Abortion care in Ireland: Developing legal and ethical frameworks for conscientious provision

Donnelly, Mary; Murray, Claire

doi:10.1002/ijgo.13025

Cited by 21 publications

(19 citation statements)

References 19 publications

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“…FMSs identified these experiences as a source of tension and conflict, as they felt that in the absence of universal feticide, perinatal palliative care is warranted for these cases, but are left ‘begging’ for support to ensure its delivery. Unfortunately, although the majority of TOPs for FFA occur within the second trimester, before viability, 35 some pregnant women within Ireland are without universal access to anomaly scans and so are at risk of a late diagnosis 13,36 . Additionally, Ireland’s legislation is without gestational limits and so creating the opportunity for late TOP for FFA.…”

Section: Discussionmentioning

confidence: 99%

“…The Republic of Ireland legislated for TOP for fatal fetal anomaly (FFA) for the first time in 2018. Prior to this, Ireland held one of the most restrictive legislative positions on TOP in the world: 11 the Eighth Amendment of the Constitution protected ‘the right to life of the unborn’, 12 and ensured that TOP, including TOP for FFA, was a criminal offence 13,14 . On 1 January 2019, the Health (Regulation of Termination of Pregnancy) Act 2018 was enacted, permitting TOP if two medical practitioners (one being an obstetrician), ‘are of the reasonable opinion’ that the fetal diagnosis is ‘likely to lead to the death of the fetus’ during the pregnancy or in the first 28 days of life 15 .…”

Section: Introductionmentioning

confidence: 99%

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Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study

Power

Meaney

O’Donoghue

2020

BJOG

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Objective To explore fetal medicine specialists’ experiences of caring for parents following a diagnosis of fatal fetal anomaly (FFA) during the implementation of termination of pregnancy (TOP) for FFA for the first time. Design Qualitative study. Setting Fetal medicine units in the Republic of Ireland. Population Ten fetal medicine specialists from five of the six fetal medicine units. Methods nvivo 12 assisted in the thematic analysis of semi‐structured in‐depth face‐to‐face interviews. Main outcome measures Fetal medicine specialists’ experiences of prenatal diagnosis and holistic management of pregnancies complicated by FFA. Results Four themes were identified: ‘not fatal enough’, ‘interactions with colleagues’, ‘supporting pregnant women’ and ‘internal conflict and emotional challenges’. Fetal medicine specialists feared getting an FFA diagnosis incorrect because of media scrutiny and criminal liability associated with the TOP for FFA legislation. Challenges with the ambiguous and ‘restrictive’ legislation were identified that ‘ostracised’ severe anomalies. Teamwork was essential to facilitate opportunities for learning and peer support; however, conflict with colleagues was experienced regarding the diagnosis of FFA, the provision of feticide and palliative care to infants born alive following TOP for FFA. Participants reported challenges implementing TOP for FFA, including the absence of institutional support and ‘stretched’ resources. Fetal medicine specialists experienced internal conflict and a psychological burden providing TOP for FFA, but did so to ‘provide full care for women’. Conclusions Our study identified challenges regarding the suitability of the Irish legislation for TOP for FFA and its rapid introduction into clinical practice. It illustrates the importance of institutional and peer support, as well as the need for supportive management, in the provision of a new service. Tweetable abstract The implementation of termination services for fatal fetal anomaly is complex and requires institutional support.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study

Power

Meaney

O’Donoghue

2020

BJOG

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“…In the United Kingdom (UK) there is currently heightened interest in abortion rights, driven in part by recent liberalisation in neighbouring Republic of Ireland [7] and, as of October 2019, decriminalisation in Northern Ireland [8] (a UK jurisdiction in which access to abortion has until now remained severely restricted), and the Isle of Man [9]. Organisations currently backing a UK-wide campaign for full decriminalisation include the Royal Colleges of Obstetricians and Gynaecologists, General Practitioners, and Midwives [10].…”

Section: Introductionmentioning

confidence: 99%

Normalising abortion: what role can health professionals play?

Maxwell

Hoggart

Bloomer

et al. 2020

BMJ Sex Reprod Health

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BackgroundDespite being a common gynaecological procedure, abortion continues to be widely stigmatised. The research and medical communities are increasingly considering ways of reducing stigma, and health professionals have a role to play in normalising abortion as part of routine sexual and reproductive healthcare (SRH). We sought to investigate how health professionals may normalise abortion and challenge prevailing negative sociocultural narratives.MethodsAs part of the Sexuality and Abortion Stigma Study (SASS), qualitative secondary analysis was conducted on two datasets containing health professionals’ accounts of providing abortion in Scotland and England. A subsample of 20 interviews were subjected to in-depth, thematic analysis.ResultsFour key themes were identified in heath professionals’ accounts: (1) encountering resistance to abortion from others working in SRH; (2) contending with prevailing negative sociocultural narratives of abortion; (3) enacting overt positivity towards abortion provision; and (4) presenting abortion as part of normal, routine healthcare.ConclusionsIt is clear that negative attitudes toward abortion persist both inside and outside of healthcare systems, and need to be challenged in order to destigmatise those accessing and providing services. Health professionals can play a key role in normalising abortion, through the ways in which they frame their work and present abortion to women they treat, and others more widely. Our analysis suggests a key way to achieve this is by presenting abortion as part of normal, routine SRH, but that appropriate support and structural change are essential for normalisation to become embedded.

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“…94 Waiting periods have also been shown to fragment delivery of abortion care. 95 Waiting periods in SRH contravene international human rights law which stipulates that States must remove, and refrain from enacting, laws and policies that create barriers in access to SRH services. The Committee on the Elimination of Discrimination Against Women (CEDAW) has specifically mentioned in its Country Reports on Slovakia, Hungary and Russia that waiting period requirements should be removed.…”

Section: Discussionmentioning

confidence: 99%

<p>Mandatory Waiting Periods Before Abortion and Sterilization: Theory and Practice</p>

Rowlands

Thomas

2020

IJWH

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Some laws insist on a fixed, compulsory waiting period between the time of obtaining consent and when abortions or sterilizations are carried out. Waiting periods are designed to allow for reflection on the decision and to minimize regret. In fact, the cognitive processing needed for these important decisions takes place relatively rapidly. Clinicians are used to handling cases individually and tailoring care appropriately, including giving more time for decision-making. Psychological considerations in relation to the role of emotion in decision-making, eg, regret, raise the possibility that waiting periods could have a detrimental impact on the emotional wellbeing of those concerned which might interfere with decision-making. Having an extended period of time to consider how much regret one might feel as a consequence of the decision one is faced with may make a person revisit a stable decision. In abortion care, waiting periods often result in an extra appointment being needed, delays in securing a procedure and personal distress for the applicant. Some women end up being beyond the gestational limit for abortion. Those requesting sterilization in a situation of active conflict in their relationship will do well to postpone a decision on sterilization. Otherwise, applicants for sterilization should not be forced to wait. Forced waiting undermines people's agency and autonomous decision-making ability. Low-income groups are particularly disadvantaged. It may be discriminatory when applied to marginalized groups. Concern about the validity of consent is best addressed by protective clinical guidelines rather than through rigid legislation. Waiting periods breach reproductive rights. Policymakers and politicians in countries that have waiting periods in sexual and reproductive health regulation should review relevant laws and policies and bring them into line with scientific and ethical evidence and international human rights law.

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Abortion care in Ireland: Developing legal and ethical frameworks for conscientious provision

Cited by 21 publications

References 19 publications

Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study

Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study

Normalising abortion: what role can health professionals play?

<p>Mandatory Waiting Periods Before Abortion and Sterilization: Theory and Practice</p>

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