What I Have Learned about "Deliberate Life-Ending" During My International Project on Death
The title of this blog post is a phrase that has been said to me at least once a week (estimating conservatively) since I left the United States. With today (June 24, 2023) being the one-year anniversary of the United States Supreme Court overturning Roe v. Wade, this topic has been more noticeably on my mind in recent weeks. And, clearly, for the past year, it has also been at the forefront of the minds of many of those I have interacted with from all around the world. Some have danced around the subjects of politics and values. Others have been direct. Some have waited for me to make some sort of indication as to my stance on various subjects. Others have asked first. Some assume my positions. And others, somewhat surprisingly to me, have assumed incorrectly.
I think generally the people I meet who want to discuss the state of the world—particularly the happenings in the US—don't want to offend me. But I have embarked on an experience to listen and learn from perspectives and experiences far and wide, similar to, and different from my own. Genuinely, I have not once been offended by any conversation about policies and I am never hesitant to jump in and speak my mind about the flaws and faults in the systems in the United States at the moment, and the trajectory I see us headed on. This is what motivated my project in the first place: The belief that we aren't—and never were—the home of all the answers and solutions.
The current status of women's rights and abortion has come up a lot since I’ve been abroad. But, as someone who will unapologetically and unabashedly put in writing that I am pro-choice, I have come to realize in my work that I knew much less about this subject than I believed.
If you go back through my blog, you can see that not an insignificant portion of my project—about child loss, the experience for families, and the support that exist in a variety of cultures—is centered around the death of a baby or a perinatal loss. What maybe is less clear, and is similarly not hugely acknowledged in all of these groups, is that again not an insignificant proportion of these losses were the result of abortions. It was naive of me, I can admit now, to not think, prior to meeting some of these families, that individuals who have had an abortion might similarly seek comfort and support through these groups. These are groups designed to serve them—as they, too, suffered the death of a baby.
Now, I say "baby" here, not as any indication as to when I personally believe that life begins, as I am not clear on that myself. I use the term because that is how these families referred to their own children and so I am aligning my terminology with theirs. Again, this is not a universal statement on the experience, understanding, and desires of all who have had an abortion, but it was generally true for those I spoke with and it is, therefore, the language I will use in this post.
US lawmakers advocating for anti-abortion policy claim to be working from a stance of care and attachment to these babies not yet born. They believe that they are making laws in line with the most humane care for the children and are doing so out of moral imperative. They make appeals based heavily on emotion. I have a bit more patience for the individuals that believe that they are the only ones looking out for these babies, who, in their eyes, have been discarded, declared unwanted, and uncared for. But I think that they are misguided and do not understand the truth of these situations well.
There is an irony that I see in this. The individuals with the strongest possible attachment to these babies are painted as disconnected and unfeeling. Those without any personal ties view themselves as deeply attached to these unborn babies. In reality, if any of these people, unrelated to the baby, were to see a fetus outside of the womb born at 12 weeks or earlier, almost all would feel fear. If I am being honest, I think that being with a baby at this stage of development, most would feel squeamish and uncomfortable; divert their eyes and never offer to cuddle. At 12 weeks gestation and younger, fetuses don't look like the babies we know born at 40 weeks. The people who'd feel the most care, affection, and love for these babies are the ones who chose to have the abortion.
It might not make sense to some of you, but just sit with it and think—they were attached enough, cared and loved enough, to make the choice to have an abortion. They chose what was the best option for them and the baby in their situation. They were not attached to a hypothetical ideal or concept of a baby or of care, but a tangible version of it. The care they chose was to end the pregnancy because it was in the best interest of those involved, at that moment, in that circumstance.
I'm not sure how many anti-choice supporters have seen a baby at 12 weeks gestation outside of a womb. I have. I'm not sure how many have heard a story of parents receiving the news that the baby they prayed to have for the past decade, their last possible embryo from IVF, was not compatible with life. I have. I'm not sure how many have sat in a room of families who have suffered baby loss and talked with a woman who leaned in to say that her baby died because she got an abortion and couldn't say it out loud because she needed the support from the group to cope and didn't know how that fact would be received. I have.
I'm not sure how many have gone into hospital rooms week after week to accompany families mere hours after an abortion. I don't know how many have been in that situation to hear and say the baby's name, wade through air thick with tears, hand parents tissues, and offer resources about what they can do to honor the baby. I have. It doesn't matter if the abortion was chosen because the timing wasn't right, the individual didn't want a baby, the baby had a genetic defect making them unable to ever live outside the womb, or a thousand other possible reasons, there will be grief.
We don't have a good understanding of grief. We don't have a good understanding of emotions in general. They are not mutually exclusive states of being. We can be relieved and sad at the same time. We can be confident in our choice and heartbroken simultaneously. We can feel connected to the life and future of an unborn baby and also choose to not see a pregnancy through to the end. We get uncomfortable when we have conflicting beliefs, behaviors, and values, but it is impossible not to. In the end, most of us end up using a variety of strategies to minimize that cognitive dissonance. But the world is not black and white. We live in the gray.
Individuals who love their family members withdraw futile life support because of the deep emotional attachment that they have to them. They decide to end their life because it is in that person's best interest. Does that mean that they killed their loved one? Does it mean that they loved them any less because they decided it was best to not continue sustaining their life? Does it mean that they should be shamed, shunned, and made to be silenced? I think it is clear that the answer in this situation to all of these questions is no. But it is harder for people to say that about other measures used to end lives.
If the option is available in some cases for me, I believe it should be available for all cases. In some states in the US, euthanasia is legal. Despite taking a class on medical ethics and writing papers on euthanasia, I didn't fully dissect and understand my own point of view on this topic until spending time in Belgium and working with folks doing research in this area.
As with abortion, I think that euthanasia gets miscategorized as a devaluing of life when I have begun seeing both as the result of attachment to life. Prior to my time in Belgium, I was in favor of assisted dying and euthanasia law, but I didn't fully understand it. I can better understand now why an individual might want to choose euthanasia if they know the rest of their life will be filled with suffering and incurable illness. I can see why someone might want to choose to die before the life that they have had and loved, becomes consumed by pain.
A few weeks ago, I had a really special opportunity to speak with the doctor from the Netherlands who developed the Groningen Protocol, which is a set of directives with criteria under which physicians can perform "active ending of life on infants." This was a protocol for doctors to outline cases for newborns when the option to parents might be provided for deliberate life-ending when their baby ages 0-12 months had hopeless, unbearable suffering and death is the most compassionate choice. This decision is in the hands of the parents, with medical professionals and others agreeing to it.
In that country, euthanasia law becomes effective and available for people starting at 12 years old, which is the age of legal competence there. So for a number of years in the Netherlands, there were legal pathways for life-ending in cases of unbearable, hopeless suffering from birth through 1-year of life and then again starting at age 12. But patients with hopeless, unbearable suffering between the ages of 1 and 12 had no such option available to them. At the current moment, regulations are being modified to remedy this and should go into practice around January 2024. These policies allow for the last resort option. It gives people the knowledge that if all else fails, they still can have a choice at the end of life (theirs or their child's). In these extreme and rare cases where there is unbearable suffering without hope for improvement, there will soon be an alternative option and care pathway available for all.
In this conversation, one of the first questions that I asked the doctor upon hearing all of this was what was the societal reaction and perception of these regulations, changes, and policies. He politely told me that he gets that question often, and almost always and exclusively from people from the United States. He explained to me that for most, knowing that the option exists provides reassurance and comfort, even though most would never be in a position to nor would choose to use it. Some, he shared, of course, are not in favor of these policies, yet they appreciate that although they would never choose deliberate life-ending for themselves or their family, they recognize the importance of having it available as an option for others who feel like it is necessary for their situation.
The Netherlands is much more transparent, as a culture, than the United States, is what I have gathered. Death is not hidden away to the same extent there as it is in the US. It is a topic that is discussed, even with small children, as a natural part of the life cycle. Part of me thinks that this greater understanding of what it means to live and what it means to die—from a perspective of discussion and openness—allows for a greater ability to choose when to live and when to die.
But going back to my point above, I think that "choosing death," as one could say, comes from the attachment to life and an acknowledgment of death. It comes from a place of compassion and vulnerability to recognize what has been had and will be lost, and also what could be gained from death.
We fear death. A lot. None of us personally have experienced death. What we are fearing is the unknown.
I think that it takes a lot of bravery, reflection, and love to choose the unknown of death over the known of the life that would be, in cases of abortion, deliberate medical life ending, and euthanasia.
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