Reality of the matter is that situations force us to make decisions that we never thought we would ever make. Decisions that leave us bruised, broken and make us feel less human. Leave us scared to face the world, the very same world that pushed us into making those decisions.
One morning my clinician gave me a referral letter to go see one of the patient in the ward who was referred for mobilization because she was weak and had lost mobility. The patient had uterine perforation post illegal abortion. patient was young, unemployed and had no co-morbidities. I was wondering why would a young woman aged 17 put her life in danger by doing an illegal abortion when it’s legal and offered in health facilities. I did not understand at all, the decision she made wasn’t the wisest decision especially for someone at her age.
After going through the folder, I went to see her. I was not really keen to see her, I just felt like she could have done better. during the subjective assessment she opens up to me as to what led her to have an illegal abortion and she explains “I never felt so judged and uncomfortable ever before in my life like I did when i went to ask for abortion”. She said she went to a local clinic where she was told how sinful abortion is and she could have prevented if she did not want a child by a stuff nurse. She immediately asked to be excused to go to the bathroom and that was her cue to leave the clinic without getting the help she needed. Her resort was to undergo illegal abortion commonly known as street abortion. A few weeks later, she fell critically ill and was rushed to the hospital where she was consequently hospitalized. After a thorough investigation, doctors diagnosed the patient with uterine perforation due to illegal abortion. Boniface, et al., (2002) states that Unsafe abortion is fraught with many complications, including pelvic sepsis, septicemia, hemorrhage, renal failure, uterine perforation, and other genital tract injuries, gastro-intestinal tract. hence she was diagnosed with uterine perforation.
Harries, et al., (2014) states that abortion is legal in South Africa after a change in legislation in 1996. The South African Choice on Termination of Pregnancy Act (CTOP) No.92 of 1996 promotes a woman’s reproductive right to have an early, safe and legal abortion. As a direct result of this legislation, abortion-related morbidity and mortality decreased by 91.1%. However, despite this legislation, there are still major barriers to women accessing abortion services. These include provider opposition to rendering or participating in abortion services often on the grounds of religious or moral beliefs, stigma associated with abortion, a dearth of providers trained and/or willing to perform abortions, and a lack of facilities designated to provide abortion services, particularly in the rural areas. Barriers to abortion provision including a shortage of abortion providers undermine the availability of safe, legal abortion, and have serious implications for women’s access to abortion services and health service planning.
However, I was curious as to what influenced her decision and tried to ask why she wanted abortion in the first place. She opened up and told me she was raped by her boyfriend which resulted in pregnancy. She said she was not prepared to be a mother since she felt it will interfere with her studies. She further highlighted that she was born in a very poor family, keeping the baby wouldn’t have been the most sensible decision for her, or her parents. According to (Torres, & Forrest, 1988) People do abortion for different reasons for instance, being unable to afford a child, not wanting to be a single parent or relationship problems, being raped, and being scared that the baby will interfere with work, school, and any other responsibilities. Which in this case is rape and not being able to afford a child. Quite sad!
It is of utmost importance to understand the autonomy of a person, which in essence is a person’s legal and mental capacity to make informed decisions. As a health care practitioner, you are obliged to respect patients and value their dignity. When a patient wants to abort, explain to them the consequences, and try to find out their reasons behind wanting to abort to ensure that they are making an informed decision. However, in this scenario, the nurse was in breach of the duty that she owes to the patient i.e. to be cautious, value dignity of the patient and inform her of the consequences of such a decision thereof. According to (Harries, Stinson & Orner, 2009) religious beliefs influence the judgment of health professionals and unwillingness to help towards abortion. The nurse’s conduct was unacceptable. She was very judgmental instead of being helpful. The ill-treatment of abortion patients is shocking. Women do not obtain the correct therapy that they are expected to receive from doctors and nurses (Hodes, 2013). There is a great deal of judgment we have experienced in the ward of women undergoing the termination of pregnancy, nursing employees are not taking good care of them or doctors refusing to help them, and making them feel guilty of their decision (Hodes, 2013). Truman & Magwentshu (2013) states that section 27 of the constitution of the Republic of south Africa, states that everyone has the right to have access to health care services including reproductive health. The patient is entitled to this right but the treatment she received from the nurse undermines the decision.
She said to me that her family does not know what is wrong with her. They do not know why she got admitted and she wants it to stay like that. She asked me to speak to the nurses and doctors for her not to say anything about the abortion to her parents. I asked her why she would want to keep such from her parents and she said they did not know that she was pregnant nor raped. she said even if they knew they would have wanted her to keep the baby hence she decided to keep it from them. I was so confused, I did not know if that was the right thing for me to do. I was not sure whether i must tell the nurses and doctors to lie to her parents taking into account that she’s still under the age of 18, her parents have the rights to know but also she have the rights to patients confidentiality. nevertheless i decided to tell the doctors and nurses exactly what she told me to say to them, I felt like it was the right thing to do for her. she has been through a lot already to deal with criticism from her parents although they also deserve to know the truth. Patient’s confidentiality comes first.
In conclusion patients decision to abort should be respected . A medical practitioner should not interfere with the decision of the patient, nor violate the patient’s ‘self-worth’ by making unpleasant and judgmental remarks because you never know what influenced or informed the patient’s decision. respect patient’s decisions !
Reference list
Boniface, A., Oye-Adeniran, Augustine V. Umoh & Steve N. N. Nnatu Source: Reproductive Health Matters, Vol. 10, No. 19, Abortion: Women Decide (May, 2002), pp. 18-21 Published by: Tayl
Harries, J., Cooper, D., Strebel, A., & Colvin, C. J. (2014). Conscientious objection and its impact on abortion service provision in South Africa: a qualitative study. Reproductive health, 11(1), 16. Retrieved from https://reproductive-health-journal.biomedcentral.com/articles/10.1186/1742-4755-11-16
Harries, J., Stinson, K., & Orner, P. (2009). Health care providers’ attitudes towards termination of pregnancy: A qualitative study in South Africa. BMC public health, 9(1), 296. Retrieved from https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-296
Hodes, R. (2013). The medical history of abortion in South Africa, c. 1970–2000. Journal of Southern African Studies, 39(3), 527-542. Retrieved from https://www.tandfonline.com/doi/full/10.1080/03057070.2013.824770
Torres, A., & Forrest, J. D. (1988). Why do women have abortions? Family planning perspectives, 20(4), 169-176. Retrieved from https://pdfs.semanticscholar.org/2c52/ac8c0fc305b346d111e018dd7ce14df57bb1.pdf
Truman, K. A., & Magwentshu, M. (2013). Abortion in a progressive legal environment: the need for vigilance in protecting and promoting access to safe abortion services in South Africa. American journal of public health, 103(3), 397-399. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301194
2 thoughts on “I HAD TO DO IT!”
Hi Masindi,
Thank you for sharing your piece, I am going to give feedback following the rubric so that it is more structured and easier to implement/follow.
Substance/Content: I think you have chosen a topic that relates to ethics and a topic we have discussed in class although I don’t think you are accurately describing the dilemma. You are mentioning the dilemma of abortion but are also including the idea of health professionals intervening in patient’s who are deciding to have an abortion or who have had an abortion… it is quite confusing to know exactly what you are trying to get at. I think rather stick to the ethical dilemma of the act of having an abortion and bring in the health professional as an additional point or experience. Because of this, I don’t think your post is yet complete. Abortion can be a simple ethical debate, in terms of explaining the different sides and points, you can find loads of literature on this, the difficulty comes in writing and engaging with the content to show the reader what you are thinking. You indicate your thoughts but I think once you are focusing more on the dilemma itself and not just writing about abortion your thoughts will be more distinct and clearer. You have drawn on evidence to make statements and included some essential information but I think there is more that can be said. Because abortion is not an original topic, try to really engage with the reader with your personal experience and thoughts. Use your clinical experience scenario more to strengthen this perspective.
Synthesis of content / Discussion / Reflection / Critical thought: You have blended the course work with your own experience but again, this can be fleshed out more. With additional evidence and a more substantial description of the dilemma you will demonstrate analytical and critical thinking. You can also make more claims and link your thoughts to these claims in addition to evidence to evaluate and apply your knowledge.
Engagement: this is more about how you engage with other posts you are commenting on. But with regards to your piece, I think you can engage more in in depth statements and claims, as I have said in the above two sections.
Writing style: I know English isn’t your first language, so I would like to commend you on your writing style. There weren’t many spelling or grammatical errors making the post easy to read. I think once you have really engaged with the ethical dilemma, try to have each paragraph deal with a new idea/claim so that it is easy for the reader to follow. Try to use similar evidence in each paragraph to strengthen your points instead of spreading the same evidence across your piece. You can improve more on a compelling introduction, an informative body and a satisfactory conclusion.
References: Your post is semi-referenced, you mention some constitution stuff but do not provide a full reference for it in your list nor in your in-text.
Time/length: The assignment was submitted on time but the length of the work is not yet appropriate to the level of the project or guidance provided by the lecturer.
Information literacy: you have not yet included any multimedia to illustrate your ideas or draw your reader in. You have the opportunity to do so, especially because this is a well-spoken about topic. Try find a picture/video that strengthens your main points and establishes a ‘unique-ness’ to your piece.
I hope this helps you, Goodluck!
Jemma
Hi Masindi, thank you for sharing your piece ! You managed to provide in-depth information regarding your clinical encounter, well done ! You illustrated your main idea clearly and it links well to the image selected given the fact that the nursing staff discriminated against the patient regarding her decision to go through with an abortion. I like how you tied in various South African laws surrounding the concept of abortion. The writing piece is appropriate in length. You have also submitted the writing piece on time.
Have you perhaps thought of perhaps placing more emphasis on your thoughts regarding the situation? It seems as though much of the focus is placed on the nursing staff and only a small aspect of your piece actually looks into your feelings regarding the situation. Please correct in text referencing ‘According to Torres and Forrest (1988) ‘ and ‘According to Harries, Stinsen and Orner (2009)’ . Thank you for sharing your piece. Hope the feedback provided will be of some assistance!
Zielke