Reproductive Issues
ABORTION
An adult woman has an unrestricted access to abortion through the end of the first
trimester. First-trimester abortions are clearly unrestricted. Women do not need the approval
or consent of anyone else to obtain a first-trimester abortion. In the second trimester the
decision is still between a woman and her physician, but the ease of access to a secondtrimester abortion is less clear. States may place regulations on free access to a secondtrimester abortion. However, second-trimester abortions are preponderantly still performed at
the patient’s discretion. Third-trimester abortions are not freely available, because the fetus is
potentially viable. Third trimester abortions are clearly restricted. Consent by the father for
an abortion is not required; the fetus is considered as a part of the woman’s body and does not
have the individual rights of ‘personhood’ until after birth.
There is no compulsion on the part of the physician to perform an abortion if performing
this procedure is ethically unacceptable to the physician. The patient has a right to have an
abortion, but they don’t have a right to force you to do it, if it is objectionable to you.
In addition, it is considered unethical for a patient to seek an abortion for the purposes of
gender selection. It is considered ethically unacceptable to determine the gender of the fetus
and then abort the fetus if the sex in unacceptable to the patient.
For example, a 23-year-old woman comes to your office seeking an abortion. You
perform gynecologic procedures and you have been trained to do abortions in the past.
However, you no longer find it morally acceptable to perform the procedure although
you know how. The patient is insisting on having the abortion and is angry with you for
“abandoning your patient.” What should you tell her?
As a general rule, if there is a procedure that the patient wants but that you do not feel
ethically comfortable performing, you should refer the patient to another physician. You
cannot be compelled to accept a patient you do not want or to do a procedure with which you
do not agree. The physician must voluntarily agree to the relationship.
CONTRACEPTION
There is no limitation on the access to contraception for either a man or a woman. It is
entirely at the discretion of the patient. This is equally true for minors. Contraception is one
of the issues for which a minor is considered partially emancipated. Parental consent is not
necessary to obtain contraception.
STERILIZATION
Both women and men have free access to sterilization. Consent is only necessary from
the patient. Spousal consent is not required for sterilization. All reproductive issues,
including abortion, contraception, and sterilization can be performed over the objection of the
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spouse. Each person has autonomy over his or her own body.
MINORS
Parental consent is not necessary for either contraception or prenatal care. In cases
involving reproductive issues for minors, the answer will be either to just treat the minor or
to “encourage discussion” with the parents. Even though parental consent is not necessary,
USMLE will still want you to encourage disclosure to parents about most reproductive issues
involving minors. The rules on parental consent in the case of abortion are less clear. Some
states require parental consent for abortions and others do not. Because USMLE is a national
examination and the rules on parental consent for abortion vary from state to state, there
cannot be a single answer that either says “no parental consent” or “yes, parental consent is
necessary.” Therefore, the answer will be “encourage the patient to discuss the issue with
parents.”
DONATION OF SPERM AND EGGS
There is no limitation on a patient’s permissibility to donate sperm and unfertilized eggs.
In addition, payment may be received for sperm and unfertilized egg donations. In other
words, there is no legal or ethical contraindication to selling sperm and unfertilized eggs.
There is, however, a prohibition against selling fertilized eggs. Fertilized eggs may be
donated, but not sold.