Thesis

1 Thesis: Legalization of Abortion Student’s Name Institutional Affiliation Course Professor’s Name Date 1 2 Should Abortion, up to the 15th Week of Gestation, Be Legal in All 50 States? For decades, abortion topic has been one of the most controversial and polarizing topics in the United States. It has been debated from both viewpoints, pro-life and pro-choice, and there is unlikely to be a consensus on the issue. As noted by Fromer (1982), the ethics of abortion must consider (a) whether the fetuses are human beings, (b) the rights of pregnant women vs. the rights of the unborn children, and (c) the overall stress that would result from unintended or undesired pregnancy. Having safe and accessible abortions allows women to have the innate right of autonomy over their bodies, while opponents strongly believe that life begins at conception. Therefore, abortions must be legal for all women up to the 15th week of gestation in all 50 states. This paper aims to advocate for safe and legal abortions while urging lawmakers to protect abortion access, up to the 15th-week gestation, in all 50 states. It will explore the benefits of pro-choice by providing supporting arguments that favor legal abortion nationwide. The intended audience consists of legislators, medical professionals, and women. It is ethically relevant to these target audiences because they must decide if this is an issue of freedom or murder. History of Abortion and Laws Roe v. Wade (1973) was a significant ruling by the United States (U.S.) Supreme Court that legalized abortion countrywide. The court ruled that the right to privacy under the Fourteenth Amendment of the U.S Constitution included women’s right to an abortion (Center for Reproductive Rights, n.d.). Before the legalization through Roe. V. Wade (1973), abortions were still carried out illegally across the nation. It was estimated that illegal abortions result in the deaths of 800,000 American women each year (Committee on Healthcare for Underserved 2 3 Women, 2020). Since the ruling of Roe v. Wade (1973), women have been able to access safe and legal abortions across the nation while receiving medical care without fear. 1992: Planned Parenthood v. Casey Despite Roe v. Wade being more of a household name, Planned Parenthood v. Casey (1992) is another Supreme Court case that holds massive significance to this subject because it changed how courts review abortion laws. Leading to this case, the State of Pennsylvania had passed a statute with five new provisions that introduced the element of “informed consent” when seeking abortions (Araujo, 1993). For instance, minors seeking abortion were required to obtain consent from their parents, women who are married had to notify their husbands, and healthcare facilities had to offer particular information to women and wait for 24 hours before conducting the activity. In this case, the Supreme Court surprisingly reaffirmed the constitutional right of a woman to have an abortion, as previously ruled in Roe v. Wade (1973). Besides, the court upheld all the five provisions introduced by the Pennsylvania state statute, except for the one about notifying a spouse. While Casey did not ease the banning of abortion, it introduced the use of the “undue burden standard,” which was more lenient than the strict scrutiny used in Roe (Moses, 2004). In previous cases, the court did not recognize the interests of states in protecting human life. After Casey, states were given more leeway in passing legislation that restricts abortion. However, with Roe v. Wade, Planned Parenthood v. Casey was overturned for guaranteeing the right to abortion before around 23 weeks, when the unborn child can survive outside the womb. Roe v. Wade Overturned: Impact on Society and Public Outrage 3 4 In June 2022, the U.S Supreme Court made a historic decision upholding that the U.S Constitution does not confer a right to abortion. This ruling overturned Roe v. Wade, which had provided constitutional protections for abortions for nearly 50 years (McGovern, 2022). It gave individual states the power to regulate all aspects of abortions that are not preempted by federal law. Evident by the public outrage caused, the ruling will have a massive impact on society. Research conducted by the Pew Research Center immediately after the decision revealed that 62% of Americans are against it as they feel abortions should be legalized in all or most cases. Women are more concerned about the decision than men, with only 21% of women strongly approving it compared to 28% of men. The overturning of Roe has had an immediate impact on society, with more expected to come. For instance, several have outlawed the provision of abortion services, and more states are expected to follow suit soon. States such as Alabama, Arkansas, Louisiana, Kentucky, Missouri, and South Dakota, among others, have already implemented laws and triggered bans on illegalizing abortions (McGovern, 2022). Around 17 more states had policies already in place, waiting for the overturning of Roe v. Wade to outlaw abortions. These laws have made it challenging for some women and their families to access abortion services. Women of color are more likely to be disproportionately impacted by this ruling. They are more likely to encounter multiple structural barriers, such as limited financial resources, making it challenging to travel out of their states to access the services (Sidik, 2022). This decision could accompany longlasting mental health complications, including increased anxiety, depression, lower self-esteem, and paranoia. Illegalizing abortion and imposing penalties on institutions offering such services increase the likelihood that people will still conduct the activity but use dangerous methods that 4 5 jeopardize women’s health and safety (Sidik, 2022). When abortions are not carried out using appropriate and safe methods, maternal deaths are likely to increase. Ethical Theory Women, like other human beings, have the right to autonomy over their bodies. This right allows women to decide whether or not to abort their unborn children. Opponents of this standpoint argue that abortion violates the fetus’ right to life. However, before the 15th week of pregnancy, the fetus is not a human being since it cannot survive outside the womb. Therefore, a fetus cannot enjoy the constitutional freedom and rights to which other human beings are entitled. As a result, the decision for or against abortion should be based on the fundamental rights of pregnant women. Based on that, abortions should be legal for all women up to the 15th week in all 50 states. Legalizing abortion up to the 15th week of pregnancy ensures that women not only enjoy safe and accessible abortion services but also enables them to exercise their right to privacy and autonomy over their bodies. It is also important to consider the overall stress associated with criminalizing abortion. As indicated by Mills (2022), socioeconomic standing and earning power are major factors controlling people’s decisions regarding when to have children. Criminalizing abortion and enforcing laws restricting access to safe and legal abortions limits people’s ability (especially those living in poverty and people of color) to determine when they can have children. This can lead to unwanted and undesired pregnancies, often accompanied by massive stress, anxiety, and depression symptoms. Therefore, women seeking an abortion should be allowed to proceed with their intentions to exercise their human right to autonomy, specifically over their bodies and lives. 5 6 Utilitarianism The theory of utilitarianism supports this standpoint (pro-choice). The utilitarian argument goes that anything that seems to balance good results and consider everyone is morally permissible. Right or bad actions are determined by their outcomes, with the ones generating the greatest utility or usefulness to society being considered the right and moral actions (Burkhardt & Nathaniel, 2013). This theory approaches ethical dilemmas through the principle of utility, whose main focus is promoting the maximization of welfare in society. Based on this, utilitarianism advocates for actions that focus on fostering happiness and pleasure for most members of society. In the case of abortion, the theory requires that the mother’s life and the consequences of unwanted pregnancy to society are considered. This theory of morality places no absolute value on human or fetus life. Therefore, this theory supports that the abortion decision should be very much up to the mother and the effects of the pregnancy on her life. Examples of circumstances that utilitarian thought requires that we consider severe fetal abnormality or probable birth defects, rape, and financial stability. Basing the decision on the fetus’ welfare ignores the long-term socioeconomic impacts such as the financial burden of children on poor parents or society and disruption of the mother’s schooling or professional career (Gensler, 1986). There is also a significant chance that children born from unwanted pregnancies will have miserable lives characterized by limited happiness, which is unfair to them. Legal and safe abortion provides a second chance for people to make proper decisions that will generate long-term happiness and less burden to society. In some circumstances, saving the mother’s life or preserving her health is more beneficial and morally justified than saving the fetus’s life (Haas, 2017). These rare occasions are 6 7 when maintaining the pregnancy endangers the lives of pregnant women. Serious infections, preeclampsia early in pregnancy, and cancer are examples of conditions that would require abortion for the sake of saving the mother’s life. If a mother dies during or after childbirth, the child’s likelihood of dying is greater. Maternal death or permanent disability is associated with multiple devastating outcomes, which is against utilitarianism. For instance, maternal deaths cause problems such as hardships and loss of productivity for families, communities, and nations. Principles Ethical approaches to abortion often appeal to some specific principles, including respect for patient autonomy, beneficence, and non-maleficence. The ethical principle of autonomy states that patients are entitled to make decisions regarding their bodies and medical care (Gawron & Watson, 2017). In the case of abortion, respect for women’s autonomy over their bodies and care involves lending firm support to the right to choose whether to end their pregnancies without state or government interference. Clinicians and nurses providing abortion services must honor the medical ethics principle of autonomy by assisting pregnant women seeking abortion in preserving bodily integrity (Watson, 2019). They should allow patients to enjoy the freedom of their decisions as well as preserve the dignity of dominion over their life’s course. In nursing, the ethical principle of beneficence is described as the obligation to promote the well-being of patients (Gawron & Watson, 2017). Burkhardt & Nathaniel (2013) indicated that beneficence has three major components: preventing harm, promoting good, and removing harm. Banning abortions is not a way of minimizing the risk of harm for pregnant women 7 8 seeking an abortion because they may often turn to less effective and unsafe abortion methods. Using dangerous techniques is a major cause of avoidable maternal deaths, and legalizing the act is a way of observing the principles of beneficence since it helps eliminate or reduce the number of maternal deaths. Clinicians and nurses offering abortion services must honor the principle of beneficence by supporting actions that prevent harm related to forced childbearing. In the U.S, 59% of women seeking abortion already have at least a child, and they are committed to meeting their current needs (Watson, 2019). Therefore, based on the principle of beneficence, the decision to end the pregnancy expresses motherly love. The same applies to young women who believe they cannot raise children yet. For them, abortion is a benevolent action that promotes good for their future children. As previously indicated, forcing pregnant women to keep unwanted or undesired pregnancies is a major source of stress and anxiety, which is detrimental to their mental health. Allowing them to have an abortion eliminates the evil of enduring the stress and mental complications associated with carrying and raising unwanted or undesired babies. The principle of non-maleficence is defined as the obligation not to cause harm or injury to patients (Gawron & Watson, 2017). Unlike beneficence, that focus on preventing and removing harm, non-maleficence focuses on avoiding things that can cause harm. This ethical principle majorly focuses on the deliberate harm that occurs when conducting beneficial actions (Burkhardt & Nathaniel, 2013). It prohibits activities that are associated with causing deliberate harm. Laws restricting abortion are examples of intentional acts that are intentionally put in place to benefit women but, in reality, cause harm, such as mental and physical health complications to the victims. The laws banning abortion intend to accomplish a positive outcome: saving the 8 9 fetus’s life. According to the principle of non-maleficence, we should avoid harm even as a consequence of doing good (Burkhardt & Nathaniel, 2013). In this case, the harm of keeping unwanted pregnancy outweighs that of terminating the pregnancy. Therefore, the principle supports that pregnant women should be allowed to access legal and safe abortion services. Opposing Views On the contrary, pregnant women should access safe and legal abortion services to save the fetus’ life. Fetuses are human beings; therefore, ending the pregnancy is morally wrong since it involves killing an innocent person. Besides, as human beings, a fetus also has the right to life. Having an abortion is a way of denying them their constitutional rights and freedom. In fact, the fetus is entitled to the same rights to life and care in the same manner as the mother. Therefore, constitutional or legal arguments in favor of pregnant women should also apply to unborn children. Deontological Theories of Ethics The deontological theories of ethics support this standpoint. Unlike utilitarianism, which focuses on the consequences, deontological theories of ethics determine the wrongness and rightness of an act based on its nature (Burkhardt & Nathaniel, 2013). According to deontological perspectives, the act of abortion involves killing an innocent human being, and therefore it is morally wrong. The religious dimension, specifically Christianity, also reinforces the deontological ethical perspective. According to Christians, every individual is a divine creation, created in God’s image and likeness (Ştefan, 2014). Life is a gift from God, and only He has the moral legitimacy and right to end it. No human has the right to end any form of human 9 10 life legitimately. Every human and implicitly, each product of human conception has the right to life unconditionally. Based on this perspective, abortion is not only an immoral act but also a sin that contradicts the universe’s divine and natural order. Principles Apart from the deontological theories, the argument against abortion for the purpose of saving the fetus is also supported by the ethical principle of justice. Burkhardt & Nathaniel (2013) described this principle as the fair, equitable, and proper treatment of people considering what is due or owed to them. Both the fetus and the mother are human beings and, therefore, should be viewed as equals before the law and enjoy the same human rights. If the pregnant mother is a moral equal to the fetus, it would be morally unjust to kill the fetus in an attempt to protect the mother. As indicated by Tardiff (2015), justice is generally served when the mother and the child survive and lead healthy and happy lives. Terminating the pregnancy is unfair to the fetus, and keeping an unintended or unwanted pregnancy is unjust to the mother. Therefore, the topic of pregnancy continuation and abortion requires a new morally upright paradigm for justice to ensure for both the fetus and the mother The ethical principle of paternalism justifies restricting an individual’s or patient’s autonomy if doing so can prevent them from harming themselves and help generate positive outcomes (Burkhardt & Nathaniel, 2013). This principle is based on the argument that the person restricting the other possesses knowledge about the subject and has the power to make decisions for others. Based on their professional knowledge, legislators understand that life begins at conception. As a result, they can use their power to criminalize abortion to save the fetus’s life. A 10 11 baby has a heartbeat at six weeks; therefore, states like Texas ban abortion after six weeks of gestation. Flaws in the Opposing Argument The opposing argument indicates that both parties have the right to life. However, it does not consider the fact that the death of the fetus is an unintentional outcome during the process of saving the mother’s life. Besides, the argument does not consider that a pregnant woman is morally justified to end the pregnancy when the fetus presents a threat to her health and life. If the fetus turns out to cause a significant risk to a mother’s life, the latter can terminate the pregnancy as a self-defense mechanism. Lastly, the opposing arguments do not consider that autonomy is a significant part of personhood. Pregnant women should be allowed to express complete freedom over decisions that affect their bodies and lives. The fetus is part of the mother’s body and therefore does not have moral status or personal autonomy independent of its mother Faith Integration Pregnant women seeking an abortion should be allowed to have safe and accessible services. This will be a way of allowing them to exercise their right to autonomy over their bodies. Luke 6:37 says, “Do not judge, and you will not be judged. Do not condemn, and you will not be condemned.” In this verse, the Bible reminds nurses of their ethical duty to provide all the necessary information and support the choices of pregnant women seeking an abortion without judgment. Besides refraining from engaging in biased treatments, nurses should put aside their standpoints and beliefs regarding abortion and instead focus on the patients’ values. 11 12 Nursing Implications The insights highlighted throughout the paper are in connection with the fundamental commitments and values of nursing as established by ANA’s Code of Ethics. This Code could help determine the boundaries of professional nursing practice concerning the topic of abortion. Specifically, Provision 8 of the Code requires that nurses collaborate with other health care professionals and public members in protecting human rights, including pregnant women seeking abortion (Faubion, 2022). The Code reminds nurses that safe and accessible health care is a universal right of everyone, and therefore they have to advance health by first protecting human rights on all levels. Advocating for safe and legal abortion is a way of protecting human rights since pregnant women have the right to privacy and the innate right to autonomy over their own bodies. Besides, supporting efforts advocating for the legalization of abortion is a way of collaborating with others to eliminate barriers and obstacles to safe and accessible healthcare services for pregnant women, especially those living in poverty and people of color. Conclusion From an ethical perspective, women seeking abortion have the innate right of autonomy over their own bodies. As a result, they should have the ability to have safe and accessible abortion services up to the 15th-week gestation in all 50 states. However, the recent Supreme Court decision to overturn Roe v. Wade and Planned Parenthood v. Casey is a major obstacle to this standpoint and could cause adverse impacts on society. The decision is likely to force women and their families to keep unintended and unwanted pregnancies, which are associated with increased stress, disruption of schooling and career plans, and financial strain. Forcing women to keep undesired pregnancies is against utilitarian thoughts since it does generate 12 13 outcomes that maximize happiness for the women and the community. While opponents of abortion argue that fetuses are human beings and therefore have equal rights and privileges as women, the argument ignores the significance of autonomy in personhood. Regardless, nurses should observe medical ethics and follow the ANA Code of Ethics to promote, advocate, and protect all patients’ rights, health, and safety. The insights discussed in this paper could help persuade legislators to protect abortions up to the 15th-week gestation, inform women about their rights regarding abortion, and provide the necessary guidance to healthcare professionals on how to execute their duties while observing ethical standards. 13 14 References Araujo, R. (1993). Abortion, Ethics, and the Common Good: Who Are We? What Do We Want? How Do We Get There? Marquette Law Review, 76(4). https://scholarship.law.marquette.edu/cgi/viewcontent.cgi?article=1665&context=mulr Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and Issues in Contemporary Nursing (4th Edition). 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Philosophical Studies, 49(1), 83–98. https://doi.org/10.1007/bf00372885 Haas, J. M. (2017). Moral Theological Analysis of Direct versus Indirect Abortion. The Linacre Quarterly, 84(3), 248–260. https://doi.org/10.1080/00243639.2017.1320888 14 15 McGovern, T. (2022). Overturning Roe v Wade has had an immediate chilling effect on reproductive healthcare. BMJ, 377, o1622. https://doi.org/10.1136/bmj.o1622 Mills, K. I. (2022, May 3). Restricting access to abortion likely to lead to mental health harm, APA asserts. American Psychological Association. https://www.apa.org/news/press/releases/2022/05/restricting-abortion-mental-healthharms Moses, M. (2004). Casey and Its Impact on Abortion Regulation. Fordham Urban Law Journal, 31(3). https://ir.lawnet.fordham.edu/cgi/viewcontent.cgi?article=2116&context=ulj Pew Research Center. (2022, July 6). Majority of Public Disapproves of Supreme Court’s Decision to Overturn Roe v. Wade. Pew Research Center – U.S. Politics & Policy. https://www.pewresearch.org/politics/2022/07/06/majority-of-public-disapproves-ofsupreme-courts-decision-to-overturn-roe-v-wade/ Sidik, S. M. (2022). The effects of overturning Roe v. Wade in seven simple charts. Nature, 608(7922), 254–257. https://doi.org/10.1038/d41586-022-02139-3 Ştefan, I. (2014). Arguments for and Against Abortion in Terms of Teleological and Deontological Theories. Procedia – Social and Behavioral Sciences, 149(2014), 927–935. https://doi.org/10.1016/j.sbspro.2014.08.301 Tardiff, R. G. (2015). Stewardship Challenges Abortion: A Proposed Means to Mitigate Abortion’s Social Divisiveness. The Linacre Quarterly, 82(3), 251–272. https://doi.org/10.1179/2050854915y.0000000006 Watson, K. (2019). Abortion as a moral good. The Lancet, 393(10177), 1196–1197. https://doi.org/10.1016/s0140-6736(19)30581-1 15 16 16

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