abortion Flashcards
what is the incidence of abortions in the uk
Common!!
1 in 3 women will have an abortion
Vast majority abortions medical
Over 80% under 9 weeks
Earlier gestations = safer procedure
Increasing gestation = marker poor access
Self referral, min. waiting times
Nowhere in Scotland offers late abortion (>20 weeks)
Often the most vulnerable
what is abortion
Abortion / therapeutic abortion / termination of pregnancy (TOP)
decision making in relation to abortions
Most people >90% are certain about their decision
Most difficult for those who are not certain
Important to ensure they have support if needed
Friends / family
Formal counselling
GMC:
“you must treat your patients with respect whatever their life choices and beliefs”
medical abortion
Mifepristone p.o. (200mg) stat (taken in clinic)
24-48 hrs later Misoprostol (800 mcg) vaginal / sublingual / buccal
Misoprostol can be repeated every three hours
Home / hospital
Surgical abortion
Manual vaccuum aspiration
Suction abotion (STOP)
Dilatation and evacuation
What does respectfully opting out of care entail?
Opting out of treatment/care is a serious moral decision
Carefully consider potential consequences before exercising right to conscientious objection.
Carefully considering the potential consequences of opting out of care.
Trying to mitigate against any adverse impact of opting out of care.
Being open and honest with colleagues to ensure all patients still receive the best care.
Telling a person requesting an abortion about your objection?
What is conscientious objection?
Includes
limited to medical staff participating in the abortion procedure.
right to opt out of providing abortion care on an individual level
obligation to ensure that the person is still able to access that care
does not include
Medical or nursing care provided to someone currently undergoing abortion treatment
Care a pregnant person requires who is considering abortion
Overturning Roe versus Wade:
Pregnant woman denied palliative chemotherapy
Misoprostol not given in an emergency to a woman with heavy bleeding as needed proof she was not still pregnant
Doctors afraid to provide care to those who are miscarrying
Why do women die from abortion?
Unsafe abortion: abortion performed by persons lacking necessary skills / environment not conforming to minimum medical standards
More common when access is legally restricted
In Africa, only ~3% abortions are performed in safe conditions
Legislation: The UK 1967 Abortion Act
Before 1967, abortion in the UK was illegal except to save the woman’s life, but unsafe and illegal abortions were very common and associated with high morbidity and mortality. 1967 Act was therefore introduced:
Two doctors must certify in good faith that at least on of five clauses apply to the woman requesting abortion
Agree on one clause
Must have an insight or understanding on the woman’s individual circumstances
Unique process across all of medicine in Britain
Covers Scotland, England and Wales
the five clauses of the abortion act
A the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated;
B the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman;
C the pregnancy has NOT exceeded its 24th 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;
D the pregnancy has NOT exceeded its 24th 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 any existing child(ren) of the family of the pregnant woman;
E 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.
May is a 23 year old university student and has been having sex with her boyfriend for around 6 months. They usually use condoms for contraception but they sometimes forget. Her menstrual cycle is regular, every 28-30days, and her last period was 6 weeks ago. Two days ago she did a home pregnancy test which was positive. She goes to see her GP and is upset and says she doesn’t know what to do, but she doesn’t think she can go through with the pregnancy as she is still at university and feels too young to have a baby.
If she wishes to have an abortion, what legal criteria must be met?
What human rights are relevant to this case and why?
How might ethical concepts (such as autonomy, beneficience, nonmalefiance etc.) be relevant to this case?
C the pregnancy has NOT exceeded its 24th 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
Right to autonomy – ethically patient should make her own decision about treatment, legally that decision is made by a doctor
Beneficience and nonmalefiance – important she is given support and the ability to make her decision and options to safe options for abortion
This doctor should not refuse to see this patient as this is not partaking in abortion treatment, but rather acute medical care
April is 15 years old and has been having sex with her boyfriend for around 6 months. They usually use condoms for contraception but they sometimes forget. Her menstrual cycle is regular, every 28-30days, and her last period was 6 weeks ago. Two days ago she did a home pregnancy test which was positive. She goes to see her GP and is upset and says she doesn’t know what to do, but she doesn’t think she can go through with the pregnancy as she is still at school and feels too young to have a baby.
What ethical and legal issues are important in this case considering her age?
What other questions are important in this girls history?
What framework can you use to assess her competency?
Ethical / legal issues and age
Can she consent to sexual intercourse?
Legally – sex under 16 is unlawful, but 13-15 year olds who are having consensual sex with someone of a similar age are generally not prosecuted as would be more harmful to do so
Does she have capacity to consent to treatment?
Is she at risk of exploitation?
See: https://www.england.nhs.uk/wp-content/uploads/2017/02/cse-pocket-guide.pdf for further information around child sexual exploitation
What other questions are important in this girls history?
How old is her boyfriend, was she being forced / coerced into sex, who has she talked to about the pregnancy, what support does she have at home / school
Angela is a 37 year old women who has 3 children aged 14, 10 and 7 years old. Her long-term partner had a vasectomy 4 months ago and was awaiting the results of a second semen sample. They had a condom failure during this time but had not accessed emergency contraception as she felt her risk of pregnancy was low. Her youngest child is currently under assessment for ADHD and ASD.
She attends her GP after a positive pregnancy test and is very upset. She feels her family is complete and feels she would struggle having another child. She doesn’t feel it would be fair on her current children especially her youngest who warrants a lot of her attention and support. She never thought she would consider to have an abortion.
If she wishes to have an abortion, what legal criteria must be met?
C the pregnancy has NOT exceeded its 24th 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;
D the pregnancy has NOT exceeded its 24th 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 any existing child(ren) of the family of the pregnant woman;
