Tag: abortion

Blog Posts (73)

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.

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.

October 7, 2016

More on Gene Editing

One version of the headline of a news item in Nature this week is, “UK bioethicists eye designer babies and CRISPR cows.” The UK’s Nuffield Council on Bioethics has just released a report, “Genome editing: an ethical review.”  The full report and a short summary are available for download here. I must say that my understanding of recent bioethical reflection in the UK leads me... // Read More »
September 19, 2016

Late Term Zika Abortions: Thankfully not Euthanasia

If I were the editor of a recent Newsweek article by Cornell Law Professor Sherry F. Colb, the above title would have been my choice for her article. I must encourage you to read the actual article, lest you believe that the summary that follows is somehow taken grossly out of context. Her concern is that a late term abortion to terminate the life of... // Read More »
September 7, 2016

Positive rights and the tyranny of political power

Thanks go to Jon Holmlund for making us aware of the “Consensus Statement on Conscientious Objection in Healthcare” written by Julian Savulescu and a like-minded group of philosophers and ethicists. The statement, which represents one extreme in the discussion of rights of conscience and not a consensus of all those involved in this issue, seeks to transform negative rights into positive rights. That is, they... // Read More »
September 2, 2016

Evil on its Face

In June of this year, a group of ethicists—should I say that I use that term loosely?—issued a “consensus statement” to guide legislation and institutional policy regarding conscientious objection in medicine.  Conscientious objection, they explained, “is the refusal to provide a certain medical service, for example an abortion or medical assistance in dying, because it conflicts with the practitioner’s moral views.”  Their words, not mine.... // Read More »
July 28, 2016

Two of the week’s news items

1)      In this week when Hillary Clinton has declared the Hyde Amendment in her gun-sight, and said that “religious objections to abortion must change,” while her party literally shouts the confident claim that abortion is an affirmative public good and a fundamental human right, a commentator flagged the Washington Post’s awarding, last October, of 3 “Pinnochios” to the claim that Planned Parenthood ‘provides’ mammograms—a canard... // Read More »
July 6, 2016

The Strange (Future) Case of Doctors & Mr. Hyde

On 28 June 2016, the Supreme Court declined to hear an appeal of a Ninth Circuit decision that forced a small pharmacy in Washington to dispense Plan B (a “morning after pill” that terminates a pregnancy via abortion) despite the religious objections of the pharmacist owners. In other words, the lower court ruled that the pharmacists must violate their conscience by prescribing Plan B or... // Read More »
July 6, 2016

The Strange (Future) Case of Doctors & Mr. Hyde

On 28 June 2016, the Supreme Court declined to hear an appeal of a Ninth Circuit decision that forced a small pharmacy in Washington to dispense Plan B (a “morning after pill” that terminates a pregnancy via abortion) despite the religious objections of the pharmacist owners. In other words, the lower court ruled that the pharmacists must violate their conscience by prescribing Plan B or... // Read More »