The ethics of choice

What about women’s choice?

Judith Jarvis Thomson, the violinist argument, and bodily autonomy

“No one should be forced to be pregnant/give birth”

“No one should be forced to be a mother”

Is abortion self-defence?

What about women’s choice?

We arrive at perhaps the most common question people ask. Indeed, the whole debate is often summed up this way: pro-life vs pro-choice. At the same time, most people, deep down, dislike that terminology, accepting it only as a compromise to debate the subject without getting bogged down in debates about language. I hesitate to call it the ‘central’ question for reasons which I’ll explain shortly.

But first, I want to be cognisant of some of the reasons ‘choice’ is held to be so important. Far too often, historically and in the modern day, women have not been given choices to which they are entitled, and in particular, have had their bodies violated – whether through rape (including marital rape), abuse, trafficking, or otherwise. These are heinous crimes and are still not especially exceptional: almost all of us know a significant number of women who have been the victim of these abuses. I certainly do. And so I want to say, first, that I am grieved by this, and I am sorry for any way I might have contributed to a society in which this is so common, and where so few perpetrators are held accountable.

Our bodies are important; when they are abused, and especially in such intimate or invasive ways, it is horrific. It is, from this perspective, easy to see why we guard our bodily integrity so fiercely. It is especially easy to see why women are so determined to do so, against the backdrop of coercion and abuse – especially in cases where that has been personally experienced.

All that to say, I do not think we should approach questions about bodily autonomy and choice with any sort of triviality; for some people, especially, this a subject which revisits old scars and threatens to disrupt them again. I understand that, and so I want to say that I do not take the issue of bodily integrity lightly; I am aware of the gravity of the pro-life claim to many women, and want to humbly suggest that it is nevertheless worthy of being heard and accepted.

So why do I hesitate to call it the ‘central’ question? It is because I’m sincerely convinced – along with many pro-choicers themselves – that the moral status of the foetus cannot be circumvented, and that if the foetus really is ‘one of us’, then it cannot be justified (except where the life of the mother is at risk). In my experience, most people who use an argument based on choice in fact use two arguments together: when it is pointed out that we wouldn’t justify the choice to kill an adult in the same way, it is usually responded that this is completely different, because the foetus isn’t a person. But that just shows that the issue isn’t really about choice at all: it is about the status of the foetus. Most pro-lifers agree: if the foetus has no value at all, then of course abortion should be valid choice. What most of us disagree about is whether that ‘if’ is true.

This isn’t a niche pro-life view. Most of the leading defenders of abortion in the ethics and legal worlds agree entirely. Kate Greasley, for example, a pro-choice legal scholar at the University of Oxford, devotes half of her book to making this point: if the foetus is a person, then abortion cannot be permissible. Lord Mance of the UK Supreme Court, in his judgment supporting the imposition of abortion on Northern Ireland in certain circumstances, puts it this way: “if [the right to life] were held to apply to unborn life, no abortion could ever be legal. In the context of abortion the right enshrined in article 2 [the right to life] would be absolute”. Many more on the pro-choice side agree besides these.

So in that sense, this answer won’t make sense unless you’ve already understood (and hopefully accepted) my view on the equal dignity and value of all human beings, including the most immature and small. If you don’t even understand that view, then of course you will not understand this discussion about choice. You may want to consider reading those questions or getting in touch. Suppose you’re on board with that. Where to start?

Well, the first thing to say is that pro-lifers, of course, agree that humans should have choices in general, and that choices should only be restricted if there is a good reason. But they believe that everyone should have choices, and sometimes these choices conflict, and more fundamental rights or choices have to come first. This is not about saying one person is more important – the whole point of the pro-life view is that no one is more important than anyone else. It is about saying that there is a more fundamental right in the case of abortion – and it even makes sense to describe this as pro-choice.

A basic medical principle of medical ethics is that when someone is temporarily unable to make a choice – perhaps they are in a coma – we have to make choices in their best interests, as well as putting them in the right environment to be able to make choices again – by giving them treatment. We don’t simply say that because they are unconscious (perhaps for a very long time), they cannot make choices. Rather, we say that we will help them to become conscious again and make choices for themselves. We do this because a) they will be able to exercise choices in future, and b) they are still a human being.

Exactly the same applies to the unborn: they are temporarily unable to make a choice, and so we have to do what is in their best interests, as well as putting them in the right environment to be able to make choices in future: by giving them the nourishment and care that they need until they are older. They are still entitled to this because a) they will be able to exercise choices in future, and b) they are still human beings.

Second, no-one is fully pro-choice. Ultimately, everyone believes in some choices: we just believe that we should not be able to abuse our choices in order to seriously harm other people. That is why we have any laws at all – to prevent the abuse of choice and to protect the vulnerable. And this is why we have pro-life laws: not to stop people choosing in general, but to stop the abuse of choice and to protect the most vulnerable human beings. No one believes in unlimited choice.

If the debate were really so simple, then abortion should be available for any reason at all at any point in the pregnancy. But polling has always shown that even when people generally support abortion, almost everyone thinks there should be legal restrictions on abortion. For example, in the overwhelmingly pro-abortion UK, over 90% of women think that abortion on the basis of the baby’s sex should be illegal. Only half a percent of women think that abortion should be legal at any point in the pregnancy. It is obvious that supporting restrictions on abortion does not mean opposing women’s rights or women’s choices – otherwise, 99.5% of women even in the UK oppose women’s rights and women’s choice. This is implausible.

This is perhaps the best way to see that almost no one considers this a simple matter of ‘choice’. In recent years I have debated against two leading abortion advocates in the UK. One thought third trimester should be illegal; one thought it should be legal. But very few people considered the former ‘anti-choice’, even though she very clearly did not believe that women should have the choice to have an abortion in the third trimester. Why not? Because they recognised that once the foetus is a person, it has a right to at least some legal protection – even if that conflicts with somebody’s choice. In that sense, almost nobody is really pro-choice. They believe that the choice to have an abortion should be available until the foetus is a person. That is the same principle that pro-lifers adopt – so we are not, in fact, so far apart. (I say more about all this in ‘Why pro-life?’).

One way in which the ‘choice’ paradigm conflict with our intuitions is when it comes to babies who survived abortions – for example, Nik Hoot, who was aborted and lost both legs and has hand deformities, as a result. Nik is an inspiring young person making the most of his life, but who shows that abortion is not just a choice about a woman’s body: it is an attack on the body of another human being, which is usually fatal. More survivors can be found here.

Another reason the argument from choice struggles is because, paradoxically, legalising something does not necessarily make people freer. We already recognise this on topics like gay conversion therapy and hymen repair surgery. Different people will frame their opposition to these practices slightly differently, but self-identified liberals often want these things to be illegal for a reason like the following: although something being legal provides an illusion of freedom, in fact, in conjunction with economics and human nature, it can actually create space for coercion on a far larger scale. Choice is not always as simple as something being legal and available.

This would, of course, be recognised by the many women coerced into abortions, discussed under ‘How common is coercion?’. This coercion can come in the form of explicit pressure as well as implicit or soft pressures, as described there.

But going further beyond this, there is a somewhat sinister history of deliberate population control behind the major abortion organisations in international development. Both the founders of IPPF and MSI were radical eugenics advocates dedicated to population control globally, especially of populations considered by privileged Europeans and Americans to be unworthy. An early American Birth Control League (later to become Planned Parenthood) director, Lothrop Stoddard, wrote a book called ‘The Rising Tide of Color Against White World Supremacy’, and complained that ‘The black man is, indeed, sharply differentiated from the other branches of mankind…The negro… has contributed virtually nothing.’ Alan Guttmacher himself, after whom the Guttmacher Institute is named, was a devout eugenicist, who supported compulsory birth control if necessary: if population decline was not quick enough, he said, ‘we’ll have to get tough’, and ‘perhaps some day a way of enforcing compulsory birth control will be feasible.’

Marie Stopes herself was also a devout eugenicist who advocated for ‘half-castes’ to be sterilised at birth and lobbied for Bills to ‘ensure the sterility of the hopelessly rotten and racially diseased’.

For these reasons, most of the venerated founders of abortion organisations vehemently opposed charity. Lothrop Stoddard believed that social reform to reduce inequality was ‘one of the most pernicious delusions that has ever afflicted mankind’, and Sanger herself (the founder of IPPF) wrote:

‘Those vast, complex, interrelated organizations aiming to control and to diminish the spread of misery and destitution and all the menacing evils that spring out of this sinisterly fertile soil, are the surest sign that our civilization has bred, is breeding and perpetuating constantly increasing numbers of defectives, delinquents and dependents. My criticism, therefore, is not directed at the “failure” of philanthropy, but rather at its success.’

It is no surprise that memos were uncovered from IPPF archives showing their complicity in training abortion providers in China and claiming that the one-child policy was the ‘people’s own choice’. They were also extremely active in India during Indira Gandhi’s forced sterilisation campaign.

USAID report that African women generally want large numbers of children (as do others). Despite this, abortion providers and population control advocates insist that the ‘fertility rate’ of Africa must be reduced. It is also no surprise that the Guttmacher Institute – a Planned Parenthood offshoot – are still funded by multiple foundations with a history of mass funding for eugenics, including the Brush Foundation, whose founding ambition was ‘furtherance of research in the field of eugenics and in the regulation of the increase in population.’

The abortion movement has been closely linked from the start with the population control and eugenics movements. In addition to individual instances of coercion and soft pressure, there is a whole background of social engineering working against women’s choice, which is regularly neglected.

A final reason the choice rhetoric is problematic is because in order for choice to be meaningful, it has to be informed. And we know that abortion providers frequently do not provide women with the information necessary to give valid consent to abortion. For example, women are told that ‘abortion does not cause mental illness’. We know this is not true. We know that abortion providers often tell women that there is no baby, that it is not alive, that it cannot feel pain, and so on. We know that women are often not told about the available alternatives. We know that they are not told the truth about foetal development. And so on. Abortion providers vehemently oppose informed consent laws – laws requiring that abortion providers give the woman informed consent before making a choice. Abortion providers themselves have been condemned by hospital regulators for giving children and disabled women abortions without properly taking consent.

If a significant minority of abortions are outright coerced, and a large number more are done in response to soft pressure, and if a significant number of women do not have valid consent taken, we might wonder whether legalisation of abortion has, on balance, liberated women. The evidence I cite under ‘How abortion harms women’ suggests it has not.

But let’s come back to the central issue. Ultimately, all of us think some choices shouldn’t be allowed. Many who think that the choice to have an abortion should be allowed do not think that the choice to walk in crowded spaces unvaccinated without a mask should be allowed. Many oppose the choice to own a gun, carry a gun, say offensive things, discriminate against people, avoid taxes, and so on.

Some think that certain choices about one’s own body should be illegal: I have recently had conversations with fellow doctors about hymen repair surgery and gay conversion therapy. Most people strongly objected to their illegality, even with the consent of the ‘patient’. The reasons differed: no one could legitimately consent to these things; their existence risks serious harm to others who do not consent; and so on. But almost everyone agreed that even some choices about one’s own body should be prohibited.

Of course, for some of these there may be lives at stake. But for others there are not, at least not directly. No one is ‘pro-choice’ in general. All of us agree that choices can be limited where there is a risk of serious harm to others (and sometimes, if there is risk of serious harm to oneself). And so in the final analysis, the argument from choice doesn’t work when we ask: the choice to what? This isn’t just a choice about what to eat for dinner, or about body art. It is the choice to end the life of a human being. The debate about the value of the child cannot be escaped by appealing to ‘choice’.

Judith Jarvis Thomson, the violinist, and bodily autonomy

Nevertheless, there remain some people who argue that, even if the foetus is a person, abortion is permissible. This is not very common – but it has been famously argued in perhaps the most famous paper on abortion of all time: Judith Jarvis Thomson’s violinist experiment. In short, she says to imagine that you wake up one day, hooked up to a famous violinist. It turns out you were needed to save this violinist’s life, since only you have the right blood type. If you wait 9 months, he will survive. If you disconnect him, he will die.

Thomson argues that even though this violinist has a right to life, that does not entail that he has a right to use your body to sustain his life. This is an important point: Thomson is not simply arguing that it is morally OK to disconnect. She argues that it might still be callous, cruel, wrong, and so on. It just wouldn’t be unjust – it is not what the right to life entails. So as an argument for the moral permissibility of abortion, it is probably not sufficient even if it is correct: it might at best show that the baby has no right to your organs. It might still be wrong to disconnect from the baby. Arguably, at best it only justifies the legal permissibility of abortion, not its moral permissibility. Though it is unclear whether it would even do that.

It is worth saying at the outset that it is easy to see how some of the violinist argument can be intuitive when women are uniquely burdened by pregnancy, and when it has been so easy for men to abandon responsibility in the past. It is hard to blame people for thinking that if men bear no responsibility for their children, neither should women. That is only fair. But the solution, in my view, is not to say that neither have responsibility: it is to say that both have responsibility, and society should be much harder on deadbeat fathers. In fact, the legalisation of abortion has made such abandonment much easier and much more prevalent, as explained under ‘How abortion harms women’. There is of course no way for a woman to completely ‘share’ her pregnancy; but societies and, especially, fathers have a paramount duty to support them however possible.

Thomson’s argument is not widely accepted in academic ethics. As you might expect, in the 50 years since Thomson’s article, there have been a number of responses – even the leading pro-choice advocates – McMahan, Singer, Tooley, and others – have almost universally rejected it, for various reasons. Occasionally, it has been argued that it would, in fact, be wrong to unplug the violinist. David Hershenov argues this, and feminist philosopher Gina Schouten argues that specifically feminist ideals of care for the vulnerable and the mixing of the political and the personal suggest that vulnerable people like the violinist and foetus may indeed have a claim on our care. I highly recommend Schouten’s paper in particular (though Hershenov’s is also good). I also have a paper in progress on this topic, arguing that if we have an obligation to pay taxes (the fruit of our bodily labour), and if imprisoning us (an infringement on bodily autonomy) for not doing so is just, then even if abortion is merely letting die rather than killing, it could still reasonably be prohibited. Arguably, our attitudes to COVID say much the same: significant restrictions on bodily autonomy (lockdowns, vaccine mandates) are widely accepted for the sake of saving lives.

The argument has certain other limitations. Clearly it only works until viability: no one could possibly defend killing the violinist if it were possible to remove him safely with ease. This makes the argument particularly vulnerable to medical progress, and especially to artificial wombs, which are rapidly developing. That leading pro-choicers are worried about artificial wombs and think that decriminalisation of abortion is needed prior to that point suggests that they want to go far beyond what Thomson’s argument would allow: ending the life of the child even when it is perfectly possible to keep the child alive away from the mother.

Another interesting twist, occasionally raised in the past but only recently fleshed out in full, is to ask whether it is obvious that the body belongs only to the woman, as Christopher Tollefsen has recently done. One could extend this further: if the baby is alive in her natural habitat, and is being threatened by the mother, couldn’t someone else (e.g. the father) reasonably be enlisted to defend the baby against that lethal force? This is far from obvious. The self-defence argument works both ways.

Others have sought to show that there are obvious disanalogies between pregnancy and the violinist situation:

  1. In the overwhelming majority of pregnancies, the woman bears some responsibility for the pregnancy. You needn’t say that consent to sex is consent to pregnancy; you just need to say that choosing to do something which leads you to have a human being dependent on you as a natural and not infrequent consequence gives you some responsibility for that dependent human being. In that case, Thomson’s argument at best works only in the case of rape (which is still, of course, a substantive and important result if true, but doesn’t work for the majority of abortions). As an example, drunk drivers bear responsibility for caring for someone if they have paralysed them, even if they took certain precautions to be careful. They did something that was inherently ‘dangerous’ and bear some responsibility. It is easy to see how this disanalogy has been seen as less forceful because it is so easy for men to abdicate their responsibility to their children. If men are allowed to have sex without the responsibility, surely women should as well? But as the drink-driving example suggests, the conclusion is not that women should be able to abdicate responsibility for an inherently risky activity – but that men should be forced to live up to their responsibilities.
  2. In every case of abortion, the woman is the mother of the child. This presumably makes a big difference. Even if abortion is not killing, it is wrong to allow your child to die without handing responsibility to someone else – even if that means you have to look after your child for a period of time until it is possible to hand the responsibility to someone else.
  3. In the case of the violinist, it is an unnatural situation: the violinist is not where he is supposed to be. He is not in his natural habitat. This is quite the opposite to the case of pregnancy, where the baby is exactly where she is supposed to be, in her natural habitat, living in the environment in which every other human being entered the world. Why think this is important? Well, for one thing, it suggests that the baby is not trespassing: if so, it will be much harder to justify using lethal force against her.
  4. Perhaps the key difference is that disconnecting the violinist looks more like letting die than killing, and the rules on letting die and killing are very, very different. In Anglo-American law, letting people die is generally legal (though not always). But killing is almost never permissible – only in self-defence or in cases of ‘necessity’ (a complex matter almost never used, and dealt with in Greasley’s book). Given that abortion is typically killing, the standard defences to homicide do not work – it is not proportionate self-defence, and it is not necessary in the relevant legal sense. So there is another disanalogy with the violinist case. Greasley’s book argues this compellingly at significant length – from a pro-choice legal perspective.

Put this all together. Suppose the violinist case were different: you were drink driving one night and knocked over your daughter, who became dependent on you for several months. Would it be permissible for you to, for example, dismember her in the way that some abortions are performed? Obviously not. Nor would it be plausible that you could morally just ‘eject’ her from your house. You have a duty to her. And you certainly have a duty not to kill her. Hence, Thomson’s argument appears to fail.

It is often thought that the reason pregnancy ethics are so controversial is because we have no analogies: pregnancy is a unique situation, unlike anything else. This is mostly true, I think, but not entirely. Kate Greasley points out that conjoined twins can be in a very similar situation, but more ‘burdensome’ still. There are some cases of conjoined twins where one twin is entirely dependent on the other – not only for 9 months, but for the rest of their lives. Moreover, the independent twin did nothing (at least, not knowingly) to cause the existence or dependence of the other twin. Yet the law has been very clear that it would be completely impermissible – morally and legally – for an independent twin in such a situation to end the life of her sister by disconnecting her. I think this is right.

Let me close by saying a bit more about the ideological background here. The argument is deeply rooted in a profoundly individualistic view of the world, according to which it is very rare for people to have claims on each other simply because they are needy. One of the things Schouten describes so well is how deeply this conflicts with fundamental feminist norms – and I would also say, with progressive, welfarist norms (the topic of my paper). Many of us in the West now recognise that the invisible hand is sometimes not the fairest dealer – some of us are in situations of great power, and others in situations of great vulnerability. Rather than the ‘each to their own’, dog-eat-dog kind of liberalism which inspired Thomson’s article, many of us on the political left are moving towards a radically community-centred ideology, where people’s being in need means we have certain duties, as a society, towards them. I doubt many of us are compelled by the idea that we could just walk past homeless people, or refugees, insisting that while it would be nice to help them, they have no right  to our money and therefore we – and the state – can just neglect them to death. That surely isn’t how morality works. When we see a vulnerable person, we realise they have a claim on society – and that claim sometimes involves our personal labour on an individual level, sometimes very significant labour. Would it be better if society could distribute all the labour equally? Perhaps. But life doesn’t always throw us convenient problems. Sometimes doing the right thing takes considerable sacrifice, or even heroism.

For more on Thomson’s argument, see the work of Gina Schouten, David Hershenov, Kate Greasley (all linked above), and a forthcoming paper by Emma Wood (which I cannot yet find online).

“No one should be forced to be pregnant/give birth”

It is absolutely true that no one should be forced to become pregnant, and no one should be forced to give birth. This can occur in the case of rape, which is a heinous crime (see ‘What about abortion in cases of rape?’). In every other case, there is a choice not to become pregnant: pregnancy is a natural consequence of sex, and everyone (except in the case of rape) has the choice whether to have sex or not. The fact that we do not necessarily like this connection does not mean we can ignore it and then claim we have a right to escape the consequences, especially when escaping the consequences can only be done by violating the fundamental rights of another human being.

Almost everyone thinks that ‘forced pregnancy’ is OK in the third trimester, for example. Almost everyone thinks that women should be ‘forced to give birth’ late in pregnancy, because almost everyone supports a ban on very late abortions. In reality, the language of ‘forcing’ is an uncharitable way of framing the issue. Pro-lifers don’t think women should be forced to become pregnant. Nor do they want to keep women pregnant, or make them give birth, just for the sake of it. That is what the language used in this question implies. But in fact, they just think that ending a pregnancy by ending the life of a child is not permissible – just as most other things we are normally allowed to do would be off-limits if the only way to do them was by ending the life of a child. Suppose, for example, it is a winter’s night, and you are in your car. The only way you can get home tonight is by running over a small child – all the other roads are closed, and there is no way to remove this child. You must either stop where you are for the night or run the child over. You could frame this as ‘being forced to sleep out in the cold in a car’. And you could rightly say that ‘no one should be forced to sleep out in the cold in a car’. But this would clearly be uncharitable: the reality is that, because of the circumstances, the only way to avoid that consequence is by ending someone’s life. Likewise in the case of abortion.

“No one should be forced to be a mother”

The same considerations as in the last question apply. But in addition, on any plausible scientific view, the pregnant woman is already a mother. Even if you don’t believe the foetus is a ‘person’, it is scientifically beyond dispute that the pregnant woman is the mother of the foetus – which, of course, is Latin for ‘offspring’, to compound the point.

One additional major problem for this argument is that pro-choicers do think that men can be forced to be fathers. If a woman has a choice about whether to keep a baby, she can force a man to be the father by giving birth. This provides a dilemma: either we have to admit that people can be forced to be parents, or we should say that men should be able to force women to abort their joint offspring. This latter option is absurd. So it seems that women can ‘force’ men to be fathers. If so, then why can’t women be ‘forced’ to be mothers? Again, this only helps to reinforce what an uncharitable interpretation of the situation this terminology involves.

Is abortion self-defence?

It could be argued that abortion is permissible as a form of self-defence. Unfortunately, this doesn’t work for a variety of reasons most comprehensively explained by pro-choice Oxford legal scholar Kate Greasley. In short, it is questionable that the foetus could count as an aggressor. But most importantly, a key element of self-defence is that the threat is proportionate to the force used. In the case of abortion, the child is killed. Hence the threat to the mother must be sufficiently serious to warrant using lethal force. This is obviously not present in the overwhelming majority of abortions, except in those few where the mother’s life is genuinely at risk. And in those cases, pro-lifers do indeed agree that abortion may be allowed (though they disagree about whether to call it ‘abortion’).

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