Description

Introduction

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 (BMA2007).

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 Times,2018).

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 (Than&Papp,2017).

 In 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.

Justice

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 Times,2018).

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).