Pregnant is part of the lifetime event
brings happiness and change
value and perspective in our life (Modh, Lundgren, & Bergbom, 2011). However, some of the
pregnancy either plan or unplan could bring negative life impact towards mother
or foetus, for example like abnormal chromosome (Goh,2005).
Chromosome abnormality especially Down
syndrome(DS) chances to be happen would increase in advance age pregnancy (Goff, et al., 2013).Investigation
would recommend in their 12 weeks of
pregnancy by using serum biomarker B-Human Chorionic Gonadotrophin( free B-Hcg),
Protein A(PAPP-A) and Nuchal translucency(NT) for chromosomal abnormality(Shiefa, Amargandhi,
Bhupendra, Moulali, & Kristine, 2013).
Abortion is an alternative option for those
pregnant do not want to keep their child in such situation as above (Goff et
al,2013). In Singapore, there are four authorize abortion. First, for those
with financial difficulties. Second, any possible foetus substantial of mental
or physical abnormality as such serious handicapped. Thirdly, pregnancy result
from rape. Lastly, any pregnancy is endangering mother’s life (TODAYS,2020).
Prior to the procedure, eligibility should
meet. As a result, citizen, legal working permit holder or whoever stay in
Singapore at least 4 months allow to make decision on abortion. On exceptional cases,
abortion decision fall on medical professional when there is a need for life
saving (Singapore Legal Advice,2018).
In the role of counselling in abortion as Advance
Practice Nurse (APN), we should provide enough information in helping patient
to make their own decision. However, due to multi-races, cultural and believe
we should be aware of the risk of ethical involved (British Medical
Association, (2007). Ethics act as a moral by doing good among physician
regardless of their believe. However, which can be a legal conduct once the
decision or behaviour is out of the social acceptance (Patil et al,2014).
In order to avoid ethical dilemma,
counselling in abortion is challenge. Thus following, will discuss the
important information need to be advice in abortion counselling for couple who
has DS foetus by using Beauchamp and Childress’s 4 principle model which
include respect autonomy, beneficence, non-maleficence and justice (TAN,2005).
Respect patient Autonomy
Autonomy and informed consent are two
important components involved in healthcare ethics. It’s consisted of bioethics
model by providing enough information and time to allows decision making
without coercion. In alternative model, mutual trust should build between
physician-patient to helps the context of disclosure prenatal testing
counselling (Nuffield Council Bioethics, 2017).
Building trust through effective
communication is important by assessing the health literacy, belief and
preference of parents on abortion before offering further investigation for
those think that the act is unmoral (Than&Papp,2017). Women has the right
to do self- determination on the decision making on abortion if she is competent.
Whereas, a competent person is who can understand, retain and weigh the
information provided. Meanwhile, she also able to communicate her decision
clearly after she weigh against the risks and benefits given by physician
The ethics of abortion be argued over the
year, is it a right of a person by making such decision or is a wrongdoing
action. Statement of pro-lifer and pro-choicer often presented as a war between
religious or conservative (Tan,2005).
A person consider has the right to make decision
if they have a full entity of moral to be called as personhood. In pro-lifer
find the idea of embryo-foetus is person even from day one in the form of
embryo. However, to be understanding as a person they should feel pain,
communicating, reasoning, selection ability and self-concept. It might consider
during quickening time while a woman feels the movement of a foetus (Austin,2019).
In DS, they don’t even gain their
personhood until reach age of 4-5 yrs. which is hard to convince that they have
the right on the decision make. It’s could be just worth to protect because
it’s containing human DNA which potential person. However, the argument is
continuing, because an embryo is giving chance nature in womb and in pro-lifer
terminating in those potential people is wrong (Svenaeus,2018).
Contrarily, on the pro-choicer shown women
has the right to make decision on abortion, because foetus is part of their
body. There are not wrong in deciding what to do on his own bodies which meant
belong to them and has right on the issues of reproductive. Ethical dilemma
occurred between mother and foetus on the autonomy perspective (Straits
As a healthcare professional we shall
respect a person autonomy of women or a foetus? However, we shouldn’t not and
not expect to oppressive patient decision, but we can justify base on the time
permitted by law, circumstance as well as state of the foetus(defects) to respect
a personal decision (Svenaeus,2018).
Beneficence and non-Maleficence
Beneficence is doing good by weighing
against the risk and benefit from the medical point of view, whilst
non-maleficence is doing no harm in the perspective of a mother and foetus.
Thus, from the risk of an abortion procedure involved should weigh. The risks like
haemorrhage, womb or cervical damage as well as affecting future childbearing should
be explained especially for those in their late 40 of pregnancy
addition, by doing good, underlying medical condition adding abortion
complication should identify, such as abnormal chromosome could have higher
chances of miscarriage. As a result, family genetic condition on DS should
identify and the plan of future child should discuss further if there is a
predisposing factor causing future abnormalities (Than&Papp,2017). If early
abortion is their decision then should proceed as early as possible by medical
or surgical methods (Harper et al, 2005). Furthermore, in Singapore which is
only allows be done when pregnancy lesser than 23 weeks. (Association of Women
for Action and Research,2018).
In the perspective of quality of life, DS
child could suffer physical impairment from the degree mild to severe. It’s
does include cognitive and motor development delay as compare to other kids.
Parents raise a DS child also should prepared that they might have degree of
intellectual disability and additional medical condition such as hearing lost.
(Down syndrome Association Singapore,2005).
Financially support in a family would be a
challenge as well. Looking after a DS might have more than one medical
condition, as well as they need to have a special area of learning for better
development. Plan of future care that might be an burden to parents if
financially unstable families (Singapore Journal, 1964).
Even DS child can live independently and
participating lots activities in live. They express themselves by self-talking
and from the old times lot of opportunities is reframe for DS child to explore
due to the discrimination within the society even they could. Being a parent to
the child is tremendously important in their development but which is not meant
from individual from society. This involved certain level psychological stress
and sadness as parent to see the child growth slower than others and negative
impact from society. As a DS child does, he or she feel happy as growing up as kids
with medical condition, will they choose if their quality of live is know going
to be affected?( Down syndrome Association Singapore,2005).
In non-maleficence, we trying to reduce the
harm bringing to the family as well as the various negative impact a child
needs to be face which is lack of quality as abortion is been offer.
Nonetheless, Skotko et al(2011), studies was done on self-perception as DS
people. Response is positive, lot of respondent reply that they are happy with
their live and staying with who they want to be. Parent with DS child also has
a high level of personal fulfilment. Thus, quality of life, is purely base on
individual needs and is not able to be judge by others.
In justice we should be fair in allocation
on our support and all resource available to whom pregnant DS foetus. The
information given to parent need to be fully disclose without keep any
information because the information in counselling eventually will be influence
a parent decision in abortion. If there are any information be kept that is not
breaking the physician-patient relationship but unreadiness of parents in
raising a malformation would bring greatly impact on their mental, emotional,
social and financial towards parents as well as the kid’s growth (New York
Every parent should be counselling before
and after prenatal as well as post abortion if there are any. Regardless their
religion, ethnicity and believe, across all should undergone counselling
through video showing and provide pamphlet to them. Telling the truth of the
malformation and suggest contraceptive methods if they are predisposing risk to
have abnormal kids (Patil et al, 2014).
Continuous emotional and moral support
should be provided for those consider abortion. Social support and
psychological support provided as well for those continue for their pregnancy.
Giving more information on the support group as well as coping mechanism
available in society equally to parents and DS kid in their future development
(Minister of Health,2010).
In view of social justice, most of the DS
growth into adulthood, some of them are working but some are being supported by
government welfare. Some could face different amount of difficulties in their
experience and increase the risk of depression. Moreover, during their puberty
period, they do not understand on their physical boundaries causing them become
victim for physical or sexually abuse. Other than that, they also might have
many of the sexually impulse other theirs age as early pregnancy can be happen.
As, proper education and continuing reinforcement should provided to protect
them develop into social issues (Zhu et al,2014).