Obstetricians' views on prenatal diagnosis and termination of pregnancy: 1980 compared with 1993

Abstract

Objective To examine the attitudes of obstetricians in England and Wales concerning prenatal diagnosis and termination of pregnancy and to compare these with a similar survey carried out in 1980. Methods Postal questionnaires, based on those used in 1980, were sent to a random sample of 555 nonacademic consultant obstetricians, 71% of whom replied. Results The proportion of consultant obstetricians with a conscientious objection to termination of pregnancy was the same in both surveys, although virtually all conscientious objectors said that they made an exception for serious fetal abnormality. A major change was in the proportion saying that they generally required an undertaking to terminate an affected pregnancy before proceeding with amniocentesis: 75% in 1980 compared with 34% in 1993. As in 1980, lower priority is given to telling women of negative test results than of positive. More obstetricians in 1993 are prepared to consider terminations later in pregnancy, both for fetal abnormality and for social reasons, than was the case in 1980, but many are not prepared to recommend termination as late in pregnancy as the law allows. In some cases this is due to misapprehensions about what is legal. There are particular problems concerning terminations for fetal anomalies that not all would consider serious. One in seven of the 1993 sample would not recommend termination for cystic fibrosis at any gestation. Only 13 % would recommend termination for Down's syndrome beyond 24 weeks. There is a need not only for clarification of the law, but also of obstetrician's willingness to implement it.

Maximizing the benefits and minimizing the risks associated with prenatal genetic testing

“…The first risk emerging from the ubiquitous use of prenatal genetic testing is the risk of coercive testing, which removes agency and choice from individuals and threatens reproductive rights (Green 1995, Rapp 1998, Ettorre 2000. Coercion, persuasion, or compulsion, may transpire directly from visible social authorities, such as the bureaucratic state or the medical profession or, alternatively, from more diffuse and insidious channels such as ambient social expectations.…”

Newborn screening for congenital heart defects: a systematic review and cost-effectiveness analysis

“…395 Informed choice is also a controversial area for professionals, and obstetricians' views of which conditions are serious enough to merit termination may not concur with women's views: 14% of obstetricians would never recommend termination for cystic fibrosis and 13% would not recommend late terminations for Down's syndrome. 396 Parents of children with metabolic disorders, asked if they would consider screening for future pregnancies, only wished to do so in 56% of cases, but 41% had acted to prevent further affected pregnancies. 397 Only one-quarter of parents of children with cystic fibrosis actually used antenatal testing in a subsequent pregnancy.…”

The Individualist Model of Autonomy and the Challenge of Disability

“…Even though a desire to know about the status of an embryo or fetus does not necessarily translate into an intention to refrain from getting pregnant or to terminate an existing pregnancy, health-care providers have historically operated under the assumption that an agreement to screening implies a belief that having a child with Down syndrome would be an undesired outcome and a wish to terminate an otherwise wanted pregnancy. Some obstetricians have been reported to be directive in their advice to pregnant women, advocating termination of fetuses with a range of genetic conditions [45,46]. While termination rate by itself does not provide a full picture of reasons behind such decisions, it is worth noting that a review of international data between 1980 and 1998 shows that 92-93% of women terminated their pregnancy following a prenatal diagnosis of Down syndrome [47].…”