Why This Nurse is Pro-Choice

A few weeks ago, I was at triage when a pale young woman came in. She was suffering complications of a therapeutic abortion; we occasionally see post-procedure patients from the Morgentaler Clinic or some other provider of therapeutic abortions with ongoing bleeding or pain. A nurse colleague triaged the patient, and her distaste, even disgust, was evident with this patient. I was, I think, a bit appalled at her reaction. Afterwards I remarked she wore her feelings on her sleeve.

“I can’t help it,” she replied. “I think abortion is wrong, and girls like her use Morgentaler’s like birth control.”

About the same time some anti-abortion activists were arrested at Carlton University, causing a slight, if predictable uproar over free speech rights and anti-abortion activism. I might mention parenthetically I myself believe anti-abortion protesters have the right to demonstrate where ever they please, within reason: demonstrating on the doorsteps of the providers of therapeutic abortion would be an obvious exception, because it’s a rather obvious attempt at intimidation, not to exercise of the right of freedom of speech or assembly. I’m not particularly swayed by the university’s argument that graphic photography displayed offends the delicate middle-class sensitivities of Carleton students and should be safely tucked away. The world is sometimes a very ugly place, and seeing what offends or disgusts us helps our understanding of it. No sunshine or lollipops here, sorry.

Both my colleague’s reaction and the protests at Carlton were a reminder to me that figuring out the whys and wherefores of therapeutic abortion is always a challenge to me and, I suspect, many health care professionals in general. I’m decidedly ambiguous. Therapeutic abortions trouble me, especially those later in pregnancy, for reasons that I can only describe as instinctive, and probably emotional. But theological arguments* (as a Christian) or ethical considerations against therapeutic abortion leave me unmoved: there is always tension between the definite autonomy and dignity of a woman versus the putative dignity and autonomy of a fetus, if indeed those characteristics can be ascribed in such a way. To put it another way, I am fairly clear that a mass of cells in the womb at four weeks is not a person; it is alive, yes, and is human because it contains human DNA in the same way that a hair follicle or a bit of skin does. But the embryo is simply not viable outside the uterus at this point and potentiality, in the sense that an acorn has the potential of an oak, is not the same as actuality. Believing a whole person is somehow contained within a fertilized egg cell at conception, as anti-abortionists do, when between a quarter and a third of all pregnancies at this point onwards will end in miscarriage, suggests a very black, cosmic practical joke.

But at twenty weeks? I’ve seen fetuses miscarried at that gestational age. I’m not so sure. Is there a time between four and twenty weeks does that mass of cells becomes a person? Or does a person become fully human when it obtains self-consciousness, which may not occur for some time after birth? I don’t pretend to have all the answers. I don’t know when human life truly begins, except to say probably not within the first trimester; sometimes I have trouble even saying when it definitely ends.

That being said, for myself, though I may dislike abortion in some circumstances, I am determinedly pro-choice. From a purely nursing perspective, therapeutic abortion is a medical procedure, and I have a duty to support any patient seeking health care, whether I agree with that choice or not. All patients have autonomy and must be treated with justice  — that is, as equally as possible — when seeking health care. In the same way, I subscribe to the premise of supporting choice in therapeutic abortions: no enforced pregnancies, no enforced abortions. To follow the anti-abortion position to its logical end — no therapeutic abortion regardless of the harm done to the mother or particular circumstances such as rape or incest, as many now advocate — denies that essential autonomy of patients who might come under my care. Obviously, personally and as a nurse, I can’t support that position.

As a nurse, I am also somewhat of a political animal, and my pro-choice views are admittedly coloured by the ideology and attitudes of the pro-life movement. In short, to believe the pro-life movement is only about ending therapeutic abortion is either to be astonishingly stupid, or disingenuous. The abortion wars are really one of the many proxy wars between a modern progressive and secular state (which as a Christian I support without hesitation, because a secular society provides the only guarantee anyone and everyone can practice their faith, or not) and an unambiguous and retrogressive social and religious conservatism. A cursory glance through pro-life websites will bear this out: the anti-abortion movement is bundled with all sorts of tangential issues dear to many conservatives, like same sex-marriage, stem cell research and (my favourite, from the Campaign Life site) “Creeping Socialism”.  It’s probably fair (and ironic) to say the radically conservative political positions of most anti-abortion organizations have made me, the fence sitter, very strongly pro-choice.

In the end, I think it comes to recognizing that inflicting my uncertainty on others denies their free action. I realize we live in an imperfect world, and sometimes our choices and decisions sometimes come to picking between equally bad options. And yes, I do believe also that there are times when therapeutic abortion is absolutely the moral choice. In the end, it’s a conflict between faith and personal morality, and (someone else’s) autonomy, and in this case, the imposition ofpersonal belief has no place in professional practice. It’s an internal conflict not easily concluded, and I suspect for me personally, I will never fully resolve it. Frankly, I have enough trouble keeping my own socks pulled up without worrying about the foibles of others.

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*I don’t want to get into the theological debates here, but it seems to me the classic “clobber” texts of the anti-abortionists, e.g. “Before I formed you in the womb I knew you,” etc (Jeremiah 1:5) are taken, as usual with these things, out of context.

Another point: various Christian denominations have written vast theological treatises have been defending the practice of warfare, which has in the past century alone has featured the deliberate killing of tens of millions. This has been called a “necessary sacrifice.” I’ve never been clear, in this context, why abortion is a sin and warfare isn’t.

[Cross-posted at Those Emergency Blues]