ethical issue paper - 330

Running head: THE ETHICS OF ABORTION 1

The Ethics of Abortion

Sarah J. Wilkins, SN/UNCW

University of North Carolina Wilmington

THE ETHICS OF ABORTION 2

The word “abortion” is powerful and relevant in society today. The mere mention of

abortion, in either a positive or a negative way, can invoke feelings of hostility or judgment. It is

an issue that has become riddled with emotion, and it is widely debated in the political sphere,

especially with upcoming elections and recent discoveries of malpractice at abortion clinics

across the States. As a student nurse aspiring to work in a maternal-infant setting, this issue will

continue to be pertinent to my field of study. Whether in a pre-natal clinic, on a delivery floor,

or on a mother-baby floor, I will be faced with the topic of abortion in numerous ways. I may be

a nurse to a patient who is considering an abortion, or I could be helping deliver or care for a

baby that is following a previous abortion. Whatever circumstance in which I find myself to be,

I must be prepared to answer questions in a non-judgmental, helpful way. If my personal beliefs

differ from those of my patients, I must strive to control my emotions, or I must seek necessary

relief so that I am not providing poor quality of care. This is an ethical dilemma because it can

result in the termination of life, however small or newly-formed it may be. It is my

responsibility as a nurse to care for each patient I am assigned; if there is an ethical dilemma in

conflict with my beliefs, it is my decision whether to continue providing unbiased care for the

patient, or whether to seek out a different nurse who does not face the same ethical dilemma as I.

However, I am responsible for ensuring that my patients receive care, whether my personal

beliefs are in conflict or not. This paper purposes to describe the nature of abortion, as well as

offering a description from both sides of the issue and how it is approached by different

healthcare workers. Finally, I will state my opinion, and how I would like to respond, should I

be faced with this situation.


Summary

Abortion is defined in two ways, as indicated by a descriptor preceding the word “abortion.” A

spontaneous abortion is “the expulsion of a pre-viable fetus by natural causes, that is, where the

expulsion has not been intentionally brought about by any agent” (Sumner, 2014). An induced

abortion is “the intentional termination of a pregnancy before the fetus is viable” (Sumner,

2014). As Sumner (2014) puts it, “Once an unwanted pregnancy is underway, abortion is the

only means available of preventing it from continuing through its normal duration.” Induced

abortion is the type of abortion as discussed further within this paper. As a nurse, I am to

provide holistic, quality care in my practice, for both the mother and the unborn child. My ethics

can be called into question when the mother of the child is requesting that our care be turned into

deliberate termination of the life inside her. There are a variety of options available to those who

desire to proceed with this course of action, and these can be performed in various clinics across

the United States.

Procedure

There are different abortion procedures used during different stages of the pregnancy

(Association, 2015). The American Pregnancy Association (2015) recommends that women

receive a sonogram before choosing an abortion, in order to determine viability and fetal age. In

the first trimester, there are a number of pills and medication combinations that can be used to

induce abortion. There is a Manual Vacuum Aspiration that can be used from 3-12 weeks, or an

aspiration technique that can end pregnancy as late as 16 weeks. This aspiration can be called

suction curettage or dilation and curettage (D&C). This D&C can also be used in the second

trimester, in addition to a D&E (evacuation). Also in the second trimester, there is an induction

option which involves a formula injected into the amniotic sac while prostaglandins are


introduced into the vagina and Pitocin administered intravenously. Late-term abortions (third

trimester) are not legal in many states, except for specific medical circumstances (Isenstein,

2015). What defines a late-term abortion is when a baby is viable – able to survive outside the

womb on its own. This is fairly commonly recognized as being at 24 weeks, according to the

American Pregnancy Association (2015) but is subject to the laws of each individual state. As

with the second trimester procedures, the D&E and the induction abortion are the two methods

used (Association, 2015).

Alternatives to Clinic Abortion

In states where abortion clinics are closing, or the practice of abortion is becoming unaccepted,

there are more people who try to self-abort, or induce abortion separate from a clinic (Stephens-

Davidowitz, 2016). This is discovered through tracked google searches for sites such as “how to

have a miscarriage” or “how to self-abort.” Included in these searches were people looking to

find abortion pills online. People who have abortions are not very likely to talk about them

afterward; therefore, statistics show that people who have self-aborted are even less likely to

discuss to their closest friends perhaps, that they have attempted to self-induce abortion

(Stephens-Davidowitz, 2016). This can impact their mental and emotional well-being, in

addition to potentially threatening their physical well-being if the self-induction is improperly

conducted.

Decision to Abort

According to statistics from February 2012, 92% of abortions performed are for reasons such as

feeling unprepared to have a child, raise a child, afford a child, or that the child would interfere

with their personal life and goals (Peterson, 2012). These reasons are not surrounded by violent


acts against women, or danger to the life of the future mother; these are purely “recreational”

reasons that demonstrate a selfish point of view on the side of the parents. In other words, these

reasons are not medically supported in favor of an abortion; it is solely at the whim of the parents

that this 92% of abortions is occurring. It is doubtful whether any rising parents would affirm

that they are completely prepared and ready to have/raise/afford a child; apprehension

foreshadows most unknowns in society and aspects of life. Therefore, this is a weighty decision,

to rationalize the ending of one life, in favor of continuing another life. As Mother Teresa once

said, “It is poverty to decide that a child must die so that you may live just as you wish”

(Peterson, 2012). Some parents may consider having an abortion when they are faced with the

realization that their unborn child has a birth defect. According to an article published in

December 2015, in the United States, about 1 in 33 babies has a birth defect – 3% of US births

(Marusinec, 2015). This could be devastating to new parents, in addition to the fear and anxiety

that would arise. Though they might not want to end the pregnancy, they may feel that it is

universally beneficial to all concerned if they were to terminate the life of a child that would be

born with a crippling defect. The concern here is who gives them the authority to make this

deific decision. Economically, it may be a wiser course of action, when comparing the

anticipated medical costs of raising a child with a severe birth defect; it may also make sense

politically, for often birth defects are looked down upon in social circles, and parents may think

that they are saving their child from future humiliation and low self-esteem. Furthermore, the

abortion that the parents of a child with a serious birth defect are considering may be legal in the

state in which they reside. However, this becomes a conflict ethically and spiritually, as I will

explain.


Foundations of Moral Code

Ethics and the religious sphere are closely tied, despite numerous attempts to separate the two.

All people have some sort of internal moral code; whether or not they adhere to this moral code

depends on their choices and their beliefs. Nonetheless, we all possess an internal sense of what

is right and acceptable and what is unacceptable. People derive this moral code initially from the

Creator, whether they choose to believe it or not; it is further impacted by their background, and

how they were raised. The Bible says in Romans 2:14-15 that, “…when Gentiles (or people who

are not Jewish by heritage) who do not have the Law do instinctively the things of the Law,

these, not having the Law, are a law to themselves, in that they show the work of the Law written

in their hearts, their conscience bearing witness and their thoughts alternately accusing or else

defending them…” (Ryrie, 2012). This indicates that the Law (God’s Word) is instilled in the

hearts of mankind, and it can be shown through their thoughts and emotions. Women who have

abortions usually experience various stages of doubt and anxiety, wondering if they are doing

“the right thing.” This is due to the inherent knowledge that they possess, to realize in some

way, that it is against human nature to terminate a natural function of life, a pregnancy. The fact

that there is counseling for post-abortion mothers testifies to the statistic that guilt is a very

strong response to a past abortion, no matter how far in the past it happened. One article

references feelings of blaming self, a sense of loss, or anger reported by women post-abortion

(Choice, 2012). These feelings, while not universal to all post-abortion women, offer insight into

the inner ethical dilemma that occurs when one deliberately and consciously terminates

something that represents human life. Sadness is an expected response after the hormonal shifts

associated with any pregnancy, especially after birth (Health, 2014); grief and guilt are not


normal reactions, and this is further confirmation that the abortion question is riddled with

ethical concerns, closely linked to one’s spiritual life.

Approaches by Healthcare Providers

It is important to filter ethical decisions through four main principles: autonomy, beneficence,

non-maleficence, and justice. Autonomy means that a patient can choose to receive or refuse

treatment, and this choice is guided by the patient’s beliefs and interests (Patil, Dode, & Ahirrao,

2014). Beneficence refers to the goal of the doctor, to always have the patient’s best interests in

mind; doctors should choose the course of action that best benefits the patient, as opposed to

something, for example, that is less expensive or time-consuming. Non-maleficence is indicative

of doing no harm. Justice is being fair and equal in how a physician offers and provides

treatment; a physician should not offer more care to one person than another, even if the first

person is older (or younger) than the second. Additionally, development should not affect how

much care a person is to receive; someone with less development is eligible for equal care as

someone who may be more fully developed, in mind or body (Patil, Dode, & Ahirrao, 2014).

The ethical dilemma is clearly outlined through these principles: an unborn fetus is still life,

though many choose to argue that it is not. Providers can choose to offer care or to deny the

option of abortion to women. Granted, these women desiring abortions could find an alternative

in a different venue, but the conscience of the healthcare provider would be satisfied. The

nurses caring for these women have these same two issues: continue to provide treatment, or

choose to find another nurse willing to give care during an abortion, in lieu of satisfying their

dilemma. If a nurse is struggling with providing care for a patient because the type of care

needed contradicts personal beliefs and ethics, it is the nurse’s responsibility to find someone

else who can take his or her place as nurse. Until the replacement is set, they are responsible for


that patient’s care. Otherwise, they will commit the act of abandonment, which will not resolve

any issues and will only create more difficulties.

Ethics Toward Women

An opposing controversy also can arise. Perhaps providers should not compel women to bear

unwanted children (Patil, Dode, & Ahirrao, 2014). This can be seen as unethical because of the

stress that childbirth places on the body of the woman. Much emphasis is placed on the

woman’s body and her life, whereas little emphasis is placed on the life and body of the unborn

child, young though it may be. Because the mother (and/or father) are the ones with the more-

developed mind, they are automatically awarded the right to decide whether or not the fetus shall

live. Providers must decide for themselves whether or not they will offer abortion services to

parents with unwanted pregnancies. This must be clearly reasoned out in advance, or providers

will find themselves in a number of difficulties arising later on. They can choose to offer these

services based on their own personal beliefs – spiritual and political – or they can choose to base

their decision on economic principles: whether or not they can afford to refrain from offering

procedures and methods. If they are decided in advance, they will be able to take a firm stance

on their beliefs, thus avoiding future difficulties of ethical dilemmas.

Personal Reaction to Issue

In Psalm 139:13, the Bible says, “For You formed my inward parts; You wove me in my

mother’s womb” (Ryrie, 2012). The “You” is referring to God, the Creator. This verse indicates

that I was then who I am now, while I was in the womb. I am no different in my personhood

than I was before birth; I am merely more developed. Similarly, a 5-year-old is more developed

than a 5-month-old; the age of someone or degree of dependence has no bearing on whether or


not someone is less human or less alive. This is the heart of the abortion issue: whether or not

the unborn fetus is considered a person. Those who venture to say that it is not are seemingly

attempting to justify something that is recognized as inherently wrong. As one article put it, pro-

life can refer to “respect for the sanctity of life” (Friedman, 2012). People who attempt to justify

abortion are ultimately not respecting the sanctity of life.

Extraterrestrial Life

Signs of life are sometimes more respected in places other than earth. For example, many might

choose to argue that a 3-week-old fetus is not truly life, for it is so underdeveloped that it could

not possibly exist outside the womb. However, if this same stage of life were found on another

planet, or elsewhere in space, it would be heralded and lauded that life was found existent on

another planet. News articles would be published, and the world would revolve in a state of

heightened glory, that another planet could sustain life, even so undeveloped as a 3-week-old

fetus. Yet daily, these forms of life are growing inside the womb, and are often being

terminated. A cell of life found on another planet would be guarded and protected beyond

imagination, while the multiple clusters of rapidly-dividing cells, growing into a human being,

are legally aborted in many places. The respect for a small cell of life discovered on Mars would

be held in higher esteem than a clump of rapidly-dividing cells residing within the womb, in the

political and scientific communities. What a sad testament to our society and its practices.

Respect for all Life

When we become desensitized to the concept of human life, we become more of a threat to

ourselves than anything outside of the world. Once we lose that respect, we deplete the moral

code, lowering it to such extremes that nearly anything can be rationalized, at any stage of


development. If we were to allow more developed, older people to have more power and

decision-making over our own lives, chaos would rapidly ensue. For example, a middle-aged

man could decide to impose all sorts of restrictions on a younger man, simply because the

younger man was less developed in mind or body than the middle-aged one. Following that line

of thought, an older man would feel the freedom to shoot the middle-aged man who is in his way

of enjoyment and relaxation (similar to how an unborn fetus can make it difficult for a woman to

experience these same pursuits).

Derivation of a Moral Code

In sum, it is important that we base our moral code on a solid foundation; the only foundation

that is of any worth must come from something higher than ourselves, and Someone Who is

perfect. If we ourselves, being imperfect, design a moral code that is supposed to achieve an

ideal of perfection, it is probable that this moral code will also have imperfections within.

However, if we receive the moral code of a God who is perfect and who is beyond our finite

space and time, we have a strong foundation on which to build our ideals of ethics. This is my

rationale for supporting the side of the argument in favor of life. I understand that mistakes can

happen, and that violence can occur, unintentionally beginning a pregnancy. However, the fact

that one person has committed a wrong does not make it acceptable to continue that wrong by

committing another. Abortion does not “un-do” a violent act against someone; it does not “un-

do” a child with a birth defect; nor does it help parents to prepare for future children, if they feel

unprepared and are encouraged to abort. Abortion has lasting effects of grief, regret, pain, and

even guilt. People may choose not to admit these feelings, and these may not be universal

emotions. However, at some point, if women acknowledge the truth of their abortion being an

unethical act, these emotions will quickly surface, thus lighting the reality of the situation.


God’s Glory is not limited

When the Bible is made the foundation for one’s ethical beliefs, it illuminates the correct

decision. God does not offer abortion as a solution for a mistake; He is able to work through our

sins, so as to glorify Himself (Romans 3:5, in Ryrie, 2012). Consider the story of David with

Bathsheba (2 Samuel 11). David committed an indecent act, in numerous ways, using his

position and his authority to gain his own means (Ryrie, 2012). God was displeased with him,

and David was eventually punished for his wrongdoing. Yet God used David’s son Solomon to

become the wisest man on earth (Ryrie, 2012). Similarly, God is still able to use any children,

whether completely normal or with defects, to bring glory to His Name, and to be blessed.

Whether their own families choose to raise them, or they are placed for adoption or in foster

care, God does not call us to end life. He calls us to obey Him, and that means allowing Him to

work, by choosing life. This is my position in this argument, and it is strongly supported by

Scripture, in accordance with my beliefs.

Action I Would Take if Confronted with Abortion

If I were confronted with this issue and were asked for my opinion, I would calmly state what I

believe and why. If I were asked to provide care surrounding an abortion for someone, I would

most likely feel the freedom to do so. If I were asked to aid in an abortion itself, however, I

would request that another nurse take my place. I do not believe that I could be justified in my

aiding of a procedure that is diametrically opposed to the Word of God. I would realize that I

would be responsible for the patient, and I would quickly find another nurse or healthcare

professional who could take my position. However, I do not believe I would be in this type of

situation, unless I were directly working in a clinic or practice that offered abortion services; it

would be in my best interests to avoid conflict and promote peace, by refraining to work at a


place that opposes my Christian beliefs. If I were faced with the option of abortion, in the case

of a heinous act against my person, or the discovery of a birth defect, I would still choose life. I

realize it would possibly be a traumatic circumstance that would prompt me to be faced with this

issue, but I serve a God Who is more powerful than my circumstances, however life-changing

they may be. I would pray and ask that His will would be done, and that I would be obedient to

Him, trusting that He would hear me (Jeremiah 29:12, in Ryrie, 2012). I am confident that God

is able to work through any sort of crisis that I or anyone else may experience, and this is why I

would choose against the option of abortion.

Abortion is consistently a recurrent issue in the widely-debated topics of society today. Working

in healthcare, especially if I choose to work in a maternal-infant capacity, I will most likely be

faced with the topic on several occasions. I anticipate encountering women who have had

previous abortions, and having the chance to offer encouragement and support. This can be an

emotionally-challenging duty of nursing, and I will endeavor perform my responsibilities to the

best of my ability. As a nurse, it is my calling to provide holistic care to my patients – not only

will I be caring for their physical needs, but also for their emotional, mental, and spiritual needs.

This topic will continue to be of interest to the population, and as a Christian nurse, I have a

wonderful opportunity to be a support and encouragement to each patient I encounter. I will

endeavor to be prepared to gently and respectfully hear and respond to the various stories of my

patients (1 Peter 3:15 in Ryrie, 2012) and I believe that this is my calling, not only as a nurse, but

also as a child of God.


ReferencesAssociation, A. P. (2015, May). Abortion Procedures. Retrieved from American Pregnancy

Association: http://americanpregnancy.org/unplanned-pregnancy/abortion-procedures/Choice, C. b. (2012, March 13). After an abortion. Retrieved from Children by Choice:

http://www.childrenbychoice.org.au/if-youre-pregnant/coping-after-an-abortionFriedman, T. (2012, October 27). Why I Am Pro-Life. New York Times, p. 13.Health, W. (2014, November 14). WebMD Women's Health. Retrieved from Abortion: Emotional

Recovery - Topic Overview: http://www.webmd.com/women/tc/abortion-emotional-recovery-topic-overview

Isenstein, L. (2015). A Look at Late-Term Abortion Restrictions, State by State. http://www.theatlantic.com/politics/archive/2015/01/a-look-at-late-term-abortion-restrictions-state-by-state/448098/: National Journal.

Marusinec, L. (2015, December 15). Healthline. Retrieved from Birth Defects: http://www.healthline.com/health/birth-defects#Overview1

Patil, A., Dode, P., & Ahirrao, A. (2014). Medical Ethics in Abortion. Indian Journal of Clinical Practice, 544-548.

Peterson, C. (2012, February 25). Abortion's Impact on Society. Lancaster Online, p. 1.Ryrie, C. (2012). Ryrie Study Bible. Chicago: Moody Publishers.Stephens-Davidowitz, S. (2016, March 5). The Return of D.I.Y. Abortion. The New York Times,

pp. 1-2.Sumner, L. (2014). Abortion and moral theory. Princeton University Press.

ethical issue paper - 330

Documents