What would you do? Reproductive Rights

Our poll shows that physicians, like the general population, are deeply divided on the ethical implications of abortion.

Jenna, 18, requests an abortion referral. Because she has irregular periods, she didn't suspect pregnancy until her clothes got tight and the results of a home pregnancy test came out positive.

On exam, her uterus is 16 to 18 weeks in size. The abortion clinic in your town only terminates pregnancies before 12 weeks. You have to request special permission from her HMO to obtain a second-trimester termination elsewhere. You oppose abortion and don't wish to approve termination of a four-month fetus. Jenna says she can't afford a child, can't sleep due to the stress, and wants the abortion quickly, before time runs out.
What would you do?

That's what we asked when we posed this and four other modern-day ethical dilemmas in our August 18 issue. Your responses indicate clearly that physicians are smack in the middle of a contentious debate.

For most Americans, the discussion, however heated, is purely theoretical. Physicians, though, are on the front lines in the abortion wars. But that doesn't mean that your opinions aren't as diverse-and as deeply felt-as those of the general population. In the above scenario, 29 percent of respondents said they'd refuse the abortion referral and give Jenna phone numbers for an obstetrician and an adoption agency; 26 percent would ask Jenna's HMO to temporarily transfer her to another primary care physician to grant her request; and 45 percent said they'd process the referral due to the principle of maternal autonomy.

For some who would try to dissuade Jenna or send her elsewhere, the problem isn't abortion per se, but the fact that she's seeking to terminate a second-trimester pregnancy. Others insist that this is a clinical issue, and it should be treated as such. As a Texas FP (respondents were given the option of remaining anonymous) notes, "I oppose abortion, but my personal views don't conflict with my medical care. The doctor has no right to make a value judgment for this patient. As long as there's no medical issue that would make abortion dangerous to the mother, then it's the doctor's responsibility to refer her for the best care possible, consistent with her wishes."

That's a minority stance, though. Most respondents say that their personal views shape their actions on this contentious topic.

Exercising the right of refusal

A few respondents who would turn Jenna down say they'd do so despite their support for abortion rights. "I think Jenna's request is based on fear and misunderstanding about the available resources," says Landi Halloran, an internist and pediatrician in Greencastle, IN. "I strongly believe abortion should remain legal, but young women who are simply frightened by an unexpected pregnancy deserve to have information about options other than abortion. This information doesn't take that long to share, and hopefully the girl will make a choice she's able to live with in the future. If her life or health were threatened by the pregnancy, I wouldn't hesitate to seek the appropriate referral for her."

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