Posts Tagged ‘informed consent’

The wonders of “choice”

March 23, 2012 1 comment

Granted, this case from the Ottawa Citizen is not representative of every woman seeking an abortion, but it does raise the question of, “What constitutes choice?”. Here are some highlights from the article:

Anna, first, asked her mother whether she would help her, if she had the baby. Her mother flatly refused, saying, “I do not want to waste my life babysitting.” Her male partner said he “wasn’t interested in a kid” and their relationship has since broken up. She tried to get an appointment with her gynecologist to discuss her options, but the first available one was two months away. She then contacted an abortion clinic, which gave her an appointment in two weeks, at which time Anna was nine weeks pregnant. She said, “I went to them to get information on abortion, to know more about my options, the consequences of an abortion. I was open to getting an abortion, because that was what everyone around me recommended I do. I saw abortion as an option, but was really not sure. I was hoping for some answers.”

What answers did Anna (not real name) get?

Anna met, first, with a nurse for a “consent interview.” She said, “The nurse told me that at this stage of the pregnancy the fetus is just a bunch of cells. I also asked her if the abortion would have any impact on my health, my future pregnancies, and so on. She said abortions had no impact at all, no consequences at all, that all that I had read (to the contrary) were myths. The nurse said, ‘In two weeks, it will be as if all this never happened’.”

Anna changed into a hospital gown and was taken into an examination room where a technician proceeded to do an ultrasound. Anna asked what the fetus looked like and could she see the ultrasound. She said, “The technician told me she was not allowed to show me the images and I was unable to see the screen,” which showed the fetus. At nine weeks gestation, it would have had a beating heart. The technician then picked up the printout of the ultrasound, but dropped it on the floor. She scrambled to gather it up quickly, saying, “You don’t want to see this.” But that’s exactly what Anna did want.

So, Anna was told that her 9-week old baby was just a “bunch of cells”, that after 2 weeks she will be as good as new and she did not have to worry herself with those pesky ultrasound images. That’s great information! Choice wins the day! But all kidding aside, this girl wanted information and was not given any so she had an abortion.

Anna said that “the attitude in Quebec, that ‘of course you should have an abortion, it is of no consequence’, is not true.” She explained, “I feel terrible. I can’t go to work. I’ve started seeing a psychologist. I feel guilty.” She mused, “I wonder why Quebec is like this.”

It’s not just Quebec. These lies about abortion travel all over the world. This is not a case of a woman exercising her choice to have an abortion, this is a case of a woman who did not have support and felt that abortion was her only chance. And, since she was told abortion was more like getting your tonsils removed than the killing of a human being, she thought “what’s the harm?”. I wonder how many more woman there are like Anna, who experienced the wonders of “choice”.


Where’s that in the Bible?

It makes me laugh when people accuse me of proselytizing on the job just because I tell patients how certain medications can work. I thought it was my job as a pharmacist to know the different mechanisms of action of drugs but apparently I am getting this information from Psalms or St. Paul’s letter to the Ephesians.

Here is an example:

A third way is by changing the womb lining, making it difficult for a fertilized egg to attach to the lining of the womb (implantation). A fertilized egg (embryo/unborn baby) needs to attach to the womb to receive blood and nutrients and continue to grow. If an embryo/unborn baby does not attach, it cannot survive.

Man, that must be straight out of the Epistle of James! Actually, this is from the patient counselling leaflet of a popular contraceptive, Alesse.

Imagine a woman, who believes that life begins at conception, taking the pill for contraceptive purposes for years and never knowing about the potential abortifacient properties of the pill. Imagine yourself as a health care provider and having that same woman come back to you and saying, “Why didn’t you tell me if you knew?” Yes, the vast majority of women do not care. However, the vast majority of patients do not care if their antibiotic can sometimes cause diarrhea but I still tell them.

Women are being lied when they think that a pill is only contraceptive in nature. Sure, a group of “experts” magically changed the time when a woman becomes pregnant but it does not negate the fact that some women truly care if they are ending a life 7 days after conception. They deserve to know full well what is happening when they take the pill. It is not about proselytizing, it is about informed consent.

Documentary about the pill now available

I’m thinking of making Fridays “Pharm Fridays” where I want to discuss the abortifacient properties of contraceptives you can easily access at your local pharmacy. Here is a documentary about the pill to get things going:

The Birth Control Pill Documentary from T Herbert on Vimeo.

Here is a 7-minute shortened video:

Also check out the website “28 Days on the Pill”.

Abortion Empowers No One, Part II

October 27, 2009 2 comments

A friend of mine called to discuss a paper she had to write for PHL281 (biothics) a few weeks ago. The essay topic was the following:

In discussing the case of Jane and Jack, George Harris says: “Jack is equally free from any responsibility to Jane in terms of the fetus should she decide to keep it” (Harris 1986, 597). Why does he think this? Is he right?

I’ll quote the relevant part of the article here (emailed to me), as I’m having a hard time finding it online:

2. Jane and Jack, two attractive, healthy individuals, meet at a party given by mutual friends. During the weeks and months that follow, a casual but pleasant sexual relationship develops between them. As a result, Jane becomes pregnant. But after learning of the pregnancy, Jack reveals that he is a moderately serious Catholic and from a combined sense of guilt, responsibility, and parental instinct proposes that they be married. Jane, on the other hand, being neither Catholic nor desirous of a husband, decides to abort. Respecting her religious differences and her right to marry whomever she pleases, Jack offers to pay all of Jane’s medical expenses, to take complete responsibility for the child after it is born, and to pay her a large sum of money to carry the fetus to term. Jane nonetheless decides to proceed with the abortion.

Similarly, in the second case, the fetus is Jane’s in a way that it is not Jack’s. The reasons, however, are slightly different than in the first case. Although Jane and Jack here each autonomously decide to pursue their interests in sex, neither has decided to pursue an interest in pro-creation. The fact that Jack has neglected to reveal his beliefs about abortion vitiates any claim he has that a harm done to the fetus is a violation of his autonomous pursuit of procreation. Rather, he has left it to Jane to assume that his only interest is in the pleasure of sex with her, and it is only this interest that she has a moral obligation to honor in terms of his autonomy. Had she promised him love and a family in order to have sex with him, she would have violated his autonomy both in regard to his interest in sex with love and his interest in procreation. Neither of these has occurred here. But though Jane is free from considerations of Jack’s autonomy in deciding whether to abort or to keep the fetus, she could decide to keep it without violating her own sense of autonomy. It is this fact that makes the fetus hers in a way that it is not Jack’s.

Yet by parity of reasoning, Jack is equally free from any responsibility to Jane in terms of the fetus should she decide to keep it. For, like Jane, he has not given his consent to the use of his body for the pursuit of her interest in procreation. He could, however, autonomously decide to take on the responsibility for the fetus. But she could not lay claim to a violation of her autonomy if he did not so choose. Had he promised her love and a family in order to have sex with her, he would have violated her autonomy in regard to her interest in sex with love and her interest in procreation. But since he has done neither of these, she has no valid claim that the fetus is a moral liability for him.’ Thus the pursuit of casual sex can be quite compatible with the principle of autonomy; it is nonetheless morally perilous for both men and women.

Sound familiar?

The Argument

The essay topic argument (focusing on the last paragraph, freeing Jack of responsibility), as I see it:

  1. Jack only gave his consent to the use of his body for sex.
  2. Giving consent to the use of one’s body for sex does not imply consent to the use of one’s body for procreation. [implied]
  3. Jack did not give his consent to the use of his body for the pursuit of procreation. [from 1+2]
  4. If one does not consent to the use of his body for the pursuit of procreation, then one is free from any responsibility regarding offspring.
  5. Therefore, Jack is free from any responsibility to Jane should she chose to “keep” the fetus. [from 3+4]

The “perilous” thing is that this is a valid argument. However, it is not a sound argument. The problem is that few people are willing to challenge the second or fourth premises, which would be necessary to reject it.

Objections to the Second Premise

The US Supreme Court has since supported the second premise.

Planned Parenthood v. Casey, the [1992] Supreme Court decision that confirmed Roe v. Wade, stated, “in some critical respects abortion is of the same character as the decision to use contraception… for two decades of economic and social developments, people have organized intimate relationships and made choices that define their views of themselves and their places in society, in reliance on the availability of abortion in the event that contraception should fail.

The idea that you can consent to the use of your body for sexual intercourse without consenting to the use of your body for procreation gets to the heart of the contraception issue. UTSFL does not take a position on contraception, as we recognize it has a complex relationship to abortion. It’s not as simple as “more condoms, less abortion,” when contraception carries with it the implicit assumption that you can pursue an interest in sex without pursuing an interest in procreation. Abortion comes to be viewed as a necessary backup to failed contraception. Otherwise, if consent to procreation is entirely separated from sex, an unwanted pregnancy can be viewed, as Harris views it, as an affront to the autonomy of a person.

Except, I don’t agree with Harris.

Objection: One cannot totally separate consent to the use of one’s body for sexual intercourse from consent to the use of one’s body for procreation

Harris treats sexual intercourse and procreation as if they’re two easily separable things, but that ignores the fundamental biological reality of sex. How do humans procreate (most of the time)? It’s the same act in both cases.

One may respond that it’s the same material act, but with different intentions or a different purpose. Even so, that calls Harris’ attempt to separate out two separate issues of autonomy into question. One’s body is “used” in the same way for sexual intercourse, whether or not the consequences of the use are the same. (Sidenote: anyone else have a problem with describing sex as “using” someone else’s body?)

The biological reality is that — often — sex produces babies. That’s how most of us came to be. Alongside unity and pleasure, procreation is one of the fundamental natural purposes of sex. This isn’t a moral idea — it’s just biology. Procreation is linked to sexual intercourse at such a basic and fundamental level that you can’t consent to the “use” of your body for sexual intercourse without consenting to the use of your body for procreation; sexual intercourse is a fundamentally procreative act.

Objection: A lack of intent does not imply a lack of consent

This objection is related to the first. Harris seems to imply that a lack of intent means a lack of consent, but this is not the way that informed consent works. Informed consent implies that one also consents to the risks of a given activity, the foreseen unintended consequences.

As long as one is informed that pregnancy is a potential result of sexual intercourse (basic knowledge of the birds and bees), pregnancy is a foreseen — albeit potentially unintended — consequence of sexual intercourse. Therefore, although pregnancy is not intended in this case, “consent to the use of one’s body for procreation” has clearly been provided by Jack, unless he somehow doesn’t realize that that’s how (most) babies are made.

A pregnancy can obviously be unintended, but consenting to sexual intercourse along with an understanding of the potential consequences (namely, pregnancy) ought to imply a certain assumption of risk.

An obligation towards the mother or her unborn child would not be a violation of Jack’s autonomy, unless you ignore the fundamental biological link between sex and pregnancy and the assumption of risk implicit in informed consent.

Objections to the Fourth Premise

Objection: A lack of consent does not imply a lack of obligation

Our society tends to believe that parents have an ethical and legal obligation towards their children. Once Jane is pregnant, Jack is already a father because he already has a child. If Jack had left Jane when the child was three years old, most would agree that he has an ethical and legal obligation to the mother in supporting their child. If Jack had never intended to have a child, that would be unfortunate and difficult for him and it would certainly complicate the situation, but it would not relieve him of that obligation.

This is actually quite important if we consider the case of rape. If a woman is raped (clearly, she has neither consented to the use of her body for sex or procreation), does she have any obligation to the child? She may have no legal obligation in many jurisdictions nowadays (a separate issue), but does she have any ethical obligation? If we believe that parents have an obligation towards their children, and the unborn is human, then the rape victim is already a parent and abortion would mean the intentional killing of her child.

Rape is a profoundly evil act, and pregnancy only makes an incredibly tragic situation that much more complicated… but abortion is also a profoundly evil act. The method of conception (and whether or not there was any intent or consent) does not change the reality of what the unborn is.

Thus, a lack of consent may well be a violation of autonomy (as rape clearly demonstrates), but that’s a separate issue from whether or not there is any responsibility regarding the offspring. A parent’s obligation not to neglect his or her child isn’t based on how that child came to be, but on what that child is.

Abortion Empowers No One

The problem is that few people will support these objections. Attacks on the second premise are extremely controversial. When you criticize the idea that sex and procreation can be neatly separated, you get accused of trying to “punish” women for having sex. The problem is that the separation isn’t based on morality, but on biology. To assert a clean separation is not to challenge traditional moral values or “heteronormativity,” but to challenge biology.

And for all those times that the challenge fails, our society promotes abortion to women as the “solution.” Abortion is necessary for people to maintain this separation in spite of reality.

But if you leave Harris’ argument uncontested so as not to compromise “the pursuit of casual sex,” abortion is a bandage applied to a fabric of social relationships built on a weak foundation — it’s not about “choice” or empowering women.

When having children became an elective rather than a natural consequence of sex, responsibility for children shifted wholly to women. Men instinctively understood that if conception could be undone, then so could their responsibility for being involved with the children women chose not to terminate.

When Jack can wash his hands of the procreative aspects of sex, Jane is left alone to deal with her pregnancy. Abortion isn’t a free choice when a woman feels as if her back is up against a wall.

Abortion empowers no one.

South Dakota strikes down part of abortion informed consent law, but leaves in the dead babies part

Feministing highlighted a federal court decision which struck down parts of the South Dakota abortion informed consent law:

In another win for reproductive justice this week, a federal judge called a South Dakota anti-choice law – which mandates that doctors tell women seeking abortions that the procedure increases the risk of suicide and suicidal thoughts – “untruthful and misleading.”

Guess what they didn’t strike down?

But the judge upheld a portion of the informed consent law, which says abortions “terminate the life of a whole separate unique living human being.”

Oh, you mean, the unborn are human and abortion causes dead babies?

That’s what we thought.