Interview with Ann Furedi, Chief Executive of BPAS

Towards the end of the previous academic year, Ann Furedi (the chief executive of BPAS, which is the UK’s leading abortion provider) came to Oxford to debate with Sophia Kuby at an event organised by OSFL. Having read Ann Furedi’s book, ‘The Moral Case for Abortion’, Henry Drysdale (former Treasurer on the OSFL committee) visited BPAS HQ to interview Ann about her position. The interview took place against the backdrop of Ann’s recent appearance on the ITV show ‘Loose Women’, where she discussed reasons for viewing abortion as another form of birth control. A full transcript of the interview can be found below:

Henry: I think we started some really interesting conversations that I wanted to carry on with.

Ann: Yeah, sure. I mean I think it came out a little bit at the debate we had down your end.

H: On my turf.

A: Yeah, on your turf, where Sophia was making the point that she wasn’t really expecting me to take the approach that I did with it. I suppose what I’ve always felt is really important is to try to be really honest about what’s going on here, because I think that it’s not an intellectual game. Clearly I regard it as a practical service that women need, but I also know that it’s something that has got an ethical and a moral foundation to it, which I am incredibly unapologetic about. I wouldn’t be able to do what I do if I wasn’t able to pin it together, and intellectually justify it.

H: Yes, and that certainly comes out in your book, that intellectual honesty and that willingness to ‘go there’. I think many people, on both sides of the debate actually, because of the ‘ick factor’, sort of really don’t want to.

A: Well it’s hard, isn’t it? It’s genuinely quite a hard thing. If you look at the intersection between the two different parts of abortion: there’s the service side of it, and there’s the ethical and moral framework. The problem in some ways is this: women who need abortions do so not out of conviction. It’s not that you have an abortion because you are intellectually pro-choice, or you are demonstrating your support for something. What generally happens is that people approach it thinking “I never thought I’d be in this situation”.

H: Well I’m with you there. It’s not a good situation to be in.

A: It is an appalling situation to be in, which is the reason I feel so strongly about it I think. So you’ve got that that goes on, but then behind on a political, ethical, and lots of other levels, you’ve got the issue of when does life begin, and what the moral significance is.

H: Well on that, here’s something I wanted to ask you: you clearly value moral autonomy. In your book, you distinguish the political level, people deciding what the law should be, and then individual, private, moral decisions. Without getting into political opinions etc., that concept of private moral decisions I think is really important.

But moral autonomy is still a moral decision. So in order to make an autonomous moral decision for yourself, that involves some private discernment of what is right and wrong. And that’s why this woman is feeling so terrible about this. How do you then feel about the euphemistic language that’s used surrounding abortion. Now you tend to go there. Most people don’t: it’s the pregnancy, not the foetus. It’s the contents of the womb, not the foetus. It’s ‘not continuing with the pregnancy’, which of course is a euphemism for killing the foetus. With that value of moral autonomy, how do you then feel about euphemistic language, and not providing all the information?

A: Hold that thought, and remind me about that second thing.

On the first thing, I think the point that you raise is a really good one, because it sounds as though, and I’ve thought a lot about this, it sounds as though I’m saying: we’re intellectual people and we’ll debate this out, and then there are these plebby types who never actually think about it, and they need the service, but then I’m also saying that every woman who comes into this is making a particular moral choice for herself.

What I really believe is that one of the things that is so special about us human beings, no matter what level of education we have, is that sense of trying to determine what’s right and wrong for ourselves. Not just for ourselves, but for our families, and indeed society as well. All of the decisions that we take are not instinctive, and are not just reflexive in the way that I believe other animals are. We can have a different discussion about the humanity of apes and dolphins, but bear with me. I am an unashamed species-ist. I think one of the things we do is a kind of rational and moral weighing up.

I’m not setting the bar very high when I talk about rational and moral reasoning, but I am saying that I think it’s something people do. And they do it even when you think about decisions about expenditure of the family income. Do I get the packet of cigarettes? Or buy the kids some sweets? There’s a whole load of “I wish it could be this or that”. My sense is that that’s always going on in people’s heads.

One of things I think is that the area in which people have the capacity to make those decisions is as broad as possible, and for me the decision about when to have a child and how to manage your fertility has to fall within those areas. I think I used the example at your meeting about the girl who had the abortion because she didn’t want the father of the child there. That, to my mind, is an example of the complex moral reasoning that people go through.

Another one is, and I’m not making this up: I was in the middle of talking to one of our managers, and she suddenly breaks off from me and says “Oh my god I completely forgot, I promised to look up the lottery results!”. And she digs the copy of the newspaper out of her bag, looks at the lottery results, rushes downstairs, where it turns out there is a client who had asked Kelly, the manager, to check the lottery results, because if she won the lottery she wouldn’t have to go through with the procedure. It’s one of those things that just sticks in my mind because the point that I’m making is that everybody makes decisions in a context, however educated or not they are.

So that’s how I think that the moral reasoning thing comes through in relation to the service delivery side of it. But I think that people would say your decision about “Can I afford it or not?”, “Would it take a lottery win?”, or something different, isn’t something that you would normally stamp as moral reasoning.

H: No, agreed.

A: But it kind of is the reasoning that people do in the context of their everyday lives.

H: But people can be wrong.

A: People can be wrong, absolutely.

H: So it’s possible that these people are making morally wrong decisions.

A: Yeah, but my point would be, as I think I’ve written, that it’s theirs to make.

H: Well, in terms of the law.

A: The law doesn’t provide people with moral autonomy to make these decisions right now. I think it should, and I will do everything that is legal to facilitate that. And the law says that abortion is prohibited unless continuing the pregnancy would be more damaging to a woman’s mental and physical health than ending it. And that enables doctors to pretty much interpret it as “it would be more damaging to compel her to give birth to a baby that she doesn’t want than to end the pregnancy”. However, is every decision a woman makes the right decision? No, because we make bad decisions all the time.

H: So here’s a question. You have a woman who is pregnant, scared, and has lots of things to worry about: the father, money, etc. She has, as we have agreed, a morally important decision to make. Aside from any legal questions, for that woman, can choosing life ever be a morally wrong decision?

A: [long pause] It depends, I think, on what you mean by choosing life.

H: Choosing not to have an abortion.

A: I think it could be. It’s the flip side, isn’t it, of me saying it can be the right decision.

I think it can be, and I would say, you know, I don’t like using these hard cases, but the one that immediately comes to mind is a woman who will decide that she’s ending this pregnancy because she’s got other young children that she really feels she needs to care for, and that require 100% of her time. The one that immediately came to my mind, which is a struggle, is that we did an audit when there was a move to lower the abortion time limit, of women who were requesting very late abortions. And we were looking at the circumstances of all the women who were between 22 and 24 weeks. One of those really sticks in my mind was a woman who already had a son with Down syndrome who was having heart surgery at the time. The reason she was late having the procedure was that she felt she couldn’t even think about getting herself sorted out until her little boy had had the surgery, and she definitely didn’t think she could have another child at this time in her life, because she was utterly absorbed in the care of her existing child. Now what we find is that, you know I said on that program, half the women we see are already mothers. So often they are saying, “I want another child, but I can’t do this now”.

H: So that’s then a woman who is struggling. My point is that we get to choose how to react to that.

A: Yes.

H: My obvious feeling is that we should support that woman. That takes money, but so does abortion. We get to choose what to fund. Why fund abortion?

A: Because from the point of view of the woman… there are some woman, who might say “it’s a financial decision”. A while ago one of the charities, or one of the churches, I don’t remember which, said “we will give women money”.

H: Because there’s a life at stake.

A: Yeah, because there’s a life at stake. I don’t think there was a huge uptake. It certainly didn’t make a dent in numbers. When people say they have a financial problem, and there’s a money issue, it’s generally not a case of getting together a couple of hundred quid. The money is a code for a whole load of other stuff that’s going on.

I think the fundamental difference, and this is the point I’m coming to, is that you see, for many people, maybe for you, because you see that biological human existence, whether in the womb or outside, as being fundamentally the most important thing on earth that must always be preserved, then you will always be looking to do what can be done to preserve that biological life. For me, I have a huge presumption in favour of life.

H: Really?

A: God yes. I have a huge presumption in favour of biological life in the womb, because of what that represents and what that can become. Having said that, on a scale of what I think is important, I can say that life in the womb matters, and I think has a huge moral value, but for me it doesn’t matter as much as some other things: bodily autonomy, and indeed moral autonomy, the ability of that woman to weigh up for herself.

H: So let’s stretch the limits of bodily autonomy a bit. Bodily autonomy you might define as the right to choose what to do with your body, based on your own internal reasoning or feelings.

One thing I think is worth observing is that in a medical context, nobody has this. Even for a medical procedure, you cannot go into a hospital and demand a treatment. A doctor can only provide that treatment if it’s in the patient’s best interests. If somebody is demanding a treatment that isn’t in their best interests, because it involves certain risks, we can’t do it. So bodily autonomy doesn’t exist.

In the context of pregnancy, you would argue that a pregnant woman has the right to decide what happens to their body. And certainly whilst they’re pregnant, in your view, that includes the contents of her womb, the foetus. Do you think it’s wrong for pregnant women to smoke?

A: I think that, erm, it’s not in the best interests of her to smoke, and it probably isn’t in the best interests of the foetus to smoke.

H: Or drink, take drugs.. Let’s go for all three.

A: Or take drugs. But I do think it is for her to determine how she wishes to live her life and where she draws the line, in exactly the way that I think that it’s certainly not in anybody’s interests to be obese, or immobile.

H: Except that in this case it involves another person.

A: But you see, from your point of view, because you are giving that… and you see this is really where I think the whole thing becomes a way of there never being a meeting of minds. This is  a point really that I was trying to bring out in that debate: what matters for you about humanity is ultimately the DNA, the biology, the biological existence of those cells. For me, what matters more are qualities that that biology has enabled somebody to develop. For me, if that human has not yet developed those faculties, it is in a slightly different position. That doesn’t mean it doesn’t matter. I have a huge presumption in favour of human life, unlike, I should say, a significant number of people I deal with.

H: I imagine so.

A: Many of them who feel that there are far too many humans on the planet. And indeed the entire tradition of the birth control movement.

H: It all gets a bit ‘end of the world’ doesn’t it?

A: It all gets a little bit horribly caught between the end of the world and a state eugenic point of view.

H: I’m glad you share my discomfort.

A: I’m sure we share more than discomfort. I have absolute total contempt and loathing. However it then comes to me to saying how much it matters in relation to… And I think this is the problem that we struggle with, and we very often don’t get the opportunity to discuss that.

H: This brings me on really nicely to something that I wanted to ask you about. I’ve read your book, three times actually, ‘A moral case for abortion’. You devote a whole chapter to this, the question of personhood, called ‘Is it human? Do we care?’. I wanted to quote you, and then we can talk from this.

You say in this chapter: “Our ability to be aware of ourselves, and our self interests, to make decisions, to take responsibility for ourselves and others, to write the story of our lives, these are the things that define us as human.” and then you say “The presence of these qualities makes one life worthy of a kind of secular sanctity, and their absence subjects one life to the determination of others.”

So I’m a doctor, I work in an NHS hospital, and I currently work on a geriatrics ward. About half my patient have severe dementia. Progressive, irreversible cognitive decline. Many of them posses none of the qualities you list as defining us as human. My question is this: are they not human? Do they not deserve to be protected and cared for? Do they not have a right to life?

A: [long pause] My answer to that is.. Yes they definitely do. Yes they definitely do, and we should do all that we can to preserve their lives.

Let me ask you this, as a doctor. If one of those patients went into heart failure. You have your heart, and you’re deciding to give it to one of those patients, or to give it to a child at the beginning of their life. Doctors make these value judgements: where is it going to go.

For me, the end of life decisions I think society is going to struggle with enormously. Partly because it hasn’t recognised some of the issues that I would pull out as being important at the start of life. And I’m thinking this through almost as I’m saying it here. I’m going to a slightly new place on this. But what I was going to say is that we all make decisions, so we say these people’s lives matter. Would a doctor making a decision between giving a heart to a 20 year-old or an 80 year-old, would he be saying that 80 year-old’s life doesn’t matter.

H: No, because it’s a different situation.

A: He would say it’s a completely different situation. He would weigh that up. I was going to make the point that there is something we need to do as individuals, and therefore socially, in terms of working through what we do think is important and what matters about human life at its various stages of development, both absolutely and relatively. Because from the point of view of what I’m morally privileging, in terms of where I stand on abortion, It’s a privileging of somebody’s decision about their own body, and about their own private life and their own private existence.

H: I think we’ve acknowledged already that it’s not, because there’s at least another human involved, a member of the human species. That’s the difference between obesity and pregnancy.

In answer to your heart failure question, which I think is a good one: we make decisions frequently not to actively treat people. However, those decisions are made in that person’s best interests. That is fully caring for that person at the end of their life.
That is not for the decision of somebody else. So for example, those patients are a financial and emotional drain on their families. Some families come in and say “I wish they would just die”.

The 96 year-old with dementia, and I currently fight every day for 3 such people, those people, by your definition, and let’s just get it right, are not defined as human. By the exact wording of this, they do not have these qualities, and therefore are not defined as human, not worthy of secular sanctity, and because of these absences, they are subject to the determination of others. The people most affected by their lives are their families. I don’t think either of us would agree that their families get to decide that they should die. But this is the case you’re making with pregnancy.

A: It is the case I’m making with pregnancy.

The reason why I’m making the case in relation to pregnancy is because with pregnancy you have a situation you have with no other. You have a direct conflict between what one individual thinks is the right thing to do about my body, and my personal circumstances, and my family, and my family life. Somebody has to make a decision in relation to that situation. Either they are going to prioritise the biological life of the foetus inside me, or they are going to prioritise my ability to make that decision for myself. That’s basically the run of it.

To my mind, it’s profoundly immoral to deny that woman the control over herself that pregnancy involves. The reason why that is a very specific situation is because you can only mitigate and preserve that biological life by directly conflicting with her bodily autonomy and her moral sense of what’s right in terms of her family, her offspring, the fruit of her womb.

When you’re talking about elderly people at the end of their life, you’re really talking about something I think that is very very different. You’re talking about people who, you know, they may be in that state then, but we know that they’ve had a life, they’ve had experience. I believe there’s something going on there, I don’t believe they are empty shells. But even if you believe they are, then us, you as a doctor, me as a fellow member of humanity, can have hopes and desires about how those people are treated, and to want to do the absolute best to nurture and nourish and all that with these people. But it doesn’t impact on somebody else’s bodily autonomy and physical abilities. So I might want my mother to die. But ultimately if I want nothing to do with my mother any more, I can walk away from the hospital, and leave her in your very competent and capable care.

H: I think that’s a fair distinction. I think we’ve moved away though from personhood.

A: We have moved away from personhood.

H: I want to bring it back, and just ask you: This definition you make of personhood… To be clear, I don’t think my patients are not people. They bring value to my life in so many ways. Acts of kindness even when they don’t know their name, for example. Made my day on Sunday. They can have such enormous value. But they do not fit this definition of human. By this definition, they are not worthy of secular sanctity, and they are subject to the determination of others. Do you agree that this paragraph needs revising?

A: I would say that what I’m writing about there is I’m dealing with the embryo, and the personhood of the embryo, and the difference between embryonic life and life after birth. So I think I’d need to read that in context. But I think that it’s pretty clear in the context of a book about the morality of abortion what I am talking about.

H: But what you’re doing is generalising what makes us human and applying it to the foetus. And what I’m saying is that generalisation that you make is false.

A: And I think that if I was writing about the end of life, which I’ve been doing a lot of thinking about recently, then what I would be doing is developing that point, to make that point that the situation that the embryo is in, of one that has no sense, that can have no sense of life, because it has not developed the faculties..

H: Yet.

A: …Yet. But that ‘yet’ is a very important point. It has not yet developed the faculties to have that appreciation. It’s different to your old people, who may have lost faculties, but certainly…

H: Have had them at a different time.

A: …Had them at a different time, and who us of* know? As you say, the person who is no longer capable of remembering their name can be capable of a whole range of other human responses. We don’t revert back. What I’m saying is that I am not entirely convinced that in a kind of aged before death situation we revert to the simple state of an embryo. I don’t know enough about this, I know f*** all about this, but I would find it quite difficult.

H: [laughs] I agree.

A: One of the things that I find utterly compelling from people who have taught me about embryonic development is the inappropriateness of projecting backwards in time from the knowledge that we have of the world around us to the way that that is perceived.

H: In what way?

A: Well, one of the things that… actually if you get the chance to hear him talk he’s really worth listening to – Stuart Derbyshire, who I work quite a lot with, writes for spiked, who is a psychologist who tends towards the neuroscience end of it. His specialist area is pain. He spends a lot of time torturing students, trying to work out how people perceive pain and their understanding of it. His point is about how important the kind of total appreciation we have of our social context is in terms of how we appreciate even stuff that appears to be very very elementary, in terms of how we see things and hear things.

And therefore the stuff which I’m sure you wouldn’t necessarily buy into which some of your colleagues might is that the embryo in the womb is just that fully formed little thinking person who knows who his mummy is and listens to Mozart and appreciates things. It’s not really like that.

H: No, agreed.

A: And that’s why I think that there’s a huge distance… I don’t think there’s an inverted bell curve in terms of human…

H: Right, we don’t revert back. But I do think that when we are trying to work out when a human life becomes a person, we do assign certain attributes, and it’s worth thinking about other people.

A: Absolutely, I agree with you.

H: So is it the ability to feel pain, clearly not.

A: No.

H: Is it consciousness? No, because we all spend a third of our lives unconscious.

A: Yeah, but I think the thing is that there’s a certain thing we do – we can go through these exercises, and so on, we can try and put things down. It’s very interesting, even in writing this book, talk about going down the rabbit hole, and so much of it ends up on the cutting room floor.
It’s absolutely pitiful. I’ve got more stuff about the consciousness of animals than you’d ever want to know. Somebody said to me there are way too many cats in that book, and it’s really true.
There’s all kinds of things we can bring in, but ultimately what it comes back to is, and this is where we get into the scratched record thing – you are looking at it from the point of view of embryo to human and consistent moral commitments and a continual privileging of that human life above all else, yes?

Whereas for me, I think what I am privileging is the moral and bodily integrity of the existing conscious human being in that situation who contains that embryo to begin with, but then will give birth to her child. I’m saying that that human life matters to me, I think it has value and worth while it’s inside her, for what it will become.

For when it’s in early infancy, and people often say to me if you’ve got that approach to abortion how do you feel about infanticide and so-on, what’s magical about the passage through the birth canal – well actually it’s because it’s then outside of the woman, and good doctors like yourself can take responsibility for that.

I think it’s got a certain degree of moral worth when it’s inside the woman, it’s got a certain amount of moral worth as it’s growing up, and then it’s got moral worth at the end of it’s life, and it’s different. I’m not going to say that it’s more or it’s less, but what I’m going to say is that until it is born, you can only realise the status that you want to give it, if there is a conflict, by somehow taking away something from that woman. And that’s what I can’t bring myself to do. I cannot bring myself to say to a woman who is pregnant and feels that is wrong for her to be pregnant and that it is wrong for her to have this child…

H: Morally wrong?

A: Yeah. I cannot bring myself to see that it can be morally right to override her agency in that situation. What it comes down to for me is that somebody is going to have to make that decision, and so the only person who I think…

H: Well, if abortion is available, and we say “abortion is fine, carry on”.

A: Well, the point about is that, you know from medical history, people have been taking decisions about whether or not to have babies for probably as long as we have connected a swelling abdomen and absence of menses with having babies. Somebody decides, and the question is who. And that’s where it’s really hard.

When I was saying to you earlier about really needing to do more thinking about the end of life stuff. It’s because that’s why I have got a position perhaps, a moral positioning in terms of some of the end of life stuff, that’s probably quite different from somebody who would say there’s an absolute and complete equivalence, because it’s simply a matter of the nature of the entity that was once the embryo and is now the ancient demented useless person.

Whereas for me, the situation and the way that society can react, the way that we as other people can express our humanity towards that, and I do think there’s something that is, again, remarkable, in the way that we express our humanity in terms of our caring and love of other more vulnerable people, right the way through.

People say to me “isn’t this a remarkably, you know, selfish, dim view of humanity, are you only saying it’s only rational people etc.”. Absolutely god no, you know, because why would you not treat people well?

And that’s why I say I have a presumption in favour of life. It doesn’t concern me at all to say that, and I think that most women would rather prevent pregnancy than end one, and I think that is because we have a sense of when conception has happened, that that is something that is special and distinct. It may be something that we are abhorred by, or it may be something that we think, you know, the circumstances… Most women who come to BPAS are pregnant by someone who they actually liked! Most people are actually in a relationship with that person. In fact, overwhelmingly they come to the clinic with their partner, and it is a decision they have made together, that this is for the best. So many women will say “in different circumstances I would continue this pregnancy”.

H: It’s almost like they’re so close…

A: Yeah, and honestly, the way I look at it is there are a certain number of women who will basically say “get rid”. But for most women, there is a… if circumstances were different, they would make a different decision. Now, it may be that those circumstances are so wildly different that it’s not close at all. So it may be that “if I wasn’t 14”, “If I was 10 years older than I am now, I would make a different decision”, “If I wasn’t in the middle of my exams”, “If my boyfriend loved me”, “If my husband wanted the baby”.

In fact, one of the things that frustrates me enormously when we have discussion about legislation and so on, is people who have got a thing about wanting to reduce the time limit, because they can cope with the idea of early abortion, but not late abortion. Very often, the reason why you’ve got someone who’s presenting later is because they’ve been trying to make it possible for them to have the baby.

H: These difficult circumstances… Let’s make it worse: husband’s a drug addict, girl’s 14, they have no money. Whatever that might be, that’s really hard. It might be that they struggle. It might also be that 10/15 years later, they come out of that, and they have a son, or a daughter, who’s going to school, who they love. I would also say that when they’re in that situation, it’s really hard, but there isn’t an option to just passively undo it.

A: That’s right.

H: ‘Not continuing with the pregnancy’ is a euphemism that is used to create that illusion, but there isn’t an option to undo it. In order to get out of that, you have to kill someone.

A: Well in order to do that, you have to do one thing or the other.

H: You have to kill the foetus.

A: You have to kill the foetus, that’s right. You are ending that life that has started.

H: And it’s that woman who has to live with that. It’s nobody else, not the abortion provider, not the legislation, it’s that woman who has to live with that. I fully believe that you are somebody of compassion and caring, and that you are a truth-seeker who is really trying to work this out. I’m not sure if this has happened, but how would you feel about a woman coming to you 5 years later utterly distraught? Maybe they can’t have a baby now, maybe they say “I made the wrong decision, I was scared, I panicked, someone told me it was ok, I cannot live with myself.” How would you feel about that?

A: First of all, I would say that there will be women who make decisions they come to regret making. You know, we all do that, and you’re right – when you say the weight of that decision lies with that woman, I think that’s absolutely right, and I think it’s an incredible burden to place on her, it’s an enormous responsibility. But ultimately you can’t put the clock back. Every woman, and I’ve made this point publicly, there is no woman sitting in an abortion clinic who isn’t wishing she could put the clock back, because it’s a s*** place to be. You’re right, she has to do one thing or another.

But the point is that that is the responsibility that sits with us in the context of our lives and our position as mothers. We take responsibility for the lives that we create, and we take responsibility for the lives that we don’t. And there will be women who come back and say “I wish I had done something different.” But, you know, there will be women who will say “I wish I hadn’t had that child”, there are women who will say “We make mistakes in life”. But I agree with you – for you, because you take the view that you do, you find it almost unimaginable that someone can take that decision and live with it without being in some kind of complete denial.

And the only thing I can say is that it’s our job to, and I really mean it when I say that BPAS is an organisation that is driven by a very very very strong value based ethos, which is about putting women in the position where they are able to make the best decision for them in this situation, where it’s going.. You know, she’s there, she’s going to take one road or the other. And the best thing you can do is to ensure that in making that decision, women are able to genuinely weigh up all the possibilities, and all the help they can get, and that they understand exactly what it is that they are deciding.

When somebody comes as says “I have no choice”, it’s the job of our councillors to say “let’s talk about that, and let’s talk about the choices that you have”. “I haven’t got any money”, well have you thought about … The last thing that you want to do is to have someone going through a procedure and then saying “I wish I hadn’t done that because of …” Typically what will happen is that a young girl will come to you and say “My parents will kill me”. Your job really is to say “do you know what? They really won’t. Talk to your parents. They might be really cross with you, or they might not be”. It would not be a humane or good service to be in any way trivialising or downplaying or coaxing.

H: I trust that you fully believe what you are saying. But I should point out that the reality of it, even in BPAS, can become a case of “you want an abortion? Right, let’s get on with it”. That happens in BPAS.

A: That’s very interesting, because a doctor made that point at your meeting, and has subsequently written to me. We had a bit of a chat after the debate, and I said please put down what you’re saying.

H: Right, ok.

A: I think it’s absolutely true. If somebody comes and says “Yup, this is what I want. I’ve made up my mind. I don’t want to talk about it.” You can’t compulsorily council people through it. Not everybody has got the…

H: We do in medicine all the time.

A: Yeah, I know.

H: And it’s absolutely right. If some asks you to chop their arm off, and don’t want to talk about it, you don’t just do it. And this happens. You know “I want my gallbladder out”. We take people’s gallbladders out all the time, but we don’t do it just because they say they want it. You can die from that procedure. If they don’t need it, we don’t do it, because it’s not right for them, not because we want to exert any kind of power over them. It is better to say that if it’s not right for you, we’re not going to do it.

A: Sure. And there are some doctors who will take the view that abortion isn’t in the interests of a woman’s health, and will take a decision based on that. But that’s a different discussion. What we’re talking about here is where doctors believe that it would be legal, and where the woman does meet the grounds of the act. And then there’s a thing about how much you have a responsibility to unpick her decision. And it’s so hard.

H: You describe various situations of hardship, like if a woman has problems with finance. “Well have you considered this?” Oh well if you have considered this and it still would be difficult, then fair enough. Or have you considered this about your relationship, or your parents.. Oh well if you have, then fair enough, and let’s go ahead.
I do not buy this idea of “maybe it will be hard, so that makes it the right decision.” I think of my mother, for example, who has had 5 children, and is a surgeon. She was both advancing in her career, and there all the time when I was a child. A lot of my friends who are now young professionals in their late 20’s and thinking of having children really look up to my mother as an inspiration.

I think we really have a choice about what we say to young women. I think we can either say “Here’s this option, you can get out of it”, or we can say “No, actually you can do this. Here’s a woman who has done this.” or you can use a more extreme example. “Here’s a woman who had a baby at 14, didn’t want to, and now loves that child more than anything and has a wonderful life.” I think we should be saying that to young women.

A: Yeah but you see what we do is… There is such a temptation to build a kind of forward going narrative around the story that isn’t there. So you have in your mind the idea of the young woman who can have the baby and have a full career. Some women can do that.
It’s funny, I might talk to someone else who works in public health and says “Oh, the 14 year-old who has the baby but can’t breast feed it”, and all these other problems that’s going on. And she’s dropped out of school, but then by having the abortion she’s gone on to have a child at 24 and she’s perfectly happy with it etc. What you can’t do is construct stories for people’s lives. All you can really do is talk to them about the circumstances that they’re in, and let them make the decision for themselves, which is a really hard thing for us.

H: So people who want to commit suicide. Our reaction to that invariably, in law, medicine, society, if you see someone standing on top of a roof, is to say…

A: Don’t do it.

H: Yeah, “It will be ok, don’t do it.” But you don’t know that. Maybe they will continue to be unhappy. But we don’t go “Well fair enough, off you go.” You fight for them and say “It can be ok, here’s what we’re going to do for you.”

A: We absolutely 100% do.

H: But that involves creating a narrative. It’s not a false narrative, it’s a hopeful narrative.

A: It’s a hopeful narrative. But it’s one I think that is of a different kind of moment, and a different kind of decision making to the decision making of a woman who is making a decision about her unwanted pregnancy. And I think that, you know, I struggle. I would be lousy as a councillor. I can’t do the non-judgemental stuff. I’m a very judgy person. I have a really strong sense of what people do and what people don’t do.

H: And I think that comes out of caring and compassion.

A: Yeah, probably does actually. Maybe it comes out of compassion, maybe it comes out of a number of various prejudices, I don’t know. But I have a very strong sense of what I think is right and wrong, and what people should do and what they shouldn’t do.

But I honestly think that when a woman is in this position, the right thing to do is to provide her with the absolute honest information about what her options are, and for her to be trusted to make the decision, to seek the advice and support that she’s got from the people around her.

And I also think that the way you describe it is that it kind of has an image caught in it as the most vulnerable person. Actually, the people who come to BPAS, of the 70,000 people we see every year, many are people like, well I expect you’d never want to be in this situation, but they’d be people like your girlfriend, or your friend’s girlfriend and so-on, with caring partners who have talked about this until the cows come home. They’re normal people who have thought these things through.

H: Of course, to be consistent with the protection of choice and protection of moral autonomy, there’s those examples of people who know all the information and make a considered moral decision. To protect choice and moral autonomy, you also have to account for and allow the examples of, for example, the 18 year-old who comes in 3 times per year and says “I want another abortion, and I don’t want to talk about it.”

A: Well what you have to do is also look at the world in its entirety. To go to your point, you’re saying there are certain people who will appreciate the perspective that’s lasered in on the embryo. But there are a lot of women who will basically say, not for any morally perverse or ignorant reason “That’s not what matters. What matters is that I’ve got a 2 year-old at home who is absorbing all my attention and I need to give him that”. Their existing life means more to them. I know it’s so far away from where you are.

H: It’s simply not the case that people can’t care for more than one child. It’s just not the case. And what if that existing child grows up, finds out, and thinks “I used to have a brother, but you had an abortion”. If you’re talking about caring for the existing child, there’s that. If you’re talking about caring for the best interests of the foetus or potential child, how could killing it possibly be in their best interests? It doesn’t work.

A: It doesn’t work in your mind.

H: Correct.

A: Because of the weight you place on that.

H: But you’re trying to place weight on that as well, by saying it’s better for it not to come into the world.

A: I’m saying I place weight on it, but I’m saying I place less weight on the fingernails and the beating heart than I do on the family decision making.

Here’s the point that needs to be addressed: I think that what you and I would both really agree on is that we live in a society that actually really undervalues human life. And I think we both of us in different ways are struggling to look at how we centre a valuing to human life back in the picture. One of the things that I find abhorrent is the disposability that you say, you know, it’s like your geriatric ward. The idea that there can be this attitude that they’re just waiting to die and they’re a waste of resources. I find that absolutely abhorrent.

But I find it equally abhorrent that what people want to do is to imagine that non-human life has those qualities.

H: To humanise animals.

A: Yeah, to humanise animals and so-on. I think that is utterly degrading. Therefore, this question of how you pull out what is distinct about us sort of comes full circle.

H: I tried to pin you down on that a couple of times. Can I ask you a favour? Your chapter “Is it human, do we care?”  – can I ask that you read that again and just think about those qualities that define us as human?

A: I will definitely do that. I think there is something really important to be looked at about end of life issues. Because I think it speaks very much to these issues. But yeah, I will look at it again.

H: There’s just a couple of things I really wanted to ask you. This is an issue in which the stakes are high. I think both of us agree that what is happening here matters. You’ve written a book called “A moral case for abortion”, so you’re clearly an intellectual truth-seeker, who is trying to work this out. And you care. Do you ever worry about the consequences if you’re wrong? What if, at the end of this process, you realise you’re wrong. Do you ever worry about that?

A: [long pause] The reason why I’m slightly literally speechless in trying to frame an answer is because it’s what I’m wrong about. I find it very difficult to imagine what could be wrong in trying to enable women to have control of their lives, and to exercise their human agency. The opposite to that would be that people become prisoners of their biology.

H: I mean we’re all prisoners of our biology. We don’t choose when to get cancer.

A: Yes, but your whole job going forward is trying to mitigate that and turn it around.

H: Yeah, but obviously I don’t regard pregnancy as a disease.

A: Yeah, no.

H: Ok.

A: I think we would be back to the dark ages, and I find it all a bit hard.

H: I see it the opposite way. Let me try to make it more specific. I think that you might well say we’re allowing women to exercise their agency and make these choices.

I would absolutely argue that it’s not as passive as that. It’s not a passive exercise. What you do is create an option. Therefore, you have responsibility for that option. Through all the reasoning in your book and our conversations, you try to justify that, and I respect that. But my question to you again is what if that justification is wrong, and you are providing this option that is not just passive, it’s not morally acceptable, and it does kill humans with equal moral status? What would you do if that were the case?

A: The thing is, it’s like, I absolutely 100% accept that what we are doing is ending life. I absolutely accept that. It’s just that morally I privilege something more than that embryonic life.

H: But what if you’re wrong about that?

A: The point about it is that if I am wrong about that, then… I will have to live with the consequences of me having made the choice to work in this particular area. As I said, I’m a very judgy person. I could be judged on the courses of action that I take. And you’re right, it’s absolutely not morally neutral, because I spend a lot of time not only providing the service, but advocating why it is that women make these choices.

H: The reason I ask is that I’ve done that in my head. I’ve imagined what I would do if I was wrong.

A: Yeah, the consequences in terms of the moral weighting, of talking a few women out of being happily unpregnant, weighed against the death of 70,000, or what have you. You’re absolutely right, the safe bet is to… it’s whatsit’s wager isn’t it? Like it makes more sense to believe in God, because if you’re wrong, you know, you’re sort of throwing yourself in the right direction. But that isn’t how intellectual life works, is it?

H: Well the question is, does that represent something that’s true, or is that just an arbitrary choice?

A: Yeah. In terms of where I stand now, I have reasoned to the best of my ability, and I have really searched myself to examine what I think is the right thing and the wrong thing. And I honestly think that what we are doing is for good.

I genuinely believe that it is good for people to be able to make these decisions about how they and their families will live. And I genuinely think that if people think that they are not in a position to bring a child into the world, that it is right for them to be able to make that decision, and for them to also be able to live with that decision. Otherwise what you do is you take away people’s responsibility for their decisions.

H: I think what you do when you provide abortions is to take away the responsibility for that life. We say “You don’t have to take responsibility for this”.

A: As you said, that is not a light choice.

H: One final question if that’s ok.

A: Go on.

H: You mentioned in Oxford after the debate, which by the way was an excellent debate.

A: It was a lovely debate, I really enjoyed it.

H: Good. Two very good speakers, and it went to some interesting places. You said something I was interested in. You said that you found it interesting that so many of us students had come to university pro-choice, but found it intellectually unsatisfying and become pro-life. You said that you were challenged by that. What challenged you about that, and in what way?

A: What challenged me about it was that I can understand why people find it hugely dissatisfying and intellectually and morally inconsistent in the way that the pro-choice case is sometimes argued.

I think that what sometimes happened is you look at … well it was very interesting with your speaker. What she did is she went through a number of positions and pulled out the inconsistency of supporting early abortions and not late abortions. The inconsistency of supporting abortion for some reasons and not others. And I think that people see that as being representative of where we’re coming from.

This tells me how much work I have got to do, and what like minded people have got to do in presenting a case which is unpalatable. It’s a case of trying to get people to understand both where we’re coming from, because I think that.. You know, it’s a bit like that loose women thing, there’s almost a no-compute “Oh my god, how could you say that”. Well it’s, you know, I would find it utterly incomprehensible for someone to say they would support abortion up to 12 weeks but not any later.

H: I agree, that’s inconsistent. My answer to that is not to do it at all.

A: No, exactly. The point is that you either fall on one side or the other. One of the reasons I’m perturbed by it is that there’s been very little discussion of the kind we’ve had. I hope that as people get better at putting a more consistent case around what we’re arguing, that it might perhaps enable people to find a rich and moral position that is based on a sense of real autonomy and choice, because I think that’s where it falls at the moment.

H: I’ll let you get on.

A: It’s been really delightful talking to you.