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Does professional orientation predict ethical sensitivities? Attitudes of paediatric and obstetric specialists toward fetuses, pregnant women and pregnancy termination
  1. Stephen D Brown1,
  2. Karen Donelan2,
  3. Yolanda Martins3,
  4. Sadath A Sayeed4,5,
  5. Christine Mitchell5,6,
  6. Terry L Buchmiller7,
  7. Kelly Burmeister3,
  8. Jeffrey L Ecker8
  1. 1Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
  2. 2Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
  4. 4Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  5. 5Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts, USA
  6. 6Office of Ethics, Boston Children's Hospital, Boston, Massachusetts, USA
  7. 7Department of Surgery, Advanced Fetal Care Center, Boston Children's Hospital, Boston, Massachusetts, USA
  8. 8Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Stephen Brown, Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA; stephen.brown{at}childrens.harvard.edu

Abstract

Background To determine (1) whether fetal care paediatric (FCP) and maternal–fetal medicine (MFM) specialists harbour differing attitudes about pregnancy termination for congenital fetal conditions, their perceived responsibilities to pregnant women and fetuses, and the fetus as a patient and (2) whether self-perceived primary responsibilities to fetuses and women and views about the fetus as a patient are associated with attitudes about clinical care.

Methods Mail survey of 434 MFM and FCP specialists (response rates 60.9% and 54.2%, respectively).

Results MFMs were more likely than FCPs to disagree with these statements (all p values<0.005): (1) ‘the presence of a fetal abnormality is not an appropriate reason for a couple to consider pregnancy termination’ (MFM : FCP—78.4% vs 63.5%); (2) ‘the effects that a child born with disabilities might have on marital and family relationships is not an appropriate reason for a couple to consider pregnancy termination’ (MFM : FCP—80.5% vs 70.2%); and (3) ‘the cost of healthcare for the future child is not an appropriate reason for a couple to consider pregnancy termination’ (MFM : FCP—73.5% vs 55.9%). 65% MFMs versus 47% FCPs disagreed that their professional responsibility is to focus primarily on fetal well-being (p<0.01). Specialists did not differ regarding the fetus as a separate patient. Responses about self-perceived responsibility to focus on fetal well-being were associated with clinical practice attitudes.

Conclusions Independent of demographic and sociopolitical characteristics, FCPs and MFMs possess divergent ethical sensitivities regarding pregnancy termination, pregnant women and fetuses, which may influence clinical care.

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