Christin Hempeler¹, Mirjam Faissner², Esther Braun³

¹ Institute of History and Ethics of Medicine, Centre of Excellence in Health Sciences, Halle University Medical Centre, School of Medicine, Martin Luther University Halle-Wittenberg

² Institute of History of Medicine and Medical Ethics, Charité – Universitätsmedizin Berlin

³ Junior Professorship in Medical Ethics with a focus on digitalisation, School of Health Sciences Brandenburg, University of Potsdam

Current developments in prenatal diagnostics, such as the increasing use of non-invasive prenatal tests (NiPTs), enable the low-risk detection of foetal abnormalities. This study examines how doctors assess the impact of these developments on counselling and decision-making processes regarding the continuation of pregnancies. In this presentation, we will present the results of the study, with particular focus on the factor of time.

Seventeen interviews were conducted with doctors who have experience in providing medical indications for termination of pregnancy, and these were analysed using qualitative content analysis.

The participants reported that NiPTs are sometimes offered as a matter of routine, although the information provided in this regard was often deemed insufficient. At the same time, it was reported that many providers of prenatal diagnostics do not perform terminations of pregnancy on medical grounds. This contributes to inadequate access to care, particularly in the case of later-term terminations. Against this background, the participants described how time plays a central role in decisions regarding whether to continue the pregnancy.

Firstly, it was reported that an abnormal NiPT result can lead to terminations being carried out without follow-up diagnostic tests whilst still within the counselling period, in order to circumvent difficulties in accessing care in the event of a later termination on medical grounds.

Secondly, according to the participants, a normal NiPT result can convey a false sense of security, which may delay further antenatal screening. As a result, foetal abnormalities are only detected later, which can postpone terminations to later weeks of pregnancy.

Thirdly, it was reported that some doctors require extensive prenatal diagnostic testing before issuing a medical indication for termination of pregnancy. This, too, can lead to later terminations, which confronts pregnant people with existing barriers to care.

According to the participants, the time pressure under which many pregnant people find themselves as a result makes it difficult to reach a well-considered decision about whether to continue with the pregnancy. To improve the situation, there is a need for both better counselling prior to NiPTs and improved access to terminations.