Maternal And Child Health Professionals’ Attitudes Toward Ethical Issues Related The Right To Life Of Defective Fetus

Objective: 1)Based on grounded theory,to construct an explanatory model of maternal and child health professionals’ ethical attitude towards the right to life of fetuses with birth defects.2)To understand the attitudes and related factors of maternal and child health professionals towards the right to life of fetuses with birth defects using quantitative method.Methods: A mixed method research design combining qualitative research and quantitative research was adopted.In the qualitative study,according to the information saturation principle,the purpose sampling was used to select 13 professionals,who are from the health institutions related to maternal and child health in Changsha City and Huaihua City of Hunan Province.From February 8,2021 to January 7,2022,a self-designed interview outline was used to investigate professionals’ attitudes towards the right to life in the prevention and treatment of birth defects through face-to-face interviews.Based on grounded theory,Nvivo12.0 was used to analyze qualitative resources.A total of 785 birth defect prevention and treatment professionals were recruited from the birth defect prevention and treatment network established by Hunan Provincial Maternal and Child Health Care Hospital from February 14 to21,2022.The following information was collected:(1)Sociodemographic and occupational characteristics of the professionals;(2)A self-designed case-based questionnaire on ethical Issues related to birth defects was used to investigate professionals’ attitudes towards the right to life of fetuses with birth defects and the factors of the consideration.SPSS24.0 was used to calculate the sample frequency and composition ratio.Odds ratios(OR)and 95% confidence intervals(95% CI)were obtained by logistic regression analysis to describe the attitudes of professionals with different characteristics towards ethical issues related to birth defects.Results:In qualitative study:(1)The 12 professionals thought that the final decision was made by the parents of the fetus,and 1 professional thought that the decision could be made jointly by the main family members.(2)Through category analysis and theoretical model construction,the ethical issues related the right to life of defective fetus are discussed.It is found that the main factors affecting the professionals’ attitude are: the factors of disease and the fetus,the factors of family and pregnant women,medical issues related factors,social factors and self-value orientation.In the quantitative study,the research group designed four cases of different types of birth defect diseases.Based on the situations described by four cases(congenital heart disease,cleft lip and palate,finger deficiency,and phenylketonuria),professionals were respectively asked about their ethical attitudes toward the right to life of the fetus with birth defect.(3)Most professionals believe that a fetus with cleft lip and palate should be born(63.5%)and a fetus with phenylketonuria should not be born(60.3%).As for the right to life of the fetus with congenital heart disease and finger deficiency,the proportion of pro-and anti-birth among professionals is close:for the fetus with congenital heart disease,the proportion is 45.4% VS 54.5%;For fetuses with finger deficiency,is 50.8% vs.59.2%.(4)Among the main factors affecting professionals’ attitude towards the right to life of fetuses with birth defects,the top three factors are:(1)"Influence on the physical function and growth of fetuses",(2)"Severity of disease" and(3)"Evaluation of professionals’ treatment indications and relevant professional advice".(5)As for who could make the final decision for the fetuses with birth defects in a family,most professionals prefer "parents of fetus",followed by "pregnant woman" and "family make the decision together".(6)Binary logistic regression showed that,the professionals have religious belief,aged 50 years or older,engaged in health care related to birth defects and was trained in the prevention and treatment of birth defects were more likely to agree the fetus with birth defects should be born.Conclusion:(1)For structural malformations that can be repaired after birth,most professionals believe that fetus should be born.For genetic metabolic diseases that cannot be cured after birth,most professionals believe that fetus should not be born.There is disagreement among professionals about birth defects with uncertain postnatal outcomes(e.g.,complex congenital heart disease)and structural malformations that result in permanent disability.(2)Factors considered by professionals in their attitudes towards the right to life of a fetus with birth defects: the top factors are "Influence on the physical function and growth of fetuses","Severity of disease" and "Evaluation of professionals’ treatment indications and relevant professional advice" and “the autonomous choice of pregnant women and their families".(3)There is a convergence of ethical attitudes among professionals regarding who should make decisions in the family about a fetus with birth defects: the final decision should be made by the parents of fetus.