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Patients' Views about Abortion

A patient's personal beliefs about abortion change the risk-benefit determinations for genetic counseling and, to a lesser extent, for fertility treatment. Physicians must not assume, however, that a patient who is opposed to abortion in the abstract will not consider abortion if she is personally faced with a high probability of giving birth to a child with a severe defect. All women, even those who are opposed to abortion, should be offered all appropriate testing and counseling. This does not mean that a physician should advocate abortion. Ideally, a patient should receive the necessary information about genetic diseases and the risks of fertility treatment without reference to either her or her physician's views about abortion. The woman's personal views about abortion should shape the risks that she is willing to assume of conceiving a child with a genetic disease, the prenatal testing to which she will consent, and under which circumstances, if any, she will terminate a pregnancy.

Physicians who do not perform abortions because of personal ethical beliefs should ensure that their beliefs do not compromise their patients' right to choose an abortion. In addition to providing every patient full information, the physician should arrange an easy referral system so that a patient who chooses an abortion can obtain it without unnecessary delay or expense. Conversely, physicians who support abortion as a valid therapeutic technique must not force their views on their patients. They must be prepared to respect the wishes of a woman who, after being fully informed of the risks and benefits of pre- or postconception testing, chooses to bear her child without regard to potential genetic diseases.

Several states have recently passed laws restricting abortion. The provisions of the Utah law are representative:

An abortion may be performed in this state only under the following circumstances:

the pregnant woman's attending physician has certified that, in the physician's professional judgment, the abortion is necessary to save her life;

the pregnancy is the result of rape or rape of a child, as defined ... that was reported by the victim to a law enforcement agency prior to the abortion;

the pregnancy is the result of incest, ... and the incident was reported by the victim to a law enforcement agency prior to the abortion;

in the professional judgment of the pregnant woman's attending physician, to prevent grave damage to the pregnant woman's medical health; or

in the professional judgment of the pregnant woman's attending physician, to prevent the birth of a child that would be born with grave defects.

After 20 weeks gestational age, measured from the date of conception, an abortion may be performed only for those purposes and circumstances described in Subsections (2)(a), (d), and (e). (Utah 1991 Session Law Service, sec. 76-7-301 et seq.)

While it will be several years before the constitutionality of these laws is fully reviewed, it is expected that the Supreme Court will allow much greater restrictions on abortion than are currently enforced.

Some states may successfully outlaw abortions except in the most limited circumstances, but probably many will retain abortion on demand. As long as abortion remains a legal option in another state, it is arguable that physicians have a legal duty to continue to discuss abortion as an alternative. Even if a state that has outlawed abortion were also to prohibit wrongful birth and wrongful life lawsuits, physicians would continue to have an ethical duty to counsel patients about the role of abortion in managing genetic diseases and when otherwise medically indicated.

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