Academic journal article The Hastings Center Report

Selective Termination of Pregnancy and Women's Reproductive Autonomy

Academic journal article The Hastings Center Report

Selective Termination of Pregnancy and Women's Reproductive Autonomy

Article excerpt

The "demand" for selective termination of pregnancy is a socially constructed response to prior medical interventions in women's reproductive processes, themselves dependent on cultural views of infertility. The development of techniques for selective termination of pregnancy has added further questions to debates about women's reproductive self-determination. The procedure is performed during the first or second trimester in some instances of multiple pregnancy, either to eliminate a fetus found through prenatal diagnosis to be handicapped or at risk of a disability, or simply to reduce the number of fetuses in the uterus. More than two hundred cases of selective termination are known to have been performed around the world. (1)

Physicians and ethicists have expressed reservations about selective termination, both with respect to its moral justification and to the formation of social Policy governing access to and resource allocation for this procedure. Selective termination has been viewed as invoking a right to kill a fetus rather than to control one's body, as with abortion, (2), and some commentators have recommended restricting the procedure to pregnancies of three or more (3) and even stipulated a need for national guidelines for the procedure. (4)

Many discussions appear to assume that selective termination is primarily a matter of acting against some fetus(es) on behalf of others. For example, Diana Brahams describes the issue as follows: Is it ethical and legally appropriate to carry out a selective reduction of pregnancy-that is, to destroy one or more fetuses in order to give the remaining fetus or fetuses a better chance? (5)

However, this construction of the problem is radically incomplete, since it omits attention to the women--their bodies and their lives-who should be at the center of any discussion of selective termination. When Margaret Somerville, for example, expresses concern about the right to kill a fetus who is competing with another for space," she neglects to mention that the "space" in question is the pregnant woman's uterus. In fact, selective termination vividly instantiates many of the central ethical and policy concerns that must be raised about the technological manipulation of women's reproductive capacities.

Evans and colleagues state that "the ethical issues [of selective termination] are the same in multiple pregnancies whether the cause is spontaneous conception or infertility treatment" (293). Such a claim is typical of many discussions in contemporary bioethics, which abstract specific moral and social problems from the cultural context that produced them. But the issue of selective termination of pregnancy demonstrates the necessity of examining the social and political environment in which issues in biomedical ethics arise.

Selective termination itself must be understood and evaluated with reference to its own particular context. The apparent need or demand for selective termination in fact is created and elaborated in response to prior technological interventions in women's reproductive processes, themselves the result of prevailing cultural interpretations of infertility.

Hence, it is essential to explore the significance of selective termination for women's reproductive autonomy. The issue acquires added urgency at this point in both Canada and the United States when access to and allocation of funding for abortion are the focus of renewed controversy. Although not precisely the same as abortion, selective termination is similar insofar as in both cases one or more fetuses are destroyed. They differ in that in abortion the pregnancy ends whereas in selective termination, ideally, the pregnancy continues with one or more fetuses still present. I will argue that, provided a permissive abortion policy is justified (that is, a policy that allows abortion until the end of the second trimester), a concern for women's reproductive autonomy precludes any general policy restricting access to selective termination of pregnancy, as well as clinical practices that discriminate on nonmedical grounds as to which women will be permitted to choose the procedure or how many fetuses they must retain. …

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