[Second-trimester therapeutic abortion. Technical and human factors involved in the medical decision]

The problem of 2nd trimester therapeutic abortion should not be viewed in terms solely of technical difficulties of operation. Important questions of ethics and proper medical practice are also raised. Prenatal diagnosis of fetal anomalies has had the happy effect of reassuring the very great majority of couples who resort to it for various indications. Some 95-99% of couples receive good news and thus have no reason to seek "preventive" abortions. Prenatal diagnosis and abortion are not likely however to lead to the near total disappearance of chromosomal metabolic or enzymatic anomalies or congenital malformations. Most hereditary ailments are recessive and the suppression of individuals carrying the defect will only slightly modify the frequency of the gene in the population. Some parents will also elect to bring pregnancies to term despite fetal defects because of religious or other personal convictions. Health care personnel in these cases should respect the wishes of the parents. The present day search for the "perfect child" has led to requests for therapeutic abortion for less serious anomalies or conditions that could be cured by medical or surgical treatment. Neither do such maternal indications as "failure of tubal sterilization" put the mothers health into the grave peril envied by the French therapeutic abortion law. Pressure by one medical specialist on another in these cases interferes with the freedom of judgment needed for good medical practice. In the case of trisomy 21 which causes Down syndrome the systematic use of amniocentesis by women at high risk such as those over 38 years old would entail considerable monetary savings for society if every affected fetus were aborted. However neither the facilities nor the motivation for amniocentesis is evenly distributed in the population. Progress needs to be made in developing true dialogue with the parents to avoid subjecting them to overwhelming social pressure in favor of abortion and to allow them to decide more freely.