IT IS A poignant picture. A tiny hand reaches out of an incision made in a womb in order to undertake corrective surgery on a fetus that has been diagnosed with spina bifida. In fact, although it looks as though the tiny hand is grasping the hand of the surgeon, the fetus was anesthetised at the time. It was the surgeon who reached out to the fetus and grasped his hand rather than the reverse. Whatever we think a picture is worth, like many words, it can be very misleading.
The debate, which has followed the publication of the picture taken during the surgery on Samuel Armas, is equally misleading. Pro-life advocates have seized on the picture as compelling evidence that the fetus is a human person, a “living being deserving of life,” not merely “the products of conception.”
Of course, to claim that a picture could resolve this apparently central contention in the abortion debate is an odd claim to make from the pro-life perspective, which generally insists that human life begins at conception, when there is nothing that looks remotely like a human baby. At that point the embryo is just a single cell, the fertilized egg.
Still, even if we would not wish to make the fetus’s resemblance to a full-term baby the basis for our moral and legal attitude to the fetus, is it really adequate to say that it is irrelevant? And what sort of reasoning makes the passage of a being from the inside to the outside of the womb the basis for personhood, and the passage from no protection, to full protection under the law?
The difficulty is that the rhetoric advanced by proponents of black and white responses to this emotive debate fails to convince. However misleading the picture may be, the response it evokes in us is not irrelevant, but neither is it the whole story.
A fuller account of the moral quandary experienced in a society that makes extensive use of abortion but which also has developed techniques of fetal surgery must say something about the profound ambivalence implied in this apparent double standard. At this point it is interesting that the positions adopted by the Anglican Church of Canada have insisted on the moral significance and dignity of fetal life and on the importance of the rights and needs of women who are clearly recognized as the primary decision makers.
How can these be held together? Only by recognizing the social context in which the needs of each are brought into conflict. Abortion is not a private tragedy but, at least in part, a social issue in which women’s experience of marginalization, poverty, and powerlessness are all central factors which need to be addressed in any adequate response to abortion.
This takes us back to the case of Samuel Armas, because there is a profound ambivalence about this story too. The clinical ethicist at the hospital that carried out the surgery on Samuel has pointed out how odd it is that parents who would never consider abortion will resort to dangerous surgery of doubtful benefit to correct a non-life threatening condition. Clearly, values other than the sanctity of life are at work here. My questions have to do again with the wider social picture.
Several news reports suggested that this procedure gives parents a choice other than abortion. There is some evidence that this is indeed the perceived choice. At the Vanderbilt clinic 75 of the 80 patients counselled by the clinical ethicist, clearly no pro-life advocate, have opted for corrective surgery. At the Toronto General Hospital about 90 per cent of diagnoses of spina bifida end in abortion.
The either-or between surgery and abortion is problematic. It is problematic because it discounts the dignity and value of life for those with disabilities and plays into the consumerist preoccupation with the perfect baby. It ignores the possibilities of productive and rewarding life for those with disability. I grew up with a neighbour who was born with spina bifida who became a widely respected expert in theatrical lighting working in London, England.
Of course, we would generally want to correct a medical condition leading to disability (although this raises some interesting questions about the range of what we take to be “normal”). But who gets a choice and who does not? In the excitement surrounding what we can do, this question is not raised.
Yet the procedure at the Vanderbilt clinic is not only experimental; it is also expensive, and available only to those who can afford it. Whatever the benefits, the cost is to contribute to the widening gap between the rich and the poor. The real ambivalence in the case of baby Armas stems from the combination of astonishing technological virtuosity with apparent naiveté about the social meanings and implications of such interventions. Eric Beresford is the Anglican Church of Canada’s co-ordinator of ethics and interfaith relations.