Wednesday, 3 February 2016

Consolations of philosophy: on the ontological status of unborn children

Well there hasn't been an awful lot of blogging going on around here lately. The events of last summer just sucked the words out of me.
The world seemed to fall away, to recede as I remained, empty. Even after I fell pregnant again, the fear that accompanied it kept me silent.  I've only recently acquired the confidence to declare this pregnancy 'real' both in public and to myself. I'm starting to feel like I don't have to pretend to be okay anymore, I can just *be* okay. And now the words are returning and i'm going to make up for lost time. I am hereby coming out of cyber hibernation!

A few people have responded positively to my post about miscarrying, saying that the silence sufferers usually maintain makes it difficult, for anyone who hasn't been through it, to understand. To that I would add, worse, that it makes it difficult for others who *do* go through it to understand what it is they are going through. So I've decided to share some of the consolations I found, funnily enough, in philosophy.

Prior to August 2016 my view of miscarriage was, I think, fairly typical. I knew it happened. I thought of it as an event in which the developmental process that ultimately results in a baby is interrupted. The process doesn't complete, and no baby results. I didn't know any grisly details about what it felt like when the process stopped, or what happened afterwards. The key thing was that I thought of it as a process in which a baby never actually features....there would have been a baby, if things had carried on. But they did not. A difference in degree, but not in kind, from the scenario in which a not-pregnant lady would have ultimately had a baby if one of her eggs had been fertilised, which it had not. A scenario that is obviously sad if the person involved was very much hoping for a baby and is very disappointed. A bit like a child who hoped for a bike for Christmas but didn't get one. Disappointing. But not tragic. Not something to feel grief about. Because there is always next time. You can always try again.

Suffice to say it didn't feel like that when it was my turn to not get the bike for Christmas. And I suspect that my grief was made harder by the fact that I considered it illegitimate. I didn't view it as rational to miss the baby, to view such a target of emotion as having existed at all. And there resulted the most terrible dissonance between the me that valued rationality and the me that was an injured animal howling in pain on the floor.

It turns out that Philosophers have had, not a great deal, but a few very worth while things to say about miscarriage. The Journal of Social Philosophy  did a whole special issue, available open access here, in which writers eloquently capture some of the puzzling aspects of miscarriage, reproductive loss and foetal death.

One interesting issue that comes up in the special issue is the question of how the relationship between a mother and her unborn child is understood. Apparently the default is relational  - pregnancy is thought of as a severable relation between two distinct individuals, where the pregnant woman, but not the foetus, is capable of attaching moral significance to the relation. Ann Cahill says this neglects the extent to which the pregnant woman often experiences her subjective individuality as being compromised by pregnancy, her identity as intertwined with the foetus.  Miscarriage can be difficult, in part, Cahill writes, because it calls the pregnant woman to question her own identity.

This, for me at least, better captures the phenomenology of pregnancy and miscarriage. I felt, less the loss of a separate entity, and more as if some part of me, my body, had been severed. I wonder if the expression 'Something died inside me', now used as a trivial metaphor to convey the sense that something we held dear was crushed, initially conveyed a feeling of despondency by comparing it to a miscarriage? Perhaps there are parallels between the experience of miscarriage and that of losing a limb - in both cases I believe that in addition to the rational sense of regret for the loss of those experiences that the lost part was expected to enable, there is something more animal, a feeling of violation, incompleteness, just really missing that part.  Some of the ambiguity about whether a foetus is a baby comes from ambiguity about whose body is injured when the foetus dies. About whether the foetus is truly a separate thing yet. 

In one particular respect a mother remains intertwined with her children whatever the developmental outcome. We know that some of a foetus's cells cross the placenta into the mothers bloodstream where they can remain for many years, with the consequence that genetic tests will occasionally misidentify the mothers' DNA.  The cells swirl around in the bloodstream, possibly for decades, possibly influencing the mother's immune system and more. Here are some sources 1 2 3 4Mothers carry with them little pieces of all the children they bore and all the children they lost as well, not only in their hearts but in their very blood.

Something that has been on my radar a lot recently is the campaign to get people to break the taboo surrounding miscarriage - to talk more openly about their own experiences. I certainly found it true that there is social awkwardness. Several people responded to my own story with confessions of their own, indicating an unwillingness to disclose one's own miscarriage except to other sufferers.One in five of you, readers, has a mother who carries a secret grief, still wounded from a loss she suffered many years ago.  Even more sadly, I felt a certain awkwardness surround me after I did break the taboo. An invisible zone of separation seemed to emerge between me and, especially, other mothers. There are many likely reasons for this. Maybe people don't realise how upsetting it is. Maybe they know there is a lot of variation in how upsetting women find it, and they don't want to assume you're upset. As with other forms of bereavement, people just don't know what to say....God knows I've been guilty of this myself. And some of the feeling was probably projected, when I was stuck in a 'glass half empty' worldview. But the now-standard convention of announcing a pregnancy only after the 12th week is premised on the assumption that if something goes wrong before that time, you'd rather nobody know.  Presumably some of the social awkwardness stems from the days in which a woman who miscarried would be suspected of doing it deliberately, whether by illegal abortion or just because she was insufficiently maternal. When we knew less about the causes of abortion it was believed that the mother willed it, even if unconsciously -she didn't want the baby enough. Of course we no longer hold mothers to blame for their miscarriages. So why would so many women still prefer nobody to know?

A key theme of the special issue is the social tension that surrounds the ontological status of unborn children, and that may explain, at least in part, the silence that tends to surround the issue. Alison Reiheld writes that miscarriage is awkward because it is "suspended in a space between socially recognised states." The woman is somewhere between parent and non-parent. It's not clear if miscarriage involves death or not, because there is no social agreement about the status of embryos. 

One possible cause of the social silence is that there is an apparent risk, in conceptualising miscarriage as involving genuine loss, of undermining women's reproductive freedom. If a baby dies when a miscarriage occurs, it implies that a baby is killed when an abortion is carried out. But if, as pro-abortionists argue, a foetus is not a person and so lacks moral status, the grief often experienced by those who miscarry is unexplained. That grief, the experience of losing a loved one, presupposes that the foetus did have moral status.

What we need, Lindsey Porter argues, is an account that provides a middle ground, where the foetus is not put entirely outside the moral sphere, but without going so far as to call the foetus a person who cannot be killed. Otherwise there is a danger that the pro-abortion movement dismisses those who grieve after a miscarriage as mistaken about the significance of their loss.

Amy Mullin seeks to accommodate the anguish that can be caused by miscarriage, without undermining reproductive autonomy, by arguing that the moral status of a foetus depends upon its potential for becoming a member of a moral community, which depends both on its own properties and, crucially, on the plans of the pregnant woman. Byron Stoyles argues, similarly, that the value of a foetus derives from two activities of the mother - calling the foetus into personhood and creating an identity as a parent.

So perhaps some of the social ambiguity about the extent to which miscarrying mothers are entitled to grieve has good cause, in that a genuine metaphysical ambiguity underlies it. There is no answer about whether something died or not - or rather, the answer depends on the mother. This gives the power to the woman to decide for herself how much grief is appropriate. The social silence is respectful, it provides the space the mother needs to conceive the event as she sees fit.

This certainly sounds like it should be empowering, and yet I have doubts. Loneliness is a large part of the phenomenology of miscarriage. We conventionally treat the loss as very private - the mother herself has lost something. But the father, the grandparents, society more generally - we tend not to think they have lost anything. Their response will often be to feel sorry for the mother, but not for themselves.(I don't pretend this is always true - many fathers feel grief that equals or exceeds that of the mother. Yet it is a common complaint on miscarriage forums that the father isn't as upset as the mother feels he *should* be - not as upset as her). But this treatment of the pain as belonging to the mother, rather than being respectful, risks alienating her. The mother seeks validation of her reaction in that of others. What can she be grieving if the grandparents have lost nothing? Is it only in her she making it up?

It is of little consolation to such a woman to tell her that the foetus really did have value, because such value exists when the mother has begun to imagine a future for the foetus and to imagine herself as a mother. The mother craves objective validation of her grief. If we say that truths about the status of embryos are subjective it undermines the need by individuals to experience their reactions as real. It injures the identity that the foetus has come to partly constitute.

I think the binary nature of our conceptions of life and death are part of the problem here. Reproduction is in fact a smoothly gradient process, but our social categories aren't able to accommodate that. The presence of a heartbeat is used to impose a sharp alive/ not alive threshold. But sufferers don't always suffer any less for learning that theirs was a 'blighted ovum' (ie no heartbeat ever started). In truth a foetus occupies a hinterland between life and death. Any unborn child is only ever a little bit alive. Terminations, however caused, always involve a bit of death. But is a bit of death always sad? Doesn't menstruation involve a little bit of death too .....a gamete that is lost, never to exist again?

Perhaps the silence that surrounds miscarriage is, after all, better than an explicit confrontation of the subjective nature of foetal value. Its a socially optimal compromise between the felt experience of miscarriage and the need to preserve reproductive autonomy, as well as the diversity of ways in which miscarriage is experienced by real women.

It rather helped me, though, to realise that the social awkwardness about miscarriage has good cause - helped with the loneliness. Helped to validate my own confusion about what had happened.

Our baby would have been born this month, if the developmental process had completed. I had a feeling that it was going to be a girl - we never tried to find out for sure because it didn't seem important at the time, but my levels of nausea had me thinking 'girl'.  I'll never stop being sad that she isn't here, even as I look forward to the birth of her little brother or sister in five months time. There is some comfort in the logic that if she had made it, this sibling could never have come to exist. But even if I never met her and know nothing about what she was/would have been like, I'll always miss her in her entire unknown yet irreplaceable individuality. And I do take comfort in the thought that something of her will always live on, in me.

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