When one fetus lives and one dies

BRUCE WALLACE August 19 1996

When one fetus lives and one dies

BRUCE WALLACE August 19 1996

When one fetus lives and one dies


The unnamed woman is 28 years old and a single mother to one child already—although the doctor who spilled her most private medical details to a British tabloid last week later insisted he had altered some facts to mask her identity. She lives in what the doctor conveyed to Sunday Express readers as “straitened” economic and social circumstances. She was also 16 weeks pregnant with twins.

So when the woman told Dr. Phillip Bennett of London’s Queen Charlotte’s Hospital that she could cope with one new baby but not two, he reluctantly agreed to her request for a “selective termination”—to abort one of the twins by injecting an anesthetic agent into its heart or bloodstream. “Killing one healthy twin sounds unethical,” said Bennett, who knew the sex of each fetus but did not tell the Express how the harrowing choice— which one lives, which dies—was reached. But, he said, it was better to follow the mother’s wishes and “leave one alive than to lose two babies.”

Not good enough, according to anti-abortion groups and their supporters. Bennett’s professional indiscretion offered up a new twist on an old debate, and the particulars of the anonymous woman’s case were soon being recounted and analyzed on national television, in newspaper columns and over pints of beer in pubs across the kingdom. “The whole prospect for her and both of her babies is horrifying,” pronounced Phyllis Bowman, director of the Society for the Protection of Unborn Children, speaking on BBC radio about a woman of whom she knew nothing more than what was contained in a few paragraphs of a Sunday tabloid. “So far as we are concerned, one baby is being killed. It will be left in the womb, its brother or sister growing beside it.” Led to believe by the tone of the Express article that the abortion had not yet occurred, various donors offered the woman financial aid totalling over $100,000 and some babysitting help if she agreed to carry the fetus to term. And within two days of Bennett’s revelations, the anti-abortion lobby sought—and won—a court injunction to stop the operation.

Too late, as it turned out. A chastened Bennett, tracked down outside his London home, told reporters that his patient had, in fact, undergone the abortion a month before. Bennett then retreated from view, awaiting the seemingly inevitable investigation by the hospital and the doctor’s professional council into why he would propel such a private matter into the public sphere. His patient, said a short statement issued by Queen Charlotte’s, “is adamant that she does not want any more details put out.” The offers of financial help disappeared. The court case was dropped. “The subject matter,” ruled high court Judge Sir Michael Turner, “has evaporated.”

Only in the narrowest sense. This may have been just one of the roughly 165,000 abortions that will be carried out in Britain this year, but the “instinctive horror” of its uncommon circumstances, as the British Medical Association’s head of ethics, Dr. Vivienne

Nathanson, put it, invigorated the ever-bitter slanging between the abortion debate’s two poles of opinion. The quickly mobilized defences of pro-choice activists denounced the pledges of financial aid as a stunt. “This case is part of the anti-abortionists’ campaign to fight to abolish abortion,” alleged Dr. Wendy Savage, a prominent gynecologist and pro-choice advocate. “The money that was being offered is like auctioning an unborn child.” Anti-abortionists were unmoved. “Anything that calls attention to the plight of unborn children helps us,” said Brendan Gerard of the Society for the Protection of Unborn Children. He said that the case exposed the British abortion law—revised just six years ago to allow terminations up until 24 weeks of pregnancy, if two doctors attest that either the mother, unborn child or other siblings face a health risk because of the birth—to be “nothing more than abortion on demand.”

But in a morality struggle where philosophical arguments have been aired to the point of predictability, both sides readily latch on

to any new development, however exceptional, to press their case. Four years ago, it was pro-choice defenders who used the instance of a 14-year-old rape victim in their fight to relax the Republic of Ireland’s constitutional ban on offering medical advice on obtaining abortions. “In that case, extreme circumstances were used as a platform to push for abortion on demand,” countercharged anti-abortion spokesman Gerard. Just two weeks ago, Britain’s anti-abortion lobby led a fight against the thawing and destruction of up to 3,300 frozen embryos— artificially fertilized eggs that were left unclaimed by their parents after a five-year time limit expired. Over the protests, the microscopic embryos were legally destroyed.

Yet despite the headlines and the hand-wringing, most medical ethicists shared the opinion that the new cases « have not altered the moral core of the debate one bit. “The gut response to the arbitrary killing of | one person over another—as the anti-abortionists g

see this latest case—means that their repugnance 8_

is being expressed in a new context,” says Raaman Gillon, editor of Britain’s Journal of Medical Ethics. “But the basic moral issue remains the same: anything you can say about the termination of the twin, you can say about any abortion.”

In fact, while selective termination remains rare, it is no longer an extraordinary procedure. British doctors performed 73 selective abortions in 1994, and the growing number, say experts, is largely due to the increase in pregnancies by in vitro fertilization. When fertility treatment produces several embryos in women for whom a multiple birth might pose health risks, doctors can now abort all but one fetus. The procedure is normally carried out around eight weeks into the pregnancy. Using ultrasound scanners to locate the unwanted fetus, which

A British doctor sparks a public furor over the ethics of 'selective termination'

at that stage is only about an inch long, doctors are able « to inject a drug to slow, and then stop, its heart.

I In last week’s sensationalized case, many anti-abor^ tion activists used graphic and ghoulish imagery to de5 scribe what follows, suggesting that the traumatized, U surviving twin would share space in the womb with a k shrivelled, mummified sibling. Nonsense, said a Lony don gynecologist and obstetrician who performs selec! § five terminations but requested anonymity to avoid be¡ * coming embroiled in the furor. “The notion that some JI kind of creature will emerge is a holdover view from the 1960s, when a twin who might die spontaneously in the womb, late in the pregnancy, could emerge looking like a mummified small baby with the placenta wrapped around it,” he said. “In this case, even at 16 weeks, the aborted fetus would become nothing more than a scar on the placenta. Only a trained eye would even be able to tell that another fetus had been conceived. A father watching the birth would never know.”

Some pro-choice advocates remained unperturbed by the abortion debate’s growing concentration on the difficult, delicate cases posed by new technologies. “New medical technology should be welcomed as giving women a greater degree of control over their bodies,” said Ann Furedi, author of Unplanned Pregnancy: Your Choices, a 1996 book that canvassed British women about why they chose to carry, abort or give their babies up for adoption. “It remains barbaric to try to force a woman to endure a pregnancy against her will, and this particular woman obviously felt that this solution was the best for her. She was able to manage

the particulars of her pregnancy where, just a few years ago, other women would not have had the option. The only question any woman should be asking herself after this is whether she can trust her doctor to respect her confidence.”

But there was another body of pro-choice defenders who confessed to being vaguely unsettled by the application of the new technology. “I find her reported request a strange one,” said Savage about the decision to abort one twin and keep the other. “It is one thing to have terminated a pregnancy when it is a one-off thing. But when you have got twins and one is aborted, you have the live twin in front of you as a constant reminder.”

That still-murky science surrounding the special relationship between twins may have tempered the enthusiasm of some prochoice defenders last week. Jen Coldwell has no doubts about

the psychological impact of losing a twin. Now 48, her twin brother died when they were 22. Trying to cope with his death led her, years later, into the Lone Twin Network, a support group for 400 or so surviving twins. “Normally, I am for abortion, and I feel very uncomfortable being anywhere near the same side as hardline conservatives,” said Coldwell, who spoke movingly about “how desperately sorry I feel for the poor mother, who has been jumped on by the whole country and is probably now hiding under the duvet from a press that is trying to track her down.” But, she continued, “I imagine that the surviving twin will feel an enormous, gaping, aching sense of loss for the rest of his or her life. Lone twins feel terrible guilt for being the survivor. You feel it might have been your fault that they died.”

There may indeed have been no new moral ammunition wielded in the abortion war that raged through Britain last week. The arguments surrounding one woman’s ordeal may have been, as ethicist Gillon described, “no different from any other abortion, except that it gave the issue another run in the media.” But he also noted that people “should not underestimate the importance of gut instinct when it comes to flagging moral issues that matter to them. Our nature is to say, This unsettles me, so maybe I should look at this again.’ ” It would not be surprising if, after facing the circumstances of this particularly difficult abortion and the way it was sensationalized, more people find themselves abandoning the camps of the convinced—and crowding onto the unsatisfactory uncertainty of the middle ground.