abortion,

Biomedical Ethics: Induced Abortion

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Abortion
Abortion is the expulsion of a living fetus from the mother’s womb before it is viable.
Abortion is the termination of pregnancy spontaneously or by induction prior to viability. Thereafter, termination of pregnancy is called delivery.

Types of Abortion
Spontaneous Abortion
Induced Abortion

Induced Abortion
Occurs as a result of artificial or mechanical interruption or due to voluntary and effective human intervention
It may be sought as an end or as a mean
  As an end: get rid of the baby
  As a mean: therapeutic abortion wherein the health of the mother is concerned.
Induced abortion is intrinsically evil and must be qualified as homicide.

Types of Induced Abortion
Abortion by D and C (Dilatation and Curettage)
Abortion by Caesarian Section or by Abdominal Hystoroctomy
Abortion by Suction
Abortion via Intra-Amniotic Infiltration
Abortion via IV infection of Prostaglandin

Abortion by D and C
Accomplished in the periods between 7 to 12 weeks gestation
Under general anesthesia
Scraping of endometrium until all embryonic or fetal matters and surrounding placental tissues are removed

Abortion by D and E
Dilation and evacuation (D and E) This is the most common procedure for ending a pregnancy between 14 and 21 weeks. It is similar to a suction D and C but with larger instruments. The cervix has to be dilated or stretched open to a size larger than required for a D and C. Suction is used along with forceps or other special instruments to ensure all the pregnancy tissue is removed. 

Abortion by CS or by Hysterotomy
Carried out in similar fashion as the procedure but after the umbilical cord is cut, the neonate is left to die without resuscitation
Done during the last trimester since no other technique is available at this stage.

Abortion by Suction
Done during the first trimester

Abortion via Intra-Amniotic Infiltration
Done by first extracting about 10 to 300cc of amniotic fluid through an abdominal puncture. This is followed by infiltration of a 20% hypertonic saline solution or 50% dextrose of water into the amniotic sac. This causes necrosis of the placenta and saline intoxication of the fetus. The fetus eventually dies within an hour.
Abortion is completed with the expulsion of the fetus at about 36 hours after the infiltration of hypertonic solution. This technique carries a certain risk of uterine perforation, not excluding the death of the abortant mother on account of the passage of the saline solution into the blood.

Abortion via IV Infection of Prostaglandin
When one considers the ideal period when to perform abortion by suction of by intra-amniotic infiltration, one observes brief internal period from 12 weeks to 16 weeks AOG, during which it is difficult to abort.
During this period, the tiny human being has acquired sufficient mass, making it difficult to suction, as the mangled parts may not easily pass through the tubing. Neither can one abort by infiltrating hypertonic solution because there is not enough amniotic fluid. Therefore, slow intravenous infusion of prostaglandin is used by those bent on getting rid of the unborn baby at this time.
Recently, a new contraceptive pill, RU 486 (Mifepristone) has been launched in the market. It is a progesterone antagonist which opposes its action to sustain pregnancy. RU 486 is associated with prostaglandin which provokes uterine contraction and expels the embryo from the womb.

Legal, Moral, and Ethical Considerations
Article II, Section 12 of the 1986 Philippine Constitution provides that “The state recognizes the sanctity of life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception.”
The direct and voluntary killing of an innocent human being is always gravely immoral, even when it is performed as a means to a good end.
Respect for human life and the radical condemnation of abortion as intrinsically evil is not an exclusive position of Catholics. All men of upright judgment share this view, which is based on what a person is and should be.
Abortion destroys life and violates the right to life. As such it is morally evil and it should not be in any way legalized and liberally permitted in the laws and constitution of a nation.

Effects of Abortion
Abortion could have varied physical and psychological effects on the woman concerned.
On the physical aspect, the woman may suffer habitual miscarriage, ectopic pregnancies, menstrual disturbances or discomfort, still births, bleeding, shock, insomnia, loss of appetite, coma, fever and cold sweat, intense pain, weight loss, frigidity.
Psychologically, a woman may manifest guilt, suicidal tendency, loss of sense of fulfillment, loss of confidence, thwarted maternal instinct, self-destructive behavior, anger, rage, helplessness, loss of interest in sex, inability to forgive herself, and intense interest in babies.

Abortion Under the Law
Criminal abortion is a grave crime in penal codes. Today, with the legislation and positive authorization of abortion in some cases, things have changed. A review of the legal proceedings of those countries which have legalized abortion show some differences in modalities, which can be observed upon reading the World Health Organization chronicle of 1976.
The chronicle summarizes the conditions or situations in which the legislation of different countries authorize the practice of abortion.
Such situations are:
When the mother is authorized to safeguard her physical and mental health
When pregnancy is the consequence of rape or incest, or when it occurs in minors
When the mother contracts sub-cola during a critical stage of gestation (which consequent risk of congenital malformations of the baby) or has been exposed to other risks (e.g. certain drugs or ionizing radiations) which can lead to defective fetal development
When Down’s syndrome or other chromosomal abnormalities are diagnosed through amniocentesis
When the parents are mentally deficient and considered incapable of adequately rearing a child.

References
Abortion (Termination Of Pregnancy) - How It's Done | SparkPeople. (n.d.). Retrieved from http://www.sparkpeople.com/resource/health_a-z_detail.asp?AZ=513&Page=4
Ciabal, L. P. (2003). Ethics for Health Professionals. Quezon: C&E.

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