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解决罗诉韦德案推翻后与堕胎专业实践相关的挑战。

Addressing challenges related to the professional practice of abortion post-Roe.

机构信息

Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY.

University of Pennsylvania, Philadelphia, PA.

出版信息

Am J Obstet Gynecol. 2024 May;230(5):532-539. doi: 10.1016/j.ajog.2023.10.026. Epub 2023 Oct 31.

Abstract

The landmark Roe vs Wade Supreme Court decision in 1973 established a constitutional right to abortion. In June 2022, the Dobbs vs Jackson Women's Health Organization Supreme Court decision brought an end to the established professional practice of abortion throughout the United States. Rights-based reductionism and zealotry threaten the professional practice of abortion. Rights-based reductionism is generally the view that moral or ethical issues can be reduced exclusively to matters of rights. In relation to abortion, there are 2 opposing forms of rights-based reductionism, namely fetal rights reductionism, which emphasizes the rights for the fetus while disregarding the rights and autonomy of the pregnant patient, and pregnant patient rights reductionism, which supports unlimited abortion without regards for the fetus. The 2 positions are irreconcilable. This article provides historical examples of the destructive nature of zealotry, which is characterized by extreme devotion to one's beliefs and an intolerant stance to opposing viewpoints, and of the importance of enlightenment to limit zealotry. This article then explores the professional responsibility model as a clinically ethically sound approach to overcome the clashing forms of rights-based reductionism and zealotry and to address the professional practice of abortion. The professional responsibility model refers to the ethical and professional obligations that obstetricians and other healthcare providers have toward pregnant patients, fetuses, and the society at large. It provides a more balanced and nuanced approach to the abortion debate, avoiding the pitfalls of reductionism and zealotry, and allows both the rights of the woman and the obligations to pregnant and fetal patients to be considered alongside broader ethical, medical, and societal implications. Constructive and respectful dialogue is crucial in addressing diverse perspectives and finding common ground. Embracing the professional responsibility model enables professionals to manage abortion responsibly, thereby prioritizing patients' interests and navigating between absolutist viewpoints to find balanced ethical solutions.

摘要

1973 年,罗诉韦德案成为美国最高法院的里程碑式判决,确立了堕胎的宪法权利。2022 年 6 月,多布斯诉杰克逊妇女健康组织案使美国各地既定的堕胎专业实践画上了句号。基于权利的简化论和狂热主义威胁着堕胎的专业实践。基于权利的简化论通常认为,道德或伦理问题可以完全简化为权利问题。在堕胎方面,存在两种对立的基于权利的简化论形式,即胎儿权利简化论,强调胎儿的权利而忽视孕妇的权利和自主权;以及孕妇权利简化论,支持无限制的堕胎而不考虑胎儿。这两种立场是不可调和的。本文提供了狂热主义的破坏性本质的历史实例,狂热主义的特点是对自己的信仰极端投入,对对立观点采取不宽容的立场,以及启蒙的重要性以限制狂热主义。本文接着探讨了专业责任模式,作为一种在临床伦理上合理的方法,以克服基于权利的简化论和狂热主义的冲突形式,并解决堕胎的专业实践问题。专业责任模式是指妇产科医生和其他医疗保健提供者对孕妇、胎儿和整个社会所负有的伦理和专业义务。它为堕胎辩论提供了一种更加平衡和细致入微的方法,避免了简化论和狂热主义的陷阱,并允许考虑到女性的权利以及对孕妇和胎儿患者的义务,同时考虑到更广泛的伦理、医学和社会影响。建设性和尊重的对话对于处理不同的观点和寻找共同点至关重要。接受专业责任模式使专业人员能够负责任地管理堕胎,从而优先考虑患者的利益,并在绝对主义观点之间进行权衡,以找到平衡的伦理解决方案。

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