How to reach a consensus on abortion.

The following is an excerpt from The Human Drama of Abortion: A Global Search for Consensus by Anibal Faundes and the late Jose Barzelatto Vanderbilt University Press, 2006, 0826515266, $24.95).

IN 1997, I (AF) HAD THE OPPORTUNITY to organize a meeting on abortion for Latin American gynecologists and obstetricians, which included parliamentarians, jurists, ethicists, and women's rights advocates as well. About forty people sat around the table for two days, discussing the social problem of abortion and proposing possible solutions. An objective account of the abortion situation in the region was presented and possible actions that could help improve the situation were discussed. Well into the second day of the meeting, a female parliamentarian from Chile raised her hand to ask for the floor. Her contribution--short and to the point--remains engraved in my memory:

"I believe this meeting is of the utmost importance, and I am fully sympathetic to the problem of women who undergo induced abortions. I feel, however, that something is missing from this discussion and you should understand that I come from Chile. For two days now, all I have heard is talk of women's rights and the consequences of abortion for women. This is quite the opposite of what I have been hearing in the Chilean Parliament over the past few years. There only the fetus exists, and all discussions center on the fetus's right to life. I wonder whether these discussions would not be more constructive if at this meeting we take care not to forget the fetus and in my parliament we do not forget the woman."

This statement was among the most important of the entire meeting. It was a very clear invitation to accept diversity of values and to recognize that progress in dialogue cannot be achieved if some of the actors ignore the arguments of others, instead of making an integral analysis of the problem.

THE SOCIAL NEED FOR AN "OVERLAPPING CONSENSUS"

Throughout history all societies have experimented with different forms of organization, with the general aim of promoting peace among their members and improving their well-being. Different forms of organization have been inspired by a variety of ideologies and value systems, usually modulated by the cultural and religious traditions of each particular society. Many models have been adopted, but none has been universally accepted.

The evolution of the organization of human societies shows a historical tendency toward increased recognition of the need to respect individual rights and to promote social justice. Perhaps the greatest difficulty in organizing a just society has been to satisfy, in an equitable manner, the aspirations of individuals with those of society--in other words, to achieve the right balance between individual good and common good or between the claims of liberty and justice.

This challenge has become progressively more urgent in recent decades as a number of circumstances have caused the world to "shrink." Technological progress, the massive and global development of communications, the increasing number of people who travel and migrate, and the globalization of the economy are forcing face-to-face interaction among people from very different cultures. Different ideologies, religions, cultures, and moral systems have to explain their differences in a rational and respectful way, both to themselves and to "the others." Inevitably, this long and difficult dialogue has tended toward identifying common values and influencing the permanent process of change that characterizes all cultures. In the process, the need to respect diversity and to develop a certain social consensus has emerged as a prerequisite to organizing a peaceful and already de facto global society.

In his last book, the late John Rawls (2001) addresses the general public, proposing "justice as fairness" as the basis for a modern democratic political system: "as a political conception of justice rather than as part of a comprehensive moral doctrine" (Rawls 2001, p. xvi). Restating his classic Theory of Justice, published in 1971 and further elaborated in subsequent publications, Rawls recognizes that there is no religion or philosophy that can provide a comprehensive view shared by all citizens on how to organize society. He adds that there will possibly never be a single view in any democratic society.

Reasonable people have different beliefs and different views on what is right and what is wrong. Accepting the existence of a "reasonable pluralism," therefore, seems to be a requirement of democratic societies. Furthermore, reasonable people with very different general views can nevertheless identify and expand some common ideas and values--what Rawls calls "an overlapping consensus"--on which to organize societies (Rawls, 2001, p. xvii). Identifying the overlapping consensus for social purposes does not impinge on the liberty of individuals or prevent groups from adhering to and acting within their own comprehensive views of morality. An overlapping consensus, however, allows them to accept that within reasonable limits other persons may act differently, following their own comprehensive views of what is right and wrong.

In order to reach an overlapping consensus, free and equal citizens must agree to engage in a fair system of social cooperation. This requires acceptance that all persons have "the capacity for a sense of justice" and "the capacity to have, to revise, and rationally to pursue a conception of the good" (Rawls 2001, pp 18, 19). In addition, it requires that the social system guarantee the absolute right of each person to an adequate set of basic liberties, such as the freedom to think, to speak, to differ, and to choose individual lifestyles and goals. Of course, there must be some agreed-upon and reasonable limits to freedom and the acceptance of some limited social and economic inequalities, as long as everyone has the right to compete fairly for the social and economic positions within the society.

We quote Rawls not only because we agree with his rejection of present systems--be they capitalist states or social-states--but also because we agree with his assessment that the practical role of political philosophy "is to focus on deeply disputed questions and to see whether, despite appearances, some underlying basis of philosophical and moral agreement can be uncovered. Or, if such a basis of agreement cannot be found, perhaps the divergence of philosophical and moral opinion at the root of divisive political differences can at least be narrowed so that social cooperation on a footing of mutual respect among citizens can still be maintained." To this end, political philosophy must be "realistically utopian," "probing the limits of practicable political possibility" (Rawls, 2001, pp. 2, 4). Utopia is understood as an ideal for which one fights rather than as something that is impossible to achieve.

An important rule for promoting a consensus is to refrain from framing the discussion as a confrontation or as a dilemma. There are occasions when choosing between two options is inevitable, although more frequently other alternative paths exist that may not be readily apparent. Another important rule is to identify the issue, its roots, and its consequences clearly and in all their complexity, based on the best objective evidence available, and to keep up with the latest knowledge and any changes in circumstances (Barzelatto and Dawson, 2003).

Building a consensus is not about denying or ignoring differences or manipulating evidence. It is a process that starts by identifying common views and values and goes on to expand the initial consensus by discussing the roots of the differences. It is a dialogue that requires mutual respect; mere tolerance will not do. Mutual respect means accepting the fact that we may, at least in part, be wrong and that someone else may, at least in part, be right. This attitude requires a strong sense of self-confidence and a solid democratic environment, both of which are indispensable to maintaining the moral integrity of a dialogue that honestly aims to build a sustainable social consensus and not merely at imposing a point of view.

IS AN "OVERLAPPING CONSENSUS" ON ABORTION POSSIBLE?

Given the acrimony and the lack of intellectual integrity that characterizes much of the public debate about abortion, reaching an overlapping consensus is at best a very difficult task. Discussing Rawls's notion of overlapping consensus with respect to abortion, two Catholic philosophers, Dombrowski and Deltete, comment that "political liberalism's handling of the abortion debate should result, at the very least, in a modus vivendi but it is also possible that the contending parties might eventually reach an overlapping consensus." (Dombrowski and Deltete, 2000, p. 104) The authors also reveal that one of them is skeptical about the latter possibility, whereas "the other shares Rawls's long-term optimism regarding achieving an overlapping consensus" (Dombrowski and Deltete, 2000, p. 117).

We believe that an overlapping consensus on abortion is possible, having as part of its foundation respect for diversity and the belief that all people are capable of acting as full moral agents. Our optimism is reinforced by the information presented in this book, which we believe incorporates the mainstream of current informed thought and analysis. Particularly inspiring for us--because differences in religious views seem to be the most difficult to overcome--is the consensus reached by prominent theologians at the 1994 interfaith meeting held in Genval and described in Chapter 8. At this meeting, prominent scholars came to agree that given the differences among and within religions and the need to respect religious freedom, no religion could impose its views about abortion on people of other faiths. Furthermore, they condoned decriminalization of abortion as a reasonable move toward decreasing human suffering. As we also saw in Chapter 8, these views on abortion were endorsed in 2004 by an international group of prominent women's rights leaders and distinguished theologians who met in Chiang Mai, Thailand, to discuss women and religion in a globalized world (Center for Health and Social Policy, 2004).

Another inspiring experience came about in response to a tragic event that occurred in Boston on December 30, 1994. A man entered a Planned Parenthood clinic with a rifle, wounded three people, and killed the receptionist. Then he drove two miles to another clinic where legal abortions were performed, shot the receptionist, and wounded another two people. The governor of Massachusetts, William F. Weld, and Boston Cardinal Bernard Law, among others, called for talks among pro-choice and pro-life leaders. Six years later, the Boston Globe published an article entitled "Talking with the Enemy," signed by six of the most prominent women in the public debate on abortion in the United States, three of them pro-life and three pro-choice. Their report revealed for the first time that they had been meeting secretly since July 1995 in response to (1) the appeal from the governor and the cardinal and (2) an invitation from Laura Chasin as part of her Public Conversations Project. Attending as individuals rather than as representatives of their organizations, their aim had been not to find common ground or compromise but "to communicate openly"; "to build relationships of mutual respect and understanding; to help deescalate the rhetoric of the abortion controversy; and, of course, to reduce the risk of future shootings" (Fowler et al., 2001, p. F-1. It is fascinating to read how apprehensive, worried, and skeptical these six women and the facilitators were before the first meeting and how difficult the first sessions were. The attendees started by deciding how to refer to each other (the accepted forms for all except one were pro-life and pro-choice, used in quotation marks) and by identifying hot-button words and phrases that should be avoided (such as murderers and religious fanatics).

By the first anniversary of the shootings, according to the article signed by the women, "each one of us had come to think differently about those 'on the other side.' ... As our mutual understanding increased, our respect and affection for one another grew" (Fowler et al., 2001, p. F-0, so much so that two of the pro-lifers attended an anniversary ceremony organized by the pro-choicers. The news media, which had been unaware of the meetings, noted the effect on the way the women spoke in public about the abortion issue.

Although they believed that their differences reflected two irreconcilable world views, the women had met privately for five and a half years (a total of more than 150 hours). During the meetings, they came to see the dignity and goodness in one another, they grew spiritually and intellectually, and they became wiser and more effective leaders. Their purpose in going public was to encourage people to engage in similar dialogues, where "people can disagree frankly and passionately, become clearer in heart and mind about their activism, and at the same time contribute to a more civil and compassionate society" (Fowler et al., 2001 p. F-1).

THE BASIS FOR AN "OVERLAPPING CONSENSUS" ON ABORTION

Although people commonly initiate discussions on abortion under the assumption that there are those who are for and those who are against abortion, in truth virtually no one is in favor of abortion per se and virtually no one is against abortion without exception. The public debate has been dominated by two extreme views: one that maintains that women always have the right to decide the fate of the fetus as a part of their bodies and one that maintains that the rights of the fetus, from the time of fertilization, always override the rights of the pregnant woman.

We believe that most people disagree with both of these two extremes and that there is already a narrow but significant overlapping consensus with respect to abortion: (1) Nobody likes the idea of having an abortion or of other people having abortions, but virtually everyone agrees that abortion is morally justified under certain circumstances. (2) There are too many avoidable abortions. (3) Unsafe abortion is a major public health problem. In order to better define and expand this consensus, public debate must focus on how abortions can be prevented and under what circumstances abortion is morally justified.

If we avoid confrontation and unnecessary aggression, it is possible to expand the existing consensus and use it to legislate and regulate abortions while respecting the different value systems of each society. A respectful dialogue would allow (as has been the goal of this book) identification of the depth and extension of the problem, its causes, and its consequences and the interventions that have proven effective in ameliorating the problem.

Taking account of available evidence and the values involved, we propose the following nine points to guide the dialogue that would define a practical consensus and the basic actions that would allow societies to decrease the number of abortions and reduce their negative consequences:

1. There is an unacceptable number of preventable abortions in the world today, and unsafe abortions represent a major public health catastrophe that could be almost completely avoided. Therefore, reducing the number of unwanted pregnancies and abortions and minimizing the human costs of unsafe abortion are desired social goals that will benefit women and society in general. Consequently, societies should promote policies and implement actions that have proven effective in achieving these objectives.

2. Respect for persons, including the recognition of and respect for diversity among individuals, is a basic ethical principle and one of the foundations of democracy. It includes freedom of religious belief and respect for diverse faiths as essential components of human social interaction. Consequently, societies that promote a dialogue that seeks to define a practical consensus on abortion should include different value systems, including differing religious perspectives, with the understanding that no religion can impose its values on those who do not profess its faith.

3. Women are human beings with the same rights as men, including the right to make decisions, freely and responsibly, about their sexuality. Nevertheless, societies have traditionally denied equal rights to women and have accepted men's right to impose their sexual decisions on their female partners. This patriarchal culture is a principal cause of unwanted pregnancy, and its passive acceptance is an obstacle to the amelioration of the problem of abortion. Consequently, societies should promote greater gender equity in all spheres of life, including a better balance of power between women and men, which will allow all women the opportunity to decide when, with whom, and under what circumstances they will pursue their sexual lives. Respecting women's right to true control over their sexual lives is an essential component of these policies and actions.

4. Broad-based, unbiased sexual and reproductive health education, rather than leading to indiscriminate sexual activity, can promote responsible sexual behavior and reduce unwanted pregnancies and induced abortions. Consequently, societies should implement education programs and campaigns based on models that have proven effective in the promotion of responsible sexual behavior and respect between genders.

5. Easy access to effective and safe contraceptive methods through high-quality, user-friendly delivery systems does not promote promiscuity and quite efficiently reduces abortion. Consequently, societies should eliminate all barriers to accessing effective contraceptive methods for all sexually active people.

6. It is not uncommon for women to turn to abortion because they lack family and social support. Consequently, societies should take action to support pregnant women who want to carry a pregnancy to term.

7. Criminalizing abortion and penalizing women who abort does not reduce the number of abortions and--by supporting the market for unsafe, backdoor abortions--greatly increases human suffering and death. Consequently, societies should decriminalize abortion, within socially acceptable limits, and legislate to prevent unwanted pregnancies.

8. When a woman meets the conditions required by the laws of her country to have an abortion, she should have easy access to safe abortion services. Consequently, societies should establish clear guidelines and regulations that will ensure the provision of safe abortion services, free of bureaucratic, economic, or political barriers.

9. Most women have unwanted pregnancies and induced abortions as a result of society's failure to protect their rights. Abortion is typically a decision made as a last resort. Moreover, health facilities have the ethical obligation to treat, without discrimination, all persons who request their services. Consequently, societies must ensure that women who suffer complications from legal or illegal abortions are treated with full respect and receive health care of the same quality as that provided to any other person who seeks medical help.

Although these views may not, at present, be shared by all groups and, indeed, those holding very extreme views may never agree to all of them, we believe they may come to be acceptable to a vast majority of the world's people. It is not the purpose of this proposal to impose the values of a majority on the views of a minority. It is our goal to find a practical agreement through which societies will be able to address all aspects of abortion and, within reasonable limits, allow women as individuals to follow their conscience in their personal decisions regarding sexuality, reproduction, and abortion.

SOME REFLECTIONS ON THE PROCESS FOR ACHIEVING CONSENSUS

Although we believe that there already exists a general global consensus that too many abortions occur and that unsafe abortion should be eliminated, the same consensus does not exist with respect to which measures should be taken to solve the problem. A major reason for this is that the scientific evidence that demonstrates the effectiveness of specific actions in reducing abortion and its consequences is not readily available to the general public.

The political will to implement the nine points proposed here requires not only clear knowledge of the scientific evidence that supports each point but also broader dissemination of accurate information on the positions of different religious and cultural value systems with respect to abortion--a necessary first step in the process of achieving an overlapping consensus. This information will reveal that the various positions are more tolerant than absolute, thus facilitating a constructive dialogue and expanding the consensus, for example, on which contraceptive methods should be made widely available, who should have access to them, and what information should be included in sex education programs.

We recognize that the process of achieving gender equity may be more difficult and more prolonged because it requires profound cultural change. Nevertheless, improving the balance of power between genders is a clear global trend that, particularly in the more developed parts of the world, has already seen considerable progress. The idea of shared responsibilities between men and women in the pursuit of their sexual and reproductive lives has become increasingly accepted. Thus, it seems logical to incorporate this concept into the growing overlapping consensus.

Virtually no one would argue against support for women who want to carry pregnancy to term. This idea, which is nevertheless rarely included in abortion-related agendas, should therefore be incorporated into the overlapping consensus in order to use public dialogue to ensure that the cultural and legal environment will facilitate the support that women need to carry pregnancies to term and raise their children.

Although the participation of religious groups in building the overlapping consensus may be a challenge, we believe we have shown that the common ground can prevail. The Genval report and the Chiang Mai declaration described in Chapter 8, are convincing examples of agreement among religious leaders on fundamental principles.

The most controversial point in our proposal--the decriminalization of abortion--is one on which there is more agreement than is readily apparent. Reasonable people disagree only with respect to the circumstances under which abortion is morally permissible, but almost everyone agrees that abortion should be legally allowed under certain circumstances. The current controversy concerns conflicting moral value systems, whereas the consensus that we seek involves a practical political approach for addressing the problem of abortion while respecting diverse moral values. Although it implies some cultural change to achieve greater respect for diversity, its concrete focus is a change in legislation, a goal that requires a respectful public dialogue that identifies reasonable restrictions. Solid leadership, to ensure the safety and accessibility of legal abortions for women who meet the legal requirements, is also required. The process of implementing the proposed actions is facilitated by public dialogue that includes collaboration among the medical establishment, women's rights advocacy groups, and the political leadership.

All cultures, including religious and moral systems, are in a constant process of change with respect to the way they apply their fundamental principles under new circumstances. Usually, it is a constructive dialogue that arises from new realities that promotes change in the application of moral values. A resistance to change caused by the uncertainties of the consequences of change is not uncommon. Unfortunately, the natural tendency to interfere with the evolution of constructive dialogue can halt progress. At its worst, this resistance, not infrequently of religious origin, may give rise to extreme responses that have tragic consequences.

The main obstacle to identifying and achieving an overlapping consensus is the existence of extremist positions that oppose change. Extremist views that are not open to respectful discussion cannot be part of the quest to identify an overlapping consensus on which to base a peaceful and just democratic society. Fortunately, extremist positions are in the minority. It is to the great majority that we address this book in the hope that it may contribute toward reducing the human drama of abortion that affects most of us, directly or indirectly, at least once in our lives.

The process of seeking and expanding a consensus is a long and hence an urgent one that involves governments, religions, and society at large.

Barzelatto J, Dawson E, "Reproduction and Sexuality in a Changing World: Reaching Consensus," in Maguire DC, ed. Sacred Rights: The Case for Contraception and Abortion in World Religions, (2003), Oxford University Press, pp 255-271.

Center for Health and Social Policy, Women and Religion in a Globelized World: A Conversation of Women's and Religious Leaders, (2004). Available at: www.chsp.org/Women and Religion in a Globalized_World.pdf.

Dombrowski DA, and Deltete R, A Brief, Liberal, Catholic Defense of Abortion, (2000), University of Illinois Press, 158pp.

Fowler A, Gamble NN, Hogan FX, Kogut M, McComish M, Thorp B, "Talking with the Enemy," Boston Globe, January 28, 2000. Available at: pubpages.unh.edu/~jds/BostonGlobe.htm.

Rawls J, and Kelly E (ed.), Justice as Fairness: A Restatement, Belknap Press of Harvard University, 2001, 214pp.

ANIBAL FAUNDES is professor of obstetrics and gynecology at the University of Campinas, Sao Paulo, Brazil, and senior researcher at CEMICAMP, an internationally renowned center for research in reproductive health. He is currently chair of the Committee on Sexual and Reproductive Rights of the International Federation of Gynecology and Obstetrics.

JOSE S. BARZELATTO was vice president of the Center for Health and Social Policy in San Francisco and a former director of both the UNDP/WHO/World Bank Special Program for Research and Training in Human Reproduction and the Reproductive Health and Population Program of the Ford Foundation.