spirituality

Adventist HealthCare, Inc. Clinical Policy Manual

Termination of Pregnancy

============================================================ Effective Date: 12/19 Policy No: AHC CP 167.0

Cross Referenced: AHC CP 63.0 Origin:

Reviewed: 3/1/21 Authority: AHC President/CEO

Revised: 02/20 Page: 1 of 8 ====================================================================================

SCOPE: All AHC entities

PURPOSE: To establish the process by which the termination of pregnancy will be reviewed

and/or performed in order that the patient and provider of services are both: 1) acting in a manner

that is permitted by State law, and 2) in compliance with the Seventh-day Adventists Guidelines on

Abortion (see Addendum A, accompanying this policy).

DEFINITIONS:

Abortion: Any action aimed at the termination of a pregnancy already established.

OB/GYN: Obstetrics and Gynecology

POLICY:

1. Adventist HealthCare (AHC) strives to meet the physical, mental, and spiritual needs of all its patients. Activities in all AHC medical facilities are to be conducted in a manner consistent with

biblical principles and the ethics, guidelines, and philosophy of the Seventh-day Adventist

Church.

2. Adventist HealthCare does not condone abortions for reasons of birth control, gender selection or convenience. Exceptional circumstances will be considered when they present significant

threats to the pregnant woman’s life, serious jeopardy to her health, and severe congenital

defects or conditions carefully diagnosed in the fetus that will most likely result in neonatal

demise or survival with no or minimal potential for viability.

3. Adventist HealthCare is committed to providing total health care, which includes the integration of the physical, mental and spiritual aspects of every person throughout all stages of life.

Adventist HealthCare will administer this policy with great compassion, in a non-judgmental

way.

4. It is the philosophy of Adventist HealthCare that the performance of termination of pregnancies must be well controlled to ensure that the practice follows the Seventh-day Adventist

Guidelines on Abortion.

5. An ad hoc Ethics Review Committee (convened and concluded within 72 hours of notification) comprised of the Chair of the entity Ethics Committee (or designee), the Spiritual Care member

of the Ethic Committee (or designee), and the Department Chair of OB/GYN (or designee),

must communicate (in person or via phone call), review and approve (except conditions in

Addendum B) each case to verify compliance with at least one of the following criteria:

a. The continuation of pregnancy would substantially impact the physical health of the mother; or

b. Severe congenital defects or conditions carefully diagnosed in the fetus that will most likely result in neonatal demise or survival with no or minimal potential for viability.

6. The deliberations and recommendations of the ad hoc Ethics Review Committee will be reported to the entity Ethics Committee, which will maintain a record of these deliberations.

Adventist HealthCare, Inc. Clinical Policy Manual

Termination of Pregnancy

============================================================ Effective Date: 12/19 Policy No: AHC CP 167.0

Cross Referenced: AHC CP 63.0 Origin:

Reviewed: 3/1/21 Authority: AHC President/CEO

Revised: 02/20 Page: 2 of 8 ====================================================================================

7. No one may be forced to administer any inducing agent or perform or participate in a termination of pregnancy.

8. The Hospital maintains the right to amend policies pertinent to voluntary interruptions of pregnancy when indicated by change in Federal or State laws, the needs of our patients and

physicians, or policies of the Seventh-day Adventist Church.

9. While no physician or practitioner is required to perform or assist in the termination of a pregnancy, prompt referral to another healthcare provider is required if failure to perform the

termination of pregnancy is reasonably likely to be:

a. The cause of death, serious physical or long-lasting injury to the patient, or b. Contrary to the standards of medical care.

PROCEDURE:

General Requirements:

1. All patients for termination of pregnancy must be counseled by the attending physician regarding the alternatives to the procedure.

a. The attending physician must provide documentation of the counseling to the Chair of OB/GYN or Ethics Review Committee and send all documentation to the Chief Medical

Officer for final approval.

b. Consent for Operative, Other Invasive & Non-Invasive Procedures form must also be signed.

c. For all termination of pregnancy performed at eight (8) weeks or more gestational age, the attending physician must complete the “Consent for Disposition of Fetus” and “Certificate

of Fetal Death” as required by Maryland statute.

d. Spousal consent for the procedure is not required. 2. Termination of pregnancy may be performed under the following circumstances:

a. Life of the mother is jeopardized b. Severe congenital defects or conditions that do not confer viability

Termination of Pregnancy for Minors:

1. If a patient seeking an abortion has not attained her 18th birthday, the physician must provide written notice of the proposed termination of pregnancy to the patient’s parent or guardian by

certified U.S. mail. A copy of the Postal Service receipt and letter must be placed in the

patient’s medical record. Notice is not required in the following circumstances:

a. If the minor is married or already the parent of a child. b. The minor does not live with a parent or guardian, and a reasonable attempt to notify the

parent or guardian is unsuccessful;

c. If in the physician’s professional judgment: i. Notice to the parent or guardian may lead to physical or emotional abuse of the minor; ii. The minor is mature and capable of giving consent for an abortion; or

Adventist HealthCare, Inc. Clinical Policy Manual

Termination of Pregnancy

============================================================ Effective Date: 12/19 Policy No: AHC CP 167.0

Cross Referenced: AHC CP 63.0 Origin:

Reviewed: 3/1/21 Authority: AHC President/CEO

Revised: 02/20 Page: 3 of 8 ====================================================================================

iii. Notification would not be in the best interest of the minor. d. The reason(s) for failure to provide notice must be documented in the patient’s medical

record.

2. The physician is prohibited from notifying the parent or guardian if the minor decided not to have the termination of pregnancy. If notice has already been provided, the physician should

send a subsequent letter immediately advising the parent or guardian of the change in plans.

3. If the parent or guardian accompanies the minor, written notice is not required. 4. The patient’s medical records should contain a written acknowledgement that the

parent/guardian is aware of the procedure to be performed. At a minimum, his/her presence

should be documented in the medical record.

REFERENCES:

Maryland COMAR §20–103. http://mgaleg.maryland.gov/webmga/frmStatutesText.aspx?

article=ghg&section=20-103&ext=html&session=2016RS&tab=subject5

Seventh-day Adventist Statement on the Biblical View of Unborn Life and its Implications for

Abortion. Approved and voted, General Conference of Seventh-day Adventists Executive

Committee, Annual Council, October 18, 2019.

Adventist HealthCare, Inc. Clinical Policy Manual

Termination of Pregnancy

============================================================ Effective Date: 12/19 Policy No: AHC CP 167.0

Cross Referenced: AHC CP 63.0 Origin:

Reviewed: 3/1/21 Authority: AHC President/CEO

Revised: 02/20 Page: 4 of 8 ====================================================================================

ADDENDUM A

STATEMENT ON THE BIBLICAL VIEW OF UNBORN LIFE

AND ITS IMPLICATIONS FOR ABORTION

VOTED, To adopt the document, Statement on the Biblical View of Unborn Life and Its

Implications for Abortion, which reads as follows:

Statement on the Biblical View of Unborn Life and Its Implications for Abortion

Human beings are created in the image of God. Part of the gift that God has given us as

humans is procreation, the ability to participate in creation along with the Author of life. This

sacred gift should always be valued and treasured. In God’s original plan every pregnancy

should be the result of the expression of love between a man and a woman committed to each

other in marriage. A pregnancy should be wanted, and each baby should be loved, valued, and

nurtured even before birth. Unfortunately, since the entrance of sin, Satan has made intentional

efforts to mar the image of God by defacing all of God’s gifts—including the gift of procreation.

Consequently, individuals are at times faced with difficult dilemmas and decisions regarding a

pregnancy.

The Seventh-day Adventist Church is committed to the teachings and principles of the

Holy Scriptures which express God’s values on life and provide guidance for prospective

mothers and fathers, medical personnel, churches, and all believers in matters of faith, doctrine,

ethical behavior, and lifestyle. The Church while not being the conscience of individual believers

has the duty to convey the principles and teachings of the Word of God.

This statement affirms the sanctity of life and presents biblical principles bearing on

abortion. As used in this statement, abortion is defined as any action aimed at the termination of

a pregnancy and does not include the spontaneous termination of a pregnancy, known also as a

miscarriage.

Biblical Principles and Teachings Relating to Abortion

As the practice of abortion must be weighed in the light of Scripture, the following

biblical principles and teachings provide guidance for the community of faith and individuals

affected by such difficult choices:

1. God upholds the value and sacredness of human life. Human life is of the greatest

value to God. Having created humanity in His image (Genesis 1:27; 2:7), God has a personal

Adventist HealthCare, Inc. Clinical Policy Manual

Termination of Pregnancy

============================================================ Effective Date: 12/19 Policy No: AHC CP 167.0

Cross Referenced: AHC CP 63.0 Origin:

Reviewed: 3/1/21 Authority: AHC President/CEO

Revised: 02/20 Page: 5 of 8 ====================================================================================

interest in people. God loves them and communicates with them, and they in turn can love and

communicate with Him.

Life is a gift of God, and God is the Giver of life. In Jesus is life (John 1:4). He has life in

Himself (John 5:26). He is the resurrection and the life (John 11:25; 14:6). He provides abundant

life (John 10:10). Those who have the Son have life (1 John 5:12). He is also the Sustainer of life

(Acts 17:25-28; Colossians 1:17; Hebrews 1:1-3), and the Holy Spirit is described as the Spirit of

life (Romans 8:2). God cares deeply for His creation and especially for humankind.

Furthermore, the importance of human life is made clear by the fact that, after the Fall

(Genesis 3), God “gave His only begotten Son, that whoever believes in Him should not perish

but have everlasting life” (John 3:16). While God could have abandoned and terminated sinful

humanity, He opted for life. Consequently, Christ’s followers will be raised from the dead and will

live in face-to-face communion with God (John 11:25-26; 1 Thessalonians 4:15-16;

Revelation 21:3). Thus, human life is of inestimable value. This is true for all stages of human

life: the unborn, children of various ages, adolescents, adults, and seniors—independent of

physical, mental, and emotional capacities. It is also true for all humans regardless of sex,

ethnicity, social status, religion, and whatever else may distinguish them. Such an understanding

of the sanctity of life gives inviolable and equal value to each and every human life and requires

it to be treated with the utmost respect and care.

2. God considers the unborn child as human life. Prenatal life is precious in God’s

sight, and the Bible describes God’s knowledge of people before they were conceived. “Your

eyes saw my substance, being yet unformed. And in Your book they all were written, the days

fashioned for me, when as yet there were none of them” (Psalm 139:16). In certain cases, God

directly guided prenatal life. Samson was to “be a Nazirite to God from the womb” (Judges 13:5).

The servant of God is “called from the womb” (Isaiah 49:1, 5). Jeremiah was already

chosen as a prophet before his birth (Jeremiah 1:5), as was Paul (Galatians 1:15), and John the

Baptist was to “be filled with the Holy Spirit, even from his mother’s womb” (Luke 1:15). Of

Jesus the angel Gabriel explained to Mary: “therefore the child to be born will be called holy—

the Son of God” (Luke 1:35). In His Incarnation Jesus Himself experienced the human prenatal

period and was recognized as the Messiah and Son of God soon after His conception (Luke 1:40-

45). The Bible already attributes to the unborn child joy (Luke 1:44) and even rivalry (Genesis

25:21-23). Those not-yet-born have a firm place with God (Job 10:8-12; 31:13-15). Biblical law

shows a strong regard for protecting human life and considers harm to or the loss of a baby or

mother as a result of a violent act a serious issue (Exodus 21:22-23).

3. The will of God regarding human life is expressed in the Ten Commandments and

explained by Jesus in the Sermon on the Mount. The Decalogue was given to God’s covenant

Adventist HealthCare, Inc. Clinical Policy Manual

Termination of Pregnancy

============================================================ Effective Date: 12/19 Policy No: AHC CP 167.0

Cross Referenced: AHC CP 63.0 Origin:

Reviewed: 3/1/21 Authority: AHC President/CEO

Revised: 02/20 Page: 6 of 8 ====================================================================================

people and the world to guide their lives and protect them. Its commandments are unchanging

truths which should be cherished, respected, and obeyed. The Psalmist praises God’s law (e.g.,

Psalm 119), and Paul calls it holy, righteous, and good (Romans 7:12). The sixth commandment

states: “You shall not kill” (Exodus 20:13), which calls for the preservation of human life. The

principle to preserve life enshrined in the sixth commandment places abortion within its scope.

Jesus reinforced the commandment not to kill in Matthew 5:21-22. Life is protected by God. It is

not measured by individuals’ abilities or their usefulness, but by the value that God’s creation

and sacrificial love has placed on it. Personhood, human value, and salvation are not earned or

merited but graciously granted by God.

4. God is the Owner of life, and human beings are His stewards. Scripture teaches

that God owns everything (Psalm 50:10-12). God has a dual claim on humans. They are His

because He is their Creator and therefore, He owns them (Psalm 139:13-16). They are also His

because He is their Redeemer and has bought them with the highest possible price—His own life

(1 Corinthians 6:19-20). This means that all human beings are stewards of whatever God has

entrusted to them, including their own lives, the lives of their children, and the unborn.

The stewardship of life also includes carrying responsibilities which in some ways limit

their choices (1 Corinthians 9:19-22). Since God is the Giver and Owner of life, human beings

do not have ultimate control over themselves and should seek to preserve life wherever possible.

The principle of the stewardship of life obligates the community of believers to guide, support,

care for, and love those facing decisions about pregnancies.

5. The Bible teaches care for the weak and the vulnerable. God Himself cares for

those who are disadvantaged and oppressed and protects them. He “shows no partiality nor takes

1a bribe. He administers justice for the fatherless and the widow, and loves the stranger, giving

him food and clothing” (Deuteronomy 10:17-18, cf. Psalm 82:3-4; James 1:27). He does not hold

children accountable for the sins of their fathers (Ezekiel 18:20). God expects the same of His

children. They are called to help vulnerable people and ease their lot (Psalm 41:1; 82:3-4; Acts

20:35). Jesus speaks of the least of His brothers (Matthew 25:40), for whom His followers are

responsible, and of the little ones who should not be despised or lost (Matthew 18:10-14). The

very youngest, namely the unborn, should be counted among them.

6. God’s grace promotes life in a world marred by sin and death. It is God’s nature

to protect, preserve, and sustain life. In addition to the providence of God over His creation

(Psalm 103:19; Colossians 1:17; Hebrews 1:3), the Bible acknowledges the wide-ranging,

devastating, and degrading effects of sin on the creation, including on human bodies. In Romans

8:20-24 Paul describes the impact of the Fall as subjecting the creation to futility. Consequently

in rare and extreme cases, human conception may produce pregnancies with fatal prospects

Adventist HealthCare, Inc. Clinical Policy Manual

Termination of Pregnancy

============================================================ Effective Date: 12/19 Policy No: AHC CP 167.0

Cross Referenced: AHC CP 63.0 Origin:

Reviewed: 3/1/21 Authority: AHC President/CEO

Revised: 02/20 Page: 7 of 8 ====================================================================================

and/or acute, life-threatening birth anomalies that present individuals and couples with

exceptional dilemmas. Decisions in such cases may be left to the conscience of the individuals

involved and their families. These decisions should be well-informed and guided by the Holy

Spirit and the biblical view of life outlined above. God’s grace promotes and protects life.

Individuals in these challenging situations may come to Him in sincerity and find direction,

comfort, and peace in the Lord.

Implications

The Seventh-day Adventist Church considers abortion out of harmony with God’s plan

for human life. It affects the unborn, the mother, the father, immediate and extended family

members, the church family, and society with long-term consequences for all. Believers aim to

trust God and follow His will for them, knowing He has their best interests in mind.

While not condoning abortion, the Church and its members are called to follow the

example of Jesus, being “full of grace and truth” (John 1:14), to (1) create an atmosphere of true

love and provide grace-filled, biblical pastoral care and loving support to those facing difficult

decisions regarding abortion; (2) enlist the help of well-functioning and committed families and

educate them to provide care for struggling individuals, couples, and families; (3) encourage

church members to open their homes to those in need, including single parents, parentless

children, and adoptive or foster care children; (4) care deeply for and support in various ways

pregnant women who decide to keep their unborn children; and (5) provide emotional and

spiritual support to those who have aborted a child for various reasons or were forced to have an

abortion and may be hurting physically, emotionally, and/or spiritually.

The issue of abortion presents enormous challenges, but it gives individuals and the

Church the opportunity to be what they aspire to be, the fellowship of brothers and sisters, the

community of believers, the family of God, revealing His immeasurable and unfailing love.

Adventist HealthCare, Inc. Clinical Policy Manual

Termination of Pregnancy

============================================================ Effective Date: 12/19 Policy No: AHC CP 167.0

Cross Referenced: AHC CP 63.0 Origin:

Reviewed: 3/1/21 Authority: AHC President/CEO

Revised: 02/20 Page: 8 of 8 ====================================================================================

ADDENDUM B

Conditions That Do Not Require an Ethics Review Committee Approval

1. Contact the Chair OB/GYN to get approval for one of these conditions. The Chair of OB/GYN may seek advice from others prior to approval. Final approval from Chief Medical Officer is

required.

a. Severe Congenital Defects carefully diagnosed in the fetus which are generally accepted as

universally lethal.

b. Maternal co-morbid conditions in which it is generally accepted that the continuation of the

pregnancy would significantly increase the chance of maternal death or substantially

compromise the physical health of the mother.