Permission for Doctors to Conduct Abortion When the Life of the Patient is at Stake: A Review
Abortion is a controversial and sensitive topic that often sparks heated debates and ethical dilemmas. However, there are situations where abortion may be necessary to save the life of the pregnant person, such as in cases of ectopic pregnancy, severe preeclampsia, or cancer. In this review, the legal, medical, and ethical aspects of abortion when the life of the patient is at stake are discussed.
The legal status of abortion varies widely across the world, ranging from complete prohibition to unrestricted access. According to the World Health Organization (WHO), 61% of the world’s population lives in countries where abortion is permitted on request or for broad social or economic reasons, 26% lives in countries where abortion is allowed only to save the life of the pregnant person or to protect their physical or mental health, and 13% lives in countries where abortion is prohibited altogether or allowed only to save the life of the pregnant person .
The legal framework for abortion in cases where the life of the patient is at stake is often unclear or ambiguous, leaving room for interpretation and discretion by health care providers, courts, and policymakers. For example, in some countries, such as Ireland and Poland, abortion is allowed only when there is a “real and substantial risk” to the life of the pregnant person, but the definition and assessment of this risk are not specified in the law . In other countries, such as El Salvador and Nicaragua, abortion is banned even when the life of the patient is at risk, leading to cases of prosecution and imprisonment of women and doctors who seek or provide life-saving abortions .
The legal barriers to access safe and timely abortion when the life of the patient is at stake can have serious consequences for their health and human rights. According to WHO, an estimated 25 million unsafe abortions occur every year, resulting in 22,800 maternal deaths and 5 million disabilities . Moreover, denying or delaying abortion when the life of the patient is at stake can amount to torture or cruel, inhuman, or degrading treatment, as recognized by several international human rights bodies .
The medical indications for abortion when the life of the patient is at stake depend on the specific circumstances and conditions of each case. However, some of the most common scenarios include:
– Ectopic pregnancy: This occurs when the fertilized egg implants outside the uterus, usually in the fallopian tube. This can cause severe bleeding and rupture of the tube, endangering the life of the pregnant person. Ectopic pregnancy cannot result in a viable fetus and requires immediate treatment, which may involve surgery or medication to terminate the pregnancy .
– Severe preeclampsia: This is a complication of pregnancy characterized by high blood pressure and damage to other organs, such as the kidneys, liver, or brain. It can lead to seizures, stroke, organ failure, or death if left untreated. Severe preeclampsia can occur at any stage of pregnancy but is more common in the third trimester. The only definitive treatment for severe preeclampsia is delivery of the fetus and placenta, which may require induction of labor or cesarean section .
– Cancer: This is a group of diseases that involve abnormal cell growth and can spread to other parts of the body. Some types of cancer can affect the reproductive organs or other organs that are affected by pregnancy hormones, such as breast cancer or leukemia. Cancer treatment may involve surgery, chemotherapy, radiation therapy, or immunotherapy, which can have harmful effects on the fetus or interfere with pregnancy outcomes. In some cases, abortion may be recommended or required to allow for effective cancer treatment and to improve the survival chances of the patient .
The ethical aspects of abortion when the life of the patient is at stake involve balancing the rights and interests of different parties: the pregnant person, the fetus, the health care providers, and society. Some of the ethical principles that may guide this decision include:
Autonomy and Pregnancy: A Critical Analysis
Autonomy is a fundamental ethical principle that respects the right of individuals to make informed and voluntary decisions about their own health and well-being. This principle is especially relevant in the context of pregnancy, where the pregnant person’s choices may affect not only their own body, but also the life and health of the fetus. However, autonomy is not an absolute right, and it may be limited by other ethical considerations, such as beneficence, non-maleficence, justice, and respect for others. In this blog post, I will critically analyze some of the ethical dilemmas that arise when applying the principle of autonomy to pregnancy, and I will suggest some possible ways to balance the competing interests and values involved.
One of the most controversial issues related to autonomy and pregnancy is abortion. Abortion is the deliberate termination of a pregnancy before the fetus can survive outside the uterus. According to the principle of autonomy, the pregnant person should have the right to decide whether to continue or end a pregnancy, based on their own values, beliefs, preferences, and circumstances. However, some people argue that abortion violates the right to life of the fetus, which is also a moral agent with inherent dignity and worth. They claim that the fetus has a potential or actual interest in living, and that this interest should be protected by law and society. Therefore, they oppose abortion on moral or religious grounds, and they advocate for legal restrictions or bans on abortion.
Another issue related to autonomy and pregnancy is maternal-fetal conflict. Maternal-fetal conflict occurs when the pregnant person’s actions or choices may harm or endanger the health or well-being of the fetus. For example, some pregnant people may smoke, drink alcohol, use drugs, refuse medical treatment, or engage in risky behaviors that may affect the fetal development or outcome. According to the principle of autonomy, the pregnant person should have the right to control their own body and lifestyle, and to refuse any intervention that they do not consent to. However, some people argue that the pregnant person has a moral duty to protect and promote the welfare of the fetus, which is also a vulnerable and dependent being. They claim that the fetus has a right to a healthy and safe environment, and that this right should be enforced by law and society. Therefore, they support legal or social interventions that may coerce or compel the pregnant person to act in the best interest of the fetus.
A third issue related to autonomy and pregnancy is surrogacy. Surrogacy is an arrangement where a person (the surrogate) agrees to carry and deliver a child for another person or couple (the intended parents), who are unable to conceive or bear a child themselves. According to the principle of autonomy, both the surrogate and the intended parents should have the right to enter into a voluntary and mutually beneficial contract, based on their own desires, motivations, and expectations. However, some people argue that surrogacy exploits or commodifies the surrogate and/or the child, who are treated as means rather than ends. They claim that surrogacy violates the dignity and integrity of human reproduction, and that it may cause psychological or emotional harm to the parties involved. Therefore, they oppose surrogacy on moral or legal grounds, and they advocate for legal prohibitions or regulations on surrogacy.
These are just some examples of how autonomy and pregnancy may conflict or interact in different situations. There is no easy or universal answer to these ethical dilemmas, as they involve complex and diverse factors, such as scientific evidence, social norms, cultural values, personal experiences, individual rights, collective responsibilities, and moral principles. Therefore, each case should be evaluated on its own merits, taking into account all the relevant aspects and perspectives. Moreover, dialogue and deliberation among all the stakeholders should be encouraged and facilitated, in order to promote mutual understanding and respect. Ultimately, autonomy should not be seen as an isolated or absolute concept, but as a relational and contextual one.
– Beauchamp TL & Childress JF (2019). Principles of Biomedical Ethics (8th ed.). Oxford University Press.
– Dickens BM & Cook RJ (2016). Legal and Ethical Issues in Obstetric Practice. Best Practice & Research Clinical Obstetrics & Gynaecology 35: 1-11.
– Donchin A (2020). Autonomy in Pregnancy: A Relational Perspective. In: Kukla R & Wayne SK (eds.). The Routledge Companion to Feminist Philosophy (pp. 431-443). Routledge.
– Wilkinson S (2016). Choosing Tomorrow’s Children: The Ethics of Selective Reproduction. Oxford University Press.