Introduction
Nurses are key players in the health care industry and their services are critical to the delivery of health care services to the population. Professional guidelines oblige nurses to give safe, competent, and comprehensive care to the patient. Even so, nurses are at times faced with ethical issues in their work lives. One of the ethical issues that nurses face concerns abortion. The World Health Organization documents that one in five pregnancies ends in abortion making abortion an issue that each nurse will have to deal with at some point in his/her career (Gallagher, Porock & Edgley, 2009). In addition to the prevalence of abortion, this practice is legal in the US, and as key personnel in health care provision; nurses have to deal with the issue. Chaloner (2009) observes that despite the legal acceptance of abortion, it remains an ethically contentious subject for many nurses in the industry. While some nurses do not have a problem with carrying out their duties as a patient undergoes an abortion, others do. For this reason, issues of abortion present significant ethical challenges for nurses. This paper will discuss the ethical issues that nurses face when tackling abortion and provide a detailed explanation of how nurses can deal with the issue in a legally and ethically sound manner.
Abortion and the need for Ethics
The practice of abortion, which is the deliberate termination of pregnancy, has had its legal and moral status change over the decades. While the practice was outlawed in many western countries for centuries, laws began to change during the 20th century and it is today legitimized in many countries. Abortion in the United States although since 1973 through individual States might restrict the situations under which abortion may legally be carried out (Chaloner, 2009). Professional guidelines direct the nurse to provide the optimal level of care for the patient and act as an informative guide on the patient’s health care choices.
The legitimacy of abortion in the eyes of the law has some influence on how the nurse should approach the issue from an ethical perspective. Laws have a moral bearing since they often reflect on the ethical and moral values of society. If the law deems abortion legal, then the nurse must abide by this since it is a reflection of societal ethics. Even so, the moral position on abortion is individually constructed and this raises some ethical issues. Ethics are the system of moral principles that help qualify a nurse’s action as either right or wrong (Johnstone, 2010). Ethics assist in the determination of what practices are acceptable when dealing with patients within the health care setting. Nurses follow ethics that are highlighted in professional nursing bodies such as the American Nurses Association and the International Council of Nurses. These bodies offer guidelines for professional and ethical conduct.
An Ethical Approach to Abortion
Nurses must consider that the patient has the right to make decisions concerning their health care. The principle of autonomy explicitly states that the patient should be allowed to make independent decisions on issues without undue pressure or influence from the nurse. Chaloner (2009) states that in all situations where individuals are deemed competent to make informed decisions, they should be allowed to make independent decisions concerning their bodies without being forced to act against their wishes. The ethical conduct for the nurse would therefore be to let the client make her own decision depending on whether or not to terminate a pregnancy. Gallagher et al. (2009) contend that abortion is a unique issue since the clients have “diagnosed” themselves with an unwanted pregnancy and decided upon their own “treatment. The nurse is not allowed to try to influence the client in any way since the nurse holds a position of authority and his/her opinion is held in high esteem by the client.
Nurses are required to provide clients with accurate information at all times and avoid withholding information that might help the client to make decisions concerning his/her health. Some nurses are opposed to nursing due to their personal or religious convictions (Gallagher et al., 2009). This might cause the nurse to avoid giving the client all the necessary information to dissuade her from engaging in the procedure. This would go against the core principle of veracity, which dictates that the nurse must be truthful with the patient. It is unethical for a nurse to choose to withhold information about options relating to pregnancy terminations just because he/she does not approve of it. Such an action is against the professional code of conduct that the nurse is supposed to abide by. Failing to provide truthful information might expose the nurse to disciplinary action by the health care institution or even legal action.
A nurse who works in an environment where abortions are carried out is required to exercise professionalism in his/her work and provide optimal care for the client. Professional ethical guidelines assert that the nurse must promote the interests of the client at all times (Johnstone, 2010). Nurses are expected to provide the best quality of care at all times. As such, the nurse must provide the client who is requesting an abortion with high-quality nursing by the nursing ethical code. The nurse must provide the patient with the necessary care and ensure that the procedure is a success. Withdrawing from the obligations later is not only unethical but also unprofessional since it will have an impact on the quality of services offered to the client.
Abortion is a contentious issue and while the law permits the practice, some nurses would prefer not to be involved in the act. Gallagher et al. (2009) state that this individual preference is often guided by personal values or religious convictions. Health care providers should not impose this obligation on a nurse if it will cause the nurse to feel that he/she is not doing the right thing. Research indicates that if a nurse is forced to act in a way that contradicts their moral values, they experienced moral distress, which causes feelings of anger, frustration, and helplessness (Varcoe et al., 2012). Such reactions will influence patient care since the nurse might distance himself/herself or withdraw from patients. This view is shared by Johnstone (2010) who asserts that if the belief system of the nurse is completely disregarded, the nurse might face psychological disturbances leading to a decrease in his/her work efficiency.
The nurse has the right to legitimately avoid participation in the abortion procedure. This conscientious objection makes it possible for a nurse who is not comfortable with abortion to avoid any direct involvement in interventions that will lead to the termination. The nurse who feels that abortion is wrong must bring the matter up with her superiors in good time. This will enable a replacement to be obtained and the client to be provided with the necessary services. However, the nurse is not allowed to discriminate against a patient who has had an abortion. Gallagher et al. (2009) document that even when a nurse is allowed to avoid playing any direct role in the abortion process; he/she must care for the patient. The nurse is expected to provide care for the patient before the operation and after the operation, if it is necessary. Should the nurse refuse to deal with a patient since she has chosen to have an elective abortion, this will surmount discrimination. Discrimination is an unacceptable action by the health care community and society.
Conclusion
This paper set out to highlight the ethical issues raised by abortion in the nursing context. It began by noting that while abortion is legal, it continues to be a contentious issue for many health care practitioners. With this consideration, the paper has documented how nurses should approach the situation to uphold legal and professional ethics. Even when the practice is against the individual values of the nurse, he/she must endeavor to be helpful to the client who is considering having an abortion. The paper has indicated that unethical conduct might cause a nurse to go against the core principles of operation and jeopardize his/her career by exposing himself to disciplinary action. Upholding ethical conduct will ensure that the client benefits from quality health care and the nurse does not engage in activity that is against his/her values.
References
Chaloner, J.K. (2009). Ethics of abortion: the arguments for and against. Nursing Standard, 23 (37), 45-48.
Gallagher, K., Porock, D., & Edgley, A. (2009). The concept of ‘nursing’ in abortion services. Journal of Advanced Nursing, 66(4), 849–857.
Johnstone, M. (2010). Questioning Nursing Ethics (Ethics & Legal). Australian Nursing Journal, 15(1), 19-31.
Varcoe, C., Pauly, B., Storch, J., Newton, L., & Kara, M. (2012). Nurses’ perceptions of and responses to morally distressing situations. Nursing Ethics, 19(4), 488-500.