Ethical Issues in Abortion

ABORTION
Definition
Abortion is the termination of a pregnancy by the removal or expulsion of a fetus or embryo from the uterus, resulting in or caused by its death.
Types
1. Spontaneous abortion * Spontaneous abortion is the expulsion of the fetus and other products of conception from the uterus before the fetus is capable of living outside of the uterus.
Spontaneous abortions are further divided into six types.
a. Threatened abortion: It is characterized by cramping and vaginal bleeding in early pregnancy with no cervical dilation. It may subside or an incomplete abortion may follow.
b. Imminent or inevitable abortion - is characterized by bleeding, cramping and cervical dilation. Termination cannot be prevented.
c. Incomplete abortion is characterized by expulsion of only part of the products of conception (usually the fetus). Bleeding occur with cervical dilation.
d. Complete abortion is characterized by complete expulsion of all products of conception.
e. Missed abortion is characterized by early fetus intrauterine death without expulsion of the products of conception. The cervix is closed, and the client may report dark brown vaginal discharge. Pregnancy test findings are negative.
f. Recurrent (habitual) abortion is spontaneous abortion of three or more consecutive pregnancies.
2. Induced abortion - this type of abortion uses drugs or instruments to stop the normal course of pregnancy. ETHICAL ISSUES * Kant Ethics- From this we can deduce that humans have intrinsic as opposed to instrumental value because they were purposely and uniquely designed in the loving image of their creator and therefore should not be treated as a means to an end but as ends in themselves (Kant). Thus, killing a fetus to reach the end that is for the benefit of the mother is not treating the fetus as a means to an end.

Applying Kant’s Categorical Imperative to abortion:
1)The Universal Law
All moral statements should be both universalisable (applied to all people in a situations) and willed to be universalised. If they are not universalisable then they are contradictions in the Law of Nature, and if they cannot be willed to be universalised they are contradictions in the Law of the Will. “So act that the maxim of your will could always hold at the same time as a principle establishing universal law”. If you were to universalise abortion the human race would become extinct and there would be no one left to have an abortion, thus abortion is a contradiction in the Law of Nature. Furthermore, one may not will abortion to be universalised in all circumstances, e.g. a mother has an abortion simply because she wants to go on holiday, and therefore can also be seen as a contradiction in the Law of the Will.

2) Treat humans as ends in themselves-
People should always be treated as ends in themselves and not as a means to an end
Kant argued that people and foetuses have intrinsic value and not instrumental value – they cannot be disposed of for the benefits of others.

Therefore, according to the Categorical Imperative, abortion is morally wrong in all circumstances. However, this is only the case if ethical status and moral worth can be extended to a pre-mature being such as a fetus. Kant did not make his view on this clear and did not deal with potentiality (the potential of a foetus to become a human).

Kant distinguished between three types of beings:
1)People–rational Agents
2) People with partial rights – people who lack rights e.g. children, mentally disabled
3) Things – animals, plants etc (things can be treated as a means to an end)

Kant did not make it clear where he classified foetuses. If they are classified as things, Kant might justify abortion on the basis that they can be treated as a means to an end.

* NATURAL LAW (ABSOLUTE, DEONTOLOGICAL) - Aquinas postulated that humans have the ability to reason which leads to a knowledge of five primary precepts. From these five primary precepts, secondary precepts can be deduced. It could be argued that abortion goes against two of Aquinas’ primary precepts:
Continuation of the human species through reproduction:
Secondary precept: No contraception, no abortion, no homosexuality
Self-preservation and preservation of the innocent:
Secondary precept: No abortion, no euthanasia
Real goods lead to flourishing – a real good might involve avoiding abortion
Apparent goods appear to be good but don’t lead to flourishing – having an abortion might appear to be a real good but in reality it is an apparent good and does not lead to human flourishing * DOCTRINE OF DOUBLE EFFECT - The doctrine of double effect could be used to justify abortion if it is a secondary consequence of a primary intention e.g. the removal of the mother’s womb with the primary intention to save her life but the secondary consequence of terminating the pregnancy. * SITUATION ETHICS (RELATIVIST, TELEOLOGICAL)
According to Fletcher’s Situation Ethics, the morality of abortion depends on the situation. Situation Ethics is based on the single maxim – agape love. Abortion could be seen to be:
LOVING – if the mother’s life is in danger (abortion is morally permissible)
NOT LOVING – if the mother does not want to have a child (abortion is immoral)
Situation 1 – Abortion is morally right when the mother’s life is in danger. The duration of the pain of the loss of the mother will be ongoing, the extent of its effects will be widespread as many family and friends will suffer from the loss, and the intensity of the pain of the death of a mother with a family to support is high.
Situation 2 – Abortion is morally wrong if the mother simply wants a promotion at work. The duration of pleasure brought by the baby is greater than the duration of pleasure brought by the promotion, the extent of the effects is widespread because the family want the baby, and the pleasure is more intense to those who want the baby than the mother’s promotion.
IT CAN BE DEDUCE THEN THAT: * Abortion in the first trimester (or before the embryo or fetus is viable outside the womb) is morally permissible; abortion after that time is immoral. * Abortion in the first trimester (or before the embryo or fetus is viable outside the womb) ought to be legal; abortion after that time ought to be illegal. * Abortion up to the third trimester (so-called late-term abortion) is morally permissible; in the third trimester, it is immoral. * Abortion up to the third trimester ought to be legal; in the third trimester, it ought to be illegal. * Abortion should always be illegal, except in some special circumstances—for example, when the mother's long-term health or life is at stake, when the pregnancy is the result of rape or incest, or when the infant is deformed or likely to be born disabled.

Clinical Death and Biological Death
Definition
Clinical death is the point at which a person's heart stops beating. Breathing and circulation stop. It's still possible to resuscitate a person who has undergone clinical death and keep them alive by artificial means.
Biological death occurs four to six minutes later, when brain cells die from lack of oxygen. Resuscitation is impossible at this point.

How to Diagnose Clinical Death
Instructions
1. Check to see if the person is breathing. Cessation of breathing is the onset of clinical death, as the organs will quickly become affected by lack of oxygen. It should be noted at this point that if the person in question is not already hospitalized, 911 should be called immediately. Time is the ultimate factor in keeping clinical death from becoming biological death. 2. Search for the victim's heartbeat. Once the heart has stopped beating, the person has entered into a state of clinical death, as the standard definition of clinical death is the cessation of breathing followed by the stopping of the heart. 3. Be prepared to act quickly! If the person is hospitalized, call for a doctor or nurse to help. If the person is not hospitalized, someone should begin to immediately administer CPR while help is being called. Every second counts once a person is clinically dead. 4. Inform the professionals as best you can about the situation. Try to figure out exactly how long the person has not been breathing and how long it has been since the heart stopped. Longer periods of time increase the risk of irreparable brain damage and absolute death. 5. Try to figure out the cause of the victim's clinical death, as it will be of paramount importance to the professionals. Clinical death can be caused by a variety of factors: hypothermia, poisoning, head injury, etc. The more the professionals know, the better the chances of saving a life.
Limits of reversal

Most tissues and organs of the body can survive clinical death for considerable periods. Blood circulation can be stopped in the entire body below the heart for at least 30 minutes, with injury to the spinal cord being a limiting factor. Detached limbs may be successfully reattached after 6 hours of no blood circulation at warm temperatures. Bone, tendon, and skin can survive as long as 8 to 12 hours.
The brain, however, appears to accumulate ischemic injury faster than any other organ. Without special treatment after circulation is restarted, full recovery of the brain after more than 3 minutes of clinical death at normal body temperature is rare. Usually brain damage or later brain death results after longer intervals of clinical death even if the heart is restarted and blood circulation is successfully restored. Brain injury is therefore the limiting factor for recovery from clinical death.

Life support during clinical death

The purpose of cardiopulmonary resuscitation (CPR) during cardiac arrest is ideally reversal of the clinically dead state by restoration of blood circulation and breathing. However there is great variation in the effectiveness of CPR for this purpose. Blood pressure is very low during manual CPR, resulting in only a ten minute average extension of survival. Yet there are cases of patients regaining consciousness during CPR while still in full cardiac arrest. In absence of cerebral function monitoring or frank return to consciousness, the neurological status of patients undergoing CPR is intrinsically uncertain. It is somewhere between the state of clinical death and a normal functioning state.

Patients supported by methods that certainly maintain enough blood circulation and oxygenation for sustaining life during stopped heartbeat and breathing, such as cardiopulmonary bypass, are not customarily considered to be clinically dead. All parts of the body except the heart and lungs continue to function normally. Clinical death occurs only if machines providing sole circulatory support are turned off.

Controlled clinical death

Certain surgeries for cerebral aneurysms or aortic arch defects require that blood circulation be stopped while repairs are performed. This deliberate temporary induction of clinical death is called circulatory arrest. It is typically performed by lowering body temperature to +18°C (+64°F), stopping the heart, stopping the brain with drugs to conserve energy, turning off the heart lung machine, and draining blood to eliminate all blood pressure. At such low temperatures the clinically dead state can be sustained without serious brain injury for up to one hour. Longer durations are possible at lower temperatures, but the usefulness of longer procedures has not been established yet.

Controlled clinical death has also been proposed as a treatment for exsanguinating trauma to create time for surgical repair.

Clinical death and the determination of death

Death was historically believed to be an event that coincided with the onset of clinical death. It is now understood that death is a series of physical events, not a single one, and determination of permanent death is dependent on other factors beyond simple cessation of breathing and heartbeat.

If clinical death occurs unexpectedly, it will be treated as a medical emergency. CPR will be initiated. In a hospital, a Code Blue will be declared and Advanced Cardiac Life Support procedures used to attempt to restart a normal heartbeat. This effort will continue until either the heart is restarted, or a physician determines that continued efforts are useless and recovery is impossible. If this determination is made, the physician will pronounce legal death and resuscitation efforts will stop.

If clinical death is expected due to terminal illness or withdrawal of supportive care, often a Do Not Resuscitate (DNR) or "no code" order will be in place. This means that no resuscitation efforts will be made, and a physician or nurse may pronounce legal death at the onset of clinical death.

A patient with working heart and lungs who is determined to be brain dead can be pronounced legally dead without clinical death occurring. However, some courts have been reluctant to impose such a determination over the religious objections of family members, such as in the Jesse Koochin case. Similar issues were also raised by the case of Mordechai Dov Brody, but the child died before a court could resolve the matter.

Ethical Issues
Natural Law: In applying this universal notion of Natural Law to the human person, one first must decide what it is that God has ordained human nature to be inclined toward. Since each thing has a nature given it by God, and each thing has a natural end, so there is a fulfillment to human activity of living. When a person discovers by reason what the purpose of living is, he or she discover his or her natural end is. Accepting the medieval dictum "happiness is what all desire" a person is happy when he or she achieves this natural end.
In this reason clinical death will still permit the process of natural process of dying, in which the law stated that a natural end is happiness. It is moral for a person to be declared a clinical death since there is no mercy killing or any procedure that forces the person to die. According to this law it is a crime to end a person’s life.
Rawls Ethics: An act is wrong if and only if it would fail to produce as much welfare as any alternative act open to the agent. In the case of clinical death all of the possibilities have been tried. However, justice is still as a virtue is used into this situation. We can therefore conclude that in this case clinical death was already an action where both the Health care providers and the significant others as well as the patient decided to withdraw every life sustaining devices. This is to be done if both parties decided. Therefore, equality is used, where it is the main factor of the virtue justice.
Virtues applied to Clinical Death Prudence (Circumspection)
It is possible that acts good in themselves and suitable to the end may become unsuitable in virtue of new circumstances. Circumspection is the ability to take into account all relevant circumstances. Circumspection is the ability to discern which is which.
Ethical Principles applied to Clinical Death
1. Stewardship BIOMEDICAL DIMENSION * Accept death not as medical failure but as parts of human life. In clinical death, it is emphasized that still natural death will occur. The Health care providers tried all means to preserve the life of the person.

2. Totality The parts exist for the whole and the good of the part that subordinated to the good of the whole. They treat the person still as a whole being. Even though they decided to identify it as a clinical death, they still work on to preserve the life of a person.
3. Beneficence - In the case of clinical death, the act of doing going is still no violated. Even though it is clinical death they still intend to preserve the life of the person and to restore back the optimum level of functioning eventhoug the chance is poor. However in this situation circumspection is now applied.

Republic of the Philippines
MARIANO MARCOS STATE UNIVERSITY
COLLEGE OF HEALTH SCIENCES
Department of Nursing
City of Batac, Ilocos Norte APPLICATION TO BIOETHICAL ISSUEABORTION AND CLINICAL DEATH |

In Partial Fulfillment of the Requirements
In NSG150 for the 2nd Semester
SY 2010-2011
Submitted By: Acidera, Christian Robenny G. Agcaoili, Joeshua Kaye Agustin, Aiza Jay Y. Amodo, Dianne C. Ariota, Marie Kaye A. Bagayas, Naomi Ruth A. Batara, Joanne Kharmel R. Bismonte, Richard Irvin M. Bul-lalayao, Kaye Audrey J. BSN III-D Group 1
Submitted To:
Cristibel Rosario RN
Clinical Instructor

March 16, 2011