Ethical decision-making in prenatal diagnosis and termination of pregnancy: a qualitative survey among physicians and midwives.
OBJECTIVE
This study was aimed at exploring the conflicts and ethical problems experienced by professionals involved in prenatal diagnosis and termination of pregnancy (TOP) in order to improve the understanding of decision-making processes and medical practices in the field of prenatal diagnosis.


METHODS
Qualitative study with in-depth tape-recorded interviews conducted in three tertiary care maternity units in France, between May 1999 and March 2000. All full-time obstetricians and half of the full-time midwives were contacted. Seventeen obstetricians and 30 midwives participated (three refusals, five missing). Interviews were transcribed and analysed successively by two different researchers.


RESULTS
All respondents stated that prenatal diagnosis and TOP raised important ethical dilemmas, the most frequent being request for abortion in case of minor anomalies. They pointed out the inability of our society to appropriately care for disabled children and the risk of eugenic pressures. The decisions and practices in prenatal diagnosis should be debated throughout society. All respondents reported that their unit did not have protocols for deciding when a TOP was justifiable. The transmission of information to the women appeared to be a problematic area. Moral conflicts and emotional distress were frequently expressed, especially by midwives who mentioned the need for more discussions and support groups in their department.


CONCLUSIONS
Health professionals involved in prenatal diagnosis face complex ethical dilemmas which raise important personal conflicts. A need for more resources for counselling women and for open debate about the consequences of the current practices clearly emerged.
Garel
M
M
Epidemiological Research Unit on Women and Children's Health, INSERM U 149, 16 avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France. garel@vjf.inserm.fr
Gosme-Seguret
S
S
Kaminski
M
M
Cuttini
M
M
D000025:Abortion, Eugenic / Q000941:ethics*; D000028:Abortion, Induced / Q000941:ethics*; D000328:Adult; D001291:Attitude of Health Personnel; D003625:Data Collection; D003657:Decision Making / Q000941:ethics; D004992:Ethics, Medical; D004995:Ethics, Professional; D005260:Female; D005602:France; D006801:Humans; D033181:Information Dissemination / Q000941:ethics; D008880:Midwifery / Q000941:ethics*; D009774:Obstetrics / Q000941:ethics*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000941:ethics*