Introduction
Abortion is one of the most contentious issues in modern society and people hold polarized positions on the issue. The core concerns in the controversy are whether women should have the right to decide to terminate a pregnancy or whether the unborn child has the right to life. One professional group that faces an ethical dilemma when dealing with abortion is nurses. Nurses are the people required to provide comprehensive care to patients in various health care settings. They play a critical role in the healthcare industry and they are required to provide services without bias. However, just like the rest of the population, nurses hold different views on the morality of abortion. In the US, abortion is legal which means that nurses can be required to serve women seeking to actively end the life of an unborn baby at their place of work. The views on abortion are divergent among nurses. Some regard abortion as a moral wrong and feel that they should not be involved in this activity. Others view it as the right of the mother and hence do not have a problem assisting the woman seeking to terminate a pregnancy. Evidently, abortion presents an ethical dilemma that many nurses face. This paper will set out to discuss abortion in the nursing context with the aim of showing how nurses can deal with this issue without breaking the law and professional nursing ethics.
The Legal Position
The legal position on abortion in the country has undergone a number of changes over the centuries. Before the 19th century, abortions were not prohibited by the government and health care workers provided abortion services to the women who needed them. The deliberate termination of pregnancies was made illegal in the US in the 19th century. However, in spite of this criminalization, abortionists continued to practice illegally up to the 20th century. In the late 20th century, the government started to change its stance on abortion. In the year 1973, a decision was reached that abortion could be legally carried out in the US, although individual states were empowered to impose restrictions on the practice (Pazol, et al., 2014).
The legality of abortion has some impact on the conduct of nurses. The law influences the moral perception of the citizens since laws reflect the values of the community. The current legal status of abortion suggests that the society accepts this activity. As professionals who are required to give health care services to the public without bias, nurses have a legal obligation to serve patients who require abortion services. However, the ethical position on abortion is not necessarily similar to the legal position. People hold unique ethical views and these views help them determine what is the right or wrong course of action. Nurses therefore need to consider more than just the legal position when dealing with this ethical dilemma. There are a number of ethical principles that nurses can use to deal with the dilemma presented by abortions.
Ethical Principles and Abortion
A report by Pazol, Creanga, Burley and Jamieson (2014) reveals that in the year 2011, the abortion ratio in the US was 219 abortions per 1,000 live births. These figures suggest that there is a prevalence of abortion in the US making it likely that a nurse will encounter an abortion case over the course of his/her professional life. Ethical codes and guidelines for ethical behavior present a framework that can help nurses deal with challenging ethical issues. When dealing with the issue of abortion, a nurse can consider his/her position using the professional nursing ethical principles.
The first principle that a nurse should consider is autonomy, which refers to the freedom of action. In the healthcare setting, it means allowing the patient to make his/her own decisions. The nurse should encourage patient autonomy and promote independent decision making. The patient should not be pressured or influenced to make a decision that the nurse things is more ethical or moral. McCarthy and Gastmans (2015) warn that nurses must never focus too much on their personal moral crises and conflicts that they neglect the patient’s autonomy. In the abortion scenario, the ethical conduct would be to allow the patient to decide for herself if she wants to terminate the pregnancy or not. Autonomy can be abused in cases where the nurse imposes his/her values on the patient. The nurse must not try to use her position of authority to influence the decision made by the woman who is contemplating terminating a pregnancy.
The second ethical principles that nurses should consider when resolving the dilemma is fidelity, which describes the essence of truthfulness within the patient-nurse relationship. As professionally trained and highly skilled workers in the healthcare setting, nurses have a lot of information on health matters. Patients often rely on the information provided by nurses to make their decisions on many health issues. In the abortion situation, the nurse should ensure that he/she gives the client accurate and complete information. Shaw and Downie (2014) reveal that there are instances where nurses might choose to withhold information from patients in order to influence the patient’s decision on whether or not to have an abortion. A nurse might also choose to supply information about abortion benefits while not addressing the possibilities of negative psychological outcomes. Such approaches are unethical since the nurse is required to be truthful when providing the patient with information. The nurse should provide complete information and leave the decision making to the patient.
The nurse faced with an abortion situation must abide by the professional ethics that require him/her to provide the patient with optimal care. Specifically, the nurse should consider the principle of beneficence which states that nurses must endeavor to do the right thing. The actions of the nurse should bring the greatest benefit to the patient (Shaw and Downie, 2014). As such, the best interest of the patient should be considered when providing health care services. In the abortion context, the nurse’s actions must be in good will. This means that in spite of the nurse’s personal feelings about abortion, he/she must be committed to providing the best service to the patient.
Conscientious Objections
Some nurses are not comfortable with abortion due to their personal values. McCarthy and Gastmans (2015) confirm that some of the demands of professional practice such as elective abortions are contrary to the individual conscience of a nurse. Forcing the nurse to act in a way that is contrary to his/her conscience leads to moral distress. A study by Varcoe, et al. (2013) revealed that nurses experienced moral distress when they were forced to provide care that compromised their personal values. Moral distress leads to anger and frustration, which might compromise the nurse’s ability to serve the patient in an optimal manner. The moral values of a nurse are therefore considered when dealing with abortion cases. Healthcare professionals are allowed to exercise the right to a conscientious objection when faced with an abortion scenario. This right makes it possible for a nurse to refrain from participating in an abortion procedure. By providing nurses with the right to exercise conscientious objection, the government makes it possible for these professionals to avoid the moral distress that might adversely affect their psychological health and work efficiency. A nurse who has a conscientious objection is expected to make his/her stand known at the earliest possible moment so that an alternative arrangement can be made for the patient (Shaw & Downie, 2014). However, the conscientious objection does not extend to providing care for the patient before and after the procedure. The nurse is required to provide service to the patient before and after the procedure and refusal to do this might be considered discrimination.
Conclusion
This paper set out to discuss abortion in the nursing context with the aim of demonstrating how nurses can deal with this controversial issue without breaking the law and professional nursing ethics. It began by highlighting the contentious nature of abortion in modern society. While abortion is legal, it is still a controversial issue and nurses have differing opinions on its morality. The paper has provided some of the ethical principles that a nurse should apply when dealing with an abortion situation. Applying these principles will ensure that the nurse upholds ethical and professional conduct in spite of his/her personal opinion on the matter. The paper has revealed that nurses have the legal right to abstain from directly participating in an abortion procedure. However, even when the nurse exercises the right to a conscientious objection, he/she is still expected to provide quality care to the patient before and after the pregnancy termination procedure.
References
McCarthy, J., & Gastmans, C. (2015). Moral distress: A review of the arguments-based nursing ethics literature. Nursing Ethics, 22(1), 131-152.
Pazol, K., Creanga, A., Burley, K., & Jamieson, D. (2014). Abortion Surveillance – United States, 2011. MMWR Surveillance Summaries, 63(11), 1-41.
Shaw, J., & Downie, J. (2014). Welcome to the Wild, Wild North: Conscientious Objection Policies Governing Canada’s Medical, Nursing, Pharmacy, and Dental Professions. Bioethics, 28(1), 33-46.
Varcoe, C., Pauly, B., Storch, J., Newton, L., & Kara, M. (2013). Nurses’ perceptions of and responses to morally distressing situations. Nursing Ethics, 19(4), 488-500.