A Contest of Ideas

Whilst there is agreement on many fronts, in particular the observation that the language about abortion has changed, the importance of trusting in clinical judgement, respecting patient autonomy, responding appropriately to maternal emergencies and that late-term terminations are never casual or rare; like all good debates, the clarification of ideas, testing the evidence with a dialectic approach, helps to approach truth cooperatively.

With the tagline “abortion is healthcare” supported by prominent peak medical bodies, in a profession that is largely collegiate, it’s understandable that not all practitioners are aware that not all medical professionals (even mainstream ones) agree that abortion is healthcare or merely a medical intervention without moral implications. Evidence contrary to this opinion would be RACGP’s own media release prior to the 2025 federal election, which stated that abortion was healthcare, but only 11% of General Practitioners prescribed medical abortions, calling for more federal assistance to improve equitable access. Perhaps there’s another reason why 89% of GPs don’t include abortion in their daily practice? Excellent reproductive healthcare can be provided without elective terminations.

Another not-so-well-known fact is that not all practitioners in Australia think ending a healthy viable pregnancy is off limits. The evidence for this, is the way the Termination of Pregnancy and Abortion Law Reform Laws were written, supported by specialised practitioners. If there was serious concern about inadvertently terminating a pregnancy of a baby that could survive, why wasn't this included in the law? It’s a glaring omission. This is why activist groups and politicians have become involved, because it’s not as settled as experts would like the public to think.

In a life-threatening maternal emergency (i.e. physical risk), there are few arguments that an emergency caesarean would be the recommended mode of delivery, in which case, if the baby has a severe congenital anomaly, it may or may not survive delivery. Whether normal or not, the baby should receive active or palliative care, whichever is deemed appropriate. At later gestations, the likelihood is that a normally developing baby will breathe and be admitted to the nursery. However, legalising termination for mental health or psychosocial reasons, could mean the baby is normal and delivery will be elective, in which case there’s time for a feticide, which achieves the primary intent of a termination in this case, a dead baby. The evidence is not conclusive that feticide leads to better outcomes for the affected mother in any psychosocial clinical scenario, and 100% not for the baby. Using medicine to end life as a solution to social problems is widely opposed in medical and bioethical fields. And if maternal suicide is the fear, why are there no perinatal clinical guidelines for suicide recommending termination as the “treatment option”? In fact perinatal guidelines for maternal suicidal ideation list prior termination of pregnancy as a risk factor, which would suggest it's a relative contraindication.

Whilst these decisions for women are never casual and are based on a perceived benefit for all involved, how can electively terminating a baby by feticide when they can survive be ethically justified? Even if an antenatal test shows a baby is at high risk for a congenital anomaly, the number of clinical cases where doctors get it wrong should be enough to err on the side of recommending assessment at delivery and then offering palliation if survival is futile, in order to protect life whenever possible, the true definition of healthcare.

Advocating for feticide and early delivery in the case of fatal fetal anomalies is also not conclusively supported by evidence. Mothers consistently report it’s the most traumatic thing they’ve ever had to face, and often avoid speaking about it and suffer chronic PTSD. Chosen loss is when mothers experience disenfranchised grief, as though they’re not entitled to grieve, because they somehow contributed to the loss. It’s become more common as termination of pregnancy has become more widely practiced.

In contrast, there's some evidence families fare better psychologically when they continue the pregnancy as far as it goes (the child is not dying or suffering while in utero). Parents often value the time spent with their baby, however short, and seeing their baby die helps parents accept the reality of their loss. Palliative care can effectively control pain and symptoms of suffering, and midwifery and neonatal staff are skilled at providing this specialised care. With current available care, a baby suffering is likely due to inexperience or a lack of resources. Unfortunately, it’s also a malicious tactic used by well-meaning paternalistic practitioners to coerce mothers into choosing termination. When they’re told their baby is “incompatible with life”, “would suffer” and “would ruin their family”, what grieving mother would think they had other options?

Static legal timelines do dictate practice and outcomes. Japan and pro-life neonatal units in the US have between 60-70% chance of survival at 22 weeks, with 60-80% with no or mild impairment, the best rates in the world. Continually improving outcomes with quality improvement practices achieves healthcare excellence.

Born alive legislation does not demand aggressive resuscitation, it advocates that the baby who’s still breathing after a termination of pregnancy procedure be treated as a patient and receive appropriate care. In a wanted pregnancy with a fatal fetal anomaly, the parents are the primary comforters until baby dies. That’s not the case in terminations where the baby is unwanted. Mothers often don’t want to see the baby and ask for them to be taken away. At times they’re left in a kidney dish or bedpan because the midwife is too busy with other patients, leaving midwives distressed by this practice. Born alive legislation was not supported by RANZCOG in the Qld inquiry, because of the fear that rural women would not be able to “access” termination of pregnancy. When feticide is inaccessible because of a remote location, passing a born alive Bill would mean that babies born alive at viable gestations would need to be resuscitated and retrieved. Most mainstream practitioners would think that is extreme and regressive. In this case, it may be more accurate it be called the anti-infanticide Bill.

It could be argued Australia is heading further into the dark ages, when maternal bodily autonomy is upheld to protect choice with few legal barriers. The decriminalisation of abortion was celebrated as a common good, but what was largely kept out of public knowledge was that the legal protection of viable babies was also removed, some of them being normal and capable of surviving with modern technology. The fact remains, there is no upper gestational limit at which abortion is illegal, and as more Australian’s become aware, it's likely more activists and politicians will join the protest, until it’s no longer up for debate.