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Pro-life Vs Pro-Choice, Impact on Nurses Role:Value Clarification, Service Delivery Vs Personal Dispositions
Date Posted: 17/Sep/2019
Authors:  Dr (Mrs) Anthonia Chiweuba, and Ijeoma Kelechi-Duruh
 
Abortion is defined as the termination of pregnancy before the stage of viability (WHO,2015).  An induced abortion is characterized by deliberate interference with the pregnancy, either by the woman herself or by someone else, with the aim of terminating it.The pro-choice group supports the right of any woman to make decision about her reproductive functions based on her own moral and ethical beliefs. Christianity particularly Catholicism, orthodox Judaism and Islam, oppose abortion on the understanding that the fetus is somehow an individual created by God for a purpose.  
 
The catholic church opposes all forms of abortion procedures whose direct purpose is to destroy a zygot blastocyst, embryo or fetus. Pope Francis describes it as the highest form of thuggery against the defenseless which leaves the women with emotional turmoil. He stated that “Abortion compounds the grief of many women who now carry with them deep physical and spiritual wounds after succumbing to the pressures of a secular culture which devalues God’s gift of sexuality and the right to life of the unborn,” the Pope said that “It must be therefore reiterated the strongest opposition to any direct attack on life, especially innocent and defenseless life, and the unborn child in the womb is the most concrete example of innocence,”. Induced abortion is  associated with  long term psychological consequences both  for the healthcare provider and the client thus the need for value clarification.
 
According to Turner, Pearson, George & Andersen (2017), Values clarification is a process in which individuals engage in honest, open-minded and critical reflection and evaluation of new or re-framed information and situations, challenge deeply-held assumptions and myths and discover or potentially transform their values. It entails examining one’s basic moral reasoning to identify the values that one finds most meaningful and important. Healthcare providers utilize value clarification tools to examine factors affecting the health personal/client decision to have an abortion (National Abortion Federation, 2005). Exercises are provided intended to help the health care provider clarify present personal values about pregnancy options, abortion, and abortion training, and also help think about those values in the context of professional judgments called upon to make. They area also intended to illustrate the possible consequences of providing or not provide service. 
 
According to National Abortion Federation (2015) value clarification include examination of:
1. External influences eg family and social group, spiritual beliefs and life stage
 
2. Personal/Internal influences e.g personal experiences with sex, Abortion, pregnancy, parenting, Adoption etc
 
3. Circumstances of decision e.g Gestational age, individual/ societal factors, comfort level with circumstances of decision of each woman’s abortion decision etc.
 
4. Professional Obligations and conflicts
 
Importance of value clarification
Personal value clarification helps the healthcare provider to refine their value systems in a low-risk environment (when not faced with a dilemma). Helps health professional ex amine their beliefs about abortion to be better able to care for women considering this option. Client value clarification help the abortion seeker to understand issues about abortion. After value clarification, client may identify other better alternatives to resolve unwanted pregnancy issues and may decide to keep the pregnancy.
 
Conscientious Objection and the provision of Abortion services /post abortion care. Section 4 of the Abortion Act 1967 (as amended by the Human Fertilisation and Embryology Act 1990) provides a right of conscientious objection (CO) which allows healthcare professionals to decline to participate in a termination of pregnancy. This right is limited only to the active participation in the termination of pregnancy where there is no emergency with regard to the physical or mental health of the pregnant woman. According to American college of Gynecology (2016), conscientious refusals that conflict with patient well being should be accommodated only if the primary duty to the patient can be fulfilled .where conscience implores physician to deviate from standard practices, they must provide potential patients with accurate and prior notice of their personal moral commitments. 
Health care providers with moral objections to specific health care services have an obligation to alert their colleagues and supervisors to these objections, in the interests of minimizing disruption in the delivery of care and minimizing burdens on other providers .Conscientious objection policies may specify that a professional who has invoked the right to refuse to provide a service must not interfere with the patient’s ability to obtain it elsewhere. In an emergency in which referral is not possible or might negatively affect a patients physical or mental health, provides have an obligation to provide medically indicated and requested care regardless of the providers personal moral obligations (ACOG,2016). 
 
CO has been defined as the refusal to participate in an activity that an individual considers incompatible with his/her religious, moral, philosophical, or ethical beliefs (Chavkin et al, 2017). Supportig, Delegating and supervising is not covered by Co thus the nurse who has involked this law will not be exempted from booking, supporting, delegating abortion services. Thus  it is recommended that  if this is in conflict  with the providers moral belief, there is need to find another job . Chavkin et al (2017) further conducted a  scan of national laws and policies that regulate CO to abortion, finding that most of those countries with regulations permit CO but circumscribe the practice in order to protect women’s access to care. 
 
A similar review from 2015 found only 22 countries that explicitly regulate CO to abortion, most of which are in European and have legally permissible abortion and national health care systems. Many of these countries stipulate who is eligible to object and restrict the circumstances in which CO is authorized. 
 
However, few countries, primarily in Scandinavia and Eastern Europe, do not discuss CO in their abortion laws, which has been interpreted to mean that providers lack a legal right to object (Fiala, Danielsson & Keikinheimo, 2016). In Nigeria abortion is illegal and CO was not discussed in the abortion law. CO cannot be invoked in the provision of post abortion care. Delivery of post-abortion care to professional standards is legitimate, necessary, and does not in itself implicate providers in another’s prior illegality or professional misconduct. Second and third trimester abortion may result to life birth. In the event of the neonate showing signs of life, the neonate should be kept warm and comfortable and offered oral nutrition for both prolife and prochoice advocates. A neonate born alive must be registered as such by law (RCON, 2017)
 
Conscientious objections and the use of contraceptives
Increasing numbers of pharmacists, physicians and nurses are refusing to dispense, prescribe or administer these forms of pregnancy prevention, citing moral objections to hormonal contraceptives. The objections are based on the belief that hormonal methods of contraception are abortifacients; that is, that the use of these methods will result in the destruction of a fertilized egg. Collectively, CO prevent government agencies from forcing the provision of services or “discriminating” against individuals and institutions that refuse to provide them; they also prevent institutions receiving certain federal funds from taking action against healthcare personnel because of their moral stands
 
In Nigeria there is no known law protecting health personals from prescribing or administering contraceptives on moral or ethical grounds. Decision to provide contraceptive services are based on a framework which focuses on principle-based ethics, which utilizes four principles to objectively analyze a given clinical situation: respect for patient/providers autonomy, beneficence, non maleficence, and justice
 
Impication for Nursing
One’s values may change in response to life experiences .Encounters with clients and colleagues may influence beliefs without  having much of a chance to reflect on these changes .An individual's values are influenced by culture, social groups, economic forces, education, and past experiences...
 
 

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