• abortion
• reproductive health politics

The cover is shabby – like a wrinkled, stained, smudged and mended plain wrapper – signalling the abjection and dirtiness with which abortion has often been associated. But Ann Furedi’s The Moral Case for Abortion is an attempt to rehabilitate abortion, as an idea and a practice, from the ethical, philosophical gutter. It is, in the author’s words, an “assault on the moral high ground.”

Going beyond familiar, utilitarian justifications for abortion as an unavoidable fact of life better performed safely than dangerously, Furedi builds a careful and largely convincing moral philosophical arguments for abortion as an actively humanitarian service. Drawing on relevant philosophical and theological argument, alongside medical and cultural ones, she places herself in a “strong, post-enlightenment philosophical tradition”, refusing the “attractive certainties” of which she accuses anti-abortion campaigners.

As Chief Executive of the British Pregnancy Advisory Service, a not-for-profit organisation providing around one-third of the abortions performed in England and Wales, Furedi is uniquely qualified to comment. But she is also uniquely ‘situated’ or, if you will, biased. Her stance as a leading pro-choice advocate, while honest and unapologetic, intruded at times on the sense of balance in an otherwise scholarly text. Chapter 3, for example, which promises ‘The Case Against Abortion’ – presents this counter-narrative somewhat abortively – evacuating objections unformed, rushing on into ‘The Case Against “The Case Against”’ – a subject with a chapter of its own. The killing of a fetus is acknowledged, but receives short shrift: “it stops a beating heart, but not … a person from living”. Anti-abortionists are lampooned first for smug certainty and tunnel vision (caring only about the fetus) then, paradoxically, for inconsistency (if abortion is acceptable in some circumstances, why not in others?) and, finally, dishonesty (morality dressed up as science). In places, it smacks of negative campaigning.

Written in active, non-objectifying language, the book comes across as refreshingly respectful and inclusive of service users, in ways that medical writing, especially on stigmatised subjects such as abortion or mental ill health, does not always. “… contraception fails and we sometimes fail to use it”, Furedi asserts, including herself in the group under study, avoiding the posture of the opining observer of an objectified patient.

Overall, I read this book with interest and gratitude, as a thoroughly researched and palpably experience-based attempt to dig beneath the familiar and often superficial discourse around abortion. Aside from healthcare practitioners, the book would potentially interest students of philosophy or theology. Whether you agree with Furedi or not, her thinking will sharpen yours. It made me think more deeply about why I choose to provide abortion services. It had that effect especially where I disagreed with the author.

And I did disagree, where I felt offered an equal and opposite certainty to those the author criticised. I wanted, instead, to find more acknowledgment for what feels to me like an unresolvable moral dilemma at the heart of abortion care. Unlike cancer surgeons who remove bad cells, and obstetricians who deliver healthy babies, we also support women in need, but in the full consciousness that we are also ending a potential human life. Furedi's image of abortion practitioner as moral crusader, freeing women to choose their own life-course, did not sit wholly comfortably.

Instead I would have welcomed greater acknowledgment of the moral uncertainty I feel. Because it seems to me that the truly humanitarian heart of abortion service provision – its bravery, if you will – lies in the fact that we offer it with humanity and respect for the women who need it, understanding it to be the lesser evil, but still, in a kind of fear and trembling: where angels fear to tread.