On abortion

The rape of the Sabine women, Giambologna

Recently someone asked me to express my views on ‘abortion’, specifically as it relates to my role at work, my personal religious views, and my experience with medical ethics. I found it an interesting little exercise because it made me think about the different roles we play in different social spheres and also the cognitive schemas which we keep constant across these spheres. For example, the religious group to which I belong and whose view I share (or at the very least accept) has a view on abortions that is easily summarised as “it is never indicated”. Now, in my role as a doctor I am at times confronted by people enquiring about termination of pregnancy services. In this scenario you could say that I am paid to educate, to assist, and to aim for the best health outcome for my patient. But I am the same human being doing both roles of Christian and doctor. The other thing to realise is that I represent only myself, not my religion or my profession – and yet to another fellow human, I am both!

I have summarised perfectly my religion’s views on abortion as “it’s never indicated”. Before I summarise my profession’s view on abortion, I must summarise my profession’s role. Doctors have sets of clinical standards and legal standards by which we must exercise our jobs. It is not just about using the best clinical method or doing things legally, it is about using the best clinical method to do legal things that are in the patient’s best interests – as dictated by the patient himself (or a substitute decision maker on his behalf). So my profession’s view of abortion you could say has to do with the performing of legal abortions in a clinically safe manner. Of course, this is given that it is requested by the patient, and is in keeping with the general direction to minimise harm to her or to improve her wellbeing. You could very generally summarise my profession’s views on abortion as “it is indicated when the patient wants it, it is the best thing for her mental and/or physical health, and it is able to be performed in a clinically safe manner”. Now, does everyone in my religion believe exactly the same thing? No! Does everyone in my profession believe the same things as each other? No, of course not. Some of us differ even in antibiotic prescribing!

Personally, I believe whether or not a thing is bad has to be decided by the person to whom the decision directly affects. For example, if my religious belief is that eating a certain food is a sin, then it IS a sin if I personally ate that food. However, if someone else doesn’t believe it is a sin and eats this particular food, then to me that person is not guilty of a sin either in his own view or mine, and I can hold no negative judgement towards that person. The question of MY view on ‘abortion: good or bad?’ for me is redundant. To me what is of relevance is what I do in one or another context. I am both a Christian and a paid medical professional, but I am above all things, a human being. Every human being approaches life with the same basic aim: to do the thing that is best for me and minimize my discomfort (physical and/or mental). No one likes to feel guilty of not doing their job adequately, and no one likes to feel that special type of guilt our religious beliefs can make us feel. Things get even more complicated when you throw in having to act in situations that will directly (and indirectly) affect at least one other human being.

I have reached a position in my life where I don’t want to change anyone’s view to that of my religion, or to change the views of my religious associates to that of my own. I have also been lucky enough to realize that my work is just that: work. So what has all this stuff on religion have to do with my discussion here on abortion? Medically, in my job, it is never my choice to decide on a patient’s medical care if he is competent to make that choice himself, regardless of their or my personal religious or personal views. My job would be to inform accurately and with scientific fact, to ensure that the person has access to adequate psychosocial support, and to aim to protect the patient from mental and psychological harm. None of these tasks have anything at all to do with my own personal religious views on anything.

You can’t discuss abortion, though, without discussing legality. I was asked whether I believed that termination of pregnancy services should be deemed “illegal”. I believe that the main reason that the concept of legality is still introduced into discussions about intentional abortions is that it is contended on some many levels that have little at all to do with either medicine or the law. The way our society deals with such “ethical” or “moral” dilemmas is to pass strict laws or rules to dictate what should be done and where and by whom. For example, a statement could be made that an unborn person has the same human and legal rights to a person who is already born. However as a society a statement like that is not very practical because there are too many things to consider, e.g. at what age or weight is a foetus a ‘person’, what anatomical or biological parts entitle a person to be called a person, etc. So we come up with laws and rules instead, saying for example that a foetus after 24 weeks of gestational age is a person and has this and that other human right but not these other ones yet, etc. This is, you’ll notice, similar in concept to Christian ideology that says “it is never indicated’.

Personally, I believe that health professionals should not be criminally prosecuted for performing abortions that are performed safely and using standard practices when a person has consented to the procedure after being adequately counselled about it. I believe it should also be legal for patients who are intellectually competent to make health care decisions to seek adequate help from health professionals for discussion and possible subsequent performing of an abortion. I also believe that it should remain illegal to perform abortions that are not medically supervised or on people who are not capable of consenting or refusing to the procedure (unless in conjunction with a substitute decision-maker that has the person’s best interests at the forefront). I am glad that termination of pregnancy techniques have been developed in a medical context. For example, it’s better that a doctor with appropriate tools and knowledge perform an abortion than a woman attempt to have one done by someone with no specialized training. To believe that outlawing something which has such a long history of occurring is going to stop it from being done, I think is quite naive.

I do have one problem with our society’s current high rate of abortion, though, and it has nothing (or everything?) to do with either religion or law or ethics. I find it concerning that the high use rate of termination of pregnancy services, and its widespread acceptance, has led to the trivialization of what is essentially (and I think, rightly so) a big decision to be made in a person’s life. It saddens me that some people are coming to think of an abortion as an option for contraception or that it is a common/simple thing like getting a mole removed from the skin. The true and often undiscussed fact is that a lot of women do not understand the psychological impact of their decisions, and the potential for negative psychological sequelae in the years to come. Ideally, no woman should opt for an abortion without having full explanation of the medical or surgical techniques and the potential risks associated. The discussion should include explanations of the changes to be expected in her body, an understanding of the foetus’ current stage of development, an exploration of her own spiritual views, and consideration of her mental and physical health. Now, I am not saying ‘don’t have an abortion because you’ll get depression or other mental problems in the future’. I am simply saying that a patient needs to be given adequate and complete information to help them form their own decisions.