STUDENT VOICES | THE 2025 CHYNN ETHICS PAPER – honorable mention essay

Between Loss and Law: The Ethical Battle for Miscarriage Care Admist Tightening Abortion Restrictions

By Lauren K. Donovan, Fordham College Rose Hill, Class of 2025

In 1995 and 1999, during her first and third pregnancies, my mother experienced two devastating miscarriages.

A common yet heartbreaking phenomenon, a miscarriage is medically defined as “the sudden loss of a pregnancy before the 20th week” for a wide variety of possible reasons, such as abnormal chromosome development and maternal health status (Mayo Clinic, 2023). What made these miscarriages particularly traumatic, my mom attests, is that in both cases the fetal material was not expelled from her body naturally. Thus, her doctors recommended she undergo what is known as a “D&C” procedure, which stands for the “dilation and curettage” of the uterine lining to remove the failed pregnancy in order to prevent infection, bleeding, and future gestational complications. Despite discussing the situation at length with her medical team and legally consenting to the procedure, she remembers turning to my dad as they walked into the hospital and asking, “This isn’t an abortion, right?”

The answer is no, yet treatments for miscarriages and abortions are often legally and morally conflated, resulting in the delay or denial of life-saving care for miscarrying women. This paper will explore the ethical implications of outlawing abortion with regard to its impact on access to miscarriage care. Further, I will argue that under the principles of the Belmont Report and utilitarian ethics, miscarriage care should be protected at all costs, even if that necessitates the decrease of abortion regulations and restrictions on a broad scale. 

The concept of abortion has long been a complex bioethical, moral, and political dilemma that is particularly relevant in the contemporary United States, as an increasing number of state governments outlaw the practice for the majority of cases under the guidance and ideals of the new Trump administration. What is seldom addressed during the abortion debate, however, is the social and medical implications abortion laws and policies have on miscarriage care. 

Miscarriages are often referred to as “spontaneous abortions” in the medical sphere, and the D&C procedure, most commonly performed after a miscarriage, is also a technique used to perform elective abortions (Mayo Clinic, 2025). The critical distinction between these two types of procedures is that a D&C performed after a miscarriage is simply the removal of excess tissue in the uterus produced by a non-viable pregnancy with no fetal heartbeat. In simpler terms, the fetus was deceased before the operation began. By contrast, a D&C abortion is the removal of a potentially viable pregnancy with a detectable fetal heartbeat, meaning the fetus is alive before it is extracted from the womb (Cleveland Clinic, 2025). 

The overlap between the treatments and language used for both abortions and miscarriages creates a dangerous gray area regarding the ethicality and legality of life-saving medical care for women. Twenty years prior to the current social upheaval surrounding abortion laws, my mom still grappled with the moral aspect of consenting to allow doctors to physically remove a pregnancy from her body, even though it was no longer viable and there was no fetal heartbeat. Clearly, my mom was not alone in that sentiment, as it’s manifesting as legitimate complications in access to necessary medical care as abortion laws tighten. 

For instance, Texas has banned abortion, but treatments for miscarriages and ectopic pregnancies, like the D&C procedure and mifepristone, a medication that helps to expel the content of the uterus, remain legal. However, interpreting the legal statutes on a case-by-case basis has proven difficult, leading to the delay or denial by doctors and pharmacists of necessary miscarriage treatments for fear of technically performing an illegal abortion (Méndez, 2022). According to an article on this issue published in the New York Times, despite confirming the loss of the pregnancy a week earlier, a Dallas hospital denied a D&C procedure to a miscarrying woman, Amanda, who was suffering from immense pain and heavy bleeding—failure to clear her uterus of the excess tissue could have resulted in life-threatening hemorrhage or sepsis, not to mention the mental distress she endured throughout the ordeal (Belluck, 2022). Amanda’s case represents a broader societal trend of how access to necessary D&C procedures has become increasingly obscured in response to changing abortion policies. 

Another example of the harmful repercussions of a lack of information and clarity on the distinction between abortion and miscarriage care can be found in the personal experience of Lauren Pope, an anti-abortion human rights activist who underwent a D&C procedure after a miscarriage and found herself in an ethical battle against herself and others when it was supposed by the media that women who have D&C procedures had abortions. “Semantic games serve only to obscure the truth,” she writes, “a D&C procedure, in and of itself, is morally neutral” (Pope, 2023). Pope’s story represents the ethical confusion in public discourse surrounding reproductive rights. Regardless of whether you agree with her view that abortion is inherently unethical, her assertion that miscarriage care is distinct from abortion—and that equating the two has traumatic and potentially life-threatening consequences—is indisputable. 

While the Belmont Report (1978) was initially developed to guide ethical research, the set of broad standards it employs can be usefully applied to any moral dilemma, including this one. First, the principle of respect for persons stipulates that all individuals must be treated as autonomous agents with the right to informed consent and protection when vulnerable (HHS, 2024). Under this simple logic, women should have the right to make autonomous, well-informed healthcare decisions, whether that be to have a D&C procedure as a result of a miscarriage or for the purpose of an abortion. Further, a professor at Southern Methodist University’s law school emphasized, “Patients need to be extremely well-informed…because the (healthcare) system is basically designed to fail” (Mendéz, 2022). Moreover, women experiencing miscarriage or unintended pregnancies are particularly vulnerable, and as such, healthcare laws and policies should safeguard their right to receive appropriate treatment.

The Belmont Report’s second principle of beneficence emphasizes maximizing possible benefits and minimizing harm (HHS, 2024). This approach is in line with Bentham’s utilitarianism, an ethical theory that distinguishes the “right” choice as the one which produces “the greatest good for the greatest number” (Driver, 2014). It has already been established that appropriate medical care following a miscarriage is critical for maternal well-being, and it is currently estimated that about one million miscarriages occur each year in the U.S. (Lens, 2021, p. 1059). When combined with the approximately 630,000 women in this country who successfully undergo an abortion each year (Diamant, 2024), it becomes clear that these treatments must be protected and made accessible under the shared ideology of utilitarianism and beneficence.

Finally, the third principle of the Belmont Report is justice, which describes the necessity for fairness in the distribution of both the benefits and burdens of research. When applied to this context, the benefits and burdens of receiving reproductive care should be spread equally among women; in other words, a woman living in Florida should not be denied a necessary D&C procedure post-miscarriage while a woman in the same situation living in California can access this treatment easily. What’s more, it is entirely unfair for this procedure to be withheld from women who desperately need it for medical reasons, like Amanda, on the absurd basis of misinterpretation or fear of abortion laws. Thus, in order to make this niche in the realm of reproductive care just, miscarriage treatments like a D&C procedure or medications like mifepristone must be protected via widespread relaxation of abortion laws, policies, and practices. Put simply, if there is a gray area between whether a procedure is a D&C for a miscarriage versus an abortion, what should be a glaringly obvious distinction, abortion regulations must be too ambiguous and oppressive. 

My mom rarely speaks about her miscarriages because thirty years later, it still makes her emotional—that is how tragic this experience can be for women even when they receive timely, effective care. As a woman intent on having children at some point in the future, the thought of suffering a miscarriage is disheartening, but being denied potentially life-or-fertility-saving medical treatment on top of that loss is terrifying. Abortion policies, like the overturning of Roe V. Wade (2022), do not just impact abortion—they affect access to all types of reproductive care, posing a significant health threat to women everywhere. The harsh, unjust reality is that while my mother received proper treatment and medical autonomy thirty years ago, I may not have those same rights today. This shift marks a dangerous regression in American society that demands immediate intervention from bioethicists to prevent unnecessary suffering and ensure women like me are not subjected to avoidable harm or loss of life. 

References

Belluck, P. (2022). They had miscarriages, and new abortion laws obstructed treatment. The New York Times. https://www.nytimes.com/2022/07/17/health/abortion-miscarriage-treatment.html 

Cleveland Clinic. (2024). What is a D&C? Cleveland Clinic. https://my.clevelandclinic.org/health/procedures/dilation-and-curettage 

Diamant, J. (2024). What the data says about abortion in the U.S. Pew Research Center. https://www.pewresearch.org/short-reads/2024/03/25/what-the-data-says-about-abortion-in-the-us/#how-many-abortions-are-there-in-the-us-each-year 

Driver, J. (2014). The History of Utilitarianism. Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/utilitarianism-history/ 

Lens, J. W. (2021). Miscarriage, Stillbirth, & Reproductive Justice. Washington University Law Review, 98(4), 1059–1115. 

Mayo Foundation for Medical Education and Research. (2023). Miscarriage. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298 

Méndez, M. (2022). Texas laws say treatments for miscarriages, ectopic pregnancies remain legal but leave lots of space for confusion. The Texas Tribune. https://www.texastribune.org/2022/07/20/texas-abortion-law-miscarriages-ectopic-pregnancies/ 

Office for Human Research Protections. (2024). The Belmont Report. HHS.gov. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/index.html