Abortion is a procedure whose relationship to medicine is neither straightforward nor agreed upon. It does have to be carried out by a licensed clinician with specific medical knowledge, but neither pregnancy nor the absence of pregnancy is a disease. They only require medical intervention (abortion for an unwanted pregnancy, or fertility treatment to bring about a pregnancy when nature does not oblige) in specific and subjective circumstances. The simultaneous medical and non-medical character of abortion has consequences for the meaning of the word ‘choice’.

While ‘pro-choice’ is the preferred term for those who support a woman’s right to have an abortion, the word also has quite different connotations. In health circles, it has become associated with the supposed empowerment of the patient, through the introduction of market competition and greater transparency, both very controversial developments. Furthermore, ‘informed choice’ has become a euphemism for individual choices that take account of official public-health information or that follow a period of counselling. Because of its non-medical aspects, however, abortion involves choice in the more fundamental sense of a moral choice, both on the part of the patient and on the part of the relevant clinicians. ‘Choice’ may be a popular buzzword in health-policy circles, but moral choice does not enjoy similar levels of official recognition or endorsement.

The 1967 Abortion Act says an abortion can only proceed if two doctors state, in good faith, that failure to abort would adversely affect a woman’s physical or mental health. Does this create space for genuine moral choice? Or is it a disingenuous compromise, bundling a multitude of reasons for choosing abortion into the category of ‘mental health’, and thus precluding the good faith the law demands? Is the meaning of a moral choice diminished if that choice can be exercised routinely, as critics of the ‘routinisation’ of abortion argue? What consequences will the introduction of new fetal-testing technologies that require only a sample of the mother’s blood, such as cell-free fetal DNA testing and whole fetal genome sequencing, have for the choice to have an abortion? And is this choice ultimately medical, or moral?

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