What Unique Moral Questions Are Raised by Pregnancy?

In her new book, The Ethics of Pregnancy, Abortion and Childbirth: Exploring Moral Choices in Childbearing, British bioethicist Dr Helen Watt addresses that question from a philosophical angle. In this interview with the Social Trends Institute Dr Watt outlines the unique moral problems raised by pregnancy.

Q. Your book title begins with ‘The ethics of pregnancy’ – what does that mean?

A. ‘Ethics of pregnancy’ is a rather unusual term – if you Google it, you won’t find very much – but there’s a rich area to explore here of connections, roles, bonds and opportunities as well as rights and duties which we just don’t find elsewhere.

Of course, some moral concerns that apply to pregnancy do apply to human beings more generally. However, there are also concerns unique to pregnancy, permitting or restricting decisions of various kinds that might be made by the woman or those around her. The woman is not a mere ‘foetal container’ or even ‘helpful stranger’ or ‘babysitter’ to the foetus: her very specific bodily relationship with the baby gives her very specific rights as well as duties.

Can you give me some examples?

Yes – one obvious example would be the right of the woman to keep and raise the baby after birth. That also applies to a woman who is not the genetic mother but a so-called ‘surrogate’ mother who carries the child for the benefit of others.

It is wrong to take a child from a surrogate mother who wants to keep it: the law itself recognizes, at least in many parts of the world, her right to keep the baby. Pregnancy makes a woman a mother – even if motherhood has already been fragmented between genetic and gestational motherhood.

The birth mother, including a surrogate mother, has rights and also duties to raise the child or otherwise ensure the child’s well-being as best she can. Special rights and duties also exist before birth: I argue in the book that the right and duty to be ‘there’ for the baby – or at least, not to be deliberately separated from it – is particularly strong while the two bodies are still very closely connected and the baby is too young to live outside the mother.

The woman’s unique bodily and familial role very much includes guardianship of the pregnancy more generally: she has the primary right to make judgment calls on things like food and drink and medical treatments for her baby and herself. Again, the woman is not a mere babysitter: she is already a parent and moreover, a parent of a special kind – the ‘body-parent’ who is therefore the guardian of the baby in a rather strong sense. Many decisions should be left to her ultimately – although there is nothing wrong with respectful offers of help and information which she may need to protect her own health and the baby’s.

Do you deal with ‘hard cases’ like medical situations where the woman’s life is at risk?

Yes, I think we need to look carefully and honestly at these cases (for example, where the pregnant woman has a heart condition) and ask what exactly is, and is not, required for everyone’s rights to be respected. All too often, those who really do want to respect the rights of both woman and baby ask only one question when considering some proposal: ‘Is the baby’s death intended?’ The answer may be no – even for interventions which are in fact quite violent and very much focused on the baby and not just the mother. But there are other questions we need to ask, just as with other kinds of ‘vital conflict’ resolution – lethal separation of conjoined twins, for example – where a bodily assault of some kind is involved, even if there is no aim to kill.

In the book, I try to show that avoiding the aim to kill is not the only absolute moral principle to respect: bodily respect for both mother and baby goes well beyond that. Of course, treatments that target the woman’s body alone are different again – the classic example here is cancer treatment, where no moral absolute is engaged, even if risks to the baby should be minimized where possible (in fact many cancer treatments do not harm the baby).

What about pregnancy after rape – does the book discuss that too?

Once pregnant the woman is already a mother, as many women acknowledge. Women can be courageous in protecting – or at least respecting – their children even in the most adverse circumstances. When writing the book, I read narratives of women who took their role as mother very seriously and welcomed the baby in some extremely fraught situations. And that includes women who became pregnant due to rape: I was surprised (though I should not have been) to see how many women in that situation not only carry their pregnancy to term, but actually keep and raise what they see very much as their own son or daughter and not just ‘the rapist’s child’.

And pregnancy where the baby has a terminal condition like anencephaly?

In writing the book, and even more since I finished it, I’ve learnt more and more about how women and men can treasure their time with a child who after birth may have only days or hours to live. I’ve read some beautiful comments from parents, with some saying that the very short time – in some cases, minutes – they had with the baby after birth was the most precious time of their lives. Pregnancy itself can be treasured while the baby is still with the mother and still alive. To be given a very adverse prenatal test result is of course devastating, and parents as well as their medical team and family should be aware of positive help available. The perinatal hospice movement can be a lifeline through pregnancy, as can parent networks such as Be Not Afraid, Every Life Counts and so on.

You mentioned surrogacy earlier; what about reproductive technologies in general – do they affect our view of pregnancy?

Yes, they certainly do seem to affect it: the symbolic structure of conception seems to be important in helping to shape parental attitudes of conditional or unconditional acceptance. One woman who found she was pregnant with twins after IVF using donor eggs asked for the twin pregnancy to be ‘reduced’ to one baby, which is not at all unknown; she confessed that the whole process had been so ‘consumerish’ already that the number of babies seemed just one more thing to control.

Many IVF embryos are of course discarded before any pregnancy begins, so the ‘products’ of the IVF ‘production process’ do tend to be treated in some ways more like manufactured objects than as human lives with their own moral claim. That is all the more reason to offer couples alternatives to IVF (NaproTechnology would be one example) that may help them have a baby while still respecting their relationship with each other and with any life conceived.

What has been the response to the book so far?

The response so far has been positive – I’m particularly pleased to have had good feedback from non-philosophers, as I’m writing from a philosophical background but not only for those who share that background. I’m very grateful that people are reading the book, which at least keeps the conversation going. The meaning and value of pregnancy and the rights and duties it carries are worth looking at in greater depth, not just because they are interesting in theory (although they are certainly that) but because they matter so much for people’s lives.

This article first appeared on the website www.socialtrendsinstitute.org and is reprinted here with kind permission of the Social Trend Institute.