Late termination of pregnancy: law, policy and decision making in four English fetal medicine units H Statham, a W Solomou, b J Green c a Centre for Family Research, University of Cambridge, Cambridge, UK b Department of Land Economy, University of Cambridge, Cambridge, UK c Mother and Infant Research Unit, Department of Health Sciences, University of York, Heslington, York, UK Correspondence: Dr H Statham, Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RF, UK. Email hes11@cam.ac.uk Accepted 15 September 2006. Published OnlineEarly 1 November 2006. Objective UK abortion law allows terminations for fetal abnormality without gestational limit. This study aimed to understand the decision-making experiences of fetal medicine professionals working within this legal framework. Design Qualitative study using semistructured interviews. Setting Four English fetal medicine units. Sample Fifteen doctors and midwives working in fetal medicine units and the Director of a related voluntary sector group. Methods Thematic analysis of transcribed interviews. Main outcome measures Attitudes to abortion legislation; how decisions are made about the offer of late abortion and feticide. Results Fetal medicine specialists acknowledged the difficulties of ensuring that they worked within the law and within their own ethical frameworks when making decisions about offering terminations after viability. Practice regarding which abnormalities meet the legal criteria appeared to be governed largely by consensus between colleagues within their own and other units and in discussion with other specialists. Study participants reported individual differences about abnormalities where they personally would not wish to be involved in a termination, and also noted a shift in general attitudes over time as to conditions that meet the legal criteria. A proscribed list was believed to be both unworkable, given the variability in diagnoses and unhelpful, leading to reduced patient care. Conclusions Research is needed to monitor attitudes to, and interpretation of, UK abortion legislation, which permits termination after a late diagnosis of fetal abnormality without gestational limit. If attitudes are changing, it is important to understand why, and what the consequences will be for parents and for health professionals. Keywords Fetal abnormality, feticide, late termination, legal and ethical framework, views of health progessionals. Please cite this paper as: Statham H, Solomou W, Green J. Late termination of pregnancy: law, policy and decision making in four English fetal medicine units. BJOG 2006;113:1402–1411. Introduction An item in Table 23, page 31 of the 2001 UK abortion statis- tics 1 gave rise to a serious challenge to how UK abortion law is enacted. This identified two terminations carried out for ‘cleft lip and palate’, with one taking place at a gestation for more than 24 weeks. Joanna Jepson argued that this abnormality did not meet the criterion of ‘a substantial risk of serious handicap’ for legal abortion at that gestation. The local police were asked to investigate, with a view to taking legal proceed- ings against the doctors who had performed the abortion. When police found no grounds to support the contention that the law had been broken and declined to prosecute, Jepson sought and was granted (on appeal, December 2003) a Judicial Review of this decision, which was extended to investigate whether UK abortion law breached European Human Rights legislation. Before the Judicial Review, the police undertook further investigations: their findings were passed to the Crown Prosecution Service who decided in March 2005 that they would not prosecute the two doctors. For over two and a half years, this case generated extensive media interest in the UK and overseas (reports listed at http://www.jjepson.org/links.php, accessed 20 July 2006) and focused attention on UK legislation, doctors who interpret that law and women making decisions after prenatal diagnosis of fetal abnormality. In spite of the publicity, it was clear that both the public and health professionals not directly involved in late diagnoses of abnormalities remained ill informed 2 . 1402 ª 2006 The Authors Journal compilation ª RCOG 2006 BJOG An International Journal of Obstetrics and Gynaecology DOI: 10.1111/j.1471-0528.2006.01144.x www.blackwellpublishing.com/bjog Fetal medicine