M.Sc. (Med.) (Bioethics and Health Law), Faculty of Health Sciences, University of the Witwatersrand, 2009This study set out to perform an ethical-legal analysis of the current
practices across the seven public health centres in South Africa that
perform feticide for congenital abnormalities. Ideally, such decisions need
to be guided by multidisciplinary discussions with the parent(s) and the
parties included in the team, e.g. Obstetricians, Neonatologists, Nursing,
Genetics counsellors and Social Workers and following the ethical
principles of beneficence and respect for autonomy. Prior to the study, it
was unknown as to whether all seven centres were using multidisciplinary
groups in the decision-making process and on what basis approvals were
being granted for feticide. The objectives of the review were to assess the
number of feticides performed, who made the decision to offer the feticide
and for what ethical or clinical indications. The results showed that all
public health facilities in South Africa differed in the criteria that were used
in making the decision to offer feticide. The clinicians varied in terms of
who was represented in the team that reviewed the cases of congenital
abnormalities. An analysis of the literature, together with a review of the
data received on the current practices, guided the development of an ethical guideline for this service as well as making recommendations as to
how the law could be strengthened in order to protect both health workers
and patients
