Healthcare professionals' attitudes towards termination of pregnancy at viable stage

INTRODUCTION: Upon prenatal diagnosis of congenital malformations, termination of pregnancy (TOP) may be an option, sometimes when the foetus is already viable (late TOP). This study aims to study attitudes towards late TOP of all tertiary healthcare professionals involved in late TOP practice.

MATERIAL AND METHODS: Mail survey among all physicians and paramedical professionals involved in late TOP decision-making in all eight centres with a Neonatal Intensive Care Unit in Flanders, Belgium (N=117). The questionnaire contained general and case-based attitude items.

RESULTS: Response rate was 79%. Respondents were either physicians (51,1%) or paramedical professionals (49,9%). The composition of professionals involved in late TOP decision-making was very heterogeneous between the eight centres. Late TOP is highly accepted in both lethal foetal conditions (100%) and serious (but not lethal) foetal conditions (95.6%). Where the foetus is healthy, 19.8% of respondents agrees with late TOP for maternal psychological problems and fewer respondents (13.2%) agree with late TOP in case of maternal socio-economic problems (p=0.002). Physicians more often prefer foeticide over neonatal palliative care in case of non-lethal foetal conditions compared to paramedical professionals (68.1% vs 53.2%, p=0.013). Almost nine out of ten respondents (89.1%) agree that in the event of a serious (non-lethal) neonatal condition, administering drugs with the explicit intention to end neonatal life is acceptable. Behavioural intentions indicate that even in situations with an unclear diagnosis and unpredictable prognosis, 85.6% of professionals would still consider late TOP.

CONCLUSIONS: Healthcare professionals practicing late TOP in Flanders, Belgium have a high degree of tolerance towards late TOP, irrespective of sociodemographic factors, and are in demand of legislative change regarding active life-ending in the foetal and neonatal period. Further research should explore correlation of attitudes to late TOP with actual medical decisions taken in daily clinical practice.