a personal decision (Svenaeus,2018



Pregnant is part of the lifetime event brings happiness and change value and perspective in our life (Modh, Lundgren, & Bergbom, 2011). However, some of the pregnancy either plan or unplan could bring negative life impact towards mother or foetus, for example like abnormal chromosome (Goh,2005).

Chromosome abnormality especially Down syndrome(DS) chances to be happen would increase in advance age pregnancy (Goff, et al., 2013).Investigation would recommend in their  12 weeks of pregnancy by using serum biomarker B-Human Chorionic Gonadotrophin( free B-Hcg), Protein A(PAPP-A) and Nuchal translucency(NT) for chromosomal abnormality(Shiefa, Amargandhi, Bhupendra, Moulali, & Kristine, 2013).

Abortion is an alternative option for those pregnant do not want to keep their child in such situation as above (Goff et al,2013). In Singapore, there are four authorize abortion. First, for those with financial difficulties. Second, any possible foetus substantial of mental or physical abnormality as such serious handicapped. Thirdly, pregnancy result from rape. Lastly, any pregnancy is endangering mother’s life (TODAYS,2020).

Prior to the procedure, eligibility should meet. As a result, citizen, legal working permit holder or whoever stay in Singapore at least 4 months allow to make decision on abortion. On exceptional cases, abortion decision fall on medical professional when there is a need for life saving (Singapore Legal Advice,2018).

In the role of counselling in abortion as Advance Practice Nurse (APN), we should provide enough information in helping patient to make their own decision. However, due to multi-races, cultural and believe we should be aware of the risk of ethical involved (British Medical Association, (2007). Ethics act as a moral by doing good among physician regardless of their believe. However, which can be a legal conduct once the decision or behaviour is out of the social acceptance (Patil et al,2014).

In order to avoid ethical dilemma, counselling in abortion is challenge. Thus following, will discuss the important information need to be advice in abortion counselling for couple who has DS foetus by using Beauchamp and Childress’s 4 principle model which include respect autonomy, beneficence, non-maleficence and justice (TAN,2005).


Respect patient Autonomy

Autonomy and informed consent are two important components involved in healthcare ethics. It’s consisted of bioethics model by providing enough information and time to allows decision making without coercion. In alternative model, mutual trust should build between physician-patient to helps the context of disclosure prenatal testing counselling (Nuffield Council Bioethics, 2017).

Building trust through effective communication is important by assessing the health literacy, belief and preference of parents on abortion before offering further investigation for those think that the act is unmoral (Than&Papp,2017). Women has the right to do self- determination on the decision making on abortion if she is competent. Whereas, a competent person is who can understand, retain and weigh the information provided. Meanwhile, she also able to communicate her decision clearly after she weigh against the risks and benefits given by physician (BMA2007).

The ethics of abortion be argued over the year, is it a right of a person by making such decision or is a wrongdoing action. Statement of pro-lifer and pro-choicer often presented as a war between religious or conservative (Tan,2005).

A person consider has the right to make decision if they have a full entity of moral to be called as personhood. In pro-lifer find the idea of embryo-foetus is person even from day one in the form of embryo. However, to be understanding as a person they should feel pain, communicating, reasoning, selection ability and self-concept. It might consider during quickening time while a woman feels the movement of a foetus (Austin,2019).

In DS, they don’t even gain their personhood until reach age of 4-5 yrs. which is hard to convince that they have the right on the decision make. It’s could be just worth to protect because it’s containing human DNA which potential person. However, the argument is continuing, because an embryo is giving chance nature in womb and in pro-lifer terminating in those potential people is wrong (Svenaeus,2018).

Contrarily, on the pro-choicer shown women has the right to make decision on abortion, because foetus is part of their body. There are not wrong in deciding what to do on his own bodies which meant belong to them and has right on the issues of reproductive. Ethical dilemma occurred between mother and foetus on the autonomy perspective (Straits Times,2018).

As a healthcare professional we shall respect a person autonomy of women or a foetus? However, we shouldn’t not and not expect to oppressive patient decision, but we can justify base on the time permitted by law, circumstance as well as state of the foetus(defects) to respect a personal decision (Svenaeus,2018