Evans M I, Drugan A, Bottoms S F, Platt L D, Rodeck C A, Hansmann M, Fletcher J C
Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University, Detroit, MI 48201.
Am J Obstet Gynecol. 1991 Apr;164(4):1092-9. doi: 10.1016/0002-9378(91)90592-f.
The ethical attitudes of health care providers toward abortion, sex selection, and selective termination of normal and anomalous fetuses in singleton or multiple pregnancies were evaluated by questionnaires distributed to members of the American Society of Human Genetics, the International Fetal Medicine and Surgery Society, the Society of Perinatal Obstetricians, ethicists, and clergy. Demographic characteristics of respondents exhibited a preponderance of men (76%), age greater than 40 (68%), and of United States residents (82%). Seventy-nine percent of respondents were in the medical profession. Approximately half of the respondents were Protestant, the rest being evenly distributed among Catholic, Jewish, and other religions. Acceptance of abortion for social indication varied by religion and gestational age but not by religious conviction, age, country, or gender of respondent. First-trimester abortion of a normal singleton pregnancy was considered more acceptable than selective termination of normal fetuses in multifetal gestations. Sex selection was considered unethical by most respondents. Selective termination was deemed ethically appropriate in quadruplets or multifetal gestations of more than five fetuses and in multiple pregnancies bearing one anomalous fetus. In the latter situation, acceptance increased with the severity of fetal anomalies and decreased from the first to the third trimester. The medical specialty of respondents was the only independent factor strongly associated with acceptance of selective termination by trimester, indication, and number of fetuses. Acceptance of selective termination among health care professionals appears to reflect not only perceptions of procedure-related risks and benefits in the index pregnancy but also individual training and religious beliefs.
通过向美国人类遗传学会、国际胎儿医学与外科学会、围产期产科医生协会的成员、伦理学家和神职人员发放问卷，评估了医疗服务提供者对堕胎、性别选择以及单胎或多胎妊娠中正常和异常胎儿的选择性终止的伦理态度。受访者的人口统计学特征显示男性占多数（76%），年龄大于40岁（68%），且美国居民占82%。79%的受访者从事医学专业。大约一半的受访者是新教徒，其余在天主教、犹太教和其他宗教中平均分布。因社会指征而接受堕胎的情况因宗教和孕周而异，但不因受访者的宗教信仰、年龄、国家或性别而异。正常单胎妊娠的早期堕胎比多胎妊娠中正常胎儿的选择性终止更易被接受。大多数受访者认为性别选择不道德。在四胞胎或五个以上胎儿的多胎妊娠以及怀有一个异常胎儿的多胎妊娠中，选择性终止被认为在伦理上是合适的。在后一种情况下，接受程度随着胎儿异常的严重程度增加而增加，从孕早期到孕晚期则下降。受访者的医学专业是与按孕周、指征和胎儿数量接受选择性终止密切相关的唯一独立因素。医疗保健专业人员对选择性终止的接受似乎不仅反映了对指数妊娠中与手术相关的风险和益处的认知，还反映了个人培训和宗教信仰。
