The principle of bodily autonomy was addressed by two speakers during last weekend’s session of the Citizens’ Assembly, which is still discussing the abortion issue. The two speakers took very different views on the issue. One speaker looked at the person as a pure individual, the other as a person in relationship with others.

Dr Joan McCarthy, from the School of Nursing and Midwifery at University College Cork, took the first view. She defended the principles of ‘autonomy’ and ‘justice’, claiming that ”respect for autonomy requires that we should not unreasonably restrict or constrain the life choices that individuals make.”

Her presentation (available here) was badly skewed by her own decision to do not discuss the moral status of the unborn, which is the central issue in all debates about abortion. Choosing not to address the value of human life before birth, without even providing a reason for this approach, compromised her whole presentation which otherwise contained some valid points.

Dr Joan McCarthy maintained that, “if we disregard a person’s autonomy, we are in some sense treating him or her, not as an individual with their own values and goals, but merely as a means, as an instrument, to achieving the goals of others. The individual becomes a means to an end rather than a person worthy of respect in their own right.”

The obvious question is if these words apply to the unborn as well. The same principles of autonomy and justice can be evoked to support or to oppose abortion, depending ultimately on what is the moral status of the unborn, which is precisely what Dr Joan McCarthy purposely ignores.

Dr McCarthy maintained that “the operationalisation of the eighth amendment in legislation and critical practice poses serious risks to the mental and physical health of pregnant women, tramples on their autonomy rights and requires of them a self-sacrifice that is unreasonable and unjust”. Would the sacrifice of their children be more reasonable and just?

She claimed that the principle of autonomy has been viewed as the foundation of other rights such as bodily integrity. This is correct but how many bodies are involved in an abortion? Obviously both the body of the woman and the body of her child. The two are intimately connected and any discussion about abortion that focuses only on one of the two bodies involved is necessarily limited and narrowminded.

Notably, Dr McCarthy did not set out what limits, if any, she would apply to abortion.

Dr Dónal O’Mathúna, a lecturer in Ethics from Dublin City University, defended instead what he called ‘the principle of relational autonomy’, meaning important decisions that happen within relationships and which bring ethical responsibilities. Self-rule autonomy focuses only on the good life of the individual while relational autonomy recognises that we live in relationships, our choices impact others and are impacted by others. (His paper is available here)

Even bodily autonomy is not an absolute principle, he argued. This is why, for example, we can’t sell our organs or inject illegal substances into our bodies. In a medical context, we can’t have an organ removed unless there are health reasons, even if it is our choice. Autonomy implies responsibility and limitations. Choices have consequences.

“Autonomy is a means to an end; it does not tell us what ends are ethical. Relational autonomy goes beyond the right to choose; it includes the responsibility to choose the right thing.” We don’t have the right to do whatever we want, Dr Dónal O’Mathúna told the audience.

He also invoked the ‘harm principle’: you make choices, so long as they do not harm others. This is precisely where the freedom of choice argument breaks down in abortion. “There is always an other where abortion is concerned. And by definition, that other ends up dead. Whatever opportunities or potential opportunities, the unborn might have, they are terminated totally.”

Dr Dónal O’Mathúna emphasised the concern for the weakest and the most vulnerable. When we protect them we also tell society that someone will take care of us if in need.

During question time, it was noticeable that Dr O’Mathúna was asked far more questions, some of them critical, than Dr McCarthy. None of the delegates thought to ask Dr McCarthy why she didn’t address the moral status of the foetus, or what limits, if any, she would place on the ‘right to choose’, or when she would think it appropriate for someone to have a make a personal sacrifice for someone else.