A Health Disparity Framework for Abortion Eliminates Critical Discourse and Debate.

Abstract

Bioethicists enter into conflict routinely, artfully applying knowledge of ethics, law, medicine and psychology to high stakes human interactions in health care settings, as facilitators and collaborators. Bioethicists understand that there are legitimate concerns and truths on both sides of a conflict. In her paper, “The Ethics of Access: Reframing the Need for Abortion Care as a Health Disparity,” Watson’s assertion that bioethicists should consider endorsing such a reframing of the abortion access issue may seem viable when considering the changing landscape of abortion access in a post-Roe context. However, this is based on the erroneous assumption that all bioethicists either are, or should be, aligned with one ethical framework with regard to reproductive rights. Mainstream bioethics tends toward hegemony on abortion; a hegemony that has resulted in an oversimplification of the issue and inadequate moral space for healthy, critical discourse and debate on the ethical complexities associated with abortion and in this case, abortion access. In the current social context, the term, “health disparity” is inexorably linked to the overlap of inequalities related to race, healthcare access, and health outcomes. Thus, the term ‘health disparity’ enshrines associated issues within a normative ethical value that few mainstream bioethicists would consider appropriate fodder for criticism. But is this helpful or even accurate? The suggestion to reframe access to abortion as a health disparity is somewhat misleading since the data show that 75% of women who access abortion care are poor (Jones et al. 2019) and 40% of all black pregnancies end in abortion (Abortion Surveillance United States 2019). Access to abortion does not appear to be the disparate variable, particularly among those in the most vulnerable populations. Seeking ways to reframe abortion in order to fit current normative categories facilitates the dynamic of reducing the abortion discussion to the binary notions of “reproductive rights” versus “pro-life”. In bioethical discourse, neither of these representative terms fully captures the ethical complexities of abortion or access to abortion. Watson (2022) mentions the “intermediate space of pluralism” as a place where women are neither forced into abortion or prevented from obtaining one. This concept can be a first step in deconstructing the traditional binary approach to abortion. A binary dynamic, fueled by ideological rhetoric promotes moral hegemony among group members. When binary stances are deconstructed, moral space is created with the attendant opportunities for mutual understanding (Beaty et al. 2021). One example of this approach is the professional responsibility model of perinatal ethics introduced by Chervenak and McCullough (2015). In this model, rights-based reductionism is criticized for giving the fetus an unconditional right to life and for giving a pregnant person unconditional rights over her body. The professional responsibility model of ethics includes obligations to both the maternal and fetal patient, including the balancing of beneficence, autonomy and justice for both patients (Chervenak and MCCullough 2015).