Documenting moral agency: a qualitative analysis of abortion decision making for fetal indications

Objectives We explored whether the decision-making process of women aborting a pregnancy for a fetal indication fit common medical ethical frameworks. Study design We applied three ethical frameworks (principlism, care ethics, and narrative ethics) in a secondary analysis of 30 qualitative interviews from women choosing 2nd trimester abortion for fetal indications. Results All 30 women offered reasoning consistent with one or more ethical frameworks. Principlism themes included avoidance of personal suffering (autonomy), and sparing a child a poor quality of life and painful medical interventions (beneficence/non-maleficence). Care ethics reasoning included relational considerations of family needs and resources, and narrative ethics reasoning contextualized this experience into the patient's life story. Conclusions This population's universal application of commonly accepted medical ethical frameworks supports the position that patients choosing fetal indication abortions should be treated as moral decision-makers and given the same respect as patients making decisions about other medical procedures. Implications These findings suggest recent political efforts blocking abortion access should be reframed as attempts to undermine the moral decision-making of women.