Sir, - Dr Patrick Hanafin commented recently on the Medical Council guidelines on abortion, suggesting that these constricted a woman's right to "reproductive autonomy" (December 18th).
Each side in the abortion debate has employed the concept of "autonomy". Those in favour of a right to abortion seek to establish that the autonomy of the pregnant woman is compromised by her not being permitted such a right. Those arguing against a right to abortion argue that the foetus itself has rights - in short, is a "person" - and accordingly has its own right to autonomy; and this right must take precedence over any right of the mother's since its very life is in question.
The complexity of many of the ethical problems concerning abortion cannot find expression within such a framework of "strict autonomy". On the "anti" side, the situation of a pregnant 13-year-old victim of incestuous rape is seen as ethically no different from that of any other pregnant woman because the particular difficulties of the mother can have no effect on the status of the foetus as a "person". On the "pro" side, the insistence on the autonomy of the mother makes it theoretically difficult to place any limitations on the right to abortion.
Let me suggest a different analysis of the concept of autonomy that would permit a more fruitful debate.
The standard view of autonomy is based on a "free-market" view of society in which each individual is, strictly speaking, under no legal obligation to help his fellow man. In contrast might I suggest a concept of "maximal autonomy". This would be based on a view of society that recognises that we are not as separate islands to each other, and that consequently sees individual autonomy as being subject to a certain legal limitation. This means that if we are uniquely placed to save the life of another at no great burden to ourselves, there should be a moral - and legal - obligation to so do. Conversely, there would be no such obligation if the burden would, in all the circumstances, be too great for us to be expected to bear.
In the abortion debate, the relevant ethical question then becomes: "Is the burden of carrying the foetus to full term too great for the mother, in her particular circumstances, to be expected to bear?"
In answering such a question the age of the mother, her mental state, whether or not she was a victim of rape or incest, the possible disability of the foetus, and the stage of the pregnancies are all highly relevant. This is so even if, for the sake of argument, we accept that the "personhood" of the foetus exists at all stages of the pregnancy.
I suggest that the concept of "maximal autonomy" might permit a constructive debate on abortion, in marked contrast to the sterile dogmatism of both sides of the abortion debate when it is conducted within the arid framework of "strict autonomy". - Yours, etc., Gerry Roche,
Department of Philosophy, University College, Cork.