Nueva Ecija University of Science and Technology

College of Nursing
Health Ethics
Kenneth Brian D. Aguilar, R.N.
Bioethical Issues
“Abortion”
Definition

An abortion is the termination of a pregnancy by the removal or

expulsion from the uterus of a fetus/embryo, resulting in or caused by
its death. An abortion can occur spontaneously due to complications
during pregnancy or can be induced, in humans and other species. In
the context of human pregnancies, an abortion induced to preserve
the health of the gravida (pregnant female) is termed a therapeutic
abortion, while an abortion induced for any other reason is termed an
elective abortion. The term abortion most commonly refers to the
induced abortion of a human pregnancy, while spontaneous abortions
are usually termed miscarriages.

Abortion has a long history and has been induced by various

methods including herbal abortifacients, the use of sharpened tools,
physical trauma and other traditional methods. Contemporary
medicine utilizes medications and surgical procedures to induce
abortion. The legality, prevalence, and cultural views on abortion vary
substantially around the world. In many parts of the world there is
prominent and divisive public controversy over the ethical and legal
issues of abortion. Abortion and abortion-related issues feature
prominently in the national politics in many nations often involving the
opposing pro-life and pro-choice worldwide social movements. The
approximate number of abortions performed worldwide in 2003 was 42
million, which declined from nearly 46 million in 1995.[citation needed]

Types of abortion

1. Spontaneous abortion

(also known as miscarriage) is the expulsion of an embryo or fetus

due to accidental trauma or natural causes before approximately the
22nd week of gestation; the definition by gestational age varies by
country.[1] Most miscarriages are due to incorrect replication of
chromosomes; they can also be caused by environmental factors. A
pregnancy that ends before 37 weeks of gestation resulting in a live-
born infant is known as a "premature birth". When a fetus dies in utero
after about 22 weeks, or during delivery, it is usually termed
"stillborn". Premature births and stillbirths are generally not considered
to be miscarriages although usage of these terms can sometimes
overlap.

The risk of spontaneous abortion decreases sharply after the

10th week from the last menstrual period (LMP). One study of 232
pregnant women showed "virtually complete [pregancy loss] by the
end of the embryonic period" (10 weeks LMP) with a pregnancy loss
rate of only 2 percent after 8.5 weeks LMP.

The most common cause of spontaneous abortion during

the first trimester is chromosomal abnormalities of the
embryo/fetus, accounting for at least 50% of sampled early
pregnancy losses Other causes include vascular disease (such as
lupus), diabetes, other hormonal problems, infection, and
abnormalities of the uterus.[6] Advancing maternal age and a patient
history of previous spontaneous abortions are the two leading factors
associated with a greater risk of spontaneous abortion. A spontaneous
abortion can also be caused by accidental trauma; intentional trauma
or stress to cause miscarriage is considered induced abortion or
feticide.

2.Induced abortion

A pregnancy can be intentionally aborted in many ways. The

manner selected depends chiefly upon the gestational age of the
embryo or fetus, which increases in size as it ages Specific procedures
may also be selected due to legality, regional availability, and doctor-
patient preference. Reasons for procuring induced abortions are
typically characterized as either therapeutic or elective. An abortion is
medically referred to as therapeutic when it is performed to:

• save the life of the pregnant woman;

• preserve the woman's physical or mental health;
• terminate pregnancy that would result in a child born with a
congenital disorder that would be fatal or associated with
significant morbidity or
• selectively reduce the number of fetuses to lessen health risks
associated with multiple pregnancy.[10]
 An abortion is referred to as elective when it is performed at the
request of the woman "for reasons other than maternal health or fetal
disease."

Abortion methods

1. Medical

"Medical abortions" are non-surgical abortions that use

pharmaceutical drugs, and are only effective in the first trimester of
pregnancy.[citation needed] Medical abortions comprise 10% of all abortions
in the United States and Europe. Combined regimens include
methotrexate or mifepristone, followed by a prostaglandin (either
misoprostol or gemeprost: misoprostol is used in the U.S.; gemeprost
is used in the UK and Sweden.) When used within 49 days gestation,
approximately 92% of women undergoing medical abortion with a
combined regimen completed it without surgical intervention.[13]
Misoprostol can be used alone, but has a lower efficacy rate than
combined regimens. In cases of failure of medical abortion, vacuum or
manual aspiration is used to complete the abortion surgically.

2. Surgical

In the first 12 weeks, suction-aspiration or vacuum abortion

is the most common method. Manual Vacuum aspiration (MVA)
abortion consists of removing the fetus or embryo, placenta and
membranes by suction using a manual syringe, while electric vacuum
aspiration (EVA) abortion uses an electric pump. These techniques are
comparable, and differ in the mechanism used to apply suction, how
early in pregnancy they can be used, and whether cervical dilation is
necessary. MVA, also known as "mini-suction" and "menstrual
extraction", can be used in very early pregnancy, and does not require
cervical dilation. Surgical techniques are sometimes referred to as
'Suction (or surgical) Termination Of Pregnancy' (STOP). From the
15th week until approximately the 26th, dilation and evacuation (D&E)
is used. D&E consists of opening the cervix of the uterus and emptying
it using surgical instruments and suction.

Dilation and curettage (D&C), the second most common method

of abortion, is a standard gynecological procedure performed for a
variety of reasons, including examination of the uterine lining for
possible malignancy, investigation of abnormal bleeding, and abortion.
Curettage refers to cleaning the walls of the uterus with a curette. The
World Health Organization recommends this procedure, also called
sharp curettage, only when MVA is unavailable. The term D and C, or
sometimes suction curette, is used as a euphemism for the first
trimester abortion procedure, whichever the method used.

A hysterotomy abortion is a procedure similar to a caesarean

section and is performed under general anesthesia. It requires a
smaller incision than a caesarean section and is used during later
stages of pregnancy.[16]

3.Other methods

Bas-relief at Angkor Wat, Cambodia, c. 1150, depicting a demon

inducing an abortion by pounding the abdomen of a pregnant woman
with a pestle

Historically, a number of herbs reputed to possess abortifacient

properties have been used in folk medicine: tansy, pennyroyal, black
cohosh, and the now-extinct silphium (see history of abortion).[24] The
use of herbs in such a manner can cause serious — even lethal — side
effects, such as multiple organ failure, and is not recommended by
physicians.[25]

Abortion is sometimes attempted by causing trauma to the

abdomen. The degree of force, if severe, can cause serious internal
injuries without necessarily succeeding in inducing miscarriage.[26] Both
accidental and deliberate abortions of this kind can be subject to
criminal liability in many countries. In Southeast Asia, there is an
ancient tradition of attempting abortion through forceful abdominal
massage. One of the bas reliefs decorating the temple of Angkor Wat
in Cambodia depicts a demon performing such an abortion upon a
woman who has been sent to the underworld.

Health considerations

Early-term surgical abortion is a simple procedure which is safer

than childbirth when performed before the 16th week. Abortion
methods, like most minimally invasive procedures, carry a small
potential for serious complications. The risk of complications can
increase depending on how far pregnancy has progressed.

Women typically experience minor pain during first-trimester

abortion procedures. In a 1979 study of 2,299 patients, 97% reported
experiencing some degree of pain. Patients rated the pain as being
less than earache or toothache, but more than headache or backache
Local and general anesthetics are used during surgical procedures.

Abortion debate

In the history of abortion, induced abortion has been the source

of considerable debate, controversy, and activism. An individual's
position on the complex ethical, moral, philosophical, biological, and
legal issues is often related to his or her value system. The main
positions are the pro-choice position, which argues in favor of access
to abortion, and the pro-life position, which argues against access to
abortion. Opinions of abortion may be described as being a
combination of beliefs on its morality, and beliefs on the responsibility,
ethical scope, and proper extent of governmental authorities in public
policy. Religious ethics also has an influence upon both personal
opinion and the greater debate over abortion (see religion and
abortion).

Abortion debates, especially pertaining to abortion laws, are

often spearheaded by groups advocating one of these two positions. In
the United States, those in favor of greater legal restrictions on, or
even complete prohibition of abortion, most often describe themselves
as pro-life while those against legal restrictions on abortion describe
themselves as pro-choice. Generally, the pro-life position argues that a
human fetus is a human being with the right to live making abortion
tantamount to murder. The pro-choice position argues that a woman
has certain reproductive rights, especially the choice whether or not to
carry a pregnancy to term.

In both public and private debate, arguments presented in favor

of or against abortion focus on either the moral permissibility of an
induced abortion, or justification of laws permitting or restricting
abortion.

Debate also focuses on whether the pregnant woman should

have to notify and/or have the consent of others in distinct cases: a
minor, her parents; a legally married or common-law wife, her
husband; or a pregnant woman, the biological father. In a 2003 Gallup
poll in the United States, 79% of male and 67% of female respondents
were in favor of legalized mandatory spousal notification; overall
support was 72% with 26% opposed.