Should Abortions Be Ruled “Non-Essential” Medical Procedures In The Pandemic Crisis? An Ethics Decision-Making Exercise

News Item:

Texas and Ohio have included abortions among the nonessential surgeries and medical procedures that they are requiring to be delayed, setting off a new front in the fight over abortion rights in the middle of the coronavirus pandemic in the United States.

Both states said they were trying to preserve extremely precious protective equipment for health care workers and to make space for a potential flood of coronavirus patients.

But abortion rights activists said that abortions should be counted as essential and that people could not wait for the procedure until the pandemic was over.

On Monday, Ken Paxton, the attorney general of Texas, clarified that the postponement of surgeries and medical procedures announced by Gov. Greg Abbott over the weekend included “any type of abortion that is not medically necessary to preserve the life or health of the mother.” Failure to do so, he said, could result in penalties of up to $1,000 or 180 days of jail time.

Oh-oh.

Is abortion truly a non-essential medical procedure? Is it ethical to treat it as one? This is a perfect storm of an ethics conflict colliding with an ethical dilemma, with so many of the factors that confound ethical analysis present. For example, is the shortage of beds and the stresses on medical services really the only factors being considered by those in making the policy decisions in Texas and Ohio? Is the pandemic really a cover, in whole or in part, for other motives, like a desire to limit abortions generally for as long as possible? Is the ethical response by a pregnant woman to comply with the policy, even to the point of giving birth. There are many ethics decisions involved here.

Let’s just focus on one of them, the decision to call abortions non-essential procedures, and run it through one of the ethics decision-making systems. I’m going to use Professor Laura Nash’s 12 Questions, from her Harvard Business Review article, “Ethics without the Sermon” (1981)]

1. Have you defined the problem accurately?

In other words, “What’s going on here?”

The problem should be defined like this: The primary objective, in addition to limiting infections, is to ensure that hospitals are not overwhelmed by cases of the virus. One step necessary to ensure that is to call on the public to postpone all use of hospital staff and space except for essential procedures that are urgent and cannot be postponed.

Are abortions such procedures?

2. How would you define the problem if you stood on the other side of the fence?

I assume the “other side of the fence” in this case would mean a woman in the midst of an unwanted pregnancy, running out of time because the pregnancy will soon be in its third trimester. Then the problem might be, “How much should I be required to sacrifice for the needs of society in a health crisis?” Not necessarily, however: a pregnant woman might look at the problem exactly the same way as the policy-maker, if she is capable of keeping self-interest out of the equation.

3. How did this situation occur in the first place?

It occurred because of the unique nature of abortion, in which the procedure is a SCOTUS-determined constitutional right despite the fact that society refuses to resolve whether it involves one  human life or two, and because the delay of the procedure, while it may not result in physical harm to the mother, will have another result of life altering proportions: responsibility for a child.

4. To whom and to what do you give your loyalty as a person and as a member of the organization?

The “organization” is the government and society, and the loyalty of elected state government officials must be the public and society as a whole, not merely one segment of it or one constituency.

5. What is your intention in making this decision?

It has to be, as the Ohio and Texas orders state, the sincere and responsible desire to control the pandemic and ensure that it can be treated effectively and across the state. The intention cannot be to use the pandemic as a justification to constrain the right to abortion, or “to save the lives of as many unborn as possible.”

6. How does this intention compare with the probable results?

The intention focusing entirely on the threat of the viral epidemic will involve potentially serious negative results for women seeking abortions.

7. Whom could your decision injure?

Women who choose to have an abortion will have their rights to do so limited, constrained, and in some cases, eliminated altogether for a crucial period of time, with serious negative consequences for the women.

8. Can you discuss the problem with the affected parties before you make your decision?

No. Time is of the essence, and again, the duty is to the entire society, not just the smaller contingent of pregnant women wanting an abortion.

9. Are you confident that your position will be as valid over a long period of time as it seems now?

In fact, the longer the policy goes on, the more individual damage it will do, assuming, as we must in this process, that the life of the mother is the only one the state can acknowledge However, the objective—controlling access to hospital care during a pandemic will be valid as long as the epidemic continues, or until sufficient beds and staff are available without constraining elective abortions.

10. Could you disclose without qualm your decision or action to your boss, the head of your organization, your colleagues, your family, the person you most admire, or society as a whole?

Absolutely, as long as the decision was based on a pure objective in society’s best interests. In this case, the “boss” would be the public.

11. What is the symbolic potential of your action if understood? If misunderstood?

The decisions of Texas and Ohio are ripe for court challenges. If upheld, the decisions would stand for the proposition that the right to abortion, like other rights, is sometimes subordinate to special needs of society when the safety and security of society as a whole is involved.

If the decision is misunderstood as a dishonest effort to use the pandemic as a justification for stopping abortions on moral or ethical grounds, then it will be devisive and undermine trust in the government.

12. Are there circumstances when you would allow exceptions to your stand? What are they?

The circumstance already added as an exception is a threat to the health of the mother. It would seem prudent, necessarily and ethical to ass an exception allowing an abortion to be performed when the pregnancy is about to enter the period where it will no longer be legal.

In the end, as the 12 questions show, this must be a utilitarian decision, as are almost all government policy calls. The insuperable  obstacle with  any such decision involving abortion is that we cannot agree on what is being balanced, and the weight of those factors that are.

12 thoughts on “Should Abortions Be Ruled “Non-Essential” Medical Procedures In The Pandemic Crisis? An Ethics Decision-Making Exercise

  1. I can answer this easily. This type of procedure if delayed will result in either the overall objective never able to be obtained or that if done within our existing time limits the procedure will kill more living cells that will become a child or increase the risk to the female patient.

    Thus it is an essential procedure.

    In short, extensive delays will obviate the ability for the patient to obtain the service at any time.

    I must go on record as being in opposition to the procedure in general but the question does not require my approval or disapproval to evaluate.

    • Additional thoughts:

      Utilitarianism proffers that the needs of the many outweigh the needs of the one. However if we evaluate the needs of the many we find it is the sum total of the needs of individuals. As a result, in order for the needs of the of one to be supplanted for the needs of another we must balance the competing needs of two distinct individuals not the amorphous concept of society.

      Bottom line, if the decision rests on making choices on who gets services and who does not then we must opt to give to the ones in greatest immediate need. However reserving supplies on potential anticipated need should not bar access to anyone seeking services in the near term when such supplies are able to be replenished .

  2. NIce Hobson’s Choice. Let the directive stand and have some number of women denied an abortion or contest the regulation and gamble on giving a case to the US Supreme Court that may end poorly for one position?

  3. I oppose abortion with my whole self, but the argument for still allowing them is strong – if we grant that they are a valid medical procedure.

    – Abortion facilities are not the same being used by Covid-19 patients, and these are unlikely to be used for treating patients with respiratory problems.
    – Abortions must be performed within a limited period of time to be effective, nine months later they are useless.
    – Abortions have a relative low risk of complications that would take medical professionals away from other obligations.

    I take this as grandstanding and throwing red meat to the base. A pure political decision in the same category as demanding carbon neutrality of airlines to support checks for Coronavirus victims.

  4. The question was answered at #1, as a matter of definition. It can be a situation that is not defining or debating “abortion,” but by a medical decision that is already defined by medical regulations, namely, a medical procedure that is defined as urgent by qualified medical personnel and which, by that definition – and ethically as well as legally – cannot be postponed. Some of the unforeseen reasons to terminate a pregnancy ASAP?: cardiovascular disease, hemorrhage, hypertension, infections and embolisms immediately affecting the mother’s life.

    And, just for curiosity’s sake, the other way round:

    Pregnant women don’t seem to become more severely unwell from COVID-19 than the general population
    Infection doesn’t seem to increase the risk of miscarriage
    There is no evidence the virus can pass from pregnant mother to baby

  5. For me, this whole thing boils down to this; part of this is they are basically claiming that abortions are using spaces/beds that could otherwise be used to treat patients suffering from the side effects of the pandemic virus but, to my knowledge, abortions are done in clinics that are dedicated to this specific procedure and not done in hospitals or general care clinics. Based on this I believe that the basis of the restriction is a lie and I think that makes it unethical.

      • Benjamin wrote, “Contrariwise, I can’t go to Mass, but that pew isn’t reserved for use as a gurney.”

        My brain is not quite fully grasping what you’re trying to say, can you explain a bit more?

        • Ah, I mean that plenty of actually essential things are running at reduced capacity if not cancelled altogether which would not be useful to reserve for the sake of hospital capacity. It strikes me as outright betrayal that I can’t attend a weekday Mass which, on a good day, boasts ten attendees but the child murderers are charging ahead at full capacity.

          There could’ve no better excuse for a revolution! The written right occupying a prominent place in the First Amendment is curtailed for reasons which scandalously are not applied to the unwritten, imaginary penumbra-right to vivisect one’s own offspring.

          Some animals are more equal than others, and all that.

          • There could’ve no better excuse

            I wonder, if I divided the incidences which autocorrect helped me by the incidences which it botched a sentence entirely, would the ratio even be above 0.1?

          • Benjamin wrote, “I mean that plenty of actually essential things are running at reduced capacity if not cancelled altogether which would not be useful to reserve for the sake of hospital capacity.”

            Thanks for that clarification.

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