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MD2002 > Ethics at the Beginning of Life > Flashcards

Ethics at the Beginning of Life Flashcards

1
Q

What is abortion ?

A

Cessation of pregnancy

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2
Q

What are other terms for medical abortions ?

A

Therapeutic Abortion / Termination of Pregnancy (TOP))

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3
Q

What are the three practical elements that contribute to medical ethics ?

A
  1. Ethical Issues
  2. Legal Framework
  3. Professional Responsibility
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4
Q

What are the aims of medical ethics ?

A

• protects our patients from us
• protects us from our patients
because this is a human relationship that has an inbuilt imbalance of power

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5
Q

What are the main ethical issues involved in abortions ?

A

Foetal Autonomy vs Maternal Autonomy: We must first determine whether the foetus is part of the woman. Is foetus seperate from the woman, high feotal autonomy and low maternal choice
If foetus part of woman, low feotal autonomy but high maternal choice. To complicate things further, foetus may be part of woman early on but not so much so anymore later on at gestational age.

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6
Q

Legally, when does implantation take place ?

A

At conception

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7
Q

Define gestational age.

A

Age starting from the first day of last period (includes a part where woman was not pregnant).

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8
Q

What may conception be defined as ?

A

Either implantation or fertilisation.

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9
Q

Define fertilisation.

A

When sperm meets egg

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10
Q

Define implantation.

A

When fertilised egg implants on endometrial surface

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11
Q

May we use differentiation to guide our decision on abortion ?

A

No because it is a very progressive process, there is no one point where we can say differentiation has taken place, no abortion after that

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12
Q

May we use brain and heart activity to guide our decision on abortion ?

A

No because there are many important stages to that (no one point where we can say there is brain and heart activity, no abortion after that)

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13
Q

Define quickening.

A

Traditional way of diagnosing pregnancy

= perceive foetal movements in the uterus

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14
Q

Define viability.

A

Viability of foetus to survive outside of uterus

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15
Q

What are the main legal issues surrounding abortion ?

A
  1. Legal status of mother: issues of capacity, consent (age of consent to any sexual activity is 16yr), confidentiality
  2. Legal status of foetus
  3. Legal status of partner: (no situation where partner can have ruling over the woman’s right to dictate
    what goes on over her own body)
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16
Q

What is case law ? Why is it important ?

A

Set of past rulings by tribunals that meet their respective jurisdictions’ rules to be cited as precedent.
Important because no leglislation telling us what foetus is, what foetus can do etc. Instead, we use past rulings.

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17
Q

What legal issues does the “St George’s Healthcare NHS Trust vs S” case involve ?
Describe the St George’s Healthcare NHS Trust vs S case

A

Legal status of foetus

• S was 35 wks pregnant. Doctors advised a Caesarean section because they believed that not to do so would result in the death of either S and/or the foetus . They considered that she was legally competent to consent.
• She refused to give consent; the doctors invoked the Mental Health Act and sought permission to perform the operation from the Courts and obtained it.
• Afterwards S appealed the decision and won: the RIGHT TO REFUSE TREATMENT (WITHHOLD CONSENT WHEN COMPETENT) IS ABSOLUTE IRRESPECTIVE OF PREGNANCY
I.e. The Mental Health Act does not apply to physical conditions

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18
Q

How are professional responsibility of doctors wrt abortion dictated ?

A

By GMC and Abortion Act 1967.

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19
Q

What are the professional responsibility of doctors with regards to abortion ? State specific rules where relevant.

A
  1. Competence and Conduct (Capacity, Consent, Confidentiality)
  2. Obligations and Options:
    - Obliged to put patient first
    - For one doctor to perform a medical abortion and for two doctors to check that at least one of the following applies, for an abortion to be carried out (not exceeded 24 weeks + risk to herself or her existing children OR to prevent injury OR to prevent potential death, OR due to probable serious handicap of newborn) (Section 1 of Abortion Act 1967)
    - Option to not participate in any treatment authorised by this Act, to which he has a conscientious objection. (GMC, Personal Beliefs and Medical Practice, Article 52 + Section 4 of Abortion Act 1967)
    - Must not refuse to provide treatment necessary to save the life of, or prevent serious deterioration in the health of, a person because the treatment conflicts with your personal beliefs (GMC, Personal Beliefs and Medical Practice, Article 13 + Section 4 of Abortion Act 1967)
    - Option to negotiate with employing body for any cases where require doctors to fulfil contractual requirements that may restrict doctors’ freedom to work in accordance with their conscience, besides in the cases of consciousness objections (where doctors can just refuse, because that’s protected by Abortion Act) (GMC, Personal Beliefs and Medical Practice)
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20
Q

How many recognised pregnancies does spontaneous abortion (miscarriage) occur in ?

A

12-24%

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21
Q

What are the clinical scenarios in which abortion is considered ?

A
  1. Unplanned pregnancy
  2. To prevent the birth of a child with severe medical problems
  3. Pregnancy resulting from rape or incest
  4. Medical conditions that endanger the woman’s
    health should the pregnancy continue e.g. diagnosis of
    cancer during pregnancy requiring urgent treatment
22
Q

What is the proportion of 1000 women aged 15-44, who underwent an abortion in:

1) England and Wales
2) Scotland

A

England and Wales: 16

Scotland: 11.6

23
Q

At what age do we find high abortion rates in the UK ?

A

22

24
Q

Describe the rate of abortion over age.

A

Parabola. Increases until age 22 then decreases progressively. BUT increase of rates during 30’s due to failure of contraceptives in mid 30s.

25
Q

What is the proportion of women receiving abortions who were single ?

A

81%

26
Q

What is the proportion of women seeking abortion who used contraceptives when they became pregnant ?

A

57%

27
Q

What is the proportion of women seeking abortion who used emergency contraceptives when they became pregnant ?

A

12%

28
Q

Medical abortion if offered up to how many weeks ?

A

10 weeks

29
Q

What are the main differences between medical and surgical abortions ?

A 
Medical Abortion
• Induce a miscarriage 
• Offered up to 10wks 
• Days to weeks to complete
• Avoids anaesthesia and invasive procedures
• High success rate 95%
• Heavy bleeding
• Requires follow up
• Patient participation in multi-step process

Surgical Abortion
• Physical evacuation of uterus (invasive)
• Offered in early pregnancy
• under GA/sedation
• Completed within predictable amount of time
• • High success rate 99%
• Light bleeding
• Does not require follow up generally
• Patient participation in single-step process

30
Q

Are most abortions today surgical or medical ?

A

Medical, about 60% (used to be surgical just a few years ago)

31
Q

Are most abortions funded by private sector, NHS funded (NHS hospital), or NHS funded (independent sector = charities) ?

A

Mainly NHS funded independent sector (followed by NHS hospitals, very little private sector)

32
Q

What are the Statutory Grounds for Abortion in 2016 ?

A

Overwhelming majority is risk to woman.

Small minority is risk to child.

33
Q

What are the World regions with highest abortion rates ?

A

Latin America and the Caribbean, Africa, Asia

34
Q

What factors does the provision of healthcare (including abortions) depend on ?

A
  • Is it Legal?
  • Who organises it?
  • What do they provide?
  • Who pays for it?
35
Q

What is the Influence of legal availability on Abortion Rate ?

A

More abortions in more restrictive countries than in most permissive countries.

36
Q

Define unsafe abortion.

A

a procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both.

37
Q

Are most of the abortions performed in the world safe, less safe, or least safe ?

A

Safe, followed by less safe, followed by least safe.

38
Q

Are most of the abortions performed in developing countries safe, less safe, or least safe ?

A

Safe, followed by less safe, followed by least safe.

39
Q

Are most of the abortions performed in developed countries safe, less safe, or least safe ?

A

Safe, followed by less safe, followed by least safe.

40
Q

Are most of the abortions performed in Africa safe, less safe, or least safe ?

A

Least safe, followed by less safe, followed by safe

41
Q

Are most of the abortions performed in Europe safe, less safe, or least safe ?

A

Safe, followed by less safe, followed by least safe.

42
Q

What is the influence of legal availability on least safe abortion rate ?

A

Where legality permissive, lowest number of unsafe abortions

Where legality restrictive, greatest number of unsafe abortions

43
Q

What are the post-abortion risks ?

A
  • Uterine infection (10%)
  • Residual products of conception (5%)
  • Excessive bleeding ( 0.1%)
  • Damage to cervix (1%)
  • Damage to uterus ( 1 in 250-1,000 if surgical; <1 in 1,000 if medical)
44
Q

What are the complications from Unsafe Abortion ?

A

1) Death
2) Injury (including hemorrhage, localised infection, genital trauma, sepsis, necrotic bowel, poor wound healing, infertility, urinary and stool incontinence, fistulas, bowel resections)

45
Q

How many deaths have taken place in the UK in 2016 due to abortion ?

A

1

46
Q

How many women are hospitalized each year for treatment of abortion-related complications ?

A

5 Million

47
Q

What proportion of maternal deaths occur in developing countries ?

A

99%

48
Q

What proportion of all maternal deaths are due to unsafe abortions ?

A

4.7% - 13.2%

49
Q

What proportion of all maternal deaths are due to unsafe abortions ?

A

4.7% - 13.2%

50
Q

What is the general complication rate following abortions ?

A

1 in 630 abortions

51
Q

What are perceived risks of legalised abortions ? illegal abortions ?

A

Legalised abortions: Greater numbers of abortions + on-demand abortions
Illegal abortions: deaths and complications (due to high levels of unsafe abortions)

MD2002 (77 decks)

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