Do women have a right to make medical decisions on abortion?

This is an entry in the Pro-Abortion series.

From Mimi and Eunice.

One of the arguments of Roe v. Wade, and one of the arguments pro-choice advocates use when confronted with people who deny the primacy of “choice,” is that we all have the right to make medical decisions about our own bodies, and that abortion, like any other surgery, is a decision that should take place between a woman and her doctor, not the government or anyone else.

This argument seems convincing at first glance, but how is such a right justified? The only plausible justification is through self-ownership: that because the woman owns her own body, she should be able to make autonomous medical decisions about her own body, just like making autonomous decisions about any other piece of property one owns. As the famous slogan says, “my body, my choice.” In this view, excising a fetus out of a woman’s body is no different than kicking out a neglectful tenant.

Since self-ownership is little more than semantic gobbledygook and we cannot make any logical sense of the proposition “a woman owns her own body” except in a purely tautological way, any such supposed right must be invalid as well. So the answer is yes, I deny the right to make medical decisions as a whole, not just in the case of abortion, insofar as it is unjustified.

This is not to say that I think medical decisions should always be imposed on individuals. In fact, most medical decisions should rightly be left to the consent of the individual. All individuals have a right to health, but no one has a right to impose any medical risks on anyone else… as long as only that one person is involved.

When other people are involved, consent goes out the window. For instance, we impose mandatory vaccinations. This makes sense from a deontological perspective; no one has the right to transmit disease to others. Of course, some people complain that the parents have a right to make medical decisions for their children, although they cannot justify this right or explain how it trumps the right to health of the child or other people.

Another example of a medical decision other people are not allowed to make is that of a quarantine. We accept that it may be necessary for people to be isolated in order to prevent the risk of them spreading disease.

As I have argued, starting a new human life represents a health risk. Many human lives begin compromised. And if we cannot guarantee the right to health of a future life, then we should not start it. To force a woman to get an abortion for health reasons is no less valid than quarantine or mandatory vaccines. The issue of ownership or choice is irrelevant in the face of possibly or probably causing real harm.

The anti-abortion advocates make a similar kind of argument, but about the decisions of doctors. They advocate that doctors should have the right to follow their conscience (through so-called “conscience clauses”) and refuse to participate in a medical treatment for personal reasons. In practice, this is merely a way to make abortions harder to obtain. On that basis, we must reject it. In theory, it is based on the principle that one must be free to “follow one’s conscience.” But this is an irrational principle if one’s conscience leads one away from the facts.

Doctors refusing to perform abortions because of their religious sentiments should no more be allowed to work with impunity than we should allow storekeepers to refuse to serve black people with impunity because of their racist sentiments. Let us be clear here, the conscience has little to do with it: what we are talking about here is primarily hatred. At least, in my opinion, such “conscience clauses” are little more than cartes blaches for hate crimes.

That aside, I have no objection with people following their own conscience, as long as they’re not hurting other people or interfering with their human rights. Any doctor who refuses to perform medical operations is interfering with a person’s right to health. This is unacceptable.

Of course, conservatives, Libertarians and other right-wing types believe there is no such thing as a positive right, that is to say, any duty to fulfill other people’s needs (as I have argued, I believe such a denial makes all rights meaningless). In this, their beliefs are bizarrely similar to another common pro-choice argument, that the pregnant woman has no duty whatsoever to keep the fetus alive. Here is an example of this argument:

Let us suppose I have a rare blood disease and I will die unless I have a blood transfusion from a compatible donor. Let us also suppose my mother is the only person on Earth who is a compatible donor. Even though I am a “person,” I have no right to receive sustenance from the blood of another person — including from my mother — without the consent of that person. However, if I were a fetus, then “pro-life” supporters say I should have this right.

I believe that this line of reasoning is deeply wrong. But it is far less clear to me why pro-choice liberals would be so convinced that these arguments are valid; if you believe in positive rights at all, then how can you not believe in the most fundamental of positive rights, the right to get whatever is needed for your bare survival? If no such positive right exists, then no positive rights can possibly exist.

Many advocates admit that this is an attempt to make a “choice” argument that is true even if one admits that the fetus is a person. A fair argumentative goal, but an ethical failure. I find it extremely hard to believe that they seriously believe in the rightness of letting people die in the name of “choice,” while at the same time being passionate partisans on health care and welfare issues.

This is just another eloquent demonstration of the atomistic individualism that results from blind belief in self-ownership. Taken to a consistent logical extreme, atomistic individualism and the rejection of positive rights can only lead to the complete breakdown of civilized life. Ironically, I used to argue like this to defend the pro-choice position when I was a Libertarian; now I realize how cruel and wrong that was. But at least I had the excuse of having sympathies with right-wing positions at the time.

It is even less excusable for pro-choice advocates to compound insult with injury by trying to attack their opponents for upholding a positive duty (made even more bizarre by the fact that most of their opponents are right-wingers who don’t believe in positive duties):

A house is on fire and someone is trapped behind a deadly wall of flame. That person will perish if we do not act to save his life. We are obligated then, to run into the fire and attempt to save his life, if we subscribe to the notion that it is a duty to take positive affirmative action.

…This would lead to people being obligated to be the ‘hyper-good samaritain’ (sic). That is risking their life and abandoning their rights in order to save the life of another. This situation, clearly, is absurd.

This is obviously a straw man, as there is no way to get from “we have a duty to take positive affirmative action” to the hyper-good samaritan position. In this example, firemen have the job of attempting to save eir life, not any random person. Any sane society acquits itself of its obligation to save people’s lives from fires by giving people the skills and the equipment needed to put out fires and save lives, not by tasking every single person, skilled or not, with the duty of rushing into fires. Unless one wishes to argue that firemen are an inadequate provision of this service, the objection surely cannot stand: it’s a complete disconnect from reality, and if the author had thought about real life for a few seconds, ey’d have realized it too.

The problem is in the equivocation of “we.” The writer assumes that when people say “we have the absolute duty to save human beings,” we’re talking about every single individual in a society having this duty. But obviously we’re talking about society as a whole having this duty, not every single individual. When we say we have a duty to save people from fires, we’re talking about society through the agency of firemen, not every single bystander.

The only reason why a pregnant woman would, if a fetus had a right to life (which it doesn’t), shoulder the entire burden of such a right is because no one else can sustain the life of the fetus but the pregnant women. In that specific case, no institution can do the job, and no other person can do the job but the pregnant woman. So the issue of whose responsibility it is becomes moot.

The anti-abortion position tries to undermine the right to make medical decisions on the basis of regret or psychological damage. Of course, this is pointless since the right to make medical decisions is nonsense. But the objection of regret is equally nonsense.

Any medical treatment decision can lead to regret in some percentage of patients. If protection from regret were sufficient to permit government regulation, government could override patient decision-making for any medical procedure, eviscerating the legal and ethical norm of informed consent in healthcare. For example, a recent study concluded that as many as one in five men who undergo prostate surgery (which may not always be necessary to preserve life or health) regret their decision, typically because of reduced sexual function. Taking Carhart’s reasoning to its logical extreme, why not permit the State to protect men from the regret that may result from their reduced virility, which may lead to depression and other psychological harms? Treatment for prostate cancer can also be an emotionally fraught decision for men, particularly due to possible sexual side effects. Yet, lawmakers do not respond to this proven risk of regret by limiting men’s treatment options; rather lawmakers and physicians work to ensure the provision of more accurate information to improve men’s decision-making. Only in the case of the gender-specific abortion decision does the law react to the possibility of patient regret–present to some degree with any medical treatment–by permitting the government to ban the treatment entirely and endanger the patient’s health.

The irrational woman: informed consent and abortion decision-making, by Maya Manian

Manian’s argument is that this is due to women being seen as irrational and unable to rationally consider risks. If this is true, then the regret argument is inherently sexist, and must be rebuked with extreme prejudice. Either way, the argument is clearly flawed; giving more information is always a better solution than illegality.

We do not have a right to not feel regret, if only because any right based on emotion is self-contradictory. Of course we don’t want to feel negative emotions, but to reject them out of hand is to plunge into mindless hedonism. Any decision we take involves risks, and those risks will sometimes become reality, inevitably creating regrets. As we see with prostate surgery, the best response to regret is to be better informed so that we are fully aware of those risks and can cope with them appropriately.