The Travails of Moral Distress for the Abortionist
November 28, 2022
by Jeffrey Barrows, DO, MA (Bioethics)
It will come as no surprise that the Journal of the American Medical Association (JAMA) recently released a special issue filled with articles and opinions arguing for the absolute necessity of access to legal abortion. One opinion that caught my attention was entitled “Implications of the Dobbs Decision for Medical Education Inadequate Training and Moral Distress.” CMDA recently publicly released a new position statement on moral distress, so I was naturally intrigued. Were the authors of this opinion piece actually going to make the argument that the lack of access to elective abortion, a procedure that has been considered immoral for thousands of years, will cause moral distress among upcoming students and residents? Exactly.
The premise of these authors is that since a significant portion of OB/Gyn residents will be training in states that do not allow abortion, they may be unable to achieve adequate expertise in the art of abortion and be “…forced to provide unethical care that will harm patients.” As always, the ethics of the American Medical Association (AMA) is focused on the visible patient, the pregnant woman, or as is now commanded, the pregnant “person.” There is never any consideration regarding the ethics of the unborn baby. One of the great mysteries of modern obstetrics is when exactly, in the eyes of the AMA or the American College of Obstetricians and Gynecologists (ACOG), does this in-utero blob of nothingness, better known by most of us as a pre-born baby, really become a baby. One would think this would be an important criterion for development by the specialty college of obstetrics. Apparently, they have been too busy writing articles emphasizing the critical importance of abortion access.
Before I can get back to the issue of moral distress, the opinion piece has dangerously raised my blood pressure by engaging in blatant misinformation. As someone who used to practice OB/Gyn, the accusation that patients with ectopic pregnancies will not get adequate care in pro-life states is nothing less than ludicrous! Where is their proof? This strawman is raised at every conceivable opportunity, yet always without proof of any systemic occurrence of this dereliction of medical duty. I practiced in a hospital in which the bylaws explicitly forbid election abortion. I can imagine that if I had approached the medical director of the hospital with the question of whether I could take care of a patient with an ectopic pregnancy, he would have looked at me as if I had suffered a brain injury. At the clinical level, there is never any question that patients with a life-threatening ectopic pregnancy deserve immediate care, regardless of state or local elective abortion statutes. To state otherwise is to grossly mislead the general population by spreading unethical misinformation.
Another favorite lie involves the care of the patient with preterm premature rupture of the membranes. This opinion piece purports that these patients will be told they cannot offer an abortion until the patient experiences “…significant morbidity from hemorrhage or sepsis related to the pregnancy.” A terrible lie! The obstetrician doesn’t have to perform an abortion—they can induce labor as the patient begins to show signs of infection. Many of these preterm babies survive to have a normal life.
But I digress.
After spewing this scaremongering misinformation, the authors return to the sensitive, emotional state of the resident desiring to develop expertise in the extinguishing of unborn life. These poor individuals are in danger of experiencing debilitating moral distress when they believe that the “…ethically appropriate course of action…” would be abortion, yet they would be unable to carry it out. It takes a great deal of ethical gymnastics to reach the conclusion that the ethically appropriate course of action involves the killing of an unborn baby. They perform those ethical gymnastics by citing a litany of ethical principles supporting their premise, including autonomy, patient welfare, social justice, beneficence, nonmaleficence and, of course, equity. If only they would apply patient welfare, beneficence, nonmaleficence and the proverbial equity to the in-utero patient. There might be a different ethical conclusion.
I’m anxious to see if this new profound respect for moral distress by the AMA and ACOG will apply to those students and residents who are pro-life and who are put into positions in which they must offer abortion as an option for their patients, even though they may not have to perform the abortion. We also have isolated cases within CMDA of residents being placed into positions in which they were pressured to perform abortions against their sincerely held beliefs. This is true moral distress. And the effects are long-lasting, often resulting in moral injury. I should acknowledge that this opinion piece does call for strategies to mitigate moral distress, so perhaps there is slight hope for pro-life students and residents.
But then again, I’m not holding my breath.