The laws and ethics of maternal decision making
A .The violation of pregnant women rights
B .The long technical procedures
2. The general opinion
A. A summary on the recently addressed legal cases.
B. The ethical principles that are established purposely to handle these issues.
C. Reviews of the underlying
3. Maternal decision making legal approaches
A. The failure to take in to consideration a pregnant woman’s entitlement to integrity and consent
B. Recognition of medical knowledge on limitation available to a prediction of possible results in obstetrics
C. Victimization of candidate of addictions and psychiatric problems
D. Women facing a threat to be dissuade from their duty of parental care
4. Recent cases
A. Charges of a woman refusing to undergo cesarean delivery – march 2004
B. January 2004 failure to undergo cesarean delivery resulting to birth of underweight infants
5. Recommendations Maternal- fetal relationship approaches
A. Informing pregnant women on the importance of medical advice
B. Court intervention in case of negligence of duty and ignorance
C. Establishment of a proper manner to address addicts and persons psychiatric illness
Abstract
In this final project a letter is addressed to the department of health and human services relating a concern pertaining to policies and legal measures established for protecting the fetus against malicious decisions made by expectant mothers on issues regarding medical interventions. The fetus in this case is often regarded as a separate entity from the pregnant woman. Therefore, limiting maternal privileges and taking legal actions towards an expectant mother on interventions causing fetal harm, ought to be addressed from a legal perspective. Present legal mechanisms available to protect the fetus through construction of a mothers thought and decision are inadequate to the extent of violating the woman’s legal right to privacy along with her personal integrity. As such, it is imperative that legislation be passed to protect the unborn fetus from such danger.
The laws and ethics of maternal decision making
- Challenges encountered
A .The violation of pregnant women’s rights
As it relates to the rights of pregnant women in our society, it cannot be assumed that they have no rights regarding the fetus they are carrying. Consequently, social planners serving in the capacity of directors of health care policy administration and human services ought to become aware that they do have privileges of consent or rejection to decisions made regarding them and the unborn fetus in their uteruses. Also, it challenges the rights of women to carry a pregnancy or abort it.
Inevitably, reflections of the existing abortion legislation will offer insights regarding this challenge to pregnant women’s rights as it exists in contemporary America. There have been years of battles in congress as it relates to passing an abortion bill, which is expected to make abortion legal under certain conditions. More importantly, Planned Parenthood contentions have now surfaced.
Planned Parenthood was discovered to be one of the greatest resource offering reproductive health care services to women in the American Society. These include, cancer screening, HIV testing and counseling as well as contraception, and abortion interventions. Contraceptive services take up 35% of Planned Parenthood Fund Association expenditure yearly and abortions 3%. Reports are that the fund provides for an estimated 300,000 abortions annually with some 3 million women being provided with various types of reproductive services (Gordon, 2002).
Now with organizations such as these, it would appear that private sector has taken control of the reproductive life of American women to the extent of making them vulnerable to decisions which have not been entirely theirs in the first place. Therefore, Planned Parenthood Organization of American is influencing women’s reproductive health distinctly apart from any national legislation limiting their privileges in impacting the reproductive decisions some 3 million women make annually. Herein lays the major challenge encountered towards harnessing this violation of women’s reproductive rights (Eckholm, 2011).
Precisely, the Freedom of Choice Act passed at 110th United States Congress in 1964 confirmed the fundamental right of choice for every woman in the United States of America ‘to bear a child; terminate a pregnancy prior to fetal viability; or terminate a pregnancy after viability when necessary to protect her life or her health’ (American Center for Law and Justice, 2007) as a policy regulation of the United States of America government.
The twenty first century challenge relates to while the Freedom of Choice Act is enforced what role is planned parenthood playing in influencing this decision ‘to bear a child; terminate a pregnancy prior to fetal viability; or terminate a pregnancy after viability when necessary to protect her life or her health’ (American Center for Law and Justice, 2007). Are the reproductive rights of women being violated in the process? How does health care administration know that these decisions are voluntary and women’s reproductive rights are not violated?
B .The long technical procedures
Insights pertaining to implications of abortion on health care in America, Dr Patrick Whelan (2010) offered his perspectives in the New England Journal of Medicine. He expressed concerns regarding unresolved legislative obstacles pertaining to affordable health insurance for accessibility to abortion services (Whelan, 2010)
Dr Whelan (2010) contends that from a recent incident in Massachusetts it was highly suggestive that universal health care coverage is related to lower rates of physicians informed abortions. It was further emphasized that this occurs in the regardless the abortion funding program. These funding agencies’ policies appeared to be more liberal than the provisions of federal legislation, which is being considered by congress, presently (Whelan, 2010).
Arguments escalate regarding law restrictions imposed by federal payments for abortion limiting the circumstances to sexual assault, incest, or jeopardy to the life of the mother. Further explanations point towards restrictions governing Medicaid coverage for abortions in the low income women category. The ‘budget appropriation rider contained in Hyde amendment’ (Whelan, 2010, p 17) ought to be adjusted for low income women to access safe reliable abortion services. Instead a shuffle of interest regarding payment boundaries are widening daily. The amendment was effective since 1976, the doctor argued (Whelan, 2010)
Whelan (2010) advocates that by ‘offering federal subsidies to private insurance companies millions of women struggling in a poor economic culture could access health insurance coverage’ (Whelan, 2010, p 17). With tendencies towards marginalizing women productivity the debate for legislators is how to provide this care without federally subsidizing abortions or, conversely, restricting access to abortion for women who subscribe to these plans (Whelan, 2010).
Meanwhile, subsequent studies show where the costs of treating women with complications of abortion are escalating. This is due to the inability to access safe reliable services according to Benson (2012) and counterparts. The researchers hypothesized that ‘unsafe abortion is a significant contributor to maternal mortality in Nigeria, and treatment of post abortion complications drains public healthcare resources’ (Benson et.al, 2012).
According to the researchers, provider estimates from provider estimates from 17 public hospitals were used to assess medications, supplies, and staff time spent, per-case. This study embraced an analysis of annual post abortion care costs (PAC) stretching across Ogun, Lagos states and the Federal Capital Territory. Estimated costs for moderate complications amounted to $112 US per case showing a 60% increase of an uncomplicated case. Where dilatation and curettage was needed costs went up by 18% per case (Benson et.al, 2012).
Annual expenditure for PAC at all public hospitals in 3 states were $807 442 US. These costs researchers explained could be reduced by safe outpatient abortion procedures. This entailed allowing midwives to service clients abandoning the use of D&C. Recommendations are that ‘availability of safe, legal abortion would further decrease cost and reduce preventable deaths from unsafe abortion’ (Benson et.al, 2012).
2. The general opinion
A. A summary on the recently addressed legal cases.
As it relates to abortion and reproductive rights of women in the modern American society this subject has gained momentum among politicians, humanitarians, feminists, sociologists, economists, religious fanatics, male interest groups, and ordinary people on the streets as well as grassroots communities. They have all voiced their opinions regarding whether to be pro-choice, pro-life or no-life-choice. These ideologies have spurred controversies among these factions in the social structure. In my opinion every woman has the right to decide for herself what is best when it comes to having an abortion/ bearing a child. It is the right according to Freedom of Choice Act that no women live in a society whereby the government or state regulations inform that decision.
American health care system does not permit Medicaid or any federal funds to be used in abortion except for special cases. The question which needs to be answered is whether abortion/ reproductive rights is a health care issue? Or because it affects women who until a few decades ago were considered minority, it is unimportant? If this is the case why is there a law that confers the fundaments right of every woman ‘to bear a child; terminate a pregnancy prior to fetal viability; or terminate a pregnancy after viability when necessary to protect her life or her health’ (American Center for Law and Justice, 2007) as a policy regulation of the United States of America government. This law became active in 1964.
Forty eight years later women desirous of terminating a pregnancy have the responsibility of funding it out of pocket except if they can prove rape or it would be detrimental to their health. Then, within this law are subsidiary legislations contradicting the position implied therein. Further, A March, 2010 press release reiterated the present political administration two faced approach regarding federal expenditure on abortion for low income women in America. President Obama’s quest to pass the ‘Obamascare’ health care reform Legislation conceded to opposing forces by issuing an executive order barring federal funding of abortion under the Affordable Care Act’ (Kliff, 2011).
The president expressed that even though he is pro-choice regarding abortions it was beyond his jurisdiction allowing federal funding for abortions. This decision reinforced maintaining the current Hyde Amendment restrictions; a law which prohibits federal funding for abortions. Hence, the advantage taken by Planned Parenthood Organizations in influencing women regarding abortion’s and other forms of contraception
B. The ethical principles that are established purposely to handle these issues.
The history of induced abortions around the world has been distasteful. It has affected developed, developing and underdeveloped nations alike. Clearly, perpetuators have been classified as women who have had abortions, desire to, and those aiding the crime. Morally, public policy and politics dominate women reproductive rights. As such, it is difficult for women to tell their story in its true essence. Often, It must be told from a premise of remorse, shame and indignity. This has been the politics of abortion/ reproductive rights, internationally.
- Reviews of the underlying
A Pew Research Center analysis concerning the politics of abortion and reproductive rights of women as it related to the 2012 elections showed where there are still immense divisions in society regarding abortion and contraception. From the Pew Center polls over the past two years (65%) of Democrats support the ideology that abortion should be legal in all or most cases. 57% Republicans confirmed their opposition to say that it should be illegal in all or most cases ( Pew Research Center, 2012).
Yet still the polls further reveal that the opposing party cannot unite on the issue to confirm its ‘wrongness’ nor ‘rightness.’ The problem lies in Republicans establishing the extent to which abortions should be legal and illegal alike. Conclusively, the division spreads across a 22% concluding that it should be illegal in all cases while 35% confirm that it should be illegal in most cases. Alternatively, the consensus among democrats is decisive. 26% say that abortion should be legal in all cases and 39% in most cases (Pew Research Center, 2012).
3. Maternal decision making legal approaches
A. The failure to take in to consideration a pregnant woman’s entitlement to integrity and consent
While Planned Parenthood may be filling the gap between available reproductive services for women and accessibility to it; it is not quite clear whether compliance to patient protections and rights as it pertains to a health care intervention is maintained. How is Planned Parenthood classified? How do they decide on whether an abortion should be performed or not is still obscure? ‘Health care workers may inadvertently infringe upon rights and protections in their zeal to provide good care’ (Study Notes: Lesson 4:1, 2013).
When scrutiny of Planned Parenthood activities have been undertaken reports surfaced showing that they do not comply with state or federal laws. A participant observation group of researchers contend that while visiting a center posing as victims of statutory rape it was observed that minors who needed parental consent for abortions were being scheduled for the procedure without informing the parent. Further, edited video and audio productions revealed that Planned Parenthood was violating the law and women’s reproductive health rights to decision making. Subsequent reports are that a 2005 federal inspection by Department of Health and Human Services revealed evidence that clinics across the country did not report cases of child sexual abuse, rape, incest, which confirmed noncompliance with federal; legislation and possible violation of women’s right to decision making in the reproductive process(Mieszkowski, 2006).
B. Recognition of medical knowledge on limitation available to a prediction of possible results in obstetrics
Quality Maternity care in United States of America as health care depends on the type of insurance coverage the woman has to cover the care of herself and infant. Maternity statistics show where in 2011 there were 3.95 million births, the second year whereby the birth rate was below the average 4 million births (Transforming Maternity care, 2013). However, most women have limited knowledge about maternal and child health services to access the best care or make decisions that can predict the best outcomes for them and their unborn fetus.
C. Victimization of candidate of addictions and psychiatric problems
There are agencies within the society that victimize pregnant women who are addicted and have psychiatric problems. However, they have reproductive rights which embody options to legal safe abortion upon their consent. They are also entitled to birth control services, access high quality reproductive healthcare, education that would empower them to make wise intelligent reproductive choices. Essentially, reproductive rights enable this vulnerable group of women to access contraception as sexually transmitted infection education and testing. Precisely, it protects them from forced ‘sterilization, abortion, and contraception, and protection from gender-based practices such as female genital mutilation’ (Knudsen, 2006, p 23).
- Women facing a threat to be dissuade from their duty of parental care
There are many websites advertising help for pregnant mothers and their babies with the option of adoption because they have an adoption network offering huge sums of money for the services. They are sometimes known as birthing centers and offer counseling which in essence acts as means of dissuading them from their parental duty by telling them that they are incapable of caring for the unborn child financially. Some m mothers surrender to the appeal under pressure and regret it later. Importantly, they did not realize what their rights were. This ought to addressed in legislation protecting such vulnerable women and their unborn fetuses from exploitation of adoption agencies (Adoption Services.org, 2013).
4. Recent cases
A. Charges of a woman refusing to undergo cesarean delivery – March
CNN reported where a Utah woman was charged in March, 20004 for murder after allegedly refusing a C- section, which resulted in the death of one of the unborn twins. Further reports were that she did not want to have an abdominal scar. However, the mother was acquitted the murder charge after the prosecutor asked the question, ‘Are we, as a society, prepared to demand more of pregnant women than of anyone else?’ The rhetorical answer was that while the mother might have been responsible the attending obstetrician as a third party could be just as accountable since the second twin was unborn(CNN, 2004).
B. January 2004 failure to undergo cesarean delivery resulting to birth of underweight infants
Recent studies show where more C- sections are being performed than traditionally done. In some cases there is no safer route of delivery than through Cesarean section because the infant might be too large to pass through the pelvis; the placenta may be low lying or other conditions of the uterus may make it impossible for a vaginal birth. If the mother’s health is threatened through medical dysfunctions then Cesarean section is the only way towards a safe delivery of mother and infant. Therefore even though the mother has rights to consent or object legally some intervention must be made to protect the unborn child( Smith, 2005).
5. Recommendations Maternal- fetal relationship approaches
A. Informing pregnant women on the importance of medical advice
Therefore, measures could be taken through health promotion programs to educate women on their rights and responsibilities pertaining to reproductive health. The state of affairs as it exists in United States of America; health care services are expensive and inaccessible to minorities such as women caught in the misery-go- round of pregnancy, poverty and more babies. Department of human services ought to combine effects and programs with department of health to provide massive community education other than Planned Parenthood interventions. Religious groups could be encouraged to join in the advocacy towards more accessible reproductive health education especially for young women in the society.
B. Court intervention in case of negligence of duty and ignorance
While the court can intervene in cases of negligence of duty and ignorance actions are limited to available legislations that would empower then take certain measures. As such, it is imperative the petitions be made addressing these issues among vulnerable populations for proper representation though the court system.
C. Establishment of a proper manner to address addicts and persons psychiatric illness
Again it is imperative that present laws regarding reproductive health of drug addicts and persons affected by psychiatric illnesses be re-evaluated and modified after a needs assessment is conducted to assess the magnitude of the problem.
References
Adoption services.org (2013). Adoption Services, Adoption Agencies plus help for pregnant
women and Birth Mothers. Retrieved on June 6th from
http://www.adoptionservices.org/
American Center for Law and Justice (2007). Executive Summary of the Freedom of Choice
Act. ACLJ.
Benson, J. KrennHrubec, K. Lazzarino, A., & Johnston, B. (2012). Public hospital costs of
treatment of abortion complications in Nigeria. Int J Gynaecol Obstet.118 Suppl 2(S)134-
40
Eckholm, E. (February 17, 2011). Planned Parenthood Financing Is Caught in Budget Feud. New
York Times.
CNN ( March,2004). Crying murder when C-section refused. CNN.com
Gordon, L. (2002). The moral property of women: a history of birth control politics in
America (3rd ed.), University Press
Knudsen, L. (2006). Reproductive Rights in a Global Context. Vanderbilt University Press of
Illinois.
Kliff, S (October 2nd, 2011). The Hyde Amendment at 35: a new abortion divide.
Washington Post
Mieszkowski, Katharine (November 4, 2006). "Abortion foes' dirty tactics: Advocates of a
California "parental notification" bill accuse Planned Parenthood of protecting sexual
predators instead of teen girls. But who is really breaking the law?" Salon.com
Pew Research Center (2012). The Complicated Politics of Abortion. Retrieved on June 5th, 2013
Smith, (2005). ACOG Committee Opinion #321: Maternal Decision Making, Ethics, and The
Law. Obstetrics & Gynecology, 106(Part 1), 1127-1137.
Transforming Maternity Care (2013). United States Maternity Care Facts and Figures. Retrieved
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http://transform.childbirthconnection.org/resources/datacenter/factsandfigures/
