Beginning life issues - Case studies - tutorial 5(1) PDF

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Abor Abortion tion Rights and/or Wrongs- T Ter er ermina mina mination tion of pre pregnanc gnanc gnancy y eit either her intentional or unintention unintentional al (accident or illness) Atkins, 2017. Case scenario 1: Kate is a 17 years old patient, unmarried and 8 weeks pregnant. She is a rather remarkable girl in that she lives independently while still a senior in a high school. She tells you that she was an adoptee given back to foster care, and then abused in that system. She is now an emancipated minor who works 30 hours per week at a service industry job while also ranking in the top 10% of her class. She is University-bound, with a full-ride scholarship for pre-med undergraduate studies at a prestigious university.

Kate has absolutely no family support, and the former boyfriend who is the father of her unborn child/foetus simply disappeared upon learning of the pregnancy. Kate is scared, has no private health insurance, and says she doesn’t want to be pregnant or a mum (“Perhaps someday, but not now!”). She rejects the adoption option, based on her own experience growing up, and wants an abortion.

Questions for discussion 1. Kate lives in Western Australia. What are the relevant laws, and identify any legal issues from this case study? Answers 

No obligation to carry a fetus to term

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Abortion legal in each state or territory since 1990. However, each state varies in its legislative approach to considering abortion. Previously abortion was illegal and punishable as a criminal offence.

Justice Menhenitt’s Victorian ruling 1969 abortion could be performed if the woman’s life was in serious danger all reforms were based on this ruling (Atkins, 2017). WA 

More than 20 weeks pregnancy considered viable only if there are severe disabilities or the mother would be harmed examples include a severe medical condition, heart disease and cancers. Two Doctors must agree to the moth(er’s abortion.

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Less than 20 weeks pregnancy in WA is only considered if the medical practitioner perceives that continuation of pregnancy would lead to more physical and mental risk than termination of a pregnancy. Alternatively that the woman would suffer serious personal, family consequences if the pregnancy continued (Atkins, 2017, p.257). Additionally there must be informed consent and counselling by another medical practitioner who is not involved in the procedure.

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Children less than 16 – A children’s court decides if it is inappropriate to involve the parents.

Victoria 

Victoria abortion law reform occurred in 2008 to enable appropriately authorised specially trained nurses and medical practitioners to complete a medical abortion 20 weeks.

Consider your views relating to her partner and his lack of choices, as men do not have any rights. Non- Maleficence- Non- Maleficence must not cause harm to the mother. However, consider your perspective relating to the fetus? Has the fetus a right to defend itself against harm. Reflect on the following:  Is the fetus a person? Arguments differ between conception and implantation, viability 20 weeks, birth, gradual progression to personhood. Strongly opposed views indicate that the fetus is a person who has both legal and moral rights. In contrast that the fetus is a part of the mother’s human body and therefor is subject to the autonomous views of the woman (Atkins, 2017). A potential person therefor has the rights of a person. Points for discussion  

Depriving of life as a person and possible good Definite harm

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Is death always a harm?? Consider the woman who does not want her pregnancy versus the woman who has previously lost pregnancies and the value that society places on the care of this woman and child e.g. changing scans, public transport, medical treatment, object of regard within society.

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Can death be a good thing e.g. if severe disabilities? To prevent harm to the mother or fetus?? Should anyone end human life? Sanctity of life Would it cause Kate harm to continue the pregnancy?

3. How would the theory of utilitarianism view this? Greatest good for all- abortion of benefit to society prevents unwanted pregnancies, increased quality of life for single mothers versus possible state dependency.

Consider if abortion was not legal? Cost to society of unwanted pregnanciesadoptions cost to mothers of illegal abortions

4. How would the theory of deontology view this? A duty to maintain pregnancy and life.

Case scenario 2:

In Perth, Western Australia, Sandra, a 14 year old girl became pregnant as a result of rape. She was too frightened to tell anyone about the rape and kept it to herself.

She suffered gastroenteritis for a few weeks following the rape and was sometimes sick during the evenings but it didn’t last for too long. Recently, she has been putting on weight and she has become rather depressed. Her mother was a little concerned about her and took her to the GP, who felt it prudent to carry out a pregnancy test, even though Sandra denied that she had had sexual relations with anyone.

The GP examined Sandra and determined that she was 21 weeks pregnant and therefore it was too late for her to have an abortion and suggested adoption.

Questions for discussion 1. What are the relevant laws, and identify any legal issues from this case study? Not obliged to continue her pregnancy to term. Unwanted pregnancy – Rape? Special considerations two medical practitioners can decide if the abortion is necessary. Hence 21 weeks not too late to abort this pregnancy in both WA and other states. Paternalism of the GP has he breached his duty of care to inform the patient of all available options?

Legal issues aged 14 – A person of less than 16 can consent to abortion if they are considered by their GP to understand the implications of the procedure. NSW Crimes Act 1900. Was Sandra trying to hide this pregnancy? Fear of her parents? Possible impact on other pregnancies- was this discussed Testing for HIV, Hep B, Hep C Issues relating to adoption Frightened to tell anyone 2. Consider Sandra’s legal capacity and competence. Aged 14 will require at least one parent to provide consent. A mature minor the Children’s Court can also decide if less than 16

3. Apply the ethical principles (Beneficence, non-maleficence, autonomy, justice) and objectively address any positives / negatives issues from the case study.

Beneficence Benefit to the mother of a late abortion. However, there are risks also to the mother in doing this e.g. Psychological and physiological Non-maleficence May cause harm to Sandra if she continues her pregnancy to term. Education, family, social issues related to teenage pregnancy. The abortion may cause the mother harm as, there are both physical and psychological risks. Additionally there are risks related to rape- sexually transmitted diseases which, may include psychological issues. Autonomy- Sandra has the right to be informed of the procedure, risks, benefits and the alternatives. It does not appear that she has been fully informed of her options. Justice- Sandra has the right to justice and an abortion if she considers this is her wish. Parents must act in her best interest otherwise the Children’s Court would decide. Sandra will require referral to the sexual assault referral centre, psychological and family support.

4. Consider how would the theory of utilitarianism view this?

5. Consider how would the theory of deontology view this?

Further reflective questions You may work with nurses who have different perspectives to your own related to abortion. How will you demonstrate respect for their position (Atkins, 2017)?

What are your nursing responsibilities? 

Work within your legal requirements

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Work within your capacity and scope of practice.

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Maintain a duty of care or request to care for someone else.

Case scenario 3:

Susan met her husband when they both just graduated from law school. She and her husband Rick wanted a large family and thus they have four children. When the couple’s youngest child was old enough to go to school Susan decided that she would like to return to legal practice. She realised how much she missed what she used to do before she became a mother and felt as if she had given up on her career. After she talked to her husband about the child care situation, Susan began her job application process as a legal assistant at a law office. While searching for a job Susan became pregnant and later on (at 20 weeks) found out that the foetus has Down syndrome. The doctor was unable to tell Susan whether the Down syndrome will be mild or severe and knowing that having a child with a disability may prevent her from ever returning to the working world she decided to an abortion without her husband’s knowledge.

Questions for discussion 1. Susan lives in Western Australia. What are the relevant laws, and identify any legal issues from this case study? 

Fetus is 20 weeks

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Doctor cannot determine whether the fetus will have mild or severe disabilities from the Downs Syndrome

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Will suffer serious personal, family and social consequences??? Personal only?

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Two practitioners have to agree that the woman or fetus has serious medical conditions is this unlikely or likely given the circumstances?

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Abortion without talking to her husband about the pregnancy is this morally or legally right

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How did she obtain the abortion? ? Discuss her alternatives- interstate etc.

2. Apply the ethical principles (Beneficence, non-maleficence, autonomy, justice) and objectively address any positives / negatives issues from the case study.

3. How would the theory of utilitarianism view this? Good for society reduced cost related to the care of a child with a disability. Reduced cost to the parents of caring for a child with a disability. 4. How would the theory of deontology view this? A duty to continue the pregnancy 5. Is having an abortion because a child has a disability justified? (consider the ethical principles here)

Further Reflection What are your thoughts and feelings relating to the following statements write them on the discussion board?

A woman is distressed on return from theatre and you observe a nurse comforting her and saying ‘You did the right thing’.

How would this situation change if the child would be normal?

Would it be justifiable by any ethical principle to obtain an abortion if the foetus was normal and all other factors stayed the same?...