Safeguarding and teleconsultation for abortion

Romanis, Elizabeth Chloe; Parsons, Jordan A; Salter, Isobel; Hampton, Thomas

doi:10.1016/s0140-6736(21)01062-x

Cited by 10 publications

(22 citation statements)

References 16 publications

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“…The purpose is to protect vulnerable individuals by identifying and appropriately responding to instances of abuse or neglect (para 14.1) [ 18 ]. Whilst the terminology of safeguarding is not universally deployed, a similar notion of promoting the wider welfare of one’s patients is observable in many countries [ 57 ].…”

Section: Tema and Safeguarding Concernsmentioning

confidence: 99%

“…The reality is, therefore, that ‘[t]he absence of remote care is […] forcing these women into a situation entirely devoid of safeguarding. Even if in-person care was considered to be the ideal, remote provision results in fewer women having no access to care or accessing care unlawfully’ (p. 557) [ 57 ]. Remote consultation increases the likelihood of vulnerable adults being identified because they may choose formal channels where they can access them without attending a clinic and administer treatment at home when the abuser is out, or in a regularly attended space outside the home without raising suspicion.…”

Section: Satisfying the Requirements Of Safeguardingmentioning

confidence: 99%

“…The British Pregnancy Advisory Service has reported that feedback from patients ‘suggests women find it easier to disclose concerns via telephone in their own homes (or location convenient to them) as opposed to in a clinical environment’ (p. 4) [ 46 ]. This could be because they feel better empowered in a familiar environment, free of some of the intimidating aspects of a clinic or hospital (p. 556) [ 57 ]. This is particularly true for population groups who have historically found interacting with healthcare professionals more difficult.…”

Section: Satisfying the Requirements Of Safeguardingmentioning

confidence: 99%

“…Of course, if the provider had reason to suspect a safeguarding matter, they could request to speak to the patient alone. However, even if the abuser is not present in the consulting room, the patient’s fear of the repercussions of disclosing can still impact on their ability to raise concerns about, or answer questions about, their safety honestly (p. 556) [ 57 ]. As noted above, the likelihood of a patient having a consultation without their abuser being aware or present is higher with TEMA because it is easier to make a secret telephone or video call than it is to account for whereabouts when attending a clinic.…”

Section: Satisfying the Requirements Of Safeguardingmentioning

confidence: 99%

“…Our focus in this paper is on England, with the Care Act 2014 as central to our discussion. 3 However, the principles that ground the concept of safeguarding—and, by extension, our discussion—should be thought of as more widely applicable, extending to Scotland, Wales, Northern Ireland, and beyond the UK [ 57 ]. The straightforward conclusion that vulnerable patients accessing TEMA can be identified and helped in much the same way as when care is delivered in person is not unique to the context of the Care Act 2014, and we use the Act simply as a tool for exploration.…”

Section: Introductionmentioning

confidence: 99%

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The Case for Telemedical Early Medical Abortion in England: Dispelling Adult Safeguarding Concerns

Parsons

Romanis

2021

Health Care Anal

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Access to abortion care has been hugely affected by the COVID-19 pandemic. This has prompted several governments to permit the use of telemedicine for fully remote care pathways, thereby ensuring pregnant people are still able to access services. One such government is that of England, where these new care pathways have been publicly scrutinised. Those opposed to telemedical early medical abortion care have raised myriad concerns, though they largely centre on matters of patient safeguarding. It is argued that healthcare professionals cannot adequately carry out their safeguarding duties if the patient is not in the room with them. These concerns lack empirical support. Emerging evidence suggests that safeguarding processes may, in fact, be more effective within telemedical abortion care pathways. In this article, we address two specific safeguarding concerns: (1) that a remote consultation prevents a healthcare professional from identifying instances of abuse, and (2) that healthcare professionals cannot reliably confirm the absence of coercion during a remote consultation. We demonstrate that such concerns are misplaced, and that safeguarding may actually be improved in telemedical care pathways as victims of abuse may find it easier to engage with services. It is inevitable that some individuals will fall through the net, but this is unavoidable even with in-person care and thus does not constitute a strong critique of the use of telemedicine in abortion care. These safeguarding concerns set aside, then, we argue that the current approval that enables telemedical early medical abortion should be afforded permanence.

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Section: Tema and Safeguarding Concernsmentioning

confidence: 99%

Section: Satisfying the Requirements Of Safeguardingmentioning

confidence: 99%

Section: Satisfying the Requirements Of Safeguardingmentioning

confidence: 99%

Section: Satisfying the Requirements Of Safeguardingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Case for Telemedical Early Medical Abortion in England: Dispelling Adult Safeguarding Concerns

Parsons

Romanis

2021

Health Care Anal

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Improvidence, Precaution, and the Logical-Empirical Disconnect in UK Health Policy

Parsons

2022

Health Care Anal

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The last decade has seen significant developments in UK health policy, with are largely claimed to be evidence based. However, such a characterisation ought, in many cases, to be questioned. Policies can be broadly understood as based primarily on either a logical or empirical case. In the absence of relevant empirical evidence, policymakers understandably appeal to logical cases. Once such evidence is available, however, it can inform policy and enable the logical case to be set aside. Such a linear policy process is not always the reality, and logical cases often continue to guide policy decisions in direct opposition to empirical evidence. In this paper, I discuss two recent examples of this disconnect between logical and empirical cases in UK health policy. The first—organ donation—illustrates an example of a significant policy change being made in opposition to the evidence. I refer to this as the improvidence approach. The second—abortion—provides an example of policymakers not making a change that has extensive supporting data. I refer to this using the more recognisable language of the precautionary approach. Ultimately, I argue that both the improvidence and precautionary approaches are examples of problematic public policy where policymakers provide no explicit justification for going against the evidence.

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"Who is driving you home today?" Escort policies as a barrier to abortion access

et al. 2022

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Safeguarding and teleconsultation for abortion

Cited by 10 publications

References 16 publications

The Case for Telemedical Early Medical Abortion in England: Dispelling Adult Safeguarding Concerns

The Case for Telemedical Early Medical Abortion in England: Dispelling Adult Safeguarding Concerns

Improvidence, Precaution, and the Logical-Empirical Disconnect in UK Health Policy

"Who is driving you home today?" Escort policies as a barrier to abortion access

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