Ethical Issues in Healthcare (Abortion)

Abstract Abortion is one of the major and popular pregnancy termination methods which have been widely practiced around the world. But the debate about ethical issues of abortion is still as controversial as ever. A large number of people consider abortion as a completely unethical as they believe that abortion murders the fetus and the expectant does not have the right to terminate the life of that fetus. Another group of people argues that expectant should be given the right to decide whether to give birth to her fetus or not. The proponents of termination of pregnancy through abortion base their opinion on the reason the expectant normally abort. In fact abortion with logical reasons seems ethical. In our effort to know and evaluate the opinion of both group, we found it difficult to come to a definite conclusion. Existing law in most countries permits abortion as a means of contraception but try to minimize the rate of this pregnancy termination considering the recent increasing order of its practice. Almost every religion has particular indication against abortion after a certain period of pregnancy but permits within a short period of time.

Ethical Issues in Healthcare (Abortion) Table of Content Page Number Abstract

1. Introduction 2. Ethical issues in Abortion 2.1 Religious Ethics Regarding Abortion 2.2 Legal issues with Abortion 2.3 Philosophical Ethics and Abortion 2.4 Reasons of undertaking abortion 3. Conclusion

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References

1. Introduction Healthcare providers have to lessen unexpected and unwanted pregnancies, assuring fully free and knowledgeable choice and offer a loving home for children. But, unluckily, we do not have appropriate processes which are 100% useful in attaining this objective. At a stage of their life, women have to terminate their pregnancy considering prevailing circumstances. No contraceptive is 100% effective, even if used as directed, so unwanted pregnancies will continue to term, to the tune of six million annually (World Health Organization,2003). Abortion is one of the major permanent pregnancy termination methods which serve the purpose. It is also found that abortion as a contraceptive method is used more than any other methods available around the world. Termination of pregnancy through abortion is in fact a sensitive, touching and complicated matter which interests religion, law and every other aspects of our society. Its never easy to come to a conclusion if it is ethical or not. In some cases pregnant women are in a great dilemma whether to abort the fetus or not. In some difficult situations expectant women find no other way than having an abortion. Some people consider abortion as murder while some says it depends on the decision of the expectant depending on the circumstances. In a nutshell, the debate regarding abortion is one of the most controversial, disturbing and unending. According to Brody (1972), doing abortion is a wrong expectant for a woman; at the time of beginning, a fetus is people with the equal rights to life as some other human being has. A large number of people support and demand for the termination of pungencies through abortion while another large portion oppose the concept of pregnancy termination through abortion and question it from ethical point of view. People from both sides have their own reasons and points why they support or oppose pregnancy termination through abortion and all those reasons and points have to be respected. In this paper we tried to emphasis on the most key subject is if pregnancy termination through abortion is ethically granted or not and should it be given lawful legality or not. To make a proper judgment on this issue, we must have complete and concise understanding about ethics and medical ethics and how they relate to creation of legislation on it. Ethics is the disciplined study of morality, a concept that encompasses right and wrong behavior, i.e., virtue versus vice (Chervenak and McCuIlough, 1992). What is right and what is wrong widely differ

from culture to culture. What is right to some culture may be wrong to some other cultures. This is why we cant say certain belief and conducts as completely ethical or unethical. Main discrepancies happen between legality and moral wrongness. Every immoral thing is not necessarily illegal. For an instance, being unfaithful in an individuals wedding is immoral, however it is not pleasing to see it made completely illegal. The main purpose of this paper is not to make you take any side of the debate, rather to help with sufficient points and reasons to evaluate both sides and get some clear understanding if abortion is ethical or not and how does existing law treat abortion. 2. Ethical Issues in Abortion Abortion has been frequently used around the world and has been practiced as a common contraceptive method since the commencement of recorded history. Nonetheless, it is yet a topic that arouses controversy, raising query regarding human existence, for instance when life starts and what it is that makes us human being, the nature of the countrys responsibility to protect the fetus, the right of females to be in charge of their own bodies, the worry about material and religious views and societys outlook and culture. The concern with abortion is that some people perceive it as murder of an innocent baby. There are roughly 42 Million abortions induced every year to 115, 000 every day, and some people argue that expectant women has exactly no right in saying if the fetus is going to be born or is going to be terminated. This portion of people wants to state that a pregnant woman must give birth to her fetus. Mainly, two people have concerns in abortion question, the fetus and its mother. Serving the mother causes the termination of life of the unborn child. If a woman claims its her right to decide either taking more children or not depending on the situation (i.e., she already has two children and cant afford more considering her ability to provide the children with equal right and facilities), we can hardly oppose her right. But how she will deny the right of the unborn child. Yet another thing is important that is mental condition of the mother taking abortion. It has been argued by Rosenfeld (1992), healthy women who want to complete an unintended pregnancy in the first trimester have few significant or negative emotional consequences. Even in some serious
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cases, some pregnant women do not want to go for having abortion as the societys outlook toward abortion is negative and they regard abortion as an unethical practice. But in some circumstances when the life of the expectant is in danger, it is really tough to decide what the expectant should do. She should save her life or take a big risk of having delivery. Ethics and human rights relate to abortion when we evaluate if a fetus should be considered as an individual or not from the time of creation of his or her first cell. If we consider a fetus as an individual, then abortion is murder and of course unethical but if we dont, then no question about ethics and human rights comes. Koyama and Williams (2005) expose to know about the consequence of abortion as of a public health situation issue by looking only at abortion rate, as well as maternal morbidity plus death. In the Eastern European countries and United States, unplanned pregnancies comprise 50% to 60% and 40% in the developing countries. One out of four pregnant women in the world has either an unexpected birth or an abortion, and in Canada and the U.S., most recent statistics illustrate 40% of women take an abortion and 2 to 3 out of 10 pregnancies ends in abortion. In the Hippocratic Oath, the prevention of abortion states that though abortion only became widely experienced in later 20th century but in older times, few terminations were performed (Connelly, 2008). 2.1 Religious Ethics Regarding Abortion Ethics is directly related to religions. We get our main ethical beliefs from our respective religions. Actually our religions teach us about right and wrong and make a permanent belief in our hearts. Different religions and cultures have separate views regarding ethical issues. Three most leading monotheistic religions- Islam, Christianity and Judaism are not agreed in their lessons within their respective religion. According to Roman Catholic teaching, a human fetus is a person from the moment of the individual's first cell (nova vitae) (Beller and Zlatnik, 1992). Several Roman Catholic Churches allowed abortion or any other contraception until the embryo was believed to have a soul, referring an 80 days period for female fetus and 40 days period for male fetus. Whatsoever the religious outlook is, people from every religion take abortion. Paradoxically, Roman Catholic women undergo proportionately more abortions than members of other religions (Beller and Zlatnik, 1992).

In Islam, pregnancy termination through abortion after 120 days period is totally forbidden. The Islamic belief says that the soul get into the fetus on the 120th day. So according to that Islamic belief, it can be concluded that pregnancy termination through abortion before 120 days is not prohibited. It is also provided that abortion is allowed in Islam if there is a good reason but it cant exceed 120 days period into the pregnancy.

2.2 Legal issues with Abortion Being something immoral or unethical does not make it illegal. Legal issues concerning pregnancy termination through abortion is completely dissimilar in different countries. Some community or group may consider some issues unethical which can be ethical to some other group of people as there is no ethical code followed around the world. But law need to be concrete, directive and conclusive. Yet Law regarding abortion and other contraceptive means varies from country to country. The abortion laws of a number of countries, including Germany and Hungary, require that a pregnant woman be provided with counseling prior to undergoing an abortion (Germany: Penal Code, C.H. Beck, 1997). In most cases these counseling is to discourage aborting the child. Pregnancy termination practices were executed at the time of the ancient Egyptians. In the USA in 1973, after a long public discussion, scientific and legal debates, law authorizing termination of pregnancy through abortion was granted. This happened after decision of Supreme Court on Roe versus Wade in that year. But in some states of the USA, such as that of California and New York, pregnancy termination had been legalized even before the Roe versus Wade decision (Beller and Zlatnik, 1992; Callahan, 1992). In Turkey, in accordance with civil and panel code, termination of pregnancy devoid of logical medical cause was prohibited before 1982 and subject to incarceration. After rigorous community debate and approval of the religious and legal authorities, pregnancy termination through abortion within 10 weeks of gestation was made lawful.

In the Hippocratic Oath, abortion is tempered to the medical ethics from both in its actual form and contemporary reformulation such as made in the World Medical Association's 1948 Declaration of Geneva (Kivity, Borow and Shoenfeld, 2009) During the 1950s and into the late 1960s, the movement to legalize abortion rested on several contentions as follows: (i) illegal termination of pregnancy does great harm to the woman who has the abortion; (ii) as health care providers, we have to provide safe contraception methods for women who do not want to become pregnant; (iii) the number of unwanted pregnancies and children should be reduced for the sake of mother and baby; women should have the right to decide whether to keep the pregnancy or not (Callahan, 1992). 2.3 Philosophical Ethics and Abortion The great philosopher Socrates was one of the earliest to make significant contribution in the field of ethics. In his Gorgias he mentioned that "It is better to have harm done to you, than to harm another." He debated saying that it is superior to have another make injustice to you than making injustice to another since one damages his or her own soul by doing injustice to others; he argued that this is a worse harm to oneself than any other pain which comes from the hands of other people. So, Socrates this point of view provides clear indication of abortion being unethical as the expectant willingly harm the fetus through abortion. Norbert Hoerster, a well-known German philosopher, claims that fetuses with severe handicaps can be like all other fetuses aborted, as born human beings with severe handicaps they have to be protected and respected like all other human beings, too (1995, 159). So, Norbert emphasized on the appropriate reason for undertaking abortion as a means of pregnancy termination. From the point of view of medical ethics, as Hippocrates stated in his book named Epidemics: 'As to disease. Make a habit of two things, to help to or to at least do not harm' (Chervenak and McCuIlough, 1992; Kadayiffi et al., 2001). As health care suppliers, we have some key principles to follow:(i)Confidentiality (ii) beneficence-based obligation (iii) always telling the truths (iv) human right (v) autonomy based obligation (vi) decision making

2.4 Reasons of undertaking abortion Women may get expectant for so many reasons, but the most frequent reason for having an abortion is that the pregnant women are not ready for the all the responsibilities of the unborn child. Yet again, most of them are not ready as they are not wedded to and not willing to marry the guys who saturated them. But we must see the picture from different viewpoints. There are some serious reasons that might make abortion ethical. Although, more than 90 percent of abortions are approved done to guard the mother's bodily or psychological health, the greater part of these abortions is executed, in reply to social rather than medical concerns. In Britain, abortion is efficiently practiced on demand (Ingham et al., 2008). It would really be brutal and cruel to compel the expectant who had been raped to give birth to a kid. Judith Jarvis Thomson maintains in her article A Defense of Abortion that the right to live does not include the right to make use of a foreign body even if this means having the fetus aborted (Thomson 1984, pp. 174 and pp. 177) In case of rape, both the expectant and the fetus are guiltless where right of both can be argued but it seems more understandable that the expectant has a right to have abortion. Compelling her not to terminate the fetus through abortion is to remind her of the rape which can be a strong mental stress on her. Let along enforcing any law against her abortion.

3. Conclusion Even after taking a close look from different viewpoints, it is really a tough job to decide if abortion is ethical or not. But it can be said that if the fetus is considered as a human being, then without any logical reason abortion is unethical. Again, pregnant women should have certain right based on prevailing circumstances, for instance the pregnancy is for rape where the birth of the child will continuously remind the women about the rape or maintain the health condition of the expectant, birth of the child may be a threat. According to different religious views, abortion after 120 days of pregnancy is considered murder of the fetus as the soul comes into the fetus within 120 days. So, it can be concluded that abortion within 120 days of pregnancy is ethical from religious point of view. Existing legislation around the world permit abortion as a means of termination of pregnancy. But these laws have been imposed in past century before these legislations abortion was considered unethical. Yet in some countries use of abortion require sufficient reasoning. Therefore, the focus of contraceptive methods like abortion is in need of beginning with and prioritizing the needs of women about abortion issues. For the improvement of medical services, the knowledge about abortion should be established by the provider by asking a few questions, significant ethical concerns should also be addressed. Possible risks and complications, pain reduction measures to control the pain level of the woman who goes through abortion. It is also important to establish the understanding of the category of unwanted pregnancy for the women involved, as well as the availability of medical abortion. The aim is to establish how the application focuses on the significance of planning the family and abortion services. At the end, it can be said that abortion should be undertaken as early as possible after getting pregnant and it should not be undertaken without any logical reason.

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References Beller FK, Zlatnik GP 1992 The beginning of human life: medical observations and ethical reflections. Clinical Obstetrics and Gynecology 35, 720-728. Broody, B., 1972. Thomson on Abortion. Philosophy and Public Affairs, 1(3), p.335-340. Callahan D 1992 The abortion debate: can this chronic public illnessbe cured? Clittical Obstetrics attd Cytiecology 35, 783-791. Chervenak FA, McCuIlough LB 1992 what is obstetrics ethics? Clinical Obstetrics and Gynecology 35, 709-719. Connelly, M., 2008. Fatal Misconception: The Struggle to Control World Population Cambridge, eds., Belknap Press of Harvard University Press. Germany: Penal Code (C.H. Beck, 1997) sec. 219; Hungary: International Helsinki Federation for Human Rights, Women 2000: An Investigation into the Status of Womens Rights in Central and South-Eastern Europe and the Newly Independent States 199-200 (2000). Ingham, R. et al., 2008. Reasons for second trimester abortion in England and Wales. Reproductive Health Matters, 16(31 Suppl), p.18-29. Kadayifci O, Urunsak IF, Atay Y, Demir C 2001 Maternal fetal tip ve etik. In: Beksa? ve ark MS (eds) Obstetrik Matertnal -Fetal Tip and Perinatoloji. Medical Network and Nobel, Ankara, 1472-1486. Koyama, A. and Williams, R., 2005. Abortion in Medical Institute Curricula. McGill Journal of Medicine. Kivity, S., Borow, M. and Shoenfeld, Y., 2009. Hippocrates Oath is challenged. The Israel Medical Association journal IMAJ, 11(10), p.581-584. Hoerster, Norbert (1995), Abtreibung im skularen Staat, Frankfurt am Main: Suhrkamp Rosenfeld, J.A., 1992. Emotional responses to therapeutic abortion. American Family Physician, 45(1), p.137-140.
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Thomson, Judith J. (1984), A Defense of Abortion, in: The Problem of Abortion, 173-188. World Health Organization 2003 Safe Abortion: Technical and Policy Guidance for Health Systems. Geneva, Switzerland, pp. 9-17.

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