Abortion issue has been a widely debatable moral concern for a long time. In 1973, the U.S. Supreme Court invalidated all laws that restricted the womens right for abortion in the first trimester (McLemore & Levi, 2011). Since then, nurses have been thoroughly involved in the abortion processes. Hereby, because of controversial and sensitive nature of the termination of pregnancy, nurses may experience dilemmas concerning their ethical and professional roles when dealing with women that seek abortion services. Thus, this essay aims to research and discuss an abortion issue in the context of nursing as well as determine how nurses should approach it while upholding legal and professional ethics.


Current Legal State of Performing Abortion

According to the current data provided by the Guttmacher Institute, unintended pregnancy takes up half of all pregnancies, whereby four out of ten cases of such pregnancies result in abortion (McLemore & Levi, 2011). Nowadays, the technologies and governments of many countries allow women to have an abortion, if they have such a need. The U. S. Supreme Courtss decision in 1973 declared that abortion was legal and that those states that had prohibited abortion acted unconstitutionally because they contradicted the constitutional right of a mother to privacy (Berer, 2009). According to this decision, a woman receives the full legal right for an abortion during the first trimester. In turn, during the second trimester, the states can regulate abortions only to protect the mothers health; and during the third trimester, they can prohibit abortions, except when there is a hazard to the mothers life by continuing the pregnancy.

Since the legislation and common law does not prohibit the provision of abortion, it is up to health care organizations to provide the services of abortion or not. Similarly, nurses have the right to choose to provide care for patients or invoke conscientious objector clauses and decline to care for patients seeking abortion services (McLemore & Levi, 2011, p. 673). Hereby, advance practice clinicians (APCS) that include physicians assistants, nurse-midwives, and advanced practice nurses are allowed to perform abortions in fourteen of the U.S. states, whereby only California has supported an independent role of APCs in providing the abortion at the legislative level. Hereby, APCs have proved to be well educated, safe practitioners, and cost effective abortion providers (McLemore & Levi, 2011, p. 675). According to Berer (2009), this has resulted in the establishment of a professional clinical training and programs in those states.

The Perceptions and Attitudes of Nurses toward Abortion

The abortion care excites both positive and negative attitudes. Although according to the statistics, nurses in the United States do not have extreme views concerning abortion; they may have different perceptions of their personal roles in abortion care (McLemore & Levi, 2011, p. 674). Hereby, the abortion issue may often arouse the ambivalence among nurses. For instance, some nurses do not want to assist with performing abortions, but have no objection to the care for women after an abortion procedure. There is also a number of nurses who do not only object to assist in abortion or to provide care after the abortion procedure but also feel ethically bound to persuade these women not to terminate the pregnancy.

For many nurses, the constitutional right of woman to privacy contradicts the right of a fetus to life. Since they suppose that the legalized abortion allows taking a life, they feel ethically and morally obliged to protect the fetuses life. Other nurses do not agree with such a pro-life position because they argue that it polarizes views and implies that all, who have not taken the anti-abortion position, are anti-life and do not value the persons life that is not true (Likis, 2009). Hereby, the evaluation of morality of abortion could be based on answering a question whether the fetus can be considered as a person with self-awareness and self-consciousness, which ought to have fundamental human rights, in particular, the right to life. However, since there is no sufficient evidence that could solidly support or reject the moral status of the fetus, the Supreme Court has not determined when the persons life begins (Berer, 2009).

For some nurses, performing abortion is a violation of their religious views and beliefs (Likis, 2009). Indeed, the religion is a significant modifier of nurses views and may have a crucial role in determining how nurses build their attitudes concerning the abortion issue. Thus, according to the statistics, 13 % of nurses have indicated the religion as a main reason for their negative and disapproving attitude towards abortion (McLemore & Levi, 2011).

The termination criterion, which is a reason for why women decide to terminate the pregnancy, is also a crucial factor influencing the nurses attitude. The termination criteria can include such factors as health of the mother, the physician advice, rape, or failed contraception. Hereby, some nurses can easy assist with the abortion if the mother or the fetus has serious anomalies, or when pregnancy may endanger the health of a woman, but feel uncomfortable in other unthreatening cases. Besides, the question whether the fetus will be able to survive, if the mother has health problems, is vital. Besides, the age of the fetus is crucial. In terms of the time constraints, some nurses agree to assist with the abortion in the first trimester of pregnancy, but not later. Hereby, according to Guttmacher Institutes statistics, nine out of ten of abortions are performed in the first trimester (McLemore & Levi, 2011). Thus, such termination criteria allow many nurses to feel comfortable and ethically assured while providing abortion services.

The Role and Responsibilities of Nurses in Abortion Services

Nurses must recognize the complexity of the issue of abortion from the ethical and legal perspectives (Likis, 2009). They have to learn the laws and regulation in nursing concerning the abortion issue. Hereby, while law is a formal rule of conduct enforced and controlled by the authority, ethics is a branch of philosophy that deals with the decision making about what is right and wrong. Understanding the law-ethical conflict is crucial because in their practice, nurses may have often to face some complex ethical moral issues, such as the abortion issue, and choose between doing legal or ethical things. In this light, the right nurses decision-making is of immense importance in the health care industry, as by making certain medical decisions, health care providers determine the fundamental questions of the patients life and well-being.

When faced with an issue of unintended pregnancy, the woman has such choices as to terminate the pregnancy that is to perform an abortion, to continue pregnancy with an aim of adoption, or to continue pregnancy with an aim of parenthood (Likis, 2009). According to McLemore & Levi (2011), the role of nurses, hereby, is to support the woman in choosing the best decision for herself and her family rather than making decisions for herself. Thus, the author argues that the abortion decision-making is not the nurses role. In turn, they have to provide the women with the adequate and comprehensive information she may need to make her personal right decision. Hereby, the nurses should recognize the physical, emotional, and psychological effects, each of the decisions may have on the women. Consequently, in order to assist women seeking for abortion with unbiased counseling, the nurses need to be provided with a proper education and trainings.

The historical role of a nurse was to provide an appropriate general care (Berer, 2009). However, the advances in the methods of abortion, in particular medical abortion that is performed by stimulation with medicine rather than a surgical operation, have contributed to the development of the role of nurses, as holistic providers of nursing care. Consequently nurses plan, manage, and lead a larger proportion of care for women seeking medical abortion. Hereby, the role of nurses has been expanded in the providing first-trimester abortion not only in the U.S. practice but in many European countries as well (Berer, 2009). Thus, in Great Britain, the nurses are allowed to perform the medical abortion, if a physician prescribes the medicine. Meanwhile in Sweden and France, the medical abortion has been organized in such a way as to diminish the role of physicians in medical abortions and, hence, decrease the staff costs. Additionally, the nurses may provide the contraceptive services as well as serve as educators on birth control and sexuality (Likis, 2009). Thus, the roles of nurses in abortion are steadily increasing.

The nurses have the right to have their own position and are not obliged to support the attitudes, with which they disagree. Moreover, they can refuse to participate in the abortion procedure or assist with the care of women after abortion, if it contradicts their ethical or moral beliefs. However, nurses have to inform their position and attitude before they begin working in an organization that performs abortions. It is unethical, if the nurse withholds her views when assigned to provide a care during or after an abortion and then refuses to do it (McLemore & Levi, 2011). If the nurses feel they are not able to care for a woman compassionately because of personal beliefs and convictions, they should announce it to a supervisor so that he/she could arrange the appropriate care for the woman.

Nurses have also some others responsibilities that must be taken into consideration in a conflict about abortion. Firstly, nurses should understand that while for some women abortion is a serious ethical dilemma that causes personal distress, for other people, it may be a violation of their religious and personal views. Secondly, nurses have to recognize and accept the emotions and beliefs of all participants, including themselves. Thirdly, they have to respect the values and beliefs of their co-workers and institutions concerning assisting in the abortion care. Overall, the nurses have to recognize the womens right to make decisions and respect them even if such choices seem to be unethical to them.

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