i The Abortion OptionA Values Clarification Guide for Health Care Professionals ID: 466382
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Why this publication was developedThe exercises in this publication are designedto help you examine your beliefs aboutabortion so that you may be better able tocare for women considering this option.Because ones beliefs about abortion arelinked to ones thoughts about sexuality,pregnancy prevention,parenting,andadoption among other issues,some exercisesexamine these topics as well.While someexercises are geared specifically towardproviders who are making decisions aboutwhether or not to obtain abortion trainingand ultimately to be involved in providingabortion services to their patients,themajority of exercises are appropriate for thewide range of health care professionals whoprovide care to women.As a health careprovider,your responsibility to assess yourfeelings about abortion and providingabortion care is greater than that of people inother professions,because your decisions willultimately determine whether or not womenreceive accurate information about theirreproductive health care options,areempowered to make the health care decisionsthat are best for them,and are able to obtainhigh quality,supportive,respectful abortionservices if they choose abortion.Further,because information about abortion is notincluded as a routine component of mostmedical school or nursing curricula,andabortion training is not incorporated intomany residency programs,most health careproviders will need to decide for themselveshow important it is to learn about abortionand/or to obtain abortion training.The following exercises are designed to helpyou critically examine the factors that mightinfluence your beliefs about parenting,adoption,and abortion and,for some,yourchoice to become trained and to provideabortion services.They are also intended toillustrate the possible consequences of yourchoice to provide or not provide service.It isfor these reasons that the National AbortionFederation developed this publication.How to use this publicationThe legal and historical overviews in Part Iprovide background information about thecontext in which abortion services arecurrently provided and the personal andpublic health implications of restrictions onwomens access to abortion.This baselineinformation can help set the stage for healthcare professionals as they proceed with thevalues clarification exercises.Many exercises that follow in Part II and PartIII can be used either individually (Part II) orin a group setting (Part III).Ideally,bothformats will be used so that you will have an i The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF THE ABORTION OPTION:A VALUES CLARIFICATION GUIDE FOR HEALTH CARE PROFESSIONALS The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Table of ContentsPart I Historical Overview of Laws,Regulations,and Consequences of Limited Access to Abortion ServicesLegal Issues in the United States and Canada............................................................................Overview of Abortion Laws and Policies in the U.S.......................................................Overview of Abortion Laws and Polices in Canada........................................................Consequences of Limited Access to Abortion Services...............................................................Examples in the U.S.during the 1950s and 1960s.........................................................Examples in the U.S.after Roe v.WadePart II Tools for Clarifying Our ValuesIntroduction Individual Exercises for Values Clarification.......................................................Section A:The Role of External Influences in the Formation of Our Values............................A.1 Family and Social Group.......................................................................................A.2 Spiritual Beliefs......................................................................................................A.3 Life Stage.............................................................................................................Section B:The Influences of Our Personal Experiences in the Formation Our Values...........B.1 Sexual Intimacy and Risk-Taking........................................................................B.2 Parenting,Adoption,Abortion,and Pregnancy Prevention.................................Section C:Self-Evaluation of Our Objectivity When Considering aWomans Pregnancy Circumstances and Her Options...........................................C.1 Examining Our Comfort Level with Gestational Age........................................C.2 Examining Our Comfort Level with Circumstances...........................................of Each Womans Abortion DecisionC.3 Individual Cases:Examining Our Potential Biases............................................C.4 Pregnancy Options Decision Making..................................................................C.5 Parenting and Adoption:Examining Our Potential Biases................................Section D:Providing Abortion Care:Professional Values Clarification Exercises..................D.1 Views about the Role of the Health Care Provider.............................................D.2 Personal Assessment of Professional Obligations................................................D.3 The Decision to Provide Abortion Care:Motivations and Obstacles to Practice................................................................D.4 Overcoming Obstacles to Providing Abortion Care:A Self Evaluation............Part III Additional Instructions for Using Selected Exercises from the Guide in a Group Setting The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Past and Present Historical Overview ofLaws,Regulations,and Consequences Legal Issues in the United States and CanadaGiven that your professional judgments,andperhaps your personal values as well,areinfluenced in part by legal limits andregulations that govern the medicalprofession,it is appropriate to give a briefoverview of the regulations and laws thatrelate to abortion.These overviews are by nomeans meant to serve as a comprehensivereview,but will provide a basis forunderstanding where the law sets limits onthe provision of abortion as opposed to whereindividual practitioners or hospitals might setAn Overview of Abortion Laws andPolicies in the United States Abortion laws differ,rather dramatically insome cases,from state to state.However,theSupreme Court has issued some keydecisions,starting with Roe v.Wadewhich today serve as the basic foundation forstate abortion laws.decision,the Court established that:(a) In the first third of a pregnancy (about thefirst 13 weeks),state laws and regulationsmay not interfere with a womans right toend a pregnancy through abortion.Thishave an abortion is left to a woman andher physician.(b) During the second third of pregnancy(about 14 to 24 weeks),state laws mayregulate abortion procedures only in orderto protect the womans health.(c) During the later part of pregnancy (afterabout 24 weeks),and after the fetus isviable,state laws may prohibit abortionexcept when it is necessary to preserve thelife or health of the woman.Most states(40 states and the District of Columbia)have passed laws to prohibit post-viabilityabortions under most circumstances and,in practice,there are only a small handfulof doctors nationwide who offer this careFor some time,the framework of Roe v.Wadeserved as the basis by which theconstitutionality of state laws related toabortion was determined.Subsequent Courtdecisions,however,particularly Parenthood v.Caseyin 1992,have establishedthat states can restrict pre-viability abortions,even in the first trimester and in ways that aremedically unnecessary,as long as suchrestrictions do not place an undue burdenonwomen seeking abortion services.Thus,statePART I:PAST AND PRESENT HISTORICAL OVERVIEW OFLAWS,REGULATIONS,AND CONSEQUENCES OFLIMITED ACCESS TO ABORTION SERVICES The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Past and Present Historical Overview ofLaws,Regulations,and Consequences court battles culminating in a 1988 SupremeCourt decision that threw out the entireabortion law as unconstitutional.This rulingbecame known as the Morgentaler decision.The Supreme Court grounded the right toabortion in womens constitutional right tosecurity of the person.One judge also foundthat the abortion law violated womens rights tofreedom of conscienceand liberty.Unlike inthe U.S.,womens equality rights are enshrinedin Canadas constitution,so courts have beenvery reluctant to confer any rights on fetuses to do so would interfere with womensestablished constitutional right to equality.Various court rulings since 1988 have deniedfetuses any legal recognition in Canada and noabortion restrictions have ever been passed.Although the Canadian legislature tried to re-criminalize abortion in 1990,the bill failed topass.Today,Canadas governments,judicialsystem,and the mainstream media are largelypro-choice.Abortion is fully funded by Medicare inCanada,except for four provinces that refuseto fully fund abortions in private clinics,eventhough they have been ordered to do so undera federal law,the Canada Health Act.Thislaw says that provinces must provide allCanadians with equal access to fully fundedhealthcare according to five basic principles:portability,accessibility,comprehensiveness,universality,and public administration.Abortion is probably the only medicallyrequired treatment that doesnt fully measureup to any of these ideals.That is becausemany provinces flout the law due to an anti-choice political bias that dismisses abortion asan electiveand abortion clinics as privatebusinesses operating outside of Canadasuniversal healthcare system.Clinics became legal only in 1988,but there isnot enough volume to support clinics except inthe largest cities.About two-thirds of abortionsin Canada are still performed in publichospitals.However,only about 20% of hospitalsperform abortions,which forces many womento travel long distances from their communities.Hospitals often restrict access to abortionbecause of arbitrary or anti-choice policies.Forexample,many hospitals impose restrictionssuch as quotas,gestational limits,and generalanesthesia requirements.Most hospitals requirephysician referrals and many have long waitingperiods.A few hospitals require the approval oftwo doctors,or parental consent for any surgeryon minors with no exception for abortion.Anti-choice doctors and hospital employeesoften act as gatekeepers,preventing womenfrom accessing abortion services or evenFinally,the Canadian Medical Associationmaintains an old policy that essentially curtailsabortions after 20 weeks,unless theyre forcompelling health or genetic reasons.Anti-choice protest activity is low in Canada,especially in recent years,although clinicprotests are still routine at some clinics,particularly in British Columbia,Ontario,andNew Brunswick.However,three Canadiandoctors were shot between 1994 and 1997,with American James Kopp as the leading The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Past and Present Historical Overview ofLaws,Regulations,and Consequences doctor down there did was send them for an X-rayto see what was in their belly-to see ifthere wereknitting needles,hooks,catheters up theirbelly...Then when they got to the ward,the firstculture for gas gangrene.It was a standard wehad,whether they had a fever or not,to take thisculture,because ifthey had gas gangrene,youreally had to take drastic measures,like surgery,heavy duty antibiotics,and all that kind ofstuff.Until the suction curettage came through,theroutine was that you accumulated all the womenuntil two oclock in the morning when all themajor surgery was done,and the last gunshotwound had been cleared out ofthe emergency room then the first-year residents dragged the patientsdown to the operating room and started doing theD.& C.s at two oclock in the morning.Thatswhen the operating room was quiet...There wouldbe two or three operating rooms going at the sametime.Between 2:00 and 6:00 AM you could get acertain number ofD.& C.s done and clean up thewomen who werent septic,scrape their uterusesand get them back upstairs so they could bedischarged in a day or two.(Joffe,p.61)A chief obstetrical resident in a public hospitalin the 1950s describing a twenty-two year oldpatient whom he treated for septic shockfollowing an illegal abortion:What happens there,the infection is sooverwhelming,the bacteria produce toxins thatlead to a collapse ofthe cardiovascular system.These patients have no blood pressure,no pulse-insome cases there is absolutely nothing you can do toreverse the situation.We gave the girl blood,cortisone,hydrocortisone nothing was working,she was not responsive.We finally figured the onlychance we had was to do a hysterectomy.We tookher to the O.R.,but Anesthesia said,We wontgive her anesthesia,without getting blood pressureor a pulse.We cant monitor where we are,and sowe might kill her with the anesthesia.So I had todo something I dont recommend to anybody,whichis a hysterectomy under local anesthesia.We got theuterus out I still have a picture ofit in myteaching files it was basically a bag ofpus.Wefound a coiled up catheter in there.When we wereall done,I was walking along beside her in thecorridor they were taking her back to her bed.And one ofthe tragedies ofthis septic shock is thatpeople remain lucid until the end,and she washolding my hand,and saying,Doctor,help me,Im dying.And I knew she was,and I knew therewas not a blessed other thing we could do for her,and before she got to her bed,around midnight,shedied,and I have been haunted by that girl eversince.(Joffe,p.58).Examples in the United States after Roe v.WadeWhile the scenarios described above occurredbefore Roe v.Wade,on a smaller scale,similarsituations sometimes still arise because safe,legal abortion is still not accessible to manywomen.A 2003 studycounties in America do not have a singleabortion provider.Some women,particularimmigrant women,are unaware that abortion islegal in the U.S.and turn to alternativemethods for self-abortion,for instance self-administered misoprostol which has beenwidely used by women in Latin Americancountries for self-abortion and is documented Finer LB, Henshaw SA. Abortion incidence and services in the United States in 2000. Perspectives on Sexual andReproductive Health2003; 34(1): 6-15. The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values Individual Exercises for ValuesClarification Sometimes it is helpful in the course ofnarrowing down our focus to look at both thedevelopment of our values.Life stage,socialculture,and our early spiritual environmentare examples of external influences on ourvalues.Individual experiences with sexualintimacy,parenting,adoption,abortion,andbirth control also have their places in theshaping of our views.The following exercisesare designed to help you identify theexperiences that may contribute to yourpresent values about both the broad andspecific aspects of abortion.Again,it is hopedthat understanding our personal beliefs aboutabortion will help us provide better care forwomen facing an unplanned pregnancy andconsidering the option of abortion.Theexercises are divided into four categories:external influences,personal experience,and,with those in mind,a womanslife circumstancesaround her abortion.Finally,professional roles and responsibilities.These exercises and questions can provide you with insights as you work through themalone.Discussing your reactions to andthoughts about them with others can alsoexpand your insights through shared anddifferent experiences.Section A:The Role of External Influencesin the Formation of Our ValuesExternal influences on our thinking canencompass many areas.As we grow up we are introduced to values and ideas by everyonearound us while we simultaneously comparethem to our personal experiences andperceptions.We have chosen to focus on the(family/race/socialgroups),our spiritual/religious beliefs,andfamily and parenting,and consequentlypregnancy options and abortion.Exercise A-1:Examining the Role ofFamily and Social Groups on OurValuesThe family or social group (i.e.heritage,extendedfamily,adoptive family,socio-economic group)that we grow up in provides us with ourcustomary beliefs and early social values.We usethese as a backdrop when we interact with othersand form opinions as we mature.Dependingupon our personal temperament we may integratethese values automatically or challenge them atdifferent points in our lives.The purpose ofthis exercise is to reflect on thesource and influence these core beliefs have onyour present ideas about parenting,abortion,andPART II TOOLS FOR CLARIFYING OUR VALUES The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values 9 6.a) Do your current values differ from thevalues you were brought up with in any ofthe following areas? Check any that apply.arge familiesfamily on welfare role of menmothers workingbirth controlabortion daycaredivorce sex beforemarrying outsidemarriageparentsof cultureb) If your values differ,what influenced thechange?___________________________7.What percentage of your current ideasabout family is culturally (family/socialgroup) influenced? ____ Influenced bypersonal experience? ____ Other? ____ Exercise A-2:Examining the Role ofSpiritual Beliefs on the Formation ofOur ValuesOur spiritual or religious beliefs may be rooted inour family or arrived at independently duringdifferent points in our lives.Some people considerthese private contemplations while others share thesebeliefs openly in their everyday interactions.Themerging ofpolitical and spiritual ideals in societyhas historically been a difficult marriage.Thepurpose ofthese questions is for you to reflect on therole ofyour spiritual beliefs in your everyday life.Take a moment to reflect on the followingother issues for you.1.Have you held the same spiritual beliefssince childhood?____________________2.How often,on average,during a day,doyou consciously refer to your spiritualbeliefs before making a decision? Aftermaking a decision? __________________3.Have you been challenged by lifecircumstances that called on actions notsupported by your religious or spiritualbeliefs? Were you able to reconcile theseactions with your beliefs at a later date?Did you do this on your own or withsupport?___________________________4.Do your beliefs about any of the followingtopics that are influenced by your spiritualvalues conflict with anyone in your life atpresent? Beliefs about family?___ Yes ___ No Beliefs about social roles?___ Yes ___ NoBeliefs about sex?___ Yes ___ NoBeliefs about birth control?___ Yes ___ NoBeliefs about abortion?___ Yes ___ NoIf yes,how have you reconciled thesedifferences?________________________ The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values discussed with others.We gather information throughour own experiences,what we read and see in themedia and literature,and from stories gleaned fromour social circle.Take a moment to reflect on thefollowing questions and ask yourselfifany oftheseexperiences affect how you would consider a patientssexual history and its role in her pregnancy.1.Was your first sexual intimacy well plannedor spontaneous? Was birth control an issue?Given your present perspective,is thereanything you would change about thatexperience? If yes,describe.___________2.How healthy is your own sex life atpresent? Is there anything you would liketo be different? If you are unable to makeany changes,how has this affected your lifeat present? Describe:_________________3.Have you always had a sexual partnerduring your adult years? If not,what wasthe longest period of time you wentwithout sexual intimacy? Describe anyeffects it had on your life at the time.___4.Which of the following have had animpact on your sexual or intimaterelationships:Sexual abuse or sexual assault_______Coerced sex_______Sexual infidelity_______(yours,partners,parents)Infertility or fear of infertility_______Sexually transmitted disease_______One night stand_______Unplanned pregnancy_______Abortion_______Drugs or alcohol_______5.Which of the topics listed in #4 abovewould you feel the most comfortablediscussing with a client having a similarexperience in her own life? ______ Theleast comfortable? ______6.Describe how your experiences (or lack of)influence your discussions with clients in apositive way._______________________7.Describe how your experiences (or lack of)influence your discussions with clients in anegative way.______________________8.What strategies would you use to improveyour comfort level with these topics if theyimpacted the life of one of your clients?__ The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values 4.If you are a parent,have you experiencedany of the following with your child(children)? (check all that apply)Health challenges_______Mental health issues_______Drug addictions _______Financial challenges_______Single parenting_______Divorce_______Death of a child_______How have you coped with these experiences?Have any of these experiences complicated orassisted in your ability to understand yourclientschoices? If yes,describe:__________AdoptionFewer ofus have personal experience with adoptionthan we do with parenting.As with parenting,it isimportant to acknowledge how our experiences orlack thereofmay influence our views ofthis option.1.If you have a personal experience withadoption,which of the following apply?(check all that apply)I am adopted_______Family member/friend is adopted_______Placed a child for adoption_______Family/friend placed _______Trying or tried to adopt_______Family member/friend_______Considered adoption when_______I or my partner became pregnantWork(ed) in the adoption field_______How have these experiences affected yourpersonal life?_________________________Have any of these experiences challenged orassisted in your objectivity as a healthprofessional when counseling a woman aboutpregnancy options? If yes,describe:_______2.If you have no personal experience withadoption,has your objectivity beenchallenged as a health professional whencounseling a woman about pregnancyoptions? If yes,describe:______________AbortionOur experiences with abortion vary.It isimportant to assess where our experiences arederived from and the influences they may have onour objective understanding ofother womenschoices.1.If you have experience with abortion,which of the following apply? (check allthat apply)My partner or I have had an abortionI have accompanied a family memberI have accompanied a friend____I am aware that a family member and/or close friend has had an abortion____ The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values If yes,how did you solve these problems?If you have been pregnant,how many of yourpregnancies are the result of any of the abovedifficulties with birth control? _______2.Have you or your partner experienced anyof the following side effects from a birthcontrol method? (check all that apply)Allergic reaction_______Weight gain_______Mood changes_______Irregular bleeding_______Nausea_______Pain_______Change in sexual performance_______Acne_______Change in sexual pleasure_______Change in libido_______If yes,how many times have you changedyour method? _______Has this caused stress in your life? If yes,describe:____________________________3.Would you describe yourself as a risk takerin general? ____ Yes ____ NoDo you take risks with your health? ___ Yes ___ No Smoker?_______Overweight?_______No exercise?_______Seatbelts?_______Sunscreen?_______Drive too fast?_______Always practice safe sex?_______Safe oral sex?_______routine tests?_______Ask potential partner about STDs before sex?_______Have you taken risks with birth control? ____ Often?_______Have you discussed this with a healthprofessional?_______Do you follow the same birth control advice yougive to clients you counsel? ___ Yes ___ NoIf no,why not?_______________________Have your experiences strained or assistedyour objectivity when you discuss birthcontrol and pregnancies with clients? If yes,describe:____________________________ The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values Exercise C-2:Examining Our ComfortLevel with Circumstances of EachWomans Abortion Decision Sometimes we are comfortable with one womansabortion decision,but are challenged by thecircumstances surrounding another womans decision.This exercise is designed for you to reflect on yourpersonal responses to the following situations.It alsoillustrates the wide range ofcircumstances that mayinfluence a woman to decide to have an abortion.___ I can accept a womans abortion decisionin any circumstance when she has madean informed and voluntary choice forabortion.___ I can accept a womans abortion decisionin certain circumstances including:(checkall that apply) ___ to end a pregnancy that threatened___ to end a pregnancy that threatenedher physical health___ to end a pregnancy that threatenedher mental health___ to end a pregnancy involvingsignificant fetal abnormality___ to end a pregnancy resulting from___ to end a pregnancy resulting frombirth control failure___ to end a pregnancy if the woman isunmarried___ to end a pregnancy if the woman isin an unstable relationship or is notin a relationship___ to end a pregnancy if the womandoes not want any more children___ to end a pregnancy if the woman isnot financially able to care for a___ to end a pregnancy if the womanfeels she is not ready for theresponsibility of having a child___ to end a pregnancy if a child wouldinterfere with educational or career___ to end a pregnancy if the woman isunready for how a child could___ to end a pregnancy if the woman isvery young___ to end a pregnancy if the woman hasnot had a previous abortion___ to end a pregnancy because of gender___ other(s):________________________ I find abortion unacceptable undervirtually any circumstances.What are the reasons for your beliefs? Howlong have you held these beliefs? _________ The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values 19 __ Dorothy is 45 years old,married withthree grown children.Neither she norher husband wants any more children.What guided your choice for number 1?What guided your choice for number 6?Was making your choices difficult or easy foryou? Explain._________________________Below are some of the arguments often madefor each of the women.In each case,if youneeded to argue for your choice,how wouldyou respond to or refute these arguments forthe women you did not choose?Gloria:Shes just beginning her life andshould have a chance to enjoy her childhood.She will have few coping skills and the childmight suffer.At her age,childbearing couldbe damaging to her health.Response:___________________________Louise:She has her hands full with twochildren at such a young age.Her previoustwo abortions indicate she is clear about notResponse:___________________________Selma:She is clear that she wants toconcentrate on her career and her newmarriage before starting a family.Response:___________________________:Her IUD failed and she is now facedwith an unplanned pregnancy.She is alsosingle and may not have the support sheResponse:___________________________Margaret:She is already coping with a highlevel of stress because of her divorce.To havesupport of a partner would be very difficult.She is clear that she does not want to have achild under these circumstances.Response:___________________________Dorothy:She and her husband are bothclear they do not want another child and feeltheir family is complete with their threegrown children.Additionally,at her age,thepregnancy is high risk.Response:___________________________ The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values Marypregnant.She and her boyfriend are planningto get married in a few years.She has highaspirations for her career and is uncertainwhether she wants children at all.Ruthis 34 years old,married with 3 children.She had just ended a month long affair andhad committed herself to her marriage whenshe discovered she was pregnant.She isunsure with which man she became pregnant.Her husband is very loving and supportivebut is unaware of his wifes involvement withLeslieis 21 years old and is midway throughShe is working 2 jobs to pay for her tuitionand expenses and is just barely getting byfinancially.She has been with her partner for2 months and is not sure where therelationship is going.Before she found outshe was pregnant,she was thinking aboutbreaking things off.Sue is 37 years old and married.She and herhusband had been trying to get pregnant for3 years.She just got back the results of heramniocentesis and they indicate that the babyhas a severe genetic abnormality.She is 16weeks pregnant.Tinais 14 years old.Although she wasntreally planning to get pregnant,she wasexcited when the test came back positive.Shehasnt told her parents yet because she knowsthat they will be angry and will not think sheis ready to be a mother.She and herboyfriend,who is 17,have been together for 8months.His parents are not very happy thattheir son is with Tina.Which two women would you choose tocontinue their pregnancies and become parents?What factors influenced your decision?Which two women would you choose tocontinue their pregnancies and makeadoption arrangements?________________What factors influenced your decision?Which two women would you choose toobtain abortions?______________________What factors influenced your decision? The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values 23 Indicate your responses to eachwoman described belowcontinue her pregnancy and make adoptionarrangementsand circle the correspondingspot on the line to identify your feelings.,age 28 has just found out she is 14 weekspregnant.She was adopted at birth by anolder North American couple who broughther from South America.She is an artist,herboyfriend is a student,both are carrying largestudent loans.She feels she has aresponsibility to her birth mother to gothrough a pregnancy and place her baby foradoption.Her partner tries to remain neutralbut is visibly very upset.very very comfortableuncomfortableVicki,age 28,has a history of mental healthproblems but is capable of making her owndecisions.She is 15 weeks pregnant and hasnot told the man involved in the pregnancythat she is pregnant.She is canceling herabortion appointment because she has seen aTV show about women who cant havechildren and she was very moved by theirplight.She has decided she would like toplace her baby for adoption to help infertilevery very comfortableuncomfortableis a single parent of two children.Shehad sex with ex-husband who is remarried.She says she cannot afford another child anddoes not feel comfortable with abortion.Shepregnancy.She says she has decided to placethe baby for adoption to a distant relative.very very comfortableuncomfortableTiffany,age 15,wants to continue herpregnancy and place her baby for adoption toa loving couple she met at her friends church.Her parents are upset and want to talk somesense into her.They believe it is in Tiffanysbest interest for her to have an abortion.Tiffany says she is not ready to be a parentand does not believein abortion.very very comfortableuncomfortableApril,age 33,has recently broken up with herboyfriend.She is devastated about thepregnancy but she does not think she couldreconcile abortion with her spiritual beliefs.Her friends and family are trying to influenceher to continue the pregnancy and raise thenot be able to provide a life that she hasimagined for a child.She has decided to placeher baby for adoption.Her boyfriend is upsetbut does not want to become a parent.very very comfortableuncomfortable The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values 25 ___ I have no obligation to my patients withregard to abortion services.___ I have no obligation to provide abortionservices for my patients as long as otherclinicians can do so.___ I have an obligation to provide factualinformation about all pregnancy optionsto my patients.___ I have an obligation to provide mypregnant patients with referrals for servicesI am not willing or able to provide.___ I have an obligation to follow up onabortion referrals I make to ensure thatmy patients have been able to access safe,high quality care.___ I have an obligation to provide whateverlegal care my patients need and that I amcompetent to provide,as long as it doesnot conflict with my personal beliefs.___ I have an obligation to provide whateverlegal care my patients need and that I amcompetent to provide,regardless of myWrite the reasons for your views.How longhave you felt this way? _________________Exercise D-3:The Decision to ProvideAbortion Care:Motivations and1.Motivations:Which,if any,of the reasons listed belowmight motivate you to provide abortions foryour patients? Check all that apply.___ Desire to provide comprehensive care formy patients___ Need for a provider for patients in thecommunity where I practice___ Commitment to help my patients avoidthe risks of self-induced,illegal,or poorquality abortions___ Belief in the rights and responsibilities of my patients to make their own moral___ Desire to see only wanted childrenbrought into the world___ Commitment to providing my patientswith the care they need,rather thanreferring them out to a provider they donot know___ Desire to be competent in as manyaspects of reproductive health care asmarketability and my career opportunities___ Desire to provide the same opportunityto obtain safe abortion services as I/mypartner had when I/she needed anabortion ___ Commitment to ensuring availability oflegal medical services for my patients___ Desire to make a public commitment toabortion rights___ Desire to foster a supportive environmentfor abortion rights and abortion providerswithin the medical community___ Other(s):________________________ The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values 27 Consider if there have there been otherto aspects of medical care.How did youdeal with those objections? Where doyour objections stem from?B.____ I believe that abortion is contrary tomy oath to do no harm.Suggestions for further personal exploration on Speak with abortion providers and learnhow they reconcile this. Consult resources on the healthabortion.Suggested resources:Doctors ofConscience:The Struggle toProvide Abortion Before and After Roe v.Wade.Boston:Beacon Press,1995.Poppema S.Why I Am An Abortion DoctorAmherst,NY:Prometheus Books,1996.Dorothy Fadimans Emmy-Award winningdocumentary trilogy From the Back Alley tothe Supreme Court and Beyond.Voices ofChoice A Multimedia Project fromPhysicians for Reproductive Choice andHealth.Information available athttp://www.prch.org/voicesofchoice.shtmlC.____ Abortion is contrary to my religiousbeliefs.Suggestions for further personal exploration on Speak with abortion providers and learnhow they reconcile this. Speak with supportive members in yourreligious congregation about how toreconcile this,if this is possible. Examine other areas of your religion that you may find contrary to yourpersonal beliefs.How are you reconcilingSuggested resources:Materials from Catholics for a Free Choice(http://www.catholicsforchoice.org/),theReligious Coalition for Reproductive Choice(http://www.rcrc.org/),or other religiouslyaffiliated groups that support abortion rights.Life Matters:The Story ofan Illegal Abortionist.A documentary.More information available athttp://www.filmakers.com/indivs/LifeMatters.D.____ I might have to face the memory ofmy own previous abortion experience(s).Suggestions for addressing this concern: Share concerns with trusted others whoknow about the experience or seekprofessional counseling or a supportgroup to work to resolve feelings aboutan abortion experience. Reflect on the benefits of helping othersthrough something you have experienced.Suggested resources:DePuy C & Dovitch D.The Healing Choice:Your Guide to Emotional Recovery After anAbortion.New York:Fireside,1997.Torre-Bueno A.Peace After Abortion:A Pro-Choice Self-Help Guide for Women and Men.San Diego:Pimpernel Press,1996.www.peaceafterabortion.com/ The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Tools for Clarifying Our Values 29 to talk to all colleagues,regardless ofSuggested resources:For suggestions for responding to commonproviding abortion services,an excerpt fromWhen People Ask Where Do You Work?Abortion and Options Counseling:AComprehensive Reference,Revised and.Granite City,IL:HopeClinic For Women,Ltd.,1995) is available athttp://www.ansirh.org/trainingworkbook/chapter9tools/Talking%20About%20Your%20Work%20With%20Others.docH.____ There are administrative barriers (e.g.malpractice coverage,third-party reimbursement,compliance with state regulations aboutabortion practice and facilities).Strategies to address these issues: Network with colleagues who provideabortion services.Speak with staff of organizations thathave expertise with abortion regulations,such as the National Abortion Federation,The Center for Reproductive Rights,andthe American Civil Liberties Union. Join a pro-choice professional organization,such as the National Abortion Federation,for professional expertise. These barriers exist for other areas ofmedical practice,too.You or your staff mayhave already found ways to solve these issues.Suggested resources:See Chapter 9 Office Practicein GoodmanS,Paul M,Wolfe M,Stewart FH and theTEACH Trainers Collaborative WorkingGroup.* Early Abortion Trainers WorkbookUCSF Center for Reproductive HealthResearch & Policy:San Francisco,CA(2004).* Hufbauer E,Schwarzman M,Curington J,Robinson S,Hastings J.Available at http://www.ansirh.org/trainingworkbook/trainingworkbook.html The Center for Reproductive HealthEducation in Family Medicine hasnumerous administrative resources availableat www.reprohealthfamilymed.org.I.____ Significant people in my life opposeabortion.Suggested ways to handle these concerns: Do not discuss this aspect of your work Listen to and acknowledge their sourcesof discomfort. Discuss with them the reasons for yourdecision to provide care. Provide written and media resources forthem to consider on the topic of abortionand abortion providers. Be willing to discuss areas where you mayalso feel some discomfort.Perhaps it is thesame area and your reconciliation of theissue may help them understand your work.J.____ I would be concerned about mypersonal safety vis-à-vis harassment andviolence by those opposed to abortion.Suggestions for addressing this concern:Keep a low profile about your involvementin providing abortion services. Study and assess the personal risk. The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF Additional Instructions for Using Selected Exercises from the Guide in a Group Setting Facilitating group exercises and groupdiscussion can be a daunting task,particularlyabout which people have strong and personalfeelings.At the same time,however,thegroup process is invaluable in terms ofclarifying ones own values and learning fromothers.Included at the end of this section is alist of resources for those who would likemore guidance and information about theprocess of facilitating group discussions.What follows are 1) tailored instructions forusing in a group setting selected exercisesfrom Part II that are most appropriate for thisforum and 2) additional questions forprompting group discussion.We haveincluded an estimate of the approximate timeto allow for completing each exercise.However,the timing of these exercisesdepends very much on a number of factorsincluding the size of the group,the level ofparticipation,the diversity of opinions held byparticipants,and the dynamics among theparticipants.Finally,it might be helpful to set the tone forgroup sessions by indicating that there is noneed to reach group consensus,but striving tounderstand each others views can be veryuseful.Further,hearing the ideas of colleaguesmight cause participants to reconsider theirinitial thoughts.The way we expand ourthinking and grow is by receiving moreinformation from other viewpoints that makea lot of sense to us it doesnt matter if wedidnt think of it first.So feel free to let newthinking change your mind at any time.Exercise C-1:Examining Our ComfortLevel with Gestational Age:(Suggested time allotment:30 minutes)Draw an imaginary line across the room andlabel the following points on the line:atconception,at implantation,at the end of thefirst trimester,at quickening,at the end of thesecond trimester,at some point in the thirdtrimester.Ask participants to stand on thewhere they stop feelingcomfortable with the idea of abortion.Askparticipants at different points along theshare what made them choosetheir position while others in the group just.Afterwards,open up the floor forto the ideasthat were expressed.Repeat for differentlevels of professional involvement in abortion:1) making abortion referrals,2) assisting withabortion services,and 3) providing abortions.PART III ADDITIONAL INSTRUCTIONS FOR USINGSELECTED EXERCISES FROM THE GUIDE IN A GROUP SETTING The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF The Abortion Option:A Values Clarification Guide for Health Care Professionals 2) How can a clinician handle personaldiscomfort in dealing with patients whosechoices are beyond the clinicians personalcomfort zone? 3) How,if at all,is a womans choice to have anabortion for reasons a health care providermight not agree with different from awoman or mans choice to make othermedically related choices,such as smoking orriding a motorcycle without a helmet,whicha health care provider might not agree with?Part 2 (Suggested time allotment:45 minutes)Ask participants to writing.Then asking how many people ranked each woman.Ask for someone who chose#1 to make the case for her;then for each ofmake the case.Ask participants not to discussor argue while the cases are being presented.How did you refute the arguments made forthe women you did not choose? 1) How did having to choose make you feel? 2) Why is it so difficult to make these kinds of3) How could you avoid ever having to makechoices of that sort in your practice?Exercise C-4:Pregnancy Options(Suggested time allotment:30 minutes)Have participants break into small groups (3-5participants) and read the six descriptions.Askthe groups to discuss and reach consensusabout which two women they will assigntoeach of the three pregnancy options (adoption,abortion,parenting).After 20 minutes,havethe groups report back the decisions they madeand the reasons for their decisions.Allow eachgroup to report their decisions withoutinterruption and then open discussion up.Additional discussion questions:1) How did it feel to have to make thesedecisions as a group? 2) Which cases,if any,were fairly easy toassign? Why?3) Which cases were most difficult? Why? Exercise C-5:Parenting and Adoption:Examining our Potential Biases (Suggested time allotment 25 minutes)Label one end of the room Very Comfortableand the other end of the room VeryUncomfortablebetween those two extremes represents aRead the descriptionsChoosing to Parentcases ask participants to go to the spot along theemotional response they have to eachdescription.Have one or two people from eachchoosing.After all stations have reported back The Abortion Option:A Values Clarification Guide for Health Care Professionals© 2005 NAF The Abortion Option:A Values Clarification Guide for Health Care Professionals 35 health care professional,you will ultimately bethe one to make or not make safe abortionservices available.What are your thoughtsDiscussion questions for Part 1:1) Which reasons for providing abortions are2) What makes them compelling? 3) Which reasons might a health care providerfind more compelling than a lay person? (i.e.In what ways has your professional educationand training influenced your beliefs?)4) What is the importance,if any,ofcommunicating the health care providersDiscussion questions for Part 2:1) Which reasons for not providing abortionsare most compelling? 2) What makes them compelling? 3) Which reasons might a health care providerfind more compelling than a lay person? (i.e.In what ways has your professional educationand training influenced your beliefs?) 4) What is the importance,if any,ofcommunicating the health care providers5) What other medical services might you optoutof providing? For what reasons? 6) If there are other services which you mightopt out of providing,how are these similar ordifferent from abortion? If you would notopt outof any other service,what aboutabortion makes it different from othermedical services?EXERCISE D-4:Obstacles to ProvidingAbortion Care:A Self-Evaluation(Suggested time allotment:45 minutes)Have participants individually.Then work on one barrier at a,asking participants to indicate whichsuggestions might enable them to overcomethat difficulty.Additional discussion questions:1) Which reasons for choosing not to provideabortions can most easily be dealt with andovercome? Why? 2) Which reasons seem most difficult to dealwith or overcome? Why? 3) How realistic are the suggestions forovercoming the reasons for choosing not toprovide abortion? 4) Are there other suggestions not included in5) What would make it easier to overcome thebarriers to providing abortions? 6) What would make it harder?Suggested References aboutFacilitating Group DiscussionsBeresford T.How To Be a Trainer.Baltimore,MD:Planned Parenthood of Maryland,1980.Boyer RP with McCormick S.Helping PeopleLearn about Sexuality.Bristol,PA:PlannedParenthood of Bucks County.Cook AT,Kirby D,Wilson P,and Atler J.Sexuality Education:A Guide to Developing andImplementing Programs.Santa Cruz,CA:Network Publications,1984.Silberman M,Auerbach C,and Silberman ML.Active Training:A Handbook ofTechniques,Designs,Case Examples,and Tips.San Francisco,CA:Jossey-Bass Inc.Publishers,1997.