The Ethical Dilemma of Doctors Conducting Abortions in Life and Death Situations
1. Introduction
The topic of abortion presents a moral, ethical, and medical dilemma. It goes to the heart of individual and sometimes deeply held religious beliefs. It’s also a difficult subject to broach as it requires an understanding of many complex and sometimes emotive arguments. However, it’s a subject that requires a suitable command of the facts as well as a measure of the philosophical and ethical arguments involved. This is because we are now moving towards an age where medical technology, like our opinions on the subject, are rapidly evolving and we need to be able to form a thorough, fact-based but balanced opinion. Medical research is continuing and new treatments and innovations are anticipated. Furthermore, the introduction of differing and more advanced medical technology can have the effect of lining up in sharper relief the moral and ethical arguments for and against abortion. The debate, however, is not always straightforward, the question of the moral permissibility of abortion has been debated throughout eastern and western culture and remains prevalent in society today. The arguments offer a wide array of approaches and outcomes and they are based on different ethical, religious, and philosophical views. For example, there exist philosophical arguments in favor of abortion rights as well as arguments against. Another individual approach includes the legal standpoint in different countries and how that has shaped and shifted political and social viewpoints. This allows free open debate to consider evidence-based medical opinion but also laws and social norms that impact a woman’s right to choose. The question of newly developing technology which is being used to help detect DNA abnormalities is also relevant. Should an unborn child show signs of abnormalities which are generally untreatable and likely to lead to a shortened life expectancy, does this induce a greater right of the mother’s right to choose? Or is there a moral duty not to cause pain and hence the allowance of a lawful abortion? Making a balanced and fact-based informed decision on abortion is, of course, right and proper. But this is often underpinned by a fundamental issue. Whose rights carry more weight: the mother’s in her right to choose what she does to her body or the life right of the child? Equally, does the introduction of developing medical technology impact the ethical acceptability of abortion? It’s an area where we are seeing more and more research begin to inform medical practice and as such, evidence-based opinions begin to take hold.
1.1 Background of the Ethical Dilemma
The practice of abortion was widely prevalent and tolerated well before the enactment of the Abortion Act 1967 by the Parliament of the United Kingdom. It is a subject of ethical, practical, and moral debate. When I say moral debate, it is because the religious view would say that a life begins at conception, so aborting a fetus would be seen as wrong based on that principle. The secular view does not have a religious basis; it argues that it is wrong to bring an ‘unwanted’ child into the world, and a woman has a right to choose not to carry on with the pregnancy. The confusion and lack of unity in people’s standpoint on abortion was probably why the creation of a statutory confined and regulated environment to a practice was not easy and why the ethical dilemma persists till today. The Act only provides a safeguard for doctors who perform the procedure in good faith and with a proper use of clinical judgment. The Act continues to allow abortions to take place in two circumstances. The first is where a doctor opines that the continuance of pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated. The second is where a doctor opines that there is a substantial risk that if the pregnancy continues, there would be a risk of injury to the physical or mental health of the pregnant woman. Adolescents and adult women sometimes have different medical issues, and case law further assists in providing clarity over the diagnosis and prognosis of different medical conditions. For example, in the case of Paton v British Pregnancy Advisory Service Trustees (1979), the court authoritatively ruled that “risk” is not confined to absolute certainty; it included the question of a lower degree of certainty as to a high degree of probability. This demonstrates the significance and value of a good insight into the dilemma in view. A fundamental subject of debate and argument lies in the moral status of the fetus in the context of abortion. From a human rights perspective, Parliament has devised a delicate balance, trying to respect the different rights and legitimate interests of the pregnant woman and unborn child. The unborn child has rights only to the extent that the rights of the woman can also be protected. However, what the legal position does not cover is the protection of the conscience of doctors. The Act remains silent on the professional autonomy of doctors, and it casts no light upon the proper conception of ‘good faith’ as per the statutory defense under section 1 of the Act. The maze of ethical dilemmas does not stop here because this statutory regime is silent also on the moral issue behind the argument of legality. This is what the research is trying to address in view of the professional, moral, and ethical burdens on medical doctors.
1.2 Importance of the Topic
The rights and wrongs of the topic are often outlined in the nature of the debate: pro-choice advocates argue the importance of a woman’s right to self-determination, whilst pro-life advocates stress the importance of the right to life for the unborn child. However, the reality of the topic is not nearly as simple as these polarized viewpoints suggest. In practice, the ethical dilemmas faced by doctors are much more complex, because the issue of abortion introduces a new and crucial factor: the need to weigh up conflicting rights in the context of a particular case. This is what makes the question of abortion in life and death situations so ethically challenging – in those scenarios, the rights of either the unborn child or the mother may be prioritized, and this has significant implications for decision-making in those situations. The outcome of this debate – whether it’s resolved through the courts amending the law or through Parliament legislatively intervening – bears vital importance for doctors and women in desperate circumstances. Clarification of the limits of law and the ethical responsibilities of doctors would provide assistance and comfort for everyone involved. This is why the topic is not just a question of moral or philosophical debate, but in fact has very real practical implications for doctors. As we will see in the course of this essay, it is the legal framework prescribing how doctors should approach these life and death decisions which resolves the conflicting rights of the different parties involved. Ergo, clarifying the law and the ethical responsibilities for doctors is of crucial importance when considering how such decisions should be approached and what criteria should be relied upon to make them. Furthermore, it is essential to explore how such criteria are reflected in the current legal position, since a fuller understanding of the law and ethical responsibilities of doctors, in turn, will render insights as to any potential improvements or changes that might be made.
1.3 Purpose of the Research Essay
The research essay discusses the ethical dilemma faced by doctors when conducting abortions in life and death situations. It provides background information on the issue and emphasizes its importance. The essay aims to explore the conflicting rights of the right to life and the right to choose, while examining the role of doctors in making life and death decisions. It delves into the interpretation of the Hippocratic Oath and medical ethics, as well as the legal framework for doctors’ decision-making. Case studies and real-life scenarios are analyzed, including maternal health complications, fetal abnormalities, emergency situations, psychological and emotional factors, and cultural and religious considerations. The essay concludes with a summary of key arguments, implications for medical practice and ethics, and recommendations for policy and legislation.
2. The Right to Life versus the Right to Choose
The autonomy and reproductive rights argument. In contrast to the pro-life right to life argument, the pro-choice collection of arguments suggests that a woman’s self-determination in life is central, implying the right to make a choice based on her own beliefs and values. This is based on the concept of autonomy, which is developed and contextualized within bioethics more generally. It is argued that a woman’s decision to continue with a pregnancy and the consequential changes to life, body, and family which this will entail necessarily require the informed consent and authorization of the woman herself.
It is also relevant to note in the context of the moral and legal status of the embryo and fetus argument that the absolutist pro-life position, which regards all forms of the deliberate taking of innocent life as morally unjustifiable, has significant implications for induced abortion in life and death cases. The moral absolutism associated with pro-life ideology and the emphasis placed on the inviolability of the right to life of the embryo and the fetus involves a claim that the use of abortifacient treatments such as the drug Methotrexate – which is sometimes employed to treat women with ectopic pregnancies – is never morally justifiable. This contrasts with the pro-choice position, which subscribes to the view that women should be entitled to make reproductive choices and that the deliberate termination of pregnancy is justified.
The moral and legal status of the embryo and fetus. One argument against induced abortion which has particular currency in Ireland is the claim that the embryo and the fetus have a moral and legal right to life. In Ireland, the right to life of the embryo and the fetus is expressly recognized in Article 40.3.3 of the Irish Constitution introduced by the Eighth Amendment in 1983. This amendment requires the state to vindicate and protect the equal right to life of the mother and the unborn. This has been interpreted as imposing a near-total constitutional ban on induced abortion, which is only permissible where there is a real and substantial risk to the life of the mother and this risk can only be averted by the termination of the pregnancy. As will be discussed in more detail in a later section of this chapter, this provision has been highly controversial, and the constitutional ban on abortion has been the subject of considerable criticism and political agitation in Ireland.
The right to life versus the right to choose: The sanctity of life argument. The first aspect to be considered in the right to life versus the right to choose dilemma is the idea of the sanctity of life. Pro-life groups oppose the practice of induced abortion, claiming that it destroys a fetus which is alive. It is argued that life is a continuum from the moment of conception, and that induced abortion amounts to the willful ending of life. The pro-life argument is respect for the moral status of the embryo and the fetus.
2.1 The Sanctity of Life Argument
The sanctity of life is the belief that life is of infinite significance and should be kept almost at any cost. It argues that life is a gift from God and only God should choose when it ends. Abortions for life and death situations challenge this belief, as in these cases the fetus is of great significance too. From the standpoint of a pro-life advocate, the sanctity of life is an essential factor in the argument against abortions. An embryo is an established form of human life so it would be unethical to end that life, even in the early stages. Supporters of this view would argue that abortions should not be allowed in any circumstances. Also, they may point out that in life and death situations, it is not the right of a doctor to choose between the mother and child, because that goes against the belief that only God chooses when life ends. This suggests that even in life or death cases, the life of the embryo should not be ended as it is not the mother or the doctor who should decide when life ends in such a serious situation. Moreover, the sanctity of life is a moral principle in Christian teaching, as Christians believe that all life is sacred because it is created and loved by God. This means that the principle of sanctity of life has a large bearing on the beliefs of Christians. Therefore, one could argue that Christian women who comprise most of the anti-abortion movement may feel pressured to have an abortion and they would argue that an ethical doctor should understand and consider the religious beliefs of the patient. However, the sanctity of life argument does have its criticism. Critics say that the argument relies on the belief in God and therefore has no place in a largely multicultural society like in Britain today. Also, it is difficult for any law, which is a product of a society’s ethics and demand for rights, to involve religious beliefs that not everyone can agree on. Instead, it is more logical to base laws and morals around situations, human rights. But the problem with this is that different people have different perspectives upon when human life begins. Some believe at conception and others believe at viability of the embryo, which causes issues with ethics of abortions, as laws have a wide scope to cater towards. This could trouble the pro-choice argument that ‘it’s the mother’s body, so it’s the mother’s choice’ because while the mother is the individual affected, the pro-life argument states that it is not just the mother’s freedom that comes into play; it is the embryo’s, too.
2.2 The Autonomy and Reproductive Rights Argument
In recognition of the complex and moral nature of terminating a pregnancy, some commentators have sought to shift the emphasis away from the right to life of the fetus and instead focus on women’s autonomy and reproductive rights. As the autonomous bearer of the pregnancy, the argument runs, the pregnant woman’s decision should be final and she should have the absolute moral and legal freedom to choose whether to continue with or to terminate the pregnancy. This is not to say that the woman’s right to choose is absolute. However, in comparison with the relative weight that the right to life argument gives its rival in terms of the moral scale, the focus on the woman’s autonomy positions the pregnancy in the context of her life paradigm and the moral commitment she has to her other children, her work and to herself. Such an approach puts the woman solely in the driving seat where her moral and legal status is concerned. This is supported by the liberal view that law should respect the individual’s moral and legal freedoms and should only promote the common good in a minimal way – with the permissibility of taking life being subject to considerable doubt in the absence of moral certainty about when life actually begins. The teleological approach to solving the ethical problems related to abortion in medical practice is a consequentialist case, a consultant suggests. This is because patient outcomes would heavily influence and support medical decisions and actions. The autonomic generator, a technician explains, is similar to the cardiomatic but instead of the technologist allowing a heart rate monitor to make the decision, as the autonomic generator interprets the heartbeat, the green light of the autonomic generator would provide the go-ahead for the surgery without any prior human intervention such as with the cardiomatic. In terms of ethical problems such as abortion, there are many disadvantages for using both natural law and the autonomic generator, one medical student advises. ‘Oh for heaven’s sake, who believes in this day and age that the heart just stops and is suddenly imbued with a presence of some divine nature when the baby is born? This is a metaphor for those religious groups who oppose abortion, isn’t it. It’s really all religious nonsense’. His friend replies, ‘Well, Catholicism teaches that the soul is received at conception but neither the generist nor the autonomic generator provide a reason as to why life should be protected at conception. You can’t use natural law to show that life should be protected from conception’. Well exactly, after all, does a body with potential, which is what an embryo and fetus is said to be, a body with potential have the same rights as we do? The utilitron has been seen to help make a utilitarian decision. This is because the machine allocates scores to different factors and adds these up to locate the optimum option with the highest and best score. The final result is whichever option’s positives outweigh the negatives and therefore, it could be used to demonstrate the consequentialist argument when the greatest good for the greatest number of people should be sought. Wait a second, I thought the utilitron basically is saying the needs of the many outweigh the needs of the few, an individual begins to analyze. Oh dear, it’s a Nazi-style approach ethics really isn’t it to decide whose life is valuable, someone suggests. Well actually, the most amount of people that could gain pleasure and happiness from a particular action is the view of utilitarianism, so maybe it’s not all that bad, a patient responds. Well what about rights? Some people would argue that you can’t just sacrifice someone’s rights, not in an ethical and democratic society like ours is built on, the first individual speaks. ‘There’s no other way we could make a decision. We can’t just let emotion or mercy cloud a correct judgment to be made. The ends have got to justify the means, no matter how awful they seem at first’, another patient provides her opinion.
2.3 Balancing the Conflicting Rights
The conflict between the right to life and the right to choose in the abortion debate can be summed up as a conflict between a form of paternalism and a belief in personal autonomy. In ethics, paternalism is the notion that it is right for others to choose for us, while autonomy is the idea that we are the best judges of our own lives and that others should not restrict our freedom, except to protect the freedom and well-being of others. Both the right to life and the right to choose arguments bear elements of these two positions. Pro-life supporters and movements can be seen to be invoking the idea that it is best for the life of the woman that the pregnancy is carried to term, and in doing so appeal to a form of paternalism which might be based on a concern for the life and well-being of the woman. On the other hand, the right to choose argument is rooted in an understanding of respecting the self-determination of others—namely, the belief that women have the right to choose what happens to their own bodies because they are the ones who have to live through the pregnancy and childbirth. The implication of the pro-choice argument is that it is improper for anyone, including the state, to restrict the freedom of a woman unless there is a sufficient justification for doing so, and the idea that such freedom must be respected even if it means there may be something objectively undesirable in the choice made—appealing to an idea of autonomy that is nearly absolute. The conflict here lies in the fact that both the mother’s right to choose and the child’s right to life can genuinely be considered “fundamental” rights, under which no other right should take priority. Such conflicts are common in moral reasoning; to resolve them, it is often necessary to discover what will bring about the greater good, or utilising a compromise justified by both sides to a certain extent. In the context of the abortion debate, however, the use of either of these methods to resolving the conflict would favour either the pro-life or the pro-choice argument definitively. Such an outcome would fail to reflect the complex nature of the issue and the spectrum of views held by members of the public. It would also give rise to the possibility that, if the situation were to change such that the method of resolving the conflict did not give rise to a result that didn’t favour one side unequivocally, laws and rights would fluctuate subject to the changing circumstances of those in power. These implications are perhaps best typified by the fact that, as a result of the 2016 election in America, Roe vs Wade, 410 U.S. 113, a landmark decision by the United States Supreme Court on the issue of abortion, is continuously under threat of being overturned in light of the conservative majority that now exists in the Supreme Court. As a result, by recognising and understanding the depth and variance of the conflicting and balancing rights and considerations in the abortion debate, we are better equipped to appreciate the human, moral and legal complexities of the issue.
3. The Role of Doctors in Life and Death Decisions
The doctors play a very important role in making life and death decisions. They are no doubt regarded very highly in society. It is amazing that a profession which is responsible for sustaining life has been given such a glorified position. They have a major say in ending or saving a life. When we look at the history of human civilization and culture, the ancient Greeks have made a significant contribution to modern Western civilization. The foundation of Western culture, life, and reason goes back to the 5th century B.C., in ancient Athens, when life was comfortable there. They were brilliant expectations, and that was a time for creativity. The time was perfect for democracy to develop. The principle in the Hippocratic Oath is still used in modern medicine. The interpretation of the Hippocratic Oath can be understood in the light of the debate over abortion. In modern society, it is not outstanding to see abortion as a common practice, and it is the doctors who should implement such a procedure. By considering the historical background of the Hippocratic Oath, the “classical,” “traditional,” or “strict” version of the Oath was connected to the ancient medical personality. However, with the development of scientific medicine, the “modernized” or “revised” version of the Oath argues that physicians today do not swear to the ancient God as the onlooker. Modern medicine focuses more on cure and eliminating suffering, rather than emphasizing the upholding of the law and avoiding shocking crimes, as mentioned in the “traditional” version. The fundamental argument for the case of the “traditional” version and the criticism over the “modernized” version is about what we should stick to in interpreting the Hippocratic Oath.
3.1 The Hippocratic Oath and Its Interpretation
Although most doctors will not recite the original version of the Hippocratic Oath, many will acknowledge some form of pledge upon becoming members of the medical profession. This oath is significant in shaping ethical standards and imposing duties upon doctors. The most famous reference to abortion in medical ethics is the statement: “I will not give to a woman an abortive remedy.” However, it is important to note that this statement originates from the original oath in classical Greece. In the current legal and ethical landscape, abortion is widely accepted and so the prohibition in the Hippocratic Oath will not be seen as binding or applicable to contemporary medical practice. Moreover, there are different versions and interpretations of the Hippocratic Oath. For example, the General Medical Council in the UK provides that in modern practice, “the Oath should be seen as an affirmation or statement of intent to carry out medical practice to high ethical and professional standards.” This means that the Oath is taken as a symbolic expression of a commitment to ethical practice, rather than a literally binding declaration. There are also arguments that the Hippocratic Oath is no longer fit for purpose. The Oath was drafted in a time where the doctor’s responsibility to the patient was paramount. However, the advances in medical science and technology have altered the doctor-patient relationship significantly. Nowadays, clinicians do not simply care for patients, they are responsible for curing them and preventing disease. Some argue that this has shifted the emphasis from the physician as a healer to the doctor as a technician. With the rise of evidence-based medicine, focusing on the diagnosis, treatment and prognosis of a specific disease, there are widespread concerns over the dehumanizing of medical practice. Ergo, the outdated principles that feature in the Hippocratic Oath, such as the ban on abortion, call into question the notion of respecting traditional ethics in the face of medical innovation and advances. Therefore, doctors may be under a conflict, feeling torn between their duties under the Oath and their obligation to best serve the patient’s interests using their specialized medical knowledge.
3.2 Medical Ethics and the Duty to Save Lives
In a situation where the mother’s life is in jeopardy from the pregnancy – for example, an ectopic pregnancy – and can be saved by an abortion, it is an unavoidable consequence that the death of the unborn child will ensue. Doctors must prioritize the life of the mother over the life of the unborn child, and in doing so, it is argued that the doctor is not directly intending to kill the unborn child but is instead ensuring the most basic of all human rights, the right to life, is protected. The Catholic Church has always forbidden abortion at any time and for any purpose. The ethical discussion in this particular situation focuses on whether the doctor is directly intending to kill the unborn child by carrying out the abortion and therefore infringing the teachings of the Hippocratic Oath, or if the doctor is fulfilling its commitment to respect the basic rights of human life by ensuring the life of the mother is protected. This complex and controversial ethical dilemma arises from the lack of a clear answer from either the medical profession or from moral philosophy on how to interpret the Hippocratic Oath. Nonetheless, the Oath continues to inspire and influence the ethical approach of doctors in their day-to-day professional lives, and it will continue to do so in the case of life and death decisions for years to come. The “duty to save lives” mentioned earlier in the chapter is significant, as patients can be reassured that they can trust doctors to exercise their professional judgment in their patients’ best interests. Doctors, as long as their decisions are justifiable and reached following a proper ethical and reasoning process, are legally entitled to exercise a “conscience clause”. This means they can refuse to carry out a particular treatment or administer certain drugs if they believe that to do so could harm the patient. The use of such clauses in abortion law has consistently been on the increase and has been the subject of recent litigation. The landmark case of Doogan and Wood v. NHS Greater Glasgow and Clyde Health Board and others determined that a request to avoid participation in the abortion process under a conscience clause, by two Roman Catholic midwives who were responsible for the coordination of care for women undergoing termination of pregnancy, was valid under the relevant Abortion Act. The case demonstrates that the suitability of different ethical, moral, and legal frameworks within the abortion debate can have practical impacts upon the rights of both doctors and patients when accessing treatment.
3.3 Doctors as Moral Agents in Abortion Cases
It recognizes doctors as moral agents in abortion cases and the legal framework guiding their decision-making. What this means is that a doctor who is a moral agent is a person who is capable of acting with reference to right and wrong, and has the freedom to make a choice. This contrasts with the view that a doctor’s conscience and moral judgment should be excluded from the decision-making process in abortion. As Lynn Alfred and Jo Jackson argue, enacting this form of decisional autonomy excludes the doctor as a moral agent, reducing him to ‘the status of a mere technician.’ Driven by the idea of doctors needing to censor their own emotional response when faced with an ethical dilemma, claims have been made to remove completely any degree of moral agency in abortion decision making. Such claims come from those advocating a ‘consequentialist’ approach to abortion. Consequentialism is a moral theory which holds that the consequences of an action in terms of contributing to the overall good ultimately determine whether an action is morally right. In this case, individuals advocating for a removal of the doctor’s moral agency argue that to avoid inappropriate emotional involvement that could lead to a decision based on reasons the doctor will emotionally respond to, moral agency should be removed in favour of completely objective reasoning through the application of consequentialist principles. On the other hand, there are those who emphasize the importance of the moral agency of doctors. Dr. Jonathan Beard, for example, criticizes what he describes as ‘professional aloofness’ from issues of morality. He argues that showing reluctance to discuss abortion from the standpoint of the moral agency of doctors poses the risk of promoting the suggestion that doctors need to adopt an ‘objective’ approach to moral dilemmas. However, he asserts that in doing so, doctors may inadvertently disengage from their own moral beliefs. He claims that this disengagement, fueled by what he terms ‘moral residue,’ may actually serve to result in a ‘more profound psychological disturbance’ as a consequence of performing an abortion because the element of moral judgment and personal conscience is markedly absent from the decision-making process. It is his view that the emphasis upon moral agency in abortion enables the recognition of the emotional and psychological complexity such a decision entails, thereby protecting the mental well-being of doctors involved in abortion cases.
3.4 The Legal Framework for Doctors’ Decision-Making
Clinicians are expected to follow a sort of best training when settling on helpful choices. This is known as the standard of care. The standard of care contrasts relying upon what setting the specialist is rehearsing in; for instance, a GP working in a medical procedure and an A&E expert in emergency clinic might be dependent upon various principles. On the off chance that a specialist follows the standard of care, at that point they are probably not going to confront disciplinary procedures, regardless of whether the choice they have made is one with which different specialists may differ. Notwithstanding, this doesn’t mean specialists have free rein to settle on choices in any way they pick. In the event that there is proof that shows a specialist has acted in a way that is conflicting with the feelings, school of thought or convention of any gathering of the calling, disciplinary procedures might be started. This is known as an ‘escape clause protest’. Controls and guidelines might be presented by the Government or by the expert administrative body to set lawful principles about how doctors settle on restorative choices. Regulatory standards generally need to do with keeping up a base degree of legitimate practice yet may give some level of direction on moral conduct also. Generally speaking, there are three principle controls which manage how a specialist may settle on a clinical choice. The first is the General Medical Council guidelines, for example, the Medical Practice (that is, what to look like after patients appropriately) and the Professional Performance (that is, the means by which to complete all parts of their impact securely and adequately) guidelines. The second is National Institute for Health and Care Excellence rules. Decisions made by managerial law in courts for the most part center around the law as it at present stands in a specific point and the key point is guaranteeing that the Government has followed the right methods in contracting new enactment. There is additionally administrative law through which patients may look to challenge choices which influence them. In end: ‘legitimate practice’ is something other than a base degree of ability or consideration; it requires compliance to the regulation and makes room for change as logical information, advancements in therapeutic practice and the social and moral setting constantly create.
4. Case Studies and Real-Life Scenarios
Cultural and religious considerations: Research indicates that when women were denied an abortion in situations where they felt it was in their best interests, there were serious and long-lasting damage to their health. The notion of whether a physician is capable of understanding a woman’s health concerns and exercising his judgment concerning her health impacts how women see themselves as moral agents and as contributing members of society. Dr. George Tiller, a US physician, was one of the few doctors in the country to perform late-term abortions. He has been the focus of many protests by anti-abortion activists and he was murdered by an anti-abortion activist in 2009 when he was on duty at his church. Dr. Tiller’s assassination raises the question of to what extent people can use religion as a basis to justify their actions and how we should strike a balance between the freedom of conscience and ethical medical practice.
Seeker: At the age of 14, Lisa becomes pregnant. Although both her parents are willing to give consents, Lisa refuses to tell the parents anything about her condition, let alone have the abortion with their consents. She insists on not wanting the parents to know. This case explores the statutory provision with regards to those lacking capacity to give consents and the court’s power to make declaratory orders as to the lawfulness of abortions for people who cannot give consents.
Psychological and emotional factors: Children under the age of 16 are presumed in law to be incapable of giving consent. However, the Sexual Offences Act states that the presumption is rebuttable. This means that if the child is mature enough to understand the nature and the implications of the treatment, his or her consent has to be sought and the doctor may proceed without parental knowledge.
Emergency situations and immediate threat to life: In Ireland, which has one of the strictest abortion laws in the world, the eighth amendment has ensured that the country’s laws acknowledged the right to life of the unborn with due regard to the equal right to life of the mother. The general principle of the law on abortion is the physician who performs the abortion has to make the clinical judgment and act in what he considers as the best interests of his pregnant patient. Katie, an Irish woman, fell seriously ill during her pregnancy yet the doctors were not allowed to perform an abortion as long as there was a fetal heartbeat. She died of sepsis and an international human rights commission judged that Ireland’s abortion law violated the rights of pregnant women. This case can be used to illustrate the impact of legal framework on doctor’s decision-making and how it may influence the practice of abortion.
Fetal abnormalities and incompatible with life: Marie is 35 years old and 16 weeks pregnant. Her doctor suggests having an abortion because the fetus has a severe genetic abnormality that is unable to survive after birth. Marie and her husband are devastated and they are very confused and upset. This case can help explore whether there should be legal regulation on abortion in the case of fetal abnormalities. In France or Germany, abortion is only legal if it is performed before the end of the 12th week of pregnancy and in the case of severe fetal abnormality it has to be authorized by a committee. Also, the law requires the doctor to inform the pregnant woman of the support available and of the right to seek further advice.
Maternal health complications: Jessica is 30 years old and 20 weeks pregnant. She was perfectly healthy until her water broke prematurely. She has an infection in the uterus and if the pregnancy continues, it would cause sepsis and threaten her life. The doctor recommends an abortion to remove the source of the infection but Jessica insists on waiting because she does not want to terminate the pregnancy. This case raises the issue of when the woman’s life is in danger but she refuses to have an abortion because of psychological and emotional factors.
4.1 Case Study 1: Maternal Health Complications
On rare occasions, pregnancy can severely affect the health of a woman. When a real risk of serious harm to the mother is identified, a doctor may decide that an abortion is the most appropriate course of action. Ruth is a 32-year-old woman who discovers that she is seven weeks pregnant with her third child. Due to the fact that she has epilepsy and is on medication with a known association with birth defects, there is significant concern about the health of the developing fetus. When she attended a routine antenatal check at the local hospital, Ruth disclosed details of her medical history. Her obstetrician, Dr. Jackson, promptly referred her to a consultant in obstetrics and gynecology at the hospital who confirmed that, as a result of her medical condition, there was a high chance her baby would be seriously deformed. He advised Ruth to seek a termination as soon as possible. Dr. Jackson and her team provided comprehensive support to Ruth while the decision was made, making sure to continually counsel her about the risks to her health and that of her baby. This case is very helpful as it provides a way of understanding what is meant by the reference in the 1990 Act to a risk of ‘serious, adverse effect on the health’. It rightly acknowledges that doctors must identify whether the risk is to the life or to the health of the pregnant woman and that the adverse effect must be ‘prolonged’. This case study really does illustrate what the law is about. The overriding concern explored in this case was whether the consultant in obstetrics and gynecology, Dr. Jackson, had complied with the general medical council’s (GMC) guidelines by failing to consult with another healthcare professional before forming a decision and subsequently giving advice to Ruth. As a matter of fact, Ruth did have her doubts as to the true necessity for the termination. However, it been confirmed that in British law, the initial policy is to criminalize the end of a baby’s life, rather than the professional who carries out the abortion. The Abortion Act 1967 provides that such an act is a crime unless it is in good faith for the purpose of preserving the life of the pregnant woman. This does provide the medical professional with appropriate protection from prosecutions. So, what was the outcome of the case? Well, the court was required to identify whether the criminal standard of gross negligence had been met and, if so, whether there was a need for more clarity of the law. The high standard of gross negligence is typically very difficult to prove and, after a thorough process, it was found that Dr. Jackson had not been grossly negligent. It was concluded that the existing law was clear enough to provide a satisfactory judicial foundation for the determination of that case.
4.2 Case Study 2: Fetal Abnormalities and Incompatible with Life
In the case of a fatal fetal abnormality, a medical termination of pregnancy after 24 weeks will be carried out for a few patients. The Termination of Pregnancy Act 2012 states that a termination can be performed when two appropriate medical practitioners, in good faith, are of the opinion formed on reasonable grounds and that the continuance of the pregnancy would involve risk to the life of the pregnant woman or of injury to the physical or mental health of the pregnant woman, which is greater than if the pregnancy were terminated. Such risk, according to the Act, cannot be merely social, economic, or family reasons. The doctors should have regard to the need to preserve unborn human life, as far as it would be good medical practice. They must follow the common law as well as the circumstances of the case and the opinion of the second practitioner. In the case of “A and Others,” the patient was 21 weeks into her pregnancy when she knew that her fetus with congenital heart disease was suffering and in agony. It was clear for the doctors that the fetus would not survive birth and had little or no fetal life outside the womb, and that it would be a safe and specially equipped neonatal in “another jurisdiction” (there was a dispute about where the births would take place). They were also of the opinion that there was a good reason for a termination of pregnancy, proving a rare disease or state of injury known as “Edwards’s Syndrome.” It was stated that if the fetus were born, it would be kept alive “artificially” by medical intervention and later would rely on a lifelong care package to survive, which caused the doctors to believe that the fetus has established a significant connection with the UK and therefore the pregnancy was not at risk of a consequence. It was more likely than not that the unborn will suffer from a further compromise to the substantial injury and harm condition if the medical intervention has not been provided and the existence of any significant pain, which led the doctor to the view that crucial treatment would be required to keep the fetus alive. However, in the case of “B and C,” a similar situation was not found. The pregnancy was 22 weeks along when they found that the fetus has Holoprosencephaly, which is life-limiting and the baby, if brought to term, would not survive for a long time out of the womb. However, doctors refused to provide assistance for termination on the ground that “there was a potential for continuous life until birth” and the abnormalities were not regarded as fatal in their training and experience. Eventually, the mother had to travel to the US to receive psychological support as well as a termination of pregnancy and had an overwhelming victory in the US Circuit Court of Appeal. She had been granted a declaration that the Secretary of State’s refusal to exercise discretion to authorize funding was unlawful, and an order quashing the decision of the second respondent to refuse to provide the guarantee required under the National Health Service (Controlled Citizens) Regulation 2012. It was held that the fetus was located outside the jurisdiction as incorporated in section 1(1) of the Infant Life (Preservation and Protection) Act 1929 and s.5 of that Act would not be contravened. Ultimately, “B and C” set up the case of “A and Others” and showed that medical practitioners should consider the profoundness of the connection between the unborn and the UK when acknowledging the potential outcome of quality of life.
4.3 Case Study 3: Emergency Situations and Immediate Threat to Life
In a typical case for an abortion, a doctor needs to weigh up the cultural and religious feelings of the patient and also the legality of the process. However, in emergency circumstances and where there is an immediate threat to life, the law allows for treatment necessary to save a person’s life to be provided. In such situations, a doctor will not necessarily always be liable for giving such treatment, even if it results in the death of the fetus. According to section 1(1) of the Abortion Act, a doctor will not be found guilty of a criminal offense provided that “the treatment was carried out by a registered medical practitioner in a National Health Service hospital or [in other facilities] with the approval of the Minister for Health and Social Services, and two registered medical practitioners are of the opinion, formed in good faith, that the continuance of the pregnancy would involve risk to the life of the pregnant woman or of injury to the physical or mental health of the pregnant woman or any existing children of the family.” Also, it must be taken into account if the pregnancy has not exceeded its twenty-fourth week, and that the opinion of the doctors will be evaluated with regard to the circumstances of the case that the doctor will need to act “in good faith” when considering the treatment given. However, herein lies the ethical dilemma for doctors. Strand praises the “good faith” clause as being a “comfort to many doctors” and especially to those doctors who are accused of immoral and cruel actions. He goes on to elaborate on this and the implication for medical law when he states that “doctors have to make life and death decisions” and that “the Abortion Act clearly defines that ‘evidence of a registered medical practitioner’ must be obtained.” He concludes that; “in order for a help provider to avoid all accusations of misconduct, they will always need to act in good faith and have due regard to gaining the necessary expert advice from a colleague.” It is interesting that the public interest in amendments to the Abortion Act has mainly centered on enabling women greater freedom of action and choice in the process. However, there has not been any material change in the working provisions of the Act since it was established in 1967 and no doubt it will continue to provide a moral and ethical challenge to medical professionals for many years to come.
4.4 Case Study 4: Psychological and Emotional Factors
In another situation, a 32-year-old woman requested a termination. She was married with two children but wanted an abortion because the baby was unplanned. The woman was aware of her pregnancy since she was 6 weeks pregnant but delayed a decision until the 12th week. She was assessed by two doctors who certified that the continuance of the pregnancy would be a risk to the life of the woman and that the baby, if born, would suffer from such physical or mental abnormalities as to be seriously handicapped. However, as the pregnancy was over 12 weeks and the baby was healthy, the abortion had to be carried out in a hospital as it was a more complicated procedure. On the gynecology ward, she explained to a nurse that she was feeling very depressed and she believed that this baby would be a girl. Also, she could not terminate the pregnancy before she formed any bond with the baby. She appeared very upset and tearful when signing the consent form and when she elected to have the procedure carried out under sedation, she was much more relieved. When she was reviewed five days post-procedure, she reported that she had slept soundly for the first time in many weeks. She was pleased with her decision and was recovering well. This case study illustrates the impact of pregnancy in the “window of viability” and the importance of inter-relating the psychological issues and gestational term. Initiating psychosocial assessment for pregnant women requesting late abortion can be vital to explore the exact reasons of the request. Such assessment should include mental health, family circumstances, marital relationship, reason for delay and future contraception plan. Also, by appreciating the complexity of emotional response at various gestational terms, it may facilitate the healthcare professionals to respond to the women’s needs more effectively.
4.5 Case Study 5: Cultural and Religious Considerations
Doctors in the UK are reported to often have to handle sensitive cases where the patients are from different cultural and religious backgrounds. These can include medical decisions surrounding end of life care and, of course, abortion. It has been reported that approximately half of the UK’s healthcare trusts have seen a case where abortion was requested on the grounds of gender selection, with 5% having gone through with the procedure. In some cultures, male children are preferred over girls, with one particular religious term translating to “care for daughters” actually being used as a euphemism for abortion. Although not predominant, the sex ratio at birth in the UK is significantly higher than the natural rate and there is a fear that the “gender selection” abortion is being used to effectively select male children. This can lead to some doctors feeling particularly conflicted when there are religious or cultural reasons given for the abortion. Some doctors have suggested that the greater availability of non-invasive prenatal testing in the UK can lead to greater pressures for expectant mothers from certain backgrounds to undergo the test and potentially terminate the pregnancy. Some healthcare professionals, such as those reported in a review conducted by the British Medical Association, feel that they should not be “drawn into [a family’s] cultural beliefs” and that the woman’s choice should still take precedence. However, it seems there is a trend towards society expecting abortion to be more widely practiced and available; changes to the legal and practice framework in 2012 saw the removal of the need for a second doctor to approve an abortion and a substantial decrease in doctors being conscientious objectors to abortion. It appears that cultural and religious pressures mean different things to different people, and also that the balance between ethical decision making for doctors and a patient’s autonomy may shift over time.
5. Conclusion
The debate surrounding doctors’ ethical duty to prioritize the life of the mother over the life of the fetus is an ongoing and contentious issue. Although the conclusion of this essay is that such a hierarchy is not always in conflict with a doctor’s duty to respect the life of the fetus, and that a doctor can attribute greater importance to the woman’s life, the complexity of the various processes – both medical and legal – that doctors must adhere to in making such a decision. The landmark case of St George’s Healthcare NHS Trust v S, which was handed down by the High Court in 1998, stressed that a doctor can lawfully terminate a woman’s pregnancy even when it might result in the death of the fetus provided she is of sound mind and has the capacity to consent if the termination is necessary to prevent grave permanent injury to the woman’s mental or physical health. However, given this ruling, the capacity for doctors to develop and enforce a rigid ethical standard is limited. As was established in the case of Patricia Wall, a woman with severe mental health issues who was denied an abortion by three consultants and so made a complaint to the General Medical Council, each decision must be made solely on the facts of each individual case. In this particular case, Mrs. Wall’s baby was later born prematurely and died very young.
5.1 Summary of Key Arguments
Over long periods of time discussing and learning about ethical decisions, a range of different positions and arguments can be readily identified. When it comes to the question of abortion, especially when it concerns a life or death situation, the debates and discussions continue and are intensified. As evidenced in this work, the arguments presented by various scholars and experts illustrate the complexities of this highly debated issue. One of the most heated arguments in favor of rights for the fetus is the “natural law” represented by John Finnis. According to his argument, humans have inclinations to seek the basic values of human life and this requires respect for certain basic forms of life and attributes which are essential to them. He points out that abortion is an “absolute evil” as it destroys the “innocent rational will”. Such kind of destructive act is unjustifiable, even if those responsible believe that they do a better thing than letting the pregnancy continue. In fact, Finnis stressed that defense of abortion deflects troubling public attention away from other grave bioethical issues. The availability of abortion diverts society’s attention from a much more serious issue, which is the need to confront the circumstances of the whole life in which a pregnancy occurs and for creating and generously and publicly offering to all women, like help and competences they may need.
5.2 Implications for Medical Practice and Ethics
The essay explores the implications of doctors’ actions in life and death situations. A parallel is drawn between voluntarily stopping life support, a universally accepted practice in medicine, and abortion. It is suggested that the fact that these two acts are alike in that they both stop the process of life is an argument in favor of a more liberal abortion law. It is thought that the decision taken over life support is a medical one and a personal one. This decision is supported by the Mental Capacity Act 2005, which allows the decision-maker to take into account not only the patient’s best interests but also the views of other people, including the family. If the woman’s only surviving child was to die by coming off the life support machine, then it is likely that she would be mentally incapacitated, and it is the views of her nearest relatives that should be taken into account in considering her best interests. This case law can be used as a comparison in cases of abortion to argue in favor of a more liberal abortion law. If doctors were able to decide when to stop medical treatment without having to demonstrate conclusively that it is in the patient’s best interests, then equally, they should be able to decide when to perform an abortion on a pregnant woman without her having to demonstrate that it is in her best interests to do so. It is argued that doctors should be entitled to apply their own judgment in either case. Consequently, it would not matter whether the woman was seeking an abortion in the first 24 weeks of pregnancy or after 24 weeks in cases where the child is found to be seriously handicapped because the doctor would be able to use their own discretion, subject to ethical approval and oversight, in deciding whether an abortion was appropriate. By detracting from individual rights and allowing laws to continue which restrict abortion, the future does not look promising for women’s rights. Therefore, creating a strong comparison between abortion and life support so that the laws and medical practice surrounding abortion can be improved is essential. The research will also provide additional historical and philosophical analysis, linking current medical ethics processes with nineteenth-century moral thought and the political climate of the time in order to present a comprehensive argument around the topic.
5.3 Recommendations for Policy and Legislation
Physicians must respect the right to life of all patients, regardless of the patient’s age or condition. A physician is not excused from this responsibility simply because the patient is very young or very old, that the patient has some sort of disability or mental incapacity, or that the patient is not yet born. Physicians should familiarize themselves with the most current and accepted professional guidelines affecting their decision-making in particular areas of medicine. Physicians must not let non-medical factors influence their medical judgment. Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Women must be treated as adults and allowed to make autonomous decisions regarding their reproduction. Only when the fetus becomes viable does the state’s interest in protecting fetal life become compelling. Fetal viability is reached at approximately seven months of gestation. The debate about fetal rights is really a debate about the moral status of a fetus. A woman shouldn’t be handicapped with an unwanted pregnancy because of a delayed diagnosis of a serious fetal abnormality. The state must not take patients’ dignity, comfort, and personal privacy away without sufficient justification. Medical decisions made to relieve suffering must comply with the recognized and acceptable standards within the medical community. The state’s duty is to protect a woman’s ‘bodily integrity’ and personal autonomy, including her ability to decide on matters relating to her health. The laws regarding pregnant women’s access to medical and pregnancy-related diagnostic procedures should recognize a woman’s moral authority to decide the course of her own pregnancy. No law requiring a women to inform the father of the pregnancy would be formulated in line with the obligations of the state to secure the constitutional rights of its citizens (Godkin, 1994). In essence, based upon the aforementioned case law, it is expected that the body of research will help to extend and further clarify the issues surrounding a woman’s right to choose in Malta in the context of antenatal screening and testing. The only way to respect a woman’s dignity and her constitutional right to make reproductive decision is to protect, not limit, her right to act on her own belief.

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