03-02-22 - Ethics at the beginning of life

Question 1

Learning outcomes

Answer 1

• Evaluate the ethical and legal issues surrounding the status of the embryo and fetus, including concepts of personhood
• Describe the legal basis on which termination of pregnancy can be carried out in Great Britain, including doctors’ professional responsibilities
• Outline key statistics relating to termination of pregnancy in Great Britain, and worldwide
• Identify and explain the ethical issues raised in the following areas: determining what constitutes a ‘serious’ handicap re: Abortion Act; feticide; a potential father’s rights; obligations of a woman to a fetus; post-coital contraception

Question 2

What are the 2 methods of termination of a pregnancy of less than 14 weeks?

What are 2 methods for 14 weeks or more?

Answer 2

• Methos of ToP for less than 14 weeks:

1) Surgical
• Manual or electric vacuum aspiration

2) Medical
• Mifepristone, followed (24-48 hours later) by misoprostol
• Misoprostol may be administered at home

• Methods for ToP for 14 weeks or more:

1) Surgical
• Vacuum aspiration or dilation and evacuation (D and E)

2) Medical
• Mifepristone, followed (24-48 hours later) by misoprostol
• Administered at a medical facility

Question 3

Outline the abortion statistics in England and Whales for 2018?

Outline these statistics for Scotland? What % of abortions are unsafe worldwide?

What % are in developing countries?

What are restrictive abortion laws not associated with?

Answer 3

• In England and Whales for 2018, 71% of abortions were medical abortions, with 98% being for the reason of social grounds, and 2% being due foetal abnormality
• In Scotland for 2018, 86% of abortions were medical abortions, with 99% being for the reason of social grounds, and 1% being due foetal abnormality
• Almost half of abortions worldwide are unsafe, with 97% being in developing countries
• Restrictive abortion laws are not associated with less abortions
• In general, where abortions are legal, they are safe
• Where illegal, mostly unsafe

Question 4

What is the abortion act 1967?

What is Offences Against the Person Act (1861)?

What is point 58 and 59 of this act?

What is the 1929 Act of Parliament?

Answer 4

• The Abortion Act 1967 states abortion is legal if carried about by registered practitioner and if risk to baby or maternal life is minimal
• Offences Against the Person Act 1861 states it is illegal for a mother to self-induce abortion or for someone else to help abort (e.g drugs/instrument)
• Point 58 of this act is administering drugs or using drugs to procure abortion
• Point 59 is procuring drugs to cause abortion
• Providing or being in possession of substances or the purpose of inducing abortion is illegal
• Abortion was not a criminal act if it was performed in order to save the life of a mother

Question 5

What is the Abortion act 1967 (amendments made in 1990)?

Answer 5

• The abortion act 1967 (1990) were statutory defences against point 68and 59 of the 1861 act
• It states subject to the provisions of this section, a person shall not be guilt of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if 2 registered medical practitioners are of the opinion formed in good faith:
1) Social grounds
2) Grave permanent injury
3) Risk to life
4) Foetal Abnormality

Question 6

What are the 4 reasons to why someone may get an abortion that make abortion legal?

Answer 6

1) Social ground (up to 24 weeks)
• If the pregnancy has not exceeded the 24th week, and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant women or any existing children of her family
• Sometimes called the social grounds for abortion
• Use to be 28 weeks before 1990 amendments
• WHO definition of health – A state of physical and mental well-being, not merely an absence of disease of infirmity

2) Grave permanent injury
• The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman

3) Risk to Life
• The continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated

4) foetal abnormality
• There is a substantial rusk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped

Question 7

What are 6 key points in law regarding abortion?

Answer 7

1) Females under the age of 16 may acquire a ToP without parental consent if competent and able to understand rusks and procedures involved
2) A doctor can conscientiously object to directly participating in ToP (but not to associated tasks and patient care)
3) Conscientious objection exists for some of the grounds (and note that’s its not a yes/no)
4) AA does not give patient’s rights to demand a ToP
5) Foetus has no legal right to life
6) One the foetus is alive outside of the uterus, it acquires legal protection of a new-born

Question 8

What does the GMC guidance say on conscientious objection?

Answer 8

• The GMC guidance states:
• You must not refuse to treat a particular patient or group of patients because of your own personal beliefs or views about them
• You must not refuse to treat the health consequences of lifestyle choices to which you object because of your beliefs

Question 9

Most people would agree that killing a child or adult is wrong. Why is the case of a foetus more difficult?

Answer 9

• This is due to different theories on when life begins:

1) The foetus has full moral status from the moment of conception or implantation
2) There is a specific time point and change in moral status
3) It’s a gradual process (thus more serious reasons needed as time progresses)

Question 10

What are the 4 different views regarding the moral status of the embryo?

Answer 10

• 4 different views regarding the moral status of the embryo

1) Identity is important
• The embryo is the same entity as the child will be

2) The embryo has the potential to be a person
3) Moral value is accorded when the embryo has the properties of a person
4) The embryo has value given by others

Question 11

What are 5 ethical concerns regarding abortion?

What are some of the associated cases with each concern?

Answer 11

• Ethical concerns regarding abortion:

1) What is a serious handicap?
• Jepson vs Chief constant Mercia Police Constabulary (2003)
• Abortion was carried out after 24 weeks due to the foetus having a cleft lip and palate
• Jepson is an individual born with a cleft lip and palate that was corrected

2) Feticide
• Some consider the foetus has the same rights as a living person
• When is an embryo a person?

3) Potential Father’s Rights
• Paton vs BPAS (1978)
• Evans vs Amicus Healthcare Ltd (2004)
• Father wanted to keep the baby, while the mother wanted an abortion
• The Father wanted rights to the foetus, but didn’t win

4) Responsibilities/obligations of woman to foetus
• Weighing benefits and costs of making women have babies when they aren’t ready to be Mothers

5) Post-coital contraception (morning after pill)
• Medical opinion is that pregnancy occurs when the fertilised egg implants into the woman’s Uterus
• R vs Secretary of State for Health
• Morning after pill given to a girl under the age of 16 due to Gillicks Competence
• Religious Mother found out