Marek Vácha2013

A 16-year-old female is in your office because she has just found out she is pregnant. She discusses her options and asks you to refer her for an abortion. She states that her parents do not know she is pregnant and she does not want them to know. What should you do?1. Refer her for the abortion without parental

notification.2. Make a „reasonable effort“ to contact the parents, but

still refer for the abortion if you cannot contact them3. Do not refer for abortion without parental consent4. Strongly encourage her to discuss the issue with her

parents.

A 16-year-old female is in your office because she has just found out she is pregnant. She discusses her options and asks you to refer her for an abortion. She states that her parents do not know she is pregnant and she does not want them to know. What should you do?1. Refer her for the abortion without parental

notification.2. Make a „reasonable effort“ to contact the parents, but

still refer for the abortion if you cannot contact them3. Do not refer for abortion without parental consent4. Strongly encourage her to discuss the issue with her

parents.

Althought competent adults have an unfettered legal right to abortion within the first trimester, this right is not universal for minor. A minor is generally defined as a person below the age of 18. The necessity of parental consent or at least notification is a mixed issue across states nationally. Some states require parental notification and some states not. hence, there is not clear answer.The only thing that is always clear is that we should

strongly encourage the patient herself to have the discussion with her parents. Even if you are within your rights to walk up to a brain-dead patient and remove the ventilator without consent of the family, the boards will always want you to answer „discuss with the family“ first if that is one of the options.

A 35-year-old married woman with four children is in your office seekingta termination of an unwanted pregnancy in the first trimester. Later in the day after you give the patient the referralm her husband calls and is very distressed because he does not want the abortion to occur. He very much wants to keep the baby and tells you that he even has a name picked out. What should you tell him?

A 35-year-old married woman with four children is in your office seekingta termination of an unwanted pregnancy in the first trimester. Later in the day after you give the patient the referralm her husband calls and is very distressed because he does not want the abortion to occur. He very much wants to keep the baby and tells you that he even has a name picked out. What should you tell him?

1. You will try to talk his wife out of the abortion.2. You will cancel the procedure immediately.3. You say you cannot hold up the termination

without a court order.4. You cannot prevent the abortion without

paternity testing confirming that he is the father.

5. You say you have an absolute duty to the mother to honor her wishes no matter what his personal feelings are.

A 35-year-old married woman with four children is in your office seekingta termination of an unwanted pregnancy in the first trimester. Later in the day after you give the patient the referralm her husband calls and is very distressed because he does not want the abortion to occur. He very much wants to keep the baby and tells you that he even has a name picked out. What should you tell him?

1. You will try to talk his wife out of the abortion.2. You will cancel the procedure immediately.3. You say you cannot hold up the termination

without a court order.4. You cannot prevent the abortion without

paternity testing confirming that he is the father.

5. You say you have an absolute duty to the mother to honor her wishes no matter what his personal feelings are.

Woman does not ned consent fron the father of the child or any member of the family.

Although a fetus may genetically contain half the genetic elements of both parents, it is the female htat must go through the delivery. Hence, the woman has a „right of ownership“ over any undelivered child because it inhabits her body.

A 30-year-old woman presents to the clinic furing her third trimester. The estimated gestational age of the fetus is 28 weeks and she is seeking an abortion. The patient is generally healthy. An ultrasound of the fetus at 26 weeks and routine genetic testing showed no abnormalities. What you should tell the patient?1. It´s okay; you will go ahead with the abortion.2. You will be happy to comply if she can get a

court order.3. No way, third-trimester abortions are prohibited4. Legally you can only do it if her life is at risk5. No, you can´t do it because the fetus is normal

A 30-year-old woman presents to the clinic furing her third trimester. The estimated gestational age of the fetus is 28 weeks and she is seeking an abortion. The patient is generally healthy. An ultrasound of the fetus at 26 weeks and routine genetic testing showed no abnormalities. What you should tell the patient?1. It´s okay; you will go ahead with the abortion.2. You will be happy to comply if she can get a

court order.3. No way, third-trimester abortions are prohibited4. Legally you can only do it if her life is at risk5. No, you can´t do it because the fetus is normal

You cannot ehtically freely abort a potentially viable fetus unless htere is a very sifnificant extenuating circumstances such as risk to the mother or a fetus so developmentally abnormal that fetal demise is certain.

Case report: Ms. A.

Ms. A is 19 years old and 25 week s pregnant. Although her pregnancy was unplanned, at no time she considered pregnancy termination. During a prenatal office visit, Ms. A reveals that she has a daily drug habit that includes crac cocaine and intravenous narcotics. She refuses to consider a change in her behavior, despite a thorough review of the potential effects of her substance abuse on her pregnancy outcome. Specifically, she refuses to participate in a methadone or other substance-abuse program.

(Baylis, F., et al. (2008) Ethical dilemmas in the care of pregnant women: rethinking „maternal-fetal conflicts“. in (Singer, P.A., Viens, A.M., (eds.) (2008) The Cambridge Textbook of Bioethics. Cambridge University Press,

Miss A.

there is a conflict between woman´s autonomy and the best interest of the fetus

Miss A.

A decision of the Supreme Court of Canada in Winnipeg Child and Family Services (Nortwest Area) v.g. (D.F.) (1997) at issue was whether there was legal authority to

order a pregnant woman to undergo counseling and hospital admission to manage a drug addiction in absence of her consent

The Supreme Court held that forced detention and treatment would violate the woman´s constitutional rights and that there was no legal basis on which to do so.

Miss A.

A decision of the Supreme Court of Canada in Winnipeg Child and Family Services (Nortwest Area) v.g. (D.F.) (1997) this decision also confirmed that the fetus is not

protected before birth and that courts have no legal grounds on which to order a competent pregnant woman to undergo a medical intervention that she does not want.

Miss A.

A decision of the Supreme Court of Canada in Winnipeg Child and Family Services (Nortwest Area) v.g. (D.F.) (1997) „Pregnant woman suffering from alcohol or substance

abuse addictions may not seek prenatal care for fear that their problems would be detected and they would be confined involuntarily and/or ordered to undergo mandatory treatment. (…) In the end, orders made to protect a fetus´health could ultimately result in its destruction.“

Miss A.

When a physician´s view of the best interest of the fetus conflicts with the view of the pregnant woman, the role of the physician is to provide counseling and persuasion, but not coercion.

(Baylis, F., et al. (2008) Ethical dilemmas in the care of pregnant women: rethinking „maternal-fetal conflicts“. in (Singer, P.A., Viens, A.M., (eds.) (2008) The Cambridge Textbook of Bioethics. Cambridge University Press, p.100)

Royal College of Obstetricians and Gynaecologists in the UK 1996: obstetricians must respect the woman´s legal

liberty to ignore or reject professional advice, even to her own detriment and that of the fetus.“

Miss A.

Physicians who treat competent patients (including competetnt pregnant patients) without their consent put themselves at risk of both criminal and civil liability

Miss A.

in many countries, the courts have recognized that the fetus does not have legal rights until it is born alive and with complete delivery from the body of the pregnant woman legal rights attach only at birth, making clear that the

fetus has no legal rights that could override the pregant woman´s right to determine her own health care (Council of Europe, 1984)

Miss B. CaseMs. B is 24 years old and has been in labor for 18

hours. The cervical dilatation has not pregressed past 3 cm. The fetal heart rate tracing has been worrisome but is now seriously abnormal, showing a profound bradycardia of 65 beats per minute. This bradycardia does not resolve with conservative measueres. Repeat pelvic examinations reveals no prolapsed cord and confirm a vertex presentations at 3 cm dilatation. The obstetrician explains to Ms. B that a cesarean section will be necessary because of suspected fetal distress. Ms. B absolutely refuses, saying „No surgery“.

(Baylis, F., et al. (2008) Ethical dilemmas in the care of pregnant women: rethinking „maternal-fetal conflicts“. in (Singer, P.A., Viens, A.M., (eds.) (2008) The Cambridge Textbook of Bioethics. Cambridge University Press)

Case of Miss B.further discussion clarifies that Ms. B i

terrified of general anesgthesia because her mother died from anesthesia complications.

Moreover, Ms. B has a strong distrust of physicians and believes that too many cesarean sections are done. When it is explained that the cesarean can be done with spinal anesthesia, and in view of the risks of the ongoing bradycardia, Ms. B agrees to the surgery.

Miss B. CaseHowever, if the patient had continued to

refuse the surgery, the physician would have been obliged to respect her decision despite the serious risks to the fetus.

Baby Doe was born with Down syndrome and a congenital blockage of his oesophagus.

Baby Doe´s esophageal atresia, with a tracheoesophageal fistula, made it impossible for him to eat. With such a malformation, anything that he

swallowed would end up not in his stomach but in his lungs.

This is a condition for which surgical repair is routine and routinely succesful. Without a surgical repair of this congenital

anomaly, he ould die of either starvation or pneumonia.

the birth weight was 2 722g and the lenght 50,8 cm from crown to heel.

After consideration of all medical information the parents decided not to authorize surgery. The infant was given phenobarbital (5mg) and morphine (2,5mg) as needed for pain and restlessness. The parents visited and held the child frequently until his death six days later.

Legal Facts parents declined repair of the fistula parents felt that „a minimally acceptable

quality of life was never present for a child suffering from such a condition“ and further that it was not in the best interest of the infant, their other two children, and the family entity as a whole for the infant to be treated.

Legal Facts he court heard testimony form the mother´s

obstetrician that he and other members of the obstetrical group believed that the infant should remain at the hospital where he was born, knowing that surgery was not possible there and that the child would soon die.

the infant´s pediatrician, although agreeing with the obstetrician´s prognosis, recommended in testimony that the infant be immediately transferred to another hospital where corrective surgery could be performed.

Legal Facts the trial court determined that the

parents „have the right to choose a medically recommended course of treatment for their child in the present circumstances.“

Ronald Reagan himself asked aides to find a way to use federal law to prevent such cases from happening again.

„What more dramatic confirmation could we have of the real issue than the Baby Doe case in Bloomington, Indiana? The death of that tiny infant tore at the hearts of all Americans because the child was undeniably a live human being — one lying helpless before the eyes of the doctors and the eyes of the nation. The real issue for the courts was not whether Baby Doe was a human being. The real issue was whether to protect the life of a human being who had Down's Syndrome, who would probably be mentally handicapped, but who needed a routine surgical procedure to unblock his esophagus and allow him to eat.

A doctor testified to the presiding judge that, even with his physical problem corrected, Baby Doe would have a "non-existent" possibility for "a minimally adequate quality of life" — in other words, that retardation was the equivalent of a crime deserving the death penalty. The judge let Baby Doe starve and die, and the Indiana Supreme Court sanctioned his decision.“

The Justice Department proposed a controversial mechanism for intervening: they defined decisions like the one made for

Baby Doe as discrimination against children with disabilities, a violation of federal civil rights laws

Any organization that was found to be in violation of civil rights laws could lose all of its funding.▪ for hospitals, this potentionally meant that they

could lose their Medicar, Medicaid and NIH funding

Neonatologists had been arguing for years that newborns had a right to medical care equivalent to that of all other citizens The Baby Doe regulations enshrined that

right in federal law.But the regulation also represented an

unprecedented intrusion of the federal government into the doctor-patient relationship.

Ultimately, the U.S. Supreme court struck down the Baby Doe regulations Hospitals, court said, could be judged only

if they refused to provide treatment for which the parents did consent.

New amendments specified three criteria for situations in which it woud permissible for doctors and parents to withhold or withdraw life-sustaining therapy:

1. The infant is chronically and irreversibly comatose

2. The provision of such treatment would merely prolong dying, not be effective in ameliorating or correcting all of the infant´s life-threatening conditions, or otherwise be futile in terms of the survival of the infant.

3. The provisions of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself under such circumstances would be inhumane.

Has the fetus right to life? right to prenatal care? right to be born of sound mind and body?

accordind to Assyrian laws, the penalty given a woman who induced her own abortion was impalement on stakes without burial it seems likely that the primary aim of these

societies was not to protect unborn human life, but to ensure that the society did not lack military manpower

(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 32)

Cicero

Cicero (106 – 43 B.C.E.): „I remember a case which occurred when I was

in Asia: how a certain woman of Miletus, who had accepted a bribe from the alternative heirs and procured her own abortion by drugs, was condemned to death: and rightly, for she had cheated the father of his hopes, his name of continuity, his family of its support, his house of an heir, and the Republic of a citizen-to-be.“

Notice that there is no mention or concern for the destruction of the conceptus, per se.

Jones, W.H., (2012) Personhood Revisited. Reproductive Technology, Bioethics, Religion and the Law. Langdon Street Press. Minneapolis, MN. p.128

„...This concern was expressed in 1861 by the Parliament of the United Kingdom, which passed the act, Offences Against the Person Act, which outlawed abortion at any stage. (...)

1869 Canada banned abortion in all provinces.

In 1873, the Congress of the United States passed the Comstock Law, which made it a crime to sell, distribute, or own abortion-related products and services.

Jones, W.H., (2012) Personhood Revisited. Reproductive Technology, Bioethics, Religion and the Law. Langdon Street Press. Minneapolis, MN. p.135

History

until 1973, except in cases where the mother´s life was in danger, abortion was a statutory crime in every state of the USA.

Roe versus Wade

The alias "Jane Roe" was used for Norma McCorvey, on whose behalf the suit was originally filed, alleging that the abortion law in Texas violated her constitutional rights and the rights of other women.

The defendant was the district attorney of Dallas County, Texas, Henry B. Wade.

„Roe versus Wade“Trimester system

The case created the "trimester" system that: gives American women an absolute right to an

abortion in the first three months of pregnancy

allows some government regulation in the second trimester of pregnancy

declares that states may restrict or ban abortions in the last trimester as the foetus nears the point where it could live outside the womb; in this trimester a woman can obtain an abortion despite any legal ban only if doctors certify it is necessary to save her life or health.

Jane Roe (Norma McCorvey) is now a new-born christian

First Trimester: unrestricted access to abortion

Second Trimester: the decision is still between woman and the physician states may place regulation on free access to a

second-trimester abortion second-trimester abortins are preponderantly still

performed at the patient´s discretion Third Trimester: abortions are not freely

available, because the fetus is potentially viable

Trimester System

Consent by the father for an abortion is not required the fetus is considered as a part of the woman´s body

and does not have the individual rights of „personhood“ until after birth.

there is no compulsion on the part of the physician to perform an abortion if performing this procedure is ethically unacceptable to the physician. the patient has a right to have an abortion, but they don´t

have a right to force you to do it, if it is objectionable to you. it is considered unethical for a patient to seek an

abortion for the purpose of gender selection.

Other remarks

It is considered ethically unacceptable to determine the gender of the fetus and then abort the fetus if the sex is unacceptable to the patient.

Fischer, C., (2006) USMLE Medical Ethics: The 100 Cases You Are Most Likely to See on the Exam. Kaplan Publishing, New York.

Other remarks

According to a USA Today, CNN Gallup Poll in May, 1999, 16 percent of Americans believe abortions should be legal for any reason, at any time during pregnancy and 55 percent of Americans believe abortion should be legal only to save the life of the mother or in cases of rape or incest.

In Gallup Poll in January 2001, people who considered themselves to be pro-life rose from 33 percent to 43 percent in the past five years, and people who considered themselves to be pro-choice decline from 56 percent to 48 percent.

(Edge, R.S., Groves, J.R., (2007) Ethics of Health care. A Guide for Clinical Practice. 3rd ed. Thomson, Delmar Learning. NY. p.253)

http://www.gallup.com/poll/1576/abortion.aspx

http://www.gallup.com/poll/147734/Americans-Split-Along-Pro-Choice-Pro-Life-Lines.aspx

spontaneous abortions – miniinterruptions – other legal interruption – extrauterine pregnancies

LegalAbortions

Child is unlikely to survive and the pregnancy threatens the mother´s life

Child is the „wrong“ sex or does not have some cosmetic features the parents desire.Mother wants to wait with pregnancy to an end of skiing season

?

Requests for Abortions

"I´d be looking at that dumb man´s face in that child and resenting it"

Reasons for Abortion

the debate is sometimes viewed as one of good versus evil, with each side demonizing the other

Michael Griffin case1993"Don't kill any more babies"

Victim: Dr George Tiller was gunned down in May 2009

Scott Roeder received in 2010 50 years in prison

Contestable statemetns

A woman has a right to limite her pregnancy.

Once a woman has chosen to continue her pregnancy, she incurs the obligations to protect and promote the health and well-being of her fetus

The state incurs obligations to limit or preclude actions that would irreversibly harm the future person.

some view abortion as morally akin to contraception - that is, preventing the maternal-child relationship from

developing, whereas others may view abortion as

"exiting a parental relationship" that has already begun

Paola, F.A., Walker, R., Nixon, L.L., (2010) Medical Ethics and Humanities. Jones and Bartlett Publishers, Sudbury, MA. p. 250

Moderate positions

pro-life but wiling to allow abortions in special

cisrcumstances, like rape or severe fetal abnormalities

pro-choice but wiling to make moral distinctions among

reasons for abortions, like rejecting sex selection as morally invalid

(Pierce, J., Randels, G., (2010) Contemporary Bioethics. Oxford University Press, NY, Oxford. p. 247)

The wrongful birth and the wrongful life „the wrongful birth“ – physicians failed to

warn prospective parents that they are at risk of conceiving or giving birth to a child with a serious genetic disorder

„the wrongful life“ – parents can also bring wrongful life suits on behalf of their children. These are more controversial because they must allege that the child would have been better off not being born

Types of Interceptions

"the morning after pill" (="Plan B pill")

effective only within seventy-two hours after unprotected sexual intercourse

Mifepristone (= RU-486; = "the abortion pill") may be used within the first sixty-three days of pregnancy interferes with the progesterone

supply and stops a prregnancy already in progress.

surgical abortion

RU 486 was approved by the U.S. Food and Drug

Administration (FDA) in September 2000

is the mother obligated to alter her behaviour t maximize the heatzg of her fetus?

should she not smoke, not drink alcoholic beverage, obtain prenatal care and maintain emotional calm?

if she does not, should the health care professsion or the society intervene for the sake of the fetus?

Three Positions

not everyone agrees that membership in the species Homo sapiens is a sufficient, or even a necessary, condition for moral consideration

gradualist view holds that an embryo or fetus gains moral status during its journey toward birth.

from the point of fertilization onward, the conceived being has the same rights or interest as an adult human being, including a right to life.

Fetuses and Pain

some experts have data suggesting that fetuses can feel pain by twenty weeks of gestation, and possibly earlier the pain receptors are present in the human ferus

´s perioral area t seven weeks of gestation the turnk, arms, and lefs develop pain receptors by

fifteen weeks of gestation what is uncertain is whether the anatomic

presence of pain receptors is equivalent to the capacity to sense or feel pain

Paola, F.A., Walker, R., Noxon, L.L., (2010) Medical Ethics and Humanities. Jones and Bartlett Publishers, Sudbury, MA. p. 274

Pro-life

various positions abortion is never morally permisible in cases where continuing a pregnancy

presents a threat to the life of the woman, abortion is morally permissible, though not morally required.

one should refrain from killing the embryo or fetus both because it is a person from the moment of fertilization but because it has the potential to become a person.

"There is no difference between a first trimester, a second trimester, a third trimester abortion or infanticide. It´s all the same human being in different stages of development. I finally got to the point I couldn´t look at those tiny bodies anymore."

Dr. Arnold Halpern, former director of a Planned Parenthood clinic

http://www.personhoodusa.com/

Stop To Genocide

Moderate positions

pro-life but wiling to allow abortions in special

cisrcumstances, like rape or severe fetal abnormalities

pro-choice but wiling to make moral distinctions among

reasons for abortions, like rejecting sex selection as morally invalid

(Pierce, J., Randels, G., (2010) Contemporary Bioethics. Oxford University Press, NY, Oxford. p. 247)

Pro-choice

various positions there are no limitations on abortion

the government should not restrict access to abortions

to criminalize it constitutes an injustice against pregnant women

genetic humanity is neither necessary or sufficient for personhood

Mary Ann Warren

criteria for personhood1. consciousness2. reasoning capacity3. self-motivated activity4. the capacity to communicate5. the presence of self-concpets and self-

awareness (1) and (2) may well be sufficient... and quite

probably (1) - (3) are sufficient but she does not explain why this criteria are

morally relevant?

Mary Ann Warren

it would be morally permissible for "a woman in her seventh month of pregnancy to obtain an abortion just to avoid having to postpone a trip to Europe."

Paola, F.A., Walker, R., Nixon, L.L., (2010) Medical Ethics and Humanities. Jones and Bartlett Publishers, Sudbury, MA. p. 253

Mary Ann Warren

Warrens view has been criticized because it suggests the moral permissibility of infanticide as well as abortion, given that a late-term fetus is not significantly different from a newborn infant in terms of its ability to meet the criteria for personhood put forth by Warren.

Paola, F.A., Walker, R., Nixon, L.L., (2010) Medical Ethics and Humanities. Jones and Bartlett Publishers, Sudbury, MA. p. 253

Mary Ann Warren

Warren find this implication of her view unacceptable.

Her response to this objection was to focus on the significance of the location of fetuses compared with newborn infants whereas a pregnant woman can free herself of the

burdens of sustaining fetal life only by detaching the fetus from her body, no such action is required in the case of a newborn.

A woman who does not want to nurture a newborn infant can walk away, leaving the burden of child rearing to others.

Paola, F.A., Walker, R., Nixon, L.L., (2010) Medical Ethics and Humanities. Jones and Bartlett Publishers, Sudbury, MA. p. 253

Peter Singer"We protest his hiring because Dr. Singer denies the intrinsic moral worth of an entire class of human beings - newborn children - and promotes policies that would deprive many infants with disabilities of their basic human right to legal protection against homicide." ... Princeton University student petition protesting Peter Singer's hiring.

Joseph Fletcher: "postnatal abortion"

After-Birth Abortions

the moral status of an infant is equivalent to that of a fetus, that is, neither can be considered a "person" in a morally relevant sense.

Hardly can a newborn be said to have aims, as the future we imagine for it is merely a projection of our minds on its potential lives. It might start having expectations and develop a minimum level of self-awareness at a very early stage, but not in the first days or few weeks after birth.

After-Birth Abortions

potential people cannot be harmed by not being brought into existence

Actual people´s well-being could be threatened by the new (even if healthy) child requiring energy, money and care which the family might happen to be in short supply of.

if economical, social or psychological circumstances change such that taking care of the offspring becomes an unbearable burden on someone, then people should be given the chance of not being forced to do something they cannot afford.

Giubilini, A., Minerva, F., (2012) After-birth abortion: why should the baby live? J Med Ethics doi:10.1136/medethics-2011-100411

The moderate Pro-choice view

abortions are not morally unproblematic but abortins are not equivalent to murder

Daniel Callahan: "abortion is justifiable only if there is a serious

health or family reason; simply an unwanted or unplanned pregnancy is not a sufficiently grave reason."

"the legalization of abortions emerged as a way of helpig women with troubled pregnancies, not that of legitimating the killing of embryos."

The moderate Pro-choice view

L.W.Sumner there is not the same moral status to all stages of

prenatal development and for ignoring the obvious differences between zygotes and forty-week fetuses.

third-trimester fetus is sentient and equally confident that the first-trimester fetus is not. = woman´s autonomy is absolute in the first and

early second trimesters but a compellig justification is required for abortions in the late second trimester or third trimester.

if a fetus is experiencing pain, we ought to assume that it has an interest in not experiencing pain

The moderate Pro-choice view

point of viability 500 g 20-23+ capable of living, especially outside the womb

Arguments FOR Abortions

is an acorn an oak tree? the mother and the unborn children are

not like two tenants in a small house which has been rented to both: the mother owns the house

Arguments FOR Abortions

My body, my right, my life, my choice, incest, rape, „my situation“

Arguments AGAINST Abortions

abortion for genetic defect is a peculiar innovation in medicine (or in preventive medicine) in which a disease is treated by eliminating the patient or, if you prefer, a disease is prevented by

"preventing" the patient

Arguments AGAINST Abortions

"...not long ago, at my own university, a physician making rounds with medical students stood over the bed of an intelligent, otherwise normal ten-year-old boy with spina bifida. "Were he to have been conceived today," the physician casually informed his entourage, "he would have been aborted."

Kass, R.L., (2002) Life, Liberty and the Defense of Dignity. Encounter Books, New York, London. p. 130

islam, judaism, christiantiy all against

A Jewish Perspective

generally, abortion is prohibited. An abortion is possible when Jewish law requires abortion if the mother´s

life or her physical or mental health is at stake Jewish law permits abortion when the risk to

the woman´s life or health (again, physical or mental) is greater than than of a normal pregnancy but not so greta as to constitute a clear and present danger to her.

A Jewish Perspective

...but "mental health" has not been interpreted broadly

A Jewish Perspective

Jewish law restricts the legitimacy of abortion to a narrow range of cases

Judaism does not see all abortion as a murder, as Catholicism does, because biblical and rabbinic sources understand the process of gestation developmentally

Talmud determines that within the first forty days after conception the zygote is "simply water".

during the rest of pregnancy, when the fetus is legally categorized "like the thigh of its mother." Because our bodies are God´s property, neither men nor women are permitted to amputated their thigh except to preserve their life or health, and so, by and large, abortion is forbidden.

A Jewish Perspective

abortion may surely not be used as a post facto form of birth control

Dorff, E.N., (2003) Matters of Life and Death. A Jewish Approach to Modern Medical Ethics. The Jewish Publication Society. Philadelphia. p. 128-133

Roman Catholic Church

the modern church asserts that "two deaths are better than one murder" (Jakobovits 1973)

(Gilbert, S.C., Tyler, A.L., Zackin, E.J., (2005) Bioethics and the New Embryology. Sinauer Associates, Inc. W.H. Freeman & comp. Sunderland, MA U.S.A. p. 38)

Jakobovits, I., (1973) Jewish views on abortion. In D.Walbert and J.Butler (eds.) Abortion, Society and Law. The Press of Case Western Reserve Unoversity, Cleveland and London

...which is not true at all (M.V.)

Donum Vitae

Thus the fruit of human generation, from the first moment of its existence, that is to say from the moment the zygote has formed, demands the unconditional respect that is morally due to the human being in his bodily and spiritual totality. The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every innocent human being to life. (Donum Vitae) 

Islam

From a hadith we can learn that the embryo becomes a person at 120 days:

Islam

On the authority of Abdullah bin Masud, who said : the messenger of Allah, and he is the truthful, the believed narrated to us :

"Verily the creation of each one of you is brought together in his mother's belly for forty days in the form of seed, then he is a clot of blood for a like period, then a morsel of flesh for a like period, then there is sent to him the angel who blows the breath of life into him and who is commanded about four matters: to write down his means of livelihood, his life span, his actions, and whether happy or unhappy. By Allah, other than Whom there is no god, verily one of you behaves like the people of Paradise until there is but an arm's length between him and it, and that which has been written over takes him and so he behaves like the people of Hell-fire and thus he enters it; and one of you behaves like the people of Hell-fire until there is but an arm's length between him and it, and that which has been written over takes him and so he behaves like the people of Paradise and thus he enters it." (Sahih al-Bukhari and Muslim)

Islam

You can see that it is 40 day + 40 days + 40 days, when the soul enters the embryo a person is created with a purpose in life.

Islam

In principle, the Qur'an condemns the killing of humans (except in the case of defense or as capital punishment), but it does not explicitly mention abortion. This leads Islamic theologians to take up different viewpoints: while the majority of early Islamic theologians permitted abortion up to day 40 of pregnancy or even up to day 120, many countries today interpret these precepts protecting unborn children more conservatively.

Although there is no actual approval of abortion in the world of Islam, there is no strict, unanimous ban on it, either. Islam has not given any precise directions with regard to the issue of abortion.

http://www.islamawareness.net/FamilyPlanning/Abortion/abortion3.html

full human life, with its attendant rights, begins only after the ensoulment of the fetus

some Muslim scholars agree that ensoulment occurs at about 120 days after conception, while other scholars hold that it occurs at about 40 days after conception

(Albar, M.A., (1995) When is the soul inspired? Contemporary Topics in Islamic Medicine. Ch.1.Jeddah: Saudi Arabia Publishing and Distributing House, pp.3-11

abortion has been allowed after implantation and before ensoulment in cases in which there were adequate juridical or medical reasons.

however, many Shias and some Sunnis have generally not permited abortion at any stage after implantation, even before ensoulment, unless the mother´s life is in danger

Daar,A.S., Bakdash,T., Khitami, A.B., (2008) Islamic Bioethics in Singer, P.A., Viens, A.M., (eds.) The Cambridge Textbook of Bioethics. Cambridge University press, Cambridge. pp.408-415

abortion after ensoulment is strictly forbidden by all islamic authorities, but the vast majority do make an exception to preserve the mother´s life

If a choice has to be made to save either the fetus or the mother, the the mother´s life would take precedence she is seen as a root, the fetus as an offshot

Daar,A.S., Bakdash,T., Khitami, A.B., (2008) Islamic Bioethics in Singer, P.A., Viens, A.M., (eds.) The Cambridge Textbook of Bioethics. Cambridge University press, Cambridge. pp.408-415

Nicolas Perruche

In 1982, Josette Perruche discovered red spots covering her four year old daughter. The child was diagnosed with German measles. Mrs Perruche told her doctor that if she was infected,

she should have an abortion rather than risk giving birth to a severely handicapped child.

Mrs Perruche underwent two blood tests, two weeks apart. Mrs Perruche's doctor assured her that it was safe to go on with the pregnancy. In fact, the tests had been contradictory. Instead of pursuing the question, Mrs Perruche's doctor reassured her. A later blood test would show that the lab had made a mistake.

Nicolas Perruche

Nicholas Perruche was born in 1983 deaf, part-blind and with severe brain damage. Within two years, Mrs Perruche had suffered a "nervous breakdown", requiring psychiatric care. Today the boy is cared for by a government institution. He spends alternate

weekened with his divorced parents.3–5

In 2000, France's highest appeals court awarded compensation to 17 year old Nicholas Perruche. The significance of the Perruche ruling was that it recognised the child's right to seek damages allegedly for being born. Prior to that only parents could seek

damages. Perruche's parents were compensated in February 1997 and then Nicholas himself was granted compensation in November 2000.

Is it better to be dead than have Down’s syndrome? Some people do believe that Down’s syndrome constitutes a life not worth living. But this view seems false. Children with Down’s syndrome can and often do lead happy and worthwhile lives. After all, we do not suggest that other (non-human) animals have a right not to be born or a life not worth living because their intelligence does not measure up to the human average.

Is there a “right not to be born”? Reproductive decision making, options and the right to information

J Savulescu