Saturday, 4 April 2015

The reader dialogue continues--trauma-informed practice

A professional colleague of mine contributed to this series of posts by positing that harm reduction could be a justifiable reason for allowing the abortion choice to remain. Another reader strongly rejected that view. Now reader one has submitted further reasoning for his position. S/he prefers to remain anonymous but extends permission for the response to be published.

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 In your previous post there is the assertion that a harm reduction approach MUST centre on an assumption that the unborn child is somehow morally subhuman (or at least less human than the unborn child's mother). I don't think this is the case at all. I posed the issue of abortion as an ethical dilemma... which necessarily requires that two moral imperatives be in conflict - and therefore whatever the choice, significant harm will unarguably come. Of course, if a woman carrying a baby who intended to have an abortion changes her mind (as in the anecdote you share in this post) - there's arguably no harm there. But I would argue that harm is not only in what happens, but also in how it happens.

In my last response I brought up the possible connection between this issue and the concept of harm reduction, now I'll bring forward the possible connection with "trauma-informed practice".

The basic concept behind trauma-informed practice is that people who have experienced significant trauma have nervous systems that, for good reasons, are tuned up to be hyper alert - enabling them to go into flight or fight mode (thus turning off their executive reasoning) at the first sign of danger.

The basic tenants, then, of trauma-informed practice are safety, collaboration, and, yes... choice. Why choice? Because anyone - but particularly anyone who has experienced significant trauma - will begin to feel threatened and cornered if they sense that they don't have choice or that someone is aiming to take their freedom to choose - their autonomous, easy exit - away from them. And at that point - the point where their amygdala fires them into a flight or fight response -  not only have we lost our ability to interact with that person's executive reasoning - they have too.

It is called "trauma-informed practice," rather than something like "responding to trauma" because trauma is actually much more common than our culture really lets on about, but, more importantly, because both we and a person who has experienced significant trauma may not ever have the chance to become aware of it - or of its effects (and therefore the necessity to respond to it). So trauma-informed practice would suggest that we treat everyone as if they had the propensities of a person who has experienced significant trauma... and offer them explicit safety, collaborative opportunities, and choice.

Doing so doesn't and will not resolve these ethical dilemmas between moral imperatives, but it will give everyone... most importantly the woman carrying the unborn baby... a fighting chance to be supported through an ethical decision-making process, which may include the kinds of information sharing that your anecdotal example in this post points to... but ALL in a process where choice is made EXPLICIT, and where signs of fight or flight are looked for and responded to assiduously... and as if someone's life depended on it... because it arguably does.

Just more food for thought, and I look forward, as always, to any response.
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