Sunday, 30 December 2012

My New Year prediction for hot debate, epicure and all that.

A New Year is a time for prediction; for considering what prospect the new year holds. My prediction is that there will be renewed efforts to change the law on abortion.

A few years ago I was being interviewed about the ethics of human embryonic stem cells on the Stephen Nolan Show on BBC Radio Northern Ireland. I was presenting the standard utilitarian case for the use of human embryonic stem cells; that the benefits might be considerable in potential treatments for damaged tissues such the spinal cord or the eye. The developments of new tissue from implanted stem cells might cure paralysis or make a blind person see. A listener phoned in to ask 'where is God in all this?' A question Stephen Nolan repeated to me. It raised the question of whether there are or should be any limits to the development of new treatments; of whether there should be any no-go areas for science and medicine. Should there be a boundary that is not crossed no matter how great the potential benefits? If there is no such boundary then what would be the ethical and moral yardstick?

Boundaries are useful for a variety of reasons. They give some assurance to others that they exist and that there are limits. They act as a brake. Some would say they are a brake on progress, others that they prevent us going too far down a 'slippery slope'. I often told my students that boundaries are there for you to get your ethical clothes snagged up in. At least you have to spend time thinking about how you will get yourself free from the snags. Boundaries have a habit of creating new dilemmas. What to do at the boundary. Boundaries beg the issue of whether there are or can be exceptions. Sticking to a boundary simply because it is there, without question, would be unethical, particularly if sticking to the boundary leads to preventable harm. Following rules isn't itself ethical. Boundaries are a bit like the trenches in WW2, you spend a lot of time trying to go over the top of them and often arguing about whether they are in the right place.

Boundaries are a social and political construct. We argue around and about them. Few are ever really satisfied with them. An example is the gestational age limit for abortions. It is a fine judgement that it should be 24 weeks rather than 20. Usually the argument is about 'viability'. A fetus at 24 weeks is now potentially 'viable'; it can be born and has a good chance of survival. A baby at 20 weeks would not be able to survive. But 'viability' changes. Two decades ago we would have said that a baby born at 24 weeks would be unlikely to survive. Whether this should shift the boundary depends on why the boundary is there. But it also depends on the nature of the decision about termination. Shifting the boundary would shift the focus to exceptions; and there would be many legitimate exceptions. It would make more difficult what is already a difficult decision. Shifting boundaries often creates more difficult ethical dilemmas than those the boundaries were created to solve. It might make society feel more 'moral' or 'self-righteous'  but it might not produce a good ethical outcome.

In relation to the boundary for late abortions, it would be well to remember that it is 12% of all abortions. But many of the arguments presented refer to the total of all abortions. There are too many we  are told, therefore there needs to be a restriction. Something needs to be done, so let's change the boundary. Yet the overwhelming majority of termination occur before 12 weeks; a long way from the boundary! Shifting the boundary would simply make it more difficult for those whose decision is already difficult. It won't address the problem of numbers of abortions; if indeed it is a problem.

So why do I predict there will be further ardent debate in 2013? The reason for my prediction is that a new update of the epicure study is due to be published in the new year by the prestigious medical journal, BMJ.  Epicure is a series of studies of survival and later health of those born at extremely low gestational ages - from 22 to 26 weeks.  The report will no doubt generate considerable debate.

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