Abortion

Question 1

What is the legal criteria to get an abortion?

Answer 1

• The pregnancy has not exceed 24^th week and the continuance of the pregnancy would involved risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman

Question 2

What are the ethical issues around abortion?

Answer 2

• Woman’s rights vs foetus future rights
• Right to autonomy
  
  • Ethically patient should make their own decision, but legally that decision is made by a doctor
• Beneficence and non-malfeasance
  
  • Important she is given support and ability to make her decision
  • Safe options for abortion

Question 3

Scenario - 15 year old wants an abortion, what are some ethical/legal issues?

Answer 3

• Can she consent to intercourse
  
  • Sex under 16 is unlawful, but 13-15 year olds who have consensual sex with someone of similar age are not prosecuted as would be more harmful
• Does she have capacity to consent to treatment
• Is she at risk of exploitation

Question 4

Scenario - 15 year old wants an abortion, what are some important questions?

Answer 4

• How old is boyfriend
• Was she being forced
• Who has she told
• What support does she have

Question 5

Scenario - 15 year old wants an abortion, what framework is used to assess competency to consent to treatment?

Answer 5

• Fraser Guidelines, Gillick Competence
• Lord Fraser states that a doctor could proceed to give contraceptive advice and treatment to a girl under 16 provide he is satisfied on the following matters
  
  • Girl understands advice
  • He cannot persuade her to inform parents or inform the parents himself
  • She is likely to have sexual intercourse with or without contraceptive treatments
  • Physical or mental health will suffer without advice
  • Her best interest

Question 6

What are the different abortion options?

Answer 6

• Medical
  
  • Early medical termination of pregnancy
    
    • Can be done at home allowing more privacy
    • Risks include heavy bleeding, incomplete procedure, GI upset
• Surgical
  
  • Surgical termination of pregnancy under general anaesthetic/manual vacuum aspiration under local anaesthetic
    
    • Less risk, shorter post-procedure bleeding
    • Can fit intrauterine contraception immediately
    • LA has shorter recovery time but GA is pain free
    • Risks are uterine perforation/cervical damage

Question 7

What is an advantage and a risk of a medical abortion?

Answer 7

Advantage - can be done at home allowing more privacy

Risk - heavy bleeding, incomplete procedure, GI upset

Question 8

What is an advantage and a risk of a surgical abortion?

Answer 8

Advantage - can fit intrauterine contraception immediately

Risk - uterine perforation/cervical damage

Question 9

Can doctors refuse to see patients who want an abortion if they do not ethically agree with it?

Answer 9

Doctor cannot refuse to see patient is it is not partaking in abortion treatment, rather acute medical care

Question 10

What is the GMC guidance to conscientious objection?

Answer 10

• Must explain to patients have conscientious objection to procedure
• Give them information to exercise right to see another doctor
• Not express disapproval of patients lifestyle
• If not practical to see another doctor must make sure arrangements are made for another qualified colleague to take over your role