Practice Dilemma - A request for pregnancy termination

The Dilemma - A young couple comes to see you to discuss an unwanted pregnancy and the possibility of an abortion. You speak to the woman separately and learn that the relationship has recently become 'complicated'. The woman confesses she is not certain that the male partner is the father, as she had recently had sex with another man. How do you handle this situation?

It is essential for the GP’s approach to be non-judgmental when discussing termination of an unwanted pregnancy with a young couple (Photograph: SPL)
It is essential for the GP’s approach to be non-judgmental when discussing termination of an unwanted pregnancy with a young couple (Photograph: SPL)

A GP's response
Dr Chris Hall is a GP in Belfast

It is, of course, essential to respond in a completely non-judgmental fashion.

The essence of the consultation in the first instance is counselling the patient regarding her options in relation to continuing with her pregnancy, or to discuss onward referral for possible termination.

She may be at risk of STIs as she has presumably been having unprotected intercourse with more than one partner. Your duty of confidentiality means that you should not consider informing her companion today that he may be at risk of STIs, rather it is the patient's responsibility to discuss the ramifications of her recent sexual contact with him and this is often best done via contact tracing through a GUM clinic.

One has to suspect that her current relationship has significant challenges ahead, but it is not for me either to judge her for this or to attempt to mediate.

It would seem prudent to arrange a follow-up consultation with her in order to discuss the important matter of long-term contraception.

A medico-legal view
Dr Jim Rodger is head of professional services with the MDDUS

What matters in this situation is the appropriateness of the request to consider a termination of the pregnancy. The GP must look at all of the factors they are required to look at under the Abortion Act to satisfy themselves the request is one they can comply with.

In normal circumstances, the husband or partner would be part of the discussion as to whether a termination is the right way forward.

The fact that the father of this particular fetus may not be the current partner needs to be considered in the future mental health of the mother and any baby. It is a factor, but not the determining factor.

Whether he needs to be involved in the decision to terminate is a matter to be considered by the doctor. The termination and consent to it must be the mother's but the husband or partner would normally be involved. In this situation he should not be excluded but his view may be taken into account because he may very well be the father.

The GP should urge the woman to be open and honest with this man, particularly now she is pregnant.

The GP must also be mindful of the possibility of this woman using termination as a form of contraception and take the opportunity to encourage her to adopt a sensible method of contraception.

The doctor must be careful not to allow personal moral values to influence their handling of this couple and the pregnancy.

A patient's opinion
Alexander Russell-Smith is an expert patient

This is a complex situation in which a variety of social and medical issues need to be considered. The main concern should be the physical and psychological wellbeing of the woman.

I feel that the first duty of the GP should be to understand the reasons for the proposed termination. The woman is likely to be under significant stress and it is therefore essential to make sure she fully understands her decision.

This is a private matter for the woman, and unless she has an express wish to involve the other partners, it must be kept private. Ultimately it will be her decision as to whether she has a termination.

I would arrange for her to attend a second appointment alone. After further discussion, if she still requests a termination of pregnancy, I would provide her with information relating to the different methods, stressing that the earlier the procedure, the safer and less traumatic.

She could be offered the option of a follow-up appointment, largely to focus on her stresses. A counsellor would be an alternative resource.

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