How making abortion routine can entrench discriminatory assumptions and increase pressure to abort for disability  

According to recent statements from the Royal College of Obstetricians and Gynaecologists, abortion ‘is an essential part of sexual and reproductive healthcare’. The abortion pills by post scheme is a part of this move to make abortion routine. This is further underlined by the RCOG in its 2024 guidance advising healthcare professionals that they are under no legal obligation to contact police if they suspect a woman has tried to bring about her own abortion. After all, the guidance points out that ‘where healthcare professionals do involve the police it should be in the patient’s best interests or needed to protect others, for example where there is a risk of death or serious harm.’  

In theory, the medical specialism of obstetrics and gynaecology involves care for pregnant women and unborn children. By positioning abortion simply as a medical procedure, and in suggesting that no one is harmed in the procedure, it seems that for the RCOG there is in reality only one patient, the expectant mother, and there is no harm caused to another. While claiming that the guidance was a necessary and compassionate response to recent police investigations following late gestation abortion and pregnancy loss, Dr Ranee Thakar, president of the RCOG stated that the guidance was ‘just one of the ways we are working towards removing abortion care from criminal law and placing it instead under medical regulation’.  

 

There are risks in thinking that abortion is simply a matter for medical regulation. In particular some decisions involving unborn babies are not purely medical decisions, and this is most obvious in the case of possible disability. In its 2010 report Termination of Pregnancy for Fetal Abnormality in England, Scotland and Wales, the RCOG found it necessary to remind its members that it cannot be assumed that a woman will choose a termination ‘even in the presence of an obviously fatal foetal condition’. While the RCOG report states that a decision to continue the pregnancy must be fully supported, anecdotal evidence suggests that this is not in fact the reality.  

 

At the July 2024 Church of England General Synod, Archbishop Justin Welby disclosed that his wife felt pressurised by hospital staff to have a termination when prenatal testing suggested that her unborn baby had a disability. Welby explained that staff simply expected his wife to opt for an abortion if the disability test came back positive. Welby observed that hospital staff did not simply provide information about the outcome of the prenatal tests, they also pointed to the high costs of bringing up a disabled child.  

 

This response of healthcare staff to foetal disability will come as no surprise to many women facing positive test results. In recent challenges to the law that allows abortion up to term after a diagnosis of Down syndrome, campaigners pointed to the outdated advice given to parents about what their child’s life would be like, and there was clear evidence of encouragement and often pressure to terminate the pregnancy. Parents were told to consider the negative quality of life their child would have. Termination for the risk of disability has become the expectation.  

 

More worryingly, healthcare professionals have told parents that, in the case of severe disability, they are prolonging the suffering of their unborn child by not agreeing to a termination, that they will cause their child further suffering during birth and when born, that their ‘doomed to die’ child is better off dead sooner rather than later. In some cases, professionals have called the continuation of pregnancy cruel. In the face of this pressure and the real moral distress felt by parents, failure to make the decision for a termination looks like moral weakness or the denial of the facts. This is pressure indeed.  

 

For the most part parents want to do the best for their children. Being told that you are being cruel or harming your unborn child by refusing to bring about his or her premature death can be harrowing. Being told that your baby is going to die anyway and so it is better to bring this about sooner rather than later is a cause for despair.  

 

In complete contrast, there are so many accounts of sensitive and careful care given to parents and to newborns whose prospects are limited to a few hours or days. Comfort care continues, appropriate palliative care put in place, photographs taken, rituals and naming ceremonies performed. After birth, care can be more tailored to the actual condition of the infant and family.  

 

When the choice of death over life becomes routine, indeed the expected response to tragic or difficult situations, there is a real risk that discriminatory attitudes become the major drivers for apparently informed decision-making. This also risks the insidious conclusion that hastening death is a helpful and acceptable solution to the kinds of difficulties that medicine finds it hard to deal with – difficulties such as suffering and living well in the last few days or months. Instead of seeing patient endurance in the face of suffering and hardship as a virtue, endurance is seen as a denial of a reality, and refusing to choose to hasten death becomes moral failure to grasp the nettle.  

 

When hastening death becomes the expected and routine choice, parents who decide to refuse a termination and resolve to look after their disabled child are seen as delusional and selfishly indulging in their own desires regardless of the financial cost to the healthcare system or the suffering of their child. Suffering and the strain on resources would have been solved early on by an abortion. When hastening death becomes routine for people with severe or terminal illness, the courageous choice is for an early death. 

 

Without the constant underpinning of the principle of the sanctity of life, a principle that cherishes all human life especially young or vulnerable life, other principles are left free floating. The sanctity of life is a principle that both refuses to hasten death and resists vitalism – that is, keeping patients alive no matter what. It is a principle that cherishes life. Continuing a pregnancy when others try to persuade us that it is useless, a waste of resources, cruel to an already doomed baby, is a real witness to the dignity of all human life from the very beginning. It is a sign of love and parents can say that they have loved their child for his whole life, however short.