Medical Ethics PHIL 148 @ Binghamton University, Sum 11


Case Study:Abortion (Care Ethics)

This week’s case study talks about a woman Susan who decided to have an abortion.  Susan met her husband when they both just graduated from law school. She and her husband Rick wanted a large family and thus they have four children. When the couple’s youngest child was old enough to go to school Susan decided that she would like to return to legal practice.  She realized how much she missed what she used to do before she became a mother and felt as if she had given up on her career. After she talked to her husband about the child care situation, Susan began her job application process as a legal assistant at a law office. While searching for a job Susan became pregnant and later on found out that the fetus has Down syndrome. The doctor was unable to tell Susan whether the Down syndrome will be mild or severe and knowing that having a child with a disability may prevent her from ever returning to the working world she decided to an abortion without her husband’s knowledge.

I’ll be looking at this case from a care ethics point of view. Care ethics’ main focus is the care of the patient, understanding that individual/person as an interdependent being, meaning that we need others for emotional and physical support. Unlike deontology and utilitarianism, care ethicists make their moral decision based on objective consideration instead of making these moral decisions objectively and impartially. It also created from the closeness of relationships, particularly trust. So for a care ethicist to  figure out what is morally right or wrong in a situation the first thing they so is to identify the relationship involved, see if it is a health relationship and finally find what obligations they produce. For an individual to carry out this act he/she must be willing to put another person before him/herself.

Care ethics deals with a patient’s need and a doctor being able to fulfill those needs.  In this case Susan felt that having an abortion would be the best approach and her doctor should respect her decision. Her doctor should be there to guide Susan and also help her through this tough decision. Susan puts her trust in her doctor that whatever decision she makes her doctor will respect it and show empathy towards her. Susan needed someone to understand what she’s going through and to be there for her. Trust is a great factor, in the situation Susan has a greater trust with her doctor than with her husband, and she may feel that if she told her husband that she wanted an abortion he would talk her out of it because his dream is to have a large family.  But in terms of Care ethics regarding the fetus, shouldn’t Susan put the baby’s needs before her own needs? Yes her fetus has a disability but she can still care for her child and she could still have a career, her bay will be dependent on her, but what baby isn’t dependent. Susan’s child still can have a normal life, e.g. look at Becky in the TV show “Glee” she has Down syndrome but she also has a career. Susan will never know what her fetus would have become in the future.

  • Do you think that Susan should have told her husband about her decision to have an abortion?
  • What other Theories of Ethics can be applied in this case?
  • Is having an abortion because a child has a disability justified?

Sorry guys for the mix up with my previous post 🙂

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  1. @Rameisha, good analysis from a care ethics standpoint. To add to your reasoning, care ethics stresses relationships between individuals. There are four main relationships that I see here that could be affected by the abortion. One realtionship is that between Susan and her kids. Since, Susan’s fetus had Down Syndrome, he/she would need special attention upon birth and for a good portion of his/her life. With the arrival of this new baby, a lot of the care and attention would be diverted from the other children to the new baby. One of two things can happen now. The children will initially get jealous of the attention the new baby is receiving but will get over it in time, or the children will embrace the new baby. If the first stipulation occurs, the relationship between Susan and her children will be turbulent temporarily but will smooth out in time. If the latter happens, Susan and the children will become closer in caring for the new baby. With either stipulation, the family will at some point become closer in taking care of the newest addition to the family.

    The second relationship to consider is that between Susan and her husband. Like you mentioned, her husband, Rick, always wanted a large family, and Susan gave up her a career temporarily in order to give that to him. Even though they decided not to have any more kids, Susan still became pregnant with Rick’s child. Technically, the baby is half Susan’s and half Rick’s. Since Susan had an abortion without telling Rick, I believe that their relationship now will become negatively affected. I believe that Susan’s guilt in not disclosing any information about Rick’s child is what will affect the relationship.

    The third relationship is between Susan and her doctor. Like you mentioned, there is a lot of trust between the two. Since Susan didnt’ tell her husband, she must have confided completely in the doctor being her primary care giver. Even though this is the only positive relationship of the four that I believe are present, I feel that this one is positive out of neccessity. The doctor is required by his profession to maintain such a relationship with the patient and provide the utmost professional care.

    The fourth relationship present here is that between Susan and her unborn baby. Once a woman becomes pregnant, I believe that an attachment instantly develops between the fetus and the woman, and it only grows with each passing day. After having the abortion, the relationship between Susan and her unborn baby is no longer existent and didn’t reach the potential that it could have.

    From a care ethics point of view, yes, Susan should have told her husband. Even though the husband isn’t aware of anything, Susan knows exactly what happens. She also knows that he baby belonged to him as much as the baby belonged to her. Knowing this and continuing on a married life with Rick, I believe that this thought will bother her for a very long time and so, will negatively affect her relationship with Rick.

    • @ Ralph thanks for your input on the Care Ethics side, you definitely touch some things that I didn’t. But even though the baby is half of Rick doesn’t Susan has a right to do what she wants with her body. I mean she will be the one who has to take care of that child.

      • @ Rameisha, from a care ethics standpoint, Susan needs to overlook her wants and desires for the sake of her relationship with Rick. She needs promote a healthy relationship with Rich and ensure that it only grows with time. By having the abortion, problems will arise and hinder the growth of the relationship. Yes, she does have a right to do what she wants with her body; however, by going through with the abortion, Susan would be acting immorally.

        • @ I think that her relationship could still be in trouble if she told her husband, but I do think telling her husband is the right thing to do and she should have done that.

  2. Hey Rameisha, like both you and Ralph- I was assigned care ethics and I think between both of you, you’ve got it pretty much down :). A few things I wanted to add to your post specifically Rameisha, I think that it’s certainly important in terms of care ethics to consider all of the relationships that are affected by the case; not just doctor-patient. Ralph pointed out three additional relationships that have to be considered.

    I’m not sure about you, but I had the most trouble with the fourth relationship- the relationship between Susan and her unborn child. I see the “potential” of their relationship being a problematic thing to try and factor. Previously I reasoned that since Susan is ultimately the one who can consciously decide how she wants the relationship to continue (or not continue) in this case, it is permissible for her to terminate the abortion. It kind of reminded me of Hornstra’s explanation of how her relationship with the fetus she planned to abort was different than the one between her and the fetus she planned to carry to term. What do you guys (Ralph and Rameisha..or anyone else) think?

    You asked if having an abortion because of a disability is justified- and I’m honestly not sure how I stand on this issue. I feel like prenatal screening is an aspect of technology that has certainly added to the difficulty of moral decisions like this one. On one hand, since abortion is legal a woman always has a right to abort her pregnancy, but is having abortion because a child will have a handicap like Down’s considered a “morally wrong” justification? It again reminds me of something that Hornstra addressed, about our society’s obsession with the idea of a “perfect baby.” It’s genuinely hard for me to say where I stand on the issue because I don’t feel as if handicapped people are “worth” any less than any other person, but if you choose to abort a handicapped fetus and not abort a “healthy” one, what does that indicate morally? On the other hand, I have little idea what I would actually decide to do in that situation.

    • @marisa I do believe that a mother has a relationship with her fetus. I think there can be a difference in the relationship between the mom and the fetus she wants verses the mom and the fetus she wants to abort. When someone wants something they have a greater appreciation of it and will do anything for it. But when someone doesn’t want something they don’t care what happens to it. In addition the fetus that is aborted may be less loved by the mom and so when the abortion is taken place there’s a greater feeling of happiness rather than sadness.

      • @Rameisha- yeah from the care ethics standpoint I feel like it’s hard to criticize Susan’s desire to end the pregnancy since she is viewing the fetus as an intrusion on her life, rather than a joy to be cherished. This distinction makes all the difference in determining the relationship that she has with her fetus.

        Hypothetically, if Susan were to find out that she was pregnant, yet the fetus was seemingly “normal” and she decided to carry it to term- do you think that this would make her decision to abort the fetus that has Down’s syndrome less moral?

        • @marisa that;s a good question. I think that Susan already acted immorally by terminating her fetus because the fetus had down syndrome. But if the fetus was normal and she decided to carry it to full term then I do believe that makes her even more immoral and selfish. This would definitely highlight the main reason why she had the abortion was solely because the fetus had a disability.

          • @Rameisha, I certainly agree that it is her intentions for the fetus that matter. Agreeing to carry a “normal” infant to term, but deciding to abort the handicapped child- indicates that the their are other motives of the mother, including perhaps moral biases about the child’s handicap. Although it would certainly be difficult to argue this from a legal perspective- as a woman is not required to give a moral exposition on her reasons for abortion, in matters of morality it counts much more.

  3. Ramiesha, I think you did a good job analyzing and explaining why abortion would be morally correct from a care ethical point of view. Like you said utilitarianism and deontology fails to look at the situation from a relational point of view but rather focuses on a “concise ethical system”. You mentioned that trust is a valuable asset in any given relationship and that in many ways it is essential in the closeness of relationships. Speaking from a deontological point of view, I would agree that Susan should have told her husband about the pregnancy and the decision to have an abortion. Like I stated in my comments to Tasha and Erika, withholding the information is a form of deception on Susans part and that constitutes as lying (something that is not tolerated in deontology). Speaking from your point of view, it can also be argued that lying to her husband can violate the trust that they once shared. Abortion would therefore not be viewed as a moral choice from both a care ethical and deontological point of view.

    Also, to answer your last question, a deontologist would say that having an abortion because of a disability is not justified. It will be viewed as using the unborn child as a mere means to an end. The term “mere means to an end” is essentially taking advantage of a situation or someone else. Susan aborting the child in order to have the benefit of going back to work demonstrates this notion. The unborn child is being taken advantage by having its life put to an end. This can also be viewed as murder depending on how one interprets the word personhood.

  4. Good summary and analyisis. You wrote that care ethics deals with a patient’s needs and that the doctor should respect that. Does Susan need to have an abortion? I don’t think she needs to since the birth of this disabled child would not be detrimental to her health but Susan deffinitely wants to have an abortion. Virtue ethics looks at the patient with compassion, sensitivity and honesty. In this way Susan’s desires as well as her needs are taken into consideration.
    I do think that she should have told her husband about the abortion because even if he did not want her to have it she still has full rights over her body. This way she fulfills her obligation of honesty to her husband and still has the abortion, even if her husband may not agree with it. By not being honest with her husband, Susan has transgressed virtue ethics. She is not compassionate or sensitive to his feelings and deffinitely not honest, the three criteria in virtue ethics.
    I can’t say if having an abortion when a child is predicted to be disabled is immoral. I would say that if someone decides to have an abortion out of good intention then it may be considered moral. Some people may feel that the child’s life may be doomed to be difficult and by having an abortion they are preventing the pain and suffering the child will endure.

  5. Good stand from the care ethics points of view. From the utilitarianism stand though having an abortion would be moral because it would be helping the greater amount of people. In care ethics you discussed how it would affect Susan’s life, but you need also to remember that she already has four other children and how it will affect their lives. The example that you gave at the end is in a case of only one child. All children need care, but more so those with special needs and you cannot compare a situation that the special needs child was an only child to a situation where the special needs child will have four other brothers and sisters. Bringing a special needs child into the whole will not only require attention as a baby and child, but even as an adult depending on how serve the Down’s is. Which means most likely the parents will out live this child and it will be left for the others to help take care of he/she. I have a close family friend, who they are now in their early 50s and he still needs to help his brother out who only has a mild case of Down’s. With having the baby she would be causing more problems for a greater amount of people. Having an abortion would make the good outweigh the evil, concluding from a utilitarianism stand point that the abortion is a moral thing to do. Do you feel if there were less children in this family the situation would change?

    • @ Jacqueline I’m not sure if the amount of children involved in this situation was to decreased that Susan would change her decision. I think she probably would still have the abortion, because that child will make her chances of ever going back to the working world less. But I do think that if the fetus wasn’t disable she would have had the baby, because in her mind she thinks that with a normal child she can still return to her previous job. This maybe with 2-3yrs, this is a better outcome than forever.

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