女性的幸福是一个空洞的宣言?在访问的挑战定性探索终止妊娠由于胎儿异常在德国。

IF 3 1区 哲学 Q1 ETHICS
Tamar Nov-Klaiman, Hilary Bowman-Smart, Ruth Horn
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引用次数: 0

摘要

背景:通过公共资助的卫生保健系统提供产前检测,包括非侵入性产前检测(NIPT),在支持生殖自主和知情选择的基础上经常是合理的。这包括围绕终止妊娠(TOP)的决策,包括由于胎儿异常诊断(TOPFA)而终止妊娠的决策。在德国,TOP受刑法管制。但是,如果在怀孕后12周(妊娠14周)内根据妇女的要求并经过强制性咨询,则可以免除处罚。在这个妊娠阶段之后,如果有必要,可以提供TOP,以确保孕妇的身心健康。然而,对于如何解释和应用这一标准,人们明显缺乏明确的认识。胎儿异常通常在要求进行TOP的时间限制过后才被发现或确认,这就带来了胎儿指征是否证明合法使用TOP的不确定性。方法:本研究探讨了对TOP的态度,决策和获取的经验,以及德国法律和监管框架的影响。它借鉴了一项定性半结构化访谈研究,该研究在2021年至2022年间进行。与会者有20名在提供NIPT方面有经验或专门知识的德国专业人员,以及7名有怀孕、生殖决策和提供NIPT经验的妇女。访谈以德语进行,然后进行转录、翻译,并使用主题分析进行分析。结果:参与者探讨了能够获得TOPFA的重要性;TOP作为禁忌程序的社会定位如何对TOPFA的获取造成实际和心理障碍;最终谁来决定是否提供TOP的紧张感;以及妊娠时间限制如何造成情绪压力,阻碍明智的决策和生育自主权。结论:我们的研究结果强调,在没有保证获得TOP的情况下提供产前检测,妇女的福祉成为德国医疗保健政策中的空洞宣言。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Women's wellbeing as an empty declaration? A qualitative exploration of challenges in accessing termination of pregnancy due to fetal anomaly in Germany.

Background: The provision of prenatal testing through publicly funded healthcare systems, including non-invasive prenatal testing (NIPT), is frequently justified on the basis of supporting reproductive autonomy and informed choice. This includes decision-making around termination of pregnancy (TOP), including where it is due to a diagnosis of fetal anomaly (TOPFA). In Germany, TOP is regulated under the criminal code. However, it is exempt from punishment, if provided upon request from the woman up to 12 weeks after conception (14 weeks gestation) and following mandatory counselling. After this gestational stage, TOP may be provided where it is necessary to ensure the physical and mental wellbeing of the pregnant woman. However, there is a significant lack of clarity about how to interpret and apply this criterion. Fetal anomaly is often detected or confirmed after the time limit for TOP upon request has passed, which introduces uncertainty whether a fetal indication justifies legal access to TOP.

Methods: This study explores attitudes towards TOP, experiences with decision-making and access, and the implications of the German legal and regulatory frameworks. It draws on a qualitative semi-structured interview study, conducted between 2021 and 2022. Participants were 20 German professionals who have experience or expertise regarding the provision of NIPT, as well as 7 women with experiences of pregnancy, reproductive decision-making and the offer of NIPT. Interviews were conducted in German, and then transcribed, translated, and analysed using thematic analysis.

Results: Participants explored the importance of being able to access TOPFA; how the social positioning of TOP as a taboo procedure creates practical and psychosocial barriers to TOPFA access; the tension of who ultimately gets to make the decision about whether TOP can be provided; and how gestational time limits create emotional stress, frustrating informed decision-making and reproductive autonomy.

Conclusions: Our findings highlight that where prenatal testing is provided in the absence of guaranteed access to TOP, women's wellbeing becomes an empty declaration in German healthcare policy.

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来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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