Textové pole: Bc. Michaela Telárová Healthcare ethics 2022 Textové pole: Abortion Obsah Introduction. 3 Abortion. 4 Opinions related to abortion. 4 Reduction of multifocal pregnancies. 5 Parental autonomy. 7 Autonomy of adolescents. 7 Conscientious objection. 8 Conclusion. 10 Used sources. 11 Introduction This essay is focused on the issue of how the world perceives abortion. In the text, I tried to process opinions about abortions, which are widespread worldwide. The knowledge I gained from the reviewed articles is supplemented by my opinions on the issue. I present information about abortions in general, about a specific type of abortion, about the autonomy of adults and adolescents, and finally about the attitude of health professionals. Abortion Abortion is a procedure that leads to the termination of pregnancy. It can be done by giving a pill or by invasive surgery. Abortion can be performed up to 24 weeks of pregnancy Abortion can be considered a routine procedure. Based on the latest information from the WHO, 6 out of 10 unintended pregnancies end in abortion. (www.who.com). Abortions are different, some women decide to terminate an unwanted pregnancy, some women abort spontaneously or as a result of an injury or illness, whether they are women who wanted to get pregnant or women who did not want to be pregnant but decided to keep the child. (Mullin 2015, page 27) The decision to terminate the pregnancy itself can have various reasons. Women who want to terminate a pregnancy often make decisions based on their health, financial or social status. The biggest dilemma is probably the decision to terminate the pregnancy based on the doctor's negative prediction about the health of the fetus or the ability of the parents to take care of the child. (Mullin, 2015 page 28). The issue of abortion is a sensitive issue for all people. In matters of ethics, we should realize that every woman perceives her body individually. And that's why individuality should be included in attitudes and opinions on this issue. Opinions related to abortion We can say that the issue of approval or, on the contrary, condemnation of abortions divided humanity into several types according to opinion. In his publication, the author Blackshaw summarized the generally prevailing attitudes. The first of the perspectives deals with human rights. We have laws that talk about compulsory vaccinations, restrictions on smoking or dealing with safety at work in order to keep people as long as possible in full health, to protect them from premature death. So the question arises, is the ban on abortion a protection of the life of the fetus? With this question, we will get to the division of people based on the idea of what a fetus is. People who are opponents will claim that abortion is an immoral act, because the fetus in a woman's body has the same moral status as other people, that is, it is a full-fledged person. (Blackshaw, 2021, page 468). Author Mulli draws attention to the fact that due to the growing sophistication of ultrasound technology, people have constructed a so-called fetal personality. (mulli, 29). Since the fetus looks like a human at an early stage, it is also given the moral status of a human being. I agree with the idea that even a fetus that is still developing is considered a full-fledged person. However, I think that the situation when deciding on the future of the fetus is a complicated process, where it is necessary to consider all the circumstances, not the status of the fetus. On the other hand, it can be countered that moral status is something that a person achieves if he has capacities such as self-awareness, desires, or rationality. (Blaskshaw 2021, page 468). So, if society was based on the essence that the fetus has the moral status of a person, and abortions would be prohibited, does this guarantee that abortions will not be performed? Blackshaw also draws attention to the fact that abortion can also be performed illegally. Illegal abortions result in thousands of women's deaths worldwide every year and occur in countries where abortion is strictly prohibited. An interesting fact is that, for example, after the legalization of abortion in Ireland, the number of abortions rose rapidly. (Blackshaw 2021, page 468). This information leads me to think which of the possibilities is more morbid, the woman having an abortion or the fact that she will try another way and pay for it with her life. Of course, there is always the possibility of a trip abroad, but I assume that it is financially more demanding. Another stated point of view is the fact that the ban on abortion leads to a high number of unwanted children who are ultimately placed in institutional care and given up for adoption. This view is confirmed by the fact that the relaxation of abortion laws in the 1960s and 1970s resulted in a significant reduction in the number of children in institutional care waiting for an adoption. (Blaskshaw, 2021, page 469). Anti-abortion people would argue that abortion is immoral because it deprives the fetus of its future, just as it is with the murder of a child. On the contrary, a group of people who support abortion will admit that the fetus has a future, but due to its low developmental stage, its needs must not exceed the woman's need to preserve her own health, freedom and life. (Dahl 2021, page 55). The issue of looking at what is and what is not a fetus is and always will be a matter of individual opinion. I think that every conceived fetus, whether wanted or not, is a living being that certainly has its own future, but it is up to the mother to decide what kind of future she will give it, the fact that the mother keeps the fetus does not guarantee a positive future for the fetus. Reduction of multifocal pregnancies This chapter is devoted to the issue of perception of multifetal pregnancies. I only encountered this type of abortion while writing this essay, and I think it brings a lot of other perspectives to the issue. Reduction of multifetal pregnancies allows a woman who is pregnant with more than one fetus to reduce their number. Based on this law, the author signs several opinions. The first opinion is that this type of abortion is unacceptable because when one fetus is removed, the other fetus may be damaged. (Dahl 2021, page57) Based on this opinion, it is possible to think about responsibility. People are responsible for the birth of a new life, therefore they are also responsible for its health, which includes, for example, the healthy lifestyle of the mother and the like. If a mother decides to accept responsibility for the child she is carrying, it seems irresponsible to meddle with his health, after all, it is an invasive intervention in the body. Therefore, this argument seems justified to me. Another often-discussed opinion is that if a woman decides to have children, she should respect their number, even if it is not what she planned for, but this can be easily countered, saying that a woman's decision to reduce the number of children may have, for example, financial reasons. Another argument describes the possibility that the sibling who was preserved may feel sadness or anxiety from the sibling in the future, if the child grows up knowing that he might have had a twin (Dahl 2021, page 61). However, if he grows up in ignorance, the question is whether he could be marked. Although there are various myths about twins, I think that in this area it is also good to think about what twins represent for society. If this kind of abortion became more widespread and twins or other multifetal pregnancies were presented as something negative, what would be the impact? Twins could be referred to as a negative impact of reproduction. The last opinion is what effect this decision has on the woman. The study reported that every woman experienced some degree of sadness after the procedure, with some women experiencing depression or having trouble bonding with their baby after giving birth. However, after about two years, most women no longer felt any psychological problems associated with the abortion and did not regret the decision. (Dahl 2021, page 62). As for the opinions that support this matter, it is parental autonomy that must be respected. Through this autonomy, we respect the patient's opinion about his health, his body and his right to make decisions about himself. In order for a woman to be able to make such a decision, it is important that she is provided with adequate information. A woman must be able to assess her own health and life situation, and if she feels that bringing more children into the world would be a burden for her, why not offer her this option? (Dahl 2021 page 65). In the overall evaluation of the study, I can say that there are generally more negative opinions than positive on the issue of abortion. However, the one opinion in favor of abortion is the most important and that is parental autonomy. It is important to realize that whether a mother will have one child or more will ultimately affect her and her immediate surroundings. Therefore, I do not think that anyone else has the right to make decisions for the mother. Parental autonomy Parental autonomy is something that is talked about at least compared to the rights of the unborn fetus. It is necessary to realize that by giving the fetus the right to life and the fetus is born, it is important for its development that it grows up in the right environment so that its parents are able to take care of it. An interesting perspective on the issue of abortion is provided by the Kantian objection, which talks about how the anti-abortion law can affect a woman. According to this objection, this law considers the woman only as a kind of incubator or container for the child, as it does not deal with the feelings or reasons of the woman to justify her decision (Blackshaw 2021 page 468) Autonomy increases when a woman is well informed about her options, about the possible need to make difficult decisions. It is also influenced by financial, emotional and social resources, which are one of the decisive factors for the ability to perform healthy education. Respecting reproductive autonomy also means that we should devote some resources to helping both women and men to become better informed in this area. However, we cannot respect autonomy without agreeing with their decision. (Mullin, 2015 page 33) Autonomy of adolescents Patient participation in decisions about their health is a big trend in recent years. But how high is the autonomy of pregnant adolescents? Among the problematic circles that result in teenage pregnancy may be insufficient sex education, myths about contraception or a lack of trust in health care providers. Emotional and sociocultural factors influence decision-making for pregnancy. The results of the Bain study showed that the majority of adolescents who experienced an abortion were significantly influenced by family members or a partner. nevertheless, they felt that they made the final decision for themselves. When asked about medical personnel in the area of decision-making, the majority said that minors should probably be helped by the nearest relative, but the final decision is always up to them, on the contrary, professions such as lawyers or teachers and especially parents claimed the opposite. Research indicates that adolescents at the age of 14-15 are already able to make correct decisions about their own health. Pregnancy at a young age brings with it a number of problems that need to be solved, such as physical and emotional maturity, financial autonomy, lack of experience in solving problems. However, making decisions about pregnancy can be different from making other decisions about your health because more people are involved in the decision-making process. (Bain 2021, pages 2-6) Adolescent pregnancy is a problem almost all over the world. I think that this type of pregnancy is highly condemned by society, and thus the decisions of either minors or their legal representatives are influenced by this very fact. Hoggart focused in his study on the moral blackshaattitudes of adolescent women after abortion. He encountered two types of view of the situation: in the first case, young women were focused on the future and pregnancy was perceived as a threat to the future, and in the second view, young women considered abortion immoral but underwent it mainly due to the influence of the environment. For women who considered abortion immoral, the decision-making process took longer and was accompanied by various personal dilemmas (Hoggart 2019, pages 3-6). I think that states that enforce anti-abortion laws should devote the same effort to building programs and interventions that would help eliminate the risk teenage pregnancy This situation is certainly difficult for everyone and can lead to more tragic endings than just miscarriage. Conscientious objection Conscientious objection is the name given to a situation where healthcare workers refuse any participation in providing treatment to patients because of their religious or moral beliefs. Refusal to participate in abortion based on moral conviction is presented as part of basic human rights. from a doctor's point of view, a woman's decision to terminate a pregnancy may be contrary to the Hippocratic Oath. Most often, discussions on this issue are led by religious organizations. (Heino 2013, pages 231-232) Because health workers in some countries can refuse this service, health workers who respect the decision to terminate a pregnancy find themselves in unpleasant situations when they are overworked. The public often comes into conflict with the healthcare organization as they claim that the healthcare professional has the right to refuse the patient, but the healthcare facility in which he works has the obligation to comply with the request. (Heino, 2013 page 233) I myself work as a health worker and I cannot imagine that I would refuse to take care of a patient, because I believe that a health worker should be impartial and should not judge other people. Although I understand doctors, as the act itself is done by their hands, and I know that some religions strictly forbid it, as it is tantamount to murder. I think about how a patient must feel who comes to the doctor already so nervous about an unknown situation and the doctor rejects her. I think it must be a terrible mental burden. Conclusion It follows from the sources used that the issue of abortion is a current and still unresolved topic. Everything indicates that it will be discussed for a long time because it is not yet realistic that both parties will be satisfied. On the one hand, there are opponents of abortion with strong arguments, as spokespeople for the fetus, and on the other hand, the mother, in an undesirable situation. Personally, I am inclined to the opinion that this decision should be up to the mothers. However, they should be sufficiently informed and given adequate care. As a woman raised in the Catholic Church, I would not be able to have an abortion, for me it is immoral. But I also dare to say that every person is responsible for his decision and everyone lives with himself. Therefore, he considers the decision to have an abortion to be an individual decision for each woman. Used sources BLACKSHAW, Bruce a Daniel RODGER. If fetuses are persons, abortion is a public health crisis. Bioethics [online]. 2021, 35(5), 465-472 [cit. 2022-12-18]. ISSN 02699702. Dostupné z: doi:10.1111/bioe.12874 DAHL, Silje Langseth, Rebekka Hylland VAKSDAL, Mathias BARRA, Espen GAMLUND a Carl Tollef SOLBERG. Abortion and multifetal pregnancy reduction: An ethical comparison. Nordic Journal of Applied Ethics / Etikk i praksis [online]. 2021, 15(1), 51-73 [cit. 2022-12-18]. ISSN 18903991. Dostupné z: doi:10.5324/eip.v15i1.3980 BAIN, Luchuo Engelbert. Understanding the meaning of autonomy in adolescent pregnancy decision-making: lessons from Ghana. Pan African Medical Journal [online]. 2021, 40, 1-11 [cit. 2022-12-18]. ISSN 19378688. Dostupné z: doi:10.11604/pamj.2021.40.34.29220 MULLIN, Amy. Early Pregnancy Losses: Multiple Meanings and Moral Considerations. Journal of Social Philosophy [online]. 2015, 46(1), 27-50 [cit. 2022-12-18]. ISSN 00472786. Dostupné z: doi:10.1111/josp.12085 Hoggart L. Moral dilemmas and abortion decision-making: Lessons learnt from abortion research in England and Wales. Glob Public Health. 2019 Jan;14(1):1-8. doi: 10.1080/17441692.2018.1474482. Epub 2018 May 21. PMID: 29779465. Heino A, Gissler M, Apter D, Fiala C. Conscientious objection and induced abortion in Europe. Eur J Contracept Reprod Health Care. 2013 Aug;18(4):231-3. doi: 10.3109/13625187.2013.819848. PMID: 23848269. https://www.who.int/news-room/fact-sheets/detail/abortion