by Allan Barsky, JD, MSW, PhD
When the Supreme Court docket of the US overturned Roe v. Wade (1973) in its determination, Dobbs v. Jackson Women’s Health Organization (2022), the bulk discovered that the U.S. Structure doesn’t embrace a proper to privateness and doesn’t confer a proper to abortion. With no federally acknowledged proper to entry abortion, every state might enact its personal legal guidelines supporting or limiting entry to abortion. In states that have already got legal guidelines limiting or prohibiting abortion, these legal guidelines might now be enforced. Many states are at present contemplating further laws, a few of that are additional limiting entry and a few of that are defending entry.
The results of the Dobbs’ determination may have far-reaching results on the lives of many individuals. The aim of this text is to discover moral points for social staff who need to help these in search of abortion care, however are training social work in states that prohibit or limit entry to abortion-related companies.
Know Your State’s Legal guidelines
Social staff ought to concentrate on the legal guidelines that present entry to, limit, or prohibit abortion within the states the place they supply companies. There are a number of organizations conserving monitor of abortion legal guidelines (e.g., https://reproductiverights.org/maps/abortion-laws-by-state). Past figuring out whether or not there’s an abortion-related statute on the books, it is very important know whether or not the legislation is at present being challenged within the courts and whether or not it’s at present being enforced. Throughout constitutional challenges, courts might both permit the legislation to stay in impact or enjoin the legislation, which means that it’s not enforceable till the courtroom points a last determination. In Florida, as an example, there’s at present a problem to its abortion legal guidelines primarily based on the Florida Structure, which supplies a selected proper to privateness and will confer a proper to entry abortion care.
Present legal guidelines relating to abortion range considerably from state to state. Some states have outright abortion bans. Some prohibit abortions after a selected timeframe (e.g., 22 weeks, 15 weeks, or when heartbeat is detected at about 5 to six weeks of gestation). Different states make it harder to entry abortion by requiring folks to endure transvaginal ultrasounds, counseling, additional appointments, ready durations, or different procedures previous to being eligible for abortions.
Some states with prohibitions have exceptions for conditions involving rape, incest, or threat to the lifetime of the one that is pregnant. Different states might not have some or all of those exceptions. One other kind of barrier to entry are legal guidelines prohibiting public or personal insurance coverage from masking the prices of abortion care. Some states are contemplating legal guidelines that criminalize serving to somebody cross state or worldwide borders to acquire an abortion. These legal guidelines could possibly be unconstitutional; nonetheless, this challenge has not been examined in courtroom. Varied states even have legal guidelines requiring parental consent earlier than a minor can entry abortion, together with prohibitions in opposition to serving to a minor journey to entry abortion care.
Along with figuring out about abortion-related legal guidelines that apply to everybody in your state, additionally take into account whether or not there are abortion-related legal guidelines or laws that apply to your observe setting or context of observe. Faculty social staff, as an example, might have particular restrictions on whether or not or how they will focus on abortion with college students (with or with out parental consent).
If you’re unsure of the present standing of abortion legal guidelines in your state, seek the advice of along with your native NASW chapter, abortion rights organizations, or your lawyer. Bear in mind, legal guidelines range from state to state. They might additionally change rapidly as a result of legislative reforms or new case precedents.
Moral Points for Social Staff Publish-Dobbs
This text just isn’t meant to debate whether or not there needs to be an absolute proper to abortion, restricted rights, or any particular kinds of prohibitions. Relatively, this text focuses on the position of social staff who might have shoppers requesting help with abortions. In states with out abortion prohibitions or restrictions, social staff might present help with out worry of violating state legal guidelines. If they’ve non secular or ethical objections to abortion, they could refer shoppers to different social staff or service suppliers who can help them (NASW Code of Ethics, 2021, s.1.16). Social staff mustn’t impose private views or beliefs on shoppers (s.1.06[b]).
So, given the Dobbs determination, what kinds of moral points might come up in states that limit or prohibit abortion care? Think about the next 4 situations:
1. Unsafe Abortions
Alexa lives in a state that prohibits abortion at 6 weeks, with out exception. She was not conscious that she was pregnant till after 6 weeks and she or he can not afford to go to a different state for abortion care. She informs you, her social employee, that she plans to acquire an abortion from somebody regionally, though the particular person lacks medical coaching and is offering abortions in an unsafe method.
Social staff consider in a shopper’s proper to self-determination (s.1.02), together with a proper to make selections about their well being care. Ethically, nonetheless, this example raises points concerning the safety of Alexa’s life and security. Self-determination doesn’t imply {that a} social employee ought to say nothing a few shopper’s plans or assist them with out query. The rules of knowledgeable consent (s.1.03) counsel that shoppers have a proper to make absolutely knowledgeable selections. On this state of affairs, it might be incumbent on the social employee to supply Alexa with entry to info that will broaden her selection set and permit her to make extra absolutely knowledgeable selections.
As an illustration, are there assets out there to assist Alexa journey to a state and to a supplier who can present secure and legally licensed abortions? Would Alexa be a very good candidate for a medication abortion (drugs which may be used to finish early pregnancies), and the way may she entry the suitable medicine and assist in a secure and authorized method? What are the dangers of in search of an abortion with a supplier who just isn’t medically educated and could also be working in unsafe situations? What authorized dangers might come up, for the shopper or others, if the shopper obtains an abortion from this supplier?[1]
Some states have or are contemplating legal guidelines that present prison and/or civil penalties for anybody who “aids or assists” with having an abortion. In these states, social staff or different serving to professionals could possibly be put in danger for referring or connecting shoppers with abortion companies. Relying on how these legal guidelines are interpreted, even participating shoppers in a supportive dialogue relating to plans for having an abortion may put social staff in danger. On condition that the Dobbs case is so current, the way and extent of this threat is troublesome to gauge. As with all prison fees, prosecutors have discretion about which kinds of fees to pursue.
As an illustration, they could deal with abortion suppliers, relatively than serving to professionals who present counseling and referrals for abortion care. In Texas, there’s a “bounty legislation” allowing odd residents to sue anybody who supplies, aids, or abets an abortion after six weeks of being pregnant. “Aiding or abetting” would possibly embrace offering a shopper with info, sharing a web site, making a referral, giving a trip, arranging lodging, or securing funding for an individual in search of abortion. Beneath Texas’s legislation, every one who sues may obtain a $10,000 “bounty” from anybody who supplies, aids, or abets a prohibited type of abortion.
In states that prohibit abortions, social staff who assist shoppers get hold of abortions is also topic to disciplinary actions by their employers in addition to by their licensing our bodies. Given the uncertainty about what kinds of conduct might put social staff in danger in numerous states, it might be useful for state licensing our bodies and state chapters {of professional} associations such because the NASW, American Psychological Affiliation, and American Counseling Affiliation, to develop and publish state-specific info and steering for his or her members. As an illustration, may a social employee who supplies post-abortion supportive counseling be topic to prison fees?
Along with the questions of learn how to assist Alexa, a person, take into account your moral and authorized obligations relating to your information of an abortion supplier who just isn’t certified or competent to supply abortions. Sure, you might have an moral obligation to take care of Alexa’s confidentiality. Nevertheless, do you even have an obligation to “do one thing” about somebody who’s offering unsafe abortions? It is a complicated moral dilemma. I can not supply a definitive evaluation or reply on this comparatively temporary article (or maybe even in an extended article). You can verify state regulatory legal guidelines to see if in case you have a authorized obligation to report somebody who’s participating in unauthorized medical observe (together with medical abortion care).
Trying on the challenge from a consequentialist strategy, you may take into account the constructive and adverse results of reporting the abortion supplier: Would reporting result in fewer unsafe abortions, or may it drive folks to hunt abortions in even much less secure conditions? Would reporting encourage folks to belief you as a social employee or would folks be much less prone to search your assist (notably these with abortion issues)? This isn’t the kind of challenge that you need to resolve by yourself. Seek the advice of with others in your neighborhood, together with teams which have authorized, psychological well being, and medical experience in relation to being pregnant and abortion care.
2. Life Endangerment
Beatrix was raped by a stranger and is pregnant. She lives in a state that prohibits abortion and has no exception for rape. While you see her for counseling, she discloses that she is considering suicide. She says that physicians have refused to supply an abortion regardless that she believes her life is endangered (due to her emotional state and ideas of suicide). You conduct a suicide evaluation and conclude that she is at excessive threat for suicide.
This case raises moral points in relation to safety of life and self-determination. Given the shopper’s threat of suicide, offering disaster intervention counseling and assist needs to be a precedence. One kind of assist that you need to take into account is advocacy. Though Beatrix has been denied abortion care, you may advocate with the physicians, serving to them perceive Beatrix’s degree of threat and the urgency of the state of affairs. If direct advocacy with the physicians just isn’t profitable, you may escalate the case by requesting that the hospital’s ethics committee evaluation the state of affairs and supply steering. It might even be useful to have interaction an lawyer or advocacy group to assist with Beatrix’s state of affairs. They might know of different medical amenities or of different appeals processes to assist Beatrix. Given the time-sensitive nature of Beatrix’s issues, it is very important act rapidly. As with the earlier state of affairs and topic to related cautions, you may additionally take into account serving to Beatrix entry abortion care in one other state.
When legal guidelines prohibiting abortions present an exception for conditions by which the pregnant particular person’s life is endangered, it is very important observe how the time period “life endangerment” is outlined and interpreted. If the legislation refers to an “imminent state of affairs” by which the particular person might die, then the danger should be life-threatening inside a brief time period. There have already been situations by which pregnant sufferers have been denied abortions regardless of having life-threatening situations as a result of the state of affairs was not at present a medical emergency (e.g., having hypertension, hemorrhaging, or infections that would result in demise, however not imminently). Physicians, social staff, and different well being care suppliers might must advocate for sufferers to have well timed abortion care, relatively than placing the affected person by way of pointless ache, struggling, and threat of mortality.
3. Legislation Enforcement
Police come to your workplace with a search warrant, requesting information for certainly one of your shoppers, Charlize. You might have been offering counseling to Charlize, a shopper who obtained an abortion in your state. Your state at present prohibits abortions. You’re a licensed scientific social employee and your licensing legal guidelines state that info obtained from shoppers in the middle of your observe are privileged and confidential. You aren’t positive how to reply to the police.
Ordinarily, the prison justice system mustn’t search information for confidential well being or psychological well being information. Along with state licensing legal guidelines, the Well being Insurance coverage Portability and Accountability Act (HIPAA) supplies privateness protections for shopper information. HIPAA and state licensing legal guidelines do present exceptions, as an example, if a shopper supplies consent to launch protected well being info (PHI). Let’s assume that the shopper doesn’t present consent on this state of affairs. As a scientific social employee, your moral obligation is to guard shopper confidentiality (s.1.07[c]). Nevertheless, there could also be authorized obligations to think about. As an illustration, it could possibly be moral to launch confidential info to guard the shopper or others from “severe, imminent hurt.”
Once more, let’s assume that this isn’t the state of affairs on this case. Nonetheless, the police have a warrant and there could possibly be authorized penalties should you refuse to cooperate. Your first response to police could possibly be, “I shouldn’t have authority to launch shopper information to anybody. Our shopper information are confidential. I want to talk with our company lawyer [or a designated person in your agency] for help.” Courts might authorize warrants provided that there’s “possible trigger” relating to unlawful conduct. Your lawyer can assist by reviewing the warrant to make sure that it’s an enforceable warrant and to find out what precisely must be shared with police.
This case additionally raises moral points about report conserving. Ordinarily, social staff ought to preserve information of key points raised by shoppers in the middle of offering companies. Some companies and social staff, nonetheless, might take into account not documenting details about abortion care whether it is unlawful of their state. They might need to shield their shopper’s privateness and keep away from placing the shopper in danger ought to their information be obtained by legislation enforcement. If the abortion just isn’t related to the needs of companies, then there could also be no cause to doc this info. If the abortion is related to the companies being supplied, then you definitely face a dilemma. In the event you embrace details about the abortion, then there could also be a threat that it’s utilized in a prison case. If you don’t embrace the knowledge, then you could be violating the NASW Code of Ethics by not offering “enough…documentation…to make sure continuity of companies” (s.3.04). For this challenge, you may seek the advice of literature on social work with survivors of rape.
To guard shopper privateness, some social staff on this subject present minimal info relating to matters that would find yourself in courtroom (notably in the event that they is likely to be used in opposition to the shopper’s pursuits). Relatively than stating particularly {that a} shopper mentioned having an abortion, as an example, the social employee may state that they mentioned medical care. Though minimal information may present some safety, it’s not an ideal resolution. If you’re subpoenaed to testify in courtroom, you may nonetheless be requested what you meant by “medical care” or whether or not the shopper spoke with you about acquiring an abortion.
4. Out-of-State Help
Daybreak is a social employee in a state that doesn’t limit or prohibit entry to abortions. She is considering of utilizing expertise, similar to interactive web sites and videoconferencing, to supply info and assist for folks dwelling in states that prohibit abortion so they could have entry to abortion care. Daybreak is unsure about whether or not providing such companies is moral and authorized.
Entry to service is a core moral precept (NASW Code of Ethics, 2021). Arguably, this precept helps providing cross-border companies for folks needing abortion care. Be aware that, for authorized functions, the situation of social work companies is usually decided by the bodily location of the shopper, not the social employee. If Daybreak is offering scientific social work companies in a state that prohibits abortion, she must adjust to the legal guidelines of that state. Accordingly, Daybreak would have to be licensed. She would additionally must know whether or not she could possibly be topic to prison or civil fees for “aiding or abetting” abortion. In response to the Dobbs determination, numerous teams have established web sites, social media, and digital clinics to assist hyperlink folks in different states with abortion companies and assist (e.g., https://www.heyjane.co).
President Biden has issued an executive order supposed to assist entry to reproductive/abortion care, together with assist for sufferers touring out of state. As soon as once more, the legal guidelines (together with this government order) are nonetheless evolving and nonetheless to be examined in courtroom. If you’re considering of providing info, assist, or counseling companies for sufferers in different states, make sure that you get hold of authorized recommendation about what kinds of actions might put you and your employer liable to being charged or sued. You might also want to work with organizations that advocate for reproductive freedom (e.g., https://www.aclu.org/other/links-other-reproductive-freedom-sites).
Conclusion
This text identifies a couple of of the numerous kinds of moral points that will come up within the aftermath of the Dobbs determination. For social staff, the NASW Code of Ethics continues to supply prudent steering by way of respecting shoppers, their rights to self-determination, knowledgeable consent, and privateness. When difficult moral points come up, search assist. Attorneys, medical professionals, abortion rights teams, your supervisor, social work colleagues, and others might be able to help by offering useful choices, tangible assist, advocacy, session, or recommendation.
Along with adapting to the brand new authorized conditions relating to abortion, know that social staff can play important roles in how abortion legal guidelines proceed to evolve. Part 6 of the NASW Code of Ethics means that social staff have moral duties to have interaction in political and social motion, and to advertise public engagement. As social staff, we are able to doc issues arising from the brand new legal guidelines and work with legislators to think about additional authorized reforms (e.g., to take away prohibitions, broaden exceptions, or improve entry to abortion care and associated companies). We will interact communities to register extra folks to vote and get out the vote in key elections. We will take part in prison circumstances as amicus curiae (buddies of the courtroom), offering advocacy briefs and stay testimony in abortion circumstances. We will educate and mobilize folks to turn into extra concerned in voting and legislative processes. We will additionally interact our skilled colleagues and allies in ongoing discussions about the very best methods to handle moral points which can be arising on this post-Dobbs period.
We might not have all of the solutions. Nonetheless, ethics is usually about having good questions and good discussions relatively than having clear solutions.
[1] With Alexa’s permission, you may ask about of her causes for in search of an abortion and whether or not she has thought-about different choices (e.g., adoption). The aim of asking about Alexa’s causes is to not query her motivation or persuade her to not have an abortion. By understanding Alexa’s issues, you might be able to assist her deal with them. If Alexa is worried about her monetary capability to care for a kid, you may focus on choices for social help. If she is worried concerning the medical dangers of her being pregnant, you may assist her entry acceptable medical care. Empower Alexa by conserving the deal with her needs and pursuits.
Allan Barsky, PhD, JD, MSW, is Professor of Social Work at Florida Atlantic College and writer of Social Work Values and Ethics (Oxford College Press).
The views expressed on this article don’t essentially signify the views of any of the organizations to which the writer is affiliated, or the views of The New Social Employee journal or White Hat Communications.
