Thursday, 6 May 2010

Oklahoma abortion laws: physicians doing harm

The recently enacted Oklahoma abortion laws have been delayed for 45 days whilst the state prepares its defence to a legal challenge. A quick recap on the substance of these laws:

Law 1) Before an abortion, the woman must have an ultrasound in which the monitor must be turned towards her so she can see the fetus, and the physician must describe the condition of the heart, limbs, and fetal organs. No exceptions for rape/incest victims.

Law 2) Any woman who has a disabled baby may not sue her physician who withheld information as to fetal deformity, even if that physician withheld the information to prevent the woman from having an abortion.

There are myriad arguments against these positions, which cannot be dealt with here. I simply wish to address the ethical implications for physicians complying with these laws, in relation of the four principles of medical ethics outlined by Beauchamp & Childress in 'Principles of Medical Ethics' (1979). These are 'non-maleficence', 'beneficence', 'respect for autonomy', and 'justice'.

Law 1) violates the principles of 'first do no harm' (non-maleficence) and 'do good' ('beneficence') if the description or visual image causes distress to the woman, as these are not required for discharging the physician's clinical duty. This indeed seems to be the case; Jennifer Mondino, a staff attorney for the Center for Reproductive Rights (who filed the suit against the enactment of the laws), stated “We have been in touch with our clients and they are telling us stories of having women break down into tears hearing the description of the ultrasound”. The law also violates the principle of 'respect for patient autonomy' if the woman does not wish for such information to be revealed.

Law 2) violates principle of 'respect for patient autonomy' as witholding information (or, indeed lying) limits options available to the patient (e.g. choosing to abort a deformed fetus), preparing her life to look after a disabled child etc. Also violates the principle of 'justice' as the physician's actions may bring a potentially unwanted child into the world who will likely be a heavy consumer of scare medical and social resources.

Counterarguments to these violations of standard ethical frameworks will likely appeal to ethical duties to 'potential persons' i.e. the fetus overriding those of the woman. These are dealt with well by Francesca Minerva at the Oxford Practical Ethics blog.

Physicians clearly have an obligation to obey the law, but they also have a duty to uphold the ethical principles of their profession. When a law clashes with those principles, it's a fairly good barometer that the law itself is ethically flawed, or designed to serve the concerns of a particular group of people or lobby whom are unlikely to find themselves falling under that law's ambit.

Update: Satire can pinpoint ethical unease with great precision. The Onion news network: New Law Requires Women To Name Baby, Paint Nursery Before Getting Abortion.

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