Termination of pregnancy for non-lethal fetal anomaly : professional perspectives

Abstract

The topic of termination of pregnancy continues to attract extensive debate in both the public arena and in the academy. Debates about termination of pregnancy for fetal anomaly (TOPFA) in particular take place against this backdrop. Social science analyses of the views of medical professional providers of TOPFA are underdeveloped, and social care professionals (who care for those living with disability) are an under represented group in research more generally. In this contentious area of public policy, the insights could make an important contribution to the on-going policy debates. Using a mixed methods approach, this thesis explores the views about the acceptability of TOPFA from the perspective of two professional groups: medical professionals and social care professionals. Four case studies were used to form a basis for the exploration, and these were selected for intrinsic exploratory value. An epidemiological overview of TOPFA acceptance rates from six areas of the UK was used to help inform the case study selection process. Data collection from professionals by questionnaires and semi-structured interviews followed. The questionnaire data suggest that the views between the professional groups were not radically different. The thematic analysis of the interview data generated two themes: theme one conceptualises the imagined child; theme two conceptualises the predicted experiences of the imagined child. When comparing the accounts given by the two professional groups, the data suggest that social care professionals also look at the wider social context of a person with an impairment when discussing their views regarding TOPFA. Medical professionals focus more on the individual impairment when discussing their views on TOPFA. Whether an anomaly can be ‘fixed’, what pain is associated with the particular anomaly, whether a normal life experience will be had were all considered against what professionals deemed a ‘morally acceptable’ outcome. Acceptable TOPFA was based on what was morally acceptable to professionals both in their professional roles, and within a personal capacity. These findings show professionals are able to negotiate acceptable TOPFA in at least some instances while maintaining a sense of moral self. This research adds support to existing arguments on the extent to which the personal views of medical professionals influence their practices. It also offers insight into a previously under researched group, social care professionals. The mixed methods and interdisciplinary approach has been crucial in providing a productive framework within which to explore the concept of acceptable TOPFA from the perspectives of professionals.