Abstract

PIP: A physician on the consultative committee for noncriminal abortions in the canton of Vaud, Switzerland, offers personal reflections on her view of her role. Physicians at the commission evaluate appeals after an initial refusal, cases of foreigners not residing in the canton for 3 months, and particularly difficult cases referred by colleagues. Members of the commission judge whether the case meets the legal criteria for noncriminal abortions. The procedures followed are basically the same as for any other medical consultation: establishing trust with the patient, gathering and evaluating data on the patient's condition, making a decision and communicating it to the patient, and using the rapport established to further therapeutic and preventive goals. The consultation is of extreme importance to the patient, because it will affect her entire future life. Establishing trust begins before the consultation and is aided by a warm and respectful reception of the woman. During the 1st minute of the consultation, the physician should make introductions, define the function of the interview, and attempt to create an authentic physician-patient relationship. The information gathering stage does not involve a physical examination as the pregnancy has already been confirmed. Linguistic problems may arise with foreign women, but use of an interpreter should be avoided if possible. The physician should seek information on whether both partners are in agreement on the abortion, and about cultural problems likely to affect the patient if the pregnancy is continued or alternatively in case of an abortion. The physician can seek further information if necessary by telephoning the patient's family doctor, social worker, or other sources. The decision should be communicated to the patient by the interviewing physician, and may be made immediately or after a period of reflection. When authorization of an abortion is granted, the patient immediately faces the prospect of the procedure itself and the attendant sadness and ambivalence. If the abortion is denied, the reasons should be explained to the patient. The preventive interventions of the physician should include explaining precisely why approval for the abortion was granted in order to avoid excessive guilt feelings, ensuring that the patient is informed about contraception, and providing accurate information about sexually transmitted diseases and HIV infection.