Hersey Alicia E, Potter-Rutledge Jai-Me, Brown Benjamin P
Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
Brown University School of Public Health, Providence, Rhode Island, USA.
J Med Ethics. 2023 Dec 14;50(1):2-5. doi: 10.1136/jme-2022-108412.
About 6% of women in the world live in countries that ban all abortions, and 34% in countries that only allow abortion to preserve maternal life or health. In the USA, over the last decades-even before Dobbs v. Jackson Women's Health Organization overturned the federal right to abortion-various states have sought to restrict abortion access. Often times, this legislation has been advanced based on legislators' personal moral values. At the bedside, in contrast, provision of abortion care should adhere to the normative principles of medical ethics and reproductive justice, centreing patients and their individual reproductive intentions and desires. Abortion regulations, through their influence on patients and providers, may facilitate or impede such ethical care at the bedside. In this paper, we present a framework to model how abortion legislation should fit into the patient-provider relationship and to clarify the dynamics by which legislation may affect healthcare encounters. Our proposed framework serves as a tool to analyse the ethical impact of abortion regulations. We propose a model for assessing abortion policies based not on legislators' or advocates' individual moral claims, but on the shared, normative framework of clinical medical ethics. Through contrasting case studies, we demonstrate how a robust normative ethical framework can recentre patients and their reproductive needs. Our model is one way to account for-and safeguard-patients' diverse viewpoints and needs in the development of abortion policy, and it can serve to ground narratives for advocacy by healthcare workers and their professional organisations.
世界上约6%的女性生活在禁止所有堕胎行为的国家，34%的女性生活在仅允许为保护孕产妇生命或健康而堕胎的国家。在美国，在过去几十年里——甚至在多布斯诉杰克逊妇女健康组织案推翻联邦堕胎权之前——各个州就一直在寻求限制堕胎途径。很多时候，这类立法是基于立法者的个人道德价值观推进的。相比之下，在临床层面，堕胎护理的提供应遵循医学伦理和生殖正义的规范原则，以患者及其个人生殖意图和愿望为中心。堕胎法规通过对患者和提供者的影响，可能会促进或阻碍临床层面的这种伦理护理。在本文中，我们提出了一个框架，用以模拟堕胎立法应如何融入医患关系，并阐明立法可能影响医疗服务过程的动态机制。我们提出的框架可作为分析堕胎法规伦理影响的工具。我们提出了一个评估堕胎政策的模型，该模型不是基于立法者或倡导者的个人道德主张，而是基于临床医学伦理的共享规范框架。通过对比案例研究，我们展示了一个强大的规范伦理框架如何能重新以患者及其生殖需求为中心。我们的模型是在堕胎政策制定过程中考虑并保障患者不同观点和需求的一种方式，它可为医护人员及其专业组织的宣传提供依据。
