Abortion is an old, but living topic for debate and disputation that remains controversial. It can defined as the process where an embryo or a fetus is removed from the uterus during pregnancy at a stage where it is incapable of independent survival (Shiel, 2018).   It is evident that the world remains divided between jurisdictions in which abortion should be legal and many people have different views and opinions about it.

In spite of what we would like to believe, everyone has opinions about abortion that have been influenced by the abortion stigma, which is a perpetuated phenomenon that has been created by anti-choice activists. The abortion stigma can be described as a set of negative attitudes and beliefs ascribed to abortion, those who seek and receive them, and those who provide them (Charles, 2018). It affects young girls, women, abortion providers, and reproductive rights advocates and communities (Charles, 2018). As a result of this vast stigmatism, these negative attitudes and beliefs act as barriers to accessing safe services which consequently force individuals to seek unsafe practices of abortion (Charles, 2018).

In South Africa, the Act no.92 of 1996 “the Choice on Termination of Pregnancy” was published in 1997 and accepted as part of the constitutional laws (Mhlanga, 2008). It outlined the legality of abortion, such as where it may be done and persons who are legally qualified to perform it. The act further explores the legal times in which an abortion may be acceptable and states that pregnancy may be terminated on request during the first 12 weeks of gestation as well as 13 weeks or more, provided that it is followed up by a qualified medical practitioner (Mhlanga, 2008). The main purpose of this act was to recognize and protect the rights of women in order to enable them to make decisions concerning reproduction and have freedom over control of their bodies (Mhlanga, 2008).

During my ICU block at Groote-Schuur Hospital, I assessed and treated a 25-year old female who was 28-weeks pregnant and had attempted to abort the pregnancy by ingesting organophosphate compounds. Organophosphate compounds are a diverse group of chemicals used in both domestic and industrial settings (Katz, 2018). Organophosphate poisoning can result from household or occupational exposure, leading to muscarinic effects, nicotinic effects, and/or central nervous system (CNS) effects – all of which could be detrimental (Katz, 2018). Although the patient had ingested copious amounts of the organophosphate, she had not successfully terminated her pregnancy.  Instead, the poisoning caused detrimental effects to herself but the baby  was not harmed.

Even though abortion is widely known and often seen, this was my first encounter with someone who had actually attempted to go through with it. I, therefore, had mixed emotions before meeting the patient. Initially, I felt upset as I could not fathom why any human would want to terminate their pregnancy, especially because of how far along into her pregnancy she was. However, after interacting with the patient and getting background information regarding the reasons behind her choices, I began feeling empathy towards her. This was strange for me because, for as long as I could remember, abortion was always perceived as a highly negative act without any room for reasoning. She had explained the violence between herself and her partner, her financial constraints, her lack of social support, and finally the peer pressure into going through with it. According to Hinman (2013), majority of young women tend to have abortions due to relationship problems, fear of being a single parent, and concern for responsibility of others. Although I still did not believe any of these reasons were valid enough to go through with an abortion, I did not have any feelings of anger or frustration towards this patient because I felt that she was making the best decision for herself.

My professionalism as a healthcare practitioner in-training was not tainted by my feelings toward abortion as I treated my patient to the best of my ability despite her choices and opinions. However, I found myself highly bothered when it was clear that this professionalism was not being reciprocated by other members of the health team. The patient would continuously complain about her  IV drip site being uncomfortable or not intact and that none of the doctors or nurses would help her. I, therefore, stepped in and approached one of the medical interns, raising my concerns regarding her discomfort and politely requested that he had a look at it. The result of this conversation left me at a loss for words when he replied: “It is her fault that she is in this place, don’t listen to her complaints.”

According to the South African Constitution Act 108 of 1996, every doctor has the responsibility to treat his/her patients equally and provide them with the same level of concern, to respect the beliefs and opinions of patients even if it differs from their own, not to practice hate speech that can be harmful/hurtful to others, and to fulfill their employment duties (Tsai, Charles & Mc’Murray, 2014). Patient’s on the other hand, have the right to not be unfairly discriminated against on the basis of their medical history as well as their beliefs/religion/race/gender, to be free from cruel and degrading treatment, and to have their privacy protected by those to whom they entrust such as healthcare workers (Tsai, Charles & Mc’Murray, 2014).

These rights and responsibilities were clearly not being practiced and it left me in an ethical dilemma that I would have never imagined myself in. Caught between two fires, I found myself treating a patient who had an abortion (which I believe to be morally wrong) and standing up for her medical services provided by a healthcare practitioner, whom I believed was being very unethical. It made me question myself to a point where I thought I was being wrong for having feelings of empathy while knowing exactly what she had done. However, after educating myself about how severely the abortion stigma can influence one’s thoughts and opinions, I realized that, with the abortion stigma aside, I had every right to feel empathetic and stand up for my patient, just as much as she had every right to have freedom over her reproductive health.

According to Shiel (2018), the Hippocratic Oath is an ethical code used as a guide for medical practitioners in order to ensure professional as well as ethical conduct and obligations. It is an oath in which all qualified health professionals have to take as a promise to exercise their profession to the best of their ability for the optimum wellbeing of the patients in their care. With the above incidence described, it is clear that there is a need to bridge the gap between what we as health professionals promise and how we uphold these promises. Furthermore, I believe the abortion stigma should not influence opinions as severely as it does because each person has a right to voice their beliefs, regardless of the surrounding attitudes.

Reference List:

Charles, M. (2018). Abortion Stigma 101 (And how it interferes with access to self-managed abortion). Retrieved 20 September 2019, from https://womenhelp.org/en/page/946/abortion-stigma-101-and-how-it-interferes-with-access-to-self-managed-abortion

Hinman, L. (2013). Abortion: An Overview of the Ethical Issues. Retrieved 20 September 2019, from https://www.researchgate.net/publication/242756317_Abortion_An_Overview_of_the_Ethical_Issues

Katz, K. (2018). Organophosphate Toxicity: Practice Essentials, Background, Pathophysiology. Retrieved 20 September 2019, from https://emedicine.medscape.com/article/167726-overview

Mhlanga, E. (2008). Summary of the Choice on Termination of Pregnancy Act, no. 92 of 1996 – ESST. Retrieved 20 September 2019, from https://ossafrica.com/esst/index.php?title=Summary_of_the_Choice_on_Termination_of_Pregnancy_Act%2C_no._92_of_1996

Shiel, W. (2018). Definition of Abortion. Retrieved 20 September 2019, from https://www.medicinenet.com/script/main/art.asp?articlekey=2091

Shiel, W. (2018). Medical Definition of Hippocratic Oath. Retrieved 20 September 2019, from https://www.medicinenet.com/script/main/art.asp?articlekey=20909

Tsai, H., Charles, M., & Mc’Murray, T. (2014). RIGHTS AND RESPONSIBILITIES OF DOCTORS AND PATIENTS. Retrieved 20 September 2019, from https://www.samedical.org/images/attachments/rights-and-responsibilities-of-doctors-and-patients-jul012.pdf