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Sunday, June 26, 2022

Abortion and Bioethics: The Principles Underpinning the US Abortion Debate

The U.S. Supreme Court will soon decide the fate of Roe v. Wade, the landmark 1973 decision that established the nationwide choice of abortion. If the court’s decision comes close to the leaked draft opinion first released by Politico in May 2022, the court’s new conservative majority will overturn Rowe.

The vicious debate over a solution is often dominated by politics. Ethics has received less attention, although it is at the heart of legal disputes. As a philosopher and bioethicist, I study moral issues in medicine and health policy, including abortion.

Bioethical approaches to abortion often appeal to four principles: respect for patient autonomy; do no harm or “do no harm”; charity or useful assistance; and justice. These principles were first developed in the 1970s to guide human research. Today, they are an important guide for many physicians and ethicists in complex medical cases.

Patient autonomy

The ethical principle of autonomy states that patients have the right to make decisions about their health care whenever possible. The American Medical Association’s Code of Medical Ethics recognizes the patient’s right to “be informed and ask questions about recommended treatment” in order to “make informed decisions about treatment.” Respect for autonomy is enshrined in informed consent laws that protect the right of patients to be aware of available medical options and to make an informed voluntary decision.

Some bioethicists see respect for autonomy as strong support for the right to abortion, arguing that if a pregnant woman wishes to terminate a pregnancy, the state should not interfere. According to one interpretation of this view, the principle of autonomy means that a person owns his body and should be free to decide what happens in and to him.

Opponents of abortion do not necessarily dispute the validity of respect for human autonomy, but may disagree on how to interpret the principle. Some consider the pregnant woman as “two patients” – the pregnant woman and the fetus.

One way to reconcile these views is to say that as an immature person becomes “more and more self-aware, rational, and autonomous, he suffers more and more,” writes philosopher Jeff McMahan. From this point of view, the fetus in the later stages is more interested in its future than the fertilized egg, and, therefore, the later in pregnancy the abortion occurs, the more it can interfere with the development of the interests of the fetus. In the US, where 92.7% of abortions occur at or before 13 weeks’ gestation, the rights of the pregnant woman can often outweigh the rights attributed to the fetus. However, at a later stage of pregnancy, the rights assigned to the fetus may take on more weight. Balancing these competing claims remains controversial.

Harmlessness and beneficence

The ethical principle of “do no harm” prohibits intentionally harming or harming a patient. This requires competent medical care that minimizes risks. Doing no harm is often combined with the principle of beneficence, the obligation to benefit patients. Together, these principles emphasize the need to do more good than harm.

The Hippocratic Oath, the traditional code of ethics for physicians, emphasizes doing no harm.
Janko Maslovarić/iStock via Getty Images Plus

Minimizing the risk of harm is prominent in the World Health Organization’s opposition to the ban on abortion because pregnant women who face barriers to abortion often resort to unsafe methods that are a major cause of preventable maternal death and morbidity worldwide.

While 97% of unsafe abortions occur in developing countries, developed countries that have reduced access to abortion have caused unintended harm. In Poland, for example, doctors fearing prosecution are hesitant to treat cancer during pregnancy or to remove a fetus after a pregnant woman’s water broke early in pregnancy before the fetus is viable. In the US, restrictive abortion laws in some states, such as Texas, make it harder to treat miscarriages and high-risk pregnancies, putting the lives of pregnant women at risk.

However, Americans who advocate turning Rowe are primarily concerned about harm to the fetus. Whether or not the fetus is considered a person, the fetus may have an interest in avoiding pain. Some ethicists believe that humane care for pregnant women in late pregnancy should include minimizing fetal pain, whether or not the pregnancy is ongoing. Neurology teaches that the human ability to experience feelings or sensations requires consciousness, which develops between 24 and 28 weeks of gestation.

Justice

Justice, the last principle of bioethics, requires equal treatment of such cases. If the pregnant woman and the fetus are morally equal, many argue that it would be unfair to kill the fetus except in self-defense if the fetus threatens the life of the pregnant woman. Others believe that even in self-defense, terminating a fetus’s life is wrong because the fetus is not morally responsible for any threat it poses.

However, abortion advocates point out that even if an abortion results in the death of an innocent person, that is not its purpose. If the ethicality of an action is judged by its goals, then abortion may be justified in cases where it fulfills an ethical goal, such as saving a woman’s life or protecting a family’s ability to care for their current children. Abortion advocates also argue that even if the fetus has the right to life, the person does not have the right to everything they need to stay alive. For example, the existence of the right to life does not entail the right to threaten the health or life of another person or grossly neglect his life plans and goals.

Equity also concerns the equitable distribution of benefits and burdens. Among rich countries, the United States has the highest rate of deaths associated with pregnancy and childbirth. Without legal protection for abortion, pregnancy and childbirth could become even more risky for Americans. Studies show that women are more likely to die during or shortly after pregnancy in states with the most restrictive abortion policies.

Minority groups stand to lose the most if the right to choose an abortion is not respected, as they benefit from a disproportionate share of abortion services. In Mississippi, for example, people of color make up 44% of the population, but 81% have abortions. Other states follow a similar pattern, leading some health activists to conclude that “restrictions on abortion are racist.”

Other marginalized groups, including low-income families, could also be hit hard by abortion restrictions, as abortions are expected to become more expensive.

Politics aside, abortion raises deep ethical questions that remain unresolved and that the courts are left to decide with the crude tool of the law. In this sense, abortion “begins as a moral argument and ends as a legal argument,” according to legal and ethicist Katherine Watson.

A moral consensus must be reached to end the legal controversy surrounding abortion. In addition, formulating one’s own moral views and understanding those of others can bring all parties closer to a principled compromise.

World Nation News Desk
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