Successfully reported this slideshow.

5530: Chapter 17


Published on

Published in: Health & Medicine
  • Be the first to comment

5530: Chapter 17

  1. 1. Chapter 17Procreation AndEthical Dilemmas 2
  2. 2. AbortionPremature termination of pregnancy. It can beclassified as spontaneous or induced. It mayoccur as an incidental result of a medicalprocedure or it may be an elective decision onthe part of the patient. 3
  3. 3. U.S. Supreme Court Decisions Right to Abortion• 1973: Roe v. Wade – First Trimester –abortion decision between woman & physician. – Second Trimester –state may reasonably regulate abortion procedure. – Third Trimester –state may prohibit all abortions except those deemed necessary to protect maternal life or health. 4
  4. 4. Abortion Review: Committee to Restrictive• 1973: Doe v. Bolton• Requirements struck down – residency – performance of abortion by Joint Commission approved hospital – approval of abortion by a medical staff committee – consultations 5
  5. 5. Funding - I• Not Required for Elective Abortions – 1977: In Beal v. Doe – The Court ruled that it is not inconsistent with the Medicaid portion of the Social Security Act to refuse to fund unnecessary (although perhaps desirable) medical services. – Maher v. Roe 6
  6. 6. Funding - II• Not Required for Therapeutic Abortions – 1980: Harris v. McRae – Different states not compelled to fund Medicaid recipients medically necessary abortions for which federal reimbursement is unavailable, but may choose to do so. – Supreme Court voted 6 to 3 states may refuse to spend public funds to provide non- therapeutic abortions for women.
  7. 7. Funding Bans: Unconstitutional in California1981: Committee to Defend Reproductive Rights v. Meyers• If the state cannot directly prohibit a womans right to obtain an abortion, may the state by discriminatory financing indirectly nullify that constitutional right? Can the state tell an indigent person that the state will provide him with welfare benefits only upon the condition that he join a designated political party or subscribe to a particular newspaper that is favored by the government? Can the state tell a poor woman that it will pay for her needed medical care b but only if she gives up her constitutional right to choose whether or not to have a child? 8
  8. 8. Funding Discrimination: Prohibited in ArizonaThe Arizona Supreme Court in Simat Corp. v. Arizona Health Care Cost Containment Sys., found that the states constitution does not permit the state & the Arizona HealthCare Cost Containment System to refuse to fund medically necessary abortion procedures for pregnant women suffering from serious illness while, at the same time, funding such procedures for victims of rape or incest or when the abortion was necessary to save the womans life. 9
  9. 9. States May Protect Viable Fetus• 1979: Colauti v. Franklin• The Supreme Court in Colautti v. Franklin voted 6 to 3 that states may seek to protect a fetus that a physician has determined could survive outside the womb. Determination of whether a particular fetus is viable & must be, a matter for judgment of the physician. 10
  10. 10. Parental Consent Statute Unconstitutional: Missouri• 1976: Danford v. Planned Parenthood• Unconstitutional to require parental consent under age 18• Statute failed to provide any definitive guidelines 11
  11. 11. Parental Consent Statute Ruled Unconstitutional: Massachusetts• 1979: Bellotti v. Baird• Parental consent requirement struck down.• MA statute too restrictive. – statute as written & construed, no minor, no matter how mature & capable of informed decision making, could receive an abortion without the consent of either both parents or a superior court judge. – making minors abortion subject in every instance to an absolute third-party veto. 12
  12. 12. Notifying Parent for Immature Minor Constitutional: Utah• 1981: H.L. Matheson• Statute requiring physician to notify parents of minor, when possible, upheld.• Parental notice does not violate constitutional rights of immature, dependent minor.• State may not, however, legislate a blanket un- reviewable power of parents to veto their daughter’s abortion. 13
  13. 13. Consent Not Required for Emancipated Minors• 1987: In re Anonymous• Consent Not Required for Emancipated Minor. 14
  14. 14. Parental Notification Not Required• 2000: Planned Parenthood v. Owen• Colorado Parental Notification Act, Colo. Rev. Stat. § § 12-37.5-101, et seq. (1998), which required physician to notify parents of a minor prior to performing an abortion upon her, violates minors rights protected by the U.S. Constitution.• The act generally prohibited physicians from performing abortions on an unemancipated minor until at least 48 hours after written notice has been delivered to minors parent, guardian, or foster parent. 15
  15. 15. Minor’s Decision to Abort Found Sufficient• 2006: In re Doe• Minor sufficiently mature – Precluded notification of parents 16
  16. 16. Justices Send Abortion Case Back to Lower Court• 2006: Ayotte v. Planned Parenthood of New England• the Supreme Court referred this case back to the appeals court – court was requested to find a way to include an exception to the law for a medical emergency 17
  17. 17. Minor’s Decision to Abort Not Sufficient• 2008: In re petition of Doe• Juvenile sought judicial waiver of statutory requirement that physician notify her parents or guardian prior to terminating her pregnancy• Juvenile failed to prove evidence of sufficient majority 18
  18. 18. State Interest Not Compelling• 1975: Poe v. Gerstein• Husbands interest in the baby was held to be insufficient to force his wife to face the mental and physical risk of pregnancy and childbirth. 19
  19. 19. Spousal Consent Unconstitutional• 1975: Doe v. Zimmerman• Pennsylvania Abortion Control Act requiring written consent of the husband unconstitutional.• Provisions impermissibly permitted husband to withhold his consent either because of his interest in potential life of the fetus or for capricious reasons.• Although fathers interest in the fetus was legitimate, it did not outweigh the mothers constitutionally protected right to an abortion. 20
  20. 20. Father of Unborn Fetus Could Not Stop Abortion• 1988: Doe v. Smith• Natural father not entitled to prevent abortion• Father demonstrated substantial instability 21
  21. 21. Spousal Consent Undue Burden• 1992: Planned Parenthood v. Casey• Spousal consent undo burden on the woman 22
  22. 22. Restricting Right to Abortion Affirmed• 1992: Planned Parenthood v. Casey• Court reaffirmed – right of women to have an abortion. – state’s power to restrict abortions after fetal viability. – principle that state has legitimate interests in protecting woman & life of fetus. 23
  23. 23. Restricting Right to Abortion AffirmedUndue burden to require spousal notificationNot undue burden to require:– a woman be informed of nature of abortion procedure& risks involved.–a woman be offered information on the fetus & onalternatives to abortion.–a woman to give her informed consent before abortionprocedure–parental consent be given for a minor seeking anabortion, providing for a judicial bypass option if theminor does not wish or cannot obtain parental consent.–there be a 24-hour waiting period before any abortioncan be performed. 24
  24. 24. Abortion Counseling - I• Physician Counseling of Patient Upheld – 1983: City of Akron v. Akron Center – States cannot mandate what information physicians provide abortion patients – states cannot require abortions for women more than three months pregnant be performed in a hospital 25
  25. 25. Abortion Counseling - II• Prohibition of Abortion Counseling Not unconstitutional – 1991: Rust Sullivan• Federal regulations that prohibit abortion counseling & referral by family planning clinics that receive funds under Title X held constitutional. 26
  26. 26. 24-Hour Waiting Period Not Burdensome• 1992: Planned Parenthood of Southwestern Pennsylvania v. Casey – Law allows for exceptions to this requirement in the event of a medical emergency.• 1993: Utah’s Women’s Clinic, Inc. v. Leavitt – law allows an exception for a medical emergency 27
  27. 27. Incompetent Persons• 1987: In re Doe• Profoundly retarded woman became pregnant during her residence in a group home as a result of a sexual attack by an unknown person. The record supported a finding that if the woman had been able to do so, she would have requested the abortion. The court properly chose welfare agencies & the womans guardian ad litem as the surrogate decision makers, rather than the womans mother.• The mother apparently had little contact with her daughter over the years. 28
  28. 28. Viability Test Required• 1989: Webster v. Reproductive• Statute upheld providing that no public facilities or employees should be used to perform abortions.• Physicians should conduct viability tests before performing abortion. 29
  29. 29. Partial-Birth Abortion - I• Plan Constitutionally Vague • 1998: Womens Medical Professional Corp. v. Voinovich• Statute banning any use of the D&X procedure was unconstitutionally vague.• Likely a properly drafted statute will eventually be judged constitutionally sound. 30
  30. 30. Partial-Birth Abortion - II• Partial-Birth Abortion: Ban Act Unconstitutional • Little Rock Family Planning Services v. Jegley, 1999• Arkansas act unconstitutional because it was unconstitutionally vague, imposed an undue burden on women seeking abortions, and it did not adequately protect the health and lives of pregnant women. 31
  31. 31. Partial Birth Abortion - III• Partial-Birth Abortion Statute Vague – 2000: Planned Parenthood of Cent. N.J. v. Farmer • partial-birth abortion statute was void for vagueness. • created undue burden on womans right to abortion.• Partial-Birth Abortion: Ban Unconstitutional – Stenberg v. Carhart 32
  32. 32. Partial Birth Abortion - IV• 2003: Partial Birth Abortion Act: 1st federal restrictions – President Bush signs federal restrictions banning late term abortions.• 2005: Bush administration asked the Supreme Court – to review an appellate courts decision holding the Partial Birth Abortion Act of 2003 unconstitutional. 33
  33. 33. Partial Birth Abortion - V• 2006: National Abortion Fed’n v. Gonzages – found to be unconstitutional – it imposed and undo burden on a woman’s right to choose previability abortion 34
  34. 34. Physicians Feeling the Heat• Picketing Physicians: Privacy Issue• Antiabortion Demonstration• Obstructing Access to Abortion Clinics 35
  35. 35. Continuing Controversy - I• Employee Refusal to Participate in Abortions – Pharmacists• Physicians feeling the heat• Use of force against demonstrators – picketing physicians’ residencies – trespass, obstructing access to abortion clinics• State abortion statutes• Abortion and Conflicting Beliefs – morality of abortion 36
  36. 36. Sterilization• Elective Sterilization – Blood Vessel Mistakenly Cut – Negligent Sterilization Pregnancy• Regulation of Sterilization for Convenience• Therapeutic Sterilization• Involuntary/Eugenic Sterilization 37
  37. 37. Artificial Insemination• Artificial insemination is the injection of seminal fluid into a woman to induce pregnancy• Consent• Confidentiality 38
  38. 38. Surrogacy• A method of reproduction whereby woman agrees to give birth to a child she will not raise the handover to a contract party – who was often unable to give birth herself• Surrogacy raises many ethical and legal issues 39
  39. 39. Wrongful Birth, Life, & Conception• Wrongful Birth• Wrongful Life• Wrongful Conception• Prevention of such Lawsuits 40
  40. 40. REVIEW QUESTIONS1. Discuss the legal and ethical issues involved in Roe v. Wade.2. Do you agree that individual states should be able to place reasonable restrictions or waiting periods? Who should determine what is reasonable?3. Should a married woman be allowed to abort without her husbands consent? 41
  41. 41. REVIEW QUESTIONS, cont.4. Give two arguments for and two arguments against partial-birth abortions.5. Explain why you think Roe v. Wade is an example of legislating morality.6. Do you agree that eugenic sterilization should be allowed? Why or why not? 42
  42. 42. REVIEW QUESTIONS, cont.7. Describe surrogacy and the legal and ethical issues that can arise.8. Describe the distinctions among wrongful birth, wrongful life, and wrongful conception. Why is there such a diversity and opinions from the different states? 43