Navigating Abortion Care Ethics for Nursing Professionals

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From the perspective of the NRLC, the 3,000 mother-helping centers that have been established around the country undermine the proposition that unwanted children actually exist. These centers provide crisis intervention for pregnant women, including medical assistance, educational opportunities, housing, and when available, job training. In addition, the NRLC reports that there are up to 36 couples waitlisted for every adoption taking place in this country. In light of these statistics and from the perspective of the NRLC, an unwanted birth is nothing more than a convenient argument to justify infanticide and fill the bank accounts of abortionists.

The fourth main prochoice argument discussed by the NRLC is that ending legalized abortion will not end abortion, because abortions will be performed illegally (Turner & Balch, 2013). The overall result will be an increase in the number of adverse outcomes, including the death of both mother and fetus. To counter this claim, the NRLC quotes mid-20th century statistics generated by Planned Parenthood, which reveal that 90% of illegal abortions were performed safely by physicians and that most adverse outcome arose during self-induced abortions. In fact, during the year before Roe v. Wade (1973) was decided by the U.S. Supreme Court the CDC reported a total of 39 deaths due to illegal abortions. The NRLC does not provide any recent statistics on the number of illegal abortions and deaths since Roe v. Wade, but does cite the comparatively large number of deaths (> 200) during legal abortions for the entire period since 1974, which seems to be an intentional way of creating the perception that legal abortion is unsafe. In fact, the number of deaths from legalized abortions has varied between 4 and 12 annually for many years, which seems a relatively tiny number given that nearly a million abortions are conducted each year (Ventura et al., 2012; Pozol et al., 2013). The point the NRLC (2013) is trying to make is that there is little difference in the safety of legal and illegal abortions, which implies the prochoice argument cannot withstand a detailed examination of the facts. The NRLC goes further and suggests that legalized abortion is nothing more than a way to increase an abortionist's profit margins.

The fifth and final main prochoice argument presented by the NRLC is that abortion is the only viable option in cases of a severe congenital defects, rape, and incest (Turner & Balch, 2013). To counter this argument, the NRLC cites Planned Parenthood statistics suggesting that less than 6% of all U.S. abortions are done for any of these reasons and then tackles each one separately. Performing an abortion to prevent the birth of a severely handicapped child was equated to discrimination against the disabled, thereby implying the prochoice position includes the sentiment that some lives are not worth living. The NRLC then goes on to describe how some of the deformities and diseases used to justify an abortion are quite minor, with the list growing longer every year despite remarkable advancements in medicine. With respect to rape and incest, the NRLC encourages prolife activists to acknowledge that real violence has been perpetrated against the mother, while suggesting that the unborn child is also a victim of the same violence. The idea that abortion could ever be a viable solution to these acts of violence, according to the NRLC, ignores the fact that one act of violence is used as an excuse to commit another act of violence (abortion).

While the policy positions of the NRLC have merit there is also a prominent 'us against them' theme underlying all of their arguments, in addition to manipulation of both the message and facts. No attempt is made to find a more rational and less divisive middle ground. Anyone seeking to find this middle ground would likely find these arguments unhelpful.

Prochoice Positions

The National Abortion Federation (NAF, 2010) takes the position that abortion is one of many legitimate reproductive choices available to women in the United States and deserving of active protection. The purpose of abortion, in addition to the other reproductive choices of parenthood and adoption, is to reduce the number of unplanned pregnancies and thus unwanted children being brought into the world. Compared to the prolife positions presented above, however, NAF does not draw any moral or ethical distinction between abortion, adoption, or keeping the child. The prochoice position is based on the principle of empowering women with the ability to choose if and when to have a family, without the government interfering in what is a very personal choice. Under this principle, women are viewed as fully capable of intelligently and responsibly determining their own reproductive fate. The prochoice position, as articulated by NAF, does not attempt to promote abortion, only to protect the right of women to decide whether or not abortion is the right choice for them. Since the focus is on protecting the reproductive freedom of women, promoting and protecting easy access to contraception is also a prominent feature of prochoice policies (NARAL, 2014).

A divisive tone is also evident among the information provided by prochoice organizations (NAF, 2010; NARAL, 2014), so any effort to find a rational middle ground is made all the more difficult by the many inflammatory statements that can be found on these websites. What seems clear, however, is that the prolife and prochoice organizations are viewing legal abortion through two distinct lenses. The prolife position seems to be mainly premised on the belief that all life is sacred, even a recently fertilized oocyte. By comparison, the prochoice perspective appears to be mainly based on the principle of protecting a woman's right and responsibility for determining her reproductive fate. On the one hand abortion destroys life and on the other it represents just one of several equivalent choices along a reproductive decision-making continuum.

The Nurses' Perspective

A recent Gallup poll discovered that Americans are fairly evenly split in terms of prolife or prochoice views (Saad, 2013). Among the 1,535 participants in the poll, 47 and 46% of the women reported holding prochoice and prolife views, respectively. The most polarizing variables were no religious affiliation, liberal, and Democrat for prochoice and Republican and conservative for prolife. When McLemore and Levi (2011) reviewed the nursing research literature on this topic for the years 1971 to 2011 they discovered that nurses in the United States and United Kingdom are no different in their views compared to the American public. Generally speaking, nurses do not hold extreme views concerning abortion like those proffered by the NRLC and NARAL. On an individual level, however, many nurses acknowledged that their views on abortion were influenced by their religious beliefs, a patient's reasons for deciding to abort, and the financial impact of an unintended pregnancy carried to term.

Among the nurses surveyed in the studies cited by McLemore and Levi (2011), 13% reported having a negative view of abortion based on their religious beliefs. Concerning the termination criteria, most nurses considered abortion a reasonable choice if the pregnancy was in the first trimester, if contraceptive measures failed, when recommended by a physician, or if maternal health was at risk. The two termination criteria which tended to be viewed negatively by nurses were the use of abortion as contraception and for gender selection. Nurses were then asked about a mother's inability to financially support a child and most acknowledged that this was a legitimate reason for terminating a pregnancy. What was probably the most counterintuitive finding was that despite nurse support of abortion in cases of maternal financial hardship, most nurses strongly disagreed with federal funding of abortion services.

McLemore and Levi (2011) further examined the legal and ethical responsibilities of nurses in relation to abortion care. Although abortion is legal in the U.S., no law requires a nurse to provide abortion services; therefore, nurses are free to choose. What remains are the more nuanced controversies of fetal personhood, conflicts between patients' and nurses' rights, fetal viability, selective reduction in multiple gestations, and the use of abortifacients drugs.

The role of a nurse when providing reproductive services was investigated by four research groups and all studies affirmed that women have three reproductive choices when faced with an unintended pregnancy: (1) abortion, (2) adoption, and (3) parenthood (McLemore & Levi, 2011). Of the several nursing roles that would be required for providing abortion services, empowering the patient to make their own choice independent of the personal beliefs and views of nursing staff would be one of the more important. All four studies emphasized the need for education and training that would provide nurses with the skills and education necessary to provide unbiased patient support and counseling.

The findings by McLemore and Levi (2011) provide a general overview of the moral and ethical issues nurses face when providing, or when asked to provide, abortion services. The reality on a case by case basis, however, is much more informative. Lipp (2008) interviewed nurses to better understand their experiences when providing abortion services.…