Healthcare professionals’ attitudes towards termination of pregnancy at viable stage

Abstract

Introduction Upon prenatal diagnosis of congenital malformations, termination of pregnancy (TOP) may be an option, sometimes at a gestational age when the fetus is already viable (late TOP). We aimed to study attitudes towards late TOP of all tertiary healthcare professionals involved in late TOP practice. Material and methods A mail survey was conducted among all physicians and paramedical professionals involved in late TOP decision‐making in all eight centers with a Neonatal Intensive Care Unit in Flanders, Belgium (N = 117). The questionnaire contained general and case‐based attitude items. Results Response rate was 79%. Respondents were either physicians (51.1%) or paramedical professionals (49.9%). The composition of professionals involved in late TOP decision‐making was heterogeneous between the eight centers. Late TOP was highly accepted in both lethal fetal conditions (100%) and serious (but not lethal) fetal conditions (95.6%). Where the fetus is healthy, 19.8% of respondents agreed with late TOP for maternal psychological problems and fewer respondents (13.2%) agreed with late TOP in the case of maternal socio‐economic problems (P = .002). Physicians more often preferred feticide over neonatal palliative care in the case of non‐lethal fetal conditions compared with paramedical professionals (68.1% vs 53.2%, P = .013). Almost nine out of ten respondents (89.1%) agreed that in the event of a serious (non‐lethal) neonatal condition, administering drugs with the explicit intention to end neonatal life was acceptable. Behavioral intentions indicate that even in situations with an unclear diagnosis and unpredictable prognosis, 85.6% of professionals would still consider late TOP. Conclusions Healthcare professionals practicing late TOP in Flanders, Belgium have a high degree of tolerance towards late TOP, irrespective of sociodemographic factors, and are demanding legislative change regarding active life‐ending in the fetal and neonatal periods. Further research should explore the correlation of attitudes to late TOP with actual medical decisions taken in daily clinical practice.

Pregnancy termination at a viable stage in daily clinical practice: A nationwide mortality follow‐back study in Flanders, Belgium

“…Palliative care and/or nonaggressive obstetric management is considered only as an option when neonatal death is inevitable within a reasonable time and/or parents prefer palliative care for their child 36 . We have already demonstrated that this option is less preferred by physicians than by paramedical professionals 37 . In 16% of all late TOPs in this study, no prenatal intervention to achieve foetal demise was taken, some of them beyond 26 weeks of pregnancy.…”

“…36 We have already demonstrated that this option is less preferred by physicians than by paramedical professionals. 37 In 16% of all late TOPs in this study, no prenatal intervention to achieve foetal demise was taken, some of them beyond 26 weeks of pregnancy. However, no foetus showed signs of viability after birth and no postnatal intervention was required.…”

Ethische Haltungen und Umgang in pränatalen Konfliktsituationen – eine Umfrage unter Geburtshelfern und Pränataldiagnostikern in Deutschland

“…In einer Vergleichsstudie von Janvier et al zeigte sich beispielsweise, dass pädiatrische Assistenzärzte seltener einen Schwangerschaftsabbruch bei fetalen Fehlbildungen als ihre geburtshilflichen Kollegen in Betracht zogen 11 . Roets et al stellte in einer Befragung unter Ärzten und Pflegepersonal heraus, dass Ärzte wiederum im Falle von nicht-letalen Fehlbildungen häufiger als die anderen Berufsgruppen einen Fetozid einer neonatalen Palliativbehandlung vorziehen würden 12 . Crowe et al zeigten in einer Befragung unter Ärzten und Sozialarbeitern hinsichtlich der Beurteilung von Schwangerschaftsabbrüchen bei Feten mit schweren angeborenen Fehlbildungen deutlich unterschiedliche professionsbezogene Perspektiven auf ein behindertes Kind und die Folgen seiner Erkrankung.…”

Feticide Before Termination of Pregnancy in Singleton Pregnancy – Trends in England and Wales 2012-2020, a cross-sectional study

“…Feticide is therefore carried out to avoid this by inducing fetal demise in the uterus before TOP. Feticide is also often preferred to live birth, followed by neonatal palliative care by parents and healthcare staff involved in terminations [3][4][5].…”