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The Abortion Option the abortion option A Values Clarification Guide for Health Care Professionals The National Abortion Federation (NAF) is the professional association of abortion providers in the United States and Canada. We are grateful to Alix Hirabayashi and Lisa Butel who revised, expanded, and updated this publication. We acknowledge Laureen Tews, MPH who provided feedback and guidance, and who developed and wrote with Terry Beresford the 1998 publication on which this guide was based. We additionally acknowledge Annie Baker, Joan Garrity, and Pat Anderson who provided expert feedback on the original 1998 publication and Educational Foundation of America, The Richard and Rhoda Goldman Fund, The John Merck Fund, Open Society Institute, and The David and Lucile Packard Foundation whose generous support of NAF’s Access Initiative Project and programs to educate health care professionals made this work possible. © 2005 National Abortion Federation 1755 Massachusetts Avenue NW, Suite 600 Washington, DC 20036 202/667-5881 www.prochoice.org THE ABORTION OPTION: A VALUES CLARIFICATION GUIDE FOR HEALTH CARE PROFESSIONALS Why this publication was developed abortion training is not incorporated into The exercises in this publication are designed many residency programs, most health care to help you examine your beliefs about providers will need to decide for themselves abortion so that you may be better able to how important it is to learn about abortion care for women considering this option. and/or to obtain abortion training. Because one’s beliefs about abortion are linked to one’s thoughts about sexuality, The following exercises are designed to help pregnancy prevention, parenting, and you critically examine the factors that might adoption among other issues, some exercises influence your beliefs about parenting, examine these topics as well. While some adoption, and abortion and, for some, your exercises are geared specifically toward choice to become trained and to provide providers who are making decisions about abortion services. They are also intended to whether or not to obtain abortion training illustrate the possible consequences of your and ultimately to be involved in providing choice to provide or not provide service. It is abortion services to their patients, the for these reasons that the National Abortion majority of exercises are appropriate for the Federation developed this publication. wide range of health care professionals who How to use this publication provide care to women. As a health care provider, your responsibility to assess your The legal and historical overviews in Part I feelings about abortion and providing provide background information about the abortion care is greater than that of people in context in which abortion services are other professions, because your decisions will currently provided and the personal and ultimately determine whether or not women public health implications of restrictions on receive accurate information about their women’s access to abortion. This baseline reproductive health care options, are information can help set the stage for health empowered to make the health care decisions care professionals as they proceed with the that are best for them, and are able to obtain values clarification exercises. high quality, supportive, respectful abortion services if they choose abortion. Further, Many exercises that follow in Part II and Part because information about abortion is not III can be used either individually (Part II) or included as a routine component of most in a group setting (Part III). Ideally, both medical school or nursing curricula, and formats will be used so that you will have an The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF i opportunity for personal reflection, free of Why it is important for health care peer pressure, as well as the benefit of hearing professionals to examine our values other people’s viewpoints and testing your In spite of our efforts at objectivity, we all beliefs against possible challenges from others hold personal values that can influence how in your group. we respond to our clients. Sometimes these values are very clear to us and are easily Further, each of the exercises is designed to articulated. Others exist at a deeper level, so stand on its own and, thus, instructors or that we don’t necessarily recognize the others using this publication, particularly in a influence they have on our behavior and group setting, can choose to use only one or judgments as health care providers. Further, two exercises that suit their particular one’s values may change in response to life objectives. Certainly all the exercises have experiences and your encounters with clients value, but given time constraints and other and colleagues may influence your beliefs considerations, the publication is designed to without your having much of a chance to give flexibility to those who use it. reflect on these changes. We have arranged the exercises in sections to The exercises presented here are intended to help guide users through the various sources help you clarify for yourself your present of influence that affect one’s values. We have personal values about pregnancy options, also included graphics in the upper corners of abortion, and abortion training, and to help the pages that can serve to orient users to the you think about those values in the context of broad categories addressed by the exercises in professional judgments you may be called this publication. upon to make. ii © 2005 NAF The Abortion Option: A Values Clarification Guide for Health Care Professionals Table of Contents Part I – Historical Overview of Laws, Regulations, and Consequences of Limited Access to Abortion Services...................................1 Legal Issues in the United States and Canada ............................................................................1 Overview of Abortion Laws and Policies in the U.S.......................................................1 Overview of Abortion Laws and Polices in Canada ........................................................2 Consequences of Limited Access to Abortion Services...............................................................4 Examples in the U.S. during the 1950’s and 1960’s .........................................................4 Examples in the U.S. after Roe v. Wade ...........................................................................5 Part II – Tools for Clarifying Our Values ..............................................................................7 Introduction – Individual Exercises for Values Clarification .......................................................7 Section A: The Role of External Influences in the Formation of Our Values............................7 A.1 – Family and Social Group .......................................................................................7 A.2 – Spiritual Beliefs......................................................................................................9 A.3 – Life Stage.............................................................................................................10 Section B: The Influences of Our Personal Experiences in the Formation Our Values...........10 B.1 – Sexual Intimacy and Risk-Taking ........................................................................10 B.2 – Parenting, Adoption, Abortion, and Pregnancy Prevention.................................12 Section C: Self-Evaluation of Our Objectivity When Considering a Woman’s Pregnancy Circumstances and Her Options ...........................................16 C.1 – Examining Our Comfort Level with Gestational Age........................................16 C.2 – Examining Our Comfort Level with Circumstances...........................................17 of Each Woman’s Abortion Decision C.3 – Individual Cases: Examining Our Potential Biases ............................................18 C.4 – Pregnancy Options Decision Making..................................................................20 C.5 – Parenting and Adoption: Examining Our Potential Biases ................................22 Section D: Providing Abortion Care: Professional Values Clarification Exercises..................24 D.1 – Views about the Role of the Health Care Provider .............................................24 D.2 – Personal Assessment of Professional Obligations................................................24 D.3 – The Decision to Provide Abortion Care: Motivations and Obstacles to Practice ................................................................25 D.4 – Overcoming Obstacles to Providing Abortion Care: A Self Evaluation ............26 Part III – Additional Instructions for Using Selected Exercises from the Guide in a Group Setting................................................31 The Abortion Option: A Values Clarification Guide for Health Care Professionals © 2005 NAF iii Past and Present – Historical Overview of Laws, Regulations, and Consequences PART I: PAST AND PRESENT – HISTORICAL OVERVIEW OF LAWS, REGULATIONS, AND CONSEQUENCES OF LIMITED ACCESS TO ABORTION SERVICES Legal Issues in the United States means that the decision whether or not to and Canada have an abortion is left to a woman and Given that your professional judgments, and her physician. perhaps your personal values as well, are influenced in part by legal limits and (b) During the second third of pregnancy regulations that govern the medical (about 14 to 24 weeks), state laws
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