"Obviously there is a conflict between confidentiality and what you are required to do by law": Chilean university faculty and student perspectives on reporting unlawful abortions.

Abstract

While Chile recently decriminalized abortion in cases of rape, lethal fetal anomaly, and to save a woman's life, most abortions are still criminalized. We assessed medical and midwifery school faculty and students' views on punishing and reporting people involved in unlawful abortion, and their understanding of their obligation to protect patient confidentiality and to report unlawful abortions. We interviewed 30 medical and midwifery school clinician faculty from seven public, private, secular and Catholic-affiliated universities, all located in the metropolitan region of Santiago, Chile. Medical (n=239) and midwifery (n=79) students at these same seven universities completed an online survey. We coded faculty interview transcripts, and analyzed codes related to maintaining patient confidentiality and reporting unlawful abortion. We summarized student views related to reporting and imprisoning people involved in unlawful abortion, and used general estimating equation (GEE) models to identify the factors associated with support for criminalization. Faculty and students generally did not support reporting or imprisoning anyone involved in an unlawful abortion and believed that protecting patient information takes precedence over reporting. Yet, faculty described pressures to report in the public sector and several cases where they or their colleagues were involved in reports. Most students somewhat/strongly agreed (78%) that patient information concerning an unlawful abortion should be kept confidential; 35% strongly/somewhat agreed that a clinician involved in an unlawful surgical abortion should be imprisoned, and 18% agreed that the woman involved should be imprisoned, with students from secular universities being significantly less likely to support reporting and punishing people involved in unlawful abortion, than students from Catholic universities. There is a need to clarify clinicians' ethical obligations in abortion care, in particular in Catholic universities, so that they can ensure that their patients have access to high quality confidential health care services.