Abortion

LECTURE I. THE PROBLEM OF ABORTION Definition: Is the expulsion of a living fetus from the mother's womb before it is viable Types: 1. 2.

Spontaneous abortion/miscarriage Induced or procured abortion a. Therapeutic - to save the life of the mother - ex. cancerous uterus, ectopic pregnancy b. Eugenic - fetal abnormalities c. Elective

Procedures: Surgical:

1.

1st trimester a. dilatation and curettage b. vacuum suction

2. 2nd trimester - saline injection, above cannot be used due to risk of bleed

3. late abortion – hysterotomy, similar to 4.

ceasarian section partial birth abortion - extraction of the body of the fetus into the vagina before the contents of the skull are sucked out, killing the unborn, after which the intact fetus is removed from the woman's body. Presently considered and illegal procedure

Medical: 1. mifepristone – RU-846 or the “abortion pill”; blocks hormone production for attachment then Prostaglandin is given after 48 hours, to trigger contractions and bleeding 2. morning-after - estrogen and progestin contraceptive pills and a progestin-only formulation (levonorgestrel). Taken within 72 hours of unprotected intercourse, disrupts follicular development and maturation of the endometrium. May or may not interrupt a pregnancy that has already implanted. 3. Intra-uterine device - fitted up to 5 days after unprotected sex. Possible Complications: subsequent spontaneous abortions, ectopic pregnancies, prematurity and sterility Historical Perspective: Ancient Greece 1. Plato - immediate upon conception 2. Aristotle - delayed hominization -- Albert the Great, Thomas Aquinas; heart; 3rd month 3. Stoics - upon birth Romans - pater familius Philippines - bitter herbs Reasons for Abortions6: 1 - incest/rape 1 - fetal abnormalities 4 - maternal health problems 50 - didn't want to be single parents/problems with current relationship 66 - cannot afford a child 75 - child would interfere with their lives

fetal age: maternal demographics: 25% - 9-10 wks 20-24 y/o - 33.1% 14% - 11-12 wks 25-29 y/o - 22.3% 5% - 13-15 wks 4% - 16-20 wks never married - 63.3% 2% - >20 wks married - 18.5% 55M/year worldwide; China US: 20M since 1973, 1.6M/year US: Roe vs. Wade The court declared: 1. In the first three months of pregnancy, the abortion decision must be left to the woman and her physician. 2. In the interest of protecting a woman's health, states may restrict but not prohibit abortions in the second three months, or trimester, of pregnancy. 3. In the last three months of pregnancy, states may regulate -- or even prohibit -- abortions to protect the life of the fetus, except when medical judgment determines that an abortion is necessary to save the life of the mother. "Jane Roe" later identified as Norma N. McCorvey Justice Blackmun retired in 1994..His carefully crafted opinion failed to identify a specific U.S. constitutional guarantee to justify the court's ruling. Instead, he based the decision on the right to privacy protected by the due process clause of the Constitution's 14th Amendment. In effect, the court was *enforcing a right that the Constitution did not specifically articulate. Amendment XIV - Citizenship rights. Ratified 7/9/1868. 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws. Doe vs. Bolton: defined the mother's health in the broadest terms to include psychological, emotional, and familial factors.. II. Ethical Considerations Inviolability of Life - Double Effect - Cooperation Autonomy III. Potential Issues Religion - Philosophy - Law Judeo-Christian Roman Catholic Sanctity of Life Taking a stand Compassion and understanding

Common humanity - we are all broken and sinful people

1. 2.

Gen 1:26-27 and God said, let us make man in our image.. Ex 20:13 do not murder Psalm 22:9-10 *nurture and presence; Psalm 139* Jeremiah 1:5

3. 4. 5.

1. 2. 3.

God sets apart human life as unique, distinctive and valuable. He preserves and protects human life as no other life on earth. That kind of life begins at conception and continues to develop where God is at work, shaping the child into the precise kind of person He desires to be.

6.

Florentino T. Timbreza: Bioethics and Moral Decisions, DLSU Press, 1993.* H.P. Dunn: Ethics for Doctors, Nurses and Patients, St. Paul's, 1997. Walter Glannon: Biomedical Ethics, Oxford University Press, 2005. John S. Feinberg and Paul D. Feinberg: Ethics for a Brave New World, Crossway Books, 1993. Benedict M. Ashley and Kevin D. O'Rourke: Ethics of Health Care, CHA, 1986.* Charles R. Swindoll: Sanctity of Life, Word Publishing, 1990.

When does life begin? Ensoulment - implantation, looks human, electrical activity, quickening, viability, birth Personhood - concious self-awareness, intelligent and free adult, interest in the future 1. Biological, Genetic or Structural View species specific DNA 2. Developmental, Sociological, Psychological and Interactive View Moral Status - potential to become persons, a valuable future Conflicts of Rights 1. Right to Life vs. Right to Control One's Body incest/rape 2. Right to Life vs. Right to Free Choice or Freedom a. Right to Life vs. Unwanted Children handicap b. Right to Life vs. Right to Be Loved c. Right to Life vs. Right to Choose One's Own Morality Pro-Choice - Women's Rights 1. A woman has to bear the risk and burden of pregnancy, delivery and child-care 2. In cases of very young, inexperienced, retarded and in cases of incest and rape 3. Control over pregnancy and the right to normal sex life 4. Unwanted children suffer 5. Defective child 6. Women cannot depend on society for help, insufficient and degrading 7. Forced to obtain abortion form illegal and dangerous abortionists 8. Using abortion as a back-up to aid population control 9. Women should not be inhibited in their right of choice by interference Pro-Life - Rights of a Child 1. destroying a life to defend her own rights 2. legalization - widespread 3. forced to act contradictory to love and care 4. excludes the father form responsibility 5. care of society for the unmarried, retarded, incest and raped 6. weakens the family as an institution - easy out 7. low regard for the human person References:

Abortion Act 1967 15 & 16 Eliz. 2, c. 87. 27 October 1967 Long title An Act to amend and clarify the law relating to termination of pregnancy by registered medical practitioners § 1 Medical termination of pregnancy (1) Subject to the provisions of this section, a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith-[(a) that the pregnancy has not exceeded its twentyfourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or (b) that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or (c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or (d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.] (2) In determining whether the continuance of a pregnancy would involve such risk of injury to health as is mentioned in paragraph (a) [or (b)] of subsection (1) of this section, account may be taken of the pregnant woman's actual or reasonably foreseeable environment. (3) Except as provided by subsection (4) of this section, any treatment for the termination of pregnancy must be carried out in a hospital vested in [the Secretary of State for the purposes of his functions under the National Health Service Act 1977 or the National Health Service (Scotland) Act 1978 [or in a hospital vested in a National Health Service trust] or in a place approved for the purposes of this section by the Secretary of State.] [(3A) The power under subsection (3) of this section to approve a place includes power, in relation to treatment consisting primarily in the use of such medicines as may be specified in the approval and

carried out in such manner as may be so specified, to approve a class of places.]

subsection and to a hospital controlled as aforesaid, and as if section 2 were omitted.

(4) Subsection (3) of this section, and so much of subsection (1) as relates to the opinion of two registered medical practitioners, shall not apply to the termination of a pregnancy by a registered medical practitioner in a case where he is of the opinion, formed in good faith, that the termination is immediately necessary to save the life or to prevent grave permanent injury to the physical or mental health of the pregnant woman.

(2) The bodies to which this section applies are any force which is a visiting force within the meaning of any of the provisions of Part I of the Visiting Forces Act 1952 and any headquarters within the meaning of the Schedule to the International Headquarters and Defence Organisations Act 1964; and for the purposes of this section--

§ 2 Notification (1) The Minister of Health in respect of England and Wales, and the Secretary of State in respect of Scotland, shall by statutory instrument make regulations to provide-(a) for requiring any such opinion as is referred to in section 1 of this Act to be certified by the practitioners or practitioner concerned in such form and at such time as may be prescribed by the regulations, and for requiring the preservation and disposal of certificates made for the purposes of the regulations; (b) for requiring any registered medical practitioner who terminates a pregnancy to give notice of the termination and such other information relating to the termination as may be so prescribed; (c) for prohibiting the disclosure, except to such persons or for such purposes as may be so prescribed, of notices given or information furnished pursuant to the regulations. (2) The information furnished in pursuance of regulations made by virtue of paragraph (b) of subsection (1) of this section shall be notified solely to the [Chief Medical Officer of the [Department of Health], or of the Welsh Office, or of the Scottish Home and Health Department]. (3) Any person who wilfully contravenes or wilfully fails to comply with the requirements of regulations under subsection (1) of this section shall be liable on summary conviction to a fine not exceeding [level 5 on the standard scale]. (4) Any statutory instrument made by virtue of this section shall be subject to annulment in pursuance of a resolution of either House of Parliament. § 3 Application of Act to visiting forces etc (1) In relation to the termination of a pregnancy in a case where the following conditions are satisfied, that is to say-(a) the treatment for termination of the pregnancy was carried out in a hospital controlled by the proper authorities of a body to which this section applies; and (b) the pregnant woman had at the time of the treatment a relevant association with that body; and (c) the treatment was carried out by a registered medical practitioner or a person who at the time of the treatment was a member of that body appointed as a medical practitioner for that body by the proper authorities of that body, this Act shall have effect as if any reference in section 1 to a registered medical practitioner and to a hospital vested in [the Secretary of State] included respectively a reference to such a person as is mentioned in paragraph (c) of this

(a) a woman shall be treated as having a relevant association at any time with a body to which this section applies if at that time-(i) in the case of such a force as aforesaid, she had a relevant association within the meaning of the said Part I with the force; and (ii) in the case of such a headquarters as aforesaid, she was a member of the headquarters or a dependant within the meaning of the Schedule aforesaid of such a member; and (b) any reference to a member of a body to which this section applies shall be construed-(i) in the case of such a force as aforesaid, as a reference to a member of or of a civilian component of that force within the meaning of the said Part I; and (ii) in the case of such a headquarters as aforesaid, as a reference to a member of that headquarters within the meaning of the Schedule aforesaid. § 4 Conscientious objection to participation in treatment (1) Subject to subsection (2) of this section, no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection: Provided that in any legal proceedings the burden of proof of conscientious objection shall rest on the person claiming to rely on it. (2) Nothing in subsection (1) of this section shall affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman. (3) . . . § 5 Supplementary provisions [(1) No offence under the Infant Life (Preservation) Act 1929 shall be committed by a registered medical practitioner who terminates a pregnancy in accordance with the provisions of this Act.] (2) For the purposes of the law relating to abortion, anything done with intent to procure [a woman's miscarriage (or, in the case of a woman carrying more than one foetus, her miscarriage of any foetus) is unlawfully done unless authorised by section 1 of this Act and, in the case of a woman carrying more than one foetus, anything done with intent to procure her miscarriage of any foetus is authorised by that section if-(a) the ground for termination of the pregnancy specified in subsection (1)(d) of that section applies in relation to any foetus and the thing is done for the purpose of procuring the miscarriage of that foetus, or (b) any of the other grounds for termination of the pregnancy specified in that section applies].

§ 6 Interpretation In this Act, the following expressions have meanings hereby assigned to them:-"the law relating to abortion" means sections 58 and 59 of the Offences against the Person Act 1861, and any rule of law relating to the procurement of abortion; § 7 Short title, commencement and extent (1) This Act may be cited as the Abortion Act 1967. (2) This Act shall come into force on the expiration of the period of six months beginning with the date on which it is passed. (3) This Act does not extend to Northern Ireland. Abortion Law Homepage Back to State Abortion Laws

The Abortion Act Women’s right to choose an abortion is regulated by The Act Relating to the Termination of Pregnancy of 1975. When the act was introduced, the woman had to fill out an application, then a committee of doctors decided if an abortion could be granted or not. In 1978 women themselves were granted the right to decide whether to terminate their pregnancies or not. This right is limited in time, and is valid until the end of the *twelfth week of the pregnancy. The Abortion Act regulates the rights and duties of women, doctors, and hospitals in connection with induced abortions. Most countries in Europe allow women the right to terminate a pregnancy within the twelfth week, but legislation varies somewhat. To have an abortion, the woman must herself fill out a form at a doctor’s office, whether that be a general practitioner’s office, or at a hospital. The doctor is under professional secrecy. If the woman is under 16 years of age, the law states that parents or guardians should be allowed to make a statement, unless there are weighty reasons against it. The woman’s opinion is always consulted. The doctor consulted by the woman is under obligation to inform about how the abortion is carried out, and possible complications. The doctor is also under obligation to inform about the support provided by society, should the woman decide not to have an abortion. The woman is under no obligation to ask for this information. When the woman signs the request for abortion, she also has to confirm that she has received information about the procedure, and possible complications. The woman also has to confirm that she has received information about the support from society available to her. She does not need to justify her decision. The doctor shall, as soon as possible, forward the woman’s request for abortion to the hospital. The Abortion Act gives the woman the right to receive information about contraceptives in connection with the abortion. This is the woman’s right, but she decides if she wants to receive this information or not. The abortion is carried out at a hospital, and the procedure is free. It is usual to meet at the hospital twice – first for a pre-examination, then for the procedure itself. The time between the first visit to the doctor, the pre-examination, and the procedure varies. Usually, the woman stays at the hospital for

observation a few hours after the procedure. At the pre-examination the woman is informed about the hospital procedures. The Abortion Act gives health personnel the right not to participate at the abortion itself, if they do not wish to. The Abortion Act also regulates what happens if the woman requests an abortion after the twelfth week of the pregnancy. The woman may apply to terminate the pregnancy, either through a doctor, or directly to the hospital. A committee consisting of two doctors makes the decision about so-called late abortions. The committee is obliged to consider the woman’s reasons. If the application is denied, it is automatically re-evaluated by a new committee, called an appeals committee. According to the law, *abortions between the twelfth and the eighteenth week of the pregnancy may be granted under certain circumstances. These include the mother’s health or her social situation; if the baby is in great danger of severe medical complications; or if the woman has become pregnant while under-age, or after sexual abuse. After the eighteenth week the reasons for terminating a pregnancy must be extremely weighty. An abortion will not be granted if the foetus is presumed to be viable at the time that the abortion is carried out. Reference: Act of 13 June 1975 Relating to the Termination of Pregnancy, with Amendments of 16 June 1975

Article II of the 1987 Constitution of the Philippines states: Section 12. The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception. The natural and primary right and duty of parents in the rearing of the youth for civic efficiency and the development of moral character shall receive the support of the Government. Revised Penal Code: Section Two. — Infanticide and abortion. Art. 256. Intentional abortion. — Any person who shall intentionally cause an abortion shall suffer: 1. The penalty of reclusion temporal, if he shall use any violence upon the person of the pregnant woman. 2. The penalty of prision mayor if, without using violence, he shall act without the consent of the woman. 3. The penalty of prision correccional in its medium and maximum periods, if the woman shall have consented. Art. 257. Unintentional abortion. — The penalty of prision correccional in its minimum and medium period shall be imposed upon any person who shall cause an abortion by violence, but unintentionally. Art. 258. Abortion practiced by the woman herself or by her parents. — The penalty of prision correccional in its medium and maximum periods shall be imposed upon a woman who shall practice abortion upon herself or shall consent that any other person should do so. Any woman who shall commit this offense to conceal her dishonor, shall suffer the penalty of prision correccional in its minimum and medium periods.

If this crime be committed by the parents of the pregnant woman or either of them, and they act with the consent of said woman for the purpose of concealing her dishonor, the offenders shall suffer the penalty of prision correccional in its medium and maximum periods. Art. 259. Abortion practiced by a physician or midwife and dispensing of abortives. — The penalties provided in Article 256 shall be imposed in its maximum period, respectively, upon any physician or midwife who, taking advantage of their scientific knowledge or skill, shall cause an abortion or assist in causing the same. Any pharmacist who, without the proper prescription from a physician, shall dispense any abortive shall suffer arresto mayor and a fine not exceeding 1,000 pesos.