Explore the importance of ethical, legal and professional values in Abortion
Abortion is a worldwide growing concern and is a controversial topic of debate. The main objective of the following essay is to explore the importance of ethical, legal and professional values in abortion. This paper will provide up to date information and comprehensive review with the help of evidence based literature research. It will also explore the possible solutions and recommendations to support ethical and legal perspectives. Initially, it will provide brief information about abortion and its legal values. Further, it will make links with ethical concept, related issues and conflicts specific to health practice. Moreover, the role of health care professionals discussed in detail where appropriate.
All the data is collected form from the University digital library which gave access to recommended electronic journals. Further literature collected from the related articles. Some sources also gained from Department of Health, British Medical Association, WHO, Royal College of Nursing, British Pregnancy Advisory Services.
According to the British Medical Association (2005) abortion is defined as the termination of pregnancy by expulsion of product of conception (foetus or embryo) from the uterus, before the foetus is viable (capable of living under normal condition and outside uterus).It is observed that, 98% of abortions are carried out because of risk to mental or physical health of women in Britain (Department of Health, 2007). It is clear from findings of the statistical bulletin (2009) that there were 189,000 abortions in the given year and highest rate was in between the age of 19-21, that was 33 per 1000. Under 16 rate was 4.0 and under 18 was 17.6 per 1000 women. Ratio of all categories was lower as compared to the year 2008 (Department of Health, 2009). According to the WHO (2004) illegal abortions are more common in developing countries as compare to developed countries due to restricted abortion laws. WHO highlighted that, 46 million abortions annually recorded and 20 million are unsafe (DOH, 2009).
The law states that two doctors need to agree that the abortion can be carried out. They will reach this decision if they believe there is a greater risk to the woman’s mental or physical health if she continues with the pregnancy than if she has an abortion. The doctor can also take social circumstances into account when making this decision (British Abortion Act, 1967). Legal limit for abortion is 24 weeks gestation either by medical or surgical means (Royal College of Gynaecologists, 2004b). Nurses should maintain proper record before and after procedure including written consent (NMC,2007).
Nurses should be familiar with the legal requirements of the Abortion Act 1967, as amended 1990 (Nursing and Midwifery Council, 2008). Nurses have professional responsibilities to act with integrity and ensure that their personal views do not affect or influence the care of the patient or client (Nursing and Midwifery Council, 2008). According to the Mental Capacity Act (2005) special consideration should be given to the woman having serious mental illness (DoH, 2001c and NMC, 2005). The nurse should assist the individual in the decision making, with the decision based on the individual’s value system. However, the nurse should not take a lsissez-faire (leadership style) approach and avoid assisting the patient. The main responsibility of the nurse is to help the individual examine values, identify conflicts, priorities goals and desired health care outcomes. Actions follow from understanding values and the best available information (NMC, 2008).
Ethics is concerned with humanization process (Ladd, 1978) especially in the field of nursing. According to the Dyck, (1977) ethics is a discipline and is a systematic analysis of what things are right or wrong, good or bad. Often the world morality is used as a substitute for ethics. Morality is merely a synonym for ethics that signifies the customary way of action (Ladd, 1978).Health care ethics sometimes also called medical ethics, biomedical ethics and bioethics. These are normative ethics specific to health science, in that it rise the question of what is right and what ought to be done in a health science situation when a moral decision is called for (Benjamin, 1992). According to the American Nurses Association ethical theory refers to a workable system that provides a proper framework within which individuals can determine and distinguish morally appropriate actions (ANA, 1997).
In nursing, ethical principles act as safety valves for social control to prevent professional misconduct and abuse of rights of clients. Rights of people must manage according to National health policy and international conventions of human rights for safe guarding (Canadian code of ethics, 2009). It is proposed that code of ethics in nursing practice emphasizes on individual’s right to autonomy, self determination, truth telling, and equality (British Medical Association, 2009). Nursing should always be based on the principles of respecting persons, doing no harms and historically obedience to authority has often provided ethical basis (Raatikainen, 1989). Due to rapid socio cultural changes and advanced technology nurses faced challenge to respond ethical basis in health services.
Respect of freedom is condition of personal growth and development, brotherhood is the condition of recognition in social participation and equality a condition for meeting for physical needs (Equality and human rights commission 2009). However, these values are linked together as a whole. Fulfilling each principle means acting for good of each dimension. To meet this approach nurses need strong ethical beliefs, professional education, comprehensive knowledge, critical analysing and thinking (Noble, 1999).
It is argued that, life is valuable and is a gift from God (Belshaw, 1997). In case of abortion, it is a sin to destroy the foetal life because it interfere the creative work of god and against his will (BBC, 2009). But if abortion is critically reviewed, there are some factors and situations that require abortion. Again if abortion views from the foetus right to live then there is serious ethical argument of personhood in the favour of foetus. Belshaw (1997) stated that, the issue of personhood in literature always surrounding the abortion debate. For the classification of personhood five traits are essential (Card, 2000) that are consciousness, capacity to reason, self motivation, capacity to communication and self concept. All these criteria cannot be assessed in foetus (Dworkin, 1993). Therefore, abortion at any gestational age is ethical. In UK fetal has no legal rights and according to the American ethical policies foetus has both moral and legal values of personhood (BMA, 2007).
According to the British Pregnancy Advisory Services (2010) every woman has right to control her own body with respect to her autonomy (independence or freedom). Abortion on the ground of maternal interest may be ethical (Gevers,1999).Abortion is a complicated topic that involves different and sometimes conflicting issues for example protecting foetal life, respecting woman right and preserving social harmony. In this situation it is very difficult to maintain balance in the value of one person’s life over another (Belshaw, 1997). Alongside it is also challenge for foetal personhood and its rights, Brown (2000) stated that if foetus is a person then its rights for using another’s body to survive, as it has no right over that person’s autonomy. Mother has the right to be separated from the foetus at any time, but doesn’t have the right to insist on its death (Card, 2000). Therefore, abortion can be done in case of mal formation but no measure to actually kill the foetus beforehand could be employed. In such circumstances nursing professionals experienced the dilemma (a problem offering at least two possibilities as, do or not do) of having to participate in abortion (Ballantyne, 2009). Sometimes it creates conscientious (refuse to perform) objection, but in critical situations they cannot be able to refusal (BMA, 2007). Tooley (1999) argued that if a foetus is classified as a person then it is only a justifiable to kill it in order to save the life of mother. However, if were not a person then it cannot be wrong to kill it, as it would not automatically have the right to life (Tooley, 1999).
Serious congenital abnormality is another major ethical issue for continuing pregnancy, as it is known that continuation have no benefit to the fetus, then the fetal interest relies on the belief that the level of welfare a child would have if born is worse than to not exist at all (Gevers, 1999). It is suggested that yet, there are some disabilities that would mean to live be worse than non existence (Sheldon, 2001). It is also reported that, handicapped people, who would fight hard to gain success in their life, for them others may think that they had not been born. So, evidence assumed that tests performed with the intention of treating the new-born and for safe delivery are morally acceptable and tests for termination often violate the principle of non-maleficence (the duty not to harm) (Finni S, 1999). People in community who violate this principle would lower the happiness because killing of foetus is like a murder (Thomson, 1999).
It is found that, pro medical genetic services are more beneficial for the detection of prenatal diagnosis and antenatal screening for the findings of congenital abnormalities (Angela, 2009)( like haemophilia, down syndrome, muscular dystrophy, cystic fibrosis and chromosomal abnormalities).It is under the principle of Utilitarianism (related with happiness and doing good). In some countries these are easily detected but there may some legal restrictions for abortions (Penchaszadeh, 1998). Hence this banned abortion law gave access to moral, social and psychological values (Simpson, 2007) in couples especially in women for termination of pregnancy. It is outlined that being known about defective foetus, women found difficulty to carry out pregnancy. In opinion, such countries should allow abortion (Angela, 2009). Seeing as many congenital abnormalities cannot be cured at any cost and if cured is too expensive. Statistics showed that, in developing countries limited human resources and low income are barriers for life long treatment (Perera, 2000).
Basically justification of a congenital abnormality exception is a major problem in countries having restricted abortion laws on the behalf of moral status of foetus (Ballentyne, 2009). Some consider that foetus has same moral status as compare to infant or child (Ashcroft, 2009) it should not countenance the destruction of foetus on the basis of the claim that it’s rearing will place an additional burden on the parents. So, parents should not allow to abort, either disabled foetus has lesser moral status after birth. It is also recommended that, all communities should learn lesson to cope with disability and their living pattern.
Moreover, in cases where women are raped, getting pregnant with such a child is yet another brutality they would be forced to bear and raise a child without father or single parenthood (Tan, 2006) such factors are more likely to create violent behaviour and adverse interpersonal relationship, further leads to parental separation and even divorce and depressive symptomatology. These should be identified at every opportunity for positive carrier (Quinlivan, 2006). Thus the option of abortion is best for them to save the life of mother. Nurses should maintain privacy, dignity and confidentiality of the client under the abortion law (RCGN, 2004).
Female infanticide is still another alarming issue in ethical practice due to cultural preferences it is known to be cruel way of getting rid of female infants (WHO,2009). In some cultures and societies there is urging for sons rather than daughters (Hussain, 2000).In these situations women usually suffer significant harms including vilification (slanderous) and physically as well as mentally abuse if she bears a daughter. According to their knowledge and understanding they are correct because of their individual preference of autonomous for freedom and to make a choice to meet their needs and desires (Rogers, 2007). They think that sons are care taker for their old age and help in keeping family name (Sumner,2009). In India statistics revealed that, from last decade the ratio of girls is continuously decreasing as compared to male child, which further create imbalance and great challenge for social fabric (Sharma, 2003). Sex determination should be totally banned and must be implemented on priority basis. At least, these should be prevented by punishment and implementation of adequate educational programmes to change behaviour and attitudes of communities and to improve importance of female child (Zeng, 2005).
Evidence suggested that worldwide there are so many couples who want to adopt child at any circumstance (Bitler, 2002). Health care professionals should be encouraged to understand the value of adoption as an option to teach the vulnerable groups (like teens, people with unplanned pregnancies, unwanted children) to reduce the abortion rate and prevention of foetal murder (Young, 2006).Therefore adoption and care homes may be an acceptable alternative for those unwanted children, who will then be ill treated after birth by their parents. It is observed that, there would be a serious ethical dilemma in forcing women for continuation of unwanted pregnancy (Gevers, 1999) because maternal interest is the most leading factor for abortion. Research also recommended that, adoption is not an alternative to abortion. It is only an option.
Ethics cannot and should not justify every thing. In some places ethical imperatives coincide with public policy and /or practice, while in other places they diverge. Policy in no nation surveyed answers entirely to all of the ethical demands. However, there is a crucial need to use and improve specific public issues such as health care, abortion and bioethics.
After passing the abortion act society has not become more welcoming to children. Parents are going away from their responsibilities for their children as well as their partners. With the existence of legal abortion thousands of children have lost their lives at the hands of doctors. Every abortion is a human tragedy for the child and for its mother. It should be avoided at any cost. Every child is an individual with its own future to respect. Abortion is a major social injustice, directed at those who are most vulnerable.
The ethical status of abortion will remain controversial for the foreseeable future. Restrictive abortion law deserve greater attention. School based educational programmes and availability of contraceptive are more important to help in reduce the teenage abortions. Strategies will then need to focus on self esteem and reducing the idealization of pregnancy as a solution to general life dissatisfaction to gain positive carrier. Health care professional should be motivated to raise the ethical issues of in their practices for social justice and equity through successful educational programmes through out their carrier. To face the complexity of bioethical issues public appreciation can also play a pivotal role in the modern society.
American Nurses Association (1997) “Position statement on cultural diversity in nursing practice”. Washington: DC The Association
Ashcroft R, et al (2009) “Prenatal diagnosis and abortion for congenital abnormalities”.American Journal of Bioethics, 9 (8): pp. 48-56
Ballantyne A, et al (2009) “Prenatal diagnosis and abortion for congenital abnormalities: is it ethical to provide one without other?” [online] Available at:http://0-web.ebscohost.com.brum.beds.ac.uk/ehost/pdfviewer/pdfviewer?hid=107&sid=dcefef83-ac24-4940-81e5-ada17cbdcf35%40sessionmgr110&vid=11 (accessed on 10th November 2010)
BBC (2009) “Ethics: Abortion”. [online] Available at: http://www.bbc.co.uk(accessed on 30th November 2010)
Belshaw C(1997) “Abortion, value and sanctity of life”. Bioethics, 11 (4) p. 130-1150
Bitler M, et al (2002) “Did abortion legalization reduce the number of unwanted childrenEvidence from adoptions”. [online] Available at: http://0-web.ebscohost.com.brum.beds.ac.uk/ehost/pdfviewer/pdfviewer?hid=105&sid=b66b57c0-0a98-4bca-b69a-8eb2c57250fc%40sessionmgr114&vid=10(accessed on 10th January 2011)
British Medical Association (2007) “The laws and ethics of abortion”. [online] Available at: http://www.bma.org.uk (accessed on 28th November 2010)
British Pregnancy Advisory Services (2010) “Abortion”. [online] Available at: http://www.bpas.org/bpaswoman/abortion(accessed on 9th January 2011)
Brown M (2000) “The morality of abortion and the deprivation of futures”. Journal of Medical Ethics, 26 (2) p. 103-7
Canadian Code of Ethics (2009) “Nursing code of ethics: Guidelines for making ethical decision making”. [online] Available at:http://www.registered-nurse-canada.com/nursing_code_of_ethics.html#top(accessed on 5th January 2011)
Card R (2000) “Infanticide and the liberal view of abortion”. Bioethics, 14 (4) p. 341-51
Department of Health (2001c) “Seeking consent working with people with learning disabilities”. Department of Health, London
Department of health (2007) “Statistical Bulletin. Abortion statistics, England and Wales”. [online] Available at: http://www.dh.gov.uk/assetRoot/04/11/75/74/04117574.pdf(accessed on 8th January 2011)
Department of health (2009) “Statistical Bulletin: Abortion statistics, England and Wales: 2009”. [online] Available at:http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_116336.pdf(accessed on 20th November 2010)
Dworkin R (1993) “Life’s domination: An argument about abortion and euthanasia”. Harper Collins, London
Finnis J (1999) “Abortion and health care ethics”. Bioethics, Blackwell publishers, Malden p. 13-20
Gevers S (1999) “Third trimester abortion for fetal abnormality”. Bioethics, 3 (4) p. 306-15
Human Rights Watch (2005) “Decisions denied”. [online] Available at:http:www.hrw.org/en/reports/2005/06/14/decisions-denied-0 (accessed on 6th January 2011)
Hussain R et al (2000) “The role of son preference in reproductive behaviour in Pakistan”. [online] Available at:http://0-web.ebscohost.com.brum.beds.ac.uk/ehost/detail?hid=105&sid=b66b57c0-0a98-4bca-b69a-8eb2c57250fc%40sessionmgr114&vid=14&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=rzh&AN=2000037256 (accessed on 10th January 2011)
Noble –AdamsR (1999) “Ethics and nursing research”. British Journal of Nursing, 8(14) p.956-60
Nursing and Midwifery Council (2008)”The code Standards of conduct, performance and ethics for nurse and midwifes”. NMC, London
Royal College of Obstetricians and Gynaecologists (2004b) “The Care of Women Requesting Induced Abortion”. [online] Available at:http://www.rcog.org.uk/resources/Public/pdf/induced_abortionfull.pdf(accessed on 2nd January 2011)
Sharma DC (2003) “Widespread concern over India’s missing girls”. [online] Available at:http://0-web.ebscohost.com.brum.beds.ac.uk/ehost/pdfviewer/pdfviewer?hid=107&sid=a11620b1-6ce4-4dbf-9588-f697b3506632%40sessionmgr110&vid=5(accessed on 3rd January 2011)
Sumner MM (2009) “The unknown genocide: how one country’s culture is destroying the girl child”. [online] Available at: http://0-web.ebscohost.com.brum.beds.ac.uk/ehost/pdfviewer/pdfviewer?hid=107&sid=a11620b1-6ce4-4dbf-9588-f697b3506632%40sessionmgr110&vid=7 (accessed on 3rd January 2011)
Tan LH, Quinlivan JA (2006) “Domestic violence, single parenthood and fathers in the setting of teenage pregnancy”. [online] Available at: http://0-web.ebscohost.com.brum.beds.ac.uk/ehost/detail?hid=110&sid=350eac2f-9fb6-45ee-a11f-6d8f884ecbe7%40sessionmgr114&vid=3&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=rzh&AN=2009152510 (accessed on 15th December 2010)
Thomson J (1999) “A defence of abortion”. Bioethics, Blackwell Publishers, Malden p. 36-45
Tooley M (1999) “Abortion and infanticide”. Bioethics, Blackwell Publishers, Malden p. 21-35
Rogers W et al (2007) “Is sex selective abortion morally justified and should it be prohibited[online] Available at:http://0-web.ebscohost.com.brum.beds.ac.uk/ehost/pdfviewer/pdfviewer?hid=105&sid=b66b57c0-0a98-4bca-b69a-8eb2c57250fc%40sessionmgr114&vid=18 (accessed on 8th January 2011)
Raatikainen R (1989) “Values and ethical principles in nursing”. Journal of Advance Nursing, 14(2) p. 92- 6
Sheldon S, Wilkinson S (2001) “Termination of pregnancy for reason of fetal disability”. Med Law Rev 9 (2) p. 85-109
Young R (2006) “Vermont Children’s Aid Society offers free training on Understanding Infant Adoption to health care”. [online] Available at:http://0-web.ebscohost.com.brum.beds.ac.uk/ehost/pdfviewer/pdfviewer?hid=105&sid=b66b57c0-0a98-4bca-b69a-8eb2c57250fc%40sessionmgr114&vid=12 (accessed on 10th January 2011)