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  • Title: Is selective abortion for a genetic disease an issue for the medical profession? A comparative study of Quebec and France.
    Author: Renaud M, Bouchard L, Kremp O, Dallaire L, Labadie JF, Bisson J, Trugeon A.
    Journal: Prenat Diagn; 1993 Aug; 13(8):691-706. PubMed ID: 8284288.
    Abstract:
    This article discusses the results of a study of the stand and attitudes of physicians from the Picardie, Nord-Pas-de-Calais region in France and the province of Quebec (Canada) regarding abortion following the diagnosis of a fetal anomaly by ultrasound, amniocentesis, or chorionic villus sampling. The study examined the degree of acceptability of abortion for several specific conditions as well as the physicians' perceptions of their role in the women's decision to abort. The study shows a consensus (over 75 per cent of the physicians surveyed) for aborting a fetus with trisomy 21. There is a similar consensus, except among Francophones in Quebec, for muscular dystrophy, cystic fibrosis, and Huntington disease. Conversely, there is no consensus (below 60 per cent) for several anomalies. In these cases, Quebec Anglophone physicians find abortion more acceptable than Quebec Francophone or French physicians. Concerning the role of the practitioners in the decision to abort, physicians in France tend to be much more directive than their overseas colleagues. Several hypotheses are suggested to explain the difference between the three groups surveyed. Attitudes toward selective abortion following prenatal diagnosis of various genetic diseases were compared in 3 groups of physicians: 588 gynecologists from northern France (Picardie region, Nord-Pas-de-Calais), 631 Francophone obstetricians-gynecologists and radiologists from Quebec, and 115 Quebec Anglophones. A mail questionnaire included items on indications for prenatal diagnosis technology, the perceived severity of a spectrum of physical and intellectual birth defects, and attitudes toward social and ethical issues implicit in prenatal testing. The acceptability of selective abortion was found to vary greatly depending on the fetal condition. Over 75% of physicians in all 3 settings supported abortion when the fetus is a carrier of trisomy 21. Also supported, but not as strongly, was abortion in cases of muscular dystrophy, cystic fibrosis, and Huntington disease. For most conditions, Quebec Francophones were least supportive of abortion and Quebec Anglophones were most supportive, with French physicians in an intermediate position. Conditions entailing limited autonomy were perceived as more severe than those associated with behavior problems or physical disabilities. In Quebec. physicians who were English-speaking, less religious, and with a more technical orientation in their specialization were most accepting of selective abortion. In France, the level of religious practice was the only attitudinal predictor. Finally, French physicians were most likely to believe that they, not parents, should play the major role in the decision regarding selective abortion, while Quebec Anglophones advocated physician neutrality. Despite cultural differences, all 3 groups of physicians tended to share a view that the prevention of the birth of a child who would be dependent on parents and the State throughout the lifespan is acceptable; also shared was opposition to selective abortion for nonutilitarian purposes, especially sex selection.
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