Late termination of pregnancy: law, policy and decision making in four English fetal medicine units

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.