Abortion and Healthcare

If one human being cannot demand the use of another’s body for their own benefit, access to abortion must be protected by the same principle.

Roughly once a month for the last few years I get a call from the local blood bank.

Because I’m type O- and used to give blood regularly, they reach out hoping I’ll be willing to schedule an appointment to give blood again and help relieve the current blood shortage.

For a variety of reasons, most of which have to do with the fact that there isn’t a donation center in the city closest to me (a city which is still an hour away) and the fact that I can’t really take time off from work as a freelancer, I haven’t been able to give.

I’m perfectly willing to give blood if I were able to do so in a reasonable amount of time, and I understand that the need is urgent and very real. I was actually about to schedule an appointment to go in when I caught Covid a little over a month ago.

But, despite the fact that my particular blood type is in high demand, and that my history shows I am theoretically willing to give blood once a month as I did in the past, no one has shown up at my door demanding that I give blood right now.

The calls from the local blood bank aren’t like the letters you get when you’re summoned for jury duty.

I can say no. In fact, I don’t even have to respond at all if I don’t want to.

Even though my donation could make a difference in the outcome of someone else’s life-or-death emergency.

Knowing all of that, I probably sound pretty callous right now. After all, what’s 3 hours out of my month compared to someone needing a blood transfusion and a shortage of all blood types, but especially my universal donor type O-?

I’m in good enough health to donate. Hell, there’s a slim possibility that the active covid antibodies in my bloodstream right now might be even more helpful for a potential transfusion recipient, or that my donation could be collected and my antibodies used to further the science behind treating Covid-19.

All of these are good and worthy reasons to donate. I probably will in the near future.

But the thing is, no matter how critical my donation might be, no matter how many people I could help by becoming a monthly donor again, no one can force me to do it.

At the end of the day, any part of my body that is still connected to me is under my direct control. I can refuse to help others by donating blood, organs, or any other part of my body. I can refuse medical treatment for myself if I don’t want my body treated that way or if I have a religious or moral objection to the treatment.

Well, there are a few parts of me that are currently exempted from body autonomy. Or at least, a few parts of me over which I do not have complete body autonomy.

Specifically, those parts are my uterus, fallopian tubes, and ovaries.

Thankfully, I live in a state which protects the right to an abortion. Even one of the more forgiving states that places fewer restrictions on that right than many others.

Theoretically, if I needed an abortion and was within the legally mandated time frame after conception, I could receive one with few questions asked, and without any legally mandated propaganda being read to me before I agreed to the procedure.

But that doesn’t mean that I could go to a doctor and ask for a sterilization procedure and expect to start that process. Likely I would be told that I’m too young, don’t have the requisite number of kids, and asked if my partner consents to my sterilization.

I have some control over my reproductive organs, but not complete control.

If I didn’t have a partner or my partner was a woman, I might be asked what would happen in the future if I settled down with a man who wanted kids, and what I would do then.

Saying that I would prefer to adopt might not be enough incentive.

In fact, if I were determined to have a sterilization procedure, I might have to argue the reasons I might not be a fit parent, or with concerns about my genetic heritage and that I was worried I might pass on an inheritable genetic condition to any biological children.

Those hoops prove that I do not have full body autonomy.

They might be there out of a sense of protectiveness, trying to prevent people from moving forward with potentially irreversible decisions out of a benevolent desire to protect then from harm, but it’s still a lack of autonomy.

Worse, the idea that people assigned female at birth, women, non-binary people, and trans-men included, cannot make decisions about their bodies for themselves is incredibly paternalistic. It’s a result of both governments and the medical system deciding that you cannot fully understand the issue and are therefore incapable of making this decision yourself.

That this attitude is leveled particularly at people assigned female at birth, people who historically have worse medical outcomes and often receive different medical treatment than people assigned male at birth, makes the issue worse.

On a fundamental level, abortion, like sterilization procedures, blood and organ donation, and any other medical procedure, is an issue of body autonomy and free will.

Arguments about when abortion is and isn’t allowed, medical necessity, and about when life truly begins are useful only if we assume that, at a certain point, people with uteri have less fundamental right to their bodies than others.

If a fetus has the right to supersede my body autonomy with their own that is fundamentally different from how we approach body autonomy in any other circumstances.

If the President of the United States or the reigning monarch of the United Kingdom desperately needed an organ donation and I was the world’s only known match, I would still not be legally compelled to donate that organ. I especially would not be compelled to give that organ if doing so put my own life or health at serious risk.

Arguably, I am a less important person than either of those two figures. Certainly, I am a less influential one and have less power and a smaller impact on the world.

Nonetheless, were my life on the line, I could say no. The decision, ultimately, would be mine.

Why does a fetus have more power in this situation than the President of the United States?

Pregnancy is, by its nature, risky. No, I’m not talking about labor and birth specifically, though those things have their own associated risks. Just being pregnant and carrying a baby have their own risks, whether you carry that baby to term and give birth or not.

Yes, some of those risks are temporary, but some are not, and all of them need to be managed carefully and can cause significant long-term changes to the body of the pregnant person.

We give people the right to control their health in almost all other situations. Why not pregnancy and reproductive health in general?

Take a common example: an active smoker with lung cancer.

Most people, especially most smokers, know that smoking increases your chances of getting lung cancer significantly and that it can also increase the severity of cancer if you do get it.

With that in mind, it can be argued that people who smoke are accepting the risk of getting cancer in much the same way that people who have sex accept the risk of getting pregnant. While pregnancy is less likely to have severe complications or kill you, it can, and sometimes does, do both.

Smokers with lung cancer are allowed to access treatment for their cancer. Pregnant people should be allowed to access care for their pregnancy, equally, no matter what kind of care they choose. Pregnancy care should include both medical care aimed at managing risks and helping ensure better outcomes, and medical care designed to end the pregnancy, regardless of the pregnant person’s reasons for wanting that care.

If at some point over the course of cancer treatment, a smoker decides that they no longer want treatment for their lung cancer, that is their right. It could be that the treatments are too arduous, or that living with lung cancer becomes too painful, or simply that they decide it's time and they would rather live however long they can without treatment.

Doctors may make alternative recommendations, but at the end of the day, the patient has the right to refuse treatment and even to some extent, to dictate which treatments they receive or don’t.

Similarly, pregnant people should have the right to control what kind of pregnancy care they receive, and at least some control over when and how they receive it.

Now, to be clear, I do think there is an argument for some amount of restriction — but I also think that we should actively consider those arguments and decide if they have merit in the face of the overwhelming importance of body autonomy.

I’ve very carefully avoided comparing the current situation to Margaret Atwood’s The Handmaid’s Tale, not because I don’t think that those comparisons are important or that there isn’t something to be said there, but because the discussion of body autonomy isn’t just about pregnancy.

Body autonomy is a central and critical issue in almost all healthcare discussions. Having had my body autonomy violated by medical professionals in the past, like when I attempted to refuse an ambulance and wasn’t allowed to do so, I have firsthand experience with how important this issue can be.

Women and people with uteruses aren’t the only people affected by our decisions as a society. Everyone is affected at some point, whether it be because they are born to a woman who decides to give them up for adoption, because they are forced to pay for a child’s existence because they helped conceive them but weren’t up to the task of parenting, or because of the social cost of funding adoption and foster care programs, protecting kids, and other economic burdens that fall to society as a whole.

And those problems are entirely separate from the reality that abortions will continue to happen whether they are legal or not. It’s simply that more people will die in the pursuit of an abortion than before.

Read that again. I’m not going to frame this as safe abortions are the ones that will be harder to get. That’s true, but it also softens the issue.

People will die because they are seeking abortions, and society has made safe abortions harder to get.

People will be killed because someone made a mistake while providing an abortion, even if they never meant for that to happen.

But, most importantly for this essay, we will have told every person who can get pregnant that their rights to control their bodies matter less than the rights of anyone who can’t get pregnant. That their very existence, in many ways, matters less than the theoretical zygote and eventually fetus that might one day need their support to survive.

Why will we be saying that?

Because we’ll be arguing that that theoretical zygote’s right to a chance at life, no matter how slim or non-existent that chance may be, matters more than the pregnant person’s right to their own life or to decide how they want their body care for.

(Remember, many places have no exceptions for the manner of conception or the health of mother or child — and even the places that do have those exceptions may make abortion so difficult to get as a practical matter that the exceptions make no difference.)

As a practical matter, this isn’t about the morality of abortion or whether getting an abortion is the right thing to do. People are allowed to make immoral decisions all the time. Something being wrong, from a particular moral perspective, doesn’t automatically mean it’s illegal. Similarly, making something legal doesn’t necessarily mean it’s good or right.

Instead, the right to an abortion is a matter of how much control we have over our own bodies and who can decide whether we have that control or don’t.

Personally, I’ve grappled with whether I would be willing to have an abortion. How bad would a pregnancy, my overall health, or the situation would have to be before I would be willing to consider one?

I don’t have an answer to that question. And, unless I someday get an abortion, I probably won’t ever answer that question.

Instead of making judgments or deciding that my choice should be everyone’s choice, I argue that every person who can get pregnant deserves the right to grapple with that decision. Further, taking that decision away from them means that, where matters of reproductive rights and health are concerned, we’ve created a class of secondary citizens. People who do not, for whatever reason we use to justify the decision, do not have the same control over their bodies.

These decisions have broad and far-reaching consequences.

We must if we believe in equal rights for women and everyone who can become pregnant, protect the right to abortion and to pregnant-patient-centered pregnancy care.

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