Benjamin Hale
  Associate Professor, Philosophy and Environmental Studies
Center for Science and Technology Policy Research
Campus Box 488
University of Colorado at Boulder
Boulder, Colorado 80309-0488
Endorsement

 

Culpability and Blame After Pregnancy Loss
Full paper available upon request

 

 

 

 

Full article in The Journal of Medical Ethics

After a death in utero many women feel a sense of responsibility for what has happened with their child. These feelings of responsibility can lead to a host of unpleasant emotions that bereaved mothers and their partners carry around with them for years. It might be thought that there are only two clear approaches to such claims of guilt: either to associate this guilt with blame, or self-blame, and chalk it up to a deep attachment to the child, to an emotional reaction that is “only natural” in the face of loss; or to associate the guilt with a misunderstanding about medical fact. The natural response to the first, psychologistic reading, is to urge bereaved parents to accept guilt as an irrational but nevertheless normal reaction to bad outcomes. The natural response to the latter, deterministic reading, is to attempt to console mothers by explaining medical probabilities, by suggesting that “sometimes bad things just happen” and that the mother “could not have prevented the outcome.” Both approaches seek to overcome the mother’s feelings of self-blame by downplaying her emotion as somehow an irrational response to events outside her control. In a sense, however, neither approach addresses the main concern.

This paper argues that the problem of feeling guilty about a pregnancy loss is primarily a moral problem, not a medical or psychological problem. To do so, it first introduces two standard approaches to women who blame themselves for a loss, characterizing these approaches as either psychologistic or deterministic. It then argues that both of these approaches underdetermine the autonomy of the mother by depending upon the notion that the mother is not culpable for the loss if she “could not have acted otherwise.” The paper then explains that not being able to act otherwise is not as strong a determinant of culpability as it might at first seem. It argues instead that one’s culpability for a bad turn of events implies strongly that they have acted for the wrong reasons, which is probably not true in the case of women who have lost their pregnancies. The practical conclusion of this paper is that women who feel a sense of guilt in the wake of their loss have a very good reason to reject both the psychologistic and the deterministic approaches to their guilt—that they are justified in feeling upset about what has gone wrong, even responsible for the life of the child, but not culpable for the unfortunate turn of events.