EXERCISES: VALUES CLARIFICATION

Adapted from The Abortion Option: A Values Clarification Guide for Health Care Professionals. NAF 2005.

 

In spite of our efforts at objectivity, we all hold personal values that can influence how we respond to patients. These exercises are intended to help you clarify your personal values about pregnancy options and abortion training, and to think about those values in the context of professional judgments you may be called upon to make.

 

EXERCISE 1.1: General Feelings about Pregnancy Options

Purpose: This exercise is designed to illustrate the range of beliefs about the acceptability of pregnancy options and to help you clarify your personal views about your patients choosing abortion, adoption, or parenthood.

  1. In general, how do you feel about your patients choosing abortion, adoption, or parenting in each of these situations? Are you challenged to accept a patient’s decision in the following circumstances?
    • If the pregnancy threatens their physical health or life
    • If the pregnancy involves significant fetal abnormality
    • If the patient is an active substance use disorder or has had previous children removed by Child Protective Services
    • If having a child would interfere with their career or education goals
    • I can accept an informed decision to choose abortion in any circumstance.
  2. Were you surprised by any of your reactions? How have your life experiences contributed to these feelings?

Teaching Points

 

EXERCISE 1.2: Gestational Age and Abortion

Purpose: This exercise is designed to help you clarify whether your beliefs are influenced by the gestational age of a pregnancy.

  1. At what gestational age do you start feeling uncomfortable about your patient choosing to have an abortion? Check all that apply.
    • At conception / implantation
    • At quickening (i.e. fetal movement) or the end of the first trimester
    • At viability or the end of the second trimester
    • At some point in the third trimester
    • It depends on the reason for the abortion
    • Other (please explain):
  2. Do you feel different about the gestational age if you are making a referral vs. performing an abortion? If so, why?

Teaching Points

 

EXERCISE 1.3: Your Feelings about Patient’s Reasons

Purpose: This exercise will help you clarify your feelings about some potentially challenging situations than may arise in abortion care.

  1. How would you feel about referring or providing an abortion for a patient who:
    1. is ambivalent about the pregnancy but whose partner wants them to terminate.
    2. wishes to obtain an abortion because they are carrying a female fetus.
    3. has had many previous abortions.
    4. indicates that they do not want any birth control method to use in the future.
  2. What factors influenced your choices? How might you handle your discomfort when caring for patients under these circumstances?

Teaching Points

 

EXERCISE 2: Feelings about Providing Abortions

Purpose: This exercise will help you clarify your feeling about abortion provision.

  1. As you embark on this experience, consider how you might disclose this training to others. Do you think there are any parallels between the stigma that patients and providers experience?
  2. Consider the following quotation on the role of “conscience” in abortion provision, and not just the historical focus on the refusal to participate. What are your thoughts on how this view affects stigma?

“[Providers] continue to offer abortion care because deeply held, core ethical beliefs compel them to do so. They see women’s reproductive autonomy as the linchpin of full personhood and self-determination, or they believe that women themselves best understand the life contexts in which childbearing decisions are made, among other reasons” (Harris 2012).

Teaching Points

 

 

EXERCISE 3: Abortion Access (Optional)

Purpose: The negative public health impact of restrictive abortion laws is well documented. The following exercise is designed to help you think through the consequences of limited access. How might your decision to offer options counseling, referrals, or services influence the accessibility of abortion where you may practice?

  1. What is your reaction to the following account?

It is estimated that for every 99 U.S. patients receiving abortion, 1 presents for care beyond the capabilities of a particular clinic. Many factors delay patients seeking care. Here are two patients’ explanations of what caused a delay in access to care from the ANSIRH Turnaway Study:

Still trying to get Medicaid and arrangements to stay for the procedure since it was out of town. Still trying to get insurance.”  23-year old Hispanic patient from New Mexico, at 22 weeks

“I didn’t find out until I was 22 weeks and getting the funding. I was determined but there was so much preventing me from getting up there.”  24-year old white patient from Minnesota, at 24 weeks

Teaching Points