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Ethical Issues Arising From The Involvement Of Psychiatrists In Late Termination Of Pregnancy
Dr Kirsty Morris
Background Psychiatrists have a long history of
involvement in advising decision making in termination of pregnancy (TOP)
Prior to liberalization of abortion laws, TOPs were often permitted if the mother’s life was at risk from psychiatric or medical conditions
Once abortion laws were liberalized, the involvement of psychiatrists declined
Legal setting Abortion legislation in all Australian
states was originally based on British law
In 1967 the United Kingdom Abortion Act was passed
Most Australian states then liberalized their laws, although there has been some variability between states
Ethical setting Status of the fetus with regard to
personhood
Conflict of rights
Conflict of duties
Who is the patient?
Relevance of fetal abnormality
Late TOP Originally performed for maternal
medical indications
Late diagnosis – psychosocial factors
Fetal abnormalities
Current roles for the psychiatristEARLY TOP Counselling a patient with an unwanted
pregnancy
Expertise in the area of mental illness and pregnancy
Supporting a patient after diagnosis of
fetal abnormality
Current roles for the psychiatristLate TOP Similar role – Late TOP more emotionally
challenging
Complex medical decision (cf organ transplants)
“Clinical ethicist”
Staff support
Problems A valid contribution to make?
Double agent role
Abuse of power
Diminishment of profession
A valid contribution to make? Difficult to predict suicide No good evidence that carrying a
pregnancy to term will be more harmful than TOP
Patients are assumed to be competent and able to make treatment decisions
Danger of over-identification with patient’s plight
Double agent problem Arises from conflicting responsibilities,
loyalties and goals Psychiatrists are frequently responsible to
parties other than the patient (hospital, family, community, justice system, insurance companies, social security system)
Conflict of interest
Abuse of power Power arises from coercion powers, from the
fact of being a physician and from patient vulnerability
Society gives psychiatrists a role in non-psychiatric decisions based on mental function
Pressure to manipulate diagnosis
Agents of social control: Nazi Germany and former Soviet Union
Diminishment of profession What is psychiatry?
Historical assumption of trust
Fidelity as an important virtue Essential for someone to become a patient Cannot be maintained if acting for another
party
Conclusions Decision to perform a late termination of
pregnancy is a difficult and complex one
Clarity needed regarding society’s views
Need for legal reform?
Psychiatry as a profession needs to consider its position
THE END
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