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Right to Life v. Right to Health? Disability and Selective Abortion

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Abstract

Should an impaired foetus be treated on the same footing as a non-impaired one? In light of the strong and divergent views on abortion across different religious and ideological perspectives, the right to life of persons with disabilities generates tension between the ‘pro-life’ and ‘pro-choice’ camps. This conflict is reflected in tensions between Articles 10 (Right to life) and 25 (Health) of the Convention on the Rights of Persons with Disabilities and the debate cuts across the disability rights and reproductive rights movements. Arguably, even assuming that life and personhood begin after birth (or at some earlier prenatal time or state) raises profound ethical and legal dilemmas that make it difficult to achieve harmonisation throughout different countries.

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Notes

  1. 1.

    Opened for signature 16 December 1966, 991 UNTS 171, in force 23 March 1976.

  2. 2.

    Opened for signature 13 December 2006, 2515 UNTS 3, in force 3 May 2008.

  3. 3.

    Women Enabled International, Abortion and Disability: Towards an Intersectional Human Rights-Based Approach (2020) at 27.

  4. 4.

    For an overview, see Marge Berer, ‘Abortion Law and Policy around the World: In Search of Decriminalization’ (2017) Health Hum Rights 13; Louise Finer and Johanna B Fine, ‘Abortion Law around the World: Progress and Pushback’ (2013) 103(4) American Journal of Public Health 585.

  5. 5.

    See Marge Berer, Abortion Law and Policy around the World (2017).

  6. 6.

    World Health Organization, Primary Health Care: Now More than Ever, World Health Report (2008) at 65, http://www.who.int/whr/2008/whr08_en.pdf.

  7. 7.

    Centre for Reproductive Rights, The World Abortion Laws, https://maps.reproductiverights.org/worldabortionlaws.

  8. 8.

    United Nations Population Division, Updated Study on Abortion Policies, 14 June 2002, POP/830.

  9. 9.

    Ivet Gonzalez, Abortion Rights in Cuba Face New Challenges, Havana Times, 4 September 2017; International Campaign for Women’s Right to Safe Abortion, Cuba – Abortion Has Been Safe and Free in Cuba for Over Half a Century, 19 September 2017.

  10. 10.

    Linda Long, Abortion in Canada, The Canadian Encyclopaedia (2020) https://www.thecanadianencyclopedia.ca/en/article/abortion.

  11. 11.

    Richard Sambaiga, Haldis Haukanes, Karen Marie Moland and Astrid Blystad, ‘Health, Life and Rights: A Discourse Analysis of a Hybrid Abortion Regime in Tanzania’ (2019) 18 International Journal for Equity in Health 1.

  12. 12.

    Amanda Cleeve et al., ‘Time to Act – Comprehensive Abortion Care in East Africa’ (2016) 4(9) Lancet Global Health e601.

  13. 13.

    Centre for Reproductive Rights, Accelerating Progress: Liberalization of Abortion Laws since ICPD, https://reproductiverights.org/sites/default/files/documents/World-Abortion-Map-AcceleratingProgress.pdf.

  14. 14.

    Polsh Constitutional Court, Ruling in Case K/120, 22 October 2020.

  15. 15.

    Tsehai Wada, ‘Abortion law in Ethiopia: A Comparative Perspective’ (2010) 2(1) Mizan Law Review 1.

  16. 16.

    Polish Constitutional Court, Ruling in Case K/120 (2020).

  17. 17.

    Lynn Gillam, ‘Prenatal Diagnosis and Discrimination against the Disabled’ (1999) 25(2) Journal of Medical Ethics 163.

  18. 18.

    Roe v. Wade, 410 US 113 (1973).

  19. 19.

    Id.

  20. 20.

    Polish Constitutional Court, Decision in Case K 26/96, 28 May 1997.

  21. 21.

    Id., Decision in Case K 14/03, 7 January 2004.

  22. 22.

    Stanisław Wójcik, ‘Religia chrześcijańska, prawo, państwo’ (2020) 2(250) Zeszyty Naukowe KUL 64,.

  23. 23.

    William Neaves, ‘The Status of the Human Embryo in Various Religions’ (2017) 144 Development 2541.

  24. 24.

    Opened for signature 20 November 1989, 1577 UNTS 3, entered into force 2 September 1990.

  25. 25.

    UN Treaty Collection, Convention on the Rights of the Child, https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-11&chapter=4&clang=_en.

  26. 26.

    UN GA, Res 1386 (XIV), 20 November 1959, Preamble.

  27. 27.

    The two most cited philosophical texts on the subject of abortion are a thought experiment with violinist Judith Jarvis Thomson, part of the work ‘A Defense of Abortion, https://spot.colorado.edu/~heathwoo/Phil160,Fall02/thomson.htm, and ‘On the Moral and Legal Status of Abortion’ by Mary Anne Warren, http://www.douglasficek.com/teaching/phil-2222/warren.pdf.

  28. 28.

    Scientists estimate that, within 5–6 days after conception, about 1/3–1/2 of embryos die (Gavin E. Jarvis, ‘Early Embryo Mortality in Natural Human Reproduction: What the Data Say’ (2016) 5 F1000Res 2765).

  29. 29.

    Convention for the Protection of Human Rights and Fundamental Freedoms, opened for signature 4 November 1950, entered into force 3 September 1953.

  30. 30.

    X v. the United Kingdom, EComHR, Appl No 8416/79, Admissibility Decision of 13 May 1980, at para 19.

  31. 31.

    Douwe Korff, The Right to Life. A Guide to the Implementation of Article 2 of the European Convention on Human Rights, Directorate General of Human Rights, Council of Europe (2006) at 10.

  32. 32.

    X v. the United Kingdom (1980) at para. 19.

  33. 33.

    Korff, The Right to Life (2006) at 10.

  34. 34.

    Tysiąc v. Poland, ECtHR, Case n. 5410/03, Judgment of 20 March 2007, at para. 135.

  35. 35.

    Korff, The Right to Life (2006) at 16.

  36. 36.

    Sujatha Jesudason and Julia Epstein, ‘The Paradox of Disability in Abortion Debates: Bringing the Pro-Choice and Disability Rights Communities Together’ (2011) 84 Contraception 541.

  37. 37.

    Nils Holtug, ‘Against Human Gene Therapy’ (1997) 6 Cambridge Quarterly of Healthcare Ethics 159.

  38. 38.

    Gillam, ‘Prenatal Diagnosis’ (2020) at 164.

  39. 39.

    Ilana Löw, ‘Abortion for Fetal Anomaly: How to Speak about a Difficult Topic’ (2020) 36 Cadernos de Saúde Pública, DOI: 10.1590/0102-311x00188618, interestingly noting:

    [T]he woman who wants a “perfect child” and is willing to terminate a pregnancy for a minor fetal anomaly seems to exist mainly in bioethicists’ theoretical debates. Empirical studies indicate that women who ask a permission to terminate a pregnancy for a fetal indication nearly always have very serious arguments to support their plea.

  40. 40.

    Löw ‘Abortion for Fetal Anomaly’ (2020).

  41. 41.

    Ibid, at 165.

  42. 42.

    Caroline Mansfield et al, ‘Termination Rates after Prenatal Diagnosis of Down Syndrome, Spina Bifida, Anencephaly, and Turner and Klinefelter Syndromes: A Systematic Literature Review’ (1999) 19 Prenatal Diagnosis 808, at 811; Dov Fox and Christopher L Griffin J, ‘Disability-Selective Abortion and the Americans with Disabilities Act’ (2009) 3 Utah Law Review 846, at 873 ff.

  43. 43.

    ‘The Finkbine Case’, Chicago Tribune, 19 June 1992.

  44. 44.

    Mansfield et al., ‘Termination Rates’ (1999) 808; Fox and Griffin, ‘Disability-selective Abortion’ (2009) 846.

  45. 45.

    See Marianne Kjelsvik, ‘Women’s Experiences When Unsure about Whether or Not to Have an Abortion in the First Trimester’ (2018) 39(4) Health Care For Women International 784.

  46. 46.

    Lynn Gillam, ‘Prenatal Diagnosis’ (1999) at 168.

  47. 47.

    Ibid, at 168–169.

  48. 48.

    Ibid, at 169.

  49. 49.

    Nicola Davis, ‘Euthanasia and Assisted Dying Rates Are Soaring. But Where Are They Legal?’, The Guardian, 15 July 2019.

  50. 50.

    ‘Treating a Foetus as a Person’, The New York Times, 5 January 2019.

  51. 51.

    United Nations Population Division, Abortion Policies: A Global Review, UN Doc. ST/ESA/SER.A/196 (2002); UN ECOSOC, Abortion Policies and Reproductive Health around the World (2014).

  52. 52.

    United Nations Population Division, Abortion Policies (2020).

  53. 53.

    African Commission on Human and Peoples’ Rights, Statement by Honourable Commissioner Lucy Asuagbor during Launch of ACHPR Campaign for the Decriminalisation of Abortion in Africa, 18 January 2016.

  54. 54.

    International Campaign for Women’s Right to Safe Abortion, The African Leaders’ Declaration on Safe, Legal Abortion as a Human Right, 20 January 2017.

  55. 55.

    Thomas Burch, ‘Induced Abortion in Japan under Eugenic Protection Law of 1948’ (1955) 2(3) Eugenics Quarterly 150.

  56. 56.

    Human Rights Watch, International Human Rights Law and Abortion in Latin America, 2 July 2005.

  57. 57.

    Adopted 7 June 1993.

  58. 58.

    Polish Constitutional Court, Ruling in Case K/120 (2020).

  59. 59.

    Statista, Number of Legal Abortions by Reason in Poland: 1994–2019, https://www.statista.com/statistics/1111281/poland-legal-abortions-number-by-reason.

  60. 60.

    Andrzej Duda przygotował ustawę ws. aborcji, Wiadomości, 2 November 2020.

  61. 61.

    Poland: Thousand Protest as Abortion Law Comes into Effect, https://www.dw.com/en/poland-thousands-protest-as-abortion-law-comes-into-effect/a-56363990.

  62. 62.

    John Hunt, ‘Out of Respect for Life: Nazi Abortion Policy in the Eastern Occupied Territories’ (1997) 1(3) Journal of Genocide Research 379.

  63. 63.

    Paola Tamma, ‘Even Where Abortion Is Legal, Access Is Not Granted’, 24 May 2018, https://www.europeandatajournalism.eu.

  64. 64.

    See, for instance. Katarzyna Granat, ‘Political and Legal Enforcement of the Rule of Law in Poland’ (2018) 4 Quaderni Costituzionali 924.

  65. 65.

    HRCte, Report of Special Rapporteur on Torture, 5 January 2016, UN Doc A/HRC/31/57; CEDAW Cte, LC v. Peru, Communication 22/2009, UN Doc. CEDAW/C/50/D/22/2009, at para. 8.18; HRCte, Whelan v. Ireland, Communication 2425/2014, UN Doc. CCPR/C/119/D/2425/2014; HRCte, Mellet v. Ireland, Communication 2324/2013, UN Doc. CCPR/C/116/D/2324/2013, at para. 7.4.

  66. 66.

    Lukasz Woznicki, ‘Uzasadnienie bez dyskusji’, Gazeta Wyborcza, 2 January .2021, at 7; tr. by the author.

  67. 67.

    Przesuwamy się w niebezpieczną stronę. Oświadczenie Rzecznika Praw Obywatelskich w związku z wyrokiem TK, January 2021, https://www.rpo.gov.pl/pl/content/oswiadczenie-rpo-trybunal-aborcja.

  68. 68.

    Referring to a diversity of views on disability, Löwy concluded that disabled people may find it easier to express their views ‘in the absence of visible and active patients’ associations’ that frequently promote strong opinions (ibid.).

  69. 69.

    Polish Constitutional Court, Decision in Case K 26/96 (1997), also specifying:

    The intensity and type of legal protection is influenced – apart from the value of the protected good – by a number of factors of a different nature that must be taken into account by the ordinary legislator when deciding on the type and intensity of legal protection.

  70. 70.

    Wojciech Sadurski, ‘Kicz konstutucyjny mgr Przyłębskiej’, Gazeta Wyborcza, 29 jan 2021, at 16.

  71. 71.

    Amy Booth, ‘Honduras Changes Constitution to Ban Abortion’, The Lancet, 30 January 2021.

  72. 72.

    ‘Argentina Liberalises Abortion, Joining a Small Group of Latin American States’, The Economist, 30 December 2020.

  73. 73.

    See Smitha Nizar, ‘Article 10: Right to Life’, in Ilias Bantekas, Michael Ashley Stein and Dimitris Anastasiou (eds.), The UN Convention on the Rights of Persons with Disabilities: A Commentary (OUP, 2018) 287, particularly at 305–311.

  74. 74.

    See Penelope Weller, ‘Article 25: Health’, in Bantekas, Stein and Anastasiou, The UN Convention (2018) 705, particularly at 714–716.

  75. 75.

    Ad Hoc Committee on a Comprehensive and Integral International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities, https://www.un.org/development/desa/disabilities/resources/ad-hoc-committee-on-a-comprehensive-and-integral-international-convention-on-the-protection-and-promotion-of-the-rights-and-dignity-of-persons-with-disabilities.html.

  76. 76.

    Ad Hoc Committee on a Comprehensive and Integral International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities, UN GA Res. 56/168, 19 December 2001.

  77. 77.

    Chair’s Draft Elements of a Comprehensive and Integral International Convention on Protection and Promotion of the Rights and Dignity of Persons with Disabilities (December 2003), https://www.un.org/esa/socdev/enable/rights/wgcontrib-chair1.htm.

  78. 78.

    Landmine Survivors Network, Daily Summary Related to Draft Article 8, 13 January 2004.

  79. 79.

    Ibid.

  80. 80.

    Ibid.

  81. 81.

    Ibid.

  82. 82.

    Ibid.

  83. 83.

    Ibid.

  84. 84.

    Ibid.

  85. 85.

    Ibid.

  86. 86.

    Ibid.

  87. 87.

    Ibid.

  88. 88.

    Ibid.

  89. 89.

    Ibid.

  90. 90.

    Ibid. Among specific provisions on the implementation process of the rights of people with disabilities, the Coalition included the ‘[r]ight to a life without stigma and discrimination’, which entails the exclusion of ‘inappropriate terminology such as defective, deficient people’, as ‘it is the duty of State parties to educate the public about people with special or different needs, people with disabilities, thereby focusing on the person first and then the differences s/he has’ (UN Enable, Ad Hoc Committee on an International Convention, Compilation of Events, Coalition of Individuals, Organisations and Agencies of the People, for the People and by the People with Disabilities in Eastern Europe (Ukraine, Russia, Belarus, Moldova and Poland), 13 December 2003 (Coalition Eastern Europe); https://www.un.org/esa/socdev/enable/rights/wgcontrib-EastEurope.htm). The Coalition indeed stressed that people who experience demeaning or humiliating treatment must be compensated either by the government or by the perpetrators (ibid.).

  91. 91.

    Ad Hoc Committee on a Comprehensive and Integral International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities, Report to the Ad Hoc Committee, UN Doc. A/AC.265/2004/WG.1, 27 January 2004, at 14.

  92. 92.

    See Bret Shaffer, ‘The Right to Life, the Convention on the Rights of Persons with Disabilities, and Abortion’ (2009) Penn State Law Review 265, at 279.

  93. 93.

    Compilation of Proposals for Elements of a Convention, 15 January 2004, http://www.un.org/esa/socdev/enable/rights/comp-element6.htm.

  94. 94.

    Ibid.

  95. 95.

    Ibid.

  96. 96.

    Enable, Article 8 Fourth Session Comments, Proposals and Amendments Submitted Electronically, https://www.un.org/esa/socdev/enable/rights/ahcstata11fscomments.htm.

  97. 97.

    Ibid.

  98. 98.

    Ibid.

  99. 99.

    Ibid.

  100. 100.

    Ibid.

  101. 101.

    Fifth Ad Hoc Committee Daily Summaries, 24 January 2005) 10 (El Salvador), http://www.un.org/esa/socdev/enable/rights/ahc5docs/ahc5sum24jan.doc.

  102. 102.

    Ibid.

  103. 103.

    Ibid.

  104. 104.

    Ibid.

  105. 105.

    Daily Summary of Discussion at the Fifth Session, 25 January 2005, https://www.un.org/esa/socdev/enable/rights/ahc5sum25jan.htm.

  106. 106.

    Ibid.

  107. 107.

    Enable, Article 8 Seventh Session Comments, Proposals and Amendments Submitted Electronically, https://www.un.org/esa/socdev/enable/rights/ahcstata10sevscomments.htm.

  108. 108.

    Ibid.

  109. 109.

    Final Report of the Ad Hoc Committee on a Comprehensive and Integral International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities, UN Doc. A/61/611, 6 December 2006.

  110. 110.

    Intervention by the Holy See at the 76th Plenary Meeting of the General Assembly of the United Nations on Human Rights and Fundamental Freedoms, Address by HE Msgr Celestino Migliore, 13 December 2006, https://www.vatican.va/roman_curia/secretariat_state/2006/documents/rc_seg-st_20061213_un-rights-persons_en.html.

  111. 111.

    Ibid.

  112. 112.

    Ibid.

  113. 113.

    Ibid.

  114. 114.

    Ibid.

  115. 115.

    ESCR Committee, Concluding Observations: Dominican Republic, UN Doc. E/C.12/DOM/CO/4, 21 October 2016, at 10, para 60(a).

  116. 116.

    HRCte, Whelan v Ireland, Comm No 2425/2014, at 14, para. 7.2.

  117. 117.

    HRCte, General Comment No. 36 (2018) on Article 6 of the International Covenant on Civil and Political Rights, on the Right to Life, UN Doc. CCPR/C/GC/36 (2018) at 5, para. 24.

  118. 118.

    Ibid, at 6, para. 26.

  119. 119.

    Ibid, at 2, para. 8. See also HRCte, Concluding Observations: Ireland, UN Doc. CCPR/C/IRL/CO/4 (2014) at para 9; Id., Concluding Observations: Great Britain and Northern Ireland UN Doc. CCPR/C/GBR/CO/7 (2015) at para 17; Id., Concluding Observations: Honduras, UN Doc. CCPR/C/HND/CO/2 (2017) at para. 17.

  120. 120.

    Working Group on the Issue of Discrimination against Women in Law and in Practice, Inputs on the Human Rights Committee Draft General Comment No. 36 on Article 6 of the International Covenant on Civil and Political Right, on the Right to Life, October 2017, at 1–2.

  121. 121.

    Ibid.

  122. 122.

    Working Group on the Issue of Discrimination against Women in Law and in Practice, Women’s Autonomy, Equality and Reproductive Health in International Human Rights: Between Recognition, Backlash and Regressive Trends, October 2017, at 1.

  123. 123.

    Committee on the Rights of Persons with Disabilities, Comments on the Draft General Comment No. 36 of the Human Rights Committee on Article 6 of the International Covenant on Civil and Political Rights (2018) at para. 1.

  124. 124.

    Ibid.

  125. 125.

    Ibid.

  126. 126.

    Section 3.

  127. 127.

    See, for instance, CteRPD, Concluding Observations: Hungary, CRPD/C/HUN/CO/1, 22 October 2012, at 3, para. 18.

  128. 128.

    CteRPD, Concluding Observations: United Kingdom, UN Doc CRPD/C/GBR/CO/1, 3 October 2017, at para. 13.

  129. 129.

    CteRPD, Concluding Observations: Austria, CRPD/C/AUT/CO/1, 13 September 2013, at para. 14.

  130. 130.

    Ibid, at para. 14.

  131. 131.

    Ibid, at para. 15.

  132. 132.

    CteRPD, Concluding Observations: Poland, UN Doc CRPD/C/POL/CO/1, 29 October 2018, at para. 44.

  133. 133.

    Marta Bergier, ‘Szkola rodzicow’, Tygodnik Powszechny, 14 February 2021, at 16–17.

  134. 134.

    Wojciech Bonowicz, ‘Życie trudne, życie piękne’, Tygodnik Powszechny, 14 February 2021, at 12–15.

  135. 135.

    Bergier, ‘Szkola rodzicow’ (2021) at 16–17.

  136. 136.

    Ibid.

  137. 137.

    Wojciech Bonowicz draws attention to the importance of the social context and climate, referring to the paradox that higher social acceptance of people with Down’s syndrome and other types of intellectual disability corresponds to a higher number of abortions performed after it is diagnosed that a child may be disabled (Bonowicz (2021) at 12–15).

  138. 138.

    Ibid.

  139. 139.

    Women Enabled International, Abortion and Disability (2020) at 26.

  140. 140.

    Ibid., at 26.

  141. 141.

    Women Enabled International, Abortion and Disability (2020) at 27.

  142. 142.

    Löwy, ‘Abortion for Fetal Anomaly’ (2020) and Diane Paul and Ilana Löwy, ‘On Objectivity in Prenatal Genetic Care’ (2018) 2(2) OBM Genetics 22.

  143. 143.

    Paul and Löwy, ‘On Objectivity” (2018) 22.

  144. 144.

    Robert A. Saul and Stephanie Hall Meredith, ‘Beyond the Genetic Diagnosis: Providing Parents What They Want to Know’ (2016) 37 Pediatr Rev 269.

  145. 145.

    Paul and Löwy, ‘On Objectivity’ (2018) at 22.

  146. 146.

    Caroline Mansfield et al., ‘Termination Rates after Prenatal Diagnosis of Down Syndrome’ (1999) at 811.

  147. 147.

    Bertha Alvarez Manninen, ‘The Replaceable Fetus: A Reflection on Abortion and Disability’, Disability Studies Quarterly Vol 35, No 1 (2015).

  148. 148.

    Websites accessed 18 January 2022.

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Authors and Affiliations

  1. Law School, University of New England, Sydney, Australia

    Ottavio Quirico

  2. Centre for European Studies, Australian National University, Canberra, Australia

    Ottavio Quirico & Katarzyna Kwapisz Williams

  3. Law Department, European University Institute, Firenze, Italy

    Ottavio Quirico

  4. Law School, Deakin University, Melbourne, VIC, Australia

    John R. Morss

  5. School of Humanities, Arts, and Social Sciences, University of New England, Sydney, NSW, Australia

    Xiang Gao

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  2. Katarzyna Kwapisz Williams
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  3. John R. Morss
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  4. Xiang Gao
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Correspondence to Ottavio Quirico .

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  1. Law School, University of New England, Sydney, Australia | Centre for European Studies, Australian National University, Canberra, Australia, Law Department, European University Institute, Firenze, Italy

    Ottavio Quirico

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Quirico, O., Williams, K.K., Morss, J.R., Gao, X. (2022). Right to Life v. Right to Health? Disability and Selective Abortion. In: Quirico, O. (eds) Inclusive Sustainability. Springer, Singapore. https://doi.org/10.1007/978-981-19-0782-1_3

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