The attitude of society and the state to abortion was changing in different periods of historical development, depending on the political, economic, and social conditions. There is one main question: whether to allow abortion or ban it. The answer to this question constitutes a moral and ethical dilemma. Lawyers, healthcare professionals, and representatives of public organizations provide varying views on the issue as well as different approaches to its solution.
Especially acute is the ethical aspect of abortion in the third trimester because the fetus at that time is almost fully developed. Thus, this paper explores the facts on abortion, its rates all over the world, reveals the peculiarities of abortion after six months and its consequences, as well as analyzes the moral and ethical issues. It also takes a look at the legal implications of this phenomenon to better understand the issue and make an attempt to determine what is wrong or right in this respect.
Facts on Abortion
Every year, approximately 42 million abortions are done all over the world (“Abortion Facts”, n.d.). According to the statistics, every day, this number reaches approximately 115,000 abortions, 21% of all pregnancies are aborted artificially; 50% of women having abortions are younger than 25 years;61% of all abortions are done before the 9th week of pregnancy; 18% happen between the 9th-10th weeks, 9.6% happen between the 11th-12th weeks, 6.7% -between the 13th-15th weeks, 3.5% - between the 16th-20th weeks, and only 1.1% of all abortions happen after the 20th week of pregnancy (“Abortion Facts”, n.d.). A majority of all abortions are done at the request of the women; others are carried out due to the health issues of women, fetal anomalies, a variety of social problems, and the smallest percent occur because of rape or incest (Finer et al., 2005).
The majority of women seek late-term abortion for the following reasons: they are raising children alone, they are depressed or using illicit substances, they are in conflict with a male partner or experiencing domestic violence, they have trouble deciding and then have access problems, and they are young and nulliparous (Foster & Kimport, 2013). However, there is a large percentage of women who just did not recognize they were pregnant (Tolentino, 2013). Also, it should be noted that women aged 20–24 are more likely to have a late abortion than those aged 25–34 (Foster & Kimport, 2013).
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According to statistics, 83% of all abortions are made in developing countries, and 17% occur in developed countries (“Abortion Facts”, n.d.). Moreover, nearly half of all abortions worldwide are unsafe, and nearly all unsafe abortions (98%) occur in developing countries. It should be also noted that, in third-world countries, 56% of all abortions are unsafe, compared with just 6% in developed regions (“Facts on Induced Abortion Worldwide”, 2015). Unsafe abortions result in approximately 70 thousand women's deaths and cause about five million disabilities per year around the globe (“Facts on Induced Abortion Worldwide”, 2015).
The United States ranks second in the number of abortions per year after China - known for its brutal policy of birth control and human rights violations. Russia is the third in this list. Western Europe, Southern Africa, and Northern Europe have the lowest abortion rates in the world. The lowest percentage of abortions is seen in Belgium and the Netherlands (“Facts on Induced Abortion Worldwide”, 2015). In China, men put pressure on women that they should not give birth to girls; husbands often threaten their wives with divorce if they do not agree to have an abortion. However, the United States is similar to China in allowing very late abortions. America is one of only four countries in the world (China, North Korea, and Canada) where abortion is legal for any reason up to the moment of birth (Zagorski, 2015).
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The Abortion after Six Months
The abortion after six months refers to the late abortion. Termination of pregnancy in the later stages is called artificial birth, and the fetus during this period is already viable (Haney, 2008). As a rule, it is made for medical reasons, based on the physician’s diagnosis and complete examination of the woman and the fetus. Sometimes, late abortion can be allowed for social reasons - for example, if the mother has already several children and no steady income. In the United States, there are only four doctors that provide abortion in such late terms (Tolentino, 2013).
There are three methods of late abortion. The first one is preterm birth, at which hormones are introduced into the body, causing a softening of the cervix and continued uterine contractions. As a result, premature birth occurs, and the fetus comes out. The second one is a caesarean section when the removal of the baby is done through an incision in the abdominal cavity of the uterus, and then - overlapping access of air to the respiratory tract. Finally, it is salt abortion. It is carried out using a needle being injected into the amniotic sac. Then, a caustic salt solution is being introduced, causing a painful fetal death (“Abortion Procedures”, 2015).
Even if the entire procedure goes under the supervision of a qualified specialist, it is not always possible to avoid the complications completely both physiological and psychological. There can be such consequences as continuous uterine bleeding, infectious and inflammatory diseases in the post-abortion period, and a depressive mood and apathy of a woman - as a consequence of experiencing psychological and hormonal shake (McAtee, 2015).
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Moral and Ethical Issues
Ethics is defined as a virtue in the nature of man. Ethics examines and regulates the laws and principles of morality, explores its origin, development, and functions, role, and practical application in the everyday life of the individual and society as a whole. Morality is a system of beliefs, norms, perceptions, value judgments regulating human activities; a peculiar form of social consciousness.
Abortion after six months is a complex moral and ethical problem. Its various aspects of religion, ethics, and morality concern both the woman and the doctor.
A woman faces a moral dilemma: the choice to give life or take it away from the future child. Late abortion is already done when the fetus begins to move and develops various physical features. It is already a human, has a unique genome, and starts to feel. At this moment, a pregnant woman begins to experience the mother's feelings.
However, the consequences of actions do not always direct what is morally required. Also, women have to understand that abortion at late terms entails awful consequences. There exists a possibility that she might never be able to give birth. Moreover, the procedure can cause serious health consequences to the woman. Nevertheless, there is still 1% of women who decide to do an abortion after six months (“Abortion Facts”, n.d.).
At the same time, moral and ethical issues arise in front of the doctors. Giving the Hippocratic Oath, doctors promise not to give any woman pessaries to induce abortion. According to Hippocrates, it is murder (Tyson, 2001). However, performing an abortion is a mandatory medical practice for some doctors to obtain a medical degree, but there are students whose ideological beliefs do not allow them not only to perform abortions but also to enter the operating rooms, where abortion is being carried out. So, they face a choice whether to visit those lessons or to do a morally right thing for them – not to attend and thereby miss the opportunity to get the desired diploma.
However, moral and ethical rules should not be always binding. They should be viewed as the guidelines to follow when handling different cases. There are situations where there is a threat to the life of the mother. In such cases, a woman may give birth to healthy children instead of one risking her own life. Respectively, the procedure may be carried out when the child’s future wellbeing is at stake. If physical or mental sufferings are likely to occur in the child born with complex disabilities, an abortion can be regarded as an act of mercy. Thus, in such cases, the issue of morality develops a dubious nature.
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In addition, a complex question of morality can be viewed from a religious perspective. Abortion is a particularly difficult decision for religious people. Abortion is condemned by major denominations of three major religions - Christianity, Islam, and Judaism - and is considered there as a form of murder (Johnston, 2003). However, the position on this issue is usually less defined and institutionalized in indigenous religions of the Far East and other parts of the world, as well as in new religious movements. "Islamic Code of Medical Ethics" states that the sanctity of human life is omnipotent in all its stages, starting with the embryo and fetus. The life of an unborn child must be saved, except in cases of absolute medical necessity recognized by the laws of Islam (Johnston, 2003).
According to Buddhism, killing is the worst negative act possible. The nature and status of the embryo in Buddhism are defined as sacred and having the full potential of human beings. Therefore, abortion corresponds to the destruction of life regardless of its stage (Johnston, 2003). According to Judaism, abortion (and in general - the reluctance to have children) is contrary to the historical and traditional outlooks of the state and a person’s mission purpose according to the outlooks of the Jewish nation. At the same time, if the pregnancy threatens the physical health of the mother, it serves as an important cause to allow abortion.
According to the Christian teaching, a consciously made abortion is a murder of a person, a violation of one of the Ten Commandments - "Thou shalt not kill", and is considered a grave sin. Only the local bishop and those who have his permission are entitled to forgive this sin after confession. Moreover, for this sin, a woman can even be excluded from the Church (Johnston, 2003).
In the case of abortion after six months, when two principles of patient autonomy and beneficence come into conflict, the beneficence must win. The fetus in such a late-period feels everything, and it is inhumane, morally wrong, and unethically to kill it. Therefore, women should be attentive to their actions. Irresponsibility towards own health, impulsive behaviors, and reluctance to realize the direct consequences of one’s actions lead to situations when the ethical and moral dilemmas are raised. However, when there is a threat to a woman’s or fetus’ life, a patient’s autonomy should come first. In such a case, the woman should make the decision that concerns her future wellbeing or that of her future child.
Legal Point of View
The problem of abortion in the human rights context is highly controversial. On the one hand, the following question arises; when the unborn child receives the right to live. On the other hand, the aspects of integrity and privacy, as well as the right to dispose of their own body are to be decided.
However, it is specified that the beginning of the human life of a fetus is recognized at 22 weeks (“When Does Human Life Begin?”, 2015). Not all the fertilized eggs (embryos) survive in the future and give rise to a new life, but the fetus at 22 weeks has already developed the features of a human being.
According to Art. 2 of the European Convention on Human Rights, the right to life extends to unborn children. However, legally, there remains the need to determine the point that would be recognized as its beginning thus the issue of termination of life. Therefore, since the issue has a dubious nature, the leading direction in the legislation in this sphere is not the right to life but the right to respect for private life, dignity, and integrity thus leaving some freedom of choice for mothers (Korff, 2006).
Proponents of the position that the woman has the right to freely choose to bear the fetus give the publications of the International Planned Parenthood Federation in support of their claims. The question of abortion is part of the issue of reproductive health, reproductive choice, and reproductive rights of a person. Reproductive health reflects an important aspect of the general health and envisions the ability to conduct progeny, free decisions in this area, and safe sex life. Reproductive choice is a manifestation of the moral autonomy of an individual in matters of sexuality and procreation. Reproductive rights are designed to create the social conditions to ensure reproductive health (“Girls Decide: Choices on Sex and Pregnancy”, 2011).
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Moreover, imposing a ban on abortion will inevitably lead to an increase in the number of criminal abortions coupled with even more dangers to a woman's reproductive health (infertility, for example). On the contrary, when abortions are legally allowed, pregnant women have no reason to seek help and suffer the consequences of the medical procedures carried out by unauthorized or even ignorant individuals.
However, the situation is even more acute with late abortions. Even if legally and morally justified, there still exists a threat to the health of women. Such abortions should be banned and be strongly controlled in order to prevent severe and fatal cases. It should only be exceptional based on significant medical reasons and by no means social. Women should not retighten to such a late date. In order to implement it, the right decision would be to make contraception and early abortion more accessible to avoid the need for inevitable late-term abortion.
In conclusion, abortion after six months is carried out only in 1% of women worldwide. The majority of them do it not only for medical reasons but also for the social ones (the inability to raising children alone, young age, or late recognition). Late abortion is forbidden almost everywhere in the world and if carried out, is illegal and in inappropriate conditions. In the United States, there are only four licensed doctors that do an abortion on such a late-term (Tolentino, 2013).
Moreover, if done, it can lead to severe consequences such as infertility, disabilities, or even death of the woman. At the same time, it is also a tough moral and ethical issue. At this stage of its development, the fetus already feels everything, and the mother has to decide whether to kill him or not, a decision that constitutes an ethical and moral dilemma especially complicated for religious people because the religion prohibits abortion. However, moral and ethical rules should not be always binding. When there is a threat to a woman’s or fetus’s life, the frames and limitations imposed by morality become blurred.
Thus, in a critical situation, the woman should have the right to decide. The abortion after six months should not be categorically banned. It will lead to an increase in illegal abortions, an increase in the number of abandoned children, and a threat to life and health of women. However, it should be allowed only from medical considerations.