Termination of pregnancy with embryopathic indication

from Wikipedia, the free encyclopedia

When abortion with embryopathischer indication (πάθος, páthos - ancient Greek among other disease) refers to the termination of a pregnancy , because in the prenatal diagnosis a serious illness or developmental disorder ( embryopathy ) of the unborn or the predisposition was found the child for a disease.

Legal basis and motivations

In Germany , this situation is subsumed in the legislation in Section 218a of the Criminal Code as a medical indication "in order to avert a danger to life or the danger of serious impairment of the physical or mental health of the pregnant woman". In such a case, termination of the pregnancy is not illegal and therefore does not count as an offense against life . The embryopathic indication was deleted as a separate number in 1995, which emphasizes the concerns of pregnant women.

On the one hand, this eliminates the time limit for the termination of pregnancy; on the other hand, it is made clear that the unborn disabled life is not subject to any special status compared to the non-disabled life. A disability or damage to the child found in the fetal development stage does not justify an indication.

In Switzerland , too , the embryopathic indication is not specifically mentioned, but falls under the medical indication. According to Article 119, Number 1 of the Criminal Code , the termination of pregnancy is unpunished "if, according to a medical judgment, it is necessary so that the pregnant woman can avert the risk of serious physical harm or severe mental distress." The risk must be all the greater, the more advanced the pregnancy is.

In Austria , Section 97 (1) (2) of the Criminal Code allows termination if “there is a serious risk that the child will be severely damaged mentally or physically”. In Austria, the term eugenic indication is used. In February 2015, the Greens called for a discussion about shortening the deadline for late abortion of disabled children, since according to the UN Disability Rights Convention, the eugenic indication discriminates against the disabled.

In Germany in 2006, 3,046 of 119,710 abortions were officially carried out under medical indication. The majority of them ultimately due to a diagnosed embryopathy. In Austria, no statistics are kept on abortions and motives.

In a 1992 survey carried out by the sociologist Irmgard Nippert of 1,157 pregnant women who had a genetic test carried out, four out of five respondents feared having to care for a disabled child for life, and one in three respondents feared the financial burdens. The self-determination of the mother and other relatives, which are discussed in fundamental rights theory , is one of the interests .

Diagnostic problem

The prenatal diagnosis allows often at an advanced stage of pregnancy the opportunity to make statements. In many cases, the interventions are therefore carried out as a so-called late termination after the 14th week of pregnancy (i.e. later than 12 weeks after conception).

In the German Criminal Code, the 24th week of pregnancy has not been a time limit for medical indications since 1995. From this stage of pregnancy, it is possible that the fetus survives the premature birth with medical help in the incubator , for example in the case of the so-called Oldenburg baby . To prevent this, the fetuses are often killed in the womb before being aborted . This procedure is not regulated in more detail by law. The direct killing with a potassium chloride solution into the heart of the embryo or by cutting off the blood supply through the umbilical cord is regarded as unacceptable in a declaration by the German Medical Association if its only goal is to kill viable fetuses outside the womb before an abortion. The British Society of Gynecologists ( Royal College of Obstetricians and Gynaecologists ), however, strongly recommends this procedure for abortions after the 22nd week in order to avoid a live birth.

In the prenatal examination, false positive as well as false negative diagnoses cannot be ruled out, as medical statistical studies at the Berlin Charité show. Significant fluctuations in the error rate of various diagnostic methods were found. For inexperienced diagnosticians z. E.g. up to 80% undetected morphological malformations by sonography (compared to a possible 10% with very experienced doctors). On the one hand, severe disabilities that could justify dropping out can go undetected. On the other hand, it may be terminated due to a false positive result. In relation to the terminations carried out after the prenatal diagnosis, the examination for the Charité University Clinic comes to a value of 6% of the terminations that were carried out due to false positive diagnoses (ie the diagnosed malformations did not even exist), using all diagnostic methods.

During an abortion in Florence, a prenatally diagnosed severe malformation of the esophagus could not be confirmed later. Here a child was aborted after 22 weeks of pregnancy. The approximately 25 centimeter tall and 500 gram child survived a short time after the procedure, which made this case known in March 2007.

There are cases in which doctors recommend discontinuation if chromosome breaks indicate a risk of 10 to 15 percent for a later disability or the pregnant mother has certain infectious diseases that mean a statistically increased risk of malformations. In these cases there is only a fundamental suspicion.

The examinations also lead to spontaneous abortions . With early detection , the risk of miscarriage arises when performing a late amniocentesis of up to 5.7% and when performing a chorionic villus sampling of up to 8.8%. In the event of a positive finding, advice on the options for action is considered to be useful before using the examination.

Ethical aspects

In 2009, a three-day period was introduced in Germany to ensure that there is a period of reflection between diagnosis and possible termination of pregnancy.

The task of assisting pregnant women in the form of an abortion leads some doctors to a conflict of conscience, especially in the case of late abortions. Furthermore, medical advances allow many disabled children, for example with Down's syndrome, better development opportunities and self-fulfillment.

In its statement in November 2003, the Protestant Church in Bavaria also sees the danger “that the pressure on pregnant women will increase not to expect sick or disabled children from society.” The disability spokesman for the ÖVP , Franz-Joseph Huainigg , brought on February 4th In 2004 a petition to delete the eugenic indication in the Austrian Parliament because it violated Article 7 BVG , which prohibits the discrimination of people with disabilities.

Such concerns stand in opposition to the social currents that already demanded eugenics at the end of the 19th century and which reached a violent climax in the National Socialist racial hygiene . Today the main argument is the follow-up costs. The director of the Clinic and Polyclinic for Gynecology and Obstetrics in Cologne , Peter Mallmann, took the position in April 2000 that prenatal diagnostics were economically necessary to reduce health care costs. In a survey in Germany at the beginning of 2001, more than half of those questioned supported prenatal examinations "because they help, for example, to reduce health care costs".

Norbert Hoerster disputes the argument that the disabled are discriminated against by embryopathic indication : “The fact that someone should have been allowed to have an abortion as a fetus does not have the slightest influence on their later rights, provided they were not aborted. This applies to the disabled as well as to the non-disabled. ”In this respect, the ethical discussion is no different from that of pre-implantation diagnosis .

Special protection against dismissal for mothers

The Federal Labor Court has ruled that the special protection against dismissal for mothers also applies to women who have terminated their pregnancy due to a medical indication. The labor judges justified their decision in December 2005 (BAG 2 AZR 462/04). In order to protect women, dismissal is not permitted up to four months after the premature end of a pregnancy. To provide a more detailed explanation, they stated that childbirth has occurred when the child weighs at least 500 grams. It is irrelevant whether it is born alive or dead.

Individual evidence

  1. ↑ Henning Schneider: Abortion, prenatal diagnosis and intrauterine therapy , 2001 ( online ( memento of March 21, 2007 in the Internet Archive ))
  2. ↑ Answer to a small question in the Bundestag. German Bundestag, printed matter 13/5364, p. 8 ( online )
  3. ↑ German Bundestag, printed matter 13/1850, p. 25 and 26: “Above all, the statements of associations for the disabled had shown that such a regulation led to the misunderstanding that the justification results from a lower respect for the right to life of an injured child. (...) This makes it clear that a disability can never lead to a reduction in the protection of life. "( Online )
  4. ↑ German Medical Association : Declaration on termination of pregnancy after prenatal diagnosis . In: Deutsches Ärzteblatt '95, Issue 47, November 20, 1998: "Such a risk can be based on the abnormal finding, but the finding alone must not automatically lead to the indication." ( Online )
  5. ^ The eugenic indication , ORF online ( Memento from April 24, 2008 in the Internet Archive )
  6. ↑ http://orf.at/#/stories/2264535/ Late abortions: Debate about shortening deadlines, ORF.at February 9, 2015
  7. ↑ Federal Statistical Office : Abortions in Germany 2000 to 2006 , March 14, 2007 ( online )
  8. ↑ Irene Hatzidimou: Between medicine and eugenics. : In: Jungle World , No. 3, 1998 ( online ( memento of September 30, 2007 in the Internet Archive ))
  9. ↑ Klaus Diedrich : Doctors demand more honesty when abortion. , 2003 ( online )
  10. ↑ German Medical Association : Declaration on termination of pregnancy after prenatal diagnosis . In: Deutsches Ärzteblatt , November 20, 1998 ( online )
  11. ↑ Recommendation RCOG regarding fetocide (English) ( Memento from November 5, 2013 in the Internet Archive )
  12. ↑ Anna Bergann: Possibilities and limits of the comparison of prenatal sonographic and autoptic examination results in fetal diagnostics. Dissertation , 2003 ( abstract online )
  13. ↑ Possibilities and limits of the comparison of prenatal sonographic and autoptic examination results in fetal diagnostics .
  14. ↑ Possibilities and limits of the comparison of prenatal sonographic and autopsy examination results in fetal diagnostics with false positive diagnoses.
  15. ↑ Aborted fetus died in Italy. In: Salzburger Nachrichten , March 8, 2007 ( online )
  16. ↑ Annegret Braun: Late terminations after prenatal diagnosis: The desire for the perfect child. In: Deutsches Ärzteblatt , October 6, 2006 ( online )
  17. ↑ Jauniaux, E. & Rodeck, C .: Use, risks and complications of amniocentesis and chorionic villous sampling for prenatal diagnosis in early pregnancy. Early pregnancy: Biology and Medicine, 1 (1995), 245-252.
  18. ↑ Bundestag adopts strict rules. In: Frankfurter Rundschau , May 13, 2009 ( online )
  19. ↑ Klaus Diedrich : Dilemma later abortion. , 2002 ( online )
  20. ↑ Evangelical Lutheran Church in Bavaria: Statement on the practice of prenatal diagnostics and the implementation of late abortions , November 27, 2003 ( online ( memento of September 27, 2007 in the Internet Archive ))
  21. ↑ Jutta Dinkermann: Child euthanasia in the Third Reich and abortion today : In: Neue Solidarität , 2000 ( online )
  22. ↑ Hendrik Berth : Genetic tests for everyone? Results of a representative survey. In: Deutsches Ärzteblatt, April 12, 2002 online ( Memento from November 6, 2003 in the Internet Archive )
  23. ^ N. Hoerster: Abortion in the secular state . Suhrkamp, ​​1991, ISBN 3-518-28529-7 , p. 157
  24. ↑ BAG, judgment of December 15, 2005, 2 AZR 462/04 ( online )

literature

  • Ulrike Berg: The problem of the “eugenic indication” as a justification. Dissertation, University of Giessen, 2006 ( online )
  • Andreas Kuhlmann: Abortion and Self-Determination. S. Fischer Verlag 1996, ISBN 3-10-041217-6
  • Eva Schumann (Ed.): Responsible conflict resolution with embryopathic findings. Göttinger Schriften zum Medizinrecht - Volume 4, Göttingen: Göttinger Universitätsverlag 2008, ISBN 978-3-940344-47-2 online version (PDF file; 1.09 MB)