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thecoolest47

Ethical case: abortion based on gender

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Mrs. S is a married 35-year-old Hindu woman expecting her fourth child. She has 3 daughters and on several occasions has expressed her desire to have a son. Because of her age she is referred for amniocentesis to rule out genetic anomalies. A healthy female fetus is reported, whereupon Mrs. S requests a termination of pregnancy. The pregnancy is now at 20 weeks.

 

http://www.cmaj.ca/cgi/content/full/163/9/1167

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what would you do as a doctor?

 

p.s. This topic is quite interesting. I know that they have actually banned gender-based pregnancy screening in India.

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Wow, I can totally see this thread turning into a heated pro-life vs pro-choice dispute.

 

To me though, the fact that the decision is based on gender doesn't really make the scenario different from other elective abortions.

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Hey guys,

 

Sorry but I'm not too familiar with what a physician is obligated to do in abortions in general. Are physicians allowed to decide whether or not to do an abortion for a patient? If they are uncomfortable doing one, are they legally allowed to say no?

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This is a really difficult scenario... If the patient had wanted a boy, they should have asked for the sex of the baby earlier on in the pregnancy. The patient, in this case, would have had a lot of time to determine the sex of her baby, and thus - whether or not to terminate her pregnancy.

 

I think in this case, the patient has a certain responsibility to be pro-active in the decisions of her pregnancy - rather than waiting for such a long time to make her decision. I also strongly feel that it is the mother's choice, regarding whether or not she would like to keep the baby. A woman should not be forced to keep a baby that she does not want (in my opinion, this also depends on how late into the pregnancy this is, again - due to my opinion that people need to have some responsibility for the baby growing inside of them).

 

I feel that I would personally not be able to perform the abortion because I feel the decision comes very late. She could have found out the sex much earlier, and terminated the pregnancy then - rather than waiting so long, especially if having a boy is such an important thing for the patient. Being cognisant that others are going to have a different opinion of this than I am, I would also inform the patient that there may be doctors who would agree to perform the abortion, and refer the patient to them for consultation.

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I agree with what someone has said earlier; the gender does not have a huge impact on me. As long as abortion is still a legal viable option (I am unsure as to what the time limit for abortion is) I would not have a problem with the woman wanting an abortion.

 

To me at least, the reasons why the person wants an abortion is much less important as to how far along the fetus has developed. Frankly I would be a little relieved that it is an older, hopefully more mature woman comming in, rather than a naive teenager who never thought to use a condom.

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So I think there are a few things that haven't been covered in the discussion that are pertinent to a tough decision like this...

 

A case like this might set the precedent for future abortions based on discrimination... genetic testing can also reveal the baby's hair and eye colour... are these potential factors that a woman could start to bring into such a serious decision? It could be a slippery slope.

 

I think that it would be prudent for any doctor to sit down and talk in depth with the patient about her motivations. It's important to know exactly what may be driving her choice. I don't think that it would be right to make any decision as a physician without understanding how factors such as family, culture or religion play into the situation.

 

Apparently, (according to the all-knowing wikipedia) third-trimester abortions are performed, although there are very few physicians who will do it. Patients are being referred to the States in some of these cases.

 

I don't know what I'd say if faced with this in a clinic, but I thought I'd add a few more things to think about.

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If I were to answer this in an interview I'd probably say that I don't know much about the standards and regulation on abortion, however, that I would adhere to what ever the law permits and the medical association recommends.

 

Digressing further, I forsee a lot of similarities to this issue as to what would go on with 'genetic testing'.

 

Counselling services must be provided to this woman in making such a decision. Her reasons for the abortion must be understood (personal, cultural, religious) and applied to the context of her own life. "Informed consent" must be given. It must be explained to her how an abortion could affect her health and what stage the developing fetus is at. Based on this information if she still decides to pursue the abortion that is her decision.

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The abortion issue centralize on the issue on the issue of the rights of the woman and the moral status of the fetus.

 

Arguments for abortion include the right to choose the fate of her body and the fundamental right to privacy. The fetus is seen as connected to her body.

 

Arguments against destroying the fetus is the moral status of the fetus as a potential person, and therefore, has a positive right of life and the negative right to be left unharmed. In the spectrum of ovum to newborn, the more a personhood an entity has, the greater its moral status.

 

At what point does life outweights privacy? Some say that fertilized eggs has the moral status of a full term fetus. Others say abortions are exceptable until birth.

 

Pregnancy acquired through rape may be morally aborted. Another instance where abortion is morally justified is when the fetus contain fetal genetically diseases.

 

The choice of abortion based on sex selection is morally unacceptable.

 

The physician must follow his or her own moral conscience in supporting or rejecting abortion. If he favours abortion, he must act according to the standards of informed consent, discussing risks, consequences, benefits, alternatives, risks to those alternatives. Those physicians that rejects abortion must determine how far he or she will go to refer the patient elsewhere, and determine how much he or she allow his or her bias to affect counselling.

 

Andy

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I would seek to speak with Mrs S about her motivations for terminating the pregnancy. What exactly are her motivations for termination? Is she worried that she is getting older, and would therefore like to have another chance at having a healthy son, sooner rather than later? Perhaps her financial situation limits, or she has a desire to only have four children. Once I understand Mrs.S's motivations and situation fully, I'd try and help her the best way I could. I'd let her know that she has a few options.Keeping the child, or delivery early and give it up for adoption. I would say, that although I respect her request for termination, at such a late stage it might not be an option, because it may be considered illegal. Two reasons I coudl think of for this potentially being illegal, is the late stage of pregnancy and the fact that the mothers health is not compramised by her having the baby. Because I'm not entirely certain that Mrs S is legally not allowed to terminate pregnancy, I would seek to find out for her, by contacting the ethics committee, or arranging a meeting with her and the committee. I would hope that with the information I gave her, and from the committee, Mrs S would do the right thing for herself, her family, and her unborn baby.

 

Mrs. S is a married 35-year-old Hindu woman expecting her fourth child. She has 3 daughters and on several occasions has expressed her desire to have a son. Because of her age she is referred for amniocentesis to rule out genetic anomalies. A healthy female fetus is reported, whereupon Mrs. S requests a termination of pregnancy. The pregnancy is now at 20 weeks.

 

http://www.cmaj.ca/cgi/content/full/163/9/1167

-------

 

what would you do as a doctor?

 

p.s. This topic is quite interesting. I know that they have actually banned gender-based pregnancy screening in India.

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Hi!

In my opinion, if you are willing to perform any abortion, you will perform this abortion. Basically, you respect the autonomy of the mother, while ensuring that she is making an informed decision, clearly outlining all the aspects of the procedure you are going to carry out. You know, "Your reason is as good as anybody elses...", because you cannot imagine how important it is to the MOTHER that she gets an abortion done.

 

 

I am open to the whole idea that a fetus has a very good chance of becoming an individual. However, just because that it has the chance of becoming an individual does not mean it currently has the rights of an individual. Then again, I guess i am not very open...:rolleyes:

 

In general, if they ask these sort of questions during an interview, they are unlikely to judge you on your views, but rather how comfortable you are with your stand on abortion and your supporting arguments.

 

:o

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