An obstetrician has a significant role to play in making regular assessment of pregnant women and to identify early signs of complications. Such women need to visit an obstetrician regularly to ascertain that the fetus is undergoing normal development. They are given advice regarding healthy living. The birth plan that is significant for effective delivery is developed by the obstetrician who assesses the risks involved and the need for regular checks. In performing their regular tasks, obstetricians are required to observe medical ethics, which make them obligated to the patients in regard to ethical practices. Specifically, they have to observe obstetric ethics. They are also obligated to observe obstetric ethics in regard to the relations of the patient. This medical ethics makes the issue of abortion controversial, especially because obstetrics have to remain firm on ethical principles.
Abortion may be performed when the fetus puts the life of the mother at risk. It may also be performed when it is discovered that the baby has certain genetic abnormalities. The two are the most significant reasons that may compel the obstetrician to recommend an abortion. Other reasons why abortion may be carried out is when the woman acquires an unwanted pregnancy either through a normal relationship or through incidences such as rape. Controversy originates from the ethical point of view whereby it becomes apparent that the fetus right to develop is largely dependent on the mother’s decision. It is regarded as ethical to terminate pregnancy at a particular stage of development and not the other. This contradicts the medical ethics which advocate the protection of an individual from inception all through to a fully developed human being. This essay is a critique of Autonomy in relation to the controversial topic of abortion. Kant’s and Utilitarian ethical theories have been discussed as well as their application to the principle of autonomy, and the issue of abortion.
The Principle of Autonomy
The principle of autonomy grants a grown up person the right and freedom to make a choice regarding particular actions to be undertaken on his/her body. In other words, it is assumed that such a person can make a sound and independent decision regarding oneself so long as it does not affect the life of other people. The law recognizes these rights that are also recognized in the medical practice as well as in the ethical principles. The principle of autonomy has is observed in many circles, although it generates controversies among critics. It is the same principle under which voluntary euthanasia takes place3. People who feel that they would better be dead because of a chronic problem that has no cure can request for euthanasia as a way of escaping the suffering. In obstetrics, the principle of autonomy generates controversy mainly because abortion involves two lives. Even though the fetus is not fully developed in to a human being, it is regarded as a human life form that has its own right4. These arguments have always hindered pregnant women from accomplishing autonomy in regard to their bodies. In many states, it is unlawful to carry out an abortion unless it poses risk to the woman. One wonders who has the right to determine whether an abortion poses risk to the person carrying the fetus. It is often ignored that regardless of what other people perceive pregnancy, it is the woman carrying it who knows how it feels with the fetus living inside her1.
The physician has a significant role to play in the maintenance of the health of the patient. This is regarded as the principle of beneficence. The physician receives training on the health of humans, and is obligated to practice within the ethical principles of the medical profession. In many occasions, the principle of beneficence has conflicted with the contemporary understanding of the principle of autonomy4. This is because if the physician is in charge of the health of the patient, he/she should be allowed to practice without hindrance. However, the autonomy of the patient in regard to what is supposed to be done on his/her body prevents the physician from executing tasks as he/she deems right. In other words, when the patient gives directions regarding how he/she should be treated, conflicts the need for training medical practitioners. The fact remains that the principle of beneficence overrides the patient’s autonomy for his/her own good. For example, an obstetrician understands the dangers involved in abortion. However, a client may insist on abortion, which according to the principle of autonomy may be allowed for the satisfaction of the patients desires with her body. However, giving in to such a request may lead to an obstetrician being accused of failing in his/her duty to protect the health of the patient if the abortion leads to undesirable complications3.
Nonmalefiscence is the practice that is viewed as an encounter between the physician and the patient whereby the physician inflicts some pain in the patient in the process of accomplishing beneficence4. In other words, the process of recovery involves certain aspects whereby the patient will have to suffer some pain to regain health. For example, when an obstetrician recommends an abortion to save the life of an endangered woman may inflict pain in the genitals while performing the operation. However, beneficence supersedes nonmalefiscence. This is the background upon which wounds and many other body malfunctions are healed. If the patient exercises the principle of autonomy and refuses to undergo nonmalficence which might be core to the healing process, there is a likelihood of not accomplishing treatment, and the patient may not benefit. This indicates a conflict between the principle of autonomy and nonmaleficence. In essence, physicians do not practice nonmaleficence as a measure to oppress or inflict unnecessary pain to the patient. Rather, this is done with positive thoughts.
The rights based ethics is a theory that highlights the rights of a person as the foundation for evenhandedness and justice. It is based on the reasoning that any action that a physician undertakes involving the patient needs to respect individual rights and freedoms. The interests of the patients should be upheld whenever engaging in any operation according to right based ethics4. For example in obstetrics, the rights of the pregnant woman need to be observed whenever making important decisions such as inducing an abortion. The patient has the right to be adequately informed regarding the intended operation, the manner in which it is to be implemented, the possible risks associated with the process as well as the possible side effects that may result from the process. No action should be undertaken that infringes the rights of the patient or hamper the accomplishment of good health. The patient has a right to decline the operation to seek services from elsewhere.
Elective abortion is the intended termination of pregnancy before the advancement of the fetus as a result of the desire of the pregnant woman. Such abortions are mainly carried out without any medical reasons or vulnerability of the mother1. Rather, the mother could be unwilling to bear a child for personal issues such as unplanned pregnancy or pregnancy acquired through rape. The woman may be willing to abort the fetus to avoid shame from public scrutiny, or lifetime sorrow. Many of the elective abortions receive resistance from the society as well as governments in countries where abortion is illegal. It is regarded as killing, which is a crime punishable by the law in many criminal justice systems. However, this raises questions from many circles regarding the autonomy of individuals in regard to doing whatever they wish with their body. Healthcare professionals need to offer the appropriate advice and guidance regarding elective abortion. It is usually difficult for obstetricians to carry out an abortion without conviction that the pregnancy may pose risk to the mother. In many cases, women carry out such abortions in secrecy4.
On the other hand, abortion that is recommended by the physician is usually meant to save the pregnant woman from the dangers she might be exposed to as a result of the pregnancy. This involves beneficence and nonmaleficence due to the fact that the woman will benefit from the painful intervention of the physician. In both elective and non-medical abortion, the healthcare professional needs to observe ethical principles in dealing with the patient requesting for the abortion. As much as it is important to observe individual rights in dealing with patients, the applicability of abortion needs to be considered. If the side effects are lethal to the patient, the healthcare professional should emphasize on the maintenance of the pregnancy2.
Kant’s Ethical Theory
Kant’s theory portrays good will as a significant component of people’s actions. Good will is viewed as one of the aspects that do not require anyone to be an expert. Kant observed that actions that are within the moral law are the ones that can be used to determine whether an individual possesses good will. According to this theory, the reason why people act in a particular manner substantiates whether an individual’s action has moral worth. Kant also observes that there is a notable distinction between actions that are morally good and morally right. He observed that it is only through acting from good will that a person can receive moral credit5. For example, morally good actions include a situation whereby an obstetrician recommends an abortion to protect the life of the mother without focusing on satisfying any personal interests or benefits. Such an action takes place through good will. Kant also argued that when human beings pursue satisfaction in their actions, they will not be moral7. In other words, actions need to be based on reason rather than individual benefits.
In contrast to Kant’s theory, utilitarianism is a theory that mainly focuses on the gains that majority of the people achieve from a particular action. An individual therefore must possess the capability to make correct predictions regarding his/her actions to ascertain that the end result will be satisfactory to the majority6. The fact that a particular action in the utilitarian theory must be satisfactory to the majority indicates that if the rights of an individual bring satisfaction to him/her alone, there is need for them to be granted. If the theory was to be applied in obstetrics, an elective abortion focused on satisfying oneself without benefiting any other person may not be allowed. This is because it does not serve the interests of the majority. However, the utilitarian theory also recognizes the fact that the actions have to be fair to even the minority. If a fetus endangers the life of the mother, abortion will not serve the interests of the majority, but if fairness is observed, the woman may be saved from abortion. This is an indication of beneficence in the utilitarian theory.
Abortion is one of the controversial issues in the medical profession. It may be carried out to protect the life of the pregnant woman as well as to satisfy her interests. Many arguments arise as to whether it is ethical to carry out an abortion, and especially regarding an individual’s autonomy. A person has a right over actions taken over his/her body, although in the healthcare profession, the principle of beneficence overrides a person’s autonomy. This is because the physician will act in his knowledge to protect the life of the patient. Nonmaleficence goes together with beneficence since as the physician engages in certain actions for the benefit of the patient; there is a likelihood of causing pain that must be felt to accomplish the desired healing. Nonmalficence therefore occurs with positive thoughts. Kant’s theory focuses on good will as fundamental to moral actions, which are not based on satisfying personal interests. The utilitarian theory is different from Kant’s theory in the sense that it is based on satisfaction of the majority. However, it recognizes the importance of fairness which overrides satisfaction of the majority.