Title:
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The "serious handicap" clause in the Abortion Act 1967 : healthcare professionals' interpretations of the grounds for termination of pregnancy
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If prenatal tests detect a genetic condition or abnormality in the fetus, a pregnant woman may
be offered a termination under the serious handicap ground of the Abortion Act 1967, which
applies in England, Scotland, and Wales. A termination is legal under this ground provided that
"there is a substantial risk that if the child were born it would suffer from such physical or mental
abnormalities as to be seriously handicapped". "Serious handicap" is not defined, and it is
healthcare professionals' role to interpret its meaning. Two registered medical practitioners must
be of the opinion, "formed in good faith", that the legal criteria have been fulfilled. This thesis
aims to further understanding of how healthcare professionals decide whether a fetal condition
is sufficiently serious for termination. Two phases of research addressed this aim:
1st phase: A systematic review that identified factors influencing healthcare professionals'
viewpoints on whether a fetal condition is sufficiently serious for termination. Two syntheses
were conducted; a narrative synthesis of 34 surveys, and a thematic synthesis of 14 qualitative
studies. A range of medical and non-medical factors were identified.
2nd phase: Primary empirical research, comprising a context-specific Q-methodological study,
which identified and systematically characterised the different ways the serious handicap ground
is interpreted by healthcare professionals working in prenatal testing and terminations for fetal
abnormality in the UK. Forty-eight participants completed a 36-statement Q-sort. Q-factor
analysis produced four statistically independent viewpoints reflecting different interpretations.
Findings are synthesised to provide a comprehensive description of how the viewpoints of
healthcare professionals on whether a condition is sufficiently serious for termination are
constructed. The ambiguities of interpreting the serious handicap ground are discussed. In
addition, the implications of variation in interpretation of "seriousness" are considered in light of
development of guidelines for healthcare professionals and the Abortion Act, should this ground
be amended.
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