Monday, January 28, 2013

Twenty-five years after R v. Morgentaler

Today is the 25th anniversary of Canada's Supreme Court decision to strike down its abortion law, which had prevented a woman from obtaining an abortion until after a panel of medical experts agreed the mother's life was at risk. Thanks to Dr. Morgentaler's long efforts, for a quarter-century most Canadians (though only few in New Brunswick and none on Prince Edward Island) have had ready access to safe, professional, confidential procedures to terminate unwanted pregnancies. Canada has largely avoided the ongoing embarrassing spectacle still seen in the United States to overturn the 40 year old Roe v. Wade decision that granted women there the right to an abortion. The most recent American attempt to restrict access is only one week old - in New Mexico, a Republican lawmaker proposed a measure that would "legally require victims of rape to carry their pregnancies to term in order to use the fetus as evidence for a sexual assault trial."

This brought to mind Canadian federal Conservative Member of Parliament Stephen Woodworth's proposed Motion 312, which last fall would have created a special committee to examine whether "a child is or is not a human being before the moment of complete birth". 

I was appalled at the motion, and relieved when it was soundly defeated in the House of Commons in September 2012. But as someone who treasures scientific discovery and the pursuit of knowledge for its own sake, why was I against a government committee whose stated purpose is the advancement of human knowledge? I found my reaction to be somewhat inconsistent.

My stance is not an absolute one. I recognize that sometimes placing a moratorium on certain aspects of research is justified while ethical, environmental, and other implications of potential discoveries can be considered and appropriate codes of conduct, safety protocols, and other procedures developed and implemented. The foremost example of this is from early 1975, when most leading biologists endorsed a self-imposed pause on genetic engineering research until the US National Institute of Health released guidelines in 1976 (these have been regularly updated). More recently, a debate rages within political and scientific circles about the wisdom of research into the H5N1 influenza virus.

But my response was not based on any variant of the precautionary principle. There were other issues that disturbed me. Why would this government, hardly known for its commitment to scientific inquiry, suddenly be interested in discovering a scientific definition for a human being? Is a government panel the right body to investigate this question? Could Mr. Woodworth, as many claimed, have had a hidden agenda, and use the findings of the committee (whatever they were) to restrict abortions in Canada to the maximum possible extent?

Furthermore, I was fundamentally uncomfortable with how the motion was phrased.

The development of life is a continuum. There is no distinct threshold before which there is only a collection of dividing cells, and after which there is a fully formed human being. It is ridiculous to argue that the few cells of a just-fertilized embryo are a complete person with full rights and protections, just as it is to say we have no moral responsibility to care for a healthy nine-month gestated unborn fetus. (This is implicitly recognized by the medical profession, as virtually no one performs an abortion after the first trimester or so unless the mother's life is at significant risk.)

Any answers such a commission would have come up with would crucially depend on how "human being" is defined. The following have all been proposed for the definition of a human being:
  • The point of development at which the fetus can survive outside the womb; 
  • When the first heartbeat, brain activity, or some other physiological trait can be first detected;
  • As soon as the fetus displays a detectable personality or identifiable set of behaviours such as pain avoidance.
All of the above are highly dependent on the current state of technology. As our knowledge of fetal development increases and detection equipment gains greater resolution, any of these definitions could in principle push back when we classify the fetus as a human being earlier and earlier in the embryonic development process.

As a scientific endeavour, such an investigation is legitimate. The problem arises, in my view, with public policy. Anti-abortion activists are not renowned for accurately reflecting the subtleties of scientific knowledge. If, for example, a paper is published claiming that a fetus displays an aversion reaction (or "pain") as early as 2.5 months, it won't matter how provisional the conclusion is, what the disclaimers are, or what caveats are attached - it will be used by religiously motivated activists (such as Stephen Woodworth) to argue that no abortions can be performed past that point. That, fundamentally, was why there was such a strong reaction from myself and many other Canadians to Mr. Woodworth's motion in the House of Commons in September. It was not based on a belief that the question is taboo or that science should not inform public policy. Instead, there is a well-founded concern that any discussion based on these premises will not be undertaken in good faith. The motion, as phrased, could not be answered in a reasonable fashion and would likely be used for purposes that stray far from scientific inquiry.

Which leads me to an observation that I hope to substantiate. I find that, in practice, the label "pro-life" is misleading. Anti-abortion activists do not seem to be generally pro-life - only very specifically pro-fetus. I do not hear of any anti-abortion protesters taking any practical steps to ensure the children resulting from pregnancies carried to term are cared for (which reminds me of my favourite bumper sticker: "If you cannot trust me with a choice, how can you trust me with a child?"). I have not noticed any support from "pro-life" groups for the elimination of capital punishment (which unambiguously kills a human being). National and global vaccination programs would be a natural fit for those that believed longer, healthier human life is a good thing. It seems to me genuine pro-life activists should support stricter gun control laws, as gun violence takes innocent lives every day in the United States. School food programs in poor neighbourhoods significantly improve the well-being of children's lives, and have large effects even into adulthood. Yet the only correlation I am aware of between being anti-abortion and supporting initiatives that are genuinely pro-life is a negative one. 

In the interest of accuracy, perhaps we should refer to those on opposite sides of the abortion debate as "pro-choice" and "pro-fetus".