Abortion: Social and Ethical Issues

The human medicine is the branch of biological sciences that studies the human body and its functioning, with the purpose of conserving and restoring the health. The medicine studies the etiology, clinical pathology, diagnosis, treatment and prophylaxis of diseases which affect the body.

From the primary medicine practiced in early stages of the history of humanity, people have reached in the present to a scientific medicine, based on evidences, which operates with concepts used in most sciences, from natural sciences (physics, chemistry, biology) to complex mathematical models and concepts borrowed from the field of philosophy and art. The progress of fundamental sciences and the research applied in the medical field provided more complex and sophisticated ways to explore the human body and led to the development of opportunities for diagnosis and treatment. There have appeared and developed new branches of medicine. The concept of health has received new meanings, the OMS defining today the state of health as a bio-psycho-social balance of the individual, and not only as the absence of any disease or infirmity.

From all these progresses results a series of medical ethics issues, most of them being still controversial. It can be mentioned, but not exhaustive: the abortion on demand or in therapeutic purposes, contraception, methods of assisted human reproduction, euthanasia (assisted death) in the case of incurable patients- maintaining them in a state of vegetation with the help of different medical devices, the use for research of different tissue harvested from human embryos.

It is moral the pregnancy interruption on demand or in case of serious illness of the fetus? This problem has many moral and religious connotations, and was political treated differently by different states. The extremes are represented by China, which has an aggressive policy of limiting the population growth, including a pro-abortion policy, and, on the other hand, the Islamic States, in which both the abortion on demand or because of therapeutic purposes are strictly prohibited by law. In Europe, most countries have legalized the abortion, but they apply in the same time policy of limiting it, by promoting methods of family planning and contraception.

The concept of "therapeutic abortion" appeared as a consequence of improvement of the prenatal diagnosis. The prenatal diagnosis is a complex medical act, considered by some as the most important procedure for preventing the genetic diseases. It involves screening tests, with an indicative value and invasive diagnosis tests, which are more accurate.

The screening tests include biochemical tests (triple test) and imaging tests (ultrasound, MRI). They present no risk for the fetus. The invasive diagnosis test include several procedures, such as the embryo biopsy and the fetal blood analysis. The last method presents the risk of abortion, of 0, 5-1%.

The triple test is a non invasive screening method for the fetus, for three markers in maternal serum. It requires a minimum quantity of venous blood from the mother. It is performed for the purpose of detecting fetal anomalies as: the neural tube defects, Down syndrome (trisomia 21), the Eduards syndrome (trisomia 18). It is indicated for the pregnant women over 35 years old, because the risk of giving birth of a fetus with genetic abnormalities increases exponentially after this age (e.g. For Down syndrome, from 0.26% at 35 years to 9.09% to 49 years), and pregnant women who already have a child born with chromosomal abnormalities.

The triple test has an indicative value, which can be performed in the second trimester of the pregnancy, between the weeks 14 - 21. It is based on the correlation between the pregnancy age and the quantitative determination of the serum markers. That's why is important to specify the actual gestational age on fetal biometrics through an ultrasound test done before. Because there can occur several false positive results, in the case of a positive result are recommended additional diagnosis tests.

Let's examine from an ethical point of view the case of a 35 years old pregnant woman who has to do in the week 17 of her pregnancy a triple test. In many cases, the pregnant woman won't be able to perform the test immediately, so the test will be scheduled a weel later.

The results won't be available instantly, but only after 3-4 days. If the result will be positive, the pregnant woman will be scheduled for another medical procedure after another 4 months. In case of a positive result, what can be done for the pregnancy at this time?

A simple calculation shows that the 35 years old pregnant woman reached after all these investigations, the gestational age of 17 + 1 + ½ + ½ + 4 = 23 weeks: sixth month of pregnancy. Can we still talk about a 'therapeutic' abortion to 'prevent the genetic disease" of the fetus? Are these expressions - euphemisms- meant to hide the fetal euthanasia? At this age of the pregnancy, the abortion could be, in fact, a premature birth of a child who, even if he would be malformed or with a genetic anomaly, he would still be a new-born alive! With the current possibilities of medicine, this new born would have the change to be kept alive. Remember the recent cases of some premature children born at this gestational age, who survived dues to the medical progress.

Where starts the 'right to life'? The scenario described above is a case of non-voluntary euthanasia, which occurs when it's ended the life of a patient who isn't able to choose by himself between living and dying, as it agreement can't be obtained due to his mental or physical state. The fetus or the malformed new born is not autonomous, he has no ability to act responsibly in order to express or not his consent. Is it moral to blame the mother or the doctor with such a responsibility?

Sources: atheism.about.com/od/abortioncontraception/p/AbortionEthics.htm, www.studyworld.com/moral_issues/abortion/ethics_of_abortion.htm, en.wikipedia.org/wiki/Ethical_aspects_of_abortion, www.buzzle.com/editorials/12-21-2005-84521.asp