abortion ethical dilemma essay

Abortion: An Ethical Dilemma

There are many reasons as to why abortion poses an ethical dilemma for most women. Reasons such as religious beliefs, medical concerns are easily resolved by reason and need. While other cases, such as pregnancies resulting from criminal acts, are more often debated and considered an ethical dilemma.

It is not difficult to see why abortion is a hotly debated topic. Any discussion that involves the ending of a life, a life that never asked to be conceived in the first place, leaves the woman with the problem of deciding when it is right to continue or end that life cycle.

The religious believe that such an important decision should be left only in the hands of God. But because of abortion, women, and men have taken on the role of God as well, dictating when and who shall live even before that person becomes a part of the real world.

Medical science has become so far advanced that doctors now have the ability to discover when a wanted pregnancy shall endanger the life of the mother. In such cases, they leave the decision to continue the pregnancy in the hands of the parents.

Again, asking them to play God and decide if they love themselves more than the life that they brought into being. In such cases, an abortive procedure may be acceptable. But then again, if it is something that occurs too late in the pregnancy, it leaves the soon to be parents at a crossroads. Unable to decide upon which decision would be best for them and their unborn child.

In the case of pregnancy resulting from rape, the fetus is definitely unwanted and unloved. Most women who find themselves in such a situation would most likely opt for an abortion. If we think about it, such a decision will fall within reason. The woman neither knows the father of the child, nor what to expect of the child once it is born.

She will be unable to love the child mainly because of the circumstances surrounding its conception and birth. However, it is in such situations that abortion should not be an option. Allowing the child to come to full term and undergoing a legal adoption procedure would be the most logical step of action because the unwanted child of another can always be loved by someone else as if she were the one who breathed life into the child.

In my opinion, abortion is a procedure that should be legally accepted as part of a woman’s basic right. I am not advocating that women undergo abortion like they do plastic surgery, but rather, I am advocating that abortion be discussed with women as something that they can choose to do if they find themselves in such a situation that calls for it.

Most women who undergo abortions do not really understand much about it because it is a taboo topic in society. An open discussion will help women come to informed decisions and help in government regulation of abortion clinics. This, in turn, will lead to more open discussions and acceptance of abortions for what it is, a way of fixing a life-altering problem for most women.

There is no wrong or right answer when it comes to abortion, mainly because each abortion case is unique in its circumstances. No woman should be held with a stigma for undergoing the procedure. It is only an ethical dilemma because society refuses to see the benefits of abortion in the lives of women. Once the benefits are more clearly spelled out, the dilemma will be over for most women.

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The Ethical Dilemma of Abortion

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This paper discusses the extremely complex and important topic and dilemma of abortion.  Specifically, that the pro-life versus pro-choice dilemma is an imperative one that continues to cause ethical tensions in the United States.  For this reason, this issue and dilemma warrants close scrutiny.  It affects many major areas including ethics, religion, politics, law, and medicine.  Ethical theories and principles of the pro-life position and the pro-choice position will be contrasted.  This paper will further discuss the arguments in the context of Roe v. Wade and its impact on laws in the United States.  The general ethics of the pro-life argument and the pro-choice argument are founded on the issues of human rights and freedom.  Three main principles that the pro-life argument argues (the Human Rights Principle, the Mens Rea Principle, and the Harm Principle) will also be discussed.  This account will not include this author’s own prescriptive response (in the form of recommendations, best practices, or similar types of judgments) and therefore, this paper does not go beyond a purely comparative method.  Lastly, the Nuremberg Code, which was created at the Nuremberg Doctors’ Trial, will be discussed.  Specifically, the Nuremberg Code will be correlated in relation to laws in the United States, as well as contemporary bioethical debates, which are misleading when comparing the use of fetal tissue for transplants from abortions to experiments done during the Holocaust and crimes of Nazi biomedical science.

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Christina M. Robinson, IUE Graduate

Christina graduated from Indiana University East with a 3.911 GPA in May, 2021 with a B.S. in Psychology and a minor of Neuroscience as well as a minor of Women's and Gender Studies.  She continues her work as a Research Assistant through IUE and is also a Supplemental Instruction Leader.  Christina hopes to continue her education in a graduate school program in the near future!

50 years after Roe, many ethics questions shape the abortion debate: 4 essential reads

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Jan. 22, 2023, marks the 50th anniversary of Roe v. Wade, the landmark Supreme Court decision that recognized a constitutional right to abortion. That stood for nearly half a century, until a majority of justices reversed it in June 2022’s Dobbs v. Jackson Women’s Health decision.

People with a broad range of views on abortion often say their faith tradition helps inform their opinions. But beyond religion, many other ethical and moral questions shape Americans’ perspectives on the topic.

Here are some of The Conversation’s most thought-provoking articles on the underlying philosophical and bioethical issues involved in abortion debates.

1. Rethinking ‘personhood’

Activism for and against abortion rights often gets summed up into two simple-sounding terms: “pro-life” and “pro-choice.”

But “‘life’ and ‘choice’ are not, in and of themselves, really the issue,” wrote Robert Launay of Northwestern University. “The central question is what – or who – constitutes a person.”

As an anthropologist , Launay studies that question in terms of culture. Different religions and societies think about personhood in different ways, he explained. Ideas about personhood in the U.S., for example, often stem from Christian ideas about the soul and are black and white – something is or isn’t considered a person.

In some of the Indigenous African traditions where he has done research, meanwhile, “many view personhood as a process rather than a once-and-for-all phenomenon” – something humans gradually acquire over time, through relationships, or through rituals.

Read more: What does it mean to be a 'person'? Different cultures have different answers

2. Moral status

Even within a single society, defining “personhood” can be complex and controversial.

Personhood is a key concern in bioethics, wrote University of Washington philosopher Nancy Jecker . In that context, being a “person” isn’t necessarily the same as being “human” – and it’s not an easy concept to nail down.

“When philosophers talk about ‘personhood,’ they are referring to something or someone having exceptionally high moral status, often described as having a right to life, an inherent dignity, or mattering for one’s own sake,” she explained. Personhood implies that someone or something can make strong moral claims, such as a claim against being interfered with. In abortion debates, Jecker added, “no one disputes the fetus’s species, but many disagree about the fetus’s personhood.”

Americans hold three main views of when personhood begins – at conception, at birth, or sometime in between – which is a central part of the country’s inability to agree about abortion rules. But the implications of how societies define personhood go much further, Jecker said, influencing areas like care for the environment and end-of-life treatment.

Read more: What is 'personhood'? The ethics question that needs a closer look in abortion debates

3. Breaking down bioethics

Given Americans’ diverse views about religion and personhood, are there other concepts that can help forge consensus?

In another article, Jecker broke down four key bioethics terms , four bedrock principles in the field: autonomy; nonmaleficence, or “do no harm”; beneficence, or providing beneficial care; and justice.

People disagree about how to interpret those principles: Someone in favor of abortion rights, for example, might be most concerned about harm to pregnant women, while someone who opposes them could be more concerned about harm to a fetus.

Understanding how people see those principles in play, though, is at least a constructive step. Jecker suggested that, short of reaching a moral consensus, “articulating our own moral views and understanding others’ can bring all sides closer to a principled compromise.”

Read more: Abortion and bioethics: Principles to guide U.S. abortion debates

4. Beyond ‘my body, my choice’

For decades, one other phrase has dominated the U.S. abortion debate: the slogan “my body, my choice.”

At this point, the catchphrase is practically synonymous with the movement for reproductive rights. It’s profoundly shaped how people think about abortion rights: as an issue of privacy, decisions that women should make for themselves with their doctors.

But “my body, my choice” doesn’t fully capture the key ideas , argued Elizabeth Lanphier , a moral philosopher and bioethicist at the University of Cincinnati. Reproductive rights aren’t just about a lack of interference, what philosophers call “negative liberty.” Abortion is also about the right to access health care.

“‘My body, my choice’ suggests that because people own their bodies, they get to control them,” she wrote. But self-ownership isn’t so valuable without also having “positive liberty,” the freedom to do something.

“My research suggests ‘my body, my choice’ was a crucial idea at the time of Roe to emphasize ownership over bodily and health care decisions,” Lanphier concluded. “But I believe the debate has since moved on – reproductive justice is about more than owning your body and your choice; it is about a right to health care.”

Read more: With abortion heading back to the Supreme Court, is it time to retire the 'my body, my choice' slogan?

Editor’s note: This story is a roundup of articles from The Conversation’s archives.

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Following the leak of a draft decision by the Supreme Court that would overturn Roe v. Wade, the Medical School’s Louise King discusses how the potential ruling might affect providers.

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How a bioethicist and doctor sees abortion

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Her work touches questions we can answer and questions we can’t. But her main focus is elsewhere: ‘the patient in front of me.’

With the leak Monday of a draft decision by the Supreme Court that would overturn Roe v. Wade, the future of abortion in the U.S. has been a highly charged topic of conversation all week. Doctors are among those wondering what’s next. Louise King is an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School and a Brigham and Women’s Hospital physician whose practice includes abortion services. King, who is also the director of reproductive bioethics for the Center for Bioethics at the Medical School, spoke with the Gazette about ethical dimensions of abortion and how a ruling against Roe might affect providers.

Louise King

GAZETTE: In the U.S., abortion is framed in broad ethical terms: life versus death, privacy versus government intrusion, etc. From a medical ethics standpoint, what are the important concerns to be balanced on this issue?

KING: I frame the topic in the context of the patient in front of me. In other words, I look primarily to autonomy and beneficence in the context of doing good for the patient. That might mean upholding that person’s choice not to proceed with what is still a very dangerous proposition, namely carrying a pregnancy to term and delivering. If someone says to me, “I’m pregnant and do not wish to be pregnant,” for a multitude of reasons, I support that decision, because the alternative of carrying to term is risky. I want to protect that person’s bodily autonomy. From a reproductive justice standpoint, I want to support persons who have uteri in making decisions about when they wish to have a family, how they want that to look, whether they want to have a family at all, in expressing their sexuality, and in all kinds of different things.

I don’t believe that life begins at conception. Among the minority of people in this country who believe that’s the case, some are vocal and aggressive in imposing that belief on others, which may happen with this upcoming decision. But quite a number of students that I meet who believe life begins at conception still don’t believe that they have the right to impose that belief on others. To contextualize what we ask of persons with uteri when we make abortion illegal, it’s helpful to compare instances where we could ask people to undergo very risky procedures to help others. For example, we don’t demand that people give blood. It’s not a big deal and it could save lives every day, but we don’t demand that anybody donate blood or bone marrow. We don’t demand kidney donations, which are less risky than childbirth nowadays.

So we generally don’t ask one human being to give so completely of themselves to another, but we do so when it’s a pregnant person. That, I believe, does not comport with our ethics. But it also doesn’t fully address the concerns of persons who believe life begins at conception. They come to those beliefs honestly, but I think they have to explore them more deeply and figure out whether, even if true — do they hold up to the point where we require somebody to have a forced pregnancy to term? I would say, within my understanding of ethics, no.

“It’s not a big deal and it could save lives every day, but we don’t demand that anybody donate blood or bone marrow. We don’t demand kidney donations, which are less risky than childbirth nowadays.”

GAZETTE: Abortion is one of the most divisive issues in the country. Is the medical profession unified on it one way or another?

KING: That’s hard to say definitively. No study or survey exists to truly quantify this. The American Medical Association and the America College of Obstetricians and Gynecologists say that abortion is health care, and I agree. ACOG is very strong in their wording about supporting the right to access abortion. Unfortunately, only 14 percent of practicing OBGYNs provide abortion care. As a profession, our words and actions don’t match. I think there’s a multitude of reasons for that. One is the stigma associated with providing abortion care in some parts of the country.

I would guess that most providers feel similarly to the majority of Americans — that abortion is health care and should be available. While I’ve met some medical students and practicing physicians in all kinds of disciplines who feel strongly that abortion is unethical, the vast majority that I’ve spoken to feel as I feel: that it’s health care and should be provided.

GAZETTE: A big part of the debate over the decades has centered on viability. Is this an issue for science to determine? Is it an issue for society? Is it an issue for religion?

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KING: I don’t think that science can tell us definitively when life begins. Life is a broad term and includes a variety of living entities. I don’t think that religion can define it because we have freedom of religion and religions see this differently. Rabbis will explain that in the Torah, it’s very clear that an embryo is simply an extension of a woman’s body, like a limb, and should not be considered another person until birth. The leaked decision presumes that one version of Christianity’s assessment of this prevails, which seems to violate our understanding of freedom of religion in this country.

Ultimately, “when life begins” isn’t the right question because it’s unanswerable. The question then must be: How do we as a society come up with a compromise that upholds the autonomous rights of the persons in front of us who may become pregnant, who may have excessive risks associated with a pregnancy, or who may simply not wish to be pregnant, that also observes whatever our society’s agreed-upon understanding is of when a protected entity exists.

I think Massachusetts absolutely gets it right. If you read the Roe Act : Abortion is allowed for any reason in the first and second trimesters, and then abortion for medical reasons or lethal fetal anomalies can extend into the third trimester with careful consideration between patient and medical teams. To me, that is an exceptionally well-thought-out compromise. This is a societal decision. It shouldn’t be made by a minority of persons based on their narrow definition of “when life begins.”

GAZETTE: If something like the leaked draft decision emerges, is there a potential for medical providers to get caught in the middle?

KING: Overturning Roe would turn the question over to the states. That would mean that those providers who exist within the states that are clearly going to go forward with legislation to outlaw abortion would be in dire situations. In Massachusetts, we could provide the care we’re already providing and would expect people to travel from out of state to us. I don’t think that the long-arm statutes would reach a provider here, that somebody could come after me from Texas if somebody traveled from Texas to me and I provided care. But if I traveled to Texas, for a conference, it might. Legal experts aren’t sure.

GAZETTE: Have you ever been threatened because you’ve offered abortions?

KING: I haven’t, but many of my colleagues have. I did my training in Texas, so I lived a long time in the South. I’ve not been threatened directly, but spoken sternly to by many people who disagreed with me. I mentioned earlier that there are plenty of people who believe life begins at conception but who do not feel they should impose their viewpoints on others — those are people I met in Texas and Louisiana. There are a lot of people like that, but they can’t speak up for fear of being ostracized. The sense that I have through all the conversations I’ve had over many years is that we are all talking past each other. You started off by saying this is a topic that divides our country, but it doesn’t. The vast majority of people are settled on having abortion as an option, having contraception as an option, and having sex education available. There’s a group of politicians who make it appear that we’re divided and build their political careers off of that. It’s incredibly disheartening and unethical for them to do so.

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Ethics and Morality

Ethics and abortion, two opposing arguments on the morality of abortion..

Posted June 7, 2019 | Reviewed by Jessica Schrader

Abortion is, once again, center stage in our political debates. According to the Guttmacher Institute, over 350 pieces of legislation restricting abortion have been introduced. Ten states have signed bans of some sort, but these are all being challenged. None of these, including "heartbeat" laws, are currently in effect. 1

Much has been written about abortion from a philosophical perspective. Here, I'd like to summarize what I believe to be the best argument on each side of the abortion debate. To be clear, I'm not advocating either position here; I'm simply trying to bring some clarity to the issues. The focus of these arguments is on the morality of abortion, not its constitutional or legal status. This is important. One might believe, as many do, that at least some abortions are immoral but that the law should not restrict choice in this realm of life. Others, of course, argue that abortion is immoral and should be illegal in most or all cases.

"Personhood"

Personhood refers to the moral status of an entity. If an entity is a person , in this particular sense, it has full moral status . A person, then, has rights , and we have obligations to that person. This includes the right to life. Both of the arguments I summarize here focus on the question of whether or not the fetus is a person, or whether or not it is the type of entity that has the right to life. This is an important aspect to focus on, because what a thing is determines how we should treat it, morally speaking. For example, if I break a leg off of a table, I haven't done anything wrong. But if I break a puppy's leg, I surely have done something wrong. I have obligations to the puppy, given what kind of creature it is, that I don't have to a table, or any other inanimate object. The issue, then, is what kind of thing a fetus is, and what that entails for how we ought to treat it.

A Pro-Choice Argument

I believe that the best type of pro-choice argument focuses on the personhood of the fetus. Mary Ann Warren has argued that fetuses are not persons; they do not have the right to life. 2 Therefore, abortion is morally permissible throughout the entire pregnancy . To see why, Warren argues that persons have the following traits:

• Consciousness: awareness of oneself, the external world, the ability to feel pain.
• Reasoning: a developed ability to solve fairly complex problems.
• Ability to communicate: on a variety of topics, with some depth.
• Self-motivated activity: ability to choose what to do (or not to do) in a way that is not determined by genetics or the environment .
• Self-concept : see themselves as _____; e.g. Kenyan, female, athlete , Muslim, Christian, atheist, etc.

The key point for Warren is that fetuses do not have any of these traits. Therefore, they are not persons. They do not have a right to life, and abortion is morally permissible. You and I do have these traits, therefore we are persons. We do have rights, including the right to life.

One problem with this argument is that we now know that fetuses are conscious at roughly the midpoint of a pregnancy, given the development timeline of fetal brain activity. Given this, some have modified Warren's argument so that it only applies to the first half of a pregnancy. This still covers the vast majority of abortions that occur in the United States, however.

A Pro-Life Argument

The following pro-life argument shares the same approach, focusing on the personhood of the fetus. However, this argument contends that fetuses are persons because in an important sense they possess all of the traits Warren lists. 3

At first glance, this sounds ridiculous. At 12 weeks, for example, fetuses are not able to engage in reasoning, they don't have a self-concept, nor are they conscious. In fact, they don't possess any of these traits.

Or do they?

In one sense, they do. To see how, consider an important distinction, the distinction between latent capacities vs. actualized capacities. Right now, I have the actualized capacity to communicate in English about the ethics of abortion. I'm demonstrating that capacity right now. I do not, however, have the actualized capacity to communicate in Spanish on this issue. I do, however, have the latent capacity to do so. If I studied Spanish, practiced it with others, or even lived in a Spanish-speaking nation for a while, I would likely be able to do so. The latent capacity I have now to communicate in Spanish would become actualized.

Here is the key point for this argument: Given the type of entities that human fetuses are, they have all of the traits of persons laid out by Mary Anne Warren. They do not possess these traits in their actualized form. But they have them in their latent form, because of their human nature. Proponents of this argument claim that possessing the traits of personhood, in their latent form, is sufficient for being a person, for having full moral status, including the right to life. They say that fetuses are not potential persons, but persons with potential. In contrast to this, Warren and others maintain that the capacities must be actualized before one is person.

The Abortion Debate

There is much confusion in the abortion debate. The existence of a heartbeat is not enough, on its own, to confer a right to life. On this, I believe many pro-lifers are mistaken. But on the pro-choice side, is it ethical to abort fetuses as a way to select the gender of one's child, for instance?

We should not focus solely on the fetus, of course, but also on the interests of the mother, father, and society as a whole. Many believe that in order to achieve this goal, we need to provide much greater support to women who may want to give birth and raise their children, but choose not to for financial, psychological, health, or relationship reasons; that adoption should be much less expensive, so that it is a live option for more qualified parents; and that quality health care should be accessible to all.

I fear , however, that one thing that gets lost in all of the dialogue, debate, and rhetoric surrounding the abortion issue is the nature of the human fetus. This is certainly not the only issue. But it is crucial to determining the morality of abortion, one way or the other. People on both sides of the debate would do well to build their views with this in mind.

https://abcnews.go.com/US/state-abortion-bans-2019-signed-effect/story?id=63172532

Mary Ann Warren, "On the Moral and Legal Status of Abortion," originally in Monist 57:1 (1973), pp. 43-61. Widely anthologized.

This is a synthesis of several pro-life arguments. For more, see the work of Robert George and Francis Beckwith on these issues.

Michael W. Austin, Ph.D. , is a professor of philosophy at Eastern Kentucky University.

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PHI 240: Ethics of Fetal Development & Abortion (Daniels)

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Bertha Alvarez Manninen

Donald marquis, judith jarvis thomson, mary anne warren, essay:  the value of choice and the choice to value: expanding the discussion about fetal life within prochoice advocacy.

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Abortion: law's ethical dilemma.

Professor Leslie Thomas KC

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This lecture delves into the history of abortion in English law, from common law to the Abortion Act 1967.

Professor Thomas KC critically examines the current state of abortion law in England, the Commonwealth Caribbean, and recent developments in the US. Is there a case for further liberalisation of abortion law?

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Abortion: Law’s Ethical Dilemma

30 November 2023

In today's lecture, we delve into the emotionally charged and ethically complex topic of abortion. This discourse evokes strong sentiments and confrontAbortion: Law's Ethical Dilemmas individuals with profound moral and ethical dilemmas. It is crucial to approach this subject with the utmost respect for the diverse perspectives and deeply held beliefs people hold. Abortion, inherently a "hard edge question," forces us to grapple with the challenging intersections of law, morality, and personal autonomy. As we traverse through the historical landscape of abortion laws in the UK, examining their impact on the Commonwealth Caribbean, and draw comparisons with global developments, we must be mindful of the profound implications this discourse holds. The urgency of addressing the decriminalization of abortion becomes apparent, underlining the need for the law to confront this intricate and contentious issue.

A brief note about terminology. In this lecture, I will be using the term “pregnant women” but I realise that this is controversial in some circles and some people might prefer “pregnant people”. The intention of this is not to erase all those who might be able to bear and have children and of course I recognise that there are also some trans men and non-binary people who are able to get pregnant, and who are also affected by abortion restrictions. To say this is not to diminish the obvious fact that abortion politics is heavily gendered, but my stance is simply to accept that most people affected by abortion restrictions are women. But I do think it is important to acknowledge that trans men and non-binary people exist too, and also have a stake in the right to abortion. That said, I will frequently be quoting statutes, case law and academic works which do refer exclusively to women.

History of Abortion Law in the UK

I’m now going to give an overview of the history of abortion law in the UK. That law differs as between England and Wales, Scotland, and Northern Ireland. My main focus will be on the English and Welsh position, but I have a few things to say about the law of Scotland and Northern Ireland.

There is uncertainty and controversy over how the English common law regulated abortion prior to 1803. It’s clear that at common law the point of “quickening” was an important threshold. I will come back to what this meant. A very early text, the Leges Henrici Primi dating from the early twelfth century, said “A woman shall do penance for three years if she intentionally brings about the loss of her embryo before forty days; if she does this after it is quick, she shall do penance for seven years as if she were a murderess.”[1]  This passage would appear to be concerned with penance in ecclesiastical law, rather than temporal criminal penalties.[2]

In the thirteenth century, Henry de Bracton wrote in his famous treaties On the Laws and Customs of England “If one strikes a pregnant woman or gives her poison in order to procure an abortion, if the foetus is already formed or quickened, especially if it is quickened, he commits homicide.”[3]

As Neil Jones writes, “in the seventeenth century the common law tide began to turn against the view that abortion was a felony.” Rather, by then it was viewed as a misdemeanour.[4]  Edward Coke’s Institutes of the Laws of England said:

“If a woman be quick with childe, and by a potion or otherwise killeth it in her wombe; or if a man beat her, whereby the childe dieth in her body, and she is delivered of a dead childe, this is a great misprision, and no murder: but if the childe be born alive, and dieth of the potion, battery, or other cause, this is murder: for in law it is accounted a reasonable creature, in rerum natura, when it is born alive.” [5]

William Blackstone said in his 1765 Commentaries on the Laws of England:

“Life is the immediate gift of God, a right inherent by nature in every individual; and it begins in contemplation of law as soon as an infant is able to stir in the mother's womb. For if a woman is quick with child, and by a potion, or otherwise, killeth it in her womb; or if any one beat her, whereby the child dieth in her body, and she is delivered of a dead child; this, though not murder, was by the antient law homicide or manslaughter. But at present it is not looked upon in quite so atrocious a light, though it remains a very heinous misdemeanor.” [6]

So, in early modern England abortion was a crime after quickening, although probably not a felony. However, there has been debate about when quickening occurred, as well as how the common law viewed abortion before quickening.

Here in England and Wales, that debate is largely only of historical interest. However, in the United States, the state of the pre-1803 English common law has become a subject of intense modern political controversy, because of the role it has played in modern US constitutional jurisprudence. In Roe v Wade 410 US 113 (1973), the well-known case in which the US Supreme Court found there to be a constitutional right to abortion, Mr Justice Blackmun wrote “It is undisputed that, at common law, abortion performed before "quickening" - the first recognizable movement of the fetus in utero, appearing usually from the 16th to the 18th week of pregnancy - was not an indictable offense.”

However, opponents of abortion have since counterattacked on this issue. They have, for example, cited the 1838 English case of R v Wycherley 173 ER 486, which may suggest that “quick” did not mean the same thing in every context[7].  A woman was convicted of murder and the question arose whether she was excused from being executed because she was pregnant or “quick with child”. The law report records that Mr Baron Gurney said ““Quick with child” is having conceived. “With quick child” is when the child has quickened. Do you understand the distinction I make?”

In an amicus brief submitted by the conservative legal scholars John Finnis and Robert George in the recent case of Dobbs v Jackson Women’s Health Organization 142 S. Ct. 2228, the authors argue that a foetus would have been viewed as “quick” from the sixth week of pregnancy, and not from the time that the pregnant woman felt movement in their womb.[8] In contrast, an amicus brief in the same case by the American Historical Association and the Organization of American Historians supports the view in Roe that “quickening” was the point at which the pregnant woman felt the foetus move.[9]  This debate was alluded to by Mr Justice Alito in a footnote in the opinion of the Court, but he did not find it necessary to resolve it. Mr Justice Alito also referred approvingly to the work of Joseph Dellapenna. Dellapenna’s work has, however, come in for robust scholarly criticism from Carla Spivack, who states that Dellapenna “distorts the evidence to press an absolutist position about the legal history”. [10]

Another complicating factor is the relationship between common law and ecclesiastical law. As we have already seen, the Leges Henrici addressed abortion in the context of penance, rather than temporal criminal penalties. Commenting on the Dobbs judgment, R.H. Helmholz argues that abortion in medieval times was principally the concern of ecclesiastical law, within the jurisdiction of ecclesiastical courts, and that ecclesiastical jurisdiction over the subject lasted well into the sixteenth century, whereafter “the jurisdictional history becomes more tangled”.[11]

I don’t propose to attempt to resolve the historical controversies. Instead, I will move on to 1803, when the English law against abortion was put on a statutory footing by Lord Ellenborough’s Act. This Act was very severe. It made it a capital offence to “cause and procure the miscarriage of any woman, then being quick with child”. It also criminalised abortion before quickening, which was made punishable with fines, imprisonment, the pillory, whipping or transportation, but not with death. According to Dickens and Cook, it was not clear whether a pregnant woman performing an abortion on themselves was criminalised by this Act.[12]  The 1803 Act was superseded by Lord Lansdowne’s Act of 1828, which in turn was superseded by the Offences against the Persons Act 1837. The latter abolished the death penalty for abortion, and also abolished the distinction between pre-quickening and post-quickening abortions.

The next major statute enacted was section 58 of the Offences against the Person Act 1861, which is still in force today. This section provides in relevant part:

“Every woman, being with child, who, with intent to procure her own miscarriage, shall unlawfully administer to herself any poison or other noxious thing, or shall unlawfully use any instrument or other means whatsoever with the like intent, and whosoever, with intent to procure the miscarriage of any woman, whether she be or be not with child, shall unlawfully administer to her or cause to be taken by her any poison or other noxious thing, or shall unlawfully use any instrument or other means whatsoever with the like intent, shall be guilty of felony”

An important caveat here is the word “unlawfully”, which left open the possibility of a defence that there was such a thing as a lawful abortion. The case of R v Bourne [1939] 1 KB 687 established that such a defence existed. In Bourne, an obstetric surgeon was indicted for performing an abortion on a 14-year-old girl who, according to the law report, had been “raped with great violence” and had become pregnant as a result of the rape.  Mr Justice Macnaghten relied by analogy on the separate offence of child destruction under the Infant Life (Preservation) Act 1929, which provided a defence where the relevant act was “done in good faith for the purpose only of preserving the life of the mother”. He accepted that the 1929 Act did not directly apply, but he said that “the proviso that it is necessary for the Crown to prove that the act was not done in good faith for the purpose only of preserving the life of the mother is in accordance with what has always been the common law of England with regard to the killing of an unborn child”.

He went on to take a relatively expansive interpretation of what was meant by “preserving the life of the mother”. He said:

“It is not contended that those words mean merely for the purpose of saving the mother from instant death. There are cases, we are told, where it is reasonably certain that a pregnant woman will not be able to deliver the child which is in her womb and survive. In such a case where the doctor anticipates, basing his opinion upon the experience of the profession, that the child cannot be delivered without the death of the mother, it is obvious that the sooner the operation is performed the better. The law does not require the doctor to wait until the unfortunate woman is in peril of immediate death. In such a case he is not only entitled, but it is his duty to perform the operation with a view to saving her life.

As I have said, I think those words ought to be construed in a reasonable sense, and, if the doctor is of opinion, on reasonable grounds and with adequate knowledge, that the probable consequence of the continuance of the pregnancy will be to make the woman a physical or mental wreck, the jury are quite entitled to take the view that the doctor who, under those circumstances and in that honest belief, operates, is operating for the purpose of preserving the life of the mother.”

The Bourne case was the leading authority in England and Wales on the section 58 offence until 1967. Elsewhere in the Commonwealth it continues to be relevant, as we will see.

I need to say a little about Scotland. The 1861 Act never applied to Scotland, and up until 1967 abortion in Scotland was a wholly common law matter. The Scottish legal scholar Jonathan Brown writes that prior to 1967 “Scots law recognised the legitimacy of therapeutic termination. Abortion was treated, primarily, as a medical matter and the dearth of Scottish case law concerning abortion may be attributed to the fact that the legal profession was reluctant to interfere with decisions made by doctors.” [13]   Brown cites the case of HM Advocate v Graham (1897) 2 Adam 412 which holds that the abortion must have been carried out “wickedly and feloniously” to be criminal. He states that there was only one case in which a Scottish medical practitioner was prosecuted, the case of HM Advocate v Ross in 1967, in which “the central issue was the fact that the termination occurred in the patient’s home; in the absence of professional medical guidance”. He further notes that Dr Ross pleaded guilty, and the case did not therefore establish any precedent that Ross’s actions were criminal.[14]

The pre-1967 abortion law of Scotland was therefore, in Brown’s words , “far from clear”. [15]   Although abortion was a crime known to the law, it appears that there were circumstances in which an abortion could lawfully be carried out.

The next major development was the Abortion Act 1967, which continues to be the governing law today in England, Scotland and Wales. It does not extend to Northern Ireland. The 1967 Act did not repeal section 58 of the 1861 Act, but provided an exception to it. Under the Act as originally enacted, an abortion could be performed by a doctor up to the 28th week of pregnancy if two doctors formed the opinion that “risk to the life of the pregnant woman, or of injury to the physical or mental health of the pregnant woman or any existing children of her family, greater than if the pregnancy were terminated”. (I say “pregnant woman” here because that is the language of the Act, but the Act of course also applies to trans men or non-binary people who are pregnant.) It also allowed abortion at any stage of pregnancy where two doctors formed the opinion that “there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped”.

The Human Fertilisation and Embryology Act 1990 amended the Act significantly. Abortion was now allowed up to the 24th week (not the 28th) where “the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family”. It was legalised at any stage of pregnancy where “the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman” or where “the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated”. It remained the case that the opinion of two doctors was required.

Pausing there, although these are relatively liberal grounds for abortion, they fall a very long way short of permitting abortion on demand. It remains doctors, not the pregnant woman, who are the primary decision-makers as to whether the criteria are met. As Fran Amery states , “abortion is still governed – albeit by the medical profession rather than directly controlled by the state” [16] .   It is therefore entirely possible for a pregnant woman to be denied an abortion under the 1967 Act, in particular where they have missed the 24-week deadline and don’t meet the more restrictive criteria for abortion after that deadline. Those pregnant who perform illegal abortions on themselves can be and sometimes are prosecuted. According to Zoe Williams writing recently in the Guardian, there were only three prosecutions in Great Britain for illegal abortions between 1861 and November 2022, but since December 2022 six women have been charged for illegal abortions. In June 2023 Carla Foster was sentenced to 28 months in prison, reduced on appeal to a suspended sentence of 14 months, for self-administering Mifepristone when she was over the 24-week limit.[17]

As an aside, given that the 1861 Act does not apply in Scotland, the question might be thought to arise as to whether the Scottish common law defence to which I referred earlier has survived, such that abortion might be lawful in Scotland even where not authorised by the 1967 Act. However, the Inner House of the Court of Session in Doogan v Greater Glasgow and Clyde Health Board 2013 SC 496 held that there was no such residual ability at common law to carry out an abortion. The case went on appeal to the Supreme Court [2015] AC 640, but not on this point.

I should also mention that the 1967 Act was never extended to Northern Ireland. Abortion remained generally illegal in Northern Ireland until recently. In Re Northern Ireland Human Rights Commission’s Application for Judicial Review [2018] NI 228, the Supreme Court was deeply divided on a challenge brought by the Northern Ireland Human Rights Commission to Northern Ireland’s abortion laws. The majority held that the Commission had no standing to bring the challenge. However, all the Justices expressed their views on the merits anyway. A majority held that the prohibition on abortion in cases of fatal foetal abnormality and rape or incest breached Article 8 of the European Convention on Human Rights, the right to private and family life. Two Justices went further and said that they would have found it incompatible with Article 3, the prohibition on inhuman and degrading treatment, as well. Another two Justices found no breaches of Article 3 or 8.[18]

Parliament has since stepped in. The Northern Ireland (Executive Formation etc) Act 2019 repealed sections 58 and 59 of the 1861 Act under the law of Northern Ireland with retrospective effect. Regulations were subsequently made in 2020 and approved by both Houses of Parliament which provided for a new legal regime regulating abortion in Northern Ireland, which is significantly different from that in England and Wales.

So, that is the UK position in a nutshell. What of the Commonwealth Caribbean? The short answer is that it varies widely. In some Commonwealth Caribbean jurisdictions, such as Antigua and Barbuda where I practise, as well as Jamaica and Trinidad and Tobago, the relevant law is copied from the English 1861 Act. The law in these jurisdictions is therefore that which was applied in England prior to 1967, including the Bourne judgment. Conversely, some other jurisdictions have enacted legislation that has significantly liberalised their abortion laws. This includes the Medical Termination of Pregnancy Act 1983 in Barbados, and the Medical Termination of Pregnancy Act 1995 in Guyana. Time doesn’t permit an exhaustive survey of these laws.

We can see, therefore, that the British and Commonwealth approach to abortion law is not uniform. However, the general approach has been to criminalise abortion but to carve out exceptions to that criminalisation. The extent of those exceptions varies by jurisdiction.

The international context

These developments have happened against the backdrop of a highly contentious international debate on abortion. Recent years have seen liberalisation of abortion law in some jurisdictions, and a tightening of restrictions in others.

A September 2023 paper by Cardenas, Singh, Harpin and Sadinsky highlights the development of international human rights law around abortion.[19]  They highlight that in 1999 the Committee for the Elimination of Discrimination against Women, or CEDAW Committee, published its General Recommendation 24 which called for the decriminalisation of abortion. In 2003 the African Union enshrined the right to abortion in certain circumstances in the Maputo Protocol. The UN Human Rights Committee in KL v Peru , communication no 1153/2003, 22 November 2005, found that the denial of an abortion to a teenage girl carrying an anencephalic foetus had violated her rights under the International Covenant on Civil and Political Rights, specifically, Article 7, the prohibition of cruel, inhuman and degrading treatment, Article 17, the right to privacy, Article 24, the right of children to special protection, and Article 2, the right to a legal remedy.

Subsequently, in Mellet v Ireland , communication no 2324/2015, 31 March 2016, the Committee found that a woman in the Republic of Ireland carrying a non-viable foetus who had had to travel abroad for an abortion had suffered cruel, inhuman, and degrading treatment, contrary to Article 7 of the Covenant. Her rights under Article 17, the right to privacy, and Article 26, the prohibition of discrimination, had also been violated. For context, since 1983, the Eighth Amendment to the Irish Constitution had enshrined a general prohibition on abortion in Irish constitutional law. The Committee reached a similar view in another Irish abortion case, Whelan v Ireland , communication no 2425/2014, 17 March 2017.

In contrast, the European Court of Human Rights had taken a more restrained view in the earlier case of A, B and C v Ireland (2011) 53 EHRR 13. That was a case brought by three Irish woman who had had to travel abroad for abortions. Their claims under Article 2 of the European Convention on Human Rights, the right to life, and Article 3, the prohibition on inhuman or degrading treatment or punishment, were held inadmissible. The Court found that there was no violation of Article 8, the right to private and family life, in relation to the first and second applicants. However, it did find such a violation in relation to the third applicant, who had a rare form of cancer and had undergone chemotherapy. This was on the ground that there was no “accessible and effective procedure” by which she could have established whether she qualified for a lawful abortion in Ireland under Irish law as it stood. This case led to the enactment of the Protection of Life During Pregnancy Act 2013, which set out a legal framework for when people would qualify for abortion in Ireland. Finally, in 2018, after the Mellet and Whelan decisions, the Irish electorate voted to repeal the Eighth Amendment to the Constitution by passing the Thirty-sixth Amendment.

In Canada, the criminal law has effectively imposed no restrictions on abortion since the judgment in R v Morgentaler [1988] 1 SCR 30 which struck down the provisions of the Criminal Code governing abortion as unconstitutional.

Conversely, the United States has recently seen highly controversial changes in the opposite direction. In Dobbs v Jackson Women’s Health Organisation , the US Supreme Court overruled its own judgment in Roe v Wade, and held that there was no constitutional right to abortion. Dobbs did not impose a national abortion ban; rather, it left it up to state legislatures to decide whether or not abortion should be legal in their respective states. Ottley, Szopa and Fletcher, writing in the Medical Law Review, have reviewed the consequences of Dobbs one year on. They highlight that “following Dobbs, the landscape of abortion access across the 50 States has become disparate and reflective of State-based preferences.” [20]   So whether a pregnant woman can access abortion in the United States is now a postcode lottery, depending on which state they happen to live in. This of course disadvantages poorer people, who are less likely to be able to travel to another state to access abortion. For that matter, even before Dobbs , there were already significant practical restrictions on abortion access in some states, which were permissible under pre- Dobbs case law. As Leslie J. Reagan states, these included “mandatory twenty-four to seventy-two-hour waiting periods, parental notification requirements for people under eighteen, forced reading of false scripts about the dangers of abortion to patients in advance of the procedure, and vaginal ultrasounds – state-mandated sexual assaults”. [21]

We have seen that Mr Justice Alito’s leading judgment in Dobbs drew heavily on English and early American legal history, but that that history is contested terrain. Leslie Reagan states that the majority opinion “gets the history egregiously wrong”. [22]

Reformation of abortion law

Having looked at the present state of abortion law, we’re now going to consider how it should be reformed. Time does not permit me to do justice to the moral and philosophical debate around abortion, but I’ll attempt to sum up my position briefly.

Generally, the classic argument against abortion is simply that a foetus is a human life, and that it is wrong to take innocent human life. As many opponents of abortion are religious, this is often coupled with the idea that a foetus has a human soul from the moment of conception. Conversely, from a secular perspective many people would argue that a blastocyst, an embryo or a foetus in the early stages of development cannot meaningfully be called persons. This naturally leads us to a thorny debate about when a person becomes a person – at conception, at birth, or at some point in between – and invites the drawing of arbitrary lines.

But the main argument made in practice by most proponents of abortion is simply based on bodily autonomy. They would say that even if the foetus is a person, the pregnant woman has an absolute right to decide what happens to their own body and is therefore not obliged to carry the foetus to term. The most powerful expression of this argument is in Judith Thomson’s “famous violinist” example:

“I propose, then, that we grant that the fetus is a person from the moment of conception. How does the argument go from here? Something like this, I take it. Every person has a right to life. So, the fetus has a right to life. No doubt the mother has a right to decide what shall happen in and to her body; everyone would grant that. But surely a person's right to life is stronger and more stringent than the mother's right to decide what happens in and to her body, and so outweighs it. So, the fetus may not be killed; an abortion may not be performed.

It sounds plausible. But now let me ask you to imagine this. You wake up in the morning and find yourself back-to-back in bed with an unconscious violinist. A famous unconscious violinist. He has been found to have a fatal kidney ailment, and the Society of Music Lovers has canvassed all the available medical records and found that you alone have the right blood type to help. They have therefore kidnapped you, and last night the violinist's circulatory system was plugged into yours, so that your kidneys can be used to extract poisons from his blood as well as your own. The director of the hospital now tells you, "Look, we're sorry the Society of Music Lovers did this to you--we would never have permitted it if we had known. But still, they did it, and the violinist is now plugged into you. To unplug you would be to kill him. But never mind, it's only for nine months. By then he will have recovered from his ailment and can safely be unplugged from you." Is it morally incumbent on you to accede to this situation? No doubt it would be very nice of you if you did, a great kindness. But do you have to accede to it? What if it were not nine months, but nine years? Or longer still? What if the director of the hospital says. "Tough luck. I agree. But now you've got to stay in bed, with the violinist plugged into you, for the rest of your life. Because remember this. All persons have a right to life, and violinists are persons. Granted you have a right to decide what happens in and to your body, but a person's right to life outweighs your right to decide what happens in and to your body. So, you cannot ever be unplugged from him." I imagine you would regard this as outrageous, which suggests that something really is wrong with that plausible-sounding argument I mentioned a moment ago.” [23]

This is a very powerful argument. Its attraction is that it does not require us to engage at all with the question of when a foetus becomes a person, because even if it is a person, the pregnant woman has no obligation to carry it to term. If that is right, it follows that a pregnant woman who wants an abortion is in principle entitled to one, or at least that the criminal law should not interfere with their choice. This leads inexorably to the proposition that abortion law should be further liberalised, so as to decriminalise abortion in all or almost all circumstances. As we have seen, this is not merely a theoretical issue, as there have recently been a number of prosecutions in England and Wales for illegal abortions.

Another key point is that restrictive abortion laws do not necessarily lower abortion rates, and that, conversely, they lead to many more unsafe “backstreet” abortions. This can have devastating effects on the health of pregnant people, usually from the poorer sections of the community, who have no choice but to resort to such abortions. In the context of Trinidad and Tobago, where the English pre-1967 law still prevails, Glennis Hyacenth and Crystal Brizan wrote in 2012 “The criminal law is a major cause of the public health problem relating to abortion in Trinidad and Tobago and may be seen as a leading cause of maternal morbidity… The interpretation of the criminal law makes it impossible for a woman with an unwanted pregnancy to obtain safe medical care in hospitals and often times drives poor women to risk their lives with dangerous procedures.” [24]

I do, however, want to make a final point, which is no less important than the other issues I have addressed in this lecture. While I believe that abortion should be fully decriminalised, I also don’t think that this is a complete answer to the issue. We also need to address the social and economic context. In her landmark 1983 essay “Racism, Birth Control and Reproductive Rights,” Angela Davis makes clear that birth control, including abortion, “is a fundamental prerequisite for the emancipation of women”. However, she also criticises the abortion rights movement of the time, stating that “arguments advanced by birth control advocates have sometimes been based on blatantly racist premises,” that “the historical record of this movement leaves much to be desired” and that “the ranks of the abortion rights campaign did not include substantial numbers of women of color”. [25]  She makes a powerful, if uncomfortable, point about the history of abortion among enslaved people:

“Black women have been aborting themselves since the earliest days of slavery. Many slave women refused to bring children into a world of interminable forced labor, where chains and floggings and sexual abuse for women were the everyday conditions of life…

Why were self-imposed abortions and reluctant acts of infanticide such common occurrences during slavery? Not because Black women had discovered solutions to their predicament, but rather because they were desperate. Abortions and infanticides were acts of desperation, motivated not by the biological birth process but by the oppressive conditions of slavery. Most of these women, no doubt, would have expressed their deepest resentment had someone hailed their abortions as a stepping stone toward freedom.” [26]

She goes on to say “What is urgently required is a broad campaign to defend the reproductive rights of all women-and especially those women whose economic circumstances often compel them to relinquish the right to reproduction itself.” [27]   She goes on to describe the practice of forced sterilisations of Black, Native and Latinx people in US history.

Reproductive rights shouldn’t begin and end with the right to abortion and contraception, important though those things are. They should also extend to changing social and economic conditions so that those who do want to raise children are able to do so. All too often, Black people, people of colour and working-class people are not afforded the same range of choices as those who are more privileged.

In conclusion, we need the full decriminalisation of abortion. Section 58 of the 1861 Act should be repealed and the remaining restrictions on abortion access should be swept away. This is particularly pressing in those Caribbean jurisdictions that have not liberalised their abortion laws and where the pre-1967 English law still applies. But we also need to change the social and economic conditions under which many marginalised people who would wish to raise children are unable to do so. That means a radical redistribution of wealth and power, and policies that support working-class parents, such as universal basic income, council housing, rent control and free childcare.

© Professor Leslie Thomas KC 2023

[1] As quoted in Carla Spivack, To "Bring Down the Flowers": The Cultural Context of Abortion Law in Early Modern England, 14 Wm. & Mary J. Women & L. 107 (2007) https://scholarship.law.wm.edu/wmjowl/vol14/iss1/4/

[2] As discussed by David Boyle,  Supreme deceit: How Sam Alito snuck medieval state Christianity into the Dobbs opinion, Salon , 13 October 2022 https://www.salon.com/2022/10/13/deceit-how-sam-alito-snuck-medieval-state-christianity-into-the-dobbs-opinion/

[3] Henry de Bracton, On the Laws and Customs of England, vol 2, p 341 https://amesfoundation.law.harvard.edu/cgi-bin/brac-hilite.cgi?Unframed+English+2+341

[4] Neil Jones, English legal history in Dobbs v Jackson [2023] IFL 8.

[5] Edward Coke, The Third Part of the Institutes of the Laws of England, p 50 https://upload.wikimedia.org/wikipedia/commons/8/8a/Edward_Coke%2C_The_Third_Part_of_the_Institutes_of_the_Laws_of_England_%281797%29.pdf

[6] Blackstone, Commentaries on the Laws of England 1:120-41 https://press-pubs.uchicago.edu/founders/documents/amendIXs1.html

[7] For example, Wycherley is cited in an amicus brief by Professor Joseph W. Delapenna in the case of Dobbs v Jackson Women’s Health Organization 142 S. Ct. 2228 https://www.supremecourt.gov/DocketPDF/19/19-1392/185316/20210806173754092_19-1392%20Amicus%20Br%20Joseph%20Dellapenna.pdf

[8] Available online at https://www.supremecourt.gov/DocketPDF/19/19-1392/185196/20210729093557582_210169a%20Amicus%20Brief%20for%20efiling%207%2029%2021.pdf

[9] Available online at https://www.supremecourt.gov/DocketPDF/19/19-1392/192957/20210920133840569_19-1392%20bsac%20Historians.pdf

[10] Carla Spivack, To "Bring Down the Flowers": The Cultural Context of Abortion Law in Early Modern England, 14 Wm. & Mary J. Women & L. 107 (2007) https://scholarship.law.wm.edu/wmjowl/vol14/iss1/4/

[11] R.H. Helmholz, Legal history and abortion in American law [2023] IFL 12

[12] Bernard M Dickens and Rebecca J. Cook, Development of Commonwealth abortion laws, International & Comparative Law Quarterly 28.3 (1979): 424-457

[13] Jonathan Brown, Scotland and the Abortion Act 1967: historic flaws, contemporary problems.  Juridical Review , 2 (2015), 135-155

[16] Fran Amery, Social Questions, Medical Answers: Contesting British Abortion Law, Social Politics 21(1) (2014)

[17] Zoe Williams, The women being prosecuted in Great Britain for abortions: ‘Her confidentiality was completely destroyed’, The Guardian, 10 November 2023

[18] See the analysis of the judgment by Robert Brett Taylor and Adelyn L.M. Wilson, UK Abortion Law: Reform Proposals, Private Members’ Bills, Devolution and the Role of the Courts, Modern Law Review 82(1) (2019)

[19] Alejandra Cardenas, Susheela Singh, Margaret Harpin and Sophia Sadinsky, Realising the Full Decriminalisation fo Abortion: A comprehensive Approach through Public Health and International Human Rights Law, Center for Reproductive Rights and Guttmacher Institute, September 2023  https://reproductiverights.org/wp-content/uploads/2023/10/Full-decriminalization-of-abortion_Article_10.13.pdf

[20] Emily Ottley, Karolina Szopa, and Jamie Fletcher. "Dobbs v Jackson Women’s Health Organization (2022): consequences one year on."  Medical Law Review  31.3 (2023): 457-468

[21] Leslie J Reagan, From When Abortion Was a Crime to Abortion Is a Crime. Bulletin of the History of Medicine, 97(1) (2023), 11-21.

[23] Judith Thomson, A Defense of Abortion, Philosophy & Public Affairs , Vol. 1, no. 1 (Fall 1971). https://spot.colorado.edu/~heathwoo/Phil160,Fall02/thomson.htm

[24] Glennis Hyacenth and Crystal Brizan, The Case of Unsafe Abortion in Trinidad and Tobago: An NGO Perspective, Social and Economic Studies 61:3 (2012): 167-186

[25] Angela Davis, Racism, Birth Control and Reproductive Rights, in Women, Race and Class, Vintage Books, 1983

This event was on Thu, 30 Nov 2023

Professor of Law

Professor Leslie Thomas KC was appointed Gresham Professor of Law in 2020 and is one of the top rated silks in the country, ranked leading individual by both Chambers and the Legal 500 (2022). He was made a QC in 2014.

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The Morning Newsletter

How Abortion Views Are Different

With the Supreme Court set to hear a major abortion case, we look at the state of public opinion.

By David Leonhardt

For nearly 50 years, public opinion has had only a limited effect on abortion policy. The Roe v. Wade decision, which the Supreme Court issued in 1973, established a constitutional right to abortion in many situations and struck down restrictions in dozens of states.

But now that the court has agreed to hear a case that could lead to the overturning of Roe , voters and legislators may soon again be determining abortion laws, state by state. This morning’s newsletter offers a guide to public opinion on the subject.

Americans’ views on abortion are sufficiently complex that both sides in the debate are able to point to survey data that suggests majority opinion is on their side — and then to argue that the data friendly to their own side is the “right” data. These competing claims can be confusing. But when you dig into the data, you discover there are some clear patterns and objective truths.

Here are five.

1. A pro-Roe majority …

Polls consistently show that a majority of Americans — 60 percent to 70 percent, in recent polls by both Gallup and Pew — say they do not want the Supreme Court to overturn Roe. Similarly, close to 60 percent of Americans say they favor abortion access in either all or most circumstances, according to Pew.

These are the numbers that abortion rights advocates often emphasize.

2. … and a pro-restriction majority

The most confounding aspect of public opinion is a contradiction between Americans’ views on Roe itself and their views on specific abortion policies: Even as most people say they support the ruling, most also say they favor restrictions that Roe does not permit .

Roe, for example, allows only limited restrictions on abortion during the second trimester, mostly involving a mother’s health. But less than 30 percent of Americans say that abortion should “generally be legal” in the second trimester, according to Gallup. Many people also oppose abortion in specific circumstances — because a fetus has Down syndrome, for example — even during the first trimester.

One sign that many Americans favor significant restrictions is in the Gallup data. Gallup uses slightly different wording from Pew, creating an option that allows people to say that abortion should be legal “in only a few” circumstances. And that is the most popular answer — with 35 percent of respondents giving it (in addition to the 20 percent who say abortion should be illegal in all circumstances).

This helps explain why many abortion rights advocates are worried that the Supreme Court will gut Roe without officially overturning it. Yes, the justices are often influenced by public opinion .

3. Remarkable stability

Opinion on some major political issues has changed substantially over the last half-century. On taxes and regulation, people’s views have ebbed and flowed. On some cultural issues — like same-sex marriage and marijuana legalization — views have moved sharply in one direction.

But opinion on abortion has barely budged . Here is Gallup’s four-category breakdown, going back to 1994:

Other survey questions show a similar pattern, with the stability stretching back to the 1970s , just after the Roe ruling.

A key reason is that abortion opinion differs only modestly by age group. Americans under 30 support abortion rights more strongly than Americans over 50, but the gap is not huge. The age gaps on marijuana legalization , same-sex marriage and climate change are all larger.

Abortion remains a vexing issue for large numbers of Americans in every generation — which suggests the debate is not likely to be resolved anytime soon.

4. A modest gender gap …

Gender plays a major role in American politics. Most women voted for Joe Biden, while most men voted for Donald Trump. On many issues, like gun control and the minimum wage , there is a large gender gap.

But the gap on abortion is not so large. If anything, it seems to be smaller than the partisan gap . That suggests, perhaps surprisingly, that there are more Democratic-voting women who favor significant abortion restrictions than Republican-voting women who favor almost universal access — while the opposite is true for men.

(One note: When people are asked whether they identify as “pro-choice” or “pro-life,” both the gender and age gaps grow. Those terms appear to prime people to think as Democrats or Republicans, rather than thinking through the details of their own policy views.)

5. … and a big class gap

One of the strongest predictors of a person’s view on abortion is educational attainment, as you can see in the chart above. Working-class Americans often favor restrictions. Many religiously observant people also favor restrictions.

It’s yet another way in which the Democratic coalition is becoming tilted toward college graduates and the Republican coalition is going in the other direction.

The bottom line

Both advocates and opponents of abortion access believe the issue is too important to be decided by public opinion. For advocates, women should have control over their bodies; after all, no major decision of men’s health is subject to a veto by politicians or other voters. And for opponents of abortion access, the life of an unborn child is too important to be subject to almost any other consideration.

If the Supreme Court overrules or substantially weakens Roe, this intense debate will play out state by state. Many states are likely to restrict abortion access substantially.

For more: Pew’s Jeff Diamant and Aleksandra Sandstrom look at opinion in each state . And The Upshot looks in detail at how and where laws may change if Roe falls .

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Many New York businesses are allowed to fully reopen today . Parts of Europe are also lifting restrictions .

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“The future of the auto industry is electric,” President Biden said during a visit to a Ford plant in Michigan.

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Israeli-Palestinian Conflict

Diplomatic efforts to end the violence are gaining urgency , with the E.U., the U.N., and others calling on the Israeli military and Hamas militants to lay down their weapons.

Israeli airstrikes have damaged Gaza’s health and sewage systems and displaced tens of thousands of people, deepening a humanitarian crisis .

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Lives Lived: With deadpan comedy and Everyman good looks, Charles Grodin first drew notice on Broadway. He went on to star onscreen in “The Heartbreak Kid,” “Midnight Run” and “Beethoven.” He died at 86 .

ARTS AND IDEAS

‘shrek’ at 20.

Nobody at DreamWorks, then a relatively new animation studio, expected “Shrek” to be a hit. “Getting sent to ‘Shrek’ felt like being sent to Siberia,” the director Vicky Jenson said.

Released 20 years ago, the movie was a departure from other animated features of the time. Its hero was a misanthropic ogre. The cheeky and crude humor made fun of fairy-tale tropes. And the film was loaded with pop culture references and contemporary songs .

Yet “Shrek” went on to spawn a billion-dollar franchise and win the first Academy Award for best animated feature. It “defined the kind of films the studio would go on to make: offbeat stories that, unlike Disney fairy tales, had more of an edge to them,” as Gina Cherelus writes in The Times .

Today, Shrek-related content is ubiquitous in memes and on social media, introducing the film to a new generation . At a sushi restaurant years ago, Jenson was delighted to overhear nearby diners talking about it. “One of them says, ‘Have you seen “Shrek”?’ And the other one is like, ‘No, no, I don’t go see kids’ stuff,’ and they go: ‘No, no, it’s not for kids. You have to go see it.’” — Sanam Yar, a Morning writer

PLAY, WATCH, EAT

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This fried snapper is topped with thyme-laced Creole sauce. Eat it while reading Pete Wells on New York City’s return to full-scale indoor dining.

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The mainstream narrative is that Sinead O’Connor ripped up a photo of the pope on “Saturday Night Live” and derailed her music career. She’d like to set the record straight .

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The hosts discussed the Giulianis .

Now Time to Play

The pangram from yesterday’s Spelling Bee was jocular . Here is today’s puzzle — or you can play online .

Here’s today’s Mini Crossword , and a clue: Euphoric feeling (four letters).

If you’re in the mood to play more, find all our games here .

Thanks for spending part of your morning with The Times. See you tomorrow. — David

P.S. Three of our colleagues’ stories appear in The Best American Food Writing 2020 : Amelia Nierenberg’s article on Hatch chiles , Kim Severson’s profile of Jamie Oliver and Pete Wells’s viral review of Peter Luger .

You can see today’s print front page here .

“ The Daily ” is about Gaza. On “ The Argument ,” a debate about critical race theory.

Lalena Fisher, Claire Moses, Ian Prasad Philbrick and Sanam Yar contributed to The Morning. You can reach the team at [email protected] .

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David Leonhardt writes The Morning, The Times's main daily newsletter. Previously at The Times, he was the Washington bureau chief, the founding editor of The Upshot, an Op-Ed columnist, and the head of The 2020 Project, on the future of the Times newsroom. He won the 2011 Pulitzer Prize for commentary. More about David Leonhardt

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Regions & Countries

1. americans’ views on whether, and in what circumstances, abortion should be legal.

As the long-running debate over abortion reaches another  key moment at the Supreme Court  and in  state legislatures across the country , a majority of U.S. adults continue to say that abortion should be legal in all or most cases. About six-in-ten Americans (61%) say abortion should be legal in “all” or “most” cases, while 37% think abortion should be  illegal  in all or most cases. These views have changed little over the past several years: In 2019, for example, 61% of adults said abortion should be legal in all or most cases, while 38% said it should be illegal in all or most cases.    Most respondents in the new survey took one of the middle options when first asked about their views on abortion, saying either that abortion should be legal in  most  cases (36%) or illegal in  most  cases (27%). 

Respondents who said abortion should either be legal in  all  cases or illegal in  all  cases received a follow-up question asking whether there should be any exceptions to such laws. Overall, 25% of adults initially said abortion should be legal in all cases, but about a quarter of this group (6% of all U.S. adults) went on to say that there should be some exceptions when abortion should be against the law.

One-in-ten adults initially answered that abortion should be illegal in all cases, but about one-in-five of these respondents (2% of all U.S. adults) followed up by saying that there are some exceptions when abortion should be permitted. 

Altogether, seven-in-ten Americans say abortion should be legal in some cases and illegal in others, including 42% who say abortion should be generally legal, but with some exceptions, and 29% who say it should be generally illegal, except in certain cases. Much smaller shares take absolutist views when it comes to the legality of abortion in the U.S., maintaining that abortion should be legal in all cases with no exceptions (19%) or illegal in all circumstances (8%). 

There is a modest gender gap in views of whether abortion should be legal, with women slightly more likely than men to say abortion should be legal in all cases or in all cases but with some exceptions (63% vs. 58%). 

Younger adults are considerably more likely than older adults to say abortion should be legal: Three-quarters of adults under 30 (74%) say abortion should be generally legal, including 30% who say it should be legal in all cases without exception. 

But there is an even larger gap in views toward abortion by partisanship: 80% of Democrats and Democratic-leaning independents say abortion should be legal in all or most cases, compared with 38% of Republicans and GOP leaners.  Previous Center research  has shown this gap widening over the past 15 years. 

Still, while partisans diverge in views of whether abortion should mostly be legal or illegal, most Democrats and Republicans do not view abortion in absolutist terms. Just 13% of Republicans say abortion should be against the law in all cases without exception; 47% say it should be illegal with some exceptions. And while three-in-ten Democrats say abortion should be permitted in all circumstances, half say it should mostly be legal – but with some exceptions. 

There also are sizable divisions within both partisan coalitions by ideology. For instance, while a majority of moderate and liberal Republicans say abortion should mostly be legal (60%), just 27% of conservative Republicans say the same. Among Democrats, self-described liberals are twice as apt as moderates and conservatives to say abortion should be legal in all cases without exception (42% vs. 20%).

Regardless of partisan affiliation, adults who say they personally know someone who has had an abortion – such as a friend, relative or themselves – are more likely to say abortion should be legal than those who say they do not know anyone who had an abortion.

Views toward abortion also vary considerably by religious affiliation – specifically among large Christian subgroups and religiously unaffiliated Americans. 

For example, roughly three-quarters of White evangelical Protestants say abortion should be illegal in all or most cases. This is far higher than the share of White non-evangelical Protestants (38%) or Black Protestants (28%) who say the same. 

Despite  Catholic teaching on abortion , a slim majority of U.S. Catholics (56%) say abortion should be legal. This includes 13% who say it should be legal in all cases without exception, and 43% who say it should be legal, but with some exceptions. 

Compared with Christians, religiously unaffiliated adults are far more likely to say abortion should be legal overall – and significantly more inclined to say it should be legal in all cases without exception. Within this group, atheists stand out: 97% say abortion should be legal, including 53% who say it should be legal in all cases without exception. Agnostics and those who describe their religion as “nothing in particular” also overwhelmingly say that abortion should be legal, but they are more likely than atheists to say there are some circumstances when abortion should be against the law.

Although the survey was conducted among Americans of many religious backgrounds, including Jews, Muslims, Buddhists and Hindus, it did not obtain enough respondents from non-Christian groups to report separately on their responses.

Abortion at various stages of pregnancy 

As a  growing number of states  debate legislation to restrict abortion – often after a certain stage of pregnancy – Americans express complex views about when   abortion should generally be legal and when it should be against the law. Overall, a majority of adults (56%) say that how long a woman has been pregnant should matter in determining when abortion should be legal, while far fewer (14%) say that this should  not  be a factor. An additional one-quarter of the public says that abortion should either be legal (19%) or illegal (8%) in all circumstances without exception; these respondents did not receive this question.

Among men and women, Republicans and Democrats, and Christians and religious “nones” who do not take absolutist positions about abortion on either side of the debate, the prevailing view is that the stage of the pregnancy should be a factor in determining whether abortion should be legal.

Americans broadly are more likely to favor restrictions on abortion later in pregnancy than earlier in pregnancy. Many adults also say the legality of abortion depends on other factors at every stage of pregnancy. 

One-in-five Americans (21%) say abortion should be  illegal  at six weeks. This includes 8% of adults who say abortion should be illegal in all cases without exception as well as 12% of adults who say that abortion should be illegal at this point. Additionally, 6% say abortion should be illegal in most cases and how long a woman has been pregnant should not matter in determining abortion’s legality. Nearly one-in-five respondents, when asked whether abortion should be legal six weeks into a pregnancy, say “it depends.” 

Americans are more divided about what should be permitted 14 weeks into a pregnancy – roughly at the end of the first trimester – although still, more people say abortion should be legal at this stage (34%) than illegal (27%), and about one-in-five say “it depends.”

Fewer adults say abortion should be legal 24 weeks into a pregnancy – about when a healthy fetus could survive outside the womb with medical care. At this stage, 22% of adults say abortion should be legal, while nearly twice as many (43%) say it should be  illegal . Again, about one-in-five adults (18%) say whether abortion should be legal at 24 weeks depends on other factors. 

Respondents who said that abortion should be illegal 24 weeks into a pregnancy or that “it depends” were asked a follow-up question about whether abortion at that point should be legal if the pregnant woman’s life is in danger or the baby would be born with severe disabilities. Most who received this question say abortion in these circumstances should be legal (54%) or that it depends on other factors (40%). Just 4% of this group maintained that abortion should be illegal in this case.

This pattern in views of abortion – whereby more favor greater restrictions on abortion as a pregnancy progresses – is evident across a variety of demographic and political groups. 

Democrats are far more likely than Republicans to say that abortion should be legal at each of the three stages of pregnancy asked about on the survey. For example, while 26% of Republicans say abortion should be legal at six weeks of pregnancy, more than twice as many Democrats say the same (61%). Similarly, while about a third of Democrats say abortion should be legal at 24 weeks of pregnancy, just 8% of Republicans say the same. 

However, neither Republicans nor Democrats uniformly express absolutist views about abortion throughout a pregnancy. Republicans are divided on abortion at six weeks: Roughly a quarter say it should be legal (26%), while a similar share say it depends (24%). A third say it should be illegal. 

Democrats are divided about whether abortion should be legal or illegal at 24 weeks, with 34% saying it should be legal, 29% saying it should be illegal, and 21% saying it depends. 

There also is considerable division among each partisan group by ideology. At six weeks of pregnancy, just one-in-five conservative Republicans (19%) say that abortion should be legal; moderate and liberal Republicans are twice as likely as their conservative counterparts to say this (39%). 

At the same time, about half of liberal Democrats (48%) say abortion at 24 weeks should be legal, while 17% say it should be illegal. Among conservative and moderate Democrats, the pattern is reversed: A plurality (39%) say abortion at this stage should be illegal, while 24% say it should be legal. 

Christian adults are far less likely than religiously unaffiliated Americans to say abortion should be legal at each stage of pregnancy.  

Among Protestants, White evangelicals stand out for their opposition to abortion. At six weeks of pregnancy, for example, 44% say abortion should be illegal, compared with 17% of White non-evangelical Protestants and 15% of Black Protestants. This pattern also is evident at 14 and 24 weeks of pregnancy, when half or more of White evangelicals say abortion should be illegal.

At six weeks, a plurality of Catholics (41%) say abortion should be legal, while smaller shares say it depends or it should be illegal. But by 24 weeks, about half of Catholics (49%) say abortion should be illegal. 

Among adults who are religiously unaffiliated, atheists stand out for their views. They are the only group in which a sizable majority says abortion should be  legal  at each point in a pregnancy. Even at 24 weeks, 62% of self-described atheists say abortion should be legal, compared with smaller shares of agnostics (43%) and those who say their religion is “nothing in particular” (31%). 

As is the case with adults overall, most religiously affiliated and religiously unaffiliated adults who originally say that abortion should be illegal or “it depends” at 24 weeks go on to say either it should be legal or it depends if the pregnant woman’s life is in danger or the baby would be born with severe disabilities. Few (4% and 5%, respectively) say abortion should be illegal at 24 weeks in these situations.

Abortion and circumstances of pregnancy 

The stage of the pregnancy is not the only factor that shapes people’s views of when abortion should be legal. Sizable majorities of U.S. adults say that abortion should be legal if the pregnancy threatens the life or health of the pregnant woman (73%) or if pregnancy is the result of rape (69%). 

There is less consensus when it comes to circumstances in which a baby may be born with severe disabilities or health problems: 53% of Americans overall say abortion should be legal in such circumstances, including 19% who say abortion should be legal in all cases and 35% who say there are some situations where abortions should be illegal, but that it should be legal in this specific type of case. A quarter of adults say “it depends” in this situation, and about one-in-five say it should be illegal (10% who say illegal in this specific circumstance and 8% who say illegal in all circumstances). 

There are sizable divides between and among partisans when it comes to views of abortion in these situations. Overall, Republicans are less likely than Democrats to say abortion should be legal in each of the three circumstances outlined in the survey. However, both partisan groups are less likely to say abortion should be legal when the baby may be born with severe disabilities or health problems than when the woman’s life is in danger or the pregnancy is the result of rape. 

Just as there are wide gaps among Republicans by ideology on whether how long a woman has been pregnant should be a factor in determining abortion’s legality, there are large gaps when it comes to circumstances in which abortions should be legal. For example, while a clear majority of moderate and liberal Republicans (71%) say abortion should be permitted when the pregnancy is the result of rape, conservative Republicans are more divided. About half (48%) say it should be legal in this situation, while 29% say it should be illegal and 21% say it depends.

The ideological gaps among Democrats are slightly less pronounced. Most Democrats say abortion should be legal in each of the three circumstances – just to varying degrees. While 77% of liberal Democrats say abortion should be legal if a baby will be born with severe disabilities or health problems, for example, a smaller majority of conservative and moderate Democrats (60%) say the same. 

White evangelical Protestants again stand out for their views on abortion in various circumstances; they are far less likely than White non-evangelical or Black Protestants to say abortion should be legal across each of the three circumstances described in the survey. 

While about half of White evangelical Protestants (51%) say abortion should be legal if a pregnancy threatens the woman’s life or health, clear majorities of other Protestant groups and Catholics say this should be the case. The same pattern holds in views of whether abortion should be legal if the pregnancy is the result of rape. Most White non-evangelical Protestants (75%), Black Protestants (71%) and Catholics (66%) say abortion should be permitted in this instance, while White evangelicals are more divided: 40% say it should be legal, while 34% say it should be  illegal  and about a quarter say it depends. 

Mirroring the pattern seen among adults overall, opinions are more varied about a situation where a baby might be born with severe disabilities or health issues. For instance, half of Catholics say abortion should be legal in such cases, while 21% say it should be illegal and 27% say it depends on the situation. 

Most religiously unaffiliated adults – including overwhelming majorities of self-described atheists – say abortion should be legal in each of the three circumstances. 

Parental notification for minors seeking abortion

Seven-in-ten U.S. adults say that doctors or other health care providers should be required to notify a parent or legal guardian if the pregnant woman seeking an abortion is under 18, while 28% say they should not be required to do so.  

Women are slightly less likely than men to say this should be a requirement (67% vs. 74%). And younger adults are far less likely than those who are older to say a parent or guardian should be notified before a doctor performs an abortion on a pregnant woman who is under 18. In fact, about half of adults ages 18 to 24 (53%) say a doctor should  not  be required to notify a parent. By contrast, 64% of adults ages 25 to 29 say doctors  should  be required to notify parents of minors seeking an abortion, as do 68% of adults ages 30 to 49 and 78% of those 50 and older. 

A large majority of Republicans (85%) say that a doctor should be required to notify the parents of a minor before an abortion, though conservative Republicans are somewhat more likely than moderate and liberal Republicans to take this position (90% vs. 77%). 

The ideological divide is even more pronounced among Democrats. Overall, a slim majority of Democrats (57%) say a parent should be notified in this circumstance, but while 72% of conservative and moderate Democrats hold this view, just 39% of liberal Democrats agree. 

By and large, most Protestant (81%) and Catholic (78%) adults say doctors should be required to notify parents of minors before an abortion. But religiously unaffiliated Americans are more divided. Majorities of both atheists (71%) and agnostics (58%) say doctors should  not  be required to notify parents of minors seeking an abortion, while six-in-ten of those who describe their religion as “nothing in particular” say such notification should be required. 

Penalties for abortions performed illegally 

Americans are divided over who should be penalized – and what that penalty should be – in a situation where an abortion occurs illegally. 

Overall, a 60% majority of adults say that if a doctor or provider performs an abortion in a situation where it is illegal, they should face a penalty. But there is less agreement when it comes to others who may have been involved in the procedure. 

While about half of the public (47%) says a woman who has an illegal abortion should face a penalty, a nearly identical share (50%) says she should not. And adults are more likely to say people who help find and schedule or pay for an abortion in a situation where it is illegal should  not  face a penalty than they are to say they should.

Views about penalties are closely correlated with overall attitudes about whether abortion should be legal or illegal. For example, just 20% of adults who say abortion should be legal in all cases without exception think doctors or providers should face a penalty if an abortion were carried out in a situation where it was illegal. This compares with 91% of those who think abortion should be illegal in all cases without exceptions. Still, regardless of how they feel about whether abortion should be legal or not, Americans are more likely to say a doctor or provider should face a penalty compared with others involved in the procedure. 

Among those who say medical providers and/or women should face penalties for illegal abortions, there is no consensus about whether they should get jail time or a less severe punishment. Among U.S. adults overall, 14% say women should serve jail time if they have an abortion in a situation where it is illegal, while 16% say they should receive a fine or community service and 17% say they are not sure what the penalty should be. 

A somewhat larger share of Americans (25%) say doctors or other medical providers should face jail time for providing illegal abortion services, while 18% say they should face fines or community service and 17% are not sure. About three-in-ten U.S. adults (31%) say doctors should lose their medical license if they perform an abortion in a situation where it is illegal.

Men are more likely than women to favor penalties for the woman or doctor in situations where abortion is illegal. About half of men (52%) say women should face a penalty, while just 43% of women say the same. Similarly, about two-thirds of men (64%) say a doctor should face a penalty, while 56% of women agree.

Republicans are considerably more likely than Democrats to say both women and doctors should face penalties – including jail time. For example, 21% of Republicans say the woman who had the abortion should face jail time, and 40% say this about the doctor who performed the abortion. Among Democrats, far smaller shares say the woman (8%) or doctor (13%) should serve jail time.  

White evangelical Protestants are more likely than other Protestant groups to favor penalties for abortions in situations where they are illegal. Fully 24% say the woman who had the abortion should serve time in jail, compared with just 12% of White non-evangelical Protestants or Black Protestants. And while about half of White evangelicals (48%) say doctors who perform illegal abortions should serve jail time, just 26% of White non-evangelical Protestants and 18% of Black Protestants share this view.

• Only respondents who said that abortion should be legal in some cases but not others and that how long a woman has been pregnant should matter in determining whether abortion should be legal received questions about abortion’s legality at specific points in the pregnancy.  ↩

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An ethical issue: nurses’ conscientious objection regarding induced abortion in South Korea

Chung mee ko.

1 College of Nursing, Sungshin Women’s University, 55, Dobong-ro 76ga-gil, Gangbuk-gu, Seoul, 01133 Republic of Korea

Chin Kang Koh

2 College of Nursing, The Research Institute of Nursing Science, Seoul National University, 103 Daehakro, Jongrogu, Seoul, 03080 Republic of Korea

3 College of Nursing, Seoul National University, 103 Daehakro, Jongrogu, Seoul, 03080 Republic of Korea

Associated Data

The dataset supporting the conclusions is available from the corresponding author on reasonable request.

The Constitutional Court of South Korea declared that an abortion ban was unconstitutional on April 11, 2019. The National Health Care System will provide abortion care across the country as a formal medical service. Conscientious objection is an issue raised during the construction of legal reforms.

One hundred sixty-seven perioperative nurses responded to the survey questionnaire. Nurses’ perception about conscientious objection, support of legislation regarding conscientious objection, and intention to object were measured. Logistic regression was used to explore the factors associated with support of the legislation and the intention to conscientiously object.

Only 28.8% of the responding nurses were aware of health care professionals’ conscientious objection. The majority (68.7%) felt that patients’ rights should be prioritized over health care professionals’ conscientious objection. On the other hand, 45.8% supported the legislation on conscientious objection to abortion, and 42.5% indicated a willingness to refuse to participate in an abortion case if conscientious objection was permitted. Religion, awareness of conscientious objection, and prioritizing of nurses’ right to conscientious objection were significantly associated with supporting the legislation. Moreover, religion and prioritizing nurses' rights were significantly associated with the intention to conscientiously object.

Conclusions

This study provides information necessary for further discussion of nurses’ conscientious objection. Nursing leaders, researchers, and educators should appeal to nurses and involve them in making policies that balance a women's right to non-discrimination and to receiving appropriate care with nurses' rights to maintain their moral integrity without compromising their professional obligation.

On April 11, 2019, the Constitutional Court of South Korea ruled that the criminalization of abortion is unconstitutional [ 1 ]. The Constitutional Court ruled that women’s self-determination would take priority during the first 22 weeks of pregnancy [ 2 ]. According to Articles 269 and 270 of Chapter XXVII, “Crimes of Abortion” in the Criminal Act, a woman who procures her own miscarriage or a healthcare provider such as an obstetrician or midwife who performs an abortion for a woman shall be punished by a fine or imprisonment [ 3 ]. The Constitutional Court ruled these two articles as constitutional discordance and gave the National Assembly until the end of December 2020 to revise the law [ 2 ]. Therefore, the National Assembly is working on reforming related provisions of the Criminal Law and the Mother and Child Health Act. The Government is also working to support law making and to align policies and regulations implementing the new ruling while researching public opinions. Throughout this process, the National Health Care System will provide abortion care across the country as a formal medical service. This indicates that many health care providers in hospitals and clinics who have never been involved with abortion because it was performed covertly in a limited number of clinics will face abortion cases for the first time in their workplaces. Nationally, the number of annual abortions covertly performed is estimated at 50,000 cases, 90% of which are surgical abortions [ 4 ].

Conscientious objection (CO) is an issue raised during the construction of legal reforms. Currently, Paragraph 1 of Article 15 (Prohibition against Refusal to Provide Medical Services) under the Medical Service Act states: “Medical personnel or the founder of a medical institution shall not upon receiving a request for medical treatment or assistance in childbirth refuse such a request without good cause” [ 5 ]. Under this legislation, health care providers’ refusal to perform an abortion is banned [ 6 ]. The Ministry of Health and Welfare virtually stated its opposition to healthcare providers’ CO considering health care access at an official meeting held at the National Assembly [ 7 ]. However, physician groups such as the Korean Society of Obstetrics and Gynecology and Korean Association of Obstetrics and Gynecology have announced their position in support of physicians’ right to CO and have asked for new abortion laws that include provisions ensuring the right of healthcare workers to refuse abortions [ 8 ]. On the other hand, nurses and other health professional groups have not provided their official position about CO.

In some countries, the law contains provisions for the right of CO to abortion. For example, " Discussion " section of the Abortion Act in the UK states that health care providers may refuse to participate in any treatment based on his or her CO [ 9 ]. The Act recognizes the right to CO status related to abortion of which provision is ethically controversial and on which many people have strong views [ 10 ]. On the other hand, other countries do not legally grant the CO of health care providers [ 11 ]. For example, Sweden does not have legislation for CO under its Abortion Act, and the Swedish Parliament has rejected including a clause for CO [ 12 ]. Moreover, the World Health Organization has expressed reservations about CO because it may delay the delivery of health care services and place a woman’s health at risk [ 13 ].

There have been arguments for and against nurses’ CO. An argument for CO is that it is a human being’s fundamental moral right. Article 9 of the European Convention on Human Rights states that everyone has the right to freedom of thought, conscience, and religion [ 14 ]. Permitting CO avoids moral distress, which might occur when a nurse performs certain acts inconsistent with his or her beliefs [ 15 ]. Nurses who declared a CO in their practice stated that this was “based on one’s conscience-based perception of morality” [ 16 , p.1343]. Moreover, CO protects health care providers by crediting the individual’s conviction, and it supports health care providers in following their religious beliefs or religious law against providing abortion-related care [ 17 ]. An argument against CO in nursing is that it might negatively influence access-of-care or appropriate health care services [ 18 ]. Patients may have fewer options, and there is concern about the possible widespread practice of CO [ 17 ]. In addition, co-workers may see objectors as leaving unpleasant tasks to their colleagues [ 15 ].

Fleming et al. conducted a systematic review and identified 23 broad reasons and 116 narrow reasons in 4 categories, namely moral, practical, religious, and legal reasons [ 17 ]. Of the narrow reasons, 70% were for and 30% against CO in abortion care by midwives and nurses. Considering these reasons, balancing nurses’ right to CO and the patient’s right to receive appropriate care is a challenge in nursing [ 18 ]. We need to carefully evaluate what treatment boundaries we allow conscience to determine when considering social and health care environments [ 10 ]. However, in South Korea, no studies have focused on nurses’ CO to abortion care, although they now face an era of legal abortion as a formal medical service. Moreover, CO policy will have great impact on perioperative nurses [ 19 ].

Perioperative nurses have the duty of providing care relating to the surgical terminations of pregnancy, which is one ethical dilemma they may face in an operation [ 19 ]. Perioperative nurses prepare the theatre for procedures and assist in termination [ 19 ]. They also provide psychosocial care for women needing an abortion and for their significant others [ 20 , 21 ]. In terms of CO, according to the American Nurses Association guidelines, scrub and circulating nurses may object to providing instruments for the termination of a pregnancy when it causes moral distress [ 22 ]. The Association for Perioperative Practice in the UK also supports nurses’ right for CO regarding surgical abortion based on the Human Fertilization and Embryology Act of 1990 [ 19 ].

The purpose of this study was to explore perioperative nurses’ attitudes towards CO regarding abortion. The specific aims were (1) to examine whether they were aware of CO and how they prioritize between nurses’ right to CO and patients’ right to get an abortion, (2) to describe agreement with legislation of nurses’ CO, and (3) to explore nurses’ intention to assert CO.

Study design

This was a cross-sectional descriptive study utilizing a self-report survey method. The data was collected in October and November 2019 .

Measurements

Prior to inquiring about the nurses’ perceptions of and ideas about CO, we provided information about CO regarding abortion care because this was unfamiliar to the majority of the nurses. We provided a brief description based on the previous literature [ 9 – 11 ]. Each concept was measured using one question we developed based on the literature. Prior to the survey, we verified face validity by having ten nurses review the questions to assess their clarity, comprehensibility, and appropriateness.

• Support of legislation on conscientious objection to abortion

We asked nurses about whether they support the legislation ensuring nurses’ rights to CO: “Do you support that nurses’ right to CO should be ensured under the law?” The answer options were “support,” “oppose,” and “neither support nor oppose.”

• 2. Intentions to assert conscientious objection

The question regarding intention to assert CO was: “Would you object to participating in abortion care if CO for nurses were to be allowed by law?” Moreover, three situations were given [ 11 ], namely “abortion because of foetal problems within 22 weeks,” “abortion because of rape within 22 weeks,” and “abortion because of unwanted pregnancy within 22 weeks.” We posited a 22-week duration in which to allow abortions, which is in accordance with the judgement of the Constitutional Court on April 11, 2019. The answer choices were “I will object,” “I will not object,” and “I do not know.”

• 3. Awareness of CO and opinions about the conflict over nurses’ CO

The question used to assess nurses’ awareness of CO was “Prior to this survey, were you aware of health care workers’ CO?” The answers were measured on a five-point Likert Scale with the following options: 1 = “fully unaware,” 2 = “unaware,” 3 = “neither aware nor unaware,” 4 = “aware,” and 5 = “fully aware.” Furthermore, to ascertain their opinion about the conflict between the rights of nurses and those of patients, we asked: "If there is a conflict between nurses’ right to CO and patients’ right to have an abortion, which do you think should take priority?" [ 10 ]. The answers allowed were “nurses’ right to CO,” “patients’ right to have an abortion,” and “I do not know.”

Data analysis

We performed logistic regression to explore related factors and their odds ratios regarding nurses’ support of legislation to ensure CO and their intention to assert CO. For the logistic regression model of the nurses’ support of the legislation, we coded the nurses’ support as a dichotomous variable. We coded “oppose” and “neither support nor oppose” as 0, and “support” as 1.

In addition, for the logistic regression model, we coded nurses’ intention to assert CO as a dichotomous variable. We assigned “0′ in all cases where they did not choose “will reject” to all three items. These three items were “abortion because of foetal anomaly within 22 weeks,” “abortion because of rape within 22 weeks,” and “abortion because of unwanted pregnancy within 22 weeks.” We assigned “1” to all cases in which the respondent choose “will reject” to at least one of the three items. We utilized crude odds ratios and confidence intervals to show the association. The significance level was 0.05.

Study participants

This study included 167 perioperative nurses who were working in an operating department, including the preoperative area, operating theatres, and post-anaesthesia care unit, in a large tertiary care university hospital in the Seoul metropolitan area of South Korea. The total number of perioperative nurses was 203. Thus, the response rate was 82%. The mean age was 34.4 years, ranging between 22 and 57 years (Table ​ (Table1). 1 ). Among the 167 perioperative nurses, 152 were female, and 15 were male. Less than half (47.3%) reported being religious. The types of religion were Protestant, Catholic, and Buddhist. No other religions were reported. The average clinical experience was 11.03 years. In terms of clinical roles, the majority (62.9%) were operating room nurses. Other roles were recovery room nurses (15.6%), anaesthesia nurses (14.4%), and physician assistants or surgical assistants (7.2%).

Characteristics of study participants (N = 167)

CO conscientious objection

In terms of CO, the mean score of awareness of CO was 2.68 (SD = 1.10). Just 48 nurses (28.8%) reported being “fully aware” or “aware” of the CO of nurses and physicians. The majority (68.7%) felt that patients’ rights should be prioritized over CO.

Legislation on conscientious objection to abortion

Among the perioperative nurses, 45.8% supported the legislation on CO to abortion, 22.9% opposed it, and 31.3% neither supported nor opposed it. In the logistic regression, age, gender, marital status, clinical experience, and clinical role were not significantly associated with the nurses’ support of the legislation on CO to abortion (Table ​ (Table2). 2 ). On the other hand, the Protestant religion was significantly associated with support. Nurses who were Protestants were more likely to support the legislation than those who had no religion (OR = 2.471; 95% CI 1.189–5.133, p  = 0.015). Moreover, the perceived importance of religion was also associated with their support of the legislation on CO to abortion (OR = 0.400, 95% CI 0.207–0.773, p  = 0.006).

Support of legislation confirming health care professionals’ right to assert conscientious objection to abortion (N = 167)

CO: conscientious objection

On the other hand, the odds ratio of the awareness of CO was 2.042, with a 95% confidence interval of 1.033–4.035 ( p  = 0.040) (Table ​ (Table2). 2 ). In addition, the odds ratio of the nurses who answered “nurses’ rights take priority” in the case of a conflict between nurses’ rights to CO and patients’ right to receive nursing care for abortion was 6.750 with a 95% confidence interval of 1.762–25.893 ( p  = 0.005) where the reference group was the nurses who answered “I do not know.”

Nurses’ intentions to assert conscientious objection.

There were three items about the intention to assert CO based on the different reasons for having an abortion (Table ​ (Table3). 3 ). In case of abortion because of foetal problems, the percentage answering that they would object was 21.6%; it was 22.8% in cases of abortion because of rape; and it was 31.3% in cases of abortion because of unwanted pregnancy.

Intentions to assert conscientious objection (N = 167)

The number of those reporting a willingness to refuse being involved in the care of those receiving abortions for at least one of the three following reasons—foetal anomaly, rape, or unwanted pregnancy—was 71 (42.5%). From the logistic regression, protestant perioperative nurses were more likely to report that they would assert CO relative to those having no religious preference as the reference group (Table ​ (Table4). 4 ). The odds ratio was 2.209 with a 95% confidence interval of 1.073–4.549. The perceived importance of religion was also a significant factor related to the intention to assert CO, and nurses who stated that nurses’ rights should be prioritized were more likely to report that they would assert CO in cases of abortion where the reference group was those answering “I do not know.” No other factor was significantly associated with the nurses’ intention to assert CO.

Factors relating to the intention to assert conscientious objection (N = 167)

This study explored perioperative nurses’ attitudes towards the legalization of CO to induced abortion, as well as their intentions to assert objector status. Prior to the legalization of abortion in the formal health care system, this study investigated nurses’ views on CO.

In this study, 45.8% supported legislation granting healthcare professionals CO status, while 22.9% opposed it. In fact, prior to this survey, most nurses (71.3%) were unaware of healthcare professionals’ CO. Logistic regression analysis showed that awareness about CO prior to this survey was significantly associated with support for the legislation. Most of the nurses in this study were unfamiliar with the issue of CO. More generally, South Koreans in the nursing profession have not actively discussed this issue. Within the nursing profession, discussions about issues regarding nurses’ CO and other related matters such as practice, policy, education, and management, are needed.

This study also asked about nurses’ view on the conflict between nurses’ right to CO and patients’ right to health care service for an abortion. The majority (68.7%) answered that patients’ rights to health care take priority, whereas 21.1% answered that nurses’ CO takes priority. In a previous study, 75.7% of nurses answered that patients’ rights to health care choices took precedence, while 24.3% answered that nurses’ CO should take precedence [ 23 ]. This is a similar trend to that in our study, which demonstrated that nurses were more than three times as likely to report that patients’ rights take priority. In our study, this was significantly associated with support for this legislation, as well as the nurses’ willingness to refuse to participate in providing abortion care. Respondents who reported that the nurses’ rights should take priority were more likely to support this legislation and to be willing to refuse to participate in providing abortion care than were those who answered “I do not know.”

There have been debates about whose rights should take precedence. Some insist that health care professionals’ right to CO should take precedence to protect their basic human rights and freedom of conscience and to prevent compromising their moral integrity and ethical well-being [ 16 ]. In addition, whether abortion is even medically beneficial to women’s health in the majority of cases is fiercely contended [ 24 ]. In contrast, others insist that health care providers’ right of conscience should not take precedence over patients’ conscience, health, and life [ 12 ]. Because it is not prima facie obvious, balance between these two competing perspectives is important in policy making. Some countries allowing CO have policies in place to reduce difficulties that women face in seeking abortion care services [ 9 ]. In other countries that prohibit CO, almost all health care providers who object to abortion choose to work in areas that are not involved in this procedure so that they can avoid moral distress while fulfilling the requirements of their professional role [ 12 ]. In South Korea, the effects of CO to abortion on health care professionals, the health care system, and women’s health needs active social discussion.

Regarding the refusal to provide abortion care, 42.5% of the nurses showed a willingness to refuse to participate in an abortion case if CO was permitted. In Davis et al., 66.4% of nurses reported they were likely to assert CO in cases that went against their religious or moral beliefs [ 23 ]. Other research has shown comparatively lower percentages. In a study by Nieminen et al., 3.5–14.1% of Finnish nursing and medical students, nurses, and physicians intended to assert CO to induced abortion [ 25 ]. Moreover, Nordstrand et al. reported that 14.7–18.5% of Norwegian medical students would be willing to refuse abortions in situations based on the length of the pregnancy and the motivation for seeking an abortion [ 26 ]. One reason for the varying rates in these studies might be that they were performed in the context of differing social reasons and health care systems. Another reason could be a measurement issue, as how the questions were asked differed between studies. Thus, it is difficult to compare the numbers directly.

Nurses’ assertion of CO to protect their moral integrity could cause problems such as discrimination against patients, limitations to patients’ access to care, difficulties in nursing staff management, and an increased workload for colleagues [ 15 ]. The number of nurses per 1,000 people in South Korea was 6.9 in 2017, which was lower than the average of 8.8 for all OECD countries and much lower than those of the top three countries (Norway, Switzerland, and Iceland with 17.7, 17.2, and 14.5, respectively) [ 27 ]. Nursing shortages and high turnover rates are issues in South Korea [ 28 ]. The Nursing shortage itself negatively affects patients’ access to care. Within the context of a national nursing shortage, nurses’ CO may have more of an effect on Korean women’s ability to receive appropriate care and may place a greater burden on managers and colleagues than it does on women in other countries that have more nurses per capita. Given nursing shortage, nurses’ ethical decision may impact patients’ access to beneficent care and nurses’ level of stress differently [ 29 ].

Although a national nursing shortage may affect the negative outcomes of nurses’ CO, certain strategies may reduce these negative outcomes. If a health care institution has a sufficient number of nurses who are non-objectors, those who object may more easily refuse when experiencing moral distress without burdening their colleagues or limiting patients’ access to care. Nurses’ CO is closely related to the issue of staffing in each institution. To protect nurses’ ethical beliefs without affecting patients’ access to care, hospital administrators and nurse managers need to make efforts to maintain a sufficient number staff and have an effective nursing staffing system in place. Moreover, ethical climates in the workplace play an important role in preventing negative outcomes from nurses’ behaviour based on their conscience [ 30 ].

On the other hand, prohibiting CO may also negatively affect patients’ health. In this study, four out of ten nurses reported their intention to CO. If CO is prohibited, nurse objectors may leave their job to avoid abortion, which would worsen the nursing shortage in abortion care. Furthermore, if they do not leave their job, they may experience negative feelings such as burnout, fatigue, anxiety, and frustration with moral distress, which could affect patients’ health and safety [ 15 ]. Therefore, considering nurses’ CO requires a more judicious approach for providing beneficial care to patients.

Of the respondents, 47.3% stated that they had a religion. Having a religion was a significant predictor of nurses’ intention to assert CO in this study. This is consistent with the findings of previous studies. In the Strickland study of medical students in the UK, Muslim and non-Muslim students had differing rates of intention to assert CO [ 31 ]. In Nordstrand et al., both perceiving religion to be important and having a religion were significantly related to medical students’ willingness to assert CO to abortion [ 26 ]. In this study, nurses who perceived religion as important were more likely to refuse to provide abortion care. Moreover, in Italy, where the Catholic Church has a greater influence on society, 68.4% of gynaecologists are conscientious objectors [ 32 ].

Regarding the type of religion, protestantism was statistically associated with nurses’ intention to assert CO, and the odds ratio for nurses who were Protestants was 2.209 (1.073–4.549; p  = 0.032) compared with those who had no religious affiliation. On the other hand, Catholicism and Buddhism were not statistically significant factors. Among the nurses, 28.1% were Protestants, 15.0% were Roman Catholic, and 4.2% were Buddhist. In the Census Data, 43.9% of the South Korean population has a religion, and Korea’s three major religions—Protestantism, Buddhism, and Roman Catholicism—account for 19.7%, 15.5%, and 7.9% of the population, respectively [ 33 ]. In this study, the percentage of Buddhists is lower than in the general population because Buddhism is most popular among the elderly population.

Prior to the Constitutional Court ruling, the Protestant and Catholic churches of South Korea strongly expressed their official positions in favour of continuing the law banning abortion, while the Buddhists remained neutral. Specifically, the legislation of the Catholic Church is strongly against abortion [ 17 ], and the Catholic Church of South Korea demonstrated its strong opposition to abortion with a cardinal announcement and a signature-gathering campaign that reached more than one million people. Also reflecting the Catholic Church’s position, previous studies have revealed Catholic health care providers’ refusal to provide abortion care [ 17 , 32 ]. However, in this study, there was no significant difference between the willingness to assert CO of Catholic nurses and nurses without a religion. The small sample size collected in the hospital could be one reason that this study does not show the influence of Catholicism. Another reason could be that Catholic nurses may have a somewhat different attitude than that of the general Catholic population because of other factors, such as professional duty. This study did not include specific questions to gather information on how the legislative framework of Catholicism impacted nurses’ intention to CO. Further research is needed to explore how nurses’ belief as Catholics increases their potential to become conscientious objectors.

This study has some limitations. First, this study used the reference of pregnancy at 22 weeks’ duration when asking about ethical dilemmas and CO; therefore, thoughts about various pregnancy durations could not be examined. Further research is needed to explore nurses’ perceptions about other pregnancy durations such as 12 and 16 weeks. Second, this study included perioperative nurses in a large hospital. However, medical abortions are more frequently provided internationally, and nurses involved in that procedure may experience a different type of stress to those involved in surgical abortions [ 34 ]. In South Korea, as abortion is legalized, the number of medical abortions will increase. Therefore, further research needs to include the perceptions of nurses in obstetrics and genecology clinics where most medical abortions are performed. Finally, this study was performed at one hospital. This limits the ability to generalize the results thereof.

This study provides information for further discussions of nurses’ CO. Four out of ten nurses reported their intention to refuse to provide abortion care. The number of nurses who supported a CO clause in the abortion law was double those who opposed it. Furthermore, the majority answered that patients’ rights to health care take priority over nurses’ right to refuse it. Nursing leaders, researchers, and educators should appeal to nurses and involve them in formulating national health care policies that balance nurses' right to maintain their moral integrity with women’s rights to nondiscrimination and appropriate care. The nursing profession should seriously consider whether insisting on nurses’ right to CO is needed and should be actively involved in the process of determining the new abortion law and related policies.

As shown in this study, a considerable number of nurses want to refuse their involvement in an abortion. If CO is prohibited as per the current position of the Ministry of Health and Welfare, strategies need to be prepared to reduce these nurses’ moral distress in providing abortion care and for preventing a nursing shortage in this field. On the other hand, even if CO is legally protected, some nurses at health care institutions with insufficient nurse manpower may have difficulty in asserting their CO. Countermeasures for this issue should be prepared. Nurses’ ethical well-being is necessary in terms of providing high-quality nursing care and in ensuring patients’ safety.

This study furthers our understanding of nurses’ CO, as it is the first empirical study on this issue in South Korea. This study is especially timely and needed as we are entering a new era of legalized abortion in South Korea. More research should be performed to provide knowledge for nursing practice. In addition, because abortion has been banned for a long time, nursing education has rarely dealt with ethical issues including CO, which is why many nurses in this study were unaware of CO to abortion. Nursing education including the undergraduate curriculum and continuing education should include material dealing with the ethical issues of abortion and related CO.

Acknowledgements

Not applicable.

Abbreviations

Authors’ contributions.

All authors, CMK, CKK, and YSL, made substantial contributions to conception and design and drafting the article. Analysis and interpretation of data were performed by CMK and CKK. All authors have read and approved the manuscript.

This work was supported by the Sungshin Women's University Research Grant of 2017. This funding source had no role in study design, execution, analyses, interpretation of the data, or decision to submit results.

Availability of data and materials

Ethics approval and consent to participate.

This study was approved by the institutional review board of the university hospital where the research was performed. Signed consent was waived, and verbal consent for participation was obtained. Nurses were fully informed and voluntarily decided to participate in the study. Data were collected and managed to protect the privacy and confidentiality of the participants.

Consent for publication

Competing interests.

The authors declare that they have no competing interests.

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