Ethical and Legal Aspects of Late Termination of Pregnancy
Late termination of pregnancy (LTOP) is usually considered to be one carried out at greater than 20 weeks gestation. It is unclear how many LTOPs are carried out each year, but there are reliable figures from some states, and extrapolating from these data suggests that the total number is between 500-1000. However, there is no specific national data collection, so the circumstances that may lead to a request for LTOP are not always known. In many cases, the request follows the late diagnosis of a severe or lethal fetal anomaly, and as such those who practice obstetric ultrasound have a significant interest in this difficult area.
The legal framework within which LTOP is carried out differs between the different jurisdictions. In WA, there is an appointed medical committee which makes decisions about LTOP, and whose actions are defined in legislation. In both NSW and Victoria there are processes of review and approval, which are defined either by the Health Department or individual hospitals. However, the legal restrictions are not well-understood, as essentially all 'not-unlawful' LTOPs are defined by the woman's request to prevent harm to herself rather than the fetus. In the ACT, termination is no longer specified in the Crimes Act, but there is a rigorous process of review and approval managed by the territory's major hospital.
The varying legal framework impacts significantly on some of the ethical issues. There is undoubtedly some variation in clinical practice across the country, which means that women are presented with different options depending on where they live. There is evidence that some women travel significant distances to gain access to LTOP. This presentation will examine the geographical legal differences, and explore how they impact on women's reproductive choices.