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

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.

Keywords: Dobbs vs Jackson Women’s Health Organization; Roe vs Wade; abortion; abortion ban; beneficence; ethics; fetal rights; fetal rights–based reductionism; pregnancy; pregnant patient rights reductionism; pregnant patient rights–based reductionism; professional responsibility model; racial inequity; reductionism; rights-based reductionism; socioeconomic inequity; supreme court; zealotry.

MeSH terms

  • Abortion, Induced* / ethics
  • Abortion, Induced* / legislation & jurisprudence
  • Abortion, Legal / ethics
  • Abortion, Legal / legislation & jurisprudence
  • Female
  • Humans
  • Patient Rights / legislation & jurisprudence
  • Pregnancy
  • Professional Practice / ethics
  • Professional Practice / legislation & jurisprudence
  • Supreme Court Decisions*
  • United States
  • Women's Rights / legislation & jurisprudence