L13 - Abortion

Question 1

What is the difference between the terms:

1 - Abortion?

2 - Miscarriage?

3 - Stillbirth?

4 - Post-coital interception?

Answer 1

• Abortion is an active measure taken to end pregnancy
• Miscarriage is the spontaneous loss of foetus before 20th week
• Stillbirth is spontaneous loss of foetus after 20th week
• Post-coital interception is where emergency contraception is taken to stop pregnancy from occurring post-fertilisation

Question 2

What is the law concerning purchasing medication online to facilitate abortion?

Answer 2

• Buying medication online to facilitate abortion is illegal

- Outside of legal provisions, abortion is illegal and punishable by life imprisonment

Question 3

What are the legal obligations of the doctor that takes responsibility for an abortion procedure?

Answer 3

1 - Notify the chief medical officer within 14 days of the termination

2 - Send a completed HSA4 form

Question 4

List the criteria according to section 1 of the Abortion Act of 1967 that determine whether an abortion can be carried out.

Answer 4

2 doctors must agree that one of the following apply:

1a: Under 24 weeks, the risk of injury to the physical or mental health of the mother or her existing children with continuation is greater than the risk of abortion
1b: Abortion is necessary to avoid grave permanent injury regarding the physical or mental health of the mother
1c: The risk to the mother’s life with continuation is greater than the risk of abortion
1d: There is substantial risk that the child would suffer from abnormalities as to be severely handicapped

Question 5

Describe the process of medical abortion.

Answer 5

1 - Oral mifepristone is taken in clinic (basically lots of oestrogen) that blocks the hormonal cascade for continuation of pregnancy

2 - Oral misoprostol is taken once a day for 3 days afterwards to promote the expulsion of the uterine contents

Question 6

Describe the process of surgical abortion.

Answer 6

• If <12 weeks gestation, suction alone is sufficient

- If >12 gestation, cervical dilation + suction is done

Question 7

List the procedures involved in conscientious objection in practice.

Answer 7

• Tell the patient you do not provide the particular treatment/procedure without causing distress or implying any judgement of the patient
• Tell the patient they have a right to see another doctor
• Make sure patient has enough info to arrange to see another doctor

Question 8

What is the limit of conscientious objection?

Answer 8

In an emergency, a doctor cannot refuse treatment that is necessary to save a life

Question 9

List 2 factors that must balance autonomy of the healthcare professional and ability to conscientiously object.

Answer 9

Autonomy of HCP (right to personal beliefs) vs justice within systems (resource management & impact on colleagues)