Nao Vang Xiong, his wife Sheng, and their two small children, ages 1 and 2, were Southeast Asian refugees. Their resettlement in the United States was being sponsored by an agency of the Catholic Church. After settling into their new community, the Xiongs visited the county health department for individual health evaluations. To their dismay, chest x-rays and other tests revealed that Mrs. Xiong had active tuberculosis. The clinic nurse, Miss Jane Murphy, explained with the help of an interpreter that Mrs. Xiong must take medications for an extended period of time and should have lots of rest and nutritious food. She was placed on anti tuberculosis medications, referred to a home care agency, and scheduled for follow-up clinic visits.
At a repeat visit to the clinic 3 months later, it was determined that Mrs. Xiong was approximately 10 weeks pregnant. Because of the high risk of fetal abnormality from taking the anti tuberculosis drugs during the first trimester of pregnancy, the clinic physician suggested that Mrs. Xiong consider an abortion. As Buddhists, she and her husband were not opposed to abortion. Arrangements for the procedure were made easily through the health department and the county hospital. The matter seemed settled.
To Miss Murphy’s surprise, the Xiongs and Mr. James Walsh, a representative of the church-sponsored agency, visited the clinic the very next day. The Xiongs appeared very upset and said, through the interpreter, that they had changed their minds about the abortion. When Miss Murphy asked why they had changed their minds, Mr. Walsh pointed out that it was directly contrary to the sponsoring agency’s religious viewpoint for Mrs. Xiong to have an abortion. He adamantly objected to the clinic’s recommendation in this regard, given that her life was not directly threatened by the pregnancy. Through the interpreter, Miss Murphy also learned that Mrs. Xiong was under the impression that she and her family would lose the agency’s support if she had the abortion. Although Miss Murphy tried to reassure Mrs. Xiong and her husband that she had the right to make this decision regard less of the sponsoring agency’s position, Mrs. Xiong was not convinced. The young family was completely dependent on the sponsoring agency and very fearful of what might hap pen to them without this support.
Miss Murphy explained to Mr. Walsh the reasons that abortion was suggested in this case and supported Mrs. Xiong’s right to make this choice without influence from the sponsoring agency. Mr. Walsh, however, insisted that abortion was morally unacceptable to the sponsoring agency. Because the agency’s representatives we re supporting the Xiongs, they could not permit them to make such a choice. He stated that he and his agency would arrange other healthcare follow-up for Mrs. Xiong and her family if the health department continued to suggest that Mrs. Xiong have an abortion.
At this point, Miss Murphy was not sure what she should do. She could decide that the Xiongs’ lack of proficiency in English and limited understanding of Mrs. Xiong’s right to choose abortion were cultural problems beyond her expertise or intervention. On the other hand, she could decide to be an advocate for the patient by communicating with the International Refugee Service and requesting another sponsor for the Xiong family. This intervention could take many weeks, however, and Mrs. Xiong would be well into the second trimester of pregnancy before the abortion could be performed. Because Mrs. Xiong’s general physical condition was weakened by her tuber culosis, Miss Murphy wondered if this choice of action would, in the long run, be in her patient’s best interests.
What are Miss Murphy’s options?
1. Should she try to help the Xiongs find alternative sponsorship? Does a nurse’s obligation extend that far?
2. Should she ask the hospital to assume the immediate medical costs with the hope of finding another sponsor in the future or persuading the existing sponsor to continue support?
3. Should she turn to a patient care ethics committee for assistance?
4. What other options might Miss Murphy consider? Or should she simply stay out of the situation altogether?
