Chapter  8: Abortion

Section 5. Decision Scenarios

Summary of Methodology for Analyzing and resolving Cases involving moral dilemmas in Health Care:

Methodology: http://depts.washington.edu/bioethx/tools/cesumm.html

Paradigm for the Method:  http://depts.washington.edu/bioethx/tools/4boxes.html

Sample Case Analysis: http://depts.washington.edu/bioethx/tools/cecase.html

Introduction to Clinical Ethics, 4th edition using the case of Dax Cowart.:

http://depts.washington.edu/bioethx/tools/ceintro.html

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SCENARIOS:

For each of the scenarios you should consider how a person would reach a decision if that person were using the basic principles from EACH of the following traditions:

  • EGOISM

  • UTILITARIANISM

  • NATURAL LAW THEORY

  • KANT's CATEGORICAL IMPERATIVE

  • RAWLS MAXI_MIN PRINCIPLE of JUSTICE as FAIRNESS

CASES:

1. Late term abortion

2. Rape of 16 year old girl

3. Poverty and Birth Control

4. Mental Defect and a 22 year old female

5. Uterine Cancer

6. Selective Abortion-One of twins Fetus with Trisomy 21(Downe's Syndrome)

7. Trisomy 21

8. Life Style choice and decision for late term abortion.

From:  Munson, Ronald. INTERVENTION AND REFLECTION.

6th ED.,Belmont, California: Wadsworth Publishing Company,2000, Page 126, Decision Scenario #1

For months doctors told eleven-year-old Visna  (as we’ll call her) and her parents that her abdominal pains were nothing but indigestion.  Then in July 1998 the truth finally emerged—Visna was twenty-seven weeks  pregnant.

                Visna’s family had emigrated from India to the Detroit suburb of Sterling Heights, Michigan, only the previous summer.  Her parents found factory jobs and rented a two-bedroom apartment, and Visna shared one of the rooms with Hari, her sixteen-year-old brother.  Sometime during the winter after their arrival in the United States, Visna told her parents that Hari had raped her, but this emerged only after Visna, who had turned twelve, was found to be pregnant.

                As soon as Bisn’s parents learned her condition, they made plans to take her to Kansas for an abortion.  Visna would have to have a late-term abortion, and because Michigan law bans almost all abortions after twenty-four weeks, her family would have to take her out of state.  But their plans were frustrated when they were leaked to a family court judge.  Charges of parental negligence were filed by prosecutors against her parents, and the court immediately removed Visna from her family and made her a ward of the state.

                At a court hearing, Visna’s doctor argued that if her pregnancy were allowed to continue, it could cause her both physical and psychological damage.  A psychologist testifice that because Visna was a Hindu, if she were forced to have an illegitimate child, it would make her unfit for marriage by another Hindu.  Her parents also expressed their worry that if Visna had a child, the child might suffer from genetic abnormalities and, in particular, might be mentally retarded, because her brother was the father.

                At the end of the hearing the prosecution announced it was convinced pregnancy might endanger Visna’s life and dropped the negligence charge against her parents.  Visna was reunited with her family, and her parents pursued their original plan of taking her to Kansas.  In Wichita, Dr. George Tiller, who had been shot in 1993 by a pro-life activist, stopped the fetus’s heart and used drugs to induce labor, thus performing a “partial-birth” abortion.

 

 

From:  Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000  Page 127, Decision Scenario 2

 

                It happened after a concert.  Sixteen-year-old Mary Pluski had gone with three of her friends to hear Bruce Springstein at Chicago’s Blanton Auditorium.  After the concert, in a crowed estimated at 11,000, Mary became separated from the other three girls.  She decided that the best thing to do was to meet them at the car.

                But when she got to the eight-story parking building, Mary realized she wasn’t sure what level they had parked on.  She though it might be somewhere in the middle so she started looking on the fourth floor.  While she was walking down the aisles of cars, two men in their early twenties, one white and the other black, stopped her an asked if she was having some kind of trouble. 

                Mary explained the situation to them, and one of the men suggested that they get his car and drive around inside the parking building.  Mary hesitated, but both seemed so polite and genuinely concerned to help that she decided to go with them. 

                Once they were in the car, however, the situation changed.  They drove out of the building and toward the South Side.  Mary pleaded with them to let her out of the car.  Then, some seven miles from the auditorium, the driver stopped the car in the dark area behind a vacant building.   Mary was then raped by both men.

                Mary was treated at Allenworth Hospital and released into the custody of her parents.  She filed a complaint with the police, but her troubles were not yet over.  Two weeks after she missed her menstrual period, tests showed that Mary was pregnant.

                “How do you feel about having this child?” asked Sarah Ruben, the Pluski family physician. 

                “I hate the idea,” Mary said.  “I feel guilty about it, though.  I mean, it’s not the child’s fault.”

                “Let me ask a delicate question,” said Dr. Ruben.  “I know from what you’ve told me before that you and your boyfriend have been having sex.  Can you be sure this pregnancy is not really the result of that?”
                Mary shook her head.  “Not really.  I use my diaphragm, but I know it doesn’t give a hundred percent guarantee.”

                “That’s right.  Now, does it make any difference to you who the father might be, so far as a decision about terminating the pregnancy is concerned?”

                “If I were to be sure it was Bob, I guess the problem would be even harder,” Mary said.

                “There are some tests we can use to give us that information,” Dr. Ruben said.  “But that would mean waiting for the embryo to develop into a fetus.  It would be easier and safer to terminate the pregnancy now.”

                Mary started crying.  “I don’t want a child,” she said.  “I don’t want any child.  I don’t care who’s the father.  It was forced on me, and I want to get rid of it.”

                “I’ll make the arrangements,” said Dr. Ruben.

 

From:  Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000  Page 127-128, Decision Scenario 3

 

                “I don’t want no more children,” Mrs. Hinson said.  “I’ve already got five, and I can’t look after them the way they should be looked after.  My husband’s been gone three years.  I don’t know where he is, but I know he ain’t coming back.”

                After two years as a psychiatric social worker, David Rossum found Mrs. Hinson’s agitation familiar.  He looked around the small living room.  It was clean but crowded with second-hand furniture.  Cheap dime-store metal frames lined the tope of the television set.  Children smiled in the blurry color snapshots.

                “You’re sure you’re pregnant?” Rossum asked.

                “The doctor at the clinic told me so,” Mrs. Hinson said. “He gave me a paper to prove it.  But I’m already on welfare and the ADC.  I can’t do right by my children if I have another one to take care of.”

                “And you can’t count on the father of this child to help you?”

                “I can’t count on him for nothing,” said Mrs. Hinson.  “I don’t even see him anymore.”

                “So what do you want to do?” Rossum asked.  He knew the answer, but the main part of his job was just listening.

                “I want an abortion.  That’s what I want.  But the people at the clinic, they told me I’d have to talk to you people first.  If you won’t say it’s okay they won’t do it, because there won’t be nobody to pay for it.”

                “That’s right,” Rossum said.  “You’ve got to have an authorization from our agency for any kind of special medical procedure of a nonemergency kind.”

 

From:  Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000  Page 128-129, Decision Scenario 4

 

                Clare Macwurter was twenty-two years old chronologically, but mentally she remained a child.  As a result of her mother’s prolonged and difficult labor, Clare had been deprived of an adequate blood-oxygen supply during her birth.  The consequence was that she suffered irreversible brain damage. 

                Clare enjoyed life and was generally a happy person.  She couldn’t read, but she liked listening to music and watching television, although she could rarely understand the stories.  She was physically attractive and, with the hep of her parents, she could care for herself. 

                Clare was also interested in sex.  When she was seventeen, she and a fellow student at the special school they attended had been caught having intercourse.  Clare’s parents had been told about the incident, but after Clare left the school the following year, they took no special precaution to ensure that Clare would not become sexually involved with anyone.  After all, she stayed at home with her mother every day, and, besides, it was a matter they didn’t much like to think about.

                The Macwurters were both surprised and upset when Clare became pregnant.  At first they couldn’t imagine how it could have happened.  They recalled that on several occasions Clare had been sent to stay at the house of Mr. Macwurter’s brother and his wife while Mrs. Macwurter went shopping.

                John Macwurter at first denied that he had anything to do with Clare’s pregnancy.  But during the course of a long and painful conversation with his brother, he admitted that he had had sexual relations with Clare. 

                “I wasn’t wholly to blame,” John Macwurter said.  “I mean, I know I shouldn’t have done it.  But still, she was interested in it too.  I didn’t really rape her.  Nothing like that.”

                The Macwurters were at a loss about what they should do.  The physician they consulted told them that Clare would probably have a perfectly normal baby.  But of course Clare couldn’t really take care of herself, much less a baby.  She was simply unfit to be a mother.  Mrs. Macwurter, for her part, was not eager to assume the additional responsibilities of caring for another child.  Mr. Macwurter would be eligible to retire in four more years and the couple had been looking forward to selling their house and moving back to the small town in Oklahoma where thy had first meet and then married.  The money they had managed to save, plus insurance and a sale of their property, would permit them to place Clare in a long-term care facility after their deaths.  Being responsible for another child would both ruin their plans and jeopardize Clare’s future well-being.

                “I never though I would say such a thing,” Mrs. Macwurter told her husband, “but I think we should arrange for Clare to have an abortion.”

                “That’s killing,” Mr. Macwurter said.

                “I’m not so sure it is.  I don’t really know.  But even if it is, I think it’s the best thing to do.”

                Mrs. Macwurter made the arrangements with Clare’s physician for an abortion to be performed.  When Mr. Macwurter asked his brother to pay for the operation, John Macwurter refused.  He explained that he was opposed to abortion and so it would not be right for him to provide money to be used in that way.

 

From:  Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000  Page 129-130, Decision Scenario 5

 

                Daniel Bocker was worried.  The message his secretary had taken merely said, “Go to see Dr. Tai at 3:30 today.”  He hadn’t been asked if 3:30 was convenient for him, and he hadn’t been given a reason for coming in.

                Mr. Bocker knew it would have to do with his wife, Mary.  She had been suffering a lot of pain during her pregnancy, and the preceding week she had been examined by a specialist that Dr. Tai, her gynecologist, had sent her to see.  The specialist had performed a thorough examination and taken blood, tissue, and urine samples, but he had told Mary nothing.

                “Thank you for coming in,” Dr. Tai said.  “I want to talk to you before I talk to your wife, because I need your help.”

                “The tests showed something bad, didn’t they?”  Mr. Bocker said.  “Something is wrong with the baby.”

                “The baby is fine, but there is something wrong with your wife, something very seriously wrong.  She has what we call uterine neoplasia.”

                “Is that cancer?”

                “Yes it is,” said Dr. Tai.  “But I don’t want either of you to panic about it.  It’s not at a very advanced stage, and at the moment it’s localized.  If an operation is performed very soon, then she has a good chance to make a full recovery.  The standard figures show about 80 percent success.”

                “But what about the baby?”

                “The pregnancy will have to be terminated,” Dr. Tai said.  “And I should tell you that your wife will not be able to have children after the operation.”

                Mr. Bocker sat quietly for a moment.  He had always wanted children; for a family without children was not a family at all.  He and Mary had talked about having at least three, and the one she was pregnant with now was the first.

                “Is it possible to save the baby?” he asked DR. Tai.

                “Mrs. Bocker is only in her fourth month; there is no chance the child could survive outside her body.”

                “But what if she didn’t have the operation, mightn’t she?”

                “It’s possible, but her chances of recovery are much less.  I Don’t know what the exact figures would be, but she would be running a terrible risk.”

                Mr. Bocker understood what Dr. Tai was saying, but he also understood what he wanted. 

                “I’m not going to encourage Mary to have an abortion,” he said.  “I want her to have a child, and I think she wants that, too.”

                “But it’s not just her decision,” Mr. Bocker said.  “It’s a family decision, hers and mine. I’m not going to agree to an abortion, even if she does want one.  I’m going to try to get her to take the extra risk and have the child before she has the operation.”

                “I think that ‘s the cruelest, most immoral thing I’ve ever heard,” Dr. Tai said.

 

From:  Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000  Page 130, Decision Scenario 6

 

                Mrs. Lois Bishop (as we will call her) learned that she was carrying twins at the same time she learned one of the twins had Down syndrome.

                “There’s no question in my mind,” she said.  “I want to have an abortion.  I had the tests done in the first place to do what I could to guarantee that I would have a normal, healthy child.  I knew from the first that there was a possibility, an experimental one, that you might want to consider as an option.”

                The possibility consisted of the destruction of the abnormally developing fetus.  IN the end, it was the possibility that Mrs. Bishop chose.  A long, thin needle was inserted through Mrs. Bishop’s abdomen and guided into the heart of the fetus.  A solution was then injected directly into the fetal heart.

                Although there was a risk that Mrs. Bishop would have a miscarriage, she did not.  The surviving twin continued to develop normally, and Mrs. Bishop had an uneventful delivery.  The child, a boy, is now over five years old.

                Dr. Savano was criticized by some physicians as “misusing medicine,” but he rejects such charges.  Mrs. Bishop also has no regrets, for if the procedure had not been performed, she would have been forced to abort both twins. 

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From:  Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000  Page 131, Decision Scenario #7

 

Helen and John Kent waited nervously in the small consulting room while Laurie Stent, their genetic counselor, went to tell Dr. Carles Blatz that they had arrived to talk to him.

                “I regret that I have some bad new for you,” Dr. Blatz told them.  “the karyotyping that we do after aminocentesis shows a chromosomal abnormality.”

                He looked at them, and Helen felt she could hardly breathe.  “What is it?” she asked.

                “It’s a condition known as tisomy-21,  and it produces a birth defect we call Down syndrome.  You may have heard of it under the old name of mongolism.”

                “Oh, God,” John said.  “How bad is it?”

                “Such children are always mentally retarded,” Dr. Blatz said.  “Some are severely retarded and others just twenty or so points below the average.  Thy have some minor physical deformities, and they sometimes have heart damage.  They typically don’t live beyond their thirties, but by and large they seem happy and have good dispositions.”

                Helen and John Looked at each other with great sadness.  “What do you think we should do?” Helen asked.  “Should I have an abortion, and then we could try again?”

                “I don’t know,” John said.  “I really don’t know.” You’ve had a hard time being pregnant these last five months, and you’d have to go through that again.  Besides, there’s no guarantee this wouldn’t happen again.”

                “But this won’t be the normal baby we wanted,” Helen said.  “Maybe in the long run we’ll be even happier than we are now.”

 

 

 

 

From:  Munson, Ronald. INTERVENTION AND REFLECTION.6th ED.,Belmont, California: Wadsworth Publishing Company,2000  Page 131, Decision Scenario #8

 

Ruth Perkins is twenty-four years old, and her husband, Carl Freedon, is four years older.  Both are employed, Ruth as an executive for Laporte Gas Transmission and Carl as a systems analyst at a St. Louis bank.  Their combine income is over $140,000 a year. 

                Perkins and Freedon live up to their income.  They have an eleven-room house with a tennis court in a high-priced suburb, they both dress well, and Carl is a modest collector of sports cars (three MG-TDs).  Both like to travel, and they try to get out of the country at least twice a year—Europe for a month in the summer and Mexico or the Caribbean for a couple of weeks during the winter.

                Perkins and Freedon have no children.  They agreed when they were married that children would not be a part of their plan for life together.  They were distressed when Ruth became pregnant and at first refused to face the problem.  They worried about it for several months, considering arguments for and against abortion.  At last they decided that Ruth should have an abortion. 

                “I don’t see why I have to go through with this interview,” Ruth said to the woman at the Morton Hospital Counseling Center.

                “It’s required of all who request an abortion,” the counselor explained. “We think it’s better for a person to be sure of what she is doing so she won’t regret it later.”

                “My husband and I are certain,” Ruth said.  “A child doesn’t fit in at all with our lifestyle.  We go out a lot, and we like to do things.  A child would just get in the way.”

                “A child can offer many pleasures,” the woman said.

                “I don’t doubt it.  If some want them, that’s fine with me.  We don’t.  Besides, we both have careers that we’re devoted to.  I’m not about to quit my job to take care of a child, and the same is true of my husband.”

                “How long have you been pregnant?”

                Ruth looked embarrassed.  “Almost six months,” she said.  “Carl and I weren’t sure what we wanted to do at first.  It took a while for us to get use to the idea.”

                “You don’ t think you waited too long?”

                “That’s stupid,” Ruth said.  She could hardly keep her voice under control.  “I didn’t mean that personally.  But Carl and I have a right to live our lives the way we want.  So far as we are concerned a six-month fetus is not a person.  If we want to get rid of it, that’s our business.”

                “Would you feel the same if it were a child already born?”

                “I might,” Ruth said.  “I mean, a baby doesn’t have much personality or anything does it? 

                “I take it you’re certain you want the abortion.”

                “Absolutely.  My husband and I think it’s the right thing for us.  If others think we’re wrong…well, it’s their right to think what they please.”

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