Abstract
The topic of termination of pregnancy continues to attract extensive debate in both the public arena and in the academy. Debates about the termination of pregnancy for fetal anomaly (TOPFA) in particular, take place against this backdrop. Social science analyses of the views of medical professional providers of TOPFA are underdeveloped, and social care professionals (who care for those living with disability) are an underrepresented group in research more generally. In this contentious area of public policy, the insights could make an important contribution to the on-going policy debates. Using a mixed methods approach, this thesis explores the views about the acceptability of TOPFA from the perspective of two professional groups: medical professionals and social care professionals. Four case studies were used to form a basis for the exploration, and these were selected for intrinsic exploratory value. An epidemiological overview of TOPFA acceptance rates from six areas of the UK was used to help inform the case study selection process. Data collection from professionals by questionnaires and semi-structured interviews followed. The questionnaire data suggest that the views between the professional groups were not radically different. The thematic analysis of the interview data generated two themes: theme one conceptualizes the imagined child; theme two conceptualizes the predicted experiences of the imagined child. When comparing the accounts given by the two professional groups, the data suggest that social care professionals also look at the wider social context of a person with impairment when discussing their views regarding TOPFA. Medical professionals focus more on individual impairment when discussing their views on TOPFA. Whether an anomaly can be ‘fixed,’ what pain is associated with the particular anomaly, whether a normal life experience will be had were all considered against what professionals deemed a ‘morally acceptable’ outcome. Acceptable TOPFA was based on what was morally acceptable to professionals both in their professional roles and within a personal capacity.
Ethical Dilemma- Late-Term Abortion for Non-Lethal Fetal Anomaly
One of the most unending, disturbing, and noxious debates in that cuts across all moral and legal structures relates to abortion. The debate on abortion is carried out at the elementary levels in most cases, unlike those related to social welfare, racism, gender inequality, and poverty. The details related to gender inequality, poverty, among others, mainly aims at coming up with strategies to reach their ends, unlike abortion, which is a conflict about ends. The most common ethical them arising from the abortion debate is the right of a fetus and the meaning of human personhood and life. The debate on abortion has mostly been based on win-at-all costs ideologies that are driven by various advocacy groups and what they only highlight is the increased nastiness in public, which does not honor any civilized nation regardless of its level of democracy. However, various abortions occur without any human intervention referred to as miscarriages. These are more ethical as they can result from natural causes about the health and wellbeing of the mother. Induced miscarriages are deliberate abortions, and they are dispiriting, unpleasant, and unethical, for they do not value human life, which starts at conception.
Delegate your assignment to our experts and they will do the rest.
Dilemma
Termination of pregnancies has become a hotly contested debate across most nations that have set laws allowing women to terminate pregnancies. The termination of pregnancies can occur because of lethal anomalies or non-lethal anomalies. Lethal anomalies encompass congenital disabilities that are caused by abnormalities in the structural features of a fetus such as the absence of a cranium or brain and thus can lead to death after or during birth. Other forms of lethal anomalies include skeletal dysplasia, caudal regression, limb-body wall complex, and renal agenesis. However, the abortions for lethal fetal anomaly has always been considered as being the tough and painful choice for the parents despite being widely supported. The supporters of abortion claim that it will help reduce suffering for the involved families. Children born with such extreme abnormalities are less likely to survive, and thus, it is deemed a necessary evil.
Nonetheless, one type of abortion that has elicited a lot of debate is on that is carried out on late-term non-lethal fetal anomalies. A non-lethal anomaly is one whereby the unborn fetus or mother to do have any form of health-related complications. Therefore, a non-lethal fetal abortion indicates that the fetus can survive if it is left to grow until over 40 weeks.
In a majority of the “late-term” abortions are carried out during the 21 st and 24 th of gestation which is late in the second trimester. At 23 weeks old, the fetus the fetus’s ears can pick sounds, and it can recognize various sound heard while in the womb at birth. It is at this point that the fetus’s viability is high and it can survive outside the womb without or with medical assistance. According to the Center for Disease Control and Prevention (2018), in 2015, about 1.3% of all abortions carried out in the USA involved fetuses above 21 weeks of gestation. In the USA, the 1973 Supreme Court landmark case, Roe v. Wade recognized abortion as being an essential right (Higgins & Dellapenna, 2013). However, the USA constitution has a couple of restrictions on abortions that occur during the late term. In the UK, the 1967 Abortion Act legalizes the termination of pregnancy for fetal anomaly (Crowe et al., 2018). However, this law has not set in place any gestational limit. A considerable number of women have used the laws in carrying out abortions even when the fetus has no non-lethal anomaly, and this is where the ethicality of the procedures arises.
It has always been argued that women have the right to control their bodies, as this is the foundation for attaining gender equality. Through allowing women to have a say on their reproductive and sexual rights, they will be able to do with their bodies whatever they please. This is based on the argument that women have traditionally been regarded as “childbearing containers” rather than people. This has brought about a contentious debate amongst scholars, philosophers, politicians and even the public on what body autonomy should entail as they try to find the connection between an individual’s sovereignty, laws, and rights over his/her body. Higgins & Dellapenna (2013) state that one of the most difficult times in a woman’s life is the pregnancy period, as it will disrupt her entire family life education, employment, and even body. Because of laws such as Roe vs. Wade and the Abortion Act of 1967 have allowed women to carry out abortions.
The abortion debate revolves around two groups “the pro-choice and pro-life.” According to the pro-choice group, abortion is just like any other surgical procedure, and it is a medical decision to be made by a woman without external interference, whether from the government or anyone else. However, the pro-life believe that in a free society, killing a child even before it is born should not be tolerated. It is at this point that an ethical dilemma arises on whether a fetus terminated during late-term pregnancy has a right or not. From a religious point of view, a human being should be respected and treated as an individual right from conception. Intentional killing or direct abortion should be regarded as being a serious immoral undertaking as the right-to-life is considered one of the most important rights possessed by people. More importantly, an evil act should never be performed with a claim that it because of the greater good. This is similar to killing an entire society involved in a conflict with another to eliminate the conflict much quicker. A fetus should be respected and viewed as a human being, and by killing, it amounts to murder. According to Crowe (2014) abortion has not always been considered as murder by most people in the UK as the termination of pregnancy is considered as being a legal undertaking, and the fetus is not viewed as being human. The fetus is only treated as a legal human once it is born, and this is against God’s will.
Late term abortion for non-lethal fetal anomaly has also become an ethical dilemma for most medical practitioners. After a health professionals graduates from medical school, one is required to take a Hippocratic Oath, and one of the codes states that “ I will maintain the utmost respect for human life, from the time of conception ” (Patil, Dode & Ahirrao,2014). A physician must apply ethical principles to his/her practice irrespective of the spiritual, religious, or personal beliefs. In most cases, a woman who intentionally or unintentionally becomes pregnant must be ready to undergo the entire pregnancy phase regardless of the risks and distress. Therefore, the termination of pregnancy brings out the conflict between the rights of the fetus and the rights of the mother. This thus brings about the question does a physician have a right to kill a fetus at the mother’s request? A physician can argue that aborting a malformed fetus is ethical as it will eliminate the pain and suffering for both the unborn child and parents. However, there is no moral ground on aborting a non-lethal fetus during its late pregnancy even though it is what the mother would want. By killing of the fetus, it is an indication the physician is depriving it off future value, and thus, this makes it wrong (Patil et al., 2014). Regardless of this, the physicians are faced with a dilemma as the law allows women to carry out abortions, and thus, they must observe and adhere to the set stipulation. However, the destruction of a fetus or embryo, overall, is wrong for abortion in itself amounts to purposefully ending of life.
Effects
It is recognized that performing abortion procedures has various psychological impacts on the medical staff and physicians. This results from the Post-Abortion Syndrome resulting from performing late-term abortions. Post-Abortion Syndrome is a branch of PTSD, can be either delayed or acute whereby the former’s syndrome appear after six months while the latter appears much later, and has a long-term impact. A considerable number of Post-Abortion Syndrome occur many months after carrying out the procedure, and they can last for years, and they tend to follow a particular “stressor” event that is not related to usual experience and has some elements of suicidal thoughts. In the stressor is of human design, the Post- Abortion Syndrome will tend to last longer and the effects or severe. Being a form of PTSD, Post-Abortion Syndrome is related to other disorders such as irritability, depression, and difficulties in coping (Reardon, 2018). The most common aspect of Post-Abortion Syndrome is denial, and this is followed by grief and guilt, thus laying down a foundation for the other disorders. In abortion procedure such as the dilation and evacuation, a physician must dismember the fetus using sharp equipment, even crush the infant’s skull, remove the body parts, and place them on a dish for disposal. Such grotesque events leave doctors suffering from Post-Abortion Syndrome.
Moreover, a large number of women are being referred late to the clinics and indication they will undergo late-term abortions, and at times, the pregnancy is exceptionally advanced. Due to the nature of the abortion procedure, the physicians face difficulties and thus are forced to implement prostaglandin termination or pregnancy (PGTOPS) that is an unpleasant procedure for the physicians. Due to the high number of prostaglandin termination of pregnancy procedure, competent and highly trained physicians quitting their jobs, as they cannot deal with the procedure’s requirements. The procedure requires a physician to inject urea into the uterus and kill the infant (Brunner & Smeltzer, 2010). The prostaglandin chemicals later induce Labor, and it takes about 4 hours for labor to complete (Brunner & Smeltzer, 2010). The physicians are forced to help the mother in delivering the dead baby and later discard it.
Additionally, the number if qualified abortionists are retiring in the USA and this is a cause for alarm, especially for the young doctors. Abortion is regarded as seeing a tedious, and it demands little technical and ethical virtues from the doctor’s part. The young doctors regard abortions as being deliberate destruction of human life, and the physicians who perform it are morally insouciant and thus bear very low prestige within the medical field. Therefore, this highlights that young doctors would not want to waste their time training on how they will carry out a procedure deemed as being destructive.
Solutions
The increasing number of late-term abortions has become a worrisome trend amongst teenagers and women. It is high time the Ministry of Education designs a curriculum that will enable children of appropriate age starting from the 5 th grade to be taught matters related to pregnancy. Through this new curriculum, it will change how sexuality-related factors are taught within the learning institutions on the negative impacts of abortions and any complications related to pregnancies (Khodakarami, 2019). Through sex education, it will be used to reduce and even eliminate the need for engaging in abortions and thus decreasing high cases of “late-term fetal” morbidity. However, for this to work there needs to be a collaboration between the teachers, parents/guardians the entire community
Additionally, a significant problem in a large number of nations affecting women is unplanned pregnancies. Unplanned pregnancies are the major causes of abortions, and the cause of the pregnancies is women not having access to or using contraceptives. The provision of birth control pills to women at no cost will have a significant effect on reducing unintended pregnancies and cutting down on abortions. There are various contraceptive methods, such as long-acting birth control and short-acting controls. The latter is more affordable as it includes the use of birth pills, rings or patches
References
Brunner, L. S., & Smeltzer, S. C. O. C. (2010). Brunner & Suddarth's textbook of medical-surgical nursing . Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Center for Disease Control and Prevention. (2018). Reproductive Health . Retrieved on 9 July 2019, from https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm
Crowe, L., Graham, R. H., Robson, S. C., & Rankin, J. (2018). Negotiating acceptable termination of pregnancy for non-lethal fetal anomaly: a qualitative study of professional perspectives. BMJ Open , 8 (3), e020815.
Crowe, L. L. (2014). Termination of pregnancy for non-lethal fetal anomaly: professional perspectives (Doctoral dissertation, Newcastle University).
Higgins, M., & Dellapenna, J. W. (2013). Roe v. Wade: Abortion and a woman's right to privacy . Minneapolis, MN: ABDO Pub.
Khodakarami, N. (2019). The Impact of Sex Education on Sexual Activity, Pregnancy, and Abortion. arXiv preprint arXiv:1903.08307 .
Patil, A. B., Dode, P., & Ahirrao, A. (2014). Medical ethics in abortion. Indian Journal of Clinical Practice , 25 (6), 544-548.
Reardon, D. C. (2018). The abortion and mental health controversy: a comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE open medicine , 6 , 2050312118807624.
