Ethical Issues Encountered in Women's Health Care

Abortion is the hot-button ethical issue in women's health care in the United States. Many of the ethical dilemmas related to women's health center on the woman's role in conceiving and bearing children, since choices about reproduction often require a close examination of beliefs and values. But issues of right and wrong can appear in subtle ways in women's health care as well, such as when a doctor fails to recognize the symptoms of a heart attack in a woman because these symptoms differ from the ones men typically experience.

Abortion

• Supporters of abortion rights believe that a woman has a right to control her own body, including the right to decide whether or not to bear a child. Opponents of abortion believe that a human embryo or fetus is a person with a right to life and that abortion is thus the murder of a person. In 1973, the U.S. Supreme Court issued a landmark decision on abortion in the case of Roe v. Wade. The court found that a woman's decision to have an abortion falls under a right to privacy based in the Fourteenth Amendment. According to the court, the right to privacy is not an absolute right and must be balanced with the state's interest in protecting the health of the mother and the potential life of the fetus. The court proposed that, since those trained in medicine, philosophy and theology could not agree on the question of when life begins, it is not the place of the courts to decide this question. Instead, the abortion decision should be left to the woman and her doctor during the early stages of pregnancy. At the point, however, when the fetus reaches "viability," that is, when it is potentially able to live outside the mother's womb, the state's interest in promoting human life outweighs the mother's right to privacy, and the state can at that point regulate or prohibit abortion, except when the life or health of the mother is at stake.

Birth Control

• Birth control has gained wide ethical acceptance worldwide, though world religions vary in their views of its morality. A recent controversy in the U.S. concerns emergency contraception. Emergency contraception is birth control that can be taken for up to five days following unprotected sex. The main mechanism of action of the drug, Plan B®, is a temporary delay of ovulation. After fertilization of an egg has occurred, however, the drug may prevent the fertilized egg from being implanted in the uterus, though the science is still inconclusive on this point. People who believe that life begins at conception see emergency contraception as a form of abortion, since it may prevent implantation of a fertilized egg.

Prenatal Diagnosis

• Prenatal screening can raise difficult ethical issues for a pregnant woman.

  Pregnant women can choose to undergo prenatal testing to detect birth defects, Down syndrome or other diseases or conditions in an embryo or fetus. If the test shows a disease or condition in the fetus, the parents face difficult ethical decisions, most notably about whether to abort the pregnancy or carry it to term. Parents may weigh the severity of the condition and their own emotional and financial capability to provide the care the child will need. Critics of prenatal screening for Down syndrome argue that providing parents with information that could lead them to abort the fetus devalues mentally and physically disabled individuals.

Domestic Violence

• About 37 percent of women who seek treatment for injuries in an emergency room were injured by a current or former intimate partner. The majority of physicians do not ask their female patients if they are experiencing domestic abuse. This raises the ethical issue of whether physicians have a responsibility to screen for domestic violence and provide assistance to victims beyond the treatment of physical injuries.

Global Perspectives

• The subordinate status of women has serious negative consequences for women's health care. Three million women a year face the prospect of female genital mutilation, a surgical procedure that exposes a woman to grave harm. Approximately 17 million women are living with HIV/AIDS worldwide, 98 percent of whom are in developing countries and who were infected by unprotected intercourse with men. Women are often unable to refuse sexual intercourse or demand the use of condoms because of sexual violence, the cultural expectation of subservience to husbands or the limitations imposed by poverty and low social status.