My preceptor handed me the chart. “Positive pregnancy test” was scratched in ink on a sticky note on the front. We were at the adolescent medicine clinic at a local under-served high school.
I knew what to do. I walked into the room, asked the patient why they were here, and confirmed that the missed periods did indeed represent pregnancy. I offered the three options: keep the baby, give the baby up for adoption, or have an abortion. The 14-year-old had not told anyone about her missed periods; I asked her if she wanted to consult anyone before making a decision, but no, she had already decided. She wanted help to set up an appointment at Planned Parenthood and I made the call. She was 14 weeks pregnant.
Personally, abortion makes me sad. I personally believe that life begins at conception. I fully admit that defining life in this way reflects only my perspective — my best guess at something only the Creator really knows. Perhaps other cultures, which define life differently, are ‘correct.’ Perhaps there is not a single objective truth, but many subjective ones.
I asked myself what I could have done differently. I have learned that there is a better way to phrase options: make a parenting plan, make an adoption plan, or make a termination plan. I would like to become more familiar with ways to refer people to good information on adoption, and parenting resources, should they be interested in these options. But I can’t make that sinking feeling in my gut go away when I think about this issue.
Several years later, a peer came to me to discuss a similar situation that he had been in, and his discomfort with it. We talked about several ethical principles and how they applied to this case:
1. Do no harm — The fetus is being harmed by abortion, but the woman’s health could be harmed by an unsafe abortion or by general distrust in healthcare because of a prior experience of feeling judged for her decisions
2. Autonomy — The idea that a patient should not feel coerced in any way into a decision, complicated by the existence of a second life and its lack of autonomy
3. Utilitarianism — The greatest good for the greatest number of people, the harm that would be done to friends/family of the mother if she died in a back-alley abortion versus lack of people who already know the child versus the potential of the child’s life but with an understanding that a very young fetus may not survive regardless and so on.
In some situations, there are no bad options. In others, there are no good options. Maybe continuing to struggle with this issue is simply appropriate for me. The lack of policy or social, one-size-fits-all, solutions does not mean that nothing can be done to improve the current situation, or that this issue is not worth me reconsidering time and time again. Perhaps someday I will find internal peace about my actions in this area, or perhaps this thorn in my side will simply continue to force me to ask hard questions and challenge myself to do better.