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Patient autonomy and criminal law
Published in Paweł Daniluk, Patient Autonomy and Criminal Law, 2023
Darina Zinovieva, Daniela Doncheva
Elective abortion must be performed in specialized hospitals of obstetrics and gynaecology or in multidisciplinary clinics or in the diagnostic-consultation and medical-dental centres for short-term observation and treatment. Voluntary abortion can also be performed in some medical establishments maintained by the Council of Ministers, the Ministry of Defence, the Ministry of Transport and Communications, the Ministry of Justice and the Ministry of Interior.7 Abortion being an interruption of a pregnancy, is performed by an obstetrician-gynaecologist (ob-gyn).
Hard Cases for Critics of Abortion
Published in Christopher Kaczor, The Ethics of Abortion, 2023
Unfortunately, determining the risk of abortion, in terms of both maternal deaths and injuries, turns out to be a question that, at least in the United States, we cannot answer with precision. Like the maternal mortality ratio (MMR), a lack of consensus exists about the timeline that should be used to link an abortion to the result of death. Should death within a month, six months, or a year after an abortion be attributed to the abortion? This question is important in particular because ectopic pregnancy is the most common reason for death in pregnancy, and elective abortion increases the risk of ectopic pregnancy. So, if the timeline for consideration is, say, a month after the abortion, then no increase in death rates due to ectopic pregnancy will be found. If in fact an abortion causes a woman to have a fatal ectopic pregnancy two years after her abortion, her death would not—simply by the time line adopted in definition—be attributed to the abortion. Yet, in some cases at least, if she had not had an abortion, she would not have had an ectopic pregnancy that led to her death. In order to know how dangerous abortion is, it is also necessary to know both how many abortions take place and the number of deaths and complications that result from these abortions. If either the numerator or the denominator of this ratio is unknown, it is impossible to determine the risk of death from abortion. If we cannot determine the risk of death from abortion, we cannot compare this risk to the risk of childbirth.
Is Abortion Medically Necessary?
Published in Nicholas Colgrove, Bruce P. Blackshaw, Daniel Rodger, Agency, Pregnancy and Persons, 2023
If, however, it is permissible to kill a fetus prior to delivering fetotoxic therapy to its mother, why is it not acceptable to risk a fetus’s life while treating the mother for cancer? Granted, elective abortion may, overall, be less risky for the mother and allow for a more controlled course of therapy. But medical necessity does not require the exclusion of all hazards. For an act to be medically necessary, it must be required to save the mother’s life, and there must be no reasonable alternative to it. Now, an extreme scenario can be imagined where a mother’s life depends on receiving urgent treatment for which there is no alternative, which her physician will not prescribe while she is pregnant. But even this is, at best, de facto medical necessity, as it assumes that fetal death must precede the administration of fetotoxic treatment.
Risk of preterm delivery after medically indicated termination of pregnancy with induced vaginal delivery: a case-control study
Published in Journal of Obstetrics and Gynaecology, 2022
Jean-Daniel Hini, Gilles Kayem, Thibaud Quibel, Paul Berveiller, Celine De Carne Carnavale, Pierre Delorme
Although abortion was legalised in France in 1975, elective abortion was authorised only if performed before 12 weeks of gestation. After 12 weeks, medically indicated termination of pregnancy (TOP, used here only to indicate medically indicated terminations) is allowed only when two physicians certify that the mother’s life is in danger or that there is ‘a strong probability that the unborn child is suffering a particularly severe disorder that is recognized as incurable at the time of diagnosis, regardless of gestational age.’ In 2016, the French Biomedicine Agency (Agence de la Biomédecine) received 4,354 TOP reports in France. Among the inductions of labour performed between 21 weeks of gestation and 31 weeks + 6 days, 86% were for TOP (Monier et al. 2019). This rate decreased as the gestational age increased.
Coexisting normal pregnancy with complete mole: a rare case report with successful pregnancy outcome
Published in Journal of Obstetrics and Gynaecology, 2021
Ioannis Tsakiridis, Apostolos Mamopoulos, Ioannis Kalogiannidis, Themistoklis Dagklis, Stamatia Aggelidou, Apostolos Athanasiadis
As already mentioned, twin pregnancies may be rarely complicated by the coexistence of a CHM and a live foetus with a normal placenta. This should be distinguished from a partial mole, which is comprised of a single triploid conceptus with an abnormal placenta (Wee and Jauniaux, 2005). Due to the uncertain outcome of these pregnancies, parents were offered and often opted for termination, so little data existed regarding the course of this condition until recent years. Based on more recent data, in twin pregnancies with a CHM and a normal foetus, parents are counselled of the high chance (more than 50%) of a favourable outcome (Lin et al. 2017). In addition, it has been long shown that there are no differences in the risk of gestational trophoblastic neoplasia (GTN) between women undergoing elective abortion and those who continue with their pregnancy (Sebire et al. 2002).
What Makes Conscientious Refusals Concerning Abortion Different
Published in The American Journal of Bioethics, 2021
There is also the argument that the nature of the medical profession differs from that of other professions that do not directly address the needs of persons in circumstances of extreme vulnerability with attendant fiduciary obligations. Hence, instead of referring to seemingly banal “professional standards,” medicine should be understood as having its own “internal morality” (Pellegrino 2001). Such reconceptualization of medicine’s guiding ethos does not in itself resolve questions regarding how this ethos should be defined and what specific values, principles, or directives it comprises. Centrally among such persistent disputes is whether elective abortion is a component—essential or otherwise—of medicine’s internal morality. Conscientious refusals thus do not involve so much a conflict of an HCP’s personal values against the values of their profession—as it is often characterized by critics (Schuklenk 2015)—but rather a conflict over what the values of the medical profession are and whether elective abortion coheres with them (Curlin and Tollefsen 2021). All of this may in fact support Fritz’s contention that HCPs should be permitted both to conscientiously refuse and to conscientiously perform abortions, regardless of what the law may say.