Abstract The legal approach to abortion is evolving from criminal prohibition towards accommodation as a life-preserving and health-preserving option, particularly in light of data on maternal mortality and morbidity. Modern momentum for liberalization comes from international adoption of the concept of reproductive health, and wider recognition that the resort to safe and dignified healthcare is a major human right. Respect for women’s reproductive self-determination legitimizes abortion as a choice when family planning services have failed, been inaccessible, or been denied by rape. Recognition of women’s rights of equal citizenship with men requires that their choices for self-determination be legally respected, not criminalized.
Abstract This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women’s powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously-based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of ‘reproductive health’ as one that supports women’s reproductive self-determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone-marrow or blood donations for their children’s survival. Women’s unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity.
Abstract Reproductive health services address contraception, sterilization and abortion, and new technologies such as gamete selection and manipulation,in vitro fertilization and surrogate motherhood. Artificial fertility control and medically assisted reproduction are opposed by conservative religions and philosophies, whose adherents may object to participation. Physicians’ conscientious objection to non-lifesaving interventions in pregnancy have long been accepted. Nurses’ claims are less recognized, allowing nonparticipation in abortions but not refusal of patient preparation and aftercare. Objections of others in health- related activities, such as serving meals to abortion patients and typing abortion referral letters, have been disallowed. Pharmacists may claim refusal rights over fulfilling prescriptions for emergency (post-coital) contraceptives and drugs for medical (i.e. non-surgical) abortion. This paper addresses limits to conscientious objection to participation in reproductive health services, and conditions to which rights of objection may be subject. Individuals have human rights to freedom of religious conscience, but institutions, as artificial legal persons, may not claim this right.
Abstract Principles of religious freedom protect physicians, nurses and others who refuse participation in medical procedures to which they hold conscientious objections. However, they cannot decline participation in procedures to save life or continuing health. Physicians who refuse to perform procedures on religious grounds must refer their patients to non-objecting practitioners. When physicians refuse to accept applicants as patients for procedures to which they object, governmental healthcare administrators must ensure that non-objecting providers are reasonably accessible. Nurses’ conscientious objections to participate directly in procedures they find religiously offensive should be accommodated, but nurses cannot object to giving patients indirect aid. Medical and nursing students cannot object to be educated about procedures in which they would not participate, but may object to having to perform them under supervision. Hospitals cannot usually claim an institutional conscientious objection, nor discriminate against potential staff applicants who would not object to participation in particular procedures.
The purpose of this paper is to address how analysts and commentators approach the relationship between abortion law and law governing medically assisted death, discussion of which is here limited to assisted suicide and voluntary active euthanasia. The issue of involuntary euthanasia or “mercy killing” of non-consenting persons is beyond the present discussion. This paper is further limited to English language literature, and to legal experience and commentary primarily from the United States of America, Britain and Canada, although reactions to developments in the Netherlands are included. Attention will be directed initially to legal and related analysts and commentators who oppose legalization both of abortion and of medically assisted death, and who resist application of the reasoning that supported decriminalization of abortion to medically assisted death. They represent the socalled Pro-Life protagonists in the debate. Language is often employed instrumentally in the conduct of the disagreement, but the practice adopted here is to refer to protagonists by the titles they give themselves.
Second, attention will be given to adherents to the so-called pro-choice position, who favor both liberalized abortion laws and tolerance of medical means by which individuals may end their own lives when they find survival excessively painful, burdensome, or undignified. Consideration is then given to those who oppose liberal abortion laws, perhaps because of fetal vulnerability, but who consider that non-vulnerable, competent persons, such as terminal patients in unrelievable distress, should be legally entitled to assistance in dying. The reverse is then addressed, concerning those who favor women’s choice on abortion, but oppose medically assisted death because, for instance, it may be exploitive of disabled patients or violative of ethical duties that health care professionals owe patients. In conclusion, it will be proposed that reconciliation of opposing views may be approached through promotion of choice, both to continue unplanned pregnancy and burdensome life, through availability of options that individuals may be encouraged and supported, but not coerced, to adopt.
Abstract The potential and actual applications of reproductive technologies have been reviewed by many governmental committees, and laws have been enacted in several countries to accommodate, limit and regulate their use. Regulatory systems have nevertheless left some legal and ethical issues unresolved, and have caused other issues to arise. Issues that regulatory systems leave unresolved, or that systems have created, include disposal of embryos that remain after patients’ treatments are concluded, and multiple implantation and pregnancy. This may result in risks to maternal, embryonic and neonatal life and health, and the contentious relief that may be achieved by selective reduction of multiple pregnancies. A further concern arises when clinics must or choose to publicize their success rates, and they compete for favorable statistics by questionable patient selection criteria and treatment priorities..
Abstract Human rights protections have developed to resist governmental intrusion in private life and choices. Abortion laws have evolved in legal practice to protect not fetuses as such but state interests, particularly in prenatal life. National and international tribunals are increasingly called upon to resolve conflicts between state enforcement of continuation of pregnancy against women’s wishes and women’s reproductive choices. Legal recognition that human life begins at conception does not resolve conflicts between respect due to women’s reproductive self-determination and due to prenatal life. Human rights protect healthcare providers’ claims to conscientious objection, but not at the cost of women’s lives and enduring health.
Abstract Objectives In 2 successive decades since 1967, legal accommodation of abortion has grown in many countries. The objective of this study was to assess whether liberalizing trends have been maintained in the last decade and whether increased protection of women’s human rights has influenced legal reform.
Methods A worldwide review was conducted of legislation and judicial rulings affecting abortion, and legal reforms were measured against governmental commitments made under international human rights treaties and at United Nations conferences.
Results Since 1987, 26 jurisdictions have extended grounds for lawful abortion, and 4 countries have restricted grounds. Additional limits on access to legal abortion services include restrictions on funding of services, mandatory counseling and reflection delay requirements, third party authorizations, and blockades of abortion clinics.
Conclusions Progressive liberalization has moved abortion laws from a focus on punishment toward concern with women’s health and welfare and with their human rights. However, widespread maternal mortality and morbidity show that reform must be accompanied by accessible abortion services and improved contraceptive care and information.
This article considers general principles of child custody law in regard to children born following artificial reproduction that employed donated sperm, ova or embryos, and the law applicable when women give birth to children conceived in order to be surrendered to others (notably their biological fathers). Claims to parental rights raise the issue of who the legal parents are, and may conflict with the apparent best interests of such children and the state’s view of its responsibility. The article considers interests of the unconceived child, the embryo and fetus in utero, the embryo extra uterum and a child born of donation, and the status of sperm, ovum and embryo donors and of “surrogate” mothers. Particular attention is given to the Ontario Law Reform Commission’s Report on Human Artificial Reproduction and Related Matters (1985), which is the first Canadian report to make wide-ranging recommendations on these issues .
Abstract Alarm over the prospect that prenatal diagnostic techniques, which permit identification of fetal sex and facilitate abortion of healthy but unwanted female fetuses has led some to urge their outright prohibition. This article argues against that response. Prenatal diagnosis permits timely action to preserve and enhance the life and health of fetuses otherwise endangered, and, by offering assurance of fetal normality, may often encourage continuation of pregnancies otherwise vulnerable to termination. Further, conditions in some societies may sometimes render excusable the inclination to abort certain healthy female fetuses. In places where abortion for fetal sex alone is recognised as unethical, however, medical licensing authorities already possess the power to discipline, for professional misconduct, physicians who prescribe or perform prenatal diagnosis purely to identify fetal sex, or those who disclose fetal sex when that is unrelated to the fetus’s medical condition.
