Ethical Issue on Abortion

Ethical Issues Surrounding Abortion

Notwithstanding the laws being passed in various states against a woman's right to chose to terminate her pregnancy, the position of this paper is that Roe v. Wade is the law of the land and a woman has the ethical and moral right to decide to have an abortion. There are many positions for and against Roe v. Wade, and there are many ethical issues that may be (and in many cases are) embraced on both sides of the issue. But the law of the land vis-a-vis a woman's right to the privacy -- regarding her own values -- when it comes to terminating a pregnancy has been determined by the High Court. As a nurse committed to fairness and ethics in healthcare issues, while I respect the rights of others to practice their own values in opposition to Roe v. Wade, I am in support of a woman's absolute right to chose what should happen to her body.

Statistical Introduction

There were approximately 1.21 million abortions performed in the U.S. 2008, according to combined data from the Centers for Disease Control, the Guttmacher Institute (provided by Abort73.com) and those are the latest statistics that can be verified. This was a drop from about 1.29 million abortions in 2002. The Kaiser Family Foundation reports that there were 1.21 million abortions performed in 2005, down from 1.61 million in 1990. Kaiser also reports that about 49% of pregnancies in the U.S. were "unintended" and of the unintended abortions, 42% resulted in abortions. There are two kinds of abortions, surgical abortions and medical abortions.

The Kaiser Family Foundation explains that 87% of all abortions are surgical, which relates to the use of "vacuum aspiration, dilation and curettage" (D&C), and "dilation and evacuation" (D&E). In most cases, surgical abortion is not performed until the pregnant woman is in her sixth week of gestation. The "medical abortion" is performed through the drug known as "RU-486" (mifepristone) that was approved by the U.S. Food and Drug Administration in 2000. The RU-486 can be administered any time following confirmation of pregnancy, and in 2005, about 13% of all abortions were done using RU-486, the Kaiser statistics reflect.

A 2012 report from Medline Plus (a component of the National Institutes of Health) shows that abortion rates among teenagers in the U.S. fell to "record lows in 2008" due to the increased use of contraceptives. About 750,000 women in the U.S. under the age of 20 years became pregnant in 2008 and 98% of those women were between 15 and 29; that is the lowest rate of teen pregnancies since 1972, writer James B. Kelleher (Medline) explains. As to the abortion rate for teenage girls, in 2008 it dropped to the lowest rate since 1972: 17.8 per 1,000 teenage girls and women received abortions in 2008. Those stats were down 59% from 1988 when 43.5 teenage women per 1,000 received abortions (Kelleher, 2012).

That having been said, African-American and Latino had pregnancy and abortion rates "two to four times higher than their white peers," according to the Guttmacher Institute (referenced by Kelleher), which is a nonprofit sexual health research organization. The speculation is that African-American and Latino females in their teenage years do not have the same access to contraceptives as Caucasian teenage females (Kelleher).

Ethical Issues and Abortion

Abortion became a legal option for women in the United States in 1972 when the U.S. Supreme Court ruled that under the U.S. Constitution, women have the right to privacy which protects "the right to choose whether to continue a pregnancy to term or to have a save and legal abortion" (Planned Parenthood). In the peer-reviewed journal, Nursing Standard, the authors provide arguments for and against abortion. The anti-abortion position by Jones and Chaloner (using deductive reasoning) is as follows:

Premise A: the fetus is an innocent human being; Premise B: it is "morally wrong to kill an innocent human being"; Conclusion: hence it is morally wrong to kill a fetus.

The pro-abortion position presented by the authors is as follows:

Premise A: the fetus has no "moral status"; Premise B: it is not morally wrong to destroy something that has no moral status; Conclusion: it is not morally wrong to destroy a fetus.

Given these two opposing premises, it then seems logical to zero in on the "accuracy of the premises" (Jones, et al., 2007, p. 45). The authors delve into auxiliary ethical issues in the article, beginning with the "pro-life" and "pro-choice" terms. A person can be both pro-life and pro-choice because someone claiming to be pro-life may also "be an advocate for freedom of choice in areas other than abortion" given that this approach supports individual rights (Jones, 46). Moreover, a pro-choice person may support a woman's right to an abortion but at the same time be in opposition to legalizing euthanasia -- and hence be pro-life in that regard (Jones, 46).

Another ethical issue related to readers in this article is technological, that is, science is presently using stem cells in the search for diseases such as Parkinson's, spinal cord injuries, Alzheimer's, and other major medical problems. Stem cells can be obtained from aborted fetuses, setting up ethical conundrums. A "father's rights" issue is also at hand vis-a-vis abortions; should a father of the unborn baby have the right to share in the woman's decision regarding abortion? This issue has gained traction in recent years, Jones explains (46).

Consent is required in many states before a minor can receive an abortion; this is another ethical issue (does the state have a right to insist that a 17-year-old girl get her parents' consent?).

As to the moral status of the fetus, Jones points to the most pertinent question in this regard which is, "when does the embryo/fetus acquire a "moral value," and beyond this point, is it wrong to interfere with it?" (46). There is clearly a difficulty in determining which point during the process from conception to birth "beyond which abortion should not be permissible," according to the pro-life position. But is that point when the fetus has a human appearance, or can be sensitive to pain? This is a moral and ethical dilemma, Jones explains (46).

Jones presents the "Maternal vs. fetal rights" which essentially pits the value of a grown female human against the value of a fetus. Feminist activists argue that for a woman "to have equal rights regarding sexual freedom, abortion must be freely available" since in all other situations, in which adults are supposed to be competent to make their own informed decisions, the autonomy of a woman is respected," Jones explains (47). Hence, given the previous sentence, women should have the opportunity to make decisions regarding their bodies and not be "forced to act against their wishes" (47). That's the maternal side of the coin in this particular aspect of the abortion debate. The fetal rights side claims that, if life at that early period is "equal to that of any other human being, it may be claimed that society has a moral duty to protect it" (Jones, 47).

Given those opposing sides, either the rights and life of the fetus is equal to the life of a grown female, or it isn't, Jones continues. The viewpoint supporting pro-choice, given the above-mentioned situation, is that: a) the fetus is "only a potential life which is reliant on the pregnant woman for existence"; and b) the woman is "already an individual, fully formed life and must, according to this view, have preference over the potential of the fetus" (Jones, 47).

Yet another ethical issue brought up by Jones in the Nursing Standard is that if a doctor determines during a woman's pregnancy that the fetus is going to be abnormal, or disabled in some serious way, an abortion can be morally justified (or at least legally justified in some jurisdictions) on the grounds of a "serious handicap" (47). But the ethical problem then becomes, "how do we define "handicapped"?" Just precisely what constitutes a serious physical handicap? Each country and within the U.S. each state must make those difficult decisions. For example, if it is determined that the child has Down syndrome, does that justify an abortion? The pro-life camp would not agree with that, and possibly many in the pro-choice side of the issue would not want to abort a child just because it has a potential serious mental handicap.

There are states in the U.S. that see abortion as such an unethical practice that they pass laws designed to both discourage and even prevent abortions. Arizona recently passed a law that "restricts" abortion, according to journalist John M. Glionna with the Los Angeles Times. Republican Governor Jan Brewer signed legislation into law that bans "most abortions after 20 weeks"; the law also requires state officials to put up a website "with images of fetuses at various states of development for women to view" (Glionna, p. 1). The article does not explain how the state would coax women to view these images of fetuses, albeit there could well be some ethical issues surrounding the posting of fetuses on an Internet site designed to either discourage or disgust women who may be considering terminating their pregnancies.

In Virginia the Republican-dominated legislature earlier this year wrote legislation that requires "women to have a transvaginal ultrasound before they may have an abortion," (Glionna, 2012). The idea behind this legislation is apparently that when a woman sees the picture created by the ultrasound she will see a fetus and perhaps feel so guilty she won't want to carry through with the abortion. Or her moral side will kick in, and she will change her mind. Is it ethical for lawmakers to force a woman to have an ultrasound prior to a legal abortion? That in itself is another questions to be pondered; in the case of Virginia, the governor, Republican Bob McDonnell "ultimately rejected the mandatory transvaginal procedure" (Glionna, p. 1).

In Mississippi, a very conservative state, where some of the strictest anti-abortion laws are already in place, a piece of legislation is on the governor's desk awaiting his signature. That law would "shut down the state's only clinic" that offers abortions for women, Glionna continues. Critics of that legislation assert that "many poor women" will be forced into "seeking risky illegal abortions" (Glionna, p. 1).

Planned Parenthood has advocated against the Arizona legislation, suggesting that residents of Arizona could face the same "crisis" as a woman in Nebraska who was "forced to continue a pregnancy even after a health crisis meant that she was going to lose the baby (Glionna, p. 2). The woman, Danielle Deaver, was forced under Nebraska's 20-week abortion ban law to deliver the baby, albeit she knew the infant would die "minutes after birth" because her doctor worried that he might be prosecuted if he assisted in any way with her abortion (Glionna, p. 2). Deaver wrote the following letter to Arizona's governor Brewer:

"Because lawmakers in my home state of Nebraska passed this sweeping abortion ban, my family's personal loss a year and a half ago became a nightmare. That my pregnancy ended, that choice was made by God. How to handle the end of my pregnancy, that should have been private. But the decision that should have remained mine and my husband's at a very difficult time was decided for us -- and it was decided by politicians we'd never met" (Glionna, p. 2).

Deaver's tragic loss opens another angle into the ethical debate over abortion. Does a legislature have the ethical right to dictate terms of pregnancy to a woman whose pregnancy is already in trouble? Conservative lawmakers believe they have the moral right to come between a woman's right to choose and her own body, and in doing so they can be challenged on the same moral and ethical grounds they use to justify their extreme legislation.

Meanwhile professor of philosophy Bertha Alvarez Manninen (Arizona State University) discusses that very law in Nebraska that Danielle Deaver got caught up in. Manninen explains that when the Nebraska lawmakers passed the law, those legislators were actually "decreasing the window for abortion by 5 weeks, into the second trimester" albeit the most common medically accepted window of time for a safe abortion had been 25 weeks (Manninen, 2010, p. 33). The point of Manninen's article in the peer-reviewed publication The American Journal of Bioethics is that she has several serious concerns that are shared by others in this milieu; one is that the "anti-choice advocates are becoming increasingly emboldened in their efforts to pass Human Life Amendments." Manninen knows full well that the activists in the pro-life movement are not shy about admitting they ultimately hope to undue Roe v. Wade. She mentions two important legal cases -- Webster v. Reproductive Health Services (1989) and Planned Parenthood of Southeastern Pennsylvania v. Casey (1992) -- that in fact reaffirmed the right to an abortion but "made it easier for individual states to impose restrictions on abortion access" (Manninen, 34).

Based on those two court decisions, several states have taken the opportunity to impose more restrictions -- enacting laws that mandate pre-abortion counseling -- including: Wisconsin, Idaho, Indiana, Kansas, Kentucky, Michigan, Louisiana, Nebraska, Ohio, Pennsylvania, Utah, South Carolina, and South Dakota. The women who are planning to terminate their pregnancies are read a "state-prepared script meant to warn them about the dangers of abortionthe psychological, physical, and emotional harm that can come from abortion" (Manninen, 34). Those thirteen states do not mention the "psychological, physical, and emotional harms that can come from childbirth and undesired parenthood," Manninen continues, noting that these thirteen states also require a 24-hour waiting period after the woman has been read the state's official anti-abortion narrative.

Manninen's second major concern in this discussion is that it appears the "pro-choice community is gradually losing the public relations battle" (34). She noticed this because her students in many instances would bring up what they believed was the "callousness with which many of those who espouse the position regard nascent human life" (34) These students had apparently read the narratives of some pro-choice advocates like Mary Anne Warren, who have claimed that late term fetuses are "no more developed than guppies" and that getting an abortion is as "morally innocuous as getting a haircut" (Manninen, 34). On page 43, Manninen insists that just because she is "pro-choice" does not mean she is "pro-abortion," since being pro-abortion implies that the act of abortion is "welcomed, encouraged, or celebrated" and that is not at all how the professor feels about abortion.