‘The tabloid test’: a qualitative interview study on the function and purpose of termination of pregnancy review committees in Victoria, Australia

Reproductive Health

Research

Casey M. Haining¹  Louise Keogh¹  Lachlan de Crespigny²  Anne O’Rourke³  Hilary Bowman-Smart⁴  Julian Savulescu⁵ 

[1] Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia;Medicine, Dentistry and Health Sciences, University of Melbourne, 3052, Parkville, VIC, Australia;Monash Business School, Monash University, Clayton, VIC, Australia;Murdoch Children’s Research Institute, 50 Flemington Rd, 3052, Parkville, VIC, Australia;Monash Bioethics Centre, Monash University, Clayton, VIC, Australia;Ethox Centre, University of Oxford, Oxford, UK;Australian Centre for Precision Health, University of South Australia, Adelaide, Australia;Murdoch Children’s Research Institute, 50 Flemington Rd, 3052, Parkville, VIC, Australia;Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK;Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;

关键词: Reproductive healthcare;    Termination of pregnancy;    Abortion;    Qualitative research;    Australia;   

DOI  :  10.1186/s12978-023-01624-w

 received in 2021-12-24, accepted in 2023-05-17,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundTermination of pregnancy (TOP) is not an uncommon procedure. Availability varies greatly between jurisdictions; however, additional institutional processes beyond legislation can also impact care and service delivery. This study serves to examine the role institutional processes can play in the delivery of TOP services, in a jurisdiction where TOP is lawful at all gestations (Victoria, Australia). As per the Abortion Law Reform Act 2008, TOPs post-24 weeks require the approval of two medical practitioners. However, in Victoria, hospitals that offer post-24 week TOPs generally require these cases to additionally go before a termination review committee for assessment prior to the service being provided. These committees are not stipulated in legislation. Information about these committees and how they operate is scarce and there is minimal information available to the public.MethodsTo trace the history, function, and decision-making processes of these committees, we conducted a qualitative interview study. We interviewed 27 healthcare professionals involved with these committees. We used purposive sampling to gain perspectives from a range of professions across 10 hospitals. Interviews were transcribed verbatim, identifying details removed and inductive thematic analysis was performed.ResultsHere, we report the three main functions of the committees as described by participants. The functions were to protect: (1) outward appearances; (2) inward functionality; and/or, (3) service users. Function (1) could mean protecting the hospital’s reputation, with the “Herald Sun test”—whether the TOP would be acceptable to readers of the Herald Sun, a tabloid newspaper—used as a heuristic. Function (2) related to logistics within the hospital and protecting the psychological wellbeing and personal reputation of healthcare professionals. The final function (3) related to ensuring patients received a high standard of care.ConclusionsThe primary functions of these committees appear to be about protecting hospitals and clinicians within a context where these procedures are controversial and stigmatized. The results of this study provide further clarity on the processes involved in the provision of TOPs at later gestations from the perspectives of the healthcare professionals involved. Institutional processes beyond those required by legislation are put in place by hospitals. These findings highlight the additional challenges faced by patients and their providers when seeking TOP at later gestations.

【 授权许可】

CC BY   
© The Author(s) 2023