JEDDAH, 3 July — A recent court ruling in France supported a woman who was prevented from exercising her right to abort a handicapped child. The woman demanded — and received — compensation from her doctor who had not informed her that her child was handicapped.The moral dilemma arising from the court’s decision is in two questions. Would a child want to live with severe disabilities? Are some lives simply not worth living?
This last seems to be the social and cultural view in France and in other parts of the world as well. Many who oppose the decision argue that the court has essentially said that a handicapped child is better off dead. Rod Dreher, in Sunday’s New York Post said: "The truth is, this is about society’s wishing to establish a right — by any means necessary — not to be burdened with caring for them."
French doctors now face the possibility of being sued for very large sums of money. As a result, doctors might be more concerned with avoiding a lawsuit than with doing what is best for the patient.
Indeed, a medical professor has pointed out that the possibility of being sued might prevent doctors from having the "confidence to admit mistakes if they feared that lawsuits would follow."
The case of abortion in Saudi Arabia however, takes on different and more complicated forms. There are religious, cultural and emotional aspects at play. As the pillar of Islam, the Kingdom prohibits abortion unless the child is severely disabled, to the extent that the disability will cause the child and/or mother severe pain. If, during pregnancy, the mother’s life or the baby’s is endangered, the mother can consider abortion as an option.
In February 1990, a committee led by Islamic scholars in Makkah agreed that abortion cannot be allowed after 120 days. The problem with abortion, they said, was that people would rather wash their hands of the burden of dealing with the disabled rather than finding the means and technology to help the child cope with their state in a positive sense.
In Islam, one of the five indispensable pillars in the Qur’an and Sunnah (the prophet’s sayings) is to preserve one’s life. It comes second only to preserving one’s religion. There are two reasons for this. One is the belief that for every disease, or disability, there is a cure, or at least something to ease the pain. As the saying goes: "God gives and takes." Islamic scholars also state that it is essential for doctors to help parents cope with their problems, so they do not lose hope.
The Qur’an does not explicitly address the issue of abortion, but there is a general agreement that it is only allowed before life is breathed into the fetus. And scholars do not agree when that is; some say 40 days, others say 80 and some even say 120 days. Some scholars oppose abortion at any stage of development, since the embryo will eventually become a living fetus. But there are women who often go to extreme measures to obtain an abortion.
In Egypt, for example, some 216,000 women were hospitalized in 1996 for treatment of abortion-related complications, according to a study of post abortion caseloads published in 1998 in International Family Planning Perspectives.
The law in most Muslims countries permits abortion under certain circumstances. A few however — Albania, Azerbaijan, Kyrgyzstan, Tajikistan, Tunisia, Turkey, Turkmenistan and Uzbekistan — permit abortion with no restrictions.
But the delicate line on this sensitive issue of abortion is still very puzzling. In fact, many Saudis were unwilling to discuss the topic while others professed total ignorance. Others preferred to say that the matter was "not for them to decide. God is the Creator and so these matters should be left up to fate."
Lujain Abbas, an administrative assistant for Samir Abbas Clinic shared this view. "It is interference with religion," Abbas said. "You cannot get rid of a child who is disabled." A mother of six, who withheld her name, said, "Do we know what is behind children with disabilities? They may be a test from God." Many mothers, she contended, will not take the gynecologist’s word and will try to consult a Muslim scholar, a sheikh, and other professionals. "In my case," said the mother, "I would seek advice from three people, including a sheikh."
A gynecologist at GNP (Pharaon Hospital) said that "although abortion in Saudi Arabia is illegal, there are certain steps doctors can take; a consultation between neurologists, pediatricians and others takes place to discuss the health of the mother, her pregnancy and the child’s condition in order to determine whether the health of the mother or the child would be endangered if the pregnancy were not terminated.
The system in Saudi Arabia requires doctors to use an ultrasound test at the end of 11 weeks of pregnancy. At 15 weeks, an examination of the hormones is made to detect Down’s Syndrome.
Finally, at 16 weeks, the doctor determines how abnormal the child will be." Surprisingly, however, the doctor also stated that "after 40 days, abortion is not allowed because the baby will have formed." In an Islamic book entitled "Fiqh Al Nawazil," doctors are given up to "120 days for the abortion to be performed."
Dr. Abeer Mohammed, a gynecologist explained that the system in Saudi Arabia allows a mother of 35 years of age and over to provide information on her background to medical professionals. This includes a history of disabilities and the aim is to see if she is likely to deliver a disabled child.
If the mother at high risk of giving birth to a severely disabled child, she may go abroad for an abortion. In other cases, she may decide not to be informed and thus face the risk of giving birth to a disabled child. "She’ll leave it up to fate," the gynecologist said. She continued, "Even if the child suffers from Down’s Syndrome, a gynecologist is not allowed to perform an abortion unless the fetus is either dead or not growing."
So the parameters in which a gynecologist can perform abortion, in her words, are "very limited," and only Saudi consultants can decide on abortion.
But her opinions and those of many others as well, are not clear. While she argued for the need to be more flexible regarding the issue of abortion — in the sense that only if the child is severely disabled should abortion be allowed — she also repeated over and over, "Not all tests are accurate, especially if we are trying to decide within the first forty days of pregnancy whether the child will be severely disabled." In other words, morality got the better of her. So the predicament continues. For one thing, Mohammed advises not to perform abortion during the first 40 days of pregnancy since accurate results will only come in the later stages of pregnancy. Then she says that a gynecologist has no right to kill a living being for the moral reasons that it is un-Islamic and unethical.
Dr. Nawal Mishkhas, a psychologist, explained the circumstances, which might force a woman to seek abortion. "There is a lot of stress, and a feeling of guilt after giving birth to a handicapped child. That child will naturally require more attention than a normal child." There are even situations when parents divorce because of the psychological strain they experience. One of Mishkhas’s pregnant patients, who has signs of an abnormal fetus, has already borne four disabled children.
"If you can prevent serious disabilities, then women should have the right to abortion," Mishkhas said.
That would not send a message to society that some lives are not worth living, she argued.
By detecting heredity diseases and problems, following up research and abiding by strict rules, the psychological strain would be lessened.
It must surely be apparent from all this discussion that the matter of abortion is not only very complex but it is also one to which there are no cut and dried solutions.
The questions may be the same but the answers and solutions will vary according to whom the question is addressed and the circumstances of each case.
