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AN ETHICAL EVALUATION OF THE DECISION TO TERMINATE THE PREGNANCY FOR MEDICAL REASONS

Year 2023, Volume: 10 Issue: 3, 85 - 95, 26.09.2023

Abstract

Introduction: The termination of pregnancy, on which no consensus has been reached yet, is a complex and controversial topic within the realm of medical ethics. This issue involves a range of ethical, moral, religious, and societal considerations, and opinions on this matter can vary widely. In addition to developing situation-specific ethical dilemmas/conflicts between the pregnant woman and the fetus, family and health professionals are also involved. The ethical dilemmas and the close importance of conflicting values in the termination of pregnancy complicate the “ethical decision-making” process. In this challenging process, institutional, central and environmental factors and ethical problems that affect attitudes are multi-factorial.
Purpose: The study aims to determine the ethical problems encountered in the decision-making process regarding the termination of pregnancy for medical reasons and the factors affecting the decision.
Materials and Methods: PubMed (including MEDLINE) and Google Scholar electronic databases constituted the primary material of this research, which was conducted between January 01, 2015 and December 31, 2021, with the descriptive content analysis method.
From these databases, attitude studies including all the terms "termination of pregnancy", "decision-making process", "medical ethics", and at least one of the terms "fetal anomaly", "ethics consultation", "counseling service" in Turkish or English were included in the study. Thirty-eight of the studies published between January 1972 and December 2021, including the relevant terms in the text of the article, were studied. The articles were classified methodologically and evaluated under three thematic headings: institutional structures that are effective in the decision-making process, central and environmental factors that are effective in the decision-making process, and ethical problems encountered in the decision-making process.
Results: The majority of the authors of the 38 articles included in the study are from women's health. 39.4% of the articles were published between 2011 and 2021, and 55.2% were conducted in Europe. The data collection method is a multiple-choice survey in 28 articles. In 50% of the studies, the sample group was composed of physicians, and in 28.9%, different groups, such as physicians, midwives, nurses, students, and social workers. All the studies focused on effective institutional structures in deciding to terminate the pregnancy. In 97.3% of the studies, central and environmental factors that are effective in the decision-making process were discussed, and in all of these studies, prenatal diagnosis test results, fetal causes in 68.4% and health problems of pregnant women in 26.3% were emphasized. Ethical problems encountered in the decision-making process were reported in 68.4% of the studies. The value of life and quality of life were emphasized in 68.4% of 38 studies, maternal-fetal rights conflict in 57.8%, social benefit in 26.3%, and discrimination and eugenics problems in 13.1%.
Conclusion: According to the findings of our study, it is seen that the results of prenatal diagnosis tests are effective in the decision-making process of termination of pregnancy, the function of institutional structures providing prenatal counseling or ethical counseling services is emphasized, and ethical problems arising from this process generally arise in the context of maternal-fetal rights conflicts. Other ethical issues more frequently emphasized in the attitude studies we have examined are the value of life, quality of life and social benefit. Although these are fundamentally critical ethical issues, the relatively little treatment of discrimination and eugenics raises concerns that these issues can be ignored.

References

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  • Francome C, Freeman E. British General Practitioners’ attitudes toward abortion. Family Planning Perspectives, 2000; 32 (4): 189-191.
  • Crowe L, Graham RH, Robson SC, Rankin J. Negotiating acceptable termination of pregnancy for non-lethal fetal anomaly: A qualitative study of professional perspectives. BMJ Open, 2018; 8 (3): e020815.
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  • Karimi M, Bonyadi M, Galehdari MR, Zareifar S. Termination of pregnancy due to Thalassemia major, Hemophilia and Down’s Syndrome: the views of Iranian physicians. BMC Medical Ethics, 2008; 9: 19.
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Etik Açıdan Gebeliğin Tıbbi Nedenlerle Sonlandırılması Kararı Üzerine Bir Değerlendirme

Year 2023, Volume: 10 Issue: 3, 85 - 95, 26.09.2023

Abstract

Giriş: Tıp etiği disiplininin, üzerinde halen uzlaşmaya varılamayan ve güncel tartışmalarının odağında yer alan, etik ikilemlerin yaşandığı konularından biri de gebeliğin sonlandırılmasıdır. Duruma özgü etik ikilemler/çatışmalar gebe kadın ile fetusun arasında gelişmesinin yanında, aile ve sağlık çalışanları da sürece dahil olurlar. Gebeliğin sonlandırılmasındaki etik ikilemler ve çatışan değerlerin yakın önemde olması “etik karar verme” sürecini zorlaştırır. Bu zorlu süreçte tutumları etkiyen kurumsal, merkezi ve çevresel faktörler ile karşılaşılan etik sorunlar çok unsurludur.
Amaç: Araştırmanın amacı, gebeliğin tıbbi nedenlerle sonlandırılmasına ilişkin karar verme sürecinde karşılaşılan etik sorunların ve sonlandırma kararını etkileyen unsurların belirlenmesidir.
Gereç ve Yöntem: Betimsel içerik analizi yöntemi ile 01 Ocak 2015 ile 31 Aralık 2021 tarihleri arasında yürütülen bu araştırmanın ana materyalini PubMed (MEDLINE dahil) ile Google Scholar elektronik veri tabanları oluşturmuştur.
Bu veri tabanlarından, Türkçe veya İngilizce “gebeliğin sonlandırılması”, “karar verme süreci”, “tıp etiği” terimlerinden tümünü ve “fetal anomali”, “etik konsültasyon”, “danışmanlık hizmeti” terimlerinden en az birini içeren tutum araştırmaları çalışmaya dahil edilmiştir. Makale metni içinde ilgili terimleri içeren ve Ocak 1972-Aralık 2021 yılları arasında yayımlanan araştırmalarından 38’i üzerinde çalışılmıştır. Makaleler metodolojik olarak sınıflandırılmış ve karar verme sürecinde etkili olan kurumsal yapılanmalar, karar verme sürecinde etkili olan merkezi ve çevresel faktörler, karar verme sürecinde karşılaşılan etik sorunlar olmak üzere üç tematik başlık altında değerlendirilmiştir.
Bulgular: Çalışmaya dahil edilen 38 makalenin yazarlarının büyük çoğunluğu kadın sağlığı alanındandır. Makalelerin %39,4’ü 2011-2021 yılları arasında yayımlanmış ve %55,2’si Avrupa kıtasında yürütülmüştür. Veri toplama yöntemi 28 makalede çoktan seçmeli ankettir. Derinlemesine görüşme ve odak grup görüşmesi tekniklerinin 2002 yılından sonra daha yaygın uygulandığı görülmüştür. Araştırmaların %50’sinde örneklem grubu hekimler, %28,9’unda hekimler, ebe, hemşire, öğrenci, sosyal hizmet uzmanı gibi farklı gruplardan oluşturulmuştur. Araştırmaların tamamında gebeliğin sonlandırılması kararının verilmesi sürecinde etkili kurumsal yapılanmalara odaklanılmıştır. Araştırmaların %97,3’ünde karar verme sürecinde etkili olan merkezi ve çevresel faktörlerin ele alındığı ve bu çalışmaların tamamında prenatal tanı testi sonuçlarına, %68,4’ünde fetusa ait nedenlere %26,3’ünde gebe kadına ait sağlık sorunlarına ağırlık verildiği belirlenmiştir. Araştırmaların %68,4’ünde karar verme sürecinde karşılaşılan etik sorunlar bildirilmiştir. Otuz sekiz araştırmanın %68,4’ünde hayatın değeri ve yaşam kalitesi, %57,8’inde maternal-fetal hak çatışması, %26,3’ünde toplumsal yarar, %13,1’inde ayrımcılık ve öjeni sorunları üzerinde durulmuştur.
Sonuç: Çalışmamızın bulgularına göre gebeliğin sonlandırılması karar verme sürecinde prenatal tanı testi sonuçlarının etkili olduğu; prenatal danışmanlık veya etik danışmanlık hizmeti veren kurumsal yapıların işlevine dikkat çekildiği ve bu süreçten kaynaklanan etik sorunların genellikle maternal-fetal hak çatışmaları bağlamında ortaya çıktığı görülmektedir. İncelediğimiz tutum araştırmalarında, üzerinde daha sık durulan öteki etik sorunlar hayatın değeri, yaşam kalitesi ve toplumsal yarardır. Araştırmalarda, temelde önemli birer etik sorun olmakla birlikte, ayrımcılık ve öjeninin nispeten daha az ele alınması, bu sorunların göz ardı edilebileceği kaygısını uyandırmaktadır.

References

  • Dickenson LD. Ethical Issues in Maternal-Fetal Medicine. Cambridge: The Press Syndicate of the University of Cambridge, 2002.
  • Köker İ. Kadın Hastalıkları ve Doğum Temel Bilgileri. Adana: Nobel Tıp Kitapevleri, 2006.
  • Burkman RT. Kontrasepsiyon ve Aile Planlaması. Editörler: Decherney AH, Nathan L, Goodwin TM, Laufer N. Çeviren: Eren S, Ayas S. Çeviri Editörü: Tıraş BM. Lange Tıp Kitapları “Current Diagnosis And Treatment” Serisi, Güncel Obstetrik ve Jinekoloji Tanı ve Tedavi. 10. Baskı, Ankara: Güneş Tıp Kitapevleri, 2010: 579-597.
  • Sert G. Vakalarla Türkiye’de Üreme Hakları. İstanbul: İnsan Kaynağını Geliştirme Vakfı, 2012.
  • WMA Declaration on Therapeutic Abortion. Oslo, 1970, 1983, 2006, 2018. Erişim: (https://www.wma.net/policies-post/wma-declaration-on-therapeutic-abortion/). Erişim Tarihi: 22.09.2022.
  • Beauchamp LT, Childress FJ. Principles of Biomedical Ethics. Fourth Edition, Oxford University Press, 1994.
  • Varol FG. Prenatal Tanıda Etik ve Yasal Boyut. Editörler: Beksaç S, Akipek Öcal Ş, Katoğlu T, Şenocak Z, Şuğle MA. Doğum Hekimliği, Maternal-Fetal Tıpta Etik ve Yasal Boyut. Ankara: Medikal Network, 2004: 206-209.
  • Çorbacıoğlu Esmer A, Yüksel A. Prenatal Tanı Sonrası Gebeliklerin Sonlandırılması ve Yasal Durum. Türkiye Halk Sağlığı Dergisi, 2011; 10 (Özel sayı Düşükler): 83-93.
  • Okuyaz S. Etik Açıdan Gebeliğin İkinci Trimestr ve Sonrasında Sonlandırılması Kararı: Doğum ve Çocuk Hekimlerinin Tutumlarına İlişkin Bir Araştırma ile Birlikte. Danışman: Funda Gülay Kadıoğlu. Çukurova Üniversitesi Sağlık Bilimleri Enstitüsü Tıp Tarihi ve Etik Anabilim Dalı Doktora Tezi. Adana: 2017.
  • Yüksel AN. Nitel Bir Araştırma Tekniği Olarak: Görüşme. Social Sciences Studies Journal (SSSJournal) 2020; 56: 547-552.
  • Baltacı, A. Nitel araştırma süreci: Nitel bir araştırma nasıl yapılır. Ahi Evran Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 2019, 5 (2): 368-388.
  • Statham H, Solomou W, Green J. Late termination of pregnancy: law, policy and decision making in four English fetal medicine units. BJOG An International Journal of Obstetrics and Gynaecology, 2006;113:1402-1411.
  • Kadıoğlu FG, Can R, Okuyaz S, Öner Yalçın S, Kadıoğlu NS. Physicians’ attitudes toward clinical ethics consultation: a research study from Turkey. Turkish Journal of Medical Sciences, 2011; 41(6): 1081-1090.
  • Doğan H, Şahinoğlu S. Fetuses with neural tube defects: ethical approaches and the role of health care professionals in Turkish health care institutions. Nursing Ethics, 2005;12 (1): 59-78.
  • Rebagliato M, Cuttini M, Broggin L, Berbik I, Vonderweid U, Hansen G, Kaminski M, Kollee LAA, Kucinskas A, Lenoir S, Levin A, Persson J, Reid M, Saracci R for the EURONIC Study Group. Neonatal end-of-life decision making physicians’ attitudes and relationship with self-reported practices in 10 European Countries. JAMA, 2000; 284 (19): 2451-2459.
  • Carnevale A, Lisker R, Villa AR, Casanueva E, Alonso E. Counselling following diagnosis of a fetal abnormality: comparison of different clinical specialists in Mexico. Am J Med Genet, 1997; 69 (1): 23-28.
  • Marteau T, Drake H, Bobrow M. Counselling following diagnosis of a fetal abnormality: the differing approaches of obstetricians, clinical geneticists, and genetic nurses. J Med Genet, 1994; 31: 864-867.
  • Norup M. Attitudes towards abortion among physicians working at obstetrical and paediatric departments in Denmark. Prenatal Diagnosis, 1998; 18: 273-280.
  • Rimon-Zarfaty N, Jotkowitz A. The Israeli abortion committees’ process of decision making: an ethical analysis. J Med Ethics, 2012; 38: 26-30.
  • Biomedical and Health Research Programme (BIOMED 2). Developments of perinatal technology and ethical decision-making during pregnancy and birth: The Obstetricians’ perspective (EUROBS project) Final Report: Part B, 2002.
  • CMA abortion survey. Can Med Assoc J, 1983; 129 (3): 261-272.
  • Black KI, Douglas H, de Costa C. Women's access to abortion after 20 weeks' gestation for fetal chromosomal abnormalities: Views and experiences of doctors in New South Wales and Queensland. Aust NZJ Obstet Gynaecol, 2015; 55 (2):144-148.
  • Francome C, Freeman E. British General Practitioners’ attitudes toward abortion. Family Planning Perspectives, 2000; 32 (4): 189-191.
  • Crowe L, Graham RH, Robson SC, Rankin J. Negotiating acceptable termination of pregnancy for non-lethal fetal anomaly: A qualitative study of professional perspectives. BMJ Open, 2018; 8 (3): e020815.
  • Zaręba K, La Rosa VL, Kołb-Sielecka E, Ciebiera M, Ragusa R, Gierus J, Commodari E, Jakiel G. Attitudes and opinions of young gynecologists on pregnancy termination: results of a cross-sectional survey in Poland. International Journal of Environmental Research and Public Health, 2020; 17 (11): 3895.
  • Garel M, Etienne E, Blondel B, Dommergues M. French midwives’ practice of termination of pregnancy for fetal abnormality. At what psychological and ethical cost. Prenat Diagn, 2007; 27: 622–628
  • Macer DRJ. Ethics and prenatal diagnosis. Genetic Disorders and the Fetus: Diagnosis, Prevention and Treatment. Baltimore: John Hopkins University Press, 1998: 999-1024.
  • Drake H, Reid M, Marteau T. Attitudes towards termination for fetal abnormality: Comparisons in three European countries. Clin Genet, 1996; 49:134-140.
  • De Silva DC, Jayawardana P, Hapangama A, Suraweera EGDN, Ranjani D, Fernando S, Karunasena C, Jinadasa S. Attitudes toward prenatal diagnosis and termination of pregnancy for genetic disorders among healthcare workers in a selected setting in Sri Lanka. Prenatal Diagnosis, 2008; 28: 715-721.
  • Karimi M, Bonyadi M, Galehdari MR, Zareifar S. Termination of pregnancy due to Thalassemia major, Hemophilia and Down’s Syndrome: the views of Iranian physicians. BMC Medical Ethics, 2008; 9: 19.
  • Szymanska M, Knapp P. Opinions of gynaecologists on prenatal diagnostics in first/second trimester and abortion--ethical aspect. Advances in Medical Sciences, 2007; 52: 182-185.
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There are 61 citations in total.

Details

Primary Language Turkish
Subjects Health Services and Systems (Other)
Journal Section ARAŞTIRMA MAKALESİ
Authors

Selda Okuyaz 0000-0002-5048-8679

Funda Gülay Kadıoğlu 0000-0001-6199-0739

Publication Date September 26, 2023
Published in Issue Year 2023 Volume: 10 Issue: 3

Cite

Vancouver Okuyaz S, Kadıoğlu FG. Etik Açıdan Gebeliğin Tıbbi Nedenlerle Sonlandırılması Kararı Üzerine Bir Değerlendirme. TJOB. 2023;10(3):85-9.