AWARE-ness in an Age of Doublethink

Doublethink means the power of holding two contradictory beliefs in one’s mind simultaneously, and accepting both of them. The Party intellectual knows in which direction his memories must be altered; he therefore knows that he is playing tricks with reality; but by the exercise of doublethink he also satisfies himself that reality is not violated. The process has to be conscious, or it would not be carried out with sufficient precision, but it also has to be unconscious, or it would bring with it a feeling of falsity and hence of guilt. Doublethink lies at the very heart of Ingsoc, since the essential act of the Party is to use conscious deception while retaining the firmness of purpose that goes with complete honesty. To tell deliberate lies while genuinely believing in them, to forget any fact that has become inconvenient, and then, when it becomes necessary again, to draw it back from oblivion for just so long as it is needed, to deny the existence of objective reality and all the while to take account of the reality which one denies — all this is indispensably necessary. Even in using the word doublethink it is necessary to exercise doublethink. For by using the word one admits that one is tampering with reality; by a fresh act of doublethink one erases this knowledge; and so on indefinitely, with the lie always one leap ahead of the truth. Ultimately it is by means of doublethink that the Party has been able — and may, for all we know, continue to be able for thousands of years — to arrest the course of history.

RECENT calls for parental or spousal consent when minors or married women seek abortions overlook some troubling potential consequences ("'Don't ask, don't tell' policy not ideal" by Dr Yik Keng Yeong and "Why parental consent laws are necessary" by Mr Darius Lee; both published on Thursday).

These requirements would be triggered only when a patient has already decided to seek a termination. Therefore, the main effect of a parental consent requirement is to give parents the power to coerce minors to bring unwanted pregnancies to term and give birth against the children's wishes.

Dr Yik also proposes a requirement for spousal consent or involvement. Taken in tandem with marital immunity for rape in the Penal Code, which treats marriage as a defence to charges of rape, this would give husbands the legal freedom to force their unwilling wives to have children.

Minors who have a relationship of trust with their family already consult their parents and listen to their views, even without a formal consent requirement. The same is true of women with loving and supportive husbands.

The proposed consent requirements will thus have the greatest effect in cases where there is the danger of family violence.

Introducing a court process will intimidate and distress patients, especially those who already live in fear of abuse. Legal inquiry into abuse allegations would be time-consuming, creating difficulties for patients already facing a 24-week time limit.

Moreover, it is difficult to see how a genuine investigative process could remain confidential and avoid the very disclosure to parents that minors at risk of family violence need to avoid.

Dr Yik believes a consent requirement may address the sexual abuse of minors.

In our experience, many sexual assault victims are reluctant to make reports because they fear they will not be trusted or believed. Denying them access to the medical services they have requested will do nothing to allay these concerns.

Mr Lee suggests that abortion carries the risk of complications, but he ignores the far greater risks attached to bringing a pregnancy to term and childbirth, which have much more significant impact on physical and mental health.

Notably, KK Women's and Children's Hospital identifies women under the age of 21 and those with unplanned pregnancies as two groups facing especially high risk of post-natal depression.

The reasoning in this letter is based on several flawed assumptions which need to be closely examined.

This letter will focus on the case for parental consent.

AWARE's inversions and consequentialism par excellence
AWARE's reasoning is solely consequentialist in nature, which fails to take into account the fundamental basis upon which parental consent laws are justified.

In "The Case for Parental Consent for Teenage Abortions", I explained that parental consent rests primarily on the following reasons derived from legal principle and medical ethics.

Firstly, legally and morally, various restrictions are imposed on young people under the age of 18 for their protection. This is based on the principle that young people are unable to fully understand the consequences of their actions, and therefore are unable to give valid informed consent. Hence, a young person under the age of 18 cannot legally purchase cigarettes or alcohol, consent to be married, nor have the capacity to enter into a contract. To allow her to undergo an abortion is an anomaly, especially when abortion is an invasive surgical procedure which carries with it various risks of complications. 

Secondly, it is unethical for a doctor to go ahead with any surgical procedure without obtaining consent from a parent or guardian where a minor is concerned. According to the Singapore Medical Council Ethical Code and Ethical Guidelines, informed consent should be given by parents on behalf of minor patients:

4.2.2 Informed consent

It is a doctor’s responsibility to ensure that a patient under his care is adequately informed about his medical condition and options for treatment so that he is able to participate in decisions about his treatment. If a procedure needs to be performed, the patient shall be made aware of the benefits, risks and possible complications of the procedure and any alternatives available to him. If the patient is a minor, or of diminished ability to give consent, this information shall be explained to his parent, guardian or person responsible for him for the purpose of his consent on behalf of the patient. [Emphasis added]

In fact, AWARE's philosophy is based on an inversion of the original loci of rights and responsibilities, which leads it to complain that "the main effect of a parental consent requirement is to give parents the power to coerce minors to bring unwanted pregnancies to term and give birth against the children's wishes".

This untenable on both legal principle and medical ethics. Young people are unable to give valid informed consent in the first place, hence there is no question of parents "coercing" minors to bring unwanted pregnancies to term or giving birth "against the children's wishes". (See also "AWARE's Sexual Indoctrination Agenda: Misrepresentations, inversions and logical non-sequitur")

Risks of abuse 
What about the risks of family violence and abuse?

Contrary to AWARE's understanding, young people are are not neatly or sharply divided into those who "have a relationship of trust with their family" on one hand and minors who "live in fear of abuse" on the other. Reality is far more complex and circumstances exist along a wide spectrum.

Furthermore, this perspective is overly one-sided and does not take into account the perspectives of the parents themselves, or even the objective reality. Allegations of abuse and family violence should be taken seriously, and not be lightly made. These fears may be highly subjective in nature and reflect the state of distress the girls are in rather than the actual reality. 

In light of all these circumstances, it would be better for an objective third party to decide the matter based on sound evidence. According to "The Case for Parental Consent for Teenage Abortions", concerns of abuse can be accommodated by a judicial bypass. This is an exception which allows the girl to apply confidentially to court to bypass the requirement of parental consent. Counsellors can always be assigned to the girl to assist her in the legal process and ensure her safety. 

Consequently, AWARE's claim that "[legal] inquiry into abuse allegations would be time-consuming, creating difficulties for patients already facing a 24-week time limit" is wholly unfounded.

Court procedures in Singapore are hardly so "time-consuming" that they take weeks and months in order to complete. For example, where there is imminent danger of family violence, an expedited personal protection order can even be obtained from the Family Court within a day.

Furthermore, this claim is grossly exaggerated in light of the realities on the ground. Most abortions are performed within the first 12 weeks of pregnancy in Singapore. In fact, only 3 out of 10,624 abortions in 2012 were performed past the 24-week limit. 

Do pregnancy and childbirth carry "far greater risks" than abortion?
AWARE claims that there are "far greater risks attached to bringing a pregnancy to term and childbirth, which have much more significant impact on physical and mental health", as compared to abortion. Is that true? 

In "The Feminist, Pro-Father, and Pro-Child Case against Abortion" I observed that abortion is harmful to women, both physically and psychologically. Various studies have arisen, showing that abortion has the following harmful effects on women's health:

• Negatively affects women's mental health. A 30-year longitudinal study showed that women who had gone through abortions had rates of mental disorder that were about 30% higher than usual. Abortion was also found to be associated with increases in risks of anxiety, alcohol misuse, illicit drug use, and suicidal behaviour. 
• Contributes to maternal mortality. A study of all women of reproductive age in Denmark over a 25 year period found that a single induced abortion increases the risk of maternal death by 45% compared to women with no history of abortion. The figure was even higher for additional abortions, 114% for women who had two abortions and 191% for women who had three or more abortions.
• Increases the risk of breast cancer. Scientifically, abortion interrupts breast maturity during pregnancy, retaining cancer-susceptible breast tissue which increases the risk of breast cancer. Statistics from Yunnan, China, confirm the link between abortion and breast cancer. The risk climbs with a higher number of previous abortions, a study showing that the risk climbs to a statistically significant 1.55-fold elevation for those with three or more abortions.
• Increases the risk of miscarriage. A study conducted among 15 general hospitals or maternity and infant health institutes in Shanghai found that induced abortion by vacuum aspiration is associated with an increased risk of first-trimester miscarriage in subsequent pregnancy. It was estimated that about 15% of first-trimester miscarriages in Shanghai is attributable to the prior history of induced abortion.

On 28 November, various letters had been written to the Straits Times forum, responding to some assertions previously made by AWARE. These letters cited various risks involved in abortion, including "bleeding and infection, and more serious ones include injury to the womb and surrounding organs" and infertility. Furthermore, Edmund Leong wrote in "Abortions raise maternal mortality risk" (28 November 2013):

Abortions carry a far higher risk of maternal mortality as well as long-term implications than normal or even extraordinary childbirths.

According to a European Journal Of Public Health study last year on women of reproductive age in Denmark, a single induced abortion increased the risk of maternal death by 45 per cent. The figure was even higher for additional abortions: 114 per cent for two abortions, and 191 per cent for three.

Given these immense risks associated with abortion that have been cited in the various letters, AWARE should at least cite risks of similar or greater magnitude associated with pregnancy and childbirth in order to respond to them. However, while AWARE recognises that "abortion carries the risk of complications", it does nothing except to boldly point to the "especially high risk of post-natal depression", to support its claim that there are "far greater risks attached to bringing a pregnancy to term and childbirth".

Such strange doublethink!

The statistics are unequivocal. Having examined statistics from Denmark, Chile and Ireland, William Saunders and Mary Novick write in "Study Confirms Childbirth is Safer for Women Than Abortion":