Case example

Dr. Gold, an obstetrician-gynecologist, spends one day a week seeing patients at a rural clinic affiliated with the teaching hospital where she has admitting privileges. The clinic is about an hour drive from the city in which her teaching hospital is located. Mrs. Farmer, a 26-year-old mother of four, has made an appointment with Dr. Gold today at the rural clinic. Dr. Gold delivered Mrs. Farmer's youngest child two years ago, but has not seen her since then. Mrs. Farmer reports that she has missed a menstrual period and fears that she might be pregnant again. A pregnancy test is done; it confirms that Mrs. Farmer is pregnant, and the pregnancy is estimated at about seven weeks. Mrs. Farmer immediately states that she does not want to have another baby. She tells Dr. Gold that her husband will be furious when he finds out that she is pregnant and could pose a danger to her and her children – he was physically violent with her during her last pregnancy. She relates that she has been using birth control to prevent pregnancy, but it has obviously failed. The couple can barely afford to support their four children. Mrs. Farmer asks Dr. Gold to terminate the pregnancy.

The multi-institution health system in which Dr. Gold works has a firm policy about abortion. It states that, if an abortion is necessary for a therapeutic reason, that is, to protect the life or health of the pregnant woman, a physician may perform the procedure. Physicians are not, however, permitted to perform elective abortions in system facilities. Dr. Gold explains this to Mrs. Farmer and tells her that the nearest clinic that performs elective abortions is located about a three-hour drive away. Mrs. Farmer begins to weep and says that she cannot travel to have the procedure because she does not have access to a car and has no one to watch her children for more than a few hours. She pleads with Dr. Gold to consider her case to be one in which the pregnancy must be terminated to protect her health, and to perform the abortion. How should Dr. Gold respond?

Abortion: an intractable problem in health care ethics

Abortion has long been a high-profile ethical and public policy issue, and it is a standard topic in undergraduate, graduate, and professional school bioethics courses.