Bioethics and its Application in Various Health Care 3.

Sociocultural Dimensions of sexuality is the sum of

Situation the cultural and social influences that affect our thought
and actions.
Introduction -Tiefer (1995) promotes the idea of social
-In characterizing society, whether ancient or modern, there constructionism which proposes that sexual identities
are two elements rather closely interconnected, which and experiences are acquired from the people around
are of prime importance, one is the economic system, them and influenced and modified by an ever-changing
the other the family system. The sexual orals of the social environment.
community will be found to consist of several layers. -There -People acquire social meanings, skills, and values from
are positive institutions embodied in law like monogamy in the people around them.
some countries and polygamy in others. -This dimension of sexuality is the sum of the cultural
-The effects of sexual ethics are the most diverse kinds influences that affect our thoughts and actions both
personal, conjugal, familial, national, and international. historical and contemporary.
-The primary motive of sexual ethics as they have existed in Example:
Western civilization since pre-Christian times has been to -Historical influences become evident when one
secure that degree of female virtue without which patriarchal considers roles of males and females as well as certain
family becomes impossible since paternity is uncertain. customs
Marriages maybe decided by the parties themselves or by -Among sources of influence are religion,
their parents multiculturalism, socioeconomic status, ethics, the
media, and politics.
Human Sexuality and its Moral Evaluation
-Human sexuality is a part of our total personality. It Reason to Study Sexuality
involves the interrelationship of biological, psychological, and 1. Obtaining accurate sexual knowledge
sociocultural dimensions. 2. Clarifying personal values
-The Sexuality Information and Education Council of the 3. Improving sexual decision making
United States encompassing the sexual knowledge, beliefs, 4. Learning the relationship between human sexuality
attitudes, values, and behaviors of individuals. Its various and personal well being
dimensions include anatomy, physiology, and biochemistry of 5. Exploring how the varied dimensions of human
sexual response system; identity, roles, personality, and sexuality influence one’s sexuality.
thoughts, feeling and relationships.
-The expression of sexuality is influenced by ethical, Major aspects of human sexuality
spiritual, cultural, and moral concerns (SEICUS 2012)
Public aspect – adversely affects others not directly involved
- Sexuality -Talks about who we are than about what we can
Private aspect – directly affects consenting adults only
do.

Interactive Nature of Social dimensions

Meaning and purpose of human sexuality
1. Biological dimensions of our sexuality involve our
physical appearance, especially the development of 1.Procreation
physical sexual characteristics; our responses to sexual 2. Pleasure
stimulation; our ability to reproduce or control fertility 3. Expression of love
and our growth and development in general. 4. Expression of friendship/liking
Example: A model of sexual response cycle, published
by a well-known researchers Masters and Johnson in
Moral issues and the public aspect of human sexuality
1966, focused mainly on physiology.
-Fisher (1992) emphasizes the genetic aspects of 1. Rape, child molestation and sadism considered harmful to
behavior. In her view, humans have a common nature set the public and controlled by law
of unconscious tendencies that are encoded in our genes. 2. Pornography, homosexuality, sex outside marriage,
She recognizes that culture plays a role in one’s sexuality, prostitution, masturbation, non-monogamous marriage and
she also seems to support essentialism, the belief that ‘unnatural’ or ‘perverted’ sex are all activities considered by
the essence of biological dimensions. some to be against public interest
Example: the sexual double standard in which men are Arguments against sexual freedom
expected to be promiscuous and women are not, is a belief held
1. Violation of tradition and family values
by many people
2. Domino argument
2. Psychological Dimensions Sexual activity is also 3. Offense to public taste
psychology our sense of being. 4. Social diseases and AIDS
-Psychological Dimensions Sexuality is probably the
clearest example of learned aspects of sexuality. Arguments for sexual freedom
-Our attitudes and feelings toward ourselves and other 1. Individual freedom
people begin to develop very early in life. 2. Traditions seen as irrelevant
-From the time we are born, we get signals from all 3. Refutation of the Domino argument
around us on how to think and act, we learn that some 4. Offensive to public taste [don’t do, look, buy]
words are wrong or dirty and that certain parts of our 5. Social diseases and AIDS promote responsibility without
body are unmentionable. restricting choice
 Premarital sex Arguments against Arguments for
1. Natural and harmless and safe Pornography
1. The undermining of traditional morality and family values
2. The encouragement of promiscuity
3. Social diseases and AIDS Arguments against
4. Fostering of guilt and ostracism 1. Degrading to human beings
5. Having children 2. Criminal – causes harm
6. The compatibility and experience 3. Degrading to women
4. Encourages ‘perversions
Fallacy Arguments for
Arguments for
1. The obsolescence of the old traditions
1. Individual discretion
2. Social diseases and AIDS – responsibility without
elimination of choice 2. No proof of degradation
3.The promiscuity fallacy 3. Help to eliminate repression
4. The guilt and ostracism fallacy 4. Crimes covered by other laws
5. Contraception and responsibility 5. ‘Exploitation’ is matter of opinion
6. Sexual experience and compatibility
7. Sexual pleasure Prostitution Arguments against
8. A private, not a public matter
1. Extramarital and commercialized sex is immoral
Sex in marriage – type relationships (including non-legal) 2. Causes crime
Continuous and lasting Purpose of sex in this relationship 3. Social diseases and AIDS
1. Intimate expression of love
2. Procreation
Arguments for prostitution
Various types of marriage relationships
1. Safe sexual release
1.Monogamy 2. Victimless crime
2. Polygamy 3. Social acceptance and governmental control
3. Group Marriage Sexual perversion or ‘unnatural’ sexual activity.

Arguments against non-monogamous marriages Marriage

1. Bible advocates marriage
2. Tradition Fundamentals of Marriage
3. Exclusivity required by law -Marriage can refer to a legal contract and civil status, a
4. Social diseases and AIDS eliminated (or greatly reduced) religious right, and a social practice, all of which vary by legal
jurisdiction, religious doctrine, and culture.
Arguments against homosexuality -St. Thomas Aquinas (ca. 1225–1274) grounded
concurring judgments about sexual morality in natural law,
1. ‘Unnatural’ and ‘perverse’ explicating marriage in terms of basic human goods, including
2. Against laws of God procreation and fidelity between spouses
3. Sets bad example for children -(Finnis 1997). Monogamous marriage, as the
4. Homosexuals regarded as main cause of AIDS arrangement fit for the rearing of children, “belong[s] to the
5. Offensive to ‘family values’ natural law.”

Arguments for homosexuality -Monogamous marriage secures paternal guidance, which

a child needs; fornication is thus a mortal sin because it
1. Non conclusive ‘proof’ of ‘natural’ laws or God’s laws.
“tends to injure the life of the offspring.” (Aquinas rejects
2.Private issue (recent Supreme Court decision striking down
polygamy on similar grounds while, like Augustine, arguing
Texas sodomy laws)
that it was once permitted to populate the earth.)
3. No link between homosexuality and inclination to child
abuse
-Marital sex employs the body for its purpose of preserving
4. Non incompatibility between homosexuality and ‘family the species, and pleasure may be a divinely ordained part of
values’ this.

-The idea that marriage has a special moral status and entails
fixed moral obligations is widespread—and philosophically
Adultery Arguments against controversial.
-Marriage is a legal contract, although an anomalous one; as
1. Violation of most personal and intimate human the idea of it as a contract has taken hold, questions have
contract arisen as to how far its obligations should be subject to
2. Bad consequences individual choice.
Masturbation Arguments against
1. Religious – abusing oneself
2. 2. Domino argument
-The contractual view of marriage implies that spouses can
choose marital obligations to suit their interests.
-However, to some, the value of marriage consists precisely in
the limitations it sets on individual choice in the service of a
greater good: thus, Hegel commented that arranged marriage
is the most ethical form of marriage because it subordinates
personal choice to the institution.
-The institutional view holds that the purpose of the
institution defines its obligations, taking precedence over
spouses' desires, either, in the two most prominent forms, in
the service of a procreative union, or to protect spousal love.
-These theories have implications for the moral status of
extra-marital sex and divorce, as well as the point and
purpose of marriage.
Contractual Views
-On the contractual view, the moral terms and obligations of
marriage are taken as a set of promises between spouses.
Their content is supplied by surrounding social and legal
practices, but their promissory nature implies that parties to
the promise can negotiate the terms and release each other
from marital obligations.
-One rationale for treating marital obligations as such
promises might be thought to be the voluntaristic account of
obligation. On this view, all special obligations (as opposed to
general duties) are the result of voluntary undertakings;
promises are then the paradigm of special obligations.
-Thus, whatever special obligations spouses have to one
another must originate in voluntary agreement, best
understood as a promise. We will return to this below.
-A second rationale is the assumption that existing marriage
practices are morally arbitrary, in the sense that there is no
special moral reason for their structure. Further, there are
diverse social understandings of marriage. If the choice
between them is morally arbitrary, there is no moral reason
for spouses to adopt one specific set of marital obligations; it
is left up to spouses to choose their terms. Thus, the
contractual account depends upon the assumption that there
is no decisive moral reason for a particular marital structure.
Issues on Sex Outside Marriage and homosexuality
Kant’s sexual pessimism:
-Because sexuality is not an inclination which one
human being has for another as such, but is an
inclination for the sex of another, it is a principle of the
degradation of human nature, in that it gives rise to the
preference of one sex to the other, and to the
dishonoring of that sex through the satisfaction of
desire.
-St. Aquinas and other Natural Law theorists would say that
our sexual faculties have one true end — procreation.
-True, sex is pleasurable, but it is pleasurable to fulfil this end.
If this is correct then sexual activity is good if, and only if, it is
consistent with procreation and bad in so far as it frustrates
that end.
-It is important to understand that the outcome is
independent of desires, wants, reasons, hopes, fears etc. and
that for the Natural Law Theorist (NLT) it is simply an
objective fact whether a sexual act is wrong or right,
something which is not affected by culture, religion, etc. This
means that for the NLT there are objective moral truths
regarding how we ought, and ought not, to behave sexually.
-Premarital sex is wrong because children would be brought
into the world outside the safe confines of marriage.
-Homosexual acts have no tendency towards procreation at
all; contraception frustrates procreative ends; masturbation
and pornography focus the sexual acts inwards towards
oneself, frustrating procreative ends. However, it is vital to
make several clarifications as people often misunderstand NLT
-The NLT is not claiming that anything that frustrates natural
ends is wrong but rather only human acts.
- So, according to the NLT, the fact that, for instance, the
Bonobo monkeys engage in “rape”, “masturbation” and
“homosexual” acts does not mean that they are doing
something morally wrong.
-Furthermore, there is a difference between using something
wrongly and not using it at all. We use a knife wrongly if we
try to use it as a violin bow but not by leaving it in the knife
drawer. So, not using sexual faculties (celibacy) is morally
acceptable for the NLT.
-However, on the face of it, NLT does seem to have a lot of
counter examples; there are lots of things that we agree are
not wrong but do seem to frustrate natural ends.
-For example, imagine I regularly walk on my hands, or I am
fed through a tube rather than using my perfectly good
mouth, both these seem to be frustrating the natural ends of
my hands and mouth, but surely such things are not morally
wrong?
-But an NLT would agree because these sorts of examples are
not cases of the faculty being used to “frustrate” the natural
end of the hands or mouth. If on the other hand we wired
someone’s jaw shut so they could not eat through the mouth,
or if someone always walked on their hands even though they
had perfectly good legs, then this might be different. But as it
stands simply using a faculty for something other than what it
is for is not the same as using that faculty to frustrate its end.
-Furthermore, the claim is not that if you use a faculty with
the knowledge that it will be frustrating then it is wrong; it is
that if you intend to use it to be frustrated. So, for example,
sex between a man and women when the woman is pregnant
is not wrong for the NLT.
-Also, the claim is not that if something is “unnatural” it is
wrong. Deciding whether something is right or wrong is not
the same as asking whether something is “man-made or not”.
If this was the case, wearing glasses and taking medication
would be wrong and the NLT is not committed to this. So, the
use of sex toys, or various medications such as Viagra is not
wrong even though they are unnatural.
-We might think that linking sex to procreation in this way would
take all the fun out of sex, but this is not the case. Just as one can eat
a dish in many different ways whilst always fulfilling the natural
function of eating, one can be involved in different forms of sexual
act, fantasy, etc. as long as it is part of the long term function of the
sexual organs (so, for example, oral sex is not necessarily ruled out as
long as it is, overall, part of a sex act that is intended for
procreation).
-As noted, the NLT does, though, rule out homosexual sex and
all forms of contraception because having sex whilst using
contraception is to use the sexual faculties whilst intending to
frustrate their end.
Philosophy of Love, Sex, and Marriage an Introduction
-Morality divides actions into right and wrong and subdivides
right actions into permissible and obligatory. Wrong actions
are ones we should not do, permissible actions are ones we
may do, and obligatory actions are ones we must do.
-To which category does romantic love belong? And does this
question even make sense since love is an emotion, not an
action? Suppose that envy is a bad emotion.
-Suppose also that Rajiv is an envious person, and that Sanjay
is neither envious nor not envious. Sanjay should take steps to
ensure that he won’t become an envious person, and Rajiv
should take steps to expunge envy in him. Morality requires
them to act in these ways. So, morality prohibiting or
permitting an emotion makes sense, including the emotion of
romantic love. If morality prohibits it, we should act to either
expunge or not cultivate it. If morality permits love but does
not consider it obligatory, we may have the emotion and act
on it. If morality considers love obligatory, we must take steps
to cultivate it in ourselves.
SEXUAL ACTIVITY AND MARRIAGE
-Some 15% of adolescent Filipino women in 2013 reported
ever having had sex.
-Among women aged 18–24, 19% said they had had sex
before age 18. This proportion was far higher than average
among the poorest women (36%) and slightly higher than
average among those living in rural areas (22%).
-One in 10 adolescent Filipino women reported ever marrying
or entering into consensual union. Teenage unions were more
than four times as common among women living in the
poorest households (17%) as among those in the wealthiest
(4%).
USE OF REPRODUCTIVE HEALTH CARE
As of 2013, 37% of married adolescent women used some
method of contraception. This level of overall use represents
an encouraging 11 percentage-point increase from the 2003
and 2008 surveys.
• However, married adolescents in the Philippines relied on
traditional methods almost as much as they did on modern
methods (17% and 19%, respectively). Adolescents were far
more likely than all women of reproductive age to be using
such methods, which have far higher failure rates than most
modern methods.
• Twenty-nine percent of married adolescents had an unmet
need for contraception, meaning that they wanted to avoid
pregnancy but were not using any contraceptive method; this
proportion is much higher than that among married women
of any other age-group (15–22%).
• Although adolescents’ level of unmet need appears to have
declined slightly since 2003 (when it was at 34%), it has
fluctuated within a narrow range.
Issues on Artificial Reproduction, its Morality and Ethico
moral Responsibility of Nurses
Artificial Insemination
-When the husband’s sperm is poor quality or motility, several
semen samples are collected from him. The samples consist
of split ejaculates, that is, the sperm-rich first portion only is
collected for freezing and later pooling for therapeutic
intrauterine insemination. Donor semen may also be used for
this purpose.
-This method again raises the problem of acceptance of male
partner for the donated sperm, who will be the father, and
confidentiality.
-Nurses are required to deal with these issues very carefully
while protecting the values of the parents.
In vitro Fertilization
-There have been remarkable developments in reproductive
medicine.
-Assisted reproductive therapies (ARTs) include in vitro
fertilization and embryo transfer (IVF–ET), gamete intra-
fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT),
ovum transfer (oocyte donation), embryo adoption and
embryo hosting.
-The lack of information or misleading information about the
success rates and the risks and benefits of treatment
alternatives prevents couples from making informed
decisions. Some of the questions that need to be answered
regarding these procedures are as follows: Should IVF be
available only to married couples? Should the embryo be
frozen for later use? Who has the ownership—the woman,
the man or both? Who are the parents—the biological or
adoptive parents? Is compensation for egg donors
acceptable? Should the donor be anonymous? What are the
long-term effects of the medications and treatments on the
women and their children and families?
-Issues arise regarding the right to reproduce, ownership of
embryo, parenthood, and parent–child bonding, rights of
research subjects and research initiatives, truth telling and
confidentiality, and intergenerational responsibilities.
-Nurses can provide information so that the couples have an
accurate understanding of their chances for a successful
pregnancy and live birth. They can also provide anticipatory
guidance about the moral and ethical dilemmas regarding the
use of ARTs. Nurses must remember that they are to act in
the client’s best interests and not their own.
Surrogate Motherhood
-Surrogate childbearing occurs when a woman agrees to
become pregnant for a childless couple. She is artificially
inseminated with the male partner’s sperm. If fertilization
occurs, the woman carries the fetus to term and then releases
the infant to the couple after birth.
-This method of resolving infertility raises many ethical
questions including the problem of religious objections to
conception, and financial and moral responsibility for a child
born with a congenital defect. The issue of candidate
selection and the rights of the surrogate mother must also be
considered.
-Surrogate childbearing occurs when a woman agrees to
become pregnant for a childless couple. She is artificially
inseminated with the male partner’s sperm. If fertilization
occurs, the woman carries the fetus to term and then releases
the infant to the couple after birth.
-This method of resolving infertility raises many ethical
questions including the problem of religious objections to
conception, and financial and moral responsibility for a child
born with a congenital defect. The issue of candidate
selection and the rights of the surrogate mother must also be
considered.
NEED FOR SURROGATE MOTHER
-The need for a surrogate mother arises because of the
inability of married couples to conceive after unprotected
coitus.
Indication
-Either male or female or both are found to be infertile;
sperm count is less, female uterus is weak, or congenital
abnormality such as small uterus or bicornate uterus because
of which the female cannot bear the child normally. In such
cases, the couple opts for surrogate mother.
Procedure
1. Informed consent from the couple and surrogate mother is
to be obtained to start this procedure.
2. Agreement form is signed by surrogate mother declaring
that the child will be handed over to the couple immediately
after birth. All expenses towards maintaining the health of the
fetus during the pregnancy period will be borne by the couple
and money will be paid after the birth of the child. The
pregnant woman should pay attention to the growth and
development of the fetus.
3. Semen analysis of male is done, and drugs are given to
promote semen count and strength. Healthy sperms are taken
from the male and the zygote is obtained from the ovum of
the female. Through the process of in vitro fertilization, the
zygote is injected or placed into the fundus of the uterus after
a series of injections of HCG, estrogen, and progesterone to
prepare the endometrium for the arrival of the zygote and to
facilitate its implantation.
4. After zygote implantation is successfully performed by the
doctors, the mother is kept in the hospital for observation to
check the growth of the embryo into foetus.
5. A series of scanning is done to confirm the fetal heartbeat
and the surrogate mother is discharged though she is kept
under the control of the couple or the hospital until term.
6. The baby is delivered and is handed over to the couple
without allowing the newborn to breastfeed, since breast
feeding will break the agreement.
7. The surrogate mother is treated in the post-partum
period; money is settled as per the agreement and the
communication between the couple and the surrogate
mother is stopped.
Morality of Abortion, Rape and other problems Related to
Destruction of Life
DEFINITION OF ABORTION
-Abortion is defined by the World Health Organization (WHO)
as the expulsion or extraction from its mother of an embryo
or fetus weighing 500 gm or less when it is not capable of
independent survival.
-It is simply termination of pregnancy, which begins at the
moment of conception, when the sperm fertilizes the egg and
ends the birth of the child.
Kinds of Abortion
1. Spontaneous Abortion
This is defined as the involuntary loss of the product of
conception prior to 28 weeks of gestation, with the
weight of the foetus being less than 1000 gm or less.
A. Complete –That is all the content in the uterus is
expelled. No treatment, except bed rest usually needed.
B. Incomplete -part or the entire placenta is retained in
the uterus. (Bleeding occurs when part of the placenta
adheres to the wall of the uterus and the uterus does not
contract to seal the blood vessels that feed the placenta.
C. Missed abortion-when the fetus is retained in the
uterus for a period of time after its death.
2. Direct or Induced Abortion
-Induced abortion means deliberate termination of
pregnancy either by medical or by surgical method
before the foetus becomes viable.
Legalized Abortion: Legal abortions are performed in
India after the MTP Act of 1971 (revised in 1975) was
passed; it is a deliberate induction of abortion prior to 20
weeks of gestation by a registered medical practitioner in
order to save the life of the mother that is at risk due to
the growing foetus in the mother’s womb.
Illegal Abortion: An illegal abortion may be self-induced,
induced by someone who is not a physician or not acting
under his/her supervision, or induced by a physician
under conditions that violate the state laws governing
abortions. Illegal abortions are often associated with life-
threatening complications.
Directed to the use of the following procedures:
1. Vacuum Aspiration –suctioning of the lining of the
uterus using thin and flexible tube through the
opening of the cervix
2. Dilation and Evacuation and Curettage (D & C) use
of suction tube to remove the fetus and placenta.
3. Prostaglandin and Saline Injection –is administered
into the amniotic sac through the wall of the uterus
to induce abortion
4. Hysterectomy –Removal of the uterus.
3. Indirect abortion –termination of pregnancy is not
directly intended but becomes only the necessary result
of another medical procedure
ISSUES IN ABORTION
There are various issues that surround the topic of abortion.
The following rights of the foetus are not protected:
1.Right of the foetus to survive
2.Right of the foetus to be respected
3.Right of foetus not to be harmed
4.Right of the foetus to get treatment for survival
5.Right of the foetus to get nutrition, safety and comfort
sociological Indications
The absolute sociological indications are as follows:
1.Pregnancy by rape or sexual abuse
2. Failure of contraceptive use
Illegal or Unsafe Abortion
1. It is usually performed by a person who is untrained
in having abortions.
2. It involves using unnatural and unsafe devices to
remove the fetus.
3. The persons who perform illegal abortion are not
registered in the Medical Council and are not
recognized by the state government; if caught, they
are liable to be sued under law and can be
imprisoned.
4. An illegal abortion may be called a “back-alley”,
“backstreet” or “backyard” abortion. India records a
 whopping 5.7 million uncared for abortions every
year and over 80 percent of the pregnant women do
not get hygienic antenatal care or are left uncared.
Every year 6.7 million abortions take place in India,
but the sad part is that of this 5.7 million are illegal.
ETHICAL PRINCIPLES OF ABORTION National Abortion
Federation (NAP)
-This is the professional association of abortion providers in
North America. The board of NAP has developed a document
of ethical principles as a guide for practitioners. These
principles help the care providers in a challenging situation.
-A care provider is expected to practice higher professional
conduct with compassion and respect for the dignity of each
affected individual.
The following are the guidelines recommended by the NAP:
1. Maintain mutual, healthy physician–nurse–patient
relationship.
2. Ensure that informed consent is signed not by force
but of the own free will of the mother.
3. In case of incompetent patients such as a minor girl
below 18 years of age or a woman with psychiatric
illness, informed consent must be obtained from the
parents or guardian.
4. While getting the informed consent signed, there are
certain principles to be followed such as providing
complete details about the abortion procedure,
treatment method, and alternatives that are
appropriate for the patient.
Reporting of Sexual Abuse in Minor or Incompetent Patients
The appropriate guidelines for reporting of sexual abuse in
case of minor or incompetent patients are as follows:
1. The nurse should understand the situation that has
its own legal obligation and should immediately
report the abuse to the concerned authorities as per
the jurisdiction.
2. The nurse should report to the concerned authorities
if the minor or incompetent patient is not capable of
giving informed consent.
3. The nurse should report to the government about
the ongoing risks of abuse and neglect of minors and
incompetent patients.
4. Before reporting to the government, the nurse has
to communicate clearly with the minor or
incompetent patient with good faith and effort.
These details about the client will not be revealed by
the nurse.
5. Once judgment is obtained from the court, the
surrogate is decided.
Avoiding Misconduct and Malpractice
1. A nurse should adhere to the following guidelines
while providing care:
2. A nurse should not do an abortion for money nor do
abortion services in a misleading manner.
3. A nurse should not verbally or physically abuse the
client.
4. A nurse should not make sexual comments or sexual
approaches to the patient.
5. A nurse should not provide care if he/she is addicted
to drug or alcohol.
6. A nurse should not practice abortion with
unpermitted drugs or use drugs beyond their expiry
date. If a nurse is found to indulge in misconduct or
malpractice, he/she is liable for punishment.
HISTORICAL BELIEFS ON ABORTION
There were many beliefs regarding abortion in the ancient
period. It was not accepted by the Greeks and Romans. The
Old Testament states that persons causing miscarriage leading
to abortion in a woman must pay a fine to the husband of the
woman; but, if they cause the woman to die, then they are
liable to be killed. The various beliefs and practices
regarding abortion in the various countries are as follows:
England
The English Common Law did not accept abortion, which was
a crime. An English law enforced in the 1803 states that
abortion after quickening is a criminal offence that requires
death penalty but is less punishable if it is before quickening.
However, in 1837, the law considering abortion to be a crime
along with the death penalty for abortion was abolished. In
1920, a law was enforced that states that abortion can be
done if the mother’s life is at risk and is done with good faith.
The USA
In the USA, having abortion was common, but it was kept
secret because of the strict laws against unmarried sexual
relationship and activity.
By the second half of 1800s, laws against abortion were
enacted.
By the 1900s, abortion became illegal in every part of the
USA, except when it was done to save the mother’s life.
In 1967, an Abortion Act was passed in England that states
that abortion can be done by a doctor, with an approval of
another two doctors, only for the following reasons:
1. The growth of the foetus will be a risk to the mother’s life
and can cause physical and mental harm.
2. The mother is mentally unsound.
3. The foetus is known to have mental or physical
abnormalities, for example, any handicap or congenital
disease, such that the child might not survive after birth.
By 1970s, abortion was legalized in most of the European
countries and Japan.
Abortion was permitted until six months of pregnancy in the
USA under a law passed by the Supreme Court in 1973.
The UK
An Abortion Act was passed in 1967 stating that abortion can
be done up to 28 weeks of pregnancy. The declaration of
Oslo, by the World Medical Association, in 1970 made it clear
that therapeutic abortion can be done only to save the
mother’s life; a competent physician permitted by an
appropriate authority can perform the abortion.
India
Abortion was not allowed in India unless medically indicated,
until the MTP Act was passed.
In mid-1960s, the government of India appointed an abortion
committee under the leadership of Dr. Shantilal Shah to
provide the statistics of abortions done illegally. The report
was submitted on 30th December 1966.
Based on the ultimate needs, in order to avoid illegal abortion
and to safeguard the mother’s life, the MTP Act was enacted
in 1972 and revised in 1975.
and image and is destroying a part of the God’s creation. It is
an unjustifiable act of wounding, and it is wrong to injure the
foetus.
Learning about all these religious beliefs will help a nurse to
react appropriately when she/he provides care for a patient
of a particular religion.

Philippines
Abortion It shall equally protect the life of the mother and the ETHICAL DILEMMAS IN ABORTION
life of the unborn from conception." The act is criminalized by There are many ethical dilemmas against and favoring
Philippine law. Articles 256, 258 and 259 of the Revised Penal abortion.
Code of the Philippines mandate imprisonment for women There are certain issues in abortion that are in dilemma or
who undergo abortion, as well as for any person who assists under debate. A nurse must have knowledge about such
in the procedure issues and handle them carefully. Some of the issues are as
follows:
RELIGIOUS BELIEFS CONCERNING ABORTION
There are many religious beliefs that influence the performing 1. Killing an innocent life is wrong. As human life begins at
of an abortion. A nurse should be oriented towards such conception, the foetus is a living being, which is very
religion beliefs. innocent. Therefore, having an abortion is wrong and is a
merciless act.
Roman Catholic Christians 2. Fetus is a person. People consider the foetus as a unique
The Catholic Church strictly prohibits abortion. According to genetic code and a unique individual, and therefore, it should
its beliefs, life begins once the fertilization is over. The foetus not be destroyed.
is independent and unique and has its own genetic code, and 3. If not killed, the foetus would also grow into a human
nobody has the right to kill the foetus mercilessly. Doing being and have a future like others; therefore, it is wrong to
abortion is a sin, and even now many hospitals of the Catholic kill the foetus and destroy its future. It is wrong to cause pain
missions never do MTP (Medical Termiation of Pregnancy) or and discomfort to the foetus. Since the foetus can feel pain by
even tubecto 18 weeks, carrying out abortion after 18 weeks of pregnancy
will cause pain to the foetus.
Hinduism 4.Legalized killing of foetus is wrong as legal killing reduces
Hinduism is based on the principle of ahimsa, which means or decreases the respect for life. It is bad for the society and
non-violence, and therefore, the beliefs of Hinduism are contributes to mercy killing called euthanasia and genocide
strongly against abortion. Hindus believe that all lives are holy and increases the mortality rate of children. Therefore,
and sacred and should be respected. Therefore, killing a abortion is always considered to be wrong.
foetus is considered to be evil. However, abortion is practiced 5.There are cases where abortion is done since there is a
by certain groups of Hindus in India because of their serious medical problem to mother or the foetus such as the
preference for male child. Female feticide has become following:
common in certain places in India. a. Pregnancy that might lead to the mother’s death, for
example, eclampsia, uncontrolled convulsion, untreatable
Islam hyperemesis that risks the mothers.
-Muslims were never allowed abortion after 120 days of b. Presence of too many fetuses in the uterus, where it is
pregnancy, but Islam allows abortion to save the life of the difficult for all of them to survive.
mother and it is justified with the following reasons: c. Defective foetus that will die if pregnancy is continued.
1.Mother is the one who gives origin to the foetus d. Defective foetus such that the baby will not be able to
2. Mother’s life is only important survive after birth.
3. Mother has duties and responsibilities
4. Mother is a part of the family 6.In some cases, abortion is done because the child will not
5. If the mother’s life is at risk, allowing the mother to die will be normal and healthy to be able to survive. The child might
also kill the foetus. suffer from serious structural or mental abnormality, which
Thus, abortion is permitted only if the life of the mother is at makes its survival difficult, for example, down syndrome or
risk. These Muslim laws are known as Sharia laws. mental retardation.
7.There are cases where abortion is done since the pregnancy
Sikhism was totally unintentional such as the following:
In Sikhism, abortion is forbidden. According to their holy text,
Guru Granth Sahib, the practice of abortion is forbidden and a. Pregnancy because of rape.
is a sin. Though the religion is against abortion, there is a b.Pregnancy that happened due to the failure of
practice of aborting the female embryo to get male children contraception.
in the family. c. Pregnancy that resulted because of unsuccessful
Judaism vasectomy.
Jewish law permits abortion in the first 40 days of pregnancy. d. Pregnancy in a mentally incapable woman, for example,
The life of the embryo at that stage is considered to be of pregnant woman with psychiatric illness such as psychosis
little value, but the religion does not permit abortion on who is not of a sound mind to take care of the foetus.
demand. Again, Judaism permits abortion only if the growing
foetus risks the life of the mother. Apart from that, the
religion says killing the foetus is breaking the God’s command 8. Abortion is also done in cases where the pregnancy was
 unintentional, but the risk was taken by the parents. The
reasons are as follows:
a. Pregnancy due to usage of failed contraceptives, even
after knowing all the advantages and disadvantages of
the contraceptive before using it.
b. Pregnancy resulted because of careless use of
contraception.
c. Pregnancy resulted because of not using contraception.

9.In some cases, abortion is done because the

pregnancy affects the lifestyle of the mother such as
follows:
a. Coping up with a disabled child is difficult for a
pregnant mother
b. Difficulty in bringing up the child because of
poverty

Thus, the arguments, debates, and ethical dilemma continue.

However, a nurse should support and go with legalized
abortion, at the same time enquiring and ensuring that the
reasons for abortion are legal

CONCLUSION
-Abortion, of course, is a serious issue that deals with two
lives, namely, the mother and foetus.
-Killing any life is wrong and is against the ethical principles.

-However, legalized abortion is done only to save the life of

the mother or to prevent the birth of a child whose survival
will be very difficult.

- A nurse should be aware of all the laws concerning abortion

and the ethical issues, dilemmas, and principles associated
with it.

- They help the nurse to guide the behavior and provide

guidelines for reacting towards abortion.

- The nurse should provide good care to the mother who has
undergone abortion, create awareness about the illegal or
unsafe abortion practices, and prevent the feticides and save
the life of the mother and the child.