Abortion and nursing activities connected to it is a point of active discussions. The issue includes various aspects, such as the moral status of a fetus, a woman’s right to manage her body, etc. However, the majority of debates concern an unborn child and a mother. Much less attention is paid to physicians and nurses, as well as their roles in performing an abortion. Still, a nurse is an important participant of any process, having special functions, rights, and duties. Sometimes the requirements to the nurse contradict his or her individual position, such as personal experience or religious beliefs. In this case, ethical dissonance leads to conflict situations. The main ethical conflict is regarding the right for human life disposal. This responsibility lies with many participants: the mother, the medical staff, and the whole society with its values and traditions. The nurse’s main duty, in this case, is not to influence the patient’s decision, but to inform her and assist in overcoming this physically and psychologically difficult period.
One of the most complicated ethical issues for a nurse is a problem of abortion. The most debatable point is its moral justification for admissibility or inadmissibility. It is the interference in the person’s life at the stage of fetal development. This issue focuses on fundamental questions of human existence, the solution of which is literally the matter of life and death. The Hippocratic Oath expressly prohibits abortion making the medic share responsibility for it of a woman. In the sphere of nursing, the abortion problem includes ethical, legal, social, and religious issues. These aspects are closely intertwined with each other. However, at the same time, they may include contradictions. Sometimes the abortion can be permissible from a legal, scientific and medical point of view, but unacceptable, according to moral or religious beliefs. The greatest number of ethical questions arises about the abortions made at women’s requests and for social reasons. This area is a direct intervention not only in the natural processes of human life but also in its spiritual and social spheres, the person’s rights and freedoms. Since the intervention is made by particular physicians and nurses their role in this process must be properly studied. The paper analyzes the problem of this procedure in the context of nursing and the particular functions of a professional nurse related to it.
The issue of abortion contains a number of contradictions inherent in the medical culture of modern society. Firstly, it is people’s attitude to this procedure as an operation being the same one as any other surgery. The opposite opinion regarding abortion as a form of killing a man (infanticide) committed inside a mother’s body. These counter opinions depend on fixing the fetus’ moral status. The status dilemma is the recognition of an embryo as a separate human being or considering it as a part of the female body (Grimes & Stuart, 2010). The second fundamental contradiction of the abortion issue is a solution of human life’s disposal problem. The question is whether anyone has a right to dispose of another person’s life even if it is the life of an unborn child. This aspect is especially significant for nurses since they often directly or indirectly participate in final decision making.
Another contradiction is the availability of abortion. The development of medical technologies including the least traumatic and painful techniques of the abortion has made them widely available in medical practice. On the other hand, medical science and practice accumulated extensive knowledge about possible negative consequences of operations for the woman’s health. Besides, abortion causes serious psycho-emotional stress, which the female has to cope with. These experiences often disrupt her life transforming into socio-psychological problems and psycho-emotional disorders. Such ones may escalate into nervous, psychosomatic and even mental illnesses.
Discussing the abortion people often treat it as an abstract phenomenon generated by economic difficulties, the decline of public morals, the lack of basic knowledge about family planning, and others. Much attention is paid to the female who has to bear a burden of physiological and psychological effects of this manipulation. Many articles analyze the status of the fetus and the negative impact of abortion on the family. However, one more participant (or several of them) of this operation remains in shadows. Physicians and nurses who perform abortions are often treated as passive instruments of the procedure. Maximally, their role is mentioned concerning the legality of abortions. Yet, they are real people. Only they see a process of abortion from the beginning to the end. The role of medics is much bigger than just doing mechanical operations, according to the written algorithm.
A nurse performs several functions related to the abortion and pre-abortion period. First of all, it is an informative and advisory function. All the medical operations must be done only after the provision of all the relevant information to the woman and obtaining her consent. Such data must include the following factors: gestational age; effects of drugs prescribed for the medical abortion, as well as the drugs for prevention of vomiting, cramps, pain and blood loss reduction; main stages of medical abortion; possible complications such as allergic reactions to drugs, pathological blood loss, incomplete abortion (the delay of the ovum in the uterus), and ongoing pregnancy. The nurse should warn the patient that complications cannot be totally excluded. However, their frequency is low, i.e. up to 5% probability (Weitz et al., 2013). Also, the nurse has to inform the woman about the required mode of behavior including sexual activity and possible consequences of its violation, about the need to take medications prescribed to her in accordance with the physician’s requirements, and the possibility of using means preventing unwanted pregnancy in future.
In the case of surgical abortion, the provided information should contain some explanation of the abortion as surgery including uterine curettage with dissection and removal of the embryo; and the purpose and essence of the operation. Patients should also be acknowledged with the possible negative effects and complications of it including a mechanical trauma of the uterus and cervix, uterine rupture, bleeding, blood clotting problems, remnants of the ovum, inflammatory diseases, embolism, effects of anesthesia, a risk of infection with hepatitis, HIV, etc. Besides, the applicable data must concern some statistics: only according to the official sources (excluding black, illegal abortions), 1453 women died of abortions within the period of 1985-2005 (Sedgh et al., 2012). Also, the patients’ attention should be focused on the categorically negative moral and ethical evaluation of the procedure by all religious denominations (the abortion is deliberate infanticide being regarded as a serious crime). The information must be maximally objective, without any psychological pressure on the woman. The nurse’s aim is not to convince the patient to refuse the abortion, but to help her make a conscious and balanced decision based on understanding all the effects and consequences of the operation.
All the aforementioned points are the duties of a nurse. However, nursing authorities have certain rights as abortion performers. The nurse may abandon abortion if it contradicts his or her morale and/or religious principles. In practice, this right is not so easy to realize. The physician’s right to refuse this procedure due to some ethical or religious causes belongs to persons, not to organizations. Under international law, the right for conscience freedom is individual. The institutions such as public hospitals do not enjoy it. Medical institutions should provide legal medical services under terms of accessibility and publicity. Some countries have established a system of health care and recruitment in such a way that there always must be doctors and nurses ready to provide appropriate legal services. Thus, medics who loyally treat abortions have higher chances to get employed. Vice versa, those who object this sort of medical services suffer from discrimination.
Another aspect of nursing ethics concerning abortion is medical secrecy. Some issues in this sphere are not regulated by laws and instructions. The nurse has no right to inform anyone about the procedure. However, sometimes this rule causes ethical contradictions. For instance, the information may be required by the father of an unborn baby. If the society treats the embryo as a kid, and not a part of the female body, the father is equally responsible for life. Keeping medical secrecy is impossible in the case of the underage girl’s abortion. The nurse is obliged to inform her parents about this procedure (Joyce, Henshaw, Dennis, Finer, & Blanchard, 2011). Many of these cases are legally regulated, but the law often contradicts morality. This conflict of external (i.e. legislation) and internal limitations (i.e. morality) results in ethical dissonance influencing the nurses’ activities.
Sometimes universal instructions do not correspond to the particular practical situations. The interrelations between the nurse and the patient are bilateral. Doctors and nurses always try to appease and understand the patient with his/her feelings and fears. Often they do not take into account the mental and individual component of abortion treating it as another case in their medical practice. The nurse must be the first person providing an individual approach to every patient. In addition, the nursing authority and the patient can have different values and belong to different social segments of society, ethnic groups, and religious denominations. A professional nurse must be able to abstract from these differences and try to empathize with the patient. If the woman has some special cultural needs and views the nursing personnel should not re-convince her. However, the nurse should help the woman to overcome the hard period of her life, respecting the patient’s internal norms and values.
In conclusion, the abortion issue is very controversial. Various cultures and religions have a different attitude to this problem, being mostly negative. However, a professional nurse should place the patient’s interests above personal viewpoints. The nurse’s duty is not to persuade the patient to refuse the abortion, but to inform her about all risks and dangers related to it. Other ethical aspects of nursing (medical secrecy, respect to a patient’s private life, etc.) also must be accurately followed. Abortion is a very delicate operation. It is often accompanied by psychological stress and the nurse’s responsibility to minimize it. These are just several ethical issues of nursing activities in the sphere of abortion. However, even they show the complexity and contradictoriness of the investigated problem.