Choice and Ethics: Discuss Amongst Yourselves


I just caught a segment of Hardball in which Chris Matthews talked with Will Saletan of Slate and Ken Blackwell of the Family Research Council about Will’s New York Times op-ed on responsibility and contraception. Will is hawking a tough message: pro-choice on abortion but heavy on the moral responsibility to avoid pregnancy when you don’t want to have a baby. It’s head and shoulders above the phony prevention message of those who are anti-abortion and can’t say the "C word" (contraception) or talk about sex, but it is difficult to make clear that abortion is a morally justifiable choice if one is pregnant and doesn’t want to or can’t have a baby, but is morally complex enough that it’s a very good idea to work really hard to prevent it.

On MSNBC’s Hardball with Chris Matthews Slate’s Will Saletan and Family Research Council’s Ken Blackwell, debate how to get past the culture wars and whether there’s an ethical responsibility to use contraception.

Will got trapped twice. Once when Matthews pushed the idea that contraception was a lesser evil to abortion, and Will agreed – I’m sure he doesn’t think contraception is anything other than an unmitigated social and moral good. And again when he fell into an ill-defined notion of discouraging abortion. I take these moments with a grain of salt; talking about morality on political talk shows is a no-win situation, but one that cannot and should not be avoided. We just need to get better at it every time. Moreover, those of us who are pro-choice feel stung whenever anyone suggests there is something we need to change and we tend to forget the tough message Will is sending to the Catholic Church and so-called progressive evangelicals like Jim Wallis. To them he is saying unequivocally: stop talking about prevention without contraception. This was the strong point of his Hardball appearance. A straightforward acceptance of sexuality as part of the human condition – and a good part.

I’d missed Will’s Times piece on the issue but caught Jodi Jacobson’s reaction and the comments on RH Reality Check last week.  I found the RH Reality Check article and discussion disturbing, but decided not weigh in.  Listening to the Hardball discussion made me reconsider. Now, let me confess I am not a Chris Matthews fan and I am both a friend of Will’s and in general agreement with his position on abortion. I say generally, because unless one believes that either fetuses or women have an absolute right to life or to abortion, none of us, even within the pro-choice community, is going to agree 100%. Sometimes Will annoys me because he seems to undercut his own position with those of us who are pro-choice by using too broad a brush and coming down too hard on us. And we in turn beat him up.

Here is where I understand Will to stand on abortion. (I ran this section by him about an hour ago and he says I got it right). He is pro-choice. He believes it is a woman’s legal right to choose to end a pregnancy and that abortion can be a morally justifiable act. To say it is a morally justifiable act is not to say that every decision to have an abortion is moral (a position some in the pro-choice community seem to take) but rather to say that since it can be either moral or immoral and the lines are difficult to draw in the abstract, it is best not to legally second guess a woman’s decision to continue or end a pregnancy. This does not mean that one should be silent about moral matters or refrain from offering a vision of when and under what circumstances abortion is morally – or if you prefer the cooler word ethically – responsible sexual and reproductive behavior. On issues of moral significance, the public wants to know what movement leaders believe, what values they have. And those of us who lead the movement have an obligation to speak to these concerns.

Now, Will takes fetal life seriously, more seriously than many of us in the movement and more seriously than many ethicists and theologians do. He thinks there is something important to society about the way we collectively and individually approach and treat the fetus. He even has some queasy thoughts about destroying early embryos to create stem cells. That means that he thinks at a minimum men and women ought to try not to create embryos or fetuses that they are likely to have to terminate and that health care professionals have a serious obligation to work with people to help them understand and accomplish that (if they themselves believe that). It may be moral for women to terminate those embryos and fetuses (I would say it is very often morally justifiable), but it would be morally preferable for both the person and society if one did not face that situation.

Let us be clear. We may all not agree with Will’s position or mine, but they are respectable views that deserve to be treated seriously and civilly. They can be critiqued, analyzed, questioned, and rejected for other views. But to treat them as "insulting to women" or ill-informed is not helpful or justified. Hurling invective does not contribute to furthering the cause of choice. Our movement has suffered many losses and has experienced an erosion of public support. The President we elected holds some of these views himself and has embarked on an approach to abortion that some of us find, to be kind, confusing. To refuse to find what is useful in the approach or thinking of outsiders who are more with us than against us would be a costly error. And, to be frank, I found Jodi’s response over the top in invective and lacking in necessary balance. This is the risk of blogging. One does not read and re-read; one does not reflect, one just cries out in pain. There is a place for that, once in awhile.

Will’s central point, aimed at those of us who are pro-choice, is that we need to think about contraception, preventing unintended pregnancy, as an ethical obligation and as leaders of the reproductive health and rights movement we should not shy away from expressing that value. There are at least two reactions to this. Agreement: I find that it treats women as competent moral agents who can hear and either accept or reject moral opinion or disagreement. We are all subject to social discourse about what is right and wrong and that is a good thing. Those on Wall Street should be subject to more of it, as should our military men and women. Disagreement: It is none of our business to preach to women. Women already know what is and is not responsible.

Will contends that there is some evidence that a significant number of women do not seem to know or have not accepted that creating a fetus is a significant moral decision to be entered into consciously and with self-reflection on the consequences. He cites Guttmacher Institute data that shows that a substantial number of women were not using and did not consider using contraception in the month they became pregnant, although they knew it existed. Jodi does not directly address that data, but offers an alternative view of why women don’t use contraception, which diminishes women’s responsibility and places the blame on the structure, system, cost, opposition, pickets, etc.

Jodi was "insulted" (more than once in the piece) by Saletan’s demand that "reproductive health counselors must speak bluntly to women who are having unprotected sex." What, she asked, does he think they do? Here was another missed opportunity. Rather than going into high gear defense of counselors, one might ask why Saletan has this view. Is there any merit to it? Having been in a room with Will and 30 leaders in the abortion rights movement and heard a number of them speak out against the introduction of a stronger ethic of personal responsibility into the choice message as well as in counseling, there is some reason for Will to believe there is a lack of commitment in some segments of the movement to this kind of discourse or to personal responsibility as a value. In a follow-up piece on his column, Will made this clearer noting that counselors do indeed give medical information about pregnancy prevention, which he distinguishes from ethical guidance.

Opinions about the expression of ethical obligations as part of choice discourse are highly varied in the movement. Again, there are respectable differences of opinion and one should be no more insulted that some leaders believe we have no business expressing our moral or ethical views to patients or the public than others are insulted that some believe it is the obligation of professionals and social movement leaders to offer patients their best advice and to express their moral views. I for one want to know what my doctor believes about these issues and I want to go to a doctor who respects and seeks out my views. Yet I also understand that not all women have my power to negotiate medical care. Can we not rationally discuss these opposing views, fleshing out the pros and cons?

RH Reality Check is a great place for these conversations to take place, but an editorial ethos that seeks light and not heat is essential to making that a reality.

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  • invalid-0

    Frances,

    Why the focus on morality? This is problematic in that many people disagree on what the moral status of the fetus should be, and a medical practitioner that places emphasis on this could end up shutting down vital lines of communication with the patient. (As in, “I won’t tell him _____ because then he’ll start scolding me.”) Don’t women already get enough of that from their family and community?

    Honestly, I don’t see why there should be much difference in how a practitioner counsels a patient to avoid unwanted pregnancy, compared to how s/he might advise against the use of cigarettes. We don’t say that smokers are immoral; we say, hey, smoking is harmful to your health, you probably want to kick the habit, do you need any help to achieve that?

    Abortion is not linked to cancer or other such disease, but it’s an unpleasant, invasive surgical procedure, and may or may not have repercussions on a woman’s psyche (depending on her own values and those of her community). Isn’t it enough for us to trust that women would prefer to avoid the need for an abortion if they can help it, and then, make it easier for them to follow through on that preference by making contraception and accurate sexual education readily available?

  • aspen-baker

    Frances, I am so glad you have weighed in on this conversation.  I admire your willingness to have tough debate, without the need to attack and defend.  Medical procedures and information are only just part of the puzzle to create emotionally, spiritually, and physically healthy people, families and communities.  Across the board, patients want to talk to each other, their doctors, and advisors about how to be on a path towards well-being and wholeness and morals surely have a role in this discussion.  It makes total sense to me that women and men would want to have these same kinds of discussions about sexuality, pregnancy, parenting, and of course, abortion.

  • invalid-0

    I appreciate your voice on this, but I find Will Saletan highly objectionable for two reasons.

    One is that he is always lecturing women. Why doesn’t he tell MEN to take contraceptive responsibility? Why doesn’t he insist that MEN get on board and be required to get contraceptive lectures when they apply for school, register for the military, get a driver’s license, have a medical check-up? Why is it always women? He never makes a peep about men, who could end all need for abortions by simply refusing to have sex without condoms.

    Secondly, I would think him for sincere if he would become an advocate not for lectures but for FREE contraception, as in England, and freely available. He also defends the right of pharmacists to deny contraception sales to women. Huh? And for women who don’t have health insurance, whose health insurance doesn’t cover prescritpions or doesn’t cover contraception, the costs of contraceptive pills can be very high.

    I’d like Will to walk in the shoes of a young woman for a few days, rather than constantly being asked to see the world from his perspective, which is utterly lacking in practical clarity.

  • invalid-0

    I can not believe we are still fighting this war after how many years? Birth control should be readily available at all times to everyone. I mean common sense should say contraceptives prevent unwanted pregnancy so therefore no to low abortions! Bingo we have a winner. In reality religion is still winning the war and we know that all religions are male dominated This tells me loud and clear that men in these religions want to keep women barefoot and pregnant,unseen ,unheard and only available when they want them. Kind of like the Taliban don’t you think?
    Why for goodness sakes are we women not more outraged!?
    Where is the media coverage on tv? I barely if ever hear about issues that effect over HALF the population??? Hello people something is really wrong with this picture. Is it that women think everything is ok, or are we being too passive?

  • invalid-0

    You have flagged a question I ask myself. I would distinguish among various actors in the field of abortion when suggesting whether or not a discussion of morality or responsibility in the context of morality should be part of their discourse. In the case of abortion, I have in other articles asked why we want to prevent the need for abortion since it is a benign procedure with few complications,in fact fewer complications than taking the pill. For years researchers have noted the the safest method of birth control is the diaphragm or condom coupled with back up abortion. Yet, we persist as a movement in saying it is a good idea to reduce the need for abortion. Why don’t we instead encourage the use of methods of contraception that will have slightly higher failure rates combined with abortion but are safer? In part it is because women themselves prefer not to have to make the decision to have an abortion – and we do advocate for women. The reasons women prefer to prevent pregnancy rather than have abortions are varied. For some it may just be a dislike of medical procedure, anesthesia, abortion is inconvenient and messy; for others, and each of us has heard different stories from women, there is some sense that all things being equal (which they never are,) there is a moral presumption in favor of giving life rather than taking it. A presumption is not an absolute.

    And whether we say it is a focus on morality or simply a focus on values, the kind of comprehensive, high quality medical care we favor will include a discussion of values. I am for that discussion between women and health care providers on all fronts, including women’s values about sex -with whom under what circumstances, having babies and being responsible parents and responsibility to ourselves, children to be and the community at large. The having kids thing is private with public consequences.

    How a health care provider has that discussion with a patient is critical. One who preaches should lose their patients if not their license.

    So let us assume the woman who is seeking an abortion is asked about her values relative to abortion. Is it a relatively neutral act for her? She does not consider it a moral matter; becoming pregnant again and having another abortion is A OK? Responsibility for her body and for creating life is just not high on her list. Well, that’s a tough call for a health provider who may decide not to intrude or to offer another perspective on what it means to have the power of life and death.

    For more women, I suspect,the desire to not face another abortion decision is stronger and having both technical information as well as insight into some of the values reasons one might want to bring to bear on deciding to make not getting pregnant again a priority would be welcome.

    The HOW is key. For me, it is a conversation in which the woman’s moral insight and the providers are shared. A provider who is trained to do this as an equal to the patient is key. That provider hears the woman’s point of view and perhaps shares it or offers an alternative. “That’s really helpful, knowing how you see this, I have a different perspective, let me share it with you.”

    I especially appreciated this comment and it has shifted my discourse a bit. I think I now would talk more about the introduction of values into counseling rather than morality. Thanks a lot.

    • invalid-0

      I too appreciate the tough questions Will makes us confront and I’m willing to go there as a general rule but I’m finding it harder to get past his tone of finger pointing to hear the substance of the argument.

      In general though I agree that we don’t just have an access problem; we have an accountability problem. As a society are not accountable for teaching young and old about sexuality in a way that stresses ‘this is who you are, get to know your desires, get to know your needs so you can develop a healthy sense of ownership over your body and your spirit and be better prepared to share with someone who appreciates that gift.’

      That is a conversation that needs to happen not just in the clinic but in churches and schools and families and ……

  • invalid-0

    “That’s really helpful, knowing how you see this, I have a different perspective, let me share it with you.”

    Oof. In the current stage of the abortion debate, hearing a statement like that is like seeing an oncoming freight train (while standing between the rails).

    I don’t know if there is a way that a provider can open a conversation on values, if that conversation takes the form of anything other than supporting what the patient believes. Context matters—this isn’t like a doctor admonishing someone to stop smoking; even the most kindly articulation of “creating fetal life is a big deal” is going to evoke the ugliest images of the abortion debate. The subject is just that raw and triggering.

    I think the values of becoming pregnant are better communicated by channels outside the doctor-patient relationship, like, say, the “Life, what a beautiful choice” television spots. I mean, it’s not like a woman won’t ever think about that if her doctor doesn’t bring it up.

  • choice-joyce

    I think it’s too bad that even many pro-choice people fall into the trap of thinking that morality and values have to be brought into the abortion equation, especially by health providers. It is simply none of their business. The counselor’s job is to make sure the woman is reasonably comfortable with her decision, for whatever reason she’s making it.

    We each have our views about the fetus and about abortion, but the only person whose values count is the pregnant woman herself. If a woman presenting for an abortion thinks her fetus is a meaningless clump of parasitic tissue that she is totally repulsed by and doesn’t give a sweet damn about, she’s RIGHT. Same reason that a woman is RIGHT if she is horrified at the thought of abortion and would never ever have one because she thinks it’s murder. It’s no-one’s place to try and substitute different values.

    Being pro-choice means allowing the woman to make the decision based on HER personal reasons and HER personal values, which we may strongly disagree with. The views of others don’t matter, whether we’re pro-choice or anti-choice. Women have the right to make mistakes and to be "immoral" (within the law). They are adults and no-one has the right to "correct" them. Our job in the pro-choice movement is to make sure that women can exercise their autonomy, not worry about whether they’re making the right decisions.

    Re the issue of contraception, I hate that this is put on women as a blame/shame thing. Men are responsible, too. But women do carry most of the burden, and as such, deserve that much more leeway and compassion when contraception isn’t accessible or effective or usable for whatever reason. No woman should EVER be blamed for getting pregnant, because that’s a natural consequence of sex, and we’re all entitled to lots of sex. Getting pregnant is a natural part of our biology, and biology is messy – pregnancy is very hard to prevent over an entire lifetime of sexual activity.

    • invalid-0

      Thank you, choice joyce, for saying that so well and so clearly. You spoke for me, too.

      One thing strikes me as the crux of the matter: The choice to abort is the choice of the woman and it’s no-one’s place to try and substitute different values or decisions. I’d add that the term “values” is only relevant for some anyway, as biological reality for one person is a personal “value” to someone else.

      Use of the word “morals” is pejorative, usually meant to slyly convey that the person who wields the term is somehow thinking more deeply or has a viewpoint with more substance, etc. That’s just crap, to put it bluntly. It’s a judgment and it’s useless and unwelcome, IMO.

      I don’t care what a man, any man, has to say about abortion. I just don’t. They can jolly well abstain or use whatever contraception they like. When they get a uterus, then I’ll listen.

  • emily-douglas

    Frances, thanks so much for this thought-provoking and thoughtful
    piece. char and Anonymous have summed up my thoughts, but I’ll weigh in
    with a little more.  On Will Saletan, as char says — I’m concerned that the abstract focus on ethics of contraception overlooks the very real problems of access (which is perhaps easier to measure) and of partner willingness to use contraception (which is harder to measure).  Studies like the Family Violence Prevention Fund’s on the practice of birth control sabotage in teen dating relationships suggest that there is far more to be understood about how negotiation around contraception occurs and how well-supported women are in using it.  When we resort to ethics to understand and frame the conversation, I worry that these public health issues are obscured and women who struggle to use contraception further marginalized.  And, yes, somehow in Saletan’s writing, the obligation is always on women to be more "ethical" in their sexual lives.

     

     

  • amanda-marcotte

    Is the candid assumption Saletan makes that women just have sex without bothering with contraception on a regular basis because of unrepetentant hussiness.  And the other assumption that clinics don’t already provide contraception counseling.  Both are false.  There’s not enough research (but more is coming out) to back it up, and it needs to be done, but a lot of the reason women don’t use contraception is not because they’re too stupid to do so, but because they have major access and usage issues, with male interference being a big one.  The small minority of women who don’t use contraception make up a big percentage of those who get abortions every year—instead of making assumptions about their intelligence, as Saletan does, why not ask them what stopped them?  I bet it would be unsavory—lots of stories of routine coercion—but illuminating.

  • amanda-marcotte

    That if Saletan is going to use Guttmacher as a resource—as he should, since they are amazing—perhaps he should dig in past the shocking figure that half of women who get abortions weren’t using any contraception at all and ask why not.  Guttmacher is huge on access issues being a major obstacle—the podcast this week has an interview with Rachel Gold about how the bureaucratic holes in the Title X and Medicaid relationship are leaving lots of women uncovered.  I just feel like every time he talks about this issue, he forgets that the women who get abortions aren’t hussies looking for a responsibility-free good time.  If anything, the fact that they get abortions is a strike in their favor for evidence that they’re responsible people—truly irresponsible women who don’t pay much attention to management of the ladyparts just have the babies and neglect them until, best case scenario, CPS takes them away.  That’s not very "pro-life", imo.  But Saletan buys right into the model that says that women who have abortions are moral failures on some level, which makes me uneasy, but that framing comes straight out of and references the belief that sexual women are immoral.  When you do that, you’re in a poor position to advocate for contraception.

     

    Unsurprisingly, that’s what Ken Blackwell lept upon, and used Saletan’s caginess on sexual morality to demagogue about how women who have sex are bad people.  

     

    Saletan’s not wrong in suggesting that closing up the contraception gap is the way to go.  But moralizing defeats the purpose, because it doesn’t address the core issues that women are dealing with.  What we need is what would make Chris Matthews’ head explode—a truly sex-positive message that says to women: a) sex is good b) you are good c) you deserve good sex and d) if you aren’t getting that in your relationship, something is wrong and you need help.  Ask clinic workers how much their patients confess bouts of coercion and miserable relationships.  But they don’t get out of them because our culture, including this clip, is always on about how bad and undeserving non-virginal women are.

  • harry834

    Amanda has great points, and I want to see how Saletan would respond.

  • invalid-0

    This has so disturbed me too- especially the lack of coverage on these issues.
    There is absolute outrage over so many other issues-(guns, censorship, etc). But I sit there and listen to Lou Dobbs and Campbell Brown and all the others- not one word, let alone one word of outrage, that women are being denied very basic medical care, that obstacles are being put up every day to impede a woman’s ability to obtain legal medications, or even obtain information. Yet no coverage and certainly no outrage from the media.
    But then again, when we do raise these issues and raise them forcefully- hmmmm- what happens? We are ignored, labeled fringe, or victims, or worse-
    Hey, you might get a kick out of this. I wrote my two representatives here in Arizona- I wanted to know where they stood on a new “abortion” bill that would label an egg, an “unborn child”.Neither had the decency to even respond to my questions or concerns.And that is a typical response wouldn’t you say?

  • invalid-0

    to defend my “ethics” w/r/t what I do with my own body. Saletan can go get stuffed. I’m sorry to see Kissling buying into his woman-shaming routine.

  • invalid-0

    Yep those two representitves are guilty as charged!
    I hear you on speaking out. It is like talking to brick walls “hello anybody listening” yeah” I live on this earth too!” They really give themselves way to much credit. I do think that this is a fight worth fighting for. We owe it to our daughters and granddaughters etc. I imagine them living in a peaceful world of equality. The right to speak and be heard. To maybe even be able to watch something other than sports on the TV for once.
    We need our own TV station not like lifetime, but one that carries news women can use to fight for equality. To keep women informed on all the injustices being done to them still. I believe many of them would be shocked to hear about much of this.

  • invalid-0

    I agree, most women would be shocked at the issues- really a lot of men would be too, but they don’t care enough to think about the issues.
    My husband for instance- he’s Republican (I’m an independent- way independent, so we pretty much avoid politics), so he was against Plan B- the Republicans were against it so he was too. I asked him what Plan B was.He didn’t know- he thought it caused abortions.
    He doesn’t even understand why I should care- I’m old- so what. But like you, I very much want our daughters and nieces and grand daughters, and even oursons, grand sons and nephews, to live in a different world than the one I see being created.

  • invalid-0

    Saletan just loves discussing this issue with other guys. What fellowship he must find and he gets to look like the reasonable guy in the crowd. Saletan has no business expecting woman to find common ground with people who don’t think they have the right to be their own moral agents. If he wants to talk about resposniblity, male responsibiity to use 100% effective birth-control, (vasectomy), is the discussion to be had. Mind you, it won’t get him on Chris Matthews or make his column at Slate very popular. However, his ignorant nagging of women is so cowardly. If he seriously wants to tackle this issue he should grow a pair and talk about those he can relate to not at people who can see right through him.