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The role of medical imaging in the abortion debate
  1. D Kirklin
  1. Correspondence to:
 Deborah Kirklin
 Senior Lecturer in Medical Humanities & Director, Centre for Medical Humanities, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Archway Campus, 2nd Floor Holborn Union Building, 2-10 Highgate Hill, London N19 5LW, UK;

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Deborah Kirklin discusses the role of medical imaging in the abortion debate

The latest developments in fetal ultrasound technology, made public by a group called Create,1 and first introduced to the wider UK public by the Evening Standard newspaper reporter Isabel Oakeshott in September 2003 and again in July 2004, have evoked a flood of responses from the public, pro-life and pro-choice campaigners, and politicians, re-igniting the debate about abortion in the UK and elsewhere. The focus of the Evening Standard articles, on the smiling, walking, and waving babies that the images purport to show, was echoed throughout the worldwide media coverage that followed. In July 2004, Sir David Steel, sponsor of the 1967 Abortion Act, publicly stated that the Create images led him to believe it was time to review the legal time limit for abortions. Prime Minister Tony Blair said he considered calls for such a review reasonable.

What interests me here is the powerful role that biomedical imaging, and the human artifice it involves, can play in influencing the nature, timing, and tone of this debate. The ultrasound technology involved is without doubt impressive. A computer is used to simulate the 3D appearance of the fetus in the womb by combining a series of 2D images and then filling in any gaps; the 4D images are generated by using the simulated 3D images to produce a rapidly changing sequence of images, an illusion of fetal movement is thereby created. The photo gallery on the Create website contains still images (generated by 3D ultrasound technology) and video clips (generated by 4D ultrasound technology). Two of these video clips are the major source of the controversy that has been generated: one appears to show a fetus smiling repetitively, the other appears to show a fetus waving its hand and forearm back and forward. A third video-clip, not shown on the website, appears to show a fetus walking in the womb. What is not immediately apparent when viewing the video clips is that these video clips are in fact video loops, with the same movement shown again and again. Thus the waving fetus is an illusion created by showing the movement of the fetus’ arm, from left to right across its body, over and over again. The smiling fetus, who appears to coyly smile then relax its mouth before coyly smiling again, is also an illusion. We do indeed see the fetus draw back its lips but instead of seeing what happens next, the illusion of smiling is created by the loop presentation of the images.

I am not pointing this out in order to deny the possibility that fetuses are capable of making the movements that these video clips purport to show, a proposition that I find totally plausible. Nor am I suggesting that the producers and distributors of these images set out intentionally to deceive those accessing them. I am, however, very interested in the potential for medically and scientifically generated images to create illusions of this sort, whether intentionally or unintentionally. It seems probable that even small changes in technology might have the potential to influence the nature of human responses to the images generated, and the subsequent decisions and actions taken as a consequence, as evidenced by the media furore that greeted these images and the influence this has had on politicians.

Perhaps unsurprisingly, for those who are pro-life it appears that these images are nothing less than technologically generated visual proof that ‘the unborn child is a living human being’.2 But those claiming that the moral argument against abortion is strengthened by these images thereby leave open the possibility that new information, in this example the role of human artifice in the generation of the Create images, may in turn weaken that very case. Some pro-choice advocates have also been tempted to focus on the relevance or otherwise of the apparent ability of fetuses to smile. Ellie Lee, Director of Pro-Choice, has argued that the apparent smile viewed in both the stills and video-clips is not in fact a smile in the sense of the social construct we understand a smile to be, stating that ‘Smiling is an activity that has social connotations. To smile requires a degree of self-consciousness and experience of interacting with other people. You do not have to be a genius to work out that a fetus, or indeed a small baby, does not have this.’3 She then goes on to dismiss the capacity to smile as a significant factor in determining the moral status of the fetus, and states her belief that the reason abortion is sanctioned by society is because of a desire to respect the autonomy of women. If Lee’s argument is about respecting the autonomy of women then her argument about when a smile is not a smile is irrelevant. The use of biological discourse in Lee’s defence of abortion implies otherwise and prepares the ground for future bio-technically based challenges to her conclusions.

The use of biological discourse to make normative arguments has little to do with intellectual rigour and much to do with politics. The use of medically generated images, and the human artifice that involves, does nothing to improve the quality of the abortion debate and is to be regretted.

Deborah Kirklin discusses the role of medical imaging in the abortion debate


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