Abortion and government policy.

There are at least three important questions to consider in any attempt to propose a government policy on the availability of abortion services. The first is whether it is theoretically possible to devise a policy that is coherent and consistent--a policy that makes rational sense in its own terms. The second is whether it is possible to devise a coherent and consistent policy that would be politically and morally acceptable--a policy that citizens would be prepared to accept or tolerate in numbers sufficient to allow the policy to be effectively implemented. The third question is how, in the pursuit of a coherent, consistent and acceptable policy, the public debate on abortion should be carried out--that is, what should be the tone and rules of civil discourse on the subject?

A "consistent and coherent policy" is one that is not inherently self-contradictory, does not show a discrepancy between its moral and political premises and its actual proposed implementation, and does not include arbitrary discriminatory features.

It seems quite easy, up in the pleasant and trouble-free heavens of pure theory, to conceive of such a policy. One coherent and consistent policy would be the outright prohibition of all abortions, backed by appropriate legal sanctions and sufficient funds to enforce the penalties, invariably applied in nondiscriminatory ways. An equally coherent and consistent policy would be one that proclaimed the right of any woman to obtain an abortion, implemented by programs and practices and public funds that ensured that any woman who wanted an abortion could get one. Such programs would have to include convenient access to abortion services, the availability of those services regardless of ability to pay and the availability in those programs of physicians and other appropriate personnel prepared to deliver the services without discrimination.

These two conceivable policies, although mirror opposites, share those features necessary to make them coherent and consistent: They take their own premises with full seriousness and follow through from them to actual programs and policies.

It would be extremely difficult actually to proclaim and enforce such a fully coherent and consistent government abortion policy in this country at the present time. The best we are likely to get is an approximation--a policy that might begin with a set of premises that are clear enough, but that almost certainly would be bedeviled by enormous problems if one were to implement it consistently and fairly. Perhaps that is the fate of any major public policy on any subject; it has to contend with forces, groups and individuals who believe it is wrong.

A policy to prohibit abortions would certainly encounter a number of obstacles: an unwillingness on the part of many state law enforcement agencies to carry out the letter of the law, or a tendency to put the investigation and prosecution of abortion cases so down on the list of priorities as to render them meaningless; the willingness of many physicians to risk breaking the law because they would know that the opinion of the public and of their medical colleagues was divided, and that the enforcement of the law would be minimal at best; the willingness of many desiring abortions to break the law because they would feel it was their moral right, or would be led by desperation, to do so, or would know--given the divided state of popular and professional opinion--that they could always find significant support for their actions. Even before the liberalization of several state abortion laws in the late 1960s and early 1970s, and well before Roe v. Wade and Doe v. Bolton in 1973, many physicians were willing to perform illegal abortions, hundreds of thousands of women were prepared to obtain them and very few law enforcement agencies sought to enforce the laws against them. It seems unimaginable that now--after nearly a decade of increasingly available legal abortions--that a policy to prohibit abortions could muster the necessary political and moral support to effect even a partial implementation.

The likelihood of a fully coherent and consistent abortion rights policy has to contend with some formidable difficulties as well. Many physicians will not perform abortions, whatever the financial or other inducements, and many hospitals will not permit them. In many areas of the country, this resistance, abetted by local lay resistance, already denies abortions to many women or creates considerable inconvenience and cost to those who wish to obtain them. It is hard to imagine any legislative remedy for the kind of inequity this situation creates; there is no constitutional way to force physicians who morally reject abortion to perform them. The success of pressure and interest groups in making effective use of the legislative and funding process to cut off public financial support for abortions indicates the vulnerability of abortion rights positions. And if legislatures and public opinion are deeply divided on abortion, it takes no great prescience to predict that future court decisions could go either way, with close votes whatever the outcome. In sum, given the confused and divided state of public opinion, with at least a large, organized and vocal minority rejecting government support of abortion rights programs, there is little reason to think that a coherent and consistent abortion rights policy has any greater chance of full implementation than would a fully coherent and consistent policy to prohibit abortions.