A Possible Rift: Autonomy and the Sanctity of Life

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Per the Pew Research Center, a majority of Americans have some religious affiliation (77%) and consider religion either very important (53%) or somewhat important (24%) to their lives (2015). This number has significant consequences both for the health of Americans, as well as the practice of medicine in the United States. Psychiatrist and director of the Duke University Center for Spirituality, Theology and Health, Dr. Harold Koenig has found that religion may “affect medical decision-making” and “induce spiritual struggles that create stress and impair health outcomes” (2004).  

I’m particularly interested in exploring these two topics – medical decision-making and the possibility of health-related spiritual struggle – as they relate to abortion care and recovery. In the US, three out of every five women who received an abortion in 2014 identified as religious (Jerman et al. 2016). How do a woman’s religious and spiritual beliefs influence her decision of whether or not to seek an abortion? If a woman decides to receive an abortion, how might her religious and spiritual beliefs impact her recovery? 

Earlier this year, reporter Rebecca Ruiz recorded the personal stories of women who had received abortions. One woman spoke about feeling “like [she] was going to hell every week sitting in church,” but proceeding with her decision:

I believe that our souls choose their journey. My soul chose this journey and I have learned a tremendous amount from it. It was the right choice for me at that time in my life.

[But] I still feel a lot of shame and… an incredible amount of regret that I was not a stronger person… I can only imagine the people who would view me in a completely different light if they knew. Perhaps I’ll break the silence someday, but most likely I will take it to my grave (Ruiz 2016).

It’s a crucial time to be looking at religious attitudes towards abortion. The outbreak of the Zika virus and the discovery of the virus’ link to fetal microcephaly has led to scrutiny of the strict restrictions on abortion in highly devout Latin American countries (Stern 2016; Pew Research Center 2014). In the US, many states at high risk for Zika transmission have been noted for their limited access to abortion care (Dreweke 2016). These states also comprise the colloquial “Bible Belt,” where religion holds powerful sway in legislative decisions, including those about abortion (Medoff 1989).

Map: Zika, abortion restrictions, and religion in the US

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In Blue is the range of the Aedes aegypti mosquito, carrier of the Zika virus; states highlighted in Purple constitute the Bible Belt; Yellow dots are states hostile to abortion, with 4-5 abortion restrictions in law; Red dots are states extremely hostile to abortion, with 6+ abortion restrictions in law. Data from the Center for Disease Control, Guttmacher Institute, and a 2011 Gallup poll on religious attitudes by state.

An example of restrictive abortion legislation comes in the form of the 2013 Texas House Bill 2 (H.B. 2), which was under challenge recently in the Supreme Court case Whole Woman’s Health v. Hellerstedt. H.B. 2 required all physicians performing abortions to have hospital admitting privileges and all abortion clinics to qualify as ambulatory surgical centers (Whole Women’s Health 2016). On the 27th of June, the Supreme Court ruled that the restrictions of H.B. 2 created unconstitutional burdens on abortion access. The bill had shuttered half of the state’s clinics and increased costs and wait times at the few remaining clinics, which abortion activists insisted demonstrates the harms of H.B. 2 (Rosenthal 2014). Anti-abortion activists argued that H.B. 2 protected women from unsafe abortions or dangerous side-effects.  

The pro- and anti-abortion debate reflects some friction between secular and religious systems of medical ethics. Medical ethics guide moral decision-making as it relates to patient care and healthcare access. Secular medical ethics, applied fairly universally in hospitals and healthcare settings in the United States, have four foundational principles – autonomy, justice, beneficence, and nonmaleficence – as defined by the late surgeon and ethicist Dr. Sherwin Nuland:  

Autonomy refers to the freedom of the patient to decide what is in his best interests, without interference from others; justice is the notion that no one should be deprived of any benefit to which he has a right, amounting, therefore, to fairness and equal opportunity in the way each individual is treated; beneficence is the physician’s obligation to do only what will protect and promote the patient’s well-being; and nonmaleficence is the physician’s obligation to avoid any undue harm to the patient (Nuland 2009).

There are as many variants of religious medical ethics as there are religions. Religious medical ethics have existed long before secular medical ethics, posing first the questions about the human condition that secular medical ethics would come to consider after developing in the late 20th century (Ramsey 2002). Principles of religious medical ethics derive from scripture. Common among the three Abrahamic religions is the sanctity of life, which is paramount and considered before autonomy (Kinzbrunner 2004; Paterson 2003; Kamali 2004).

Religious and secular medical ethics are not generally incompatible (Veatch 2012). However, in the case of abortion, a rift does potentially arise. Secular medical ethics permit abortion as an expression of the autonomy of the patient to undergo a safe medical procedure (Hewson 2001). In contrast, Judeo-Christian and Islamic medical ethics place scripture-based limitations on abortions. Depending on the school of thought, this could mean total restriction, total restriction unless in the case of harm to the mother, or total restriction after a certain time point, usually when the fetus is considered to have a soul (Schenker 2000).

Click to enlarge.

Over the course of the next several weeks, I’ll be delving into this possible rift in hopes of getting a better understanding of how women reconcile their religious and spiritual beliefs with abortion (or how they don’t). I plan to interview obstetrician-gynecologists about whether faith factored into their decision to provide abortions or, more likely, not – only about 14% do (Stulberg et al. 2011). I’ll visit local reproductive healthcare centers to learn about their philosophies towards abortion access.

Above all, I hope to gain insight on an issue constantly politicized and hyper-polarized, with lines drawn and distance created. I look forward to interacting with a wealth of diverse perspectives.     

 

Citations:

  1. Christopher, E. (2006). Religious aspects of contraception. Reviews in Gynaecological and Perinatal Practice6(3), 192-198.
  2. Dreweke, J (2016). Countering Zika Globally and in the United States: Women’s Right to Self-Determination Must Be Central. Guttmacher Policy Review, 19(1), 25-27.
  3. Engelhardt, HT. (1974). The ontology of abortion. Ethics84(3), 217-234.
  4. Hewson, B. (2001). Reproductive autonomy and the ethics of abortion. Journal of medical ethics, 27(suppl 2), ii10-ii14.
  5. Jerman J, Jones RK, Onda T (2016). Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008. New York: Guttmacher Institute. Retrieved from https://www.guttmacher.org/report/characteristics-us-abortion-patients-2014.
  6. Jones, D. A. (2005). The human embryo in the Christian tradition: a reconsideration. Journal of medical ethics31(12), 710-714.
  7. Kamali, M. H. (2004). Sanctity of Life. Dignity of Man. Islamic Texts Society, 31-35.
  8. Kinzbrunner, B. M. (2004). Jewish medical ethics and end-of-life care. Journal of Palliative Medicine, 7(4), 558-573.
  9. Koenig, HG (2004). Religion, spirituality, and medicine: research findings and implications for clinical practice. South Med J, 97(12), 1194-1200
  10. Larijani, B., & Zahedi, F. (2004). Islamic perspective on human cloning and stem cell research. Transplantation Proceedings, 36(10), 3188-3189.
  11. Medoff, MH (1989). Constituencies, ideology, and the demand for abortion legislation. Public Choice, 60(2), 185-191.
  12. Nuland S (2009). Autonomy amuck. New Republic.
  13. Paterson, C (2003). A Life Not Worth Living? Studies in Christian Ethics, 16(2):1-20.
  14. Pew Research Center (2014). Religion in Latin America: Widespread Change in a Historically
    Catholic Region. Retrieved from http://www.pewforum.org/2014/11/13/religion-in-latin-america/.
  15. Pew Research Center (2015). Religion and Public Life: Religious Landscape Survey. Retrieved from http://www.pewforum.org/religious-landscape-study/.
  16. Ramsey, P (2002). The patient as person: explorations in medical ethics. Yale University Press.
  17. Ruiz, Rebecca (2016).’I am sick of being silenced: 14 women share their abortion stories. Mashable. Retrieved from http://mashable.com/2016/03/06/abortion-stigma-women-stories/.
  18. Rosenthal BM, Collette M (2014). Women seeking abortions scramble to find places to go: Abortion centers try to adapt after court approves tough Texas law. Houston Chronicle.
  19. Schenker, JG (2000). Women’s reproductive health: monotheistic religious perspectives. International journal of gynecology & obstetrics, 70(1), 77-86.
  20. Stern, AM (2016). Zika and reproductive justice. Cadernos de Saúde Pública, 32(5).
  21. Stulberg, DB, Dude, AM, Dahlquist, I, & Curlin, FA (2011). Abortion provision among practicing obstetrician–gynecologists. Obstetrics and gynecology, 118(3), 609.
  22. Veatch, R. M. (2012). Hippocratic, religious, and secular medical ethics: The points of conflict. Georgetown University Press.
  23. White, K. A. (1999). Crisis of conscience: reconciling religious health care providers’ beliefs and patients’ rights. Stanford Law Review, 1703-1749.
  24. Whole Woman’s Health v. Hellerstedt. (2016). Oyez. Retrieved June 20, 2016, from https://www.oyez.org/cases/2015/15-274

2 Comments

  1. John Graham says:

    Dear Zara: This, your first blog in a series, is lovely. I greatly appreciate the box which talks about how various faiths view Ensoulment and Personhood, an important understanding. I look forward to your next blog on the subject.

  2. Linda Tavel, MD says:

    Thank you for taking on this incredibly thorny issue. I have always been a big fan of “contra-ception”, in other words, attempting to prevent the pregnancy in the first place. I acknowledge the legal and autonomous rights a woman has to her own body, but always worried about the little soul within. I find abortions for gender selection disturbing, but those are my Western thoughts. Now with Zika and the well-known impact of the virus on the fetus, my tight-grip on judgement is loosening. I feel absolutely that a woman with high risk of Zika infection–or known infection–should be able to make the choice for terminating that pregnancy, the earlier the better. No woman feels “great” about having that procedure. We should make sure that counseling is available for those who wish it.

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