A few weeks ago, I was at triage when a pale young woman came in. She was suffering complications of a therapeutic abortion; we occasionally see post-procedure patients from the Morgentaler Clinic or some other provider of therapeutic abortions with ongoing bleeding or pain. A nurse colleague triaged the patient, and her distaste, even disgust, was evident with this patient. I was, I think, a bit appalled at her reaction. Afterwards I remarked she wore her feelings on her sleeve.
“I can’t help it,” she replied. “I think abortion is wrong, and girls like her use Morgentaler’s like birth control.”
About the same time some anti-abortion activists were arrested at Carlton University, causing a slight, if predictable uproar over free speech rights and anti-abortion activism. I might mention parenthetically I myself believe anti-abortion protesters have the right to demonstrate where ever they please, within reason: demonstrating on the doorsteps of the providers of therapeutic abortion would be an obvious exception, because it’s a rather obvious attempt at intimidation, not to exercise of the right of freedom of speech or assembly. I’m not particularly swayed by the university’s argument that graphic photography displayed offends the delicate middle-class sensitivities of Carleton students and should be safely tucked away. The world is sometimes a very ugly place, and seeing what offends or disgusts us helps our understanding of it. No sunshine or lollipops here, sorry.
Both my colleague’s reaction and the protests at Carlton were a reminder to me that figuring out the whys and wherefores of therapeutic abortion is always a challenge to me and, I suspect, many health care professionals in general. I’m decidedly ambiguous. Therapeutic abortions trouble me, especially those later in pregnancy, for reasons that I can only describe as instinctive, and probably emotional. But theological arguments* (as a Christian) or ethical considerations against therapeutic abortion leave me unmoved: there is always tension between the definite autonomy and dignity of a woman versus the putative dignity and autonomy of a fetus, if indeed those characteristics can be ascribed in such a way. To put it another way, I am fairly clear that a mass of cells in the womb at four weeks is not a person; it is alive, yes, and is human because it contains human DNA in the same way that a hair follicle or a bit of skin does. But the embryo is simply not viable outside the uterus at this point and potentiality, in the sense that an acorn has the potential of an oak, is not the same as actuality. Believing a whole person is somehow contained within a fertilized egg cell at conception, as anti-abortionists do, when between a quarter and a third of all pregnancies at this point onwards will end in miscarriage, suggests a very black, cosmic practical joke.
But at twenty weeks? I’ve seen fetuses miscarried at that gestational age. I’m not so sure. Is there a time between four and twenty weeks does that mass of cells becomes a person? Or does a person become fully human when it obtains self-consciousness, which may not occur for some time after birth? I don’t pretend to have all the answers. I don’t know when human life truly begins, except to say probably not within the first trimester; sometimes I have trouble even saying when it definitely ends.
That being said, for myself, though I may dislike abortion in some circumstances, I am determinedly pro-choice. From a purely nursing perspective, therapeutic abortion is a medical procedure, and I have a duty to support any patient seeking health care, whether I agree with that choice or not. All patients have autonomy and must be treated with justice — that is, as equally as possible — when seeking health care. In the same way, I subscribe to the premise of supporting choice in therapeutic abortions: no enforced pregnancies, no enforced abortions. To follow the anti-abortion position to its logical end — no therapeutic abortion regardless of the harm done to the mother or particular circumstances such as rape or incest, as many now advocate — denies that essential autonomy of patients who might come under my care. Obviously, personally and as a nurse, I can’t support that position.
As a nurse, I am also somewhat of a political animal, and my pro-choice views are admittedly coloured by the ideology and attitudes of the pro-life movement. In short, to believe the pro-life movement is only about ending therapeutic abortion is either to be astonishingly stupid, or disingenuous. The abortion wars are really one of the many proxy wars between a modern progressive and secular state (which as a Christian I support without hesitation, because a secular society provides the only guarantee anyone and everyone can practice their faith, or not) and an unambiguous and retrogressive social and religious conservatism. A cursory glance through pro-life websites will bear this out: the anti-abortion movement is bundled with all sorts of tangential issues dear to many conservatives, like same sex-marriage, stem cell research and (my favourite, from the Campaign Life site) “Creeping Socialism”. It’s probably fair (and ironic) to say the radically conservative political positions of most anti-abortion organizations have made me, the fence sitter, very strongly pro-choice.
In the end, I think it comes to recognizing that inflicting my uncertainty on others denies their free action. I realize we live in an imperfect world, and sometimes our choices and decisions sometimes come to picking between equally bad options. And yes, I do believe also that there are times when therapeutic abortion is absolutely the moral choice. In the end, it’s a conflict between faith and personal morality, and (someone else’s) autonomy, and in this case, the imposition of personal belief has no place in professional practice. It’s an internal conflict not easily concluded, and I suspect for me personally, I will never fully resolve it. Frankly, I have enough trouble keeping my own socks pulled up without worrying about the foibles of others.
___________
*I don’t want to get into the theological debates here, but it seems to me the classic “clobber” texts of the anti-abortionists, e.g. “Before I formed you in the womb I knew you,” etc (Jeremiah 1:5) are taken, as usual with these things, out of context.
Another point: various Christian denominations have written vast theological treatises have been defending the practice of warfare, which has in the past century alone has featured the deliberate killing of tens of millions. This has been called a “necessary sacrifice.” I’ve never been clear, in this context, why abortion is a sin and warfare isn’t.
[Cross-posted at Sister Sage’s Musings]
Those Emergency Blues 
#1 by jenjilks on Thursday 21 October 2010 - 1117
Hear, hear, TERN! Well said.
To hold judgment over another human being is atrocious. And judging others is unacceptable in the health care system.
We all make our choices. It is our right. I had one, after failed birth control, when I was a teen in 1st year university. It was not easy. I tell you now that it is much like a miscarriage having one in the first trimester, and the sadness, guilt, angst that ensues. But I was a very sick young lady, quite ignorant of it all. Throwing up every morning. Passing out and feeling nausea.
Only two boyfriends in my life…at that time. What did I know about it all?
Thank you for speaking up for all of us so eloquently.
#2 by Anonymous on Thursday 21 October 2010 - 1347
Thank you.
Several years ago, my tubal ligation failed (HSG showed one tube still open two months after the original surgery). I had a medical abortion at just under five weeks.
I had a scheduled follow-up appointment with a specific nurse, but when I went to the front desk and said “I have an appointment with ___” I found out that nurse had refused to treat me (really!). This made an already difficult situation more stressful and furthermore, made me angry. She did not deserve to have her job at that practice, given that she was unwilling to perform all of the duties required, resulting in inconvenience and embarrassment to me. I would have liked to have told her this to her face. Instead, I left the practice.
I don’t know what I would have done had I experienced complications, been forced to visit an emergency department and encountered a nurse like her. I probably would have left, honestly. After my experiences with various health care professionals involved in my care, I’ve come to the conclusion that I’d rather die than seek treatment in certain situations. Yes, I’ve thought that through: I’d rather go without care.
#3 by GothamNurse on Thursday 21 October 2010 - 1725
I’ve said this before – and gotten into hot water for it – but what the f*ck. I’ll say it again. If you choose nursing as a profession and your religious beliefs could possibly interfere with your care for a patient or prevent you from providing the best possible care, both physically and spiritually, to a patient, then you need to choose another career. I’ll go to my grave carrying the belief that medicine/nursing/healthcare is perhaps the one career path where personal religious beliefs absolutely cannot play a role in providing care. They just can’t…
#4 by Cartoon Character on Friday 22 October 2010 - 0131
Most people figure because of my L&D background that I am against abortions. I am not. I am solidly pro-choice. Out of safety of the woman-because no surgical procedure is absolutely safe, I would suggest to her that there are alternate methods to prevent if it is the case of birth control method…. but who am I to judge if someone wants a TAB? As a nurse I am to give care without prejudice….and I found out while working with pedophiles and sex offenders in prison that that is possible. People are human beings. I dont think I would go as far to say that a nurse shouldn’t be a nurse if she/he can’t look after a patient objectively….I would suggest she/he work in a different area of nursing where you don’t come in contact with the type of patient you have issues with….there are lots of options. Also, it isn’t always a religious belief that interferes with good patient care – I have to say from observation…..
ohh. I love your statement btw:
“a secular society provides the only guarantee anyone and everyone can practice their faith, or not”. I am saving that one! :)
#5 by Raquel on Friday 22 October 2010 - 0839
What that young patient needed from her nurse was some compassion and TLC not judgement. That is never the nurse’s right, no matter what their opinion. Would Jesus be mean and cold to that young woman? I think not.