The Kansas Anti-Abortion Bill: An Affront to Autonomy

On Monday, the state of Kansas in the USA passed an anti-abortion bill which includes several morally controversial measures (http://www.huffingtonpost.com/2012/05/04/kansas-abortion-bill_n_1478706.html). One measure receiving a great deal of media attention is the provision to prohibit tax deductions for abortion insurance coverage, thus making a women’s ability to have an abortion far more dependent on her socio-economic status. This is of course an important issue, but I shall address an aspect of the bill which I find even more disagreeable.

For me, the most outrageous aspect of the bill is that it mandates the imposition of an unwarranted bias against abortion on the woman seeking the abortion, and it does so in a manner which severely undermines her autonomy. It does so by means of two provisions. First, the bill mandates that doctors tell women that abortion causes breast cancer. Now, if abortion did indeed cause breast cancer, then a doctor’s telling their patient this information would not merely be morally permissible, but morally obligatory. However, the purported link between abortion and breast cancer suggested by studies in the 1990s has since been dismissed by a great number of experts in the field, in the light of extensive research (for instance by the National Cancer Institute http://www.cancer.gov/cancertopics/factsheet/Risk/reproductive-history) which has concluded that abortion does not increase the risk of breast cancer. Accordingly, the bill does not just recommend that doctors inform patients of the health risks involved in abortion. Rather, the bill enforces doctors to propagate a hypothesis which lacks conclusive scientific evidence as a scientific truth. This is wholly irresponsible, since patients will most likely treat their physician’s opinion regarding health risks as unimpeachable. Moreover, whilst patients may be willing to accept some health risk in order to have an abortion, it seems unlikely that they will have one if they have it on good authority that having an abortion will directly cause them to have breast cancer. In so far as acting on false beliefs can undermine an agent’s autonomy, legally requiring doctors to propogate this apparently false claim threatens the woman’s capacity to autonomously decide whether to have an abortion.

As if this was not destructive enough to the relationship of trust between doctor and patient, another provision in the bill allows doctors to withhold medical information from a patient if it might lead her to have an abortion (which, one might observe, could even include the information that she is pregnant). Again, this is wholly irresponsible; since autonomy seems to require the agent’s having knowledge of relevant information pertaining to their decision, this provision completely robs the patient of her autonomy. Not only that, but it does so in the context of a crucial decision concerning the woman’s health and well-being. Furthermore, the effect of withholding information in this case does not just affect the patient’s autonomy in this local instance. Given the life changing nature of having an unwanted child, it also seems that withholding information which might lead to an abortion will also affect the agent’s global autonomy.

It seems that the only way in which defenders of the bill could defend this second provision is to argue that the ‘therapeutic privilege’ of withholding information from patients is morally justifiable if disclosing information might endanger the patient’s own life or psychological health. In view of this, they might argue that if disclosing certain information might endanger the life of a foetus, it may be morally permissible to withhold the information; the value of the patient’s autonomy, they may argue, should be trumped by the foetus’ right to life.

Needless to say, this argument does not get off the ground unless one assumes that the foetus has a right to life. I do not wish to open up this debate here; however, it is prudent to note one thing. Whatever one’s position may be on the matter, the view that the embryo is a person or has a right to life is far from being an unimpeachable metaphysical or moral truth; there are significant and difficult objections that proponents of these views must face, leaving grounds for uncertainty. However, to return to the Kansas bill, if the justification for withholding information from the patient here is that the information is likely to make the patient want to have an abortion, then in most cases, this seems to presuppose that the woman herself does not hold the view that the embryo has a right to life; if she did, then hardly any information could persuade her to have an abortion. Yet, if this is so, then by claiming that the withholding of information in the context of abortion is morally justifiable, policy makers are tacitly imposing the view that the embryo has a right to life upon those who do not hold this view. Given the grounds for uncertainty on these philosophical questions, this seems reprehensible.

Some conservatives might deem the imposition of this view to be a necessary measure. However, there are reasons why even such conservatives have reason to regard the Kansas bill with disdain. Consider the sort of information that might lead a woman to possibly want an abortion. Such information might include information about potential foetal abnormality, or danger to the mother’s health. Even if this information might lead the woman to want to have an abortion, there are other reasons why knowing this information is critically important. Surely one reason that even conservatives can agree upon is that the woman can only go about planning her life in a manner which will allow the potential child to receive a suitable upbringing, if she is aware of information regarding both her own post-natal health, and the child’s. Again, the withholding of information that the Kansas bill allows threatens the autonomy of pregnant women to plan their lives in the light of their actual circumstances.

The Kansas bill represents a diabolical affront to autonomy. If one believes that the foetus does not have a right to life, then this violation of autonomy is surely indefensible. Yet, even if one believes that the foetus does have a right to life, this does not warrant support of the Kansas bill. Rather, one should support the wholesale prohibition of abortion, and not this back door approach which, although likely to succeed in preventing abortions, will surely have severely damaging consequences for the parent’s autonomy.

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One Response to The Kansas Anti-Abortion Bill: An Affront to Autonomy

  • John H says:

    An enjoyable piece ‘Pugh’.

    A few points:

    1. Couldn’t a conservative also say that the pro-choice person is imposing his view on the conservative in allowing abortion? By parity of reasoning, is this not also objectionable, given the uncertainty in the case?

    2. More broadly, the uncertainty argument seems to militate in favour of a pro-life position. Work on normative uncertainty demonstrates this. If we have some credence in the view that killing a foetus is murder, and some credence in the view that it is just permissible, it seems like we should not kill the foetus. If we did, we would risk doing something very morally bad or something merely permissible.

    3. Finally, if one did think abortion was murder but was acting in a country in which one is prevented from prohibiting abortion (like the USA, by the Supreme Court), then it seems rational to try to limit the number of abortions that people get. One could do this by limiting the autonomy that people have.
    e.g. suppose that there is a country where one is allowed to kill Jews if one wants. If Conor is a lawmaker who believes killing Jews to be wrong, he is justified in giving out information that reduces the likelihood that people will kill Jews. That is, even if giving out false information compromises people’s autonomy. One can debate whether the exercise of autonomy involved in killing Jews is valuable, but it is reasonable to assume it is not. One could also say that such an act could not be autonomous, but then the same would apply to an abortion if abortion is murder.

    For those reasons, whether you are right or not seems to depend on whether abortion is murder or not, which is beyond the scope of this blog post.

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