Abortion Decisions and the Duty to Screen: Clinical, Ethical, and Legal Implications of Predictive Risk Factors of Post-Abortion Maladjustment

Article excerpt

David C. Reardon, Abortion Decisions and the Duty to Screen: Clinical, Ethical, and Legal Implications of Predictive Risk Factors of Post-Abortion Maladjustment, 20 J. CONTEMPORARY HEALTH L. & POLICY 33 (2003).

It is important to realize, from the very start, that the views, opinions, and priorities of the physicians and institutions that provide abortions will generally vary from those of the individual women they serve. Moreover, this difference in beliefs and philosophy may result in substantive differences in what women considering abortion expect and what abortion providers provide. These differences in expectations, interests, and views about abortion have a direct bearing on the subject of this article: the inadequate screening and counseling of women considering abortion.

Women seeking abortions are seldom being evaluated for risk factors that reliably predict higher rates of negative physical and psychological complications. Inadequate screening is a matter of negligence in two regards. First, the failure to screen for known risk factors means that the physician has neglected to develop an informed medical recommendation based on the individual woman's unique risk factors and circumstances. Since the counsel the physician gives the woman does not include information about known risk factors, it is not properly grounded on medical evidence. second, inadequate screening is the direct cause of inadequate disclosure of risks to the woman. When women are not informed of the risk factors they possess and the negative outcomes associated with those particular factors, their consent is uninformed.

For example, using just five screening criteria-(1) a history of psychosocial instability; (2) a poor or unstable relationship with the male partner; (3) few friends; (4) a poor work pattern; and (5) failure to take contraceptive precautions-Elizabeth Belsey, et al., determined that sixty- eight percent of the 326 abortion patients she studied were at higher risk for negative reactions and should have been referred for more extensive counseling. Of this high risk group, seventy-two percent actually developed negative post-abortion reactions (guilt; regret; disturbance of marital, sexual, or interpersonal relationships; or difficulty in coping with day-to-day activities) during the three month follow-up period. The Belsey study is just one of at least thirty-four studies identifying statistically validated risk factors for emotional maladjustment to abortion.

The need for full disclosure of risk factors and their associated risks is especially important because many abortion patients are ambivalent about their choices in the first place. In some surveys, as many as eighty percent have stated they would have kept their pregnancies under better circumstances or if they were supported to do so by their significant others. Because the initial decision to abort is often tentative, or even made solely to please others, information about risks may be exactly what a woman is looking for as an excuse to keep her child when everyone else is pressuring her into an unwanted abortion.

Full disclosure is important because reports of inadequate, inaccurate, or biased counseling are statistically associated with reports of more frequent and more severe negative psychological reactions post-abortion. Proper screening and full disclosure reduce the risk that the patient will subsequently feel that: (1) she is "alone" in feeling negative reactions that "no one else feels"; (2) she was ill-prepared for the adjustments that must follow an abortion; or (3) she was exploited by "abortion profiteers" who hid the full truth from her in a time of crisis and confusion.

In every other area of medicine, patients are familiar with the experience of being screened for risk factors prior to treatment. As a result, women seeking abortions may naturally assume that their abortion counselors will be screening them for any known risk factors. …