New Voices: On ethics, education and abortion

Opinion editor’s note: This article, part of our New Voices collection, was written by a first-time contributor to Star Tribune Opinion. For more information about our efforts to continually expand the range of views we publish, see startribune.com/opinion/newvoices.

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Throughout our first year of medical school, we discuss ethical principles in medicine, often portrayed as four pillars: nonmaleficence, autonomy, justice and beneficence. Generally, the law protects providers and patients who operate under these principles. If we are working in the best interests of our patients and granting them the autonomy they deserve, we are on the right side of the law. The threat to the right to abortion promises to tear that framework apart. Overturning Roe v. Wade would make it illegal in many states to practice ethical medicine.

The principle of nonmaleficence, or to do no harm, should be straightforward. Forced birth threatens the lives of patients. There are myriad reasons someone may wish to discontinue a pregnancy. It may pose an immediate threat to the pregnant person’s health, it may burden them with cost and commitment they are not equipped to withstand, it may pose too great a psychological toll to carry a pregnancy to term. The phrase “do no harm,” has often been co-opted by anti-abortion activists claiming to act in the interests of an underdeveloped fetus. In reality, fertilization is not a guarantee of life, even without medical intervention. Spontaneous abortion is normal and common — an estimated 1 in 4 pregnancies results in miscarriage. Nonmaleficence refers to living patients — and their decision about their health is the only one that matters.

The principle of autonomy is both simple and complex. In medicine, we recognize the right an individual has to make decisions regarding their own body. Anyone can get their ears pierced or choose to donate a kidney. A person can, if faced with a massive bleed and fully informed of the consequences, refuse a lifesaving blood transfusion. These are choices we as individuals make about our own bodies that others must honor. Even in the stickier questions around continuing treatment for a terminal illness or end-of-life care, we are taught to adhere to the gold standard of following the patient’s wishes. Abortion is no different. Denying a patient the care they need is an assault on their autonomy.

Justice is intimately wound up in this argument. The U.S. has the highest maternal mortality rate among developed countries in the world, driven by a disparity in care and outcomes for Black patients. By limiting abortion access, these inequities will continue to disproportionately affect Black communities. Studies show that restricting abortion does not decrease the number of abortions performed. It merely forces them to occur later, as patients seek care elsewhere or in unsafe, self-sought manners. Overturning Roe v. Wade is a sentencing especially for low-income patients of color: to either face the dangerous gamut of unwanted childbirth, or the unregulated market of self-sought abortions.

Finally, we reach beneficence, the ethical principle to do the good and right thing. Health care relies on a fiduciary relationship: We must always place the patient’s interests before our own. This principle underscores the agreement we all make upon entrance into medical school. Sometimes we will have to set aside our personal opinions to do what is right by the patient. Sometimes, against all recommendations and indications, a patient will refuse treatment. As long as we have done our job educating the patient on the impact of such a decision, we have nothing more to do than respect the patient’s right to make that choice.

Here in Minnesota, our Supreme Court has argued that reproductive freedom is a fundamental right, though nothing is guaranteed. State lawmakers routinely attempt to chip away at abortion access by slipping restrictions into unrelated laws. Patients seeking abortions are already required to endure a 24-hour waiting period and receive inaccurate information on the risks. Should Roe v. Wade be overturned, Minnesota will likely be an island in a sea of states eager to eliminate abortion access. We must be prepared for both an influx of patients from neighboring states and a legislative onslaught from within.

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