Abortion – WMA – The World Medical Association

Adopted by the 24^th World Medical Assembly, Oslo, Norway, August 1970
and revised by the 35^th World Medical Assembly, Venice, Italy, October 1983,
the 57^th WMA General Assembly, Pilanesberg, South Africa, October 2006,
and the 69^th WMA General Assembly, Reykjavik, Iceland, October 2018

Preamble

Medically-indicated termination of pregnancy refers only to interruption of pregnancy due to health reasons, in accordance with principles of evidence-based medicine and good clinical practice. This Declaration does not include or imply any views on termination of pregnancy carried out for any reason other than medical indication.
Termination of pregnancy is a medical matter between the patient and the physician. Attitudes toward termination of pregnancy are a matter of individual conviction and conscience that should be respected.
A circumstance where the patient may be harmed by carrying the pregnancy to term presents a conflict between the life of the foetus and the health of the pregnant woman. Diverse responses to resolve this dilemma reflect the diverse cultural, legal, traditional, and regional standards of medical care throughout the world.

Recommendations

Physicians should be aware of local termination of pregnancy laws, regulations and reporting requirements. National laws, norms, standards, and clinical practice related to termination of pregnancy should promote and protect women’s health, dignity and their human rights, voluntary informed consent, and autonomy in decision-making, confidentiality and privacy. National medical associations should advocate that national health policy upholds these principles.
Where the law allows medically-indicated termination of pregnancy to be performed, the procedure should be performed by a competent physician and only in extreme cases by another qualified health care worker, in accordance with evidence-based medicine principles and good medical practice in an approved facility that meets required medical standards.
The convictions of both the physician and the patient should be respected.
Patients must be supported appropriately and provided with necessary medical and psychological treatment along with appropriate counselling if desired.
Physicians have a right to conscientious objection to performing an abortion; therefore, they may withdraw while ensuring the continuity of medical care by a qualified colleague. In all cases, physician must perform those procedures necessary to save the woman’s life and to prevent serious injury to her health.
Physicians must work with relevant institutions and authorities to ensure that no woman is harmed because medically-indicated termination of pregnancy services are unavailable.

Adopted by the 60^th WMA General Assembly, New Delhi, India, October 2009,
and revised by the 70^th WMA General Assembly, Tbilisi, Georgia, October 2019

WHEREAS,

In 2006, Nicaragua adopted a penal code that criminalises abortion in all circumstances, including any medical treatment of a pregnant woman which results in the death of or injury to an embryo or fetus.

According to the UN Population Fund (UNFPA), despite improvement of national sexual and reproductive health indicators, Nicaragua continues to have one of the highest teenage pregnancy and maternal mortality rates in the Americas region, in particular in lower income rural population groups.

This legislation:

Has a negative impact on the health of women in Nicaragua resulting in preventable deaths of women and the embryo or fetus they are carrying.
Places physicians at risk of imprisonment if they carry out abortions, even to save a pregnant woman’s life, unless they follow the Nicaraguan Ministry of Health’s (MINSA) 2006 Obstetric Protocols designed for high emergency care alone.
Requires physicians to report to police, women and girls for suspected abortions, in breach of their duty of confidentiality towards patients and placing them in a conflict between the law and medical ethics.

The WMA Statement on Medically-Indicated Termination of Pregnancy (October 2018) provides that: “National laws, norms, standards, and clinical practice related to termination of pregnancy should promote and protect women’s health, dignity and their human rights, voluntary informed consent, and autonomy in decision-making, confidentiality and privacy. National medical associations should advocate that national health policy upholds these principles.”

The WMA reiterates its Resolution on Criminalisation of Medical Practice (October 2013) recommending that its members “oppose government intrusions into the practice of medicine and in healthcare decision making, including the government’s ability to define appropriate medical practice through imposition of criminal penalties.”

THEREFORE, the World Medical Association and its constituent members urge the Nicaraguan government to repeal its penal code criminalizing abortion and develop in its place a legislation that promotes and protects women’s human rights, dignity and health, including adequate access to reproductive healthcare, and that allows physicians to perform their duties in line with medical ethics and particularly medical confidentiality.

Adopted by the 41st World Medical Assembly Hong Kong, September 1989
and rescinded at the WMA General Assembly, Pilanesberg, South Africa, 2006

PREAMBLE

The prospect of therapeutically effective fetal tissue transplants for disorders such as diabetes and Parkinson’s disease has raised new questions in the ethical discussion on fetal research. These questions are distinct from those addressed in the 1970s that focused on invasive procedures performed by some researchers on living, viable fetuses. They are also separate from the questions that were raised by the development of new techniques for prenatal diagnosis such as fetoscopy and chorionic villus sampling. Although the use of transplanted tissue from a fetus after spontaneous or induced abortion would appear to be analogous to the use of cadaver tissue and organs, the moral issue for many is the possibility that the decision to have an abortion will become coupled with the decision to donate fetal tissue for the transplantation procedure itself.

The utilization of human fetal tissue for transplantations is, for the most part, based upon a large body of research data derived from experimental animal models. At this time, the number of such transplants performed has been relatively small but the various applications are promising avenues of clinical investigation for certain disorders. The demand for fetal tissue transplantation for neural or pancreatic cell engrafments may be expected to increase if further clinical studies conclusively show that this procedure provides long-term reversal of neural or endrocrine deficits.

Prominent among the currently identified ethical concerns is the potential for fetal transplants to influence a woman’s decision to have an abortion. These concerns are based, at least in part, on the possibility that some women may wish to become pregnant for the sole purpose of aborting the fetus and either donating the tissue to a relative or selling the tissue for financial gain. Others suggest that a woman who is ambivalent about a decision to have an abortion might be swayed by arguments about the good that could be achieved if she opts to terminate the pregnancy. These concerns demand the prohibition of:

the donation of fetal tissue to designated recipients;
the sale of such tissue; and
the request for consent to use the tissue for transplantation before a final decision regarding abortion has been made.

The abortion process may also be influenced inappropriately by the physician. Consequently, measures must be taken to assure that decisions to donate fetal tissue for transplantation do not affect either the techniques used to induce the abortion or the timing of the procedure itself with respect to the gestational age of the fetus. Also to avoid conflict of interest, physicians and other health care personnel involved in performing abortions should not receive any direct or indirect benefit from the research or transplantation use of tissues derived from the aborted fetus. The retrieval and preservation of usable tissue cannot become the primary focus of abortion. Therefore, members of the transplant team should not influence or participate in the abortion process.

There is a potential commercial gain for those involved in the retrieval, storage, testing, preparation, and delivery of fetal tissues. Providing fetal tissue by nonprofit mechanisms designated to cover costs only would reduce the possibility of direct or indirect influence on a woman to acquire her consent for donation of the aborted fetal remains.

RECOMMENDATIONS

The World Medical Association affirms that the use of fetal tissue for transplantation purposes is still in an experimental stage and should only be ethically permissible when:

The World Medical Association Declaration of Helsinki and the Declaration on Human Organ Transplantation are followed, as they pertain to the donor and the recipient of the fetal tissue transplant.
Fetal tissue is provided in a manner consistent with the World Medical Association Statement on Live Organ Trade and that such tissue not be provided in exchange for financial remuneration above that which is necessary to cover reasonable expenses.
The recipient of the tissue is not designated by the donor.
A final decision regarding abortion is made before initiating discussion of the transplantation use of fetal tissue. Absolute independence is established and guaranteed between the medical team performing the abortion and the team using the fetus for therapeutic purposes.
Decision concerning the timing of the abortion is based on the state of health of the mother, and of the fetus. Decisions regarding the technique used to induce abortion, as well as the timing of the abortion in relation to the gestational age of the fetus, are based on concern for the safety of the pregnant woman.
Health care personnel involved in the termination of a particular pregnancy do not participate in or receive any benefit from the transplantation of tissue from the abortus of the same pregnancy.
Informed consent on behalf of both the donor and the recipient is obtained in accordance with applicable law.