In the time I have been in hospitals it has never been a first-hand experience to deal with pregnancy and abortion as that is slightly out of my course’s scope. I have had an encounter with quite a number of individuals during all my clinical blocks, each of them presenting with various conditions and all arising from different life’s spheres with different backgrounds and circumstances. One day, on a normal hospital day I got a referral for a new patient who was presenting with an unspecified lower back pain. She was presenting with added symptoms like paraesthesia and radicular pains. In the pursuit of gathering her medical history as with any new patient, I learned that the patient had a past medical history at the hospital. It was recorded that she performed an abortion at 28 weeks of gestation. She did all of this process at home through pills she bought from a “shady” place with a “suspicious dr.” I quote her words. Ever since the failed attempt of terminating her pregnancy she has been experiencing a constant back pain that radiates all the down her leg to the sole of foot, also she’s had to go for a surgery to remove the baby and all the gestational remnants that had formed at the stage of attempted abortion.

There are a lot of debates and statements that either argue or state whether abortion is right or wrong. People arguing over the mother’s body, some saying she has no right to kill an “innocent soul”, others arguing it is her right to do whatever she wants about her unborn child. Oftentimes people only focus on the physical component of the mother and the baby, ruling out other factors that could have influenced the decision to terminate the pregnancy. It might have a psychological impact on the mother, bringing back bad memories or denting her sense of self (Bateb, 2011). An unexpected baby can also have a big financial impact on someones life, and other people are already facing serious financial restraints.

Personally, I’ve always looked at abortion from my religious context; that it is against the will of God and a huge and unforgivable sin a human can ever perform. Until in the recent years, when I became more open minded about how different we are as people and how each and everyone of us is entitled to their own beliefs and morals. Learning about this really open my mind to a plethora of things in life. The moment I went through the patient’s history I deduced right there that the patient might be going through serious psychological issues following the past event, and that I would have to be more sensitive and adjust to her level of emotional state. However, the sister in charge at that ward did not think so. She rudely said to me, “clearly you’ll be dealing with a pyscho. Who does what this person did? and they expect us to be on our feet for them. I’ve worked here more than 15 years now and I am sure this patient is on drugs or something.” This was very disturbing for me coming from a person with so much experience however, it had no impact on how I still conducted my patient during our session.

The decision to go through termination of pregnancy is never an easy decision to make. Many are factors that could have played role in the decision taken by the mother, e.g she might have been abused by the father of child or rather threatened to do it, and the decision to do it would be merely to protect her unborn child from the abuse that he or she would have been born into. The mother could have suffered severe abuse and decided not to have the baby because it would bring back too many of the memories that she went through (Lathrop, n.d.). In some cultures or religions it is shunned upon any women getting an abortion so mother’s that make the decision to terminate a pregnancy get kicked out of the community or left on their own without any support. In some work places, pregnant woman are not allowed to work so they will be forced to take longer leave without an extra income and that may be a problem when the mother have others to provide for. Some mothers base their decision solely on the fact that they will not be able to provide for the child.

This was the very first time I had to treat a patient, who I was aware of had an abortion. Up until 1996 abortion in South Africa was allowed in a few limited circumstances, but that changed in 1997 when Act no.92 of 1996 the Choice on Termination of Pregnancy act was accepted as part of the constitution. According to this act a pregnancy may be terminated on request during the first 12 weeks of gestation as well as 13 weeks or more, following a consultation with one or more medical practitioners. This act defined the circumstances of abortion, legal places where it may be done as well as persons legally allowed to perform the abortion. This act was developed to recognize the rights of females with regards to decisions regarding their bodies, to advance equality and achieve the freedoms described in the human rights, which our constitution is based on. Thus this act is clearly in favor of abortion and termination of the life of the fetus. On the other hand, apart from the freedoms described in the Universal decleration of Human Rights, one specific right also needs to be taken into consideration and that is that everyone has the right to life

Life can medically be defined as “an organismic state characterized by capacity for metabolism, growth, reaction to stimuli, and reproduction.” (Merriam-webster.com, 2019). The Bible provides us with various scriptures strengthening the fact that God views life as starting before birth. Galatians 1:15 says “But even before I was born, God chose me and called me by his marvelous grace” (NLT). If you look at the definition of life and take into account what Scripture says, it makes sense that a fetus/embryo can be classified as “life” and that their lives deserve preserving. I believe that taking a life is considered murder, thus abortion can be seen as equal to taking the life of another person, however I can understand why a woman would possibly be willing to go through with it. According to Lawrence et al., (2005) reasons why women get abortions include interference of their education and work (financial implication), being afraid of being a single parent, feeling too irresponsible to care for a child as well as relationship and social issues. In cases of rape or abusive relationships, women are often forced into situations of pregnancy and may not have the resources to raise the child. If the child was conceived in an act of violence the mother might not be able to adequately love the child and provide a caring environment for him/her. Thus I can see what could lead women to making these decisions in specific situations, but there are other non-violent routes that could be followed, for example adoption. This being said the Bible provides us with a basis of wrong and right, which includes how we should treat people regardless of who they are or what they have done. Matthews 22:39 states “Love your neighbor as yourself” and Luke 6:13 reads “Do to others as you would have them do to you.” According to the Bill of Human Rights everyone has the right to dignity and equality. So even though I might believe that what she did was not right, I still respected my patient and treated her with care and compassion to the best of my ability.

The ethical dilemma with the doctor was the fact that not only was she violating the Hippocratic oath she undertook (which qualified health professionals have to take ensuring that they exercise their profession to their upmost best of their ability for the well-fare of the patients in their care), and ignoring a multi-disciplinary team advisement, but she was also practicing in a contradictory manner to the policy set in place to ensure the best quality health care in South Africa. This is known as the policy on quality of health care developed by the National Health Department of South Africa in 2000/2001 (NHD annual report, Pretoria, 2000/2001). This policy was put in place to be followed by public and private health care practitioners and institutions to ensure that the best quality of health care is provided to patients in South Africa. According to Section 27 of the South African constitution a person has the right to have access to health care services and the responsibility of the government to fulfill this right includes providing health care services.

I reported the incident to my clinician, who assured me that she would take the necessary further steps to ensure that something like this would not happen again. I then consulted with a different doctor who was on call later that week, who confirmed her postpartum depression diagnosis and advised me how to address and work with the patient during treatment sessions.

We face multiple ethical dilemmas on a daily basis in most of the government institutions and I now better understand that it is my responsibility wherever I am placed to work, to change and address these situations.

References:

Lawrence et al.. (2005). Reasons US Women Have Abortions: Quantitative and Qualitative Perspectives. Perspectives on Sexual and Reproductive Health, 37(3), 110-118.

Merriam-webstercom. (2019). Merriam-webstercom. Retrieved 3 March, 2019, from https://www.merriam-webster.com/dictionary/life

Bateb, A. (2011). Psychological Consequences of Abortion among the Post Abortion Care Seeking Women in Tehran. Retrieved from www.ncbi.nlm.nih.gov: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395931/

Lathrop, A. (n.d.). Pregnancy Resulting From Rape. Retrieved from www.jognn.org: https://www.jognn.org/article/S0884-2175(15)33527-9/fulltext