Almost all discussions about reproductive ethics are invariably deformed by analogizing to abortion. The train of thought goes something like this: the conclusion of an ethics discussion must result in confirming the right to abortion; anything that limits a woman’s reproductive choices could potentially impact the right to abortion; therefore, there can never be any limits to women’s reproductive choices.
That argument is weak, wrong and does not consider what the “choice” in pro-choice actually means. The “choice” is the decision to have an abortion, and it does not extend to any possible choice in reproductive ethics. That’s why Nadya Suleman had a right to get pregnant, a right to terminate the pregnancy and a right to carry it to term. She had no right to deliberately conceive octuplets, however, and it is a misunderstanding of reproductive rights to claim that she did.
Ultimately the protection for the choice of abortion is rooted in the right to bodily autonomy. No one can interfere with a person’s right to control his or her own body. No one can force an individual to donate a kidney, to accept a particular medical treatment, or even to accept lifesaving care. The individual has no obligation to do any of those things, and always has a right to say “no.” But that does not mean that the converse is true. Bodily autonomy is the right to refuse various measures, but there is no concomitant right to undergo whatever medical procedures one might wish.
Similarly, the right to an abortion is rooted in the right to refuse to continue a pregnancy, particularly because pregnancy has a small but real risk of death. No woman can be forced to remain pregnant against her will.
Bodily autonomy allows the individual to refuse to donate a kidney. It does not allow the individual to have a doctor remove his kidney to sell to someone else. It also does not confer the right to have a leg amputated or an eye put out, simply because the patient might desire it.
Bodily autonomy means that patients have the right to refuse cancer care even if that might lead to death from cancer. It does not mean that they have the right to receive chemotherapy when they don’t have cancer, because they want to see what chemotherapy is like. Nor does it mean that they have the right to demand unapproved medical treatments or inappropriate medical treatments, no matter how much they believe that they might work, or how desperately they want them.
The right to an abortion implies a concomitant right to get pregnant spontaneously and to carry a pregnancy to term. Yet women who cannot get pregnant have no “right” to infertility care. Moreover, even if they are paying for infertility care, they have no right to dictate inappropriate fertility treatment or unapproved fertility treatment. That means that there is no right to demand an excessive number of embryos to be transferred even if that’s what the patient might want. The current medico-ethical recommendation for women under the age of 35 is two embryos. There is no “right” to demand more, and the right to control one’s own body does not confer the right to demand more.
Nadya Suleman had no “right” to conceive octuplets. She had no “right” to demand that 8 embryos be returned to her uterus, and the doctor had no “right” to put them there. If, as seems more plausible, she conceived octuplets using fertility medication, she had no “right” to take excessive doses of medication, and certainly no “right” to take fertility medication if she did not meet the medical definition of infertility.
In the rush to protect abortion rights, people should not ignore the rest of medical ethics. The right to end a pregnancy does not confer the right to begin one using artificial means. The right to selectively reduce a multiple pregnancy does not confer the right to create a multiple pregnancy of any number of embryos. In fact, the right to control one’s body does not confer the right to demand medical treatment of any kind if it is not medically indicated.
The “right to choose” is the right to choose to terminate a pregnancy; it does not confer a right to choose anything, even if it is a reproductive choice.
