Tag: abortion

Blog Posts (81)

March 24, 2017

A “disabled” person speaks out against a particular form of discrimination

Amidst lots of dark and tragic stories, a bright ray on the BBC website this week: Kathleen Humberstone, a 17 year-old English girl with Down syndrome, addressed the UN in Geneva to mark World Down Syndrome Day. Rather than reading anything I have to say, a far better use of your time would be to read what Ms. Humberstone said. You can find the full text here; if you scroll down... // Read More »
March 14, 2017

What are the Ethics of Avoidance?

Mark McQuain, in his February 21st blog post, discussed an interesting article which proposed that ethical decisions be made by robots. Although the author’s specific arguments invite numerous responses, underneath these arguments lies the question: why does modern man spend such effort to use technology to rid himself of yet another intrinsic function of his existence? It seems to me that this wish to pass... // Read More »
March 2, 2017

The ethics of conscientious objection: Caring for patients and supporting providers

Although conscientious objection arises in various areas of medicine, notably end-of-life issues (e.g. physician assisted death), it is ubiquitous in all aspects of reproductive medicine and women’s health care. Indeed, it is discussed extensively in the academic bioethics literature, clinical practice, healthcare law and policy (e.g. the Hobby Lobby Supreme Court case), and in the popular press. Part of the reason conscientious objection is so commonplace in reproductive medicine and women’s healthcare is because of the controversial nature of abortion and emergency contraception.

The topic of conscientious objection forces us to confront the boundaries of professional obligations and individual rights. Which should be prioritized when they conflict? The common stance of most professional medical organizations is that providers have an obligation to refer if they oppose a practice/prescription based on personal beliefs (e.g. providers should provide a referral if a patient requests an abortion and they oppose abortion due to philosophical or religious reasons), but not if they believe the practice/prescription doesn’t align with standard of care (e.g. providers don’t have to provide a referral if a patient requests antibiotics for the common cold).

The position of most medical organizations on conscious objection raises some concerns. First, there are logistical and feasibility concerns. While it may be easier to uphold providers’ conscientious objection in densely populated areas, in rural areas where there may only be one provider, thereby making it difficult to find someone to refer patients to. It is burdensome for patients to travel far away to receive medical care that they could receive locally if the provider did not have a conscientious objection.  

Second, there are concerns about violating the beliefs of individual providers. Some providers may believe that a certain medical practice/prescription, such as abortion, is so evil that even making a referral violates their religious or philosophical beliefs by making them an “accomplice” in what they see an immoral act. However, it may be difficult for patients to know where to go to receive care if they don’t have a referral. Furthermore, providers who intentionally withhold information about medically appropriate care (e.g. not mentioning that abortion is an accepted standard of care option for a woman carrying a fetus with a lethal abnormality) can be seen as violating the principles of nonmaleficence and informed consent.

Although there are some concerns with the position of most medical organizations on conscientious objection, ultimately it does its best to protect the interests of both patients and providers. One of the main goals of medicine is to care for patients according to the accepted medical standard of care. When providers have a conscience objection to a particular standard of care, they still have an obligation to their particular patients to ensure the patients receive the care that they need. Referring their patients to another provider safeguards the health of the patients while preventing the provider from having to participate in care that violates deeply held beliefs.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

March 1, 2017

The Gift of Finitude

I’ve been thinking a lot lately about finitude. About limits. Incompleteness. Even failure. Like the friend of a friend who is dying and has just been admitted to hospice, whose young teenaged daughter is facing the prospect of a life without her mother. Like the colleague who is grieving the loss of both a spouse and a parent within a month of each other. Like... // Read More »
February 23, 2017

Still further on heritable human gene editing

I want to spend a little time—several consecutive posts—on the subject of heritable gene editing in humans, and on the recent report by the National Academies of Science, Engineering, and Medicine on it.  The topic bears more attention than a single blog post, written in a bit of a rush, based on only the initial release of the report, pending a deeper dive.  That is... // Read More »
February 7, 2017

Secular Bioethical Mumblings of The Supreme Court

In the blog yesterday, Neil Skjoldal reminded us that bioethics will likely again play a role in the upcoming nomination process of Judge Neil Gorsuch to be an Associate Justice on the Supreme Court of the United States (SCOTUS). Why is this the case? To paraphrase Professor H. Tristram Engelhardt, I believe it is due in part to the inability of moral strangers to resolve... // Read More »
January 12, 2017

Fetal tissue research furor continues

At the end of 2016, the Select Investigative Panel of the House Energy and Commerce Committee published its report—all 485 pages—of its investigation into procurement of tissue from aborted fetuses for research.  The investigation had been prompted by the 2015 undercover videos from David Daleiden and his “Center for Medical Progress,” which was adduced to support charges that Planned Parenthood clinics, in particular, had violated... // Read More »
December 11, 2016

The 14-day rule: Time to double down?

The “world’s leading scientists” gathered at University College London on 7 December 2016 to explore extending the 14-day limit on embryo experimentation from 14 days to 28 days. Presently the consensus of that meeting is not known. The Guardian has published a nice summary of the background and future implications of the issue (link HERE). Jon Holmlund offered his comments in this blog back in... // Read More »
November 23, 2016

Christian ethics and the powerless

The recent political campaign and election week have had many of us thinking about politics and government. For those of us who look at bioethics from a biblical perspective we have had to think about how our perspective on moral issues affects public policy and how we as a people govern ourselves. What do we do when no one seems to support a public policy... // Read More »
October 20, 2016

The Ethics of Crisis Pregnancy Centers

"Pregnant? Scared? Need Help?" read signs along major thoroughfares in the southern United States. Many Americans have seen signs like these, often simultaneously advertising free pregnancy and sexually transmitted infection (STI) testing. Unless experiencing a unplanned pregnancy, most people pass by these signs without a second thought. However, for some of our most vulnerable patients, the establishments posting these advertisements - known as crisis pregnancy centers - represent a significant ethical difficulty in reproductive healthcare. Although these organizations are almost exclusively run by community volunteers, they represent themselves as healthcare workers by wearing lab coats and scrubs, providing lab testing and ultrasounds, and setting up offices that look like medical clinics. This would be problematic in itself from a legal perspective but the political and religious perspectives of these organizations provides serious ethical questions as well. Far from unbiased, crisis pregnancy centers (CPCs) are usually religiously affiliated organizations with a hard right agenda of preventing abortion at any cost. Medical evidence and scientific fact are not considered in this equation so clients of CPCs are often told that abortion causes breast cancer, infertility, psychiatric disorders (such as the entirely fictitious post-abortion syndrome), and even, in one case, kidney failure and subsequent dialysis. Furthermore, results of testing done at CPCs are frequently fabricated or ignored - clients are given falsely negative pregnancy test results or incorrect dating ultrasounds to prevent those considering an abortion from pursuing other care. CPC clients are usually unaware that these organizations do not employ trained medical providers or that they have a political agenda. However, the intent is clearly to strongly imply to CPC clients that they are being given information by medical personnel. As such, it seems fair to evaluate CPCs using principles of medical ethics, such as the four basic principles of beneficence, nonmaleficence, autonomy, and justice.

There is no question that the principle of autonomy is violated at these centers egregiously - purposefully providing misleading or false information takes away a person's ability to make informed decisions. However, the other three principles come into play with CPCs as well. Since there are rarely real medical providers at these centers, patients with serious health issues may be given advice that is, at best, suboptimal and, at worst, dangerous, arguably violating the principle of nonmaleficence. When a patient is told they are not pregnant when they are, they will not be able to seek timely prenatal care and are potentially put at risk for complications of pregnancy. When a non-expert performs an ultrasound and provides inaccurate results, fetal abnormalities, ectopic pregnancies, and other concerns go unrecognized. One center in Texas was documented telling a patient with a history of transposition of the great vessels that pregnancy was likely uncomplicated for her and would require “occasional monitoring,” rather than the extensive cardiologic and obstetric care that she would need throughout her pregnancy. These scenarios are not uncommon at CPCs and clearly have the potential to cause harm to patients seen in their offices. The principle of justice should also be considered in the case of CPCs as well – most situate themselves in areas of low socioeconomic status and target low income people as primary clients. These are generally the patients who can least afford access to healthcare and typically have lower levels of education, making them the least able to afford to care for an additional child and most vulnerable to the tactics of CPCs. It is hardly just when vulnerable patients, frequently people of color, are targeted to receive radically different healthcare and information than those with greater financial means, who would be less likely to be looking for low cost services.

Beneficence is the only principle of the four that could be debated depending on one's political and ethical leanings. A more pro-life leaning position might argue that the beneficence attributable to the fetus by potentially preventing an abortion should be considered with the discussion surrounding CPCs. This, of course, is predicated on the assumption that CPCs help to prevent abortions at all, which has yet to be adequately studied, although many CPCs tout the numbers of supposedly prevented abortions on promotional materials. Conversely, a pro-choice argument would be more concerned with the pregnant person, the potential benefits and risks of continuing a pregnancy and abortion, and the beneficence attributable to them. Overall, the patient should be able to determine for themselves what beneficence is for them and whether the patient should be treated as a patient. Regardless of stance, any ethical analysis would involve weighing multiple factors to determine whether or not a particular practice should be considered ethical. Looking at the complete picture surrounding CPCs and considering the violations of nonbeneficence, autonomy, and justice as previously outlined, it is not difficult to conclude that the practices of CPCs are not ethical and should not be endorsed by mainstream medical providers.

Although the ethical violations are clear, the course of action with regard to CPCs is not. These centers tend to fall into a legal gray area, as they are not officially bound by rules regarding medical practitioners and generally fall under non-commercial and/or speech stipulations when it comes to false advertisement litigation. Complicating the issue further is the fact that not every CPC operates this way – some centers follow strict guidelines regarding usage of scientific evidence and disclosure of non-medical personnel status, usually in states that regulate these centers. There is also no question that there is a need for services in populations targeted by CPCs and that, if operated appropriately, they could be a force for good in low income communities. Thus, although it’s difficult to universally condemn the practice, advocacy for regulation of CPCs, especially those who receive state funding, seems key. As medical practitioners, it is important to be aware of the existence of CPCs and their ethical problems. Furthermore, one of the best things we can do for our patients is make sure they do not fall prey to such predatory practices by advocating for laws that plainly identify CPCs as non-medical practices and/or require fact-based counseling, particularly in those centers that receive state and federal funding. Regardless of personal feelings on abortion, honest and ethical practices with patients should be an issue that all medical practitioners can agree with. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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News (13)

March 5, 2014 3:04 pm

Planned Parenthood, Tucson gynecologist, fighting tighter regulations on abortion drugs

Planned Parenthood and a Tucson gynecologist are asking a federal judge to block new rules that will sharply restrict ability to perform abortions using drugs instead of surgery.

February 3, 2014 2:49 pm

Thank The Pill For Abortion Rate Drop

The abortion rate in the U.S. has reached its lowest level since Roe v Wade. Why credit should go to Planned Parenthood, not the GOP.

March 15, 2013 5:02 pm

Bill in North Dakota Bans Abortion After Heartbeat Is Found

Little more than a week after Arkansas adopted the country’s most stringent abortion limits, banning the procedure at 12 weeks of pregnancy, the North Dakota Legislature on Friday passed a more restrictive bill that would ban most abortions as early as 6 weeks into pregnancy.

January 16, 2013 2:11 pm

As "Roe v. Wade" turns 40, most oppose reversing abortion ruling (Yahoo News)

Most Americans remain opposed to overturning the controversial U.S. Supreme Court decision in Roe v. Wade, which 40 years ago legalized abortion at least in the first three months of pregnancy, according to a poll released Wednesday.

December 11, 2012 2:42 pm

North Carolina barred from issuing "Choose Life" license plates (Yahoo)

A federal judge has permanently blocked North Carolina from issuing an anti-abortion specialty license plate, ruling that offering plates with a “Choose Life” slogan without an alternative supporting abortion rights is unconstitutional.

November 15, 2012 6:41 pm

Ireland to Clarify Abortion Rules After Woman's Death (Reuters)

Ireland’s government pledged on Thursday to clarify its abortion laws after an Indian woman who was refused a termination died from blood poisoning in an Irish hospital.  Activists  say the refusal by doctors to terminate the pregnancy earlier may have contributed to her death.

August 2, 2012 10:01 am

The flawed basis behind fetal-pain abortion laws (Washington Post)

On Thursday, Arizona’s new abortion law will take effect, outlawing the procedure after 20 weeks of pregnancy — a much earlier threshold than in any other law that has been upheld in court. Like-minded laws have been enacted in Nebraska, Alabama, Idaho, Indiana, Kansas, Oklahoma, Georgia and Louisiana, and a bill similarly limiting abortion in the District drew support Tuesday from a majority of the U.S. House, but not from enough members to pass.

June 7, 2012 12:37 pm

Doctors caught in the abortion wars (Salon)

“Civil disobedience,” is what they called for. Two prominent doctors, Marcia Angell and Michael Greene — both professors at Harvard Medical School; Angell the former editor in chief of the New England Journal of Medicine – were saying doctors should disobey some of the most common abortion restrictions. “They should make it clear that they will not perform procedures, such as ultrasound examinations, unless they are medically indicated and desired by their patients,” Angell and Greene wrote in an Op-Ed in USA Today on May 15. “And they should refuse to provide inaccurate information about the consequences of abortion, or to follow any other prepared script in counseling their patients, particularly when it involves treating women like children.”

June 1, 2012 9:05 am

House Rejects Bill to Ban Sex-Selective Abortions (New York Times)

The House on Thursday rejected a measure that sought to impose fines and prison terms on doctors who perform abortions on women who are trying to select the gender of their offspring — a practice known as sex-selective abortion. The legislation, which required two-thirds support to win passage under the fast-track procedure used to bring it to the floor, fell short on a vote of 246 to 168. Republicans did not anticipate that the legislation would pass, but saw it as an opportunity to force Democrats to vote on an issue with appeal among conservatives.

May 21, 2012 4:50 pm

Column: Where are the doctors? (USA Today)

Since the choice to terminate an unwanted pregnancy was established by the U.S. Supreme Court in 1973 inRoe v. Wade, almost one in three women have had abortions. The legality of contraception was established even earlier, in 1965, in Griswold v. Connecticut, and tens of millions of women use some form of artificial contraception. But there is now an unprecedented and sweeping legal assault on women’s reproductive rights. New legislation is being introduced, and sometimes passed, in state after state that would roll back access to abortion and contraception, mainly by intruding on the relationship between doctor and patient.

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