Investigating the views and experiences of Fetal Medicine Practitioners offering late termination of pregnancy in the Western Cape

Master Thesis


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Introduction: Fetal medicine practitioners (FMPs) are responsible for making decisions about the appropriateness of a late termination of pregnancy (LTOP) based on their assessment of the severity of the prenatal diagnosis while also taking into account the practical, legal and ethical aspects. This study aimed to investigate the views and experiences of FMPs involved in LTOP decision-making in the Western Cape and how these views may guide decisions to offer LTOP. Specifically, the research questions guiding this study aimed to investigate FMPs views on the Choice on Termination of Pregnancy Act (CTOPA), No. 92 of 1996, as well as their attitudes towards the provision and ethics of LTOP. Methodology: A total of six semi-structured, individual face-to-face interviews were conducted between February and March 2020 in the privacy of the participant's office. All interviews were audio-recorded and transcribed. Interpretive phenomenological analysis was used as a framework to analyse the data and transcripts were managed using NVivo 12 software. Results and Discussion: Participants believed that the CTOPA is based on the principle of gradualism and that while women have reproductive choice, TOP becomes progressively restricted as gestation advances to protect the fetus. However, they felt that the specified cut-offs in the CTOPA are arbitrary and open to interpretation and believed there is a need for further documentation to guide practitioners as to which conditions should be considered for LTOP. When making a decision to offer LTOP, participants considered various factors including fetal age, whether a feticide was required and the prognosis. Participants considered that conditions which qualified as severe were untreatable and would have a significant, long-term negative impact on the individual's functioning and quality of life. When considering acceptability of LTOP, participants felt that LTOP was justified to prevent suffering for both the future child and for the parents. However, participants did not believe that LTOP was justified to prevent all disability. Lastly, participants valued societal consensus when making morally demanding decisions and believed that decisions around LTOP needed to be made by multidisciplinary teams to ensure objectivity, as well as to share the moral burden.