| Summary of findings
Terms of reference
for inquiry
Scope of Inquiry
Introduction
Review of Australian
and world literature
Oral consultations
and written consultations including submissions from professional bodies
Submissions from
general public
Findings
1. Current practice
in Victoria in major hospitals
- 1.1
Royal Women’s Hospital
- 1.2
Monash Medical Centre
- 1.3
Mercy Hospital for Women
2.
Reasons for late termination
3.
Termination when there is fetal abnormality
4.
Termination for severe illness in the mother
- 4.1
Complications of pregnancy
- 4.2
Primary maternal conditions
5.
Termination for conditions or the fetus that would cause severe illness
to the mother
6.
Termination for psychological or social health of the mother
7.
The methods used for termination
8.
The optimal management of the termination
- 8.1
Pre diagnosis
- 8.2
Post diagnosis - counselling
- 8.3
The care of the mother post-termination
- 8.4
The disposal of fetal remains and the handling of an infant stillborn
- 8.5
Risks of late termination vs first trimester abortion or birth at
term
- 8.6
Guidance for the Medical Profession
Legal
aspects of termination. Victorian Law. International Law.
Training
and the continuity of service
Acknowledgments
References
The report on the ethical issues and practice of late term termination of pregnancy was prepared by the Medical Practitioners Board of Victoria at the request of the Victorian Minister for Health, Mr R Knowles.
In preparing the report, the Board conducted a review of recent scientific, legal, ethical and clinical literature, invited submissions from interested organisations and consulted relevant clinical and professional bodies. In addition it received submissions from the general community in response to a public advertisement.
Summary of findings
- Terminations of pregnancy beyond 20 weeks gestation are performed in the State’s two major obstetric hospitals and carried out for serious fetal abnormality and life threatening maternal illness.
- Terminations of pregnancy beyond 20 weeks for psychosocial reasons may be carried out in the private sector, but the Board received no formal evidence of this, nor if they do take place, with what frequency.
- The Royal Women’s Hospital and Monash Medical Centre provide similar services for termination of pregnancy for severe fetal abnormality. The services are provided by professional teams which include an obstetrician, ultrasonographer, geneticists, nursing staff and counsellors, with additional referral to other specialists. Termination of pregnancy is performed after counselling and on the request of the woman who is fully informed about the fetal abnormality. There is provision of ongoing support.
- The Medical Practitioners Board of Victoria commends the clinical standards set by the Royal Women’s Hospital and Monash Medical Centre. These may be considered to be the minimum standards expected by an institution performing terminations of pregnancy beyond 20 weeks in the state of Victoria.
- Both institutions provide comprehensive care of the mother, encompassing her physical and emotional needs and those of her family, with careful regard for the grieving process and the respectful handling of the delivered fetus.
- There are a number of reasons why termination for fetal abnormality may not be made until late in pregnancy. In some cases it is due to organisational difficulty or delayed diagnosis. In many cases however, a decision could not be made earlier due to the limitations of screening or to deterioration in the fetal state, and the need for time for counselling and for the parents to consider. Women in rural areas may be at a disadvantage due to lack of access to specialist investigation or advice.
- The degree of fetal abnormality leading to termination varies from a condition incompatible with life, to one that would lead to long term disability and dependency.
- The importance of appropriate and timely screening for fetal abnormality by well trained and experienced staff was noted.
- Termination of pregnancy at a late stage may be needed for severe illness of the mother or complications of pregnancy.
- There are two methods that are used in Victoria to terminate pregnancy beyond 20 weeks. These are (i) Induction of labour with prostaglandin and (ii) Dilatation and evacuation after cervical preparation with prostaglandin. Both procedures are considered safe when carried out by experienced and well-trained professionals.
- There are a number of factors that may influence the decision as to which method should be used, including the mother’s preference, the need to obtain an intact fetus for examination to enable genetic counselling, and the state of the pregnancy.
- In late term termination of pregnancy in particular, provision of counselling and support of the mother is essential. Disposal of the fetal remains and the handling of the stillborn infant should be made with respect and according to the wishes of the parents.
- Although Victorian law does not recognise fetal abnormality as an indication for performing termination of pregnancy, such terminations performed at the two major institutions in Victoria are carried out on the grounds of being necessary to preserve the woman from a serious danger to her physical or mental health.
- It is unlikely that the ethical and moral issues related to late term termination can be resolved in view of the strongly held and widely diverse views of individuals and organisations within the community.
- The Medical Practitioners Board of Victoria considers that if late term termination of pregnancy is to be carried out, it should be done in accordance with best clinical practice. The Board intends to issue guidelines for best clinical practice to the medical profession, based on findings outlined in Section 8, ‘The optimal management of the termination’ on page 40 in this report.
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