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Pekar-Zlotin M, Nehama-Berman Y, Melcer Y, Radinsky II, Maymon R. Impact of policy change on late-term abortion: a two-decade analysis. Arch Gynecol Obstet 2024; 310:1607-1610. [PMID: 39012439 DOI: 10.1007/s00404-024-07625-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE Advances in ultrasound and molecular genetics have changed the field of late termination of pregnancy (LTOP), sparking ethical debates worldwide. In 2007, Israel updated its LTOP policies, requiring a 30% or higher probability of severe handicap for approval of LTOP after 24 weeks' gestation. PURPOSE In this retrospective study, we compared LTOP indications and approval rates before (Group 1: 1998-2007) and after (Group 2: 2008-2021) this policy change. METHODS Shamir medical records from January 1, 1998 to December 31, 2021 were examined and yielded 4047 abortions, of which 248 were identified as LTOP preformed after 24 weeks' gestation. These cases were then categorized into two groups. Data including maternal age, obstetric history, indications for abortion, diagnosis, week of termination, and genetic/sonographic findings were analyzed. The approval rates and indications pre- and post-policy change were compared. RESULTS Group 1 (LTOP 1998-2007) comprised 95 cases (10.6%), and Group 2 (LTOP 2008-2021) was composed of 153 cases (4.9%). Fetal structural anomalies remained the dominant indication for both groups (67.4 and 65.3%, respectively), with a slight increase in confirmed genetic anomalies from 26.3% (Group 1) to 28% (Group 2). CONCLUSION Our findings indicate a decrees in the proportion per year from 10.6 to 4.9% LTOP. Technological advances in genetic evaluation and sonography may have contributed to the early increased detection and decrees in cases reaching LTOP. These results highlight the importance of ongoing ethical reviews and adherence to strict protocols for early detection and termination before 24 weeks' gestation.
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Affiliation(s)
- Marina Pekar-Zlotin
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), affiliated with the School of Medicine, Tel Aviv University, Zerifin, Tel Aviv, Israel.
| | - Yael Nehama-Berman
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), affiliated with the School of Medicine, Tel Aviv University, Zerifin, Tel Aviv, Israel
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), affiliated with the School of Medicine, Tel Aviv University, Zerifin, Tel Aviv, Israel
| | - Igal Igor Radinsky
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), affiliated with the School of Medicine, Tel Aviv University, Zerifin, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), affiliated with the School of Medicine, Tel Aviv University, Zerifin, Tel Aviv, Israel
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Haining CM, Bowman-Smart H, O'Rourke A, de Crespigny L, Keogh LA, Savulescu J. The 'Institutional Lottery': Institutional variation in the processes involved in accessing late abortion in Victoria, Australia. WOMENS STUDIES INTERNATIONAL FORUM 2023; 101:102822. [PMID: 39077555 PMCID: PMC11285594 DOI: 10.1016/j.wsif.2023.102822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/06/2023] [Accepted: 08/26/2023] [Indexed: 07/31/2024]
Abstract
Despite abortion being decriminalised in Victoria, Australia, access remains difficult, especially at later gestations. Institutions (i.e. health services) place restrictions on the availability of late abortions and/or require additional requirements to be satisfied (e.g. Hospital Termination Review Committee approval), as a consequence of local regulation (i.e. policies and processes determined at the institutional level). This paper reports on the results of 27 interviews with Victorian health professionals about late abortion processes and the operation of Termination Review Committees in Victorian health services, which were analysed thematically. The results reveal the operation of an 'institutional lottery' whereby patients' experiences in seeking late abortion services were variable and largely shaped by the institution(s) they found themselves in.
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Affiliation(s)
- Casey Michelle Haining
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Hilary Bowman-Smart
- Australian Centre for Precision Health, University of South Australia, South Australia, Australia
- Murdoch Children's Research Institute, Victoria, Australia
- Monash Bioethics Centre, Monash University, Victoria, Australia
| | - Anne O'Rourke
- Monash Business School, Monash University, Victoria, Australia
| | - Lachlan de Crespigny
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Louise Anne Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Julian Savulescu
- Murdoch Children's Research Institute, Victoria, Australia
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Melbourne Law School, University of Melbourne, Victoria, Australia
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Terece C, Turan G, Uckan HH, Eser A, Ozler MR, Gunbay S, Taner MZ. The analysis of pregnancies terminated before and after the limit of viability: A medicolegal view. J Forensic Leg Med 2023; 95:102491. [PMID: 36758309 DOI: 10.1016/j.jflm.2023.102491] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE In the present study, the purpose was to determine the indications of pregnancy termination procedures that are performed before and after the limit of viability (between 10 and 22 weeks) in a tertiary center and to investigate the characteristics of the cases in which fetocide procedure was offered after the limit of viability (22 weeks and later). It also aimed to discuss the legal deadline for the fetocide procedure and legal aspect of pregnancy termination. MATERIAL AND METHOD The present study was conducted as a result of the retrospective examination of 198 cases who underwent pregnancy termination after the 10th week of pregnancy (the legal limit for voluntary termination of pregnancy in our country) in our clinic and met the study criteria. The cases were divided into two main groups as Early Termination (10-22 weeks) and Late Termination (22 weeks and later). The characteristics of these groups (i.e. reason for termination, termination week) and the characteristics of the cases in which fetocide procedure was performed and the cases that were not (i.e. termination week, reasons for termination) were compared. RESULTS A total of 171 (86%) cases were under 22 weeks and 27 (14%) were 22 weeks or more. In the cases terminated early, the gestational week was found to be highest [20 + 1 (12+3-21 + 1)] in those with preterm premature rupture of membranes, and lowest in those with fetal gastrointestinal abnormalities. No statistically significant differences were detected between the termination reason and the gestational week in the late-terminated group, and also, although the termination week of 5 patients for whom the fetocide procedure was offered [median = 23 + 1 (22+4-26 + 0] was higher than the week of 22 patients for whom the fetocide procedure was not offered [median = 22 + 4 (22+1-25 + 4], the difference was not found to be statistically significant. CONCLUSION Since the majority of pregnancy terminations are performed before the viable period, the need for the fetocide procedure in pregnancy terminations is relatively low, and we think that this rate will decrease even more because the rate of early diagnosis of fetal anomalies increases as a result of developments in ultrasonographic imaging. Families who choose the termination of pregnancy search for other countries with appropriate legislation and the loss of time and the indecision of the family might cause the application of pregnancy termination after the viable period because of the limitations in the legal regulations of countries.
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Affiliation(s)
- Cem Terece
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Gokce Turan
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Hasan Hüseyin Uckan
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Ayla Eser
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Mustafa Rasit Ozler
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Suheda Gunbay
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Mehmet Zeki Taner
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
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Treff NR, Savulescu J, de Melo-Martín I, Shulman LP, Feinberg EC. Should preimplantation genetic testing for polygenic disease be offered to all - or none? Fertil Steril 2022; 117:1162-1167. [PMID: 35513906 DOI: 10.1016/j.fertnstert.2022.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Nathan R Treff
- Genomic Prediction Inc., North Brunswick, New Jersey; Department of Obstetrics Gynecology and Reproductive Sciences, Rutgers University, New Brunswick, New Jersey
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom; Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lee P Shulman
- Feinberg School of Medicine-Northwestern University, Chicago, Illinois; Reproductive Genetics Innovations, Chicago, Illinois
| | - Eve C Feinberg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Baumann S, Darquy S, Miry C, Duchange N, Moutel G. Termination of pregnancy for foetal indication in the French context analysis of decision-making in a Multidisciplinary Centre For Prenatal Diagnosis. J Gynecol Obstet Hum Reprod 2021; 50:102067. [PMID: 33484935 DOI: 10.1016/j.jogoh.2021.102067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 11/26/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In France, termination of pregnancy (TOP) for medical reasons is legal, regardless of the term, after authorisation by a Multidisciplinary Centre for Prenatal Diagnosis (MCPD). This study analyses the elements supporting the TOP decision-making process faced with a foetal pathology. STUDY DESIGN Medical records of one MCPD were analysed for the period 2013 and 2014 and semi-structured interviews with MCPD members were conducted. RESULTS Out of 265 files concerning foetal indications, all but one resulted in a decision for TOP. The main indications in number for TOP were malformations and chromosomal abnormalities. For indications such as trisomy 21, authorisations are generally given without discussion. Our results underline the importance that professionals attach to the collegiality of decisions, particularly in situations of uncertainty. CONCLUSION This study provides information about the activity of MCPDs within the field of prenatal diagnosis and shows the importance of these structures in supporting women and couples whilst respecting their autonomy. At present, the role of the MCPD is in the process of evolving and could become an information and advisory board for women, based on collegial expertise to guide their decision-making.
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Affiliation(s)
- Sophie Baumann
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, 14000 Caen, France
| | - Sylviane Darquy
- Univ. Bordeaux, Inserm U1219, EPICENE, Cancer et expositions environnementales, 33000 Bordeaux, France.
| | - Claire Miry
- Hôpital Universitaire de Strasbourg, Service de Médecine fœtale, 67091 Strasbourg cedex, France
| | | | - Grégoire Moutel
- Normandie univ, UNICAEN, Inserm U1086, ANTICIPE, 14000 Caen, France; Espace régional d'éthique, CHU de Caen, Normandie Université, 14000 Caen, France
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Attitudes and Opinions of Young Gynecologists on Pregnancy Termination: Results of a Cross-Sectional Survey in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113895. [PMID: 32486362 PMCID: PMC7311986 DOI: 10.3390/ijerph17113895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
Background: This paper aims to explore the attitudes and opinions of a group of Polish young gynecologists toward pregnancy termination. Method: An anonymous questionnaire was completed by physicians who participated in obligatory trainee courses held in 2019 in Warsaw. Results: The study group included 71 physicians with an average age of 29 years (SD 3.05). A considerable number of the physicians accepted terminations for medical reasons up to the end of pregnancy, especially in cases of lethal defects (46%) and a serious disease in the mother (34%). Only 6% of the group of gynecologists not performing terminations claimed that the procedure was contrary to their conscience, and 62% of them stated that such procedures were not performed at their hospital. Terminations would be performed by 90% of the respondents in cases of lethal defects of the fetus and by 80% if severe irreversible fetal defects were diagnosed. Conclusions: The main problem associated with the inaccessibility of pregnancy termination in Poland is not linked to individuals, meaning medical personnel and the possibility of invoking the conscience clause, but probably to the lack of approval for terminations granted by hospital supervisors. Adequate knowledge on pregnancy termination procedures, fetal defects, and diseases in the mother translated into the changes of opinions on pregnancy terminations.
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Kiver VII, Altmann J, Kamhieh-Milz J, Weichert A. A 17-year analysis of pregnancies termination ≥14 weeks of gestation in a German level 1 perinatal center. J Perinat Med 2019; 47:847-856. [PMID: 31494633 DOI: 10.1515/jpm-2019-0072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/08/2019] [Indexed: 11/15/2022]
Abstract
Background When discussing termination of pregnancy (TOP) after the first trimester, the main foci are the ethics and psychological reasoning/consequences. In daily clinical practice, physicians are often faced with affected women querying the frequency of their condition(s) and decisions made by women in similar situations. The present study aimed to provide an overview of a representable number of such cases. Methods Cases of TOP beyond 14 + 0 weeks of gestation were collected between January 2000 and December 2017 in the Department of Obstetrics. Fetal and/or maternal medical causes leading to TOP were extracted and presented. Results A total of 1746 TOPs ≥14 + 0 weeks were performed. Reasons leading to TOP were subcategorized into 23 groups. The main medical diagnoses were trisomy 21 (15.5%), neurological malformations (11.0%), and cardiac and major vessel malformations (7.9%). There was no statistical difference concerning maternal age or gravida/para between the groups. The average gestational age (GA) was 21.0 weeks, varying between 16.2 and 24.2 weeks in the 23 subgroups, with an average of 23.6% per year of TOPs after viability. Conclusion An overview of the various causes of TOP and their frequency within a large dataset are shown here. According to data provided by the German Federal Statistical Office, the overall number of TOPs has declined over the past two decades; however, the number and percentage of TOPs beyond viability have increased continuously in Germany. Only early detection of maternal and fetal constitution can prevent a portion of TOP after viability.
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Affiliation(s)
- Verena I I Kiver
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Judith Altmann
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Julian Kamhieh-Milz
- Department of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Weichert
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
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Zareba K, Ciebiera M, Gierus J, Jakiel G. Perceptions of attending medical staff by women accessing pregnancy termination in Poland: a qualitative study. EUR J CONTRACEP REPR 2019; 24:124-129. [PMID: 30931638 DOI: 10.1080/13625187.2019.1590698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Polish society is strongly influenced by the Catholic Church and Poland has one of the most restrictive abortion laws in Europe. We attempted to gather information by questionnaire from women considering termination of pregnancy (TOP). Women were asked about their perceptions of the attending medical staff and whether they felt they had been fully informed of their rights, as well as about conduct of the procedure itself in light of physicians' use of the 'conscience clause'. METHODS Between June 2014 and May 2016 all women deemed eligible for TOP for medical reasons were asked to complete an anonymous questionnaire (n = 240). A total of 150 questionnaires (62.5%) were returned and analysed. RESULTS Most respondents (95%) lived in a town or city, and a significant number (40%) lived outside the area where the study centre was located. The main reason for such a large group of out-of-region respondents (53%) was the lack of centres offering TOP in the area where the women lived. Only one attending obstetrician did not support a decision to abort the pregnancy. Although 65% of treating physicians supported the woman's decision, only 8% were willing to perform the procedure themselves. CONCLUSION Most regional centres offer no access to TOP, despite the legal right of women to abort their pregnancy in the event of a severe fetal defect. Some physicians refuse to perform abortions, citing conscientious objection. Double standards among treating physicians have been detected, as many support the decision of their patient but refuse to perform the procedure themselves.
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Affiliation(s)
- Kornelia Zareba
- a First Department of Obstetrics and Gynaecology , Centre of Postgraduate Medical Education , Warsaw , Poland
| | - Michał Ciebiera
- b Second Department of Obstetrics and Gynaecology , Centre of Postgraduate Medical Education , Warsaw , Poland
| | - Jacek Gierus
- c Department of Psychiatry, Faculty of Health Sciences , Medical University of Warsaw , Warsaw , Poland
| | - Grzegorz Jakiel
- a First Department of Obstetrics and Gynaecology , Centre of Postgraduate Medical Education , Warsaw , Poland
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A NORMATİVE ASSESSMENT ON POSSIBLE EFFECTS OF PRENATAL TESTS ON PREGNANT WOMEN, THE DISABLED, AND THE SOCIETY. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2018. [DOI: 10.21673/anadoluklin.371881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Crowe L, Graham RH, Robson SC, Rankin J. A survey of health professionals' views on acceptable gestational age and termination of pregnancy for fetal anomaly. Eur J Med Genet 2018; 61:493-498. [PMID: 29777898 DOI: 10.1016/j.ejmg.2018.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/08/2018] [Indexed: 11/18/2022]
Abstract
Termination of pregnancy for fetal anomaly is legal in the UK with no upper limit, if two doctors, in good faith, agree "there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped". This is Clause E of the Human Fertlisation and Embryology Act. The most commonly sighted Clause is C, which states "the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman". This study aimed to investigate health professionals' views on gestational age and acceptable termination of pregnancy for fetal anomaly (TOPFA). We undertook a questionnaire survey of UK health professionals working in fetal medicine, obstetrics and gynaecology and neonatology. A study pack consisting of a self-completion questionnaire, an invitation letter, participant information sheet, and a stamped addressed return envelope, were sent to health professionals. We used four fetal anomalies as case study examples in the questionnaire: isolated cleft lip, hypoplastic left heart, spina bifida and trisomy 21. These anomalies were chosen as they differed in terms of the type of anomaly, the type of impairment, and the perceived severity. Forty-one study packs were returned. For anomalies deemed less serious, later gestational ages were an important consideration when deciding acceptable TOPFA. The prognosis of an anomaly was considered an important factor in deciding whether a TOPFA was acceptable alongside gestational age. Clause C of the current UK legislation, which allows a legal termination prior to 24 weeks gestational age if continuing with the pregnancy would impact the mental health of the mother, was deemed a reasonable option for termination when parents are requesting a TOPFA. For each case study example, health professionals responded that TOPFA at '25 weeks and over' was acceptable (cleft lip n = 1; hypoplastic left heart n = 19; spina bifida n = 13 and Trisomy 21 n = 10). Professionals also distinguished between their personal and professional views. These findings offer new insight into how gestational age considerations influence professionals' conceptualisation of acceptable TOPFA.
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Affiliation(s)
- Lisa Crowe
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, NE2 4AX, UK.
| | - Ruth H Graham
- School of Geography, Politics and Sociology, 5th Floor Claremont Bridge Building, Newcastle University, NE1 7RU, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, 3rd Floor William Leech Building, Newcastle University, NE2 4HH, UK
| | - Judith Rankin
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, NE2 4AX, UK
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Crowe L, Graham RH, Robson SC, Rankin J. Negotiating acceptable termination of pregnancy for non-lethal fetal anomaly: a qualitative study of professional perspectives. BMJ Open 2018; 8:e020815. [PMID: 29500216 PMCID: PMC5855171 DOI: 10.1136/bmjopen-2017-020815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aims to explore the perspectives of professionals around the issue of termination of pregnancy for non-lethal fetal anomaly (TOPFA). METHODS Semi-structured interviews were undertaken with medical professionals (14 consultants in fetal medicine, obstetrics, neonatology and paediatrics) and social care professionals (nine individuals with roles supporting people living with impairment) from the Northeast of England. Analysis adopted an inductive thematic approach facilitated by NVivo. RESULTS The overarching theme to emerge from the interview data was of professionals, medical and social care, wanting to present an acceptable self-image of their views on TOPFA. Professionals' values on 'fixing', pain and 'normality' influenced what aspects of moral acceptability they gave priority to in terms of their standpoint and, in turn, their conceptualisations of acceptable TOPFA. Thus, if a termination could be defended morally, including negotiation of several key issues (including 'fixing', perceptions of pain and normality), then participants conceptualised TOPFA as an acceptable pregnancy outcome. CONCLUSION Despite different professional experiences, these professional groups were able to negotiate their way through difficult terrain to conceptualise TOPFA as a morally acceptable principle. While professionals have different moral thresholds, no one argued for a restriction of the current legislation. The data suggest that social care professionals also look at the wider social context of a person with an impairment when discussing their views regarding TOPFA. Medical professionals focus more on the individual impairment when discussing their views on TOPFA.
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Affiliation(s)
- Lisa Crowe
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth H Graham
- Sociology and Politics, School of Geography, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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12
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Lotto R, Smith LK, Armstrong N. Clinicians' perspectives of parental decision-making following diagnosis of a severe congenital anomaly: a qualitative study. BMJ Open 2017; 7:e014716. [PMID: 28588110 PMCID: PMC5729983 DOI: 10.1136/bmjopen-2016-014716] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore clinicians' perspectives on supporting parents' decision-making following diagnosis of a severe congenital anomaly, and how this is shaped by current policy. METHODS This paper reports data collated as part of a larger project examining parents' decision-making following antenatal diagnosis. The focus of this paper is the data arising from semistructured interviews conducted with 18 clinicians, with findings further supported by data generated from consultations between clinicians and parents. All interviews and consultations were audio-recorded and transcribed verbatim, with analysis based on the constant comparative approach. RESULTS Three key themes emerged which together shape the practice of clinicians working in this area: first, the law governing termination of pregnancy (TOP) and how clinicians believe this influences the context in which decisions about whether to terminate or continue an affected pregnancy are made; second, approaches to the management of cases seen as particularly challenging; and third, how clinicians understand their role when working with parents. These themes combine to create a strong desire on the part of clinicians for parents to engage in a particular 'rational' form of decision-making and to be able to demonstrate the enactment of this. This is seen as important in order to ensure the 'right' decision has been reached and, particularly when the decision is to terminate, will withstand possible scrutiny. CONCLUSIONS The policy context in which these decisions are made strongly shapes how clinicians practise and what they want to see from the parents with whom they work. The ways in which they seek to overcome the difficulties in interpreting the law may result in variations in the offer of late TOP, both between and within units. This may inadvertently affect the options available to women least able to engage in this idealised form of decision-making.
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Affiliation(s)
- Robyn Lotto
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
| | - Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK
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Dettmeyer R, Lang J, Axt-Fliedner R, Birngruber C, Tinneberg HR, Degenhardt J. Termination of Pregnancy for Medical Indications under Sec. 218a Para. 2 of the German Criminal Code - Real-life Data from the "Gießen Model". Geburtshilfe Frauenheilkd 2017; 77:352-357. [PMID: 28552998 DOI: 10.1055/s-0043-103461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Following the legal provisions on the termination of pregnancies in Art. 13 of the SFHG (Law on the Assistance for Pregnant Women and Families, passed on 27.07.1992, BGBl. I, p. 1398) the so-called embryopathic indication for termination was abandoned. Since then, sec. 218a para. 2 of the German Criminal Code (StGB) states that for late terminations, i.e., terminations after the 12th week of gestation post conception, the pregnant woman must be in exceptional distress "according to medical opinion". Method Between 01.05.2012 and 25.07.2016, a total of 160 pregnancy terminations were carried out in Gießen University Hospital under sec. 218a para. 2 StGB. The following data were obtained from the patients' files: age of the pregnant woman, number of pregnancies, type of fetal disease or malformation, time of diagnosis, medical and psychosocial counseling given to the pregnant woman, time of termination or delivery, type of termination, fetal gender. Results 160 pregnant women (mean age: 31.6 years) underwent termination of pregnancy between the 13th - 37th week of gestation. Chromosomal anomalies were diagnosed prenatally in 60 cases, and anomalies were diagnosed on ultrasonography in 100 cases, with the preponderance of cases presenting with developmental disorders of the central nervous system and cardiovascular system. Conclusion In addition to recording intrauterine fetal disorders, when pregnancies are terminated under sec. 218a para. 2 StGB, treating physicians are expected to give plausible reasons why "according to medical opinion" the pregnancy represents a danger to the life of the pregnant woman or of grave injury to her physical or mental health and enter these reasons in the patient's medical records.
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Affiliation(s)
- Reinhard Dettmeyer
- Universitätsklinikum Gießen & Marburg GmbH, Justus-Liebig-Universität Gießen, Institut für Rechtsmedizin, Gießen, Germany
| | - Juliane Lang
- Universitätsklinikum Gießen & Marburg GmbH, Justus-Liebig-Universität Gießen, Institut für Rechtsmedizin, Gießen, Germany
| | - Roland Axt-Fliedner
- Universitätsklinikum Gießen & Marburg GmbH, Justus-Liebig-Universität Gießen, Klinik für Frauenheilkunde und Geburtshilfe, Gießen, Germany
| | - Christoph Birngruber
- Universitätsklinikum Gießen & Marburg GmbH, Justus-Liebig-Universität Gießen, Institut für Rechtsmedizin, Gießen, Germany
| | - Hans-Rudolf Tinneberg
- Universitätsklinikum Gießen & Marburg GmbH, Justus-Liebig-Universität Gießen, Klinik für Frauenheilkunde und Geburtshilfe, Gießen, Germany
| | - Jan Degenhardt
- Universitätsklinikum Gießen & Marburg GmbH, Justus-Liebig-Universität Gießen, Klinik für Frauenheilkunde und Geburtshilfe, Gießen, Germany
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Iltis AS. Prenatal screening and prenatal diagnosis: contemporary practices in light of the past. JOURNAL OF MEDICAL ETHICS 2016; 42:334-339. [PMID: 27161556 DOI: 10.1136/medethics-2016-103623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
The 20th century eugenics movement in the USA and contemporary practices involving prenatal screening (PNS), prenatal diagnosis (PND), abortion and preimplantation genetic diagnosis (PGD) share important morally relevant similarities. I summarise some features of the 20th century eugenics movement; describe the contemporary standard of care in the USA regarding PNS, PND, abortion and PGD; and demonstrate that the 'old eugenics' the contemporary standard of care share the underlying view that social resources should be invested to prevent the birth of people with certain characteristics. This comparison makes evident the difficulty of crafting moral arguments that treat some uses of PNS, PND, abortion and PGD as licit and others as illicit.
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Black KI, Douglas H, de Costa C. Women's access to abortion after 20 weeks' gestation for fetal chromosomal abnormalities: Views and experiences of doctors in New South Wales and Queensland. Aust N Z J Obstet Gynaecol 2015; 55:144-8. [DOI: 10.1111/ajo.12305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Kirsten I. Black
- Discipline of Obstetrics, Gynaecology and Neonatology; University of Sydney; Sydney New South Wales Australia
| | - Heather Douglas
- TC Beirne School of Law; The University of Queensland; Brisbane Queensland Australia
| | - Caroline de Costa
- Obstetrics and Gynaecology; James Cook University School of Medicine; Cairns Queensland Australia
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16
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Wilkinson D, de Crespigny L, Xafis V. Ethical language and decision-making for prenatally diagnosed lethal malformations. Semin Fetal Neonatal Med 2014; 19:306-11. [PMID: 25200733 PMCID: PMC4339700 DOI: 10.1016/j.siny.2014.08.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In clinical practice, and in the medical literature, severe congenital malformations such as trisomy 18, anencephaly, and renal agenesis are frequently referred to as 'lethal' or as 'incompatible with life'. However, there is no agreement about a definition of lethal malformations, nor which conditions should be included in this category. Review of outcomes for malformations commonly designated 'lethal' reveals that prolonged survival is possible, even if rare. This article analyses the concept of lethal malformations and compares it to the problematic concept of 'futility'. We recommend avoiding the term 'lethal' and suggest that counseling should focus on salient prognostic features instead. For conditions with a high chance of early death or profound impairment in survivors despite treatment, perinatal and neonatal palliative care would be ethical. However, active obstetric and neonatal management, if desired, may also sometimes be appropriate.
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Affiliation(s)
- Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; Robinson Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia.
| | - Lachlan de Crespigny
- Department of Obstetrics and Gynaecology, University of Melbourne, Blairgowrie, Victoria, Australia
| | - Vicki Xafis
- Robinson Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia, Australia
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17
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The effect of a policy change on late termination of pregnancy in Israel. Int J Gynaecol Obstet 2014; 125:141-3. [DOI: 10.1016/j.ijgo.2013.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/22/2013] [Accepted: 01/15/2014] [Indexed: 11/23/2022]
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18
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Wilkinson DJC, de Crespigny L, Lees C, Savulescu J, Thiele P, Tran T, Watkins A. Perinatal management of trisomy 18: a survey of obstetricians in Australia, New Zealand and the UK. Prenat Diagn 2014; 34:42-9. [PMID: 24122837 PMCID: PMC3963474 DOI: 10.1002/pd.4249] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/20/2013] [Accepted: 09/29/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to explore the attitudes of obstetricians in Australia, New Zealand and the UK towards prenatally diagnosed trisomy 18 (T18). METHOD Obstetricians were contacted by email and invited to participate in an anonymous electronic survey. RESULTS Survey responses were obtained from 1018/3717 (27%) practicing obstetricians/gynaecologists. Most (60%) had managed a case of T18 in the last 2 years. Eighty-five per cent believed that T18 was a 'lethal malformation', although 38% expected at least half of liveborn infants to survive for more than 1 week. Twenty-one per cent indicated that a vegetative existence was the best developmental outcome for surviving children. In a case of antenatally diagnosed T18, 95% of obstetricians would provide a mother with the option of termination. If requested, 99% would provide maternal-focused obstetric care (aimed at maternal wellbeing rather than fetal survival), whereas 80% would provide fetal-oriented obstetric care (to maximise fetal survival). Twenty-eight per cent would never discuss the option of caesarean; 21% would always discuss this option. Management options, attitudes and knowledge of T18 were associated with location, practice type, gender and religion of obstetricians. CONCLUSION There is variability in obstetricians' attitudes towards T18, with significant implications for management of affected pregnancies.
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Affiliation(s)
- D J C Wilkinson
- Robinson Institute, University of AdelaideAdelaide, Australia
- Oxford Uehiro Centre for Practical Ethics, University of OxfordOxford, UK
| | - L de Crespigny
- Oxford Uehiro Centre for Practical Ethics, University of OxfordOxford, UK
| | - C Lees
- Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS TrustDu Cane Rd, London, W12 0HS
| | - J Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of OxfordOxford, UK
| | - P Thiele
- Monash UniversityFrankston, Australia
| | - T Tran
- Robinson Institute, University of AdelaideAdelaide, Australia
| | - A Watkins
- Mercy Hospital for WomenMelbourne, Australia
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Legendre CM, Moutel G, Drouin R, Favre R, Bouffard C. Differences between selective termination of pregnancy and fetal reduction in multiple pregnancy: a narrative review. Reprod Biomed Online 2013; 26:542-54. [PMID: 23518032 DOI: 10.1016/j.rbmo.2013.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
Abstract
Although selective termination of pregnancy and fetal reduction in multiple pregnancy both involve the termination in utero of the development of live fetuses, these two procedures are different in several aspects. Nevertheless, several authors tend to amalgamate and confuse their psychosocial consequences and the ethical issues they raise. Therefore, this narrative review, derived from a comparative analysis of 91 articles, shines a light on these amalgamations and confusions, as well as on the medical, contextual, experiential and ethical differences specific to selective termination and fetal reduction.
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Affiliation(s)
- Claire-Marie Legendre
- Division of Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Québec, Canada
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Abstract
Screening can identify individuals at increased risk of or in the early stage of a disease at a time when intervention can reduce the risk of morbidity and mortality. There are many ethical issues that have arisen as a result of screening. These can relate to the process of screening in general or to specific screening programs. Examples of the former include issues related to consent for screening, the utility of the screening tests employed and issues of funding of screening programs and equity of access to screening. Ethical issues related to three specific areas of screening are explored in more detail: reproductive screening, screening for disease with onset in adulthood and newborn screening. It is critical that ethical issues are considered in planning screening programs so as to ensure that the main focus of screening, preventing morbidity, is maximised. There are many lessons to be learnt from the many screening programs that have been conducted worldwide. No doubt new ethical issues will arise as new technologies and new treatments are developed, enabling screening for more conditions at lower relative costs.
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21
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Late termination of pregnancy for fetal abnormalities: The perspective of Indian lay persons and medical practitioners. Prenat Diagn 2011; 31:1286-91. [DOI: 10.1002/pd.2887] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 05/11/2011] [Accepted: 09/06/2011] [Indexed: 11/07/2022]
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22
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Décision d’interruption médicale de grossesse : le point de vue des soignants français. ACTA ACUST UNITED AC 2011; 39:198-204. [DOI: 10.1016/j.gyobfe.2011.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/01/2011] [Indexed: 11/23/2022]
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23
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Dommergues M, Mandelbrot L, Mahieu-Caputo D, Boudjema N, Durand-Zaleski I. Termination of pregnancy following prenatal diagnosis in France: how severe are the foetal anomalies? Prenat Diagn 2010; 30:531-9. [DOI: 10.1002/pd.2510] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Mills C. Case commentary: absent fetal hand. Australas J Ultrasound Med 2010; 13:27-28. [PMID: 28191081 PMCID: PMC5024863 DOI: 10.1002/j.2205-0140.2010.tb00154.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Catherine Mills
- Centre for Values; Ethics and the Law in Medicine; University of Sydney; Sydney New South Wales 2006 Australia
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25
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Habiba M, Da Frè M, Taylor DJ, Arnaud C, Bleker O, Lingman G, Gomez MM, Gratia P, Heyl W, Viafora C. Late termination of pregnancy: a comparison of obstetricians’ experience in eight European countries. BJOG 2009; 116:1340-9. [DOI: 10.1111/j.1471-0528.2009.02228.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Crespigny LJ, Savulescu J. Pregnant women with fetal abnormalities: the forgotten people in the abortion debate. Med J Aust 2008. [DOI: 10.5694/j.1326-5377.2008.tb01908.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lachlan J Crespigny
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC
- Murdoch Childrens Research Institute, Melbourne, VIC
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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27
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Crespigny LJ, Savulescu J. Pregnant women with fetal abnormalities: the forgotten people in the abortion debate. Med J Aust 2008; 188:100-3. [DOI: 10.5694/j.1326-5377.2008.tb01531.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 11/18/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Lachlan J Crespigny
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC
- Murdoch Childrens Research Institute, Melbourne, VIC
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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28
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Graham RH, Robson SC, Rankin JM. Understanding feticide: an analytic review. Soc Sci Med 2007; 66:289-300. [PMID: 17920742 DOI: 10.1016/j.socscimed.2007.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Indexed: 10/22/2022]
Abstract
The medical procedure of 'feticide' has been used in clinical practice since the early 1990s in the UK. The procedure constitutes a sensitive aspect of late termination of pregnancy (TOP), an issue that is in itself contentious. The procedure has attracted attention from academic and policy commentators, but recently the medical profession has expressed some uncertainty with respect to the legal position of live birth following TOP, and professional discretion in providing feticide. To understand the meaning of these comments better, we argue that it is helpful to acknowledge the rhetoric that shapes the academic discourse on feticide. In this paper, we review how feticide has been conceptualised within academic discourse, demonstrating that the concept has multiple meanings, some of which could be considered politically charged. We then consider some examples of the comments made about the legal uncertainties of feticide, highlighting assumptions made about the problematic nature of professional discretion. Ultimately, we suggest that a better understanding of the context of feticide is needed to ensure that future research in this area of health care engages adequately with issues of professional discretion.
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29
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Statham H, Solomou W, Green J. Late termination of pregnancy: law, policy and decision making in four English fetal medicine units. BJOG 2006; 113:1402-11. [PMID: 17081178 DOI: 10.1111/j.1471-0528.2006.01144.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE UK abortion law allows terminations for fetal abnormality without gestational limit. This study aimed to understand the decision-making experiences of fetal medicine professionals working within this legal framework. DESIGN Qualitative study using semistructured interviews. SETTING Four English fetal medicine units. SAMPLE Fifteen doctors and midwives working in fetal medicine units and the Director of a related voluntary sector group. METHODS Thematic analysis of transcribed interviews. MAIN OUTCOME MEASURES Attitudes to abortion legislation; how decisions are made about the offer of late abortion and feticide. RESULTS Fetal medicine specialists acknowledged the difficulties of ensuring that they worked within the law and within their own ethical frameworks when making decisions about offering terminations after viability. Practice regarding which abnormalities meet the legal criteria appeared to be governed largely by consensus between colleagues within their own and other units and in discussion with other specialists. Study participants reported individual differences about abnormalities where they personally would not wish to be involved in a termination, and also noted a shift in general attitudes over time as to conditions that meet the legal criteria. A proscribed list was believed to be both unworkable, given the variability in diagnoses and unhelpful, leading to reduced patient care. CONCLUSIONS Research is needed to monitor attitudes to, and interpretation of, UK abortion legislation, which permits termination after a late diagnosis of fetal abnormality without gestational limit. If attitudes are changing, it is important to understand why, and what the consequences will be for parents and for health professionals.
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Affiliation(s)
- H Statham
- Centre for Family Research, University of Cambridge, Cambridge, UK.
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30
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Abstract
Deeply held religious beliefs may conflict with some aspects of medical practice. But doctors cannot make moral judgments on behalf of patients
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Affiliation(s)
- Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford OX1 1PT.
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31
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32
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De Crespigny LJ, Savulescu J. Abortion: time to clarify Australia's confusing laws. Med J Aust 2004; 181:201-3. [PMID: 15310254 DOI: 10.5694/j.1326-5377.2004.tb06236.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Accepted: 05/25/2004] [Indexed: 11/17/2022]
Abstract
Australian criminal law is a matter for states and territories. In relation to abortion, many laws are unclear and outdated, and are inconsistent between states and territories. Doctors practise under time constraints and on a case-by-case basis. Most current laws have grey areas that leave doctors vulnerable to accusations, negative publicity and career damage, especially in the case of late abortions. All jurisdictions should follow the Australian Capital Territory's lead in allowing women to access abortion without fear of criminal prosecution. Federal, state and territory governments should introduce a single clear national law on abortion, both in early and late pregnancy.
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33
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Abstract
AIMS To review the indications and outcomes for abortion beyond 20 weeks' gestation within an environment of legislated notifiable pregnancy termination. METHODS In Western Australia legislation allowing abortion > or = 20 weeks' gestation for serious maternal-fetal conditions was enacted in May 1998. Late abortions are only permitted in a single state institution and are notifiable by law. All pregnancy terminations > or = 20 weeks' gestation performed since this legislation were prospectively identified with the indications and outcomes reviewed. RESULTS During the study period, 219 women underwent abortion > or = 20 weeks' gestation, representing 0.5% of all abortions in the state. Comparison with 438 contemporanous medical abortions for fetal anomaly at 14-20 weeks' gestations was made. Misoprostol was the primary abortifacient for both. The median maternal age for termination at 14-20 weeks was 32 years (interquartile range (IQR) 27, 36) and 30 years (IQR 26, 34) at > or = 20 weeks' gestation (P < 0.001). There was no significant difference in maternal gravidity or parity. The principal indications for terminations > or = 20 weeks were: karyotypic (28.8%); cardiac anomalies (15.5%) and neural tube defects (11.9%). Cardiac anomalies represented 5.0% of fetal anomaly terminations at 14-20 weeks (P < 0.01). The median time for medical abortion was 15.4 h (IQR 11.5, 23.2) at 14-20 weeks' gestation compared with 18.3 h (IQR 13.3, 26.1) at gestations greater than 20 weeks (P < 0.001). A total of 13.2% of terminations were performed at gestations beyond 24 weeks. CONCLUSIONS Abortion > or = 20 weeks' gestation under medically regulated legislation is used primarily for serious fetal anomalies. The women are younger and the abortion duration is greater for late pregnancy termination compared with those conducted at earlier gestations. The majority of late terminations occur < 23 weeks' gestation and the incidence has remained stable since the legislation was enacted.
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Affiliation(s)
- Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
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34
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Guillem P, Fabre B, Cans C, Robert-Gnansia E, Jouk PS. Trends in elective terminations of pregnancy between 1989 and 2000 in a French county (the Isère). Prenat Diagn 2003; 23:877-83. [PMID: 14634970 DOI: 10.1002/pd.711] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study was performed in order to provide a description of indications for induced elective terminations of pregnancy (ETOP), their characteristics (e.g. gestational age), and their evolution over time. DESIGN OF THE STUDY This is an epidemiological study. The geographic area covered is the French county of 'Isère', which represents a mean of 14 000 births per year over the study period. MATERIALS AND METHODS Data on ETOPs were collected actively from medical records by a register of childhood deficiencies and adverse perinatal events in this county. Between 1989 and 2000, 996 ETOPs were notified. RESULTS Four main grounds for ETOPs were identified: (1) morphological anomalies with normal karyotype (39%), (2) chromosomal anomalies (35%), (3) other fetal grounds (16%), and (4) maternal indications (10%). Prevalence rates for the first two grounds increased significantly over the study period respectively from 2.0 to 2.9 and from 1.4 to 2.7 per 1000. Among the ETOPs carried out because of fetal indications, the percentage of late ETOPs (from 24 weeks of gestation) was 34.6%, and remained stable over the studied period. In some cases, a medical consensus was not reached with respect to indications for termination (sex chromosome anomalies, limb defects). We estimated the percentage of these cases as being 2.7% of the figure for fetal indications, without any variation in prevalence over the whole period (p = 0.59). The increasing number of ETOPs that occurred in the chromosomal aberrations group during the study period is thought to be due to an increase in diagnostic sensitivity. The increase that occurred in the morphological anomalies group is thought to be due both to an increase in sensitivity and to a widening of the field with respect to indications, some of which have an uncertain prognosis (e.g. agenesis of the corpus callosum). CONCLUSION This study provides useful data for monitoring medical practice consistency within the field of prenatal diagnosis, and for the drive to keep medical practice within ethically acceptable limits.
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Affiliation(s)
- P Guillem
- Registre des Handicaps de l'Enfant et Observatoire Périnatal, Grenoble, Cedex, France.
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Abstract
Dental genetic disorders can cause severe social and psychological effects in affected individuals. The cost of treatment can be considerable, not only in financial terms but also in time spent during treatment. In theory it is, or will soon be, possible to use advances in molecular genetics for pre-natal testing, for selection of embryos using in vitro fertilization techniques, and for gene therapy. The questions we pose are whether these approaches are appropriate. We hope that this review will stimulate debate on these issues.
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Affiliation(s)
- M Aldred
- Department of Dentistry, Royal Children's Hospital, Melbourne, Australia.
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36
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De Crespigny L, Savulescu J. Is paternalism alive and well in obstetric ultrasound? Helping couples choose their children. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:213-216. [PMID: 12230438 DOI: 10.1046/j.1469-0705.2002.00807_1.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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37
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Henrich W, Stupin JH, Bühling KJ, Bührer C, Bassir C, Dudenhausen JW. Prenatal sonographic findings of thalamic cavernous angioma. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:518-522. [PMID: 11982990 DOI: 10.1046/j.1469-0705.2002.00700.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A cavernous angioma of the thalamus is a rare congenital brain tumor. We report the perinatal management and follow-up to 2 years in a case diagnosed in utero at 37 weeks of gestation, and review the literature.
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Affiliation(s)
- W Henrich
- University Department of Obstetrics, Charité, Campus Virchow-Klinikum, Humboldt University Berlin, Germany.
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