In an ethical debate, abortion is described as a medical process that purposely terminates a pregnancy before giving birth to a fetus or embryo. Many women face conflicting decisions on whether or not to terminate their pregnancy or go through with it. According to Hanschmidt et al. (2016), an ethical dilemma behind abortion is a controversial issue that experiences constant mental clash between conservatives and liberals. There exist strong arguments for and against the idea of abortion, which is entwined to a point that it is difficult to decide. The uncertainty of this issue lies in the several pieces of conflict. The abortion talks consider the moralities, the sins of intentionally eliminating a fetus and killing a developing life. Social concerns about family, gender, and sexuality always entwin moral views of abortion. Besides, the relative influence of these social concerns on the view of abortion depends on historical and cultural contexts. Although abortion is a controversial topic in history, an individual bases the decision of whether or not to support abortion upon considering its ethical issues .
Historical Background of Abortion
The history of abortion can be analyzed using various contexts that surround its ethical dilemma. Historical, legal, and scientific contexts summarize the complete history and origin of the ethical dilemma surrounding abortion.
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Historical Context
People could easily access abortifacient during the time of the Persian Empire. An abortifacient is a non-specific term that refers to substances that induced abortion, ranging from prescription medication to herbs ( Calkin, 2019) . However, despite the availability of abortifacient, people received severe punishments for performing an abortion. During Old Greece and the Roman era, some people resorted to abortion without hesitation ( Obladen, 2018) . It is because neither Roman nor Greek law protected the unborn fetus. Besides, the religious practices and laws at these two eras did not condemn or ban abortion. Plato and Aristotle supported abortion to be performed as a way of reducing excess population. However, physicians, religious pastors, and philosophers debated the morality of terminating an unborn fetus. As a result, it led to the eruption of the Hippocratic Oath, which took a position against abortion ( Calkin, 2019) . The Hippocratic Oath reflected the ideas of most of the Pythagoreans and included physician views renouncing the use of abortive remedies. The Oath mentions that "I will not give a woman an abortive remedy." It also adds that "In purity and holiness I will guard my life and my art ( Hendricks, 2018) .”
Specific Christian teaching on abortion developed in the Old Testament to guide Christian valuation of life indicated that people were to love their neighbor as they loved themselves. St Augustine regarded abortion as the killing of a human being or homicide because he believed that abortion defiled the primary aim of marital intercourse ( Calkin, 2019) . Some of the scholars in the Catholic Church, such as Thomas Aquinas, did not consider an unformed embryo to have a soul ( Hendricks, 2018) . Therefore, they believed that the fetus only possesses a soul three months after conception. This view led to the distinction between formed and unformed life, which led to more ethical dilemmas on abortion. Most Christian theologians in the late middle ages maintained the distinction between formed and unformed life, considering abortion of undeveloped embryos as less sin than the formed life ( Hendricks, 2018) . The theologians interpreted abortion of formed life as a homicide since they believed it involved the destruction of future man. In 1869, the Catholic Church believed that immediate rational ensoulment occurs at fertilization ( Calkin, 2019) .
Legal Context
The legislation started to replace the common laws after the civil war years. Abortion in colonial America was condoned and common enough to appear in the medical and legal records. The United States did not have official abortion laws until 1821 ( Ziegler, 2017) . In addition, abortion before quickening became illegal in the 1860s. At the beginning of legislation, the laws were lenient with those that performed abortions before quickening ( Ziegler, 2017) . However, in the middle and late 19 th century, the statutory laws and penalties for abortion abandoned the quickening distinction, which led to more punishment of those that performed abortion ( Obladen, 2018) . The United States banned practically all forms of abortion for about a hundred years. However, in 1973, the Supreme Court announced the original abortion statute as unconstitutional ( Tatalovich, 2019) . In its ruling, the court declared that the state has no right to interfere in a woman's decision to abort during the first trimester of pregnancy, having consulted the doctor. However, since abortion performed during the second trimester is more hazardous, the state enacted a regulation against abortion at this stage to protect maternal health. During this period, however, the mother still has the chance to decide on the fate of their child. When the fetus has reached viability in the last trimester, the state banned abortion to protect potential human life ( Ziegler, 2017) . The state prohibits abortion at this stage, except for necessities that lead to preserving the mother's life or health.
Moreover, based on the cases presented by Doe versus Bolton and Roe versus Wade, the court ruled that future state abortion law would have to meet trimester guidelines ( Obladen, 2018) . According to the ruling, during the first trimester, which occurs within the first three months of pregnancy, the state must not interfere with the abortion procedure and leave the decision entirely on a woman and her physician. However, in the second trimester, which occurs during the second three months of pregnancy, the state laws may only apply to protect maternal health. The ruling means that it may be the state's duty to find qualified personnel to conduct the abortion and find a safe institution to conduct the procedure. At this point, the ruling forbids the state from enacting laws that protect the fetus. In the 1973 Doe versus Bolton ruling, the court also provided the guideline for the third trimester, which is the period after the sixth pregnancy month ( Tatalovich, 2019) . During this period, the court decided that those who participate in abortion will receive severe punishment unless the abortion was meant to protect the life or health of the woman. This ruling did not imply that women have a complete right to abortion based on their pregnancy conditions ( Ziegler, 2017) . However, this ruling took a different position in the twentieth century as cases of legal abortion rose in the United States.
The Essence of the Topic on Abortion
Several groups of people and organizations work to ensure access to safe abortion for women globally. Therefore, this increases the need for guidance on appropriate ways to communicate abortions in a non-stigmatizing and clear manner. Exploring the ethical dilemma behind abortion equips an individual with appropriate arguments for and against abortion, which shapes their belief and view on the issue ( Tatalovich, 2019) . Based on the presented literature on abortion and analysis of different contexts and perspectives on the issue, it helps to eliminate possible bias in judgment about the issue. Furthermore, as various organizations fight to protect women's right to reproductive liberty, ethical analysis of abortion helps to provide accurate information on the subject, which can be applied to challenge stigma ( Clifton, 2021 ) .
Analysis of Ethical Issues of Abortion
The abortion debate is associated with several ethical issues, including the right of the society and its obligation, the woman's right and her obligation, and the fetus's right. Besides, medical professionals also face several ethical issues when performing an abortion.
The Fetus Right
The lawyer that presented the Roe versus Wade case in the US Supreme Court in 1973 argued that the fetus is not a human being. Therefore, one critical dimension of this ethical dilemma is to find a specific definition of human life and some of the factors that can be used to recognize its presence ( Ziegler, 2017) . It is also important to define factors that can place value on human life and compare it with other values. Nonetheless, in a state of philosophical pluralism and biological ignorance, the bioethical issue that the fetus is not a person can neither be disapproved nor approved to the satisfaction of all ( Tatalovich, 2019) . In the opinion of Robert Cook, no one can legitimately claim to have greater moral sensitivity than their opponent, and a moral claim cannot legitimately exclude the other from the politics. Therefore, if an individual claims that a fetus possesses humanity from conception, it must have the right to life. The definition of the right to live, according to Pope John Paul II, is that the fetus has the right to be born and the right to continue living until they naturally die. In a statement released by John Paul II, he stated that "As long as I live, I have the right to live" ( Tatalovich, 2019) . Therefore, according to this religious leader, denying the fetus its right to live is immoral.
Buye applies moral reasoning to respond to the dilemma of whether killing or the fetus should be considered killing a human. First, she responds to whether the fetus should get the same protection given to humans, including the right to live. In her response, she differentiates abortions performed at early stages of life and those done during late pregnancy months, after the child’s body parts have developed ( Ziegler, 2017) . She uses this moral reasoning to argue that abortion done during the early stages of pregnancy does not infringe the right to live. However, she states that abortion done in the late stages of pregnancy violates the fetus' right to live. In a different argument over the fetus's right to live, Karl Barth argues that the embryo or the fetus has autonomy ( Ziegler, 2017) . He states that the fetus has its blood circulation, nervous system, and brain. He further argues that the fetus can be healthy if the mother is critically ill or maybe critically ill without the illness affecting the mother. In addition, Karl Barth claims that the fetus may be rescued through surgical operation after the mother's death or may die as the mother still lives. Therefore, based on these claims, he asserts that the fetus is a human being and, as such, should have its right to live.
On the contrary, Joseph Fletcher, the founder of situational ethics, argues that a fetus lacks any moral standing because it lacks any characteristic of a human being ( Obladen, 2018) . According to him, the fetus does not have any status by virtue that can be considered during moral decision-making. In his argument, Fletcher relates the connection between the fetus and human being to an acorn and the oak ( Obladen, 2018) . Hence, he argues that abortion is not an ethical issue since the inference of his perspective suggests that there are no ethical boundaries that limit what an individual can do with the fetus ( Tatalovich, 2019) . According to him, the only ethical concern in the abortion process of the possible outcome that might affect an individual during the abortion process.
The Woman’s Right and Her Obligations
According to health care ethics, applying the moral principle of autonomy reveals that decisions concerning a woman’s health and care lie entirely on her. The ethics further reveal that health care professionals must ensure that the woman’s wishes are respected to the latter ( Obladen, 2018) . According to some writers, autonomy is the ability to reflect on and identify with one's base preferences or desires through higher-level preferences or desires. Beauchamp and Childress (2019) use an example of a smoker who desires to smoke and has a higher level decision to stop smoking. In this case, autonomy would illustrate an individual who can sensibly repudiate, identify with, and accept desires from a lower order personally without any persuasions. Beauchamp and Childress (2019) state that autonomy constitutes such repudiation or acceptance of the first order preferences at a higher level. Therefore, based on this analysis, women should make normal decisions without manipulating or regulating influences that govern their actions.
Moreover, Buye argues on women’s rights and their obligations by questioning whether anyone, infant or adult, has the right to continue relying on another's physical processes against their consent. However, Bhattacharyya (2021) coherently answers Buyer's question that a woman who becomes pregnant despite every precaution or due to rape has no obligation to keep the baby. According to his perspective, abortion is a termination of continued support from the mother to fetus rather than undeserved termination of a child’s life ( Tatalovich, 2019) . Thus, he argues that a woman who becomes pregnant through forced circumstances can stop her support to the fetus without ethical violation of her right to live. However, even those individuals who support this perspective under the specified situations might experience difficulties implementing it involuntary pregnancies ( Obladen, 2018) . If the pregnancy is voluntary, the mother's obligation to the fetus can be defined otherwise, and termination of the fetus might be considered without any feasible ethical choice.
The Society’s Rights and its Obligations
As society struggles to balance values, it needs to determine where to put a boundary between specific issues. In the abortion issue, society should determine conditions and variables that determine its ability to develop an abortion policy. Some people argue that if a society implements a restraining policy against abortion, the continuation of the pregnancy will threaten some women ( Obladen, 2018) . As a result, it might disrupt the women’s career and mode of existence, leading to the birth of mentally and physically impaired children. A child born against the parents' will might also place a great psychological and economic burden on their family. On the contrary, some people also argue that a society that implements a policy that accepts abortion lessens the members’ shared instinct to protect the helpless and diminishes its respect for life.
The issue of the legalization of abortion is quite controversial. However, most countries implement abortion laws where it determines most essential to preserve women's physical health. Most laws do not specify the aspect of physical health that should be protected. Instead, they state that abortion is allowed if it prevents the chances of injuring the mothers' health ( Räsänen, 2017) . For example, Portugal and Spain narrow down the abortion law to protect against lasting and serious damage to the mother's health. Besides, abortion laws in most countries are meant to protect women’s mental health. For instance, abortion is allowed when ante-natal diagnosis suggests that carrying a fetus might lead to congenital impairment ( Fine et al., 2017) . Mental health can also incorporate distress resulting from spacing and number of children, income, and career. However, it should be emphasized that while applying these abortion regulations, they can be more permissive than the text suggests, especially when the woman's health is at stake ( Räsänen, 2017) . For instance, the Swiss penal code bans abortion except during the curative ending of a pregnancy. On the other hand, Belgium and France allow abortion if the woman is distressed due to social and economic situations.
Countries and societies implement different arrangements to help their abortion, including providing a procedure for the process and informing the woman on the associated risks and available alternatives for the abortion. For example, Belgium provides sole responsibility to the woman to decide whether the pregnancy will result in her distress or not ( Fine et al., 2017) . In France, the involved woman must consult with the doctor and social worker to confirm her decision to end the pregnancy. Other societies implement abortion policies based on the fetus’ physical impairment. For instance, Wales and France allow abortion if the child risks developing serious mental and physical impairment ( Fine et al., 2017) . However, the impairment must be authorized by the state medical board. Therefore, society has an obligation to implement policies that safeguard the women's mental health state associated with abortion.
Medical Professionals and Abortion
Physicians face an ethical dilemma in interrupting the pregnancy since it conflicts with their obligation to preserve life and treat diseases. Most clinicians find it difficult to go against their obligation while others accept to perform an abortion under special circumstances such as fetus abnormalities ( Dickens, 2019) . Clinicians encounter three different types of an ethical dilemmas. The first aspect involves questions of professional ethics. The second involves the impact of health care policies on the personnel, while the last one is how the doctor follows the ethics of abortion. Professional ethics involves issues such as involvement in non-therapeutic abortions, forced medical treatment, and forced abortion ( Obladen, 2018) . When presented with the need to perform an abortion, physicians should decide whether to cooperate with the patient based on its ethics. They should ordinarily withdraw from those abortions that they approve to be unethical. Physicians also experience ethical dilemmas if they work in hospitals that perform abortions ( Dickens, 2019) . Medical professionals who see abortion as murder always have problems with their conscience when delivering care. In contrast, those who see nothing wrong with abortion feel comfortable working in such an environment.
Strong feelings linked with abortion can push some people in one way or the other to seek institutional regulations that restrict those who disagree. For instance, Catholic healthcare facilities might decide to ban clinicians who take part in an abortion and those who fail to condemn abortion ( Dickens, 2019 ; Obladen, 2018) . On the other hand, hospitals that allow abortion might deny employment or privileges to physicians who do not have an abortion. Therefore, medical professionals always experience ethical dilemmas on whether to follow their conscience or institutional policies ( Dickens, 2019) . Some of the policies might be against their conscience, which makes the issue quite controversial. Besides, physicians might experience pressure from families that are against abortion in case one of the members want to perform an abortion. In such a case, the doctor whose conscience allows for abortion should advise the family of the appropriate procedure, existing alternatives, associated risks, and the cost ( Reilly, 2018) . Conclusively, all the arguments presented under this subtopic presents debatable points that should be considered during the analysis of ethical issues of abortion at any level.
Politics of Abortion
The US's leading abortion rights advocacy and lobbying groups include the National Organization for Women, the American Civil Liberties Union, the National Abortion Federation, Planned Parenthood, NARAL Pro-Choice America. Besides, most feminist organizations in the US support abortion and reproductive freedom ( Reilly, 2018) . NARAL Pro-Choice America campaigns for paid parental leave, birth control, and access to abortion. The organization also advocates for the Whole Woman's Health and EACH Woman Act ( Obladen, 2018) . The latter policy aims to eliminate the Hyde Amendment, which forbids beneficiaries of federal programs such as Medicaid from getting support to perform an abortion ( Reilly, 2018) . The Texas government implemented restrictions that made it difficult for their women to access abortion, which the Supreme Court ruled unconstitutional. The National Abortion Federation provides a platform where patients and providers can share their experiences on abortion ( Clifton, 2021 ) . It also ensures quality abortion care within the US.
Members of Congress are blatantly divided by party concerning the issue of abortion. About all Republicans in the House of Representatives and the US Senate reflect their party’s position against abortion rights ( Clifton, 2021 ) . On the other side, about all Democrats support their party in the stand for abortion. Just like any other political issue, a substantial number of minorities of Democrats and Republicans report that they do not agree with the dominant position on abortion of their respective parties. Research indicates that Democrats with less education have high chances to split their party on decisions and stand about abortion. President Joe Biden has always supported Roe v. Wade’s 1973 court ruling that provided the constitutional right to perform an abortion only during the first trimester ( Clifton, 2021 ) . Former President Donald Trump stated during his 1999 campaign that he was pro-choice.
Future Evolution of Abortion and Speculations
The current passage of many restraining abortion laws in Missouri, Ohio, Georgia, and Alabama has increased speculations on the future of abortion access in the US ( Ziegler, 2017) . The current improvements in technology and informatics might make people gain trust in the abortion process. Future technological advancements are speculated to develop an efficient and safe care system, which can perform a successful abortion without causing health problems to the mother. As a result, a Pew Research Center survey conducted in 2019 revealed that in 2050, 55% of Americans believe that abortion will be legal with some restrictions to control individuals willing to perform it ( Ziegler, 2017) . On the other hand, 22% of US citizens believe that abortion will be legal with no restrictions by 2050. The survey further revealed that one-five of the citizens speculate that abortion will be illegal by 2050. 5% of this population speculate that abortion will be illegal with no exceptions, while 16% believe there will be exceptions for certain cases ( Ziegler, 2017) . Most state anti-abortion sponsors consider these controversies in opinions possible tests that could make the Supreme Court reconsider the decision made in 1973 during the Roe v. Wade court ruling.
Opinions on future speculations on abortion go beyond Americans' present views on the need to legalize abortion in the future. In a different survey conducted by the Center in 2018, 37% of the US public said that abortion should be illegal in most or all cases, while 58% said it should be legal in most or all cases ( Calkin, 2019) . The abortion debate has led to the public division for decades, mostly based on the political parties of the public. For instance, 83% of Democrats and 71% of Republicans believe that abortion will be legal in 30 years ( Ziegler, 2017) . The US citizens also revealed their opinions on the preferred party that they think could deal with policies on contraception and abortion. A survey conducted in June 2018 indicated that 31% believe that Republicans can do a better job, while half had more confidence in Democrats.
People’s religious beliefs also associate with the views on the future speculations of abortion and contraceptives. Fifteen percent of white mainline Protestants believe that termination of pregnancy will be legal with no restrictions by 2050, while 24% of white evangelical protestants agreed on the same ( Calkin, 2019) . On the other end, 4% of Catholics, 4% white evangelicals, and 12% black Protestants believe that abortion will be illegal with no exceptions to special cases by 2050 ( Calkin, 2019) . Analysis of the entire American population based on religion revealed that 49% of all Protestants believe that by 2050, abortion will be illegal with no exception, compared to 61% of Americans with no religious connection. Apart from religious and political beliefs, the educational background of participants is also linked to their future speculations on abortion. For instance, 64% of college degree holders in the US believe that abortion will be illegal with some restrictions in 30-years’ time ( Calkin, 2019) . Although, on the contrary, only 47% of those with high school degrees participants' educational backgrounds view abortion as a women's issue, gender analysis also revealed almost similar views on the future of abortion. A survey conducted in 2018 on the need to legalize abortion indicated that 57% of men and 60% of women said it should be legal in most or all cases ( Calkin, 2019) . In the same survey, 76% of women and 78% of men believed that abortion would be legalized by 2050.
Personal Opinion and Recommendations
I think women should be given sole responsibility to decide on whether or not to perform an abortion. Deciding whether or not abortion should be legalized causes too many controversies, and it is not appropriate to decide except for the woman. Abortion involves the woman's body and the fate of her baby. Therefore, nobody should be allowed to make any decision on her behalf. Nonetheless, when contraceptives fail, abortion is such case is not ethical compared to removing a baby out of a rape victim, which also experiences ethical issues. As a pro-choice individual, I believe that policies should not force any woman to bear children they do not want to care for or may not love. Women should offer both emotional and financial support to their children. Therefore, if they cannot meet such obligations, it would be good for them to decide on their fate.
Achievement of DNP Essentials
The DNP essentials outline eight initial curricular elements that address the evolving models of healthcare economics, the social and political forces that drive healthcare policies, the expanding volume of new essential practices, and the complexity and cost of care systems ( Oermann & Hays, 2015) . The analysis and presentation of this DNP paper aligned with the American Association of Colleges of nursing essentials.
Scientific Underpinning of Practice. The scholarly paper on the ethics of abortion demonstrated the integration of analytical, psychosocial, and biophysical sciences that support ideas on abortion. In addition, analyzing the historical background of abortion and scientific concepts such as the Hippocratic Oath enhances the project's credibility with the community, healthcare providers, and patients.
Organizational and Systems Leadership for Quality. Society has complex healthcare needs, such as abortion, as addressed in the paper. Therefore, analysis of nursing practice and science of the issue helps address some of the controversies on the issue.
Clinical Scholarship and Analytical Methods for Evidence-Based Practice . The paper fulfilled this DNP essential by addressing potential ethical dilemmas associated with healthcare delivery and the implementation of abortion. In addition, the root cause analysis of abortion helped to uncover the cause of present problems, which are used to implement evidence-based practice.
Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care : The paper describes the possible use of technology to develop safe and efficient abortion procedures, which can enhance the healthcare system and eliminate possible controversies.
Health Care Policy for Advocacy in Health Care : The paper identifies problems caused by abortion based on current existing policies in different states. It evaluates organizations and federal policies that regulate the performance of abortion within the country.
Interprofessional Collaboration for Improving Patient and Population Health Outcomes : This essential has been achieved by analyzing how medical professionals work together based on their conscience on abortion to enhance care outcomes.
Clinical Prevention and Population Health for Improving the Nation’s Health : to understand the origin of the ethical dilemma on abortion, the paper provides occupational, biostatistical, and epidemiological data on the issue. It includes disparities in gender, religion, and politics on abortion.
Advanced Nursing Practice : This DNP essential guides medical professionals to promote safe and quality care. As physicians face controversies in decisions on abortion, ANP will enable them to make informed decisions to avoid exploitation by care facilities that support abortion. They should deliver appropriate care based on their instincts to ensure safe and quality care to eliminate existing disparities.
Conclusion
There exist strong arguments for and against the idea of abortion, which causes ethical dilemma on the issue. Proper analysis of the historical background of abortion helps to understand the current ethical dilemma on abortion. Analysis of ethical issues in abortion involves an insight into the fetus's rights, the rights of the mother and her obligations, the obligation of the society, and ethical issues faced by medical professionals. Abortion also faces political controversies since political parties and organizations have different stands on the issue. Most people speculate that abortion will be legalized by 2050, with some restrictions placed to guide the level and reasons for abortion. The speculations differ depending on religious backgrounds, political parties, and gender of the members. The paper has been structured to fulfill all the eight DNP essentials by incorporating ideas to develop a quality DNP research paper.
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