Essay Sample on Interruption of a Pregnancy with a Live Fetus

Introduction

During pregnancy, a patient undergoes a prenatal screening. However, at times the diagnostic tests may reveal complicated situations where patients and professionals have to deliberate on whether to continue the pregnancy. Occasionally, parents can choose to medically terminate the pregnancy, especially when a health condition poses a threat to a mother's life. On the other hand, pregnancy termination elicits different reactions in that some people are religiously opposed irrespective of the outcome while others advocate for it; this poses a dilemma.

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Ethical Dilemma

I work at a Catholic health hospital that has moral and religious beliefs on abortion. A few weeks ago I encountered an ethical dilemma. I had a patient who was 21 weeks pregnant with spontaneous rupture of membranes as well as signs and symptoms of chorioamnionitis. Due to the risk of infection, the situation appeared to be life-threatening for both the mother and the unborn child. Hence, I had to terminate the pregnancy through the use of misoprostol. The method of misoprostol results in minimal complications or side effects of a patient, and is conducted for pregnancies between thirteen and twenty-two weeks; thus it fitted in the condition of the patient.

Typically, a twenty-one-week pregnancy means that the fetus is still developing its organs. Therefore, the amniotic fluid is essential for protecting the developing child against physical impact, infection or prevention of the umbilical cord from getting compressed. However, with the rupture of the membranes and chorioamnionitis, the fetus can neither move nor breathe; this is necessary for the development of bones, lungs, and chest. Additionally, the situation can result in fetal deformity, for instance, underdeveloped lungs. This makes it hard for a fetus to survive outside the womb.

Ethical Framework

The ethical framework for abortion providers played an essential role in guiding my nursing practice as well as decision making. This moral principle serves as the ultimate guide in the challenging situation on abortion, especially where one is interacting with a broader medical and non-medical community. According to the National Abortion Federation, it is the primary obligation of a health care provider to maintain high standards of abortion care. More so, in a clinician-patient relationship, the ultimate responsibility is the medical duty to advocate, advance as well as protect the health and well-being of a patient.

Nonetheless, laws that compromise compassionate and safe abortion care puts one in an ethical dilemma. Additionally, working in a Catholic hospital makes the situation harder. Hence, I had to obtain informed consent from the patient; this assisted in showing that the patient was not coerced in any manner to end her pregnancy. Besides, the informed consent dictates that the healthcare provider must discuss with the patient about the treatment decisions as well as the description of the abortion procedure, medically accurate benefits and risks of the process, and available alternatives.

Decision's Impact

I had to administer 400 micrograms of misoprostol to the patient every three to six hours. However, I was cautious because a dose of more than 800 micrograms is likely to have side effects, especially diarrhea. Further, in some patients, the drug can result in fever, chills and abdominal cramps. Infection or rupture of the uterus may be one of the associated complications; these side effects can cause distress or trauma to a patient.

Additionally, the drug can result in bleeding; hence I counseled the patient on the typical bleeding patterns as well as informing that the situation could vary among patients. Nonetheless, the patient had no contraindications; thus I recommended ibuprofen to assist in the pain management of abdominal cramping.

Also, I had to counsel the patient on the severe adverse events of a miscarriage; this would help her to monitor the signs and symptoms of a miscarriage; thus minimizing complication risks via early detection. Signs of an infection may include vagina discharge with a strong odor, uterine/ abdominal cramping, fever, and chills. Nonetheless, I informed the patient that vaginal bleeding could occur due to the passing of uterus content. However, if the bleeding was heavy and prolonged, the patient had to notify one immediately.

The decision about pregnancy termination risked my nursing practice in that I had to explain to the hospital board why I initiated the resolution. More so, it was hard to convince them because Catholic hospitals have strong ethics and religious beliefs about abortion. However, the condition at hand was threatening both to the mother and the unborn child. More so, induced labor could not have assisted since the fetus was 21 weeks; hence there were no survival chances. The decision affected me psychologically because it was like killing an innocent life. Besides, I was risking my nursing practice, but I had to save a life.

HIPAA Law Impact on Pregnancy Termination

Institutions performing abortion may or may not be covered under the HIPAA act (Electronic frontier foundation, n.d). However, this depends on whether they electronically transmit health information. But if the institution is covered, then the information on the abortion reports is protected health information that has to meet HIPAA de-identification standards. The biggest challenge for abortion reporting is that the forms are subject to disclosure as public records due to the freedom of information laws; this can result in the violation of a patient's privacy. Nevertheless, there are a lot of anti-abortion battles in the society; this question on what more can be done to de-identify the data on abortion, especially in a legal proceeding where reports have to be provided as a shred of evidence.

What could have been done Differently The alternative method would have been amniopatch treatment. The procedure involves the sealing of the ruptured membranes by infusing a cryoprecipitate and platelet concentrate into the amniotic cavity; this forms a plug hence, sealing the infected area due to fibrin formation and platelet activation (Sung et al., 2017). The complete sealing of the defected membranes gives room for prolongation of pregnancy. However, it is scarce for spontaneous rupture of membranes to seal. Nonetheless, the amniopatch treatment relies on factors such as intrauterine infection as well as the location and size of the membrane defects. Hence, patients with spontaneously ruptured membranes have very few chances for a successful amniopatch treatment.

Conclusion

Working in a Catholic hospital poses an ethical dilemma in that one may be caught between ethics, religious beliefs and saving a life. In most cases, treatment, medication, and operations of women in these institutions can only be permitted if the situation cannot be safely postponed even if it would result in the death of the unborn child. However, some cases are life-threatening where one is supposed to make emergency procedures to save mothers. For instance, the interruption of a pregnancy with a fetus under 24 weeks, especially when a woman has spontaneous rupture of membranes and chorioamnionitis; this is life threatening to both the woman and the unborn child.

References

1033 Electronic frontier foundation. (n.d.). Abortion reporting. Retrieved from Electronic frontier foundation: https://www.eff.org/issues/abortion-reporting

Sung, J.-H., Kuk, J.-Y., Cha, H.-H., Choi, S.-J., Roh, C.-R., & Kim, J.-H. (2017). Amniopatch treatment for preterm premature rupture of membranes before 23 weeks gestation and factors associated with its success. Taiwanese Journal of Obstetrics and Gynecology, 599-605.