Professor John Wyatt – 5 things we learnt

Last week OSFL hosted Professor John Wyatt, a professor of ethics and perinatology at UCL, who worked for more than 20 years as a consultant neonatologist at University College Hospital. The talk was full of fascinating insights from a career spent caring for newborns as young as 22 weeks, and the minefield of ethical dilemmas that naturally occur when dealing with such fragile human life. Here are five things we learnt from his talk:

1) Neonatology is a high tech world and the technology is always improving.

It is incredible to see how many preterm newborns are surviving from as young as 23 weeks

and that of those who do survive, a very large proportion suffer little or no impairment. The study below shows that in 2006 90% of babies born at 26 weeks suffered no impairment later in life.

2) The prediction about a future “quality of life” is often highly inaccurate and subjective.

The very concept of a ‘quality of life’ is entirely subjective and so judgments will tend to reflect the prejudices and presuppositions of doctors and parents. The idea also assumes a form of biological determinism which is not supported by the evidence, and so the concept of a single variable called ‘quality of life’ is incoherent. Any one life has multiple dimensions of experience that are impossible to quantify and summarize with a single number, such as motor function, sensory function, cognitive function, creative abilities, relational experiences and family bonds, social resources, mood and affective experiences, and many others besides.

One study asked a whole range of disabled adolescents to rate the value of their lives, then they asked the parents to rate the value of their disabled adolescents’ lives, and finally they asked the pediatricians to do the same. The research showed that the disabled people put the value of their lives the highest, the parents put it somewhere in the middle, and the pediatricians put it the lowest.

Clinicians tend to assume that a biological impairment such as impaired neuromotor function translates automatically into a loss of well-being or life-satisfaction. As a result they tend to be blinded to the effects of social, economic and political factors in the lives of disabled children and adults. The problems of living and coping with disability may be as much a consequence of poor social attitudes and the lack of aids, resources and support, as the medical impairment itself.

3) Everybody is coming from somewhere

When discussing these highly complex ethical questions, it is important to bear in mind that no one approaches the question from an entirely neutral perspective, but that everyone is coming from somewhere.

This is particularly important with respect to the relationship between parents and healthcare professionals. The ideal is that the relationship is seen as “expert-expert”, based on the mutual respect for the differing expertise of the parties. Healthcare professionals of course bring expertise on the level of technical proficiency, but should also make sure to  include humanity, compassion, wisdom, and ethical integrity.

4) A way to help with difficult decisions about whether or not to withdraw life support: balance the benefits and burdens of treatment

It is painfully difficult making decisions about when it is appropriate to withdraw life support from a newborn, but the most helpful way to look at it is to balance the benefits and the burdens of the treatment. As soon as the burdens outweigh the benefits, the treatment becomes abusive and there is a legitimate reason to withdraw them.

We must also bear in mind the key ethical distinction between withdrawing treatment and euthanasia: intention. Withdrawing treatment does not have the intention of death, whereas euthanasia does. Intentions matter in a moral universe, and are central to the legal analysis of actions, so should be carefully considered in the ethical implications of actions.

5) Neonatal care is a way of saying to these tiny little beings: “it’s good that you exist, it’s good that you’re in the world”.

Caring for these vulnerable newborns is a profound and rewarding experience. Even when intensive support is withdrawn, it is vital that care continues, in the form of food and fluids, pain relief, and tender loving care.

Allowing a baby to die at peace, with symptoms controlled and in his or her parents’ arms, can be as much a triumph of neonatal care as when the child recovers and goes home.

If you would like to read more about Professor John Wyatt and his work as a neonatologist, consider buying his book, Matters of Life and Death.

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A Ghost of a Chance? Turning all Feminists into Pro-Life Feminists

 

In 2014-2015, I somehow ended up chairing a college gender equality society. In doing so, I spent a year as a ‘closeted’ pro-life feminist – who’d only come to that position after taking up the role – amongst a group of very smart, idealistic, and compassionate pro-choice feminists.

During fresher’s week that year, I tried doing what I thought would be the most important part of the job – trying to win people who disagreed with me over to the feminist cause. One thing I noticed quickly was that at lot of ‘gotcha’ objections had something in common: “So if you’re interested in ‘equality’, why don’t you do anything about men’s rights?” (We have done at least one event on this a year actually!) ‘Why don’t you do events on the Middle East?” (We just did one.) ‘”Why are all you western feminists being culturally imperialist doing events on the middle-east in a pitying superior way without talking to women from the Middle East? (Our event on Iran consisted of a screening of Persepolis followed by a talk by an Iranian academic!).

The point of all this, is a general one: if you’re part of a movement that people have negative impressions of, these impressions can be quite difficult to dispel. People accuse you of things without checking that you’ve actually done them. A portion of those people will probably continue to believe that you are guilty of these things, even if you tell them they’re wrong. Winning them over can be a bit like convincing someone ghosts exists if they think you’re a crazy guy who believes in ghosts. ‘But there is a ghost in my house actually’ doesn’t cut it. You pretty much have to physically drag them over to the ghost. Seeing might not even be enough. Sometimes it feels like you have to do the equivalent of actually introducing them to, and making them shake hands with the ghost to get them to really believe you. It’s not easy.

This is sometimes what it’s like trying to convince people feminism isn’t some hypocritical, self-centred movement for rich western women. It’s also what it can be like for pro-life feminists trying to win over our pro-choice counter parts – there are some pretty common ideas that people will believe about you without necessarily having any good reason to do so: that you are motivated by paternalistic concerns and don’t trust women to be make their own decisions, that you are not genuine and just cynically using the feminist label as a talking point etc.

If you want to look for pro-life feminist arguments, or examples of pro-life feminist organisations they’re a google search away.

So I’d like to focus on something more specific. I’ve spent a lot of time thinking about how to win over pro-choice feminists like the people I was on the committee with: how to win back the mainstream feminist movement and win over pro-choice feminists given that trying to do so can often be much like telling a ghost doubter you’ve seen a ghost.* Sometimes, because of the ghost doubter phenomenon, great points just aren’t convincing. Here are some ideas and tactics I think could help counter that.

1) Use pro-choice sources to back up your arguments. If you are talking about how the aftermath of abortion can often be difficult for women, or how women are sometimes pressured into abortions by male partners, and workplaces that expect women’s bodies to accommodate them rather than the other way around, try to start off by using pro-choice resources like 1-in-3 (a pro-choice website where women post their abortion stories anonymously). Pro-life websites aren’t credible sources here – it’s like backing up your claim about the ghost using testimony from the strange kid at school who set up a ‘ghost appreciation society’. Of course, pro-choice sources can take you only so far, but if you aren’t using a pro-choice source, try to use a neutral one instead, such as the NHS or Wikipedia, even if they gloss over some of the details.

2) Speak their ‘language’ (equal rights, discrimination, ableism, prejudice, dehumanisation!). The pro-choice stance of saying that some human’s rights are dependent on their value to other people, or their physical and mental capacities is not usual feminist rhetoric! Emphasise the fact that a pro-life culture requires a huge cultural shift, a revolution. You don’t want to return to the 1950s – like them you want a new, better world. Make sure they know this. This isn’t a culture war between them and you – you share a lot of values.

3) Emphasising the women’s welfare is important BUT the crucial issue at stake is that this is a human rights issue for humans who aren’t born yet. The worst thing about abortion is that it kills. It is awful that some (not all) women regret abortions they were pressured into, or got when they thought they had no other options, but the reason abortion is wrong, is not that women regret it or are hurt by it – make this very clear. I have been at a debate on abortion where a very large chunk of the Q&A was about the number of women who regret abortions. One person said ‘shouldn’t women be allowed to make their own mistakes even if they regret them’. This was a reasonable reaction because from his point of view, abortion is not the killing of a human being like us. Unless you bring it back to that to the fact that this is a human rights abuse, it will look a little like you are just saying ‘we need to protect all these poor silly women from themselves’. Which is of course not what you are saying.

4) Women are moral agents who are just as capable of making decisions as men. Make sure they know that you know that! Be careful about making general statements that focus too much on women who are victims or who are hurt, without going into the structures that put them into those situations or bringing up any suggestions as to how to help them – that is what they expect you to do…Because of background assumptions to the contrary, you really want to show that you know these are rational adults who are placed in difficult situations (except when they aren’t adults) – not little girls who are too silly to understand what’s at stake.

5) Acknowledge that there are cases where being pregnant is incredibly tough, and if women don’t get an abortion they will be making sacrifices to continue with the pregnancy and this is unfair. You don’t need to minimise the real suffering carrying pregnancies to term can sometimes involve to make your point. If you are talking to someone who is well versed in pro-choice feminism, and you never address this, you may not really deal with their main concern and you might end up talking past each other. If you do bring it up, talking about ways in which some of these unfair structures (like say the lack of support for student parents) can be changed is a great way to find common ground.

6) Don’t let them get away with saying opposing late term abortions, or ‘abortion on demand’ is misogynistic or to do with a mistrust in women, a ‘belief that women will just get abortions like sandwiches.’ Just say that women get late term abortions because they end up in situations that are genuinely difficult (and give examples or think of reasons, as usual using neutral or pro-choice resources when possible). They happen and we all know they do. But this is still a human rights abuse.

7) Go to feminist events (if you have the time). Don’t say you care. Prove it to them.

8) Acknowledge mistakes. I find that if you actually get caught out on making a mistake and acknowledge it, it makes people much more likely to do the same to you. Besides, they might have ghosts of their own to show you.

*By the way this is merely an analogy, I don’t believe in ghosts, or mean that people who are the ghost doubters in this analogy are irrational or silly.

 

Ciara O’Rourke is a Philosophy student at Trinity College Dublin where she was a Gender Equality Society committee member for two years (2013-2015)