.

The third point is I do not think it is a case of being more 'sensitive' to the fetus, I think we have to be more aware of the fetus. I do not think you can build strong ethical argumentation around abortion that ignores the whole picture. I do not think that one element of the picture has to become or should become the be all and the end all. But I do think if you pretend that the woman is the only thing in the picture or that there is something else in the picture but it is totally irrelevant I do not think your argument will be complete, satisfying, or convincing. I think you can say that the fetus has value and not that value never overrides the value not only of the woman's life but her aspirations and her goals and her capabilities and capacities at any given time. But I do not think that we can ignore the fetus.

Finally, I think we have to be more forthright in relation to what is said by those who are opposed to abortion, particularly the Catholic Bishops. We need to forthrightly confront the claim that the fetus is a person, that it has exactly the same moral and physical status as born people, an opinion that has been put forward by those who are opposed to abortion brazenly and as if it were absolute and total fact. It is not fact and anyone who asserts it so self righteously is really ignoring truth. I think that in that sense it is our ignoring of the fetus by which I mean our inability to say quite frankly: we have examined the medical evidence; we have examined the biological evidence; we have examined the philosophical evidence, the theological evidence; we have looked at all of these things and by every parameter that is known in science, philosophy, social sciences etc. the fetus does not meet the conditions of personhood. If I believed otherwise I would not be sitting at this table and doing the work that I do.

Ellie Lee

Thanks very much Frances. I will move finally to Ann Furedi, who I want to talk to about pro-choice opinion in this country. It is striking that quite often when those who support legal abortion make the case for women's access to abortion, the way in which they justify this is through presenting the woman as in some way a victim of her situation. For example pro-choice opinion has often used the examples of women who have been raped or very young women who find themselves with unwanted pregnancy, to try and garner support for access to abortion. Alternatively pro-choice discourse talks of the desperate situation in which a pregnant woman finds herself, where she cannot manage financially, where her relationship is on the rocks, and where she cannot possibly manage to look after a child. There is also the language of sadness and regret, expressing how difficult the woman finds it to make the decision to abort. It is through these mechanisms, which portray the woman as a victim, or emotionally troubled in seeking abortion, that pro-choice opinion is often most comfortable in making the case for women's access to abortion. There does not seem to be at present another framework which departs from this presentation of the woman. I wondered what you thought about this. Is there is any other way that we could present the woman who wants an abortion? Or does the current approach make sense because in some way it is effective by gaining sympathy for women who abort?

Ann Furedi

I think you have described the situation accurately, and we have a problem because it does not make sense to attempt to gain support for abortion in this way. The majority of women who seek abortion in this country, and I imagine in the States as well, are not really the victims that they are made out to be. They are women who could incorporate a child into their lives if they absolutely had to. They would not have a nervous breakdown, they would not fall to pieces, they would not be entirely impoverished. These women are not seeking to end the pregnancy because they are incapable of coping, but because they do not want to have to cope. Quite simply, they do not want to be pregnant any more, and the pro choice movement must decide whether it supports women for whom abortion is a matter of choice rather than necessity.

One of the big dangers we face is this: if we are always talking about the 'hard cases' - the young woman who is raped or somebody who could not possibly afford to have a child - then we do leave our way open for the restriction of the current access to abortion to those who do not seem such 'hard cases'. We could end up with a situation where those who can show convincingly that they are in dire straights are able to obtain abortion, but women who simply do not want to be pregnant (i.e. the majority of women who request the procedure) are seen as having insufficient case. At the very least, we end up with a situation where women who request abortion are humiliated by being made to play the part of 'victims' when in fact they are capable, decisive, normal women.

This one of the horrendous things about the present situation: women are unable to say 'look I want to end this pregnancy because I do not want to have a child'. Instead they are forced into the language of 'I cannot cope with it, I cannot handle it' and so on. This is a huge problem. Frances was absolutely right when she spoke of the defensiveness of much pro-choice opinion.

People feel much more comfortable discussing women who seek abortion as victims, because they are aware of the point that Frances made: that when you have fetus pitted against a woman the woman will lose. She is bound to because the fetus looks like a little baby, we are all very sympathetic towards it as the innocent life. In contrast it is easy for people to believe that the woman should have used contraception better, and she should not be in a situation where she needs to have an abortion. There is an implicit recognition of this -although it may not always be conscious- in the attempt to present the woman as a victim too. It suggests that people should 'pity her'.

Probably, one of the reasons why we have come to this approach, is that in the pro-choice movement we have tended to be a little lazy about intellectually confronting the arguments and issues. The movement is infected with a kind of philistinism. There is a strident pro-choice tradition which repeats the mantra of 'a woman's right to choose' whilst self-consciously refusing to engage with the issues raised by the anti-choice movement. This is a problem because some of these issues need to be addressed and it is possible put forward a convincing and compelling case from our point of view. I am thinking of issues such as: When does life begin? When does life become morally significant? What do we mean by rights? What does it mean to suggest that fetuses have rights? Because we have failed to systematically address these issues, many pro-choice people feel on the defensive because they feel we are unable to answer these questions.

Ellie Lee

Perhaps we could pursue this a bit further in looking at public opinion. I know that is something that you have written about, and the way in which you have characterised the way people look at abortion today is as 'wrong but the right thing to do'. By this I think you mean that people see abortion as morally wrong and morally problematic, but in a certain circumstance, the right thing to do nevertheless. I agree with you that if you simply attempt to deal with that view by sloganising that abortion is 'a woman's right to choose', you do not find a way of changing the view that there is a wrong done when a woman has an abortion. On the other hand I am concerned that we do not want to concede ground on this and I would not want to be in a situation where we do in any way go along with the idea that there is anything wrong with having an abortion. I therefore agree that we have got to make sure that we have taken into account the sense that people have about abortion at the moment. I do think that in the end however we need to have some very clear conclusions about it. How do you think we can relate to public opinion?

Ann Furedi

The whole issue of public opinion is something that you have to unpack a little because it is very difficult to define. Very often pollsters are asking people to make judgements about issues on which -in the normal course of events- they have no concern with at all. For example, consider questions about abortion time limits: 'do you think abortion should be legal at 20 weeks, at 22 weeks, or 24 weeks ?' This is not something that normal people give much thought to. We might spend a lot of time worrying about it, but most people are probably not thinking about whether they are for it at 24 weeks as opposed to 22 weeks. They just do not like late abortions.

Birth Control Trust commissioned Mori to do some research on this. What we found was that in fact there was a very permissive attitude towards legal abortion and more than two thirds of people thought that abortion should be legally available to all those want it, which is a good result. However, the results seemed to be different when the same people were asked: 'do you approve or disapprove of abortion in the following circumstances?' Here the results were quite often much lower, especially when you came to the issue of fetal abnormality. In this case people thought abortion should be legal but they did not approve of it. There was a sense that people felt abortion was morally wrong in the abstract, but the right thing for people to do in some circumstances.

It strikes me that perhaps we have a very easy argument in terms of the law because people do not like the idea of a woman being forced to continue a pregnancy against her will. There are a lot of opportunistic arguments that we can garner around that. We still have to confront the fact that people do not approve of abortion. Now there are two ways of dealing with this. We can either take the attitude that we regard it as being the lesser of a number of evils that a woman faces. This implies that we accept abortion is 'a wrong', but we think that it is less of a wrong than to force a woman to continue a pregnancy. Or we can, (and I must admit this is the view that I hold) revisit what people think is actually wrong about ending a pregnancy and why they think that the life of the fetus at that particular stage has the moral significance where it competes with the wishes of the woman. This approach means we have to take on a lot of discussions that people do find difficult - such as whether or not it is legitimate for abortion to be regarded as means of fertility regulation? Whether or not we do think that the fetus at any stage in its development has equivalent moral significance? These are difficult issues which are not easily measured through opinion polls partly because, as Frances correctly indicated, they concern issues that are not even directly to do with abortion but the way people feel about themselves and the role of women, what they think about sex and so on. So it is hard but if we do not confront it I think we are going to be pushed into an ever increasing defensive position.

Ellie Lee

The final issue I wanted to raise with you briefly is the issue of abortion for abnormality. It does seem to be a question that many pro-choice people say is 'difficult'. I think the particular concern is that if you make a forthright defence of abortion for abnormality you run the risk of offending already existing disabled people. What are your thoughts on that?

Ann Furedi

It has become a very difficult and very sensitive issue and it is certainly quite difficult to talk about it on a public platform. I was debating this issue at the Oxford Union this week, which was very heated at certain moments and you can understand why. My own attitude is that quite frankly I think that women are creatures of conscience, and that women should be able to make choices about their pregnancy no matter what their reasons are for choosing a particular course of action. I find it deeply troubling that some supposedly pro-choice feminists insist that abortion on grounds of fetal abnormality should be outlawed. I find their veto on abortion just as repugnant as that of doctors who refuse to accept that a woman should have the inalienable right to decide about her pregnancy. It is not for us to decide whether a woman's reason for abortion is 'good enough'. It is enough that she thinks it is.

Further to that, I think many people are unsettled by the notion that a woman should make a decision about what she perceives to be the quality of her pregnancy. People seem to find it easier to accept that a woman does not want to be pregnant in the abstract than because the child that would be born is not the child she wanted. I think it's understandable that a woman's attitude to her pregnancy may change if she discovers that her child will never be able to fulfil her hopes for it - but even if you find this contemptible, I still think you must accord the woman the right to make the choice.

The issue that is the most difficult to really deal with, and which underpins the argument that comes from the disability lobby, is that our attitude towards abnormal pregnancies says something about our attitude towards disabled people. This argument supposes that you regard the fetus in the same way that you regard a born person, and it is an attitude that I really do not accept. My support for the choice of abortion when there is evidence of Down's syndrome does not in any way shape my attitude towards people who have Downs syndrome. I think the whole notion that your attitude towards people is the same as your attitude towards the fetus in the womb is ludicrous. It is perverse to find oneself sharing a platform with people who support women's choice of abortion when a pregnancy is unwanted because it is inconvenient, but not when it is affected by a disability. The argument that the attitude towards Down's fetuses legitimises discrimination against people affected by the syndrome is accepted, whilst the argument that abortion of inconvenient pregnancies legitimises the abuse of inconvenient children would - correctly - be laughed out of court.

Ellie Lee

Thank you very much to all our speakers. I will now take questions from the floor.

Question

Helen Reece (UCL Law School) In obtaining abortion, women have to jump through hoops and present their request according to the 'victim' approach you have discussed. I think that women tend to internalise that. I would like to give an example of a close friend of mine who has had an unwanted, unplanned pregnancy. She said that although she does support abortion in principle she did not think she had a good enough case. She said that her pregnancy has had an enormous impact on her life, and that she could not simply end it without a very good reason.

I wondered if you think that women actually internalise society's attitudes to abortion and judge themselves in that way and make very real decisions about their own lives on that basis? I also just wanted to ask John why he thought that abortion was a particularly unpleasant operation? I have no medical experience at all but from the outside I would imagine doing brain surgery would be much more messy and unpleasant.

Ann Furedi

I think that you are absolutely right that if you have a legal and social framework which says in essence that women can only have abortions if they cannot cope then it does frame the terms of the way in which women see themselves which is a great problem.

John Parsons

I made my comment about abortion being an unpleasant operation looking at it from a surgeon's point of view. Other operations to you may seem to be messy and ugly, where to me they can be actually quite beautiful. Once you are a surgeon you do not see blood, you see what you are doing and it can be quite aesthetically attractive to a surgeon. When you are doing termination procedures, especially later terminations, you are exposed to a rather gross, destructive process dealing with bits and pieces of fetuses, which are not very nice. I suppose it is an emotional response as well as an aesthetic response, but that is why earlier terminations are so much easier to manage, because you can actually do them in an aesthetic way. If you are doing a suction termination you virtually do not see anything, so it is nice and tidy. If you do later terminations you may see things which are not very pleasant. That is why we are not keen on people observing abortions. I was recently asked if I would have a journalist join me at work, who wanted to write for the Daily Telegraph. After discussing with other people we decided this was probably was not a terribly good idea because it does not really help women who have got to make this decision to hear how unpleasant it is. I am talking therefore really from a doctor's point of view and explaining why doctors are not that enthusiastic about abortion.

Question

Helen Reece

Is it in terms of what you are doing though I still cannot see why aesthetically abortion is worse than any other operation.

John Parsons

I do not actually mind it. The doing is not such a big problem because there are technical challenges that you have to overcome and you get some pleasure from that.

Question

Helen Reece

On balance then is it more personal rather than aesthetic?

John Parsons

Well this is the balance isn't it? You have to feel strongly enough that this is worthwhile doing and that outweighs the feeling that you are destroying life. A doctor can actually come out with a positive feeling about it. I like doing local anaesthetic terminations because you can talk to the woman while you are doing it and get to know her. I can tell however, if you do twelve terminations with general anaesthetic on a whole bunch of women that you do not know, you do not have a terribly positive feeling at the end of it even if you are very pro-choice.

Frances Kissling

This is very interesting in terms of the title of the session, considering what can we say and what we cannot say about abortion. How can we deal with this issue in public? This conversation does not go on among pro-choice people and certainly does not go on in the public arena very often. It is a very difficult discussion because each time you hear someone say any of these words or concepts, such as 'destruction' or 'unpleasant', you are thinking: 'How does the person who is opposed to abortion react to this?' 'How are they going to use this in a way that distorts what you are really saying and meaning about in order to enhance their argument?'

The other issue where I might depart a bit from Ann and possibly also from John concerns your question on internalising views on abortion. I start my moral and ethical exploration from a presumption in favour of life. I am opposed to killing people in war, I am opposed to capital punishment. I have not reached a level of respect for life that includes vegetarianism but in general I think that living things not just people, but all living things should not be destroyed unnecessarily. I would inject into a personal, moral, or legal conversation about an abortion the question of where does abortion fit in terms of a presumption in favour of life?

I respond differently to the woman in your case who examined her life experience, her capacities, her reasons for a potential abortion and who said 'my reasons were not serious enough and therefore I choose to continue this pregnancy'. I do not assume that she is internalising victimisation. I think she has made a moral decision and the factor that she weighed in that decision included a presumption that generally goes in favour of life, of not just persons but life in general, and in this case she says the presumption in favour of life is not outweighed by her circumstances. This is good moral decision making, not necessarily internalisation. Maybe she did internalise society's views on abortion, but her approach should not a priori be seen as internalisation. When we say this we start to sound like absolutists in terms of being pro-abortion not pro-choice, and that is where we lose people. They see us as just automatically assuming that any time for any reason there is no moral discourse that includes a question about the value of life that is relevant to the abortion decision. That is not my belief.

Ann Furedi

I had a very sobering experience recently talking to my chairman who is Emeritus Reader in Obstetrics and Gynaecology. I had watched a banned Pro-Life Alliance film and it was the most disgusting thing I have ever seen in my life. It did not make me feel any differently about abortion, but as John says when you are seeing slithering eyeballs and cleaved heads and so on, it is terrible. I was recounting to my chairman how horrible I thought this was and he just said to me very quietly: 'Well Ann what on earth did you think happened?' He then proceeded to give a whole load of other anecdotes which I will not disrupt your digestive system with.

This is what I mean when I think that there is sometimes a certain amount of laziness that creeps into the way we that think about these things. We do block certain things out in the way that we sometimes describe abortion. It is quite common for people to say: 'Well it is just like another operation'. Well actually it is not, because when you look at what you are doing in relation to abortion even without going into the particular moral framework discussion that Frances is having, we can all accept that whichever way you look at it, you are talking about the destruction of a biological life and you are talking about the destruction of a potential child. Now you might in your own value system decide to accord that no particular moral worth, but you are still ending something which is seen to have a particular and unique potential. I think that most of us probably feel that that is not just an incidental decision that you take which makes it just like any other medical procedure. I think we can only put forward a convincing case if we confront what abortion is and what it involves and if we can honestly discuss it and work out a framework that incorporates that.

Question

David Nolan (Birth Control Trust)

This is a question to Frances, thinking about 'Don't mention the 'A' word'. It seems that the 'A' word is at the centre of the American discourse and the discussion emerges emotionally and very violently on occasion in the US. In Britain we characterise the Americans as being very 'passionate' on this issue. I am not very happy with this characterisation. How do you account for the difference in the discussion, comparing the US and Britain?

Question

Ann Rossiter (Irish Abortion Solidarity Campaign) I understand exactly why people feel so tentative about this issue. I am stating my case on the basis of my own back-street abortion, and the fact that I actually participated in carrying out a back-street abortion, when I lived in Spain under Franco, when abortion was a very serious criminal offence. I also want to point out the fact that I am Irish and active in organisations here. I am involved with the Irish Women's Abortion Support Group where we have supported women from Ireland seeking abortion in England in a variety of ways since the 1980s, and I'm involved with the recently resurrected Irish Abortion Solidarity Campaign.

My strategy in relation to trying to get the 'A' word actually mentioned in Ireland was to talk about my own experience, yet rather than being on the receiving end of a great deal of verbal and possibly physical violence I have been at the end of a great deal of silence. Some of my nicer friends have actually suggested in a round about way that I might be something of an exhibitionist. I am not actually disputing that but the fact of the matter is that it has not been always the easiest thing to take the shocking route. Recently John, you were on a television programme that the Irish Abortion Solidarity Campaign participated in that appeared over here called 'A Woman's Fight to Choose'. That programme has met, with deadly silence. There is no debate.

Now I have no problem in dealing with these issues myself and I have to say that I did not find the participation in the back-street abortion that distasteful. It was in fact extremely interesting and I actually thought I might go on and do medicine but I have lousy maths so I would never make it! The issue more broadly is that we are experiencing evasion all of the time. I thought that the Irish situation, covered in a programme made for TV, would actually provoke a debate. Yet quite the contrary.

I also want to add that I am a teacher of special needs people, and I deal with people with a great deal of disability and impairment both intellectually and physically. I just wonder, what would happen if those who proclaim to have views on all of this were to come and see the level of rejection that exists on the part of the parents, on the part of families, and on the part of society of people who are actually in residential care for the rest of their lives. I wonder if we need to air that side of things as well.

Question

Para Teare (GenderWatch) I used to be a theatre nurse and I have worked in operations of all sorts including abortions, both very late abortions and very early abortions. I am pro-choice and I have tended to treat all those operations as simply operations like any other. I have a question to all the panellists.

Abortion must be probably the only operation where someone else decides for you whether or not you can have it. Two doctors still have to decide I think for a woman to have an abortion. Should we not go further in so far as we support a pro-choice view and campaign for the woman to make the choice on the basis that the choice is always made with a lot of thought and a certain amount of emotion involved?

Frances Kissling

I want to comment on the question about the United States. It is very complicated in many areas, but in terms of abortion the US situation reinforces some of my earlier comments. It shows that opposition to abortion is not based upon respect for fetal life, but is based upon many deeper sentiments about women and their value, what they should get to decide in society, and to some extent on men's frustration and their own inability to bear children and to give life, and to control the life and death phenomenon completely. I think the reason the United States has so much more violence than other countries is because the US law is so much more explicit in saying that abortion is women's business and about women's rights. It has no subterfuge. US law now has restrictions but it has no legal subterfuges that say a woman has to go and talk to two doctors and she must give particular reasons for having an abortion. Basically the US law says that there is a fundamental right to privacy, and that right to privacy is broad enough to include a woman's right to make all sorts of decisions about reproduction. This drives people crazy. It is so hard for a small segment of the population to accept this, that it does drive them to violence. So if you want a little more violence in your country you just go and get yourself a better abortion law!

Ellie Lee


Have you got any comments about Ireland?

Frances Kissling

Not just in Ireland, but in many other places, where apart from a small number of committed advocates on both sides of this question, the overwhelming societal reaction to abortion is silence. People do not want to engage on this issue, and they are embarrassed by people who do: who do tell their own stories, who do lay their lives on the line. It just struck me as such a tragedy that to talk about abortion is still such a taboo.

I wonder what we can do as pro-choice advocates to open the discourse so that ordinary people who have complex, not conflicting, not difficult, not sensitive, not squeamish, not ambivalent, but complex views on this subject feel that they can get into the debate?

John Parsons

In answer to the question about two signatures, I certainly feel that all the doctors that I know how perform abortions regard the two doctors signatures as a complete anachronism and it is basically just a routine. I sign abortion forms sometimes months after they have done them. It is an absurdity and an irritation so the sooner it is changed the better from my point of view. It is a compromise that we have had to make in the past and I do not know how easy it is going to be to reverse it

Ann Furedi

The conflict that Frances raised is one of the reasons why abortion services have actually operated relatively smoothly in this country. The procedure is so medicalised. It is far easier to sit in a debate and say: 'How can somebody deny a woman a procedure when two doctors have agreed it is essential for her mental health?' 'What kind of a person are you, how can you do this?' That is much easier than to say abortion is a woman's right.

My own view is that we need to have a situation in this country where a woman can clearly and unambiguously exercise a right to choose to end an unplanned pregnancy. I think that only then can you de-stigmatise abortion. At the moment it is ludicrous that abortion is not seen as being a way of dealing with unplanned pregnancies, but is seen as a way of dealing with women's mental health problems.

To give an example, the Department of Health have just put out a consultation document on teenage pregnancy which is around 16 pages long and does not mention the 'A' word once. It is not in there as an issue. It is just ignored because it is not seen as legitimate for them to talk about and that has significant policy implications.

Question

I have two points. As you pointed out most people's opinion on abortion is framed by ignorance and irrational gut feelings. They are swayed more by the appealing cute babies, and the fact that abortion is an ugly procedure. Do you think that coming up with cool rational arguments in favour of the pro-choice position is really going to do anything to advance the pro-choice position? Secondly, Frances you made the point that this is a patriarchal society where men need to control women. I would contrast that very Western oriented view of the world with Japan where the position of women is degraded and debased to an extent that even Western men find quite appalling, and yet abortion in Japan has no more moral value attached to it than having your tonsils removed and is a very common method of birth control.

Question

I wanted to come back to the point that Frances made at the beginning in terms of the issue being more about control of fertility than the 'right to life'. One of the issues I am very concerned about at the moment, as I am on an ethics committee, is the civil liberty implications around ethics and the whole discussion about control of decision making in these matters, where there is increasing management of medical treatment and the introduction of pastoral counselling for many different medical treatments. What do you think about this?

Question

Christina Bachmayer (Novo magazine) I am from Germany and I have been shocked by the way the discussion has gone in my country. To give one example, a couple of weeks ago there was a discussion about the pill. The pill was being presented as something that prevents people from having good sex. A woman was talking about how when she takes the pill and she knows she cannot conceive that makes her sex life really terrible and she does not like it, so she can only have good sex when she knows she can also conceive at the same time. I think that the terms of the discussion on reproductive matters have completely changed. I used to be pro-abortion because I thought women are oppressed and therefore we need to be pro-abortion. Now there seems to be another discussion that we must deal with, which is couched in different terms. The question is if we do realise that there is something else behind concerns about abortion today, which I thought you addressed well, how do we confront it?

Ann Furedi

I honestly think it is very difficult. There is a real 'head and heart' situation now in relation to abortion, and I think that it is certainly not going to do us any harm to try to meet the arguments that seem to us to be more irrational and give a constructive, rational and considered case for what we need to argue for. I also think that if perhaps we can turn some of the focus on its head then there are more gains that can be made. I am irritated enormously that virtually any discussion about ethics that takes place is very much an ethical discussion which centres on the rightness or wrongness of destroying a fetus. I think that perhaps one thing we can do is to begin to construct an ethical framework which looks at the issue more from the woman's point of view. We can start to look more at the ethics of denying the woman the right to bodily autonomy, and issues of consent in carrying out medical treatments at particular times, to begin to repose what an ethics of abortion actually means. We can try to put the living woman at the centre of things rather than the fetus. I do not think this is going to be an easy thing to do but I think it would be a creative process to try to get the pro-choice movement engaged in it.

Frances Kissling

To respond to the point about controlling fertility, these efforts extend beyond control designed to push women to continue pregnancies to an effort to control women's lives. They can take the form of forcing women to continue pregnancies and forcing women to abort. We have examples of both. The Japanese situation is not as cut and dried as you presented it. Yes, abortion is totally available in Japan, and is used as a method of birth control. Yet in Japan the pill is still illegal. So what is the element of control in making the pill illegal? What does it say about how the Japanese government thinks women should conduct their sexual and reproductive lives when it voted two years ago to make the pill illegal again, yet makes abortion widely available?

Additionally, abortion is not such a simple thing. As a medical procedure it is as simple as tonsillectomy, but it is not only a medical procedure. In Japan if you look beneath the situation and you look at what is happening after abortions, abortion is not without consequences however: control goes both ways.

Question

Kevin Kelly (journalist) I do not think there is a conspiracy of silence over the abortion question in Ireland. I think the problem in Ireland is that the pro-choice movement does not have very much support and in answer calls it a conspiracy of silence. Walk down the street and the Youth Defence are there with pictures of fetuses saying they want to keep the abortion laws the way they are. Frances, surely you are having a go at the Catholic Church yet there is rock solid support in the Church for the Catholic position on abortion. Perhaps in the end if you are involved with a certain group you should get out of the club if you do not like the rules?

Frances Kissling

The Catholic Church is not a club, it is a religion and it is a family. You may not like the members of you family but they are still your family. Furthermore, many Catholics do not support the position of the church on abortion whether they live in Zambia, the Philippines, Equador, United States, England, or Ireland. Catholics on the whole are just like everybody else. They think abortion should be legal. They have a lot of good reasons for not speaking up because if you speak up as a Catholic on this issue and disagree with the church you will be punished. You cannot know what Catholics think by what they publicly say because the fear factor and the censorship factor is so high. But poll after poll, and I would be happy to give you a whole collection of polls, shows that Catholics are pro-choice.

Question

Liz Frayn (Glasgow Medical School) I am a medical student and I have had some disturbing experiences just recently doing gynaecology where during tutorials you are discussing late abortion and there are several people in the room tutting because they disagree with it so much, but the doctor does not confront that in the discussion which I think is wrong. I think your statistic John, that only 7 out of your twenty medical students will do abortion is shocking especially when they are saying they actually agree with it in principle. I think surely that is going to have some sort of impact on practice in the future?

Question

Jennifer Cunnigham (Paediatrician, Glasgow) I disagree with the idea that an aversion to abortion is a reaction among all doctors or that it is understandable. Medical students will have to perform lots of unpleasant tasks and nasty operations and should not be making a fuss about abortion. This reaction builds abortion up to be much more than it is, where in reality it is a simple medical procedure that women need.

Ellie Lee

We have run out of time, so I will ask John and Ann to respond finally.

John Parsons

In reply to the medical student, that was quite interesting. I am not sure how to handle medical students who appear to be unsupportive of women's choice. I do rather regard my teaching in gynaecology as teaching how to do, what to do, complications etc. and most medical students have some sort of ethical course as part of their training anyway. I am not sure how much I should be taking on these people, since after all they have probably got views that I am not going to be able to change in five minutes. I am there to teach them how to do gynaecology not the ethics of the whole business. With regard to their willingness to perform abortions, you have got to remember that medical students in the minority are going to want to be surgeons. A lot of the reasons why people do not want to be surgeons are the same reasons as the woman in the audience who turned her nose up at the thought of performing any operation. So honestly I think 37 per cent of the students who are willing to do the procedure was pretty good actually, so I disagree with you.

Ann Furedi

In some ways I wish life could be as easy as having a kind of 'pull yourself together and let's just get on with it' attitude. I actually have a lot of sympathy with you because I sometimes feel like that. I think 'Why are we getting so bogged down in what should be a fairly straightforward issue?' However, the problem is that we have to formulate arguments in such a way that they engage with debates that are broadly going on. One of the problems with the abortion discussion is that is not solely about abortion. It has got to do with attitudes to the way in which women are perceived, to sexuality, the way that life is perceived and the way that life is valued and the quality that we give to it. So consequently it seems to me that if we say let's just get back to basics on the issue, you end up talking to yourself. More importantly what then happens is that you leave the whole area of ethical and abstract debate for other people to inhabit. That is why I think we do have to really bend the stick towards trying to engage and creatively come up with arguments. This is not a concession, so please do not misunderstand me. I would not in any way move from an absolute support for a woman's right to choose under any circumstances but I do feel that we need now to develop more arguments to convince other people of that position rather than perhaps 20 years ago when the abortion issue was posed in a different way.

 
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