The Cognitive Dissonance of Aborting a 'Child'

Editor’s Note: This article previously appeared in a different format as part of The Atlantic’s Notes section, retired in 2021.

Another reader emails her story of undergoing a late-term abortion after her fetus was diagnosed with a severe brain abnormality. She offers a challenge: Why is there any cognitive or moral dissonance in thinking about her fetus as her child, but still choosing to abort?

More on that in a minute. First, her story in her own words:

In December of 2014, I was six and a half months pregnant with my first baby when she was diagnosed with a rare brain abnormality called lissencephaly. Lissencephaly means “smooth brain,” which refers to the condition’s characteristic lack of folding in the cortex. There are a range of possible outcomes, but they’re all pretty grim.

Children with lissencephaly have painful seizures that are often very difficult to control with medication. Most have problems breathing and swallowing that result in frequent respiratory infections and choking episodes, even involving their own saliva. They often require a feeding tube to survive.

Many have no cognitive development beyond three-to-five month milestones and cannot even track motion with their eyes or smile socially. They typically have little to no control of their bodies and cannot lift their heads or roll over, let alone sit or crawl.

In some less severe cases, children with lissencephaly have the ability to learn a few simple hand signs and, in very rare cases, learn to walk. However, even in those abnormally mild cases, the children still suffer from seizures, respiratory infections, and choking fits. The maximum life expectancy is six to ten years, so most of them die much younger than that.

The folding of the cortex largely happens during the second trimester, so lissencephaly is almost never diagnosed before 25 weeks of pregnancy and often isn’t diagnosed until after birth. My baby's condition was only detected because the ventricles in her brain were measuring on the upper end of the normal range at my second trimester anatomy scan (at 18 weeks) and the examining doctor decided to have me come back to check on the brain development.

The follow-up at 22 weeks detected further abnormalities, but at that point we were told there was still a 70 percent chance our baby would have normal cognitive development or only minor developmental delays.

They were not able to diagnose her lissencephaly until 28 weeks. Given the relatively early presentation of the folding issues in her case, our doctors predicted that she would be on the more severe end of the spectrum. But even the best prognosis for children with lissencephaly is bad enough that if I were facing the same prognosis, I would not want my own life prolonged. My own medical advance directive stipulates that I do not want a feeding tube or artificial respiration if I would be in severe pain or not be able to recover basic life functions, such as being able to communicate and perceive much of the world around me. I thought it would be immoral to bring my baby into the world knowing how much she was likely to suffer.

I was past the legal limit on abortion in my home state of Michigan, so my husband and I made the decision to travel to one of the four clinics in the country that perform later abortions for fetal medical indication. We paid $12,500 out-of-pocket for the procedure. Dr. Hern at the Boulder Abortion Clinic stopped my baby’s heart with an injection of digoxin on December 16, 2014 and began a three-day process of dilating my cervix with expanding seaweed sticks called laminaria. I delivered her intact and still on December 19.

As the reader mentions, Hern is one of the four openly advertising late-term abortion providers in the United States. Boulder Abortion Clinic is in Colorado; the other three doctors work at clinics in Bellevue, Nebraska, and Albuquerque, New Mexico. The four doctors were featured in After Tiller, a documentary inspired by the murder of late-term abortion provider George Tiller in May 2009:

A few things strike me about the way this reader describes her and her husband’s decision-making process. She focuses on the level of suffering that the child would have experienced if she had been born, suggesting that prevention of pain is her highest moral priority. She employs empathy—“if I were facing the same prognosis, I would not want my own life prolonged”—in trying to figure out what’s best for her unborn child. And most strikingly, she doesn’t shy away from using “person” words—“she,” “her,” “baby.” There’s a reason for this, she writes:

I refer to her as a baby and as my child because the pregnancy was planned and wanted, I loved her very much (and still do), and at the point where we got her diagnosis and chose to end her life, she was likely “viable” in the sense that if I had gone into labor spontaneously, she would have had a chance of surviving, at least for the limited duration a child with her condition can survive.

She may not have been able to do what most people probably mean when they use the word “think,” but I don’t think that means she did not have a moral identity. Indeed, one of the primary reasons I chose to have an abortion was because I did not want her to suffer the way she almost certainly would have if she had been born alive. Is there any reason to care about the suffering of an entity that has no moral identity?

The decision to have an abortion was also based on considerations about my health, lifestyle, and career. Having a late-term abortion was the best way to protect my health and especially my chances of being able to get pregnant again. Although there are some risks associated with a late-term abortion, they are much smaller than the risks associated with a full-term birth, particularly when there is a chance the baby’s head will swell with fluid, which is always a risk in the case of brain abnormalities.

My husband and I also considered what our lives would be like if we had to manage the care and supervision of a severely disabled child. We likely would not have chosen to welcome another child into our lives in that situation, and I would have had to leave my job permanently.

The entity I aborted was a human child—my child, my much-loved, much-wanted, first baby. But my choice to have an abortion and my ability to do so was also a health, lifestyle, and career issue. I don’t see why those things ought to be seen as mutually exclusive or the source of any “cognitive dissonance,” as you put it.

To me, the most interesting parts of this story are the alternate-scenario questions: What if … ? If you believe that a fetus has a moral identity—which not all women, and certainly not all philosophers, do—what are the boundary lines of a mother’s (and, to add more complication, father’s) moral right to make decisions about the life of her child?

For example: How much anticipated future pain and suffering for the child is enough to justify eliminating that life? How much anticipated risk to the mother’s health is enough, or projected suffering in carrying the child to term?

If disability-based suffering isn’t the main factor in making the decision—such as in the amicus brief filed by female lawyers who said having an abortion was a crucial factor in their career success—is there more dissonance in deciding to end the future life of a human with a “moral identity”?

Finally: What are the shades of moral difference between terminating a fetus that could not survive outside the womb vs. one that can, even if, as in this case, it would suffer from significant disabilities? What’s the difference between those decisions and the decision to kill such a child after it has been born, or let it die? That last question, about infanticide, is particularly charged, not least because of the common-sense “disgust” factor. As Jeff McMahan, a former Rutgers professor who’s now at Oxford, wrote in 2007:

Although philosophers have conducted a wide-ranging debate about the morality of abortion for more than thirty years, generating in the process an extensive literature on the topic, they have, with very few exceptions, shrunk from extending the debate to include a discussion of infanticide. I know from discussions with prominent writers on ethics that some have been deterred from writing on the subject by fear of possible consequences for their reputations, careers and even physical security ... My own experience is much more limited, but tends to confirm that discussing infanticide is not the best way to win friends or secure admiring book reviews.

More on that here. In the meantime, send thoughts to hello@theatlantic.com, along with more of your stories—particularly ones that show some of the moral ambiguity in these choices.