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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
1x Speed
2x Speed
1. Abortion
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It is no part of the medical practitioner’s business to use manipulation or compulsion with patients.
~ Aristotle
Bleeding Secrets
The Tragic Consequences of Illegal Abortion and the Importance of Medical Responsibility
It was a cold winter day in January when the local police department received a distressing call from a woman who had been rushed to the hospital after experiencing severe bleeding. The woman, who was found to be pregnant, had arrived at the hospital without a clear understanding of how she had started bleeding or the extent of her injuries. As the medical team worked quickly to stabilize her, they realized that she had undergone an illegal abortion, and it was only a matter of time before she would succumb to her injuries.
The police immediately launched an investigation to find out who had performed the illegal abortion and to bring them to justice. The case was complicated by the fact that abortion laws had recently been overturned, giving the state the power to regulate abortions. The investigation team had to navigate the new legal landscape and gather evidence to build a case against the perpetrator.
As they delved deeper into the case, they discovered that the woman had sought the services of a medical practitioner who had refused to perform the abortion due to personal convictions. The practitioner had referred her to another individual, who was not licensed to perform abortions and who had botched the procedure, leading to the woman’s hospitalization.
The investigation team also uncovered evidence that the medical practitioner had failed to provide appropriate counseling to the woman and had not informed her of her options or the risks involved in seeking an illegal abortion. The practitioner’s failure to uphold the principles of beneficence (do good) and nonmaleficence (do no harm) had led to the tragic outcome.
In the end, the investigation team was able to bring the illegal abortionist and the medical practitioner to justice. The case highlighted the importance of providing appropriate counseling and referrals for patients seeking abortion services, particularly in a legal environment that is constantly shifting.
It also underscored the responsibility of medical practitioners to uphold the principles of beneficence and nonmaleficence, even when their personal convictions may conflict with a patient’s needs. While the legality of abortion continues to be a contentious issue, it is essential that medical practitioners prioritize the well-being of their patients and provide them with the information and care they need to make informed decisions about their health.
Abstract
The Roe v. Wade ruling by the Supreme Court of the United States in 1973 determined that access to safe and legal abortions is a fundamental constitutional right protected under the Due Process Clause of the Fourteenth Amendment. In 1992, the Planned Parenthood v. Casey ruling upheld the right to have an abortion but allowed for first-trimester restrictions by states. In 2022, the Dobbs v. Jackson ruling overruled the previous two decisions and returned the authority to regulate abortion to the people and their elected representatives. The American Medical Association criticized the ruling as a violation of patient rights and a government intrusion into the medical examination room. The Association of Bioethics Program Directors affirmed practitioners’ obligation to support patient autonomy, provide all available options, ensure economic equity, and protect patient confidentiality. Practitioners have a moral obligation to promote patient best interests and provide or refer for a legal abortion based on the principles of beneficence and nonmaleficence. If a practitioner is unwilling to perform an abortion due to personal convictions, they must refer the patient to another practitioner in a nonjudgmental manner.
**
Think
[1:1] On January 22, 1973, in the Roe v. Wade ruling, The Supreme Court Of The United States (SCOTUS) affirmed that access to safe and legal abortions was a fundamental constitutional right.
[1:2] Fundamental rights are those rights that have a high degree of protection from government encroachment, usually identified in the Constitution or found under The Due Process Clause. The Due Process Clause of the Fourteenth Amendment is the source of an array of constitutional rights not explicitly listed in the Constitution.
[1:3] It was argued in Roe v. Wade that the Due Process Clause provided a fundamental “right to privacy” that protected a pregnant woman’s liberty to choose whether or not to have an abortion. Since access to safe and legal abortions was determined to be a fundamental constitutional right, every state then was mandated to have at least one abortion clinic. States that had only one abortion clinic were: Kentucky, Mississippi, Missouri, North Dakota, South Dakota and West Virginia.
[1:4] On June 29, 1992, in the Planned Parenthood v. Casey ruling, SCOTUS upheld the constitutional right to have an abortion and rejected the necessity for a waiting period, spousal notification, and parental consent for minors. However, the Supreme Court also overturned the Roe trimester framework, replacing it with fetal viability, allowing states to implement first trimester restrictions.
[1:5] On June 24, 2022, in the Dobbs v. Jackson ruling, the Supreme Court majority opinion overruled Roe and Casey declaring:
The constitution makes no reference to abortion, and no such right is implicitly protected by any constitutional provision … The inescapable conclusion is that a right to abortion is not deeply rooted in the Nation’s history and traditions. … Our job, is to interpret the law, apply longstanding principles of stare decisis, [precedence]. … Roe and Casey must be overruled, and the authority to regulate abortion must be returned to the people and their elected representatives.
[1:6] However, the minority opinion dissented, arguing:
Today, the Court … says that from the very moment of fertilization, … a State can force [a woman] to bring a pregnancy to term. The Court does not act “neutrally” when it leaves everything up to the States. … Withdrawing a woman’s right to choose whether to continue a pregnancy does not mean that no choice is being made. It means that a majority of today’s Court has [transferred] this choice from women and given it to the States. … we dissent.
[1:7] And on the same day, The American Medical Association (AMA) in a press release stated:
The American Medical Association is deeply disturbed by the U.S. Supreme Court’s decision to overturn nearly a half century of precedent protecting patients’ right to critical reproductive health care—representing an egregious allowance of government intrusion into the medical examination room, a direct attack on the practice of medicine and the patient-physician relationship, and a brazen violation of patients’ rights to evidence-based reproductive health services.
[1:8] On June 29, 2022, The Association of Bioethics Program Directors (ABPD) comprising the leadership of nearly 100 academic bioethics programs at medical centers and universities across North America wrote and approved the “Bioethics Guidance For The Post-Dobbes Landscape”, affirming that practitioners are to:
- A. counsel their prenatal patients about all available options within the medical standards of care and where such care is legally available;
- B. support economic equity for prenatal and postpartum patients, neonates, and children; and
- C. protect the patient’s right to confidentiality and privacy along with the legality of patient referral practices.
Assess
Patient: 1) Autonomy
[1:9] A patient’s right to provide informed consent is a central tenet of the patient-practitioner relationship. An adult pregnant patient with decisional capacity has the right to provide an informed consent decision for whether or not a medical practitioner is authorized to perform an abortion in states in which it is legal.
[1:10] For minors, most states have some parental involvement laws, such as parental notification or parental consent. However, if parental consent is required and not attainable, the minor is allowed to file for a judicial bypass. If the minor does not want to inform the parents about their pregnancy, then the practitioner needs to determine why that is the case, along with encouraging the benefits of discussing the minor’s pregnancy with their parents, all while ensuring that the minor’s patient-practitioner confidentiality and privacy will not be abrogated unless there is a medical emergency, or is required by law.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[1:11] Medical practitioners have the moral obligation of promoting the patient’s best interests using the patient’s reasonable goals, values, and priorities. The moral principles of beneficence (do good) and nonmaleficence (do no harm) come from this professional mandate. Depending upon the circumstances, an abortion can satisfy one or both moral principles, professionally obligating the practitioner to make available or perform a legal abortion.
[1:12] If under justifiable conditions a practitioner is unwilling to perform a legal abortion due to personal convictions, then the practitioner must, under the professional principles of beneficence (do good) and nonmaleficence (do no harm), refer the patient, in a nonjudgmental way, to another qualified practitioner in a timely manner. The American College of Obstetricians and Gynecologists (ACOG) recommends that providers with moral or religious objections to abortion should practice with or in proximity to individuals who do not share their views and that referral processes are in place to provide access to the service that the practitioner does not wish to provide.
[1:13] The American College of Obstetricians and Gynecologists (ACOG) states:
Physicians and other health care providers have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request. In resource-poor areas, access to safe and legal reproductive services should be maintained. Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care.
[1:14] As stated, there are exceptions to this conscientious objector provision, such as during a medical emergency. If during a medical emergency it is determined that an abortive procedure is what the medical standards of care would provide, and no other practitioners are available to perform the abortion, then failure to provide the procedure would be a violation of the professional principles of beneficence (do good), nonmaleficence (do no harm), and the public policy principle of justice (be fair).
Public Policy: 4) Justice
[1:15] Although access to safe and legal abortions is no longer a fundamental constitutional right, that does not mean abortion is unconstitutional. Rather, it means that the Federal Government (by Congress) and States (through legislation) now have the authority to regulate abortion. As a result, abortion laws will vary dramatically from state to state and from date to date, with differing regulations regarding who, when, where, how, and even if citizens can have access to abortions.
[1:16] Socially, there is very little consensus on the fair distribution of abortion access because there is very little consensus as to what the status of a fetus is or ought to be. The public is deeply divided, and even with public discussions, there has been very little progress towards reaching a social consensus or compromise.
Conclude
[1:17] Abortion laws vary dramatically from state to state and are subject to the rapid change of partisan politics. However, the moral and professional responsibility for safe and appropriate medical referrals, and for encouraging the minor who is pregnant to discuss their pregnancy with their parents is a professionally and socially recognized responsibility of practitioners.
[1:18] In summary, abortion laws continue to be a complex and ever-changing issue in the United States, with significant variation across states and subject to the influence of partisan politics. Despite this, medical practitioners must maintain their commitment to promoting patient best interests, providing or referring for legal abortion services when necessary, and supporting minors in discussing their pregnancies with their parents. Upholding these professional responsibilities is essential in ensuring safe and appropriate care for all patients, regardless of the political climate.
**
1. Review Questions
1. On January 22, 1973, in the Roe v. Wade ruling, The Supreme Court affirmed that access to safe and legal abortions was a fundamental constitutional right.
2. On June 29, 1992, in the Planned Parenthood v. Casey ruling, SCOTUS upheld the constitutional right to have an abortion, and rejected the necessity for a waiting period, spousal notice, and parental consent for minors.
3. On June 24, 2022, in the Dobbs v. Jackson ruling, the Supreme Court made abortion illegal.
4. For a minor who does not want to inform their parents about their pregnancy, it is essential that the practitioner:
5. Practitioners who are unwilling to perform a legal abortion due to personal convictions must:
6. In an emergency in which the medical standard of care requires an abortion, and there is no other available practitioner to perform the procedure, the practitioner has an obligation to provide the abortion even if the practitioner is a conscientious objector.
**
Wrong 😕
[1:1] On January 22, 1973, in the Roe v. Wade ruling, The Supreme Court Of The United States (SCOTUS) affirmed that access to safe and legal abortions was a fundamental constitutional right.
CORRECT! 🙂
[1:1] On January 22, 1973, in the Roe v. Wade ruling, The Supreme Court Of The United States (SCOTUS) affirmed that access to safe and legal abortions was a fundamental constitutional right.
CORRECT! 🙂
[1:4] On June 29, 1992, in the Planned Parenthood v. Casey ruling, The Supreme Court Of The United States (SCOTUS) upheld the constitutional right to have an abortion, and rejected the necessity for a waiting period, spousal notice, and parental consent for minors.
Wrong 😕
[1:4] On June 29, 1992, in the Planned Parenthood v. Casey ruling, The Supreme Court Of The United States (SCOTUS) upheld the constitutional right to have an abortion, and rejected the necessity for a waiting period, spousal notice, and parental consent for minors.
CORRECT! 🙂
[1:15] Although access to safe and legal abortions is no longer a fundamental constitutional right, that does not mean abortion is unconstitutional. Rather, it means that the Federal Government (by Congress) and States (through legislation) now have the authority to regulate abortion. As a result, abortion laws will vary dramatically from state to state and from date to date, with differing regulations regarding who, when, where, how, and even if citizens can have access to abortions.
Wrong 😕
[1:15] Although access to safe and legal abortions is no longer a fundamental constitutional right, that does not mean abortion is unconstitutional. Rather, it means that the Federal Government (by Congress) and States (through legislation) now have the authority to regulate abortion. As a result, abortion laws will vary dramatically from state to state and from date to date, with differing regulations regarding who, when, where, how, and even if citizens can have access to abortions.
CORRECT! 🙂
[1:10] For minors, most states have some parental involvement laws, such as parental notification or parental consent. However, if parental consent is required and not attainable, the minor is allowed to file for a judicial bypass. If the minor does not want to inform the parents about their pregnancy, then the practitioner needs to determine why that is the case, along with encouraging the benefits of discussing the minor’s pregnancy with their parents, all while ensuring that the minor’s patient-practitioner confidentiality and privacy will not be abrogated unless there is a medical emergency, or required by law.
Wrong 😕
[1:10] For minors, most states have some parental involvement laws, such as parental notification or parental consent. However, if parental consent is required and not attainable, the minor is allowed to file for a judicial bypass. If the minor does not want to inform the parents about their pregnancy, then the practitioner needs to determine why that is the case, along with encouraging the benefits of discussing the minor’s pregnancy with their parents, all while ensuring that the minor’s patient-practitioner confidentiality and privacy will not be abrogated unless there is a medical emergency, or required by law.
CORRECT! 🙂
[1:12] If under justifiable conditions a practitioner is unwilling to perform a legal abortion due to personal convictions, then the practitioner must, under the professional principles of beneficence (do good) and nonmaleficence (do no harm), refer the patient, in a nonjudgmental way, to another qualified practitioner in a timely manner. The American College of Obstetricians and Gynecologists (ACOG) recommends that providers with moral or religious objections to abortion should practice with or in proximity to individuals who do not share their views and that referral processes are in place to provide access to the service that the practitioner does not wish to provide.
Wrong 😕
[1:12] If under justifiable conditions a practitioner is unwilling to perform a legal abortion due to personal convictions, then the practitioner must, under the professional principles of beneficence (do good) and nonmaleficence (do no harm), refer the patient, in a nonjudgmental way, to another qualified practitioner in a timely manner. The American College of Obstetricians and Gynecologists (ACOG) recommends that providers with moral or religious objections to abortion should practice with or in proximity to individuals who do not share their views and that referral processes are in place to provide access to the service that the practitioner does not wish to provide.
CORRECT! 🙂
[1:14] As stated, there are exceptions to this conscientious objector provision, such as during a medical emergency. If during a medical emergency, it is determined that an abortive procedure is what the medical standards of care would provide, and no other practitioners are available to perform the abortion, then failure to provide the procedure would be a violation of the professional principles of beneficence (do good), nonmaleficence (do no harm), and the public policy principle of justice (be fair).
Wrong 😕
[1:14] As stated, there are exceptions to this conscientious objector provision, such as during a medical emergency. If during a medical emergency, it is determined that an abortive procedure is what the medical standards of care would provide, and no other practitioners are available to perform the abortion, then failure to provide the procedure would be a violation of the professional principles of beneficence (do good), nonmaleficence (do no harm), and the public policy principle of justice (be fair).
1. Clinical Vignettes
1. On January 22, 1973, Ms. Kristen Anderson, a 22-year-old teacher presented to your clinic seeking information on their reproductive options. The patient was unmarried and sexually active and had a positive pregnancy test. The patient was concerned about their ability to access safe and legal abortion services and heard conflicting information about the laws surrounding abortion. According to the Supreme Court of the United States (SCOTUS) ruling in Roe v. Wade on January 22, 1973, what was its determination of the legal status of access to safe and legal abortion?
2. On June 29, 1992, Ms. Diana Hendrickson, a 17-year-old waitress presented to your clinic seeking information on their reproductive options. The patient was unmarried and sexually active and had a positive pregnancy test. The patient was concerned about their ability to access safe and legal abortion services and heard conflicting information about the laws surrounding abortion. According to the Supreme Court of the United States (SCOTUS) ruling in Planned Parenthood v. Casey on June 29, 1992, what was its determination of the legal status of access to safe and legal abortion?
3. Ms. Hazel Reyes, a 25-year-old delivery driver presents to your clinic to discuss their reproductive options. The patient is unmarried and sexually active and has a positive pregnancy test. The patient is concerned about their ability to access safe and legal abortion services and has heard conflicting information about the laws surrounding abortion. According to the Supreme Court of the United States (SCOTUS) ruling in Dobbs v. Jackson on June 24, 2022, what was its determination of the legal status of access to safe and legal abortion?
4. Ms. Kaylee Hernandez, a 16-year-old high school student presents to your clinic seeking information about their reproductive options. The patient is pregnant and does not want to inform their parents about the pregnancy. The patient has heard about the option of a judicial bypass but is unsure about the process. What should the practitioner do regarding informing the minor's parents about the pregnancy and protecting the patient's confidentiality and privacy?
5. Ms. Yvonne Kim, a 35-year-old Accountant presents to the emergency room with severe abdominal pain and bleeding. After examination and assessment, it is determined that the patient requires an abortion due to a medical emergency as the medical standard of care. However, the practitioner has personal conviction against performing abortions and they are the only practitioner on duty and available. What does the practitioner do?
Wrong 😕
Explanation: The Supreme Court of the United States (SCOTUS) ruling in Roe v. Wade on January 22, 1973 determined that access to safe and legal abortion was a fundamental constitutional right [1:1]. This means that women have the right to make their own decisions about their reproductive health, including the decision to have an abortion, without undue interference from the government or other third parties [1:2]. The ruling established a framework for balancing the rights of pregnant women and the interests of the state in protecting potential life [1:3]. This ruling has been the subject of ongoing political and legal controversy in the United States [1:4].
CORRECT! 🙂
Explanation: The Supreme Court of the United States (SCOTUS) ruling in Roe v. Wade on January 22, 1973 determined that access to safe and legal abortion was a fundamental constitutional right [1:1]. This means that women have the right to make their own decisions about their reproductive health, including the decision to have an abortion, without undue interference from the government or other third parties [1:2]. The ruling established a framework for balancing the rights of pregnant women and the interests of the state in protecting potential life [1:3]. This ruling has been the subject of ongoing political and legal controversy in the United States [1:4].
Wrong 😕
Explanation: The Supreme Court of the United States (SCOTUS) ruling in Planned Parenthood v. Casey on June 29, 1992 upheld the constitutional right to have an abortion [1:1], but rejected the trimester framework established by Roe v. Wade [1:2] and replaced it with the concept of fetal viability [1:2]. The ruling stated that the state has an interest in protecting the potential life of the fetus from the point of viability, which is generally around 24 weeks of pregnancy [1:2][1:4], and can regulate or prohibit abortion after that point [1:2]. However, prior to viability, the state cannot impose an undue burden on a woman's right to access safe and legal abortion services [1:2][1:4]. The ruling also struck down the requirement for spousal notification and a waiting period before obtaining an abortion [1:4], but upheld the requirement for parental consent for minors, with the provision for a judicial bypass option [1:4]. Overall, the ruling reaffirmed the fundamental constitutional right to access safe and legal abortion [1:1], but allowed greater state regulation of the procedure than under the previous Roe framework [1:2].
CORRECT! 🙂
Explanation: The Supreme Court of the United States (SCOTUS) ruling in Planned Parenthood v. Casey on June 29, 1992 upheld the constitutional right to have an abortion [1:1], but rejected the trimester framework established by Roe v. Wade [1:2] and replaced it with the concept of fetal viability [1:2]. The ruling stated that the state has an interest in protecting the potential life of the fetus from the point of viability, which is generally around 24 weeks of pregnancy [1:2][1:4], and can regulate or prohibit abortion after that point [1:2]. However, prior to viability, the state cannot impose an undue burden on a woman's right to access safe and legal abortion services [1:2][1:4]. The ruling also struck down the requirement for spousal notification and a waiting period before obtaining an abortion [1:4], but upheld the requirement for parental consent for minors, with the provision for a judicial bypass option [1:4]. Overall, the ruling reaffirmed the fundamental constitutional right to access safe and legal abortion [1:1], but allowed greater state regulation of the procedure than under the previous Roe framework [1:2].
Wrong 😕
Explanation: The Supreme Court of the United States (SCOTUS) ruling in Dobbs v. Jackson on June 24, 2022 overruled the previous rulings in Roe v. Wade and Planned Parenthood v. Casey [2:1] and transferred the authority to regulate abortion from the patient-practitioner decision to elected state representatives [2:2]. The ruling upheld a Mississippi law that prohibited abortions after 15 weeks of pregnancy, with only narrow exceptions for medical emergencies or fetal abnormalities, and effectively allowed states to ban abortions before fetal viability, which is typically around 24 weeks of pregnancy [2:3]. The ruling rejected the viability standard established in Roe and Casey, stating that it was not supported by the Constitution and that the state's interest in protecting potential life begins at conception [2:4]. The ruling did not declare the right to have an abortion unconstitutional, but it allows states to regulate or prohibit abortions as they see fit, subject to certain limits [2:5]. This ruling has been highly controversial and has been seen as a significant setback for reproductive rights in the United States [2:6].
CORRECT! 🙂
Explanation: The Supreme Court of the United States (SCOTUS) ruling in Dobbs v. Jackson on June 24, 2022 overruled the previous rulings in Roe v. Wade and Planned Parenthood v. Casey [2:1] and transferred the authority to regulate abortion from the patient-practitioner decision to elected state representatives [2:2]. The ruling upheld a Mississippi law that prohibited abortions after 15 weeks of pregnancy, with only narrow exceptions for medical emergencies or fetal abnormalities, and effectively allowed states to ban abortions before fetal viability, which is typically around 24 weeks of pregnancy [2:3]. The ruling rejected the viability standard established in Roe and Casey, stating that it was not supported by the Constitution and that the state's interest in protecting potential life begins at conception [2:4]. The ruling did not declare the right to have an abortion unconstitutional, but it allows states to regulate or prohibit abortions as they see fit, subject to certain limits [2:5]. This ruling has been highly controversial and has been seen as a significant setback for reproductive rights in the United States [2:6].
Wrong 😕
Explanation: When a minor patient expresses a desire to keep their pregnancy confidential from their parents, the practitioner should respect the patient's wishes and ensure that their patient-practitioner confidentiality and privacy are protected. The practitioner should provide the minor with information about their reproductive options, including the option of a judicial bypass, which allows the minor to obtain an abortion without parental involvement [1:10]. The practitioner should encourage the minor to discuss their pregnancy with their parents, as this may be in the best interest of the minor's health and well-being [1:10], but ultimately, the decision should be left up to the minor [1:9]. The practitioner should also ensure that the minor is fully informed about the risks and benefits of their reproductive options and provide them with appropriate referrals for further care, such as counseling or other support services [1:10]. It is important to remember that minors have a right to access reproductive health care services and to make decisions about their own bodies, even if they are not yet legally adults [1:10].
CORRECT! 🙂
Explanation: When a minor patient expresses a desire to keep their pregnancy confidential from their parents, the practitioner should respect the patient's wishes and ensure that their patient-practitioner confidentiality and privacy are protected. The practitioner should provide the minor with information about their reproductive options, including the option of a judicial bypass, which allows the minor to obtain an abortion without parental involvement [1:10]. The practitioner should encourage the minor to discuss their pregnancy with their parents, as this may be in the best interest of the minor's health and well-being [1:10], but ultimately, the decision should be left up to the minor [1:9]. The practitioner should also ensure that the minor is fully informed about the risks and benefits of their reproductive options and provide them with appropriate referrals for further care, such as counseling or other support services [1:10]. It is important to remember that minors have a right to access reproductive health care services and to make decisions about their own bodies, even if they are not yet legally adults [1:10].
Wrong 😕
Explanation: In this scenario, the practitioner has a professional and ethical duty to provide the necessary medical treatment to save the patient's life, which in this case requires an abortion due to a medical emergency. Refusing to perform the procedure due to personal convictions would violate the practitioner's professional obligations and could put the patient's life at risk, which is not acceptable in the medical profession [1:14]. Delaying the procedure until another practitioner becomes available could also put the patient's life at risk and would not be in line with the medical standard of care. Therefore, the practitioner should provide the necessary procedure to save the patient's life, even if it goes against their personal convictions, as this is in line with professional principles and public policy [1:12]. However, it is important for the practitioner to receive support and counseling to help process any emotional or moral conflicts they may experience as a result of providing care that goes against their personal convictions [1:13].
CORRECT! 🙂
Explanation: In this scenario, the practitioner has a professional and ethical duty to provide the necessary medical treatment to save the patient's life, which in this case requires an abortion due to a medical emergency. Refusing to perform the procedure due to personal convictions would violate the practitioner's professional obligations and could put the patient's life at risk, which is not acceptable in the medical profession [1:14]. Delaying the procedure until another practitioner becomes available could also put the patient's life at risk and would not be in line with the medical standard of care. Therefore, the practitioner should provide the necessary procedure to save the patient's life, even if it goes against their personal convictions, as this is in line with professional principles and public policy [1:12]. However, it is important for the practitioner to receive support and counseling to help process any emotional or moral conflicts they may experience as a result of providing care that goes against their personal convictions [1:13].
**
1. Cases: 1a, 1b
Instructions
1. Read Prompt, 2. Think, Assess, & Conclude (TAC), then 3. Select an answer that mirrors the TAC conclusion.
Note: After success, select each of the wrong answers to understand why each of them is wrong.
1a
An adult patient is 8 weeks pregnant and presents to a local clinic in a state where abortions are legally allowed through the end of the first trimester and requests to have an abortion. The patient’s partner accompanies the patient, and vehemently disagrees with the patient’s choice to have an abortion and argues that the practitioner should not perform the abortion, as the partner, the second biological parent, has every right to participate in the fate of the fetus.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
1b
A minor is 4 weeks pregnant and presents to a local clinic in a state where abortions are legally allowed through the end of the first trimester. The patient’s parents are strict Catholics and are opposed to abortions. The patient requests an abortion, and that the patient’s parents not be notified or have access to the patient’s medical records.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
Wrong 😕
A. The partner of the pregnant patient must be considered for a legal abortion.
The pregnant patient is not a “fetal container” and has the constitutional right of self-determination, independent of any other individual(s), (such as a spouse), groups, (such as anti-women’s choice), associational groups, (such as a churches), and institutions, (such as universities).
Wrong 😕
B. The fetus is a person and must be considered for a legal abortion.
The fetus is human, but the fetus is not legally a person until it exits the womb.
CORRECT! 🙂
THINK (Question)
Does a pregnant patient have full authority to have a legal abortion?
ASSESS
- • Patient Autonomy (informed consent)
An adult pregnant patient with decisional capacity has the right to provide an autonomous informed consent decision for whether or not a medical practitioner is authorized to perform an abortion in states where it is legal, independent of any other party. - • Practitioner Beneficence (do good) & Nonmaleficence (do no harm)
Depending upon the circumstances, an abortion can satisfy one or both moral principles, professionally obligating the practitioner to make available or perform a legal abortion. - • Public-Policy Justice (be fair)
How abortions are legally regulated varies dramatically from state to state and from date to date.
CONCLUDE
The pregnant patient has full authority to have a legal abortion.
Wrong 😕
D. A legal abortion is an oxymoron.
Abortion is not unconstitutional rather the authority of abortion access has been relegated to each State, and/or Congress.
Wrong 😕
A. Depends on Federal Law.
Federal law does require that states that wish to continue receiving federal funding have laws for the protection of vulnerable populations such as children and the elderly. However, the specifics on parental notifications and/or parental involvement is left up to the individual states.
CORRECT! 🙂
THINK (Question)
Can a minor get an abortion without parental notification?
ASSESS
- • Patient Autonomy (informed consent)
If the minor does not want to inform the parents about their pregnancy, then the practitioner needs to ensure that the minor’s patient-practitioner confidentiality and privacy will not be abrogated unless there is a medical emergency or required by law. - • Practitioner Beneficence (do good) & Nonmaleficence (do no harm)
The practitioner needs to determine why the minor does not want to inform their parents, and encourage the benefits of discussing the minor’s pregnancy with them. - • Public-Policy Justice (be fair)
The minor patient should be referred to a public clinic where the billing of services and tests will not be reported on the parent’s insurance. Doing otherwise would be the same as disclosing the pregnancy to the parents. Lastly, each state has differing parental involvement laws when a minor requests an abortion.
CONCLUDE
Depends on state law.
Wrong 😕
C. Religious doctrine has more authority than patient autonomy.
Religious doctrine does have authority over associational beliefs, but there is a constitutional separation between religion, and federal & state authority.
Wrong 😕
D. Parents must always provide consent when treating a minor.
Federal law does require that states that wish to continue receiving federal funding have laws for the protection of vulnerable populations such as children and the elderly. However, the specifics on parental notifications and/or parental involvement is left up to the individual states.
