Trust doctors on abortion,
By Ann Furedi
This article appeared in The
The Rev Joanna Jepson says she was shocked to discover that,
last year, a woman ended her six-month pregnancy because the
foetus was affected by cleft palate. I was shocked to find
out that Ms Jepson, a Church of England curate, had tried
to bring a legal case against the police for failing to prosecute
the doctor who performed the procedure. I was outraged to
discover that she was prepared to initiate a judicial review
to determine whether this condition was a sufficiently serious
handicap to permit a legal abortion. And I am extremely disappointed
at the decision made yesterday by the high court to allow
the case to be taken to a judicial review.
Late abortion is a contentious
issue, especially when foetal abnormality is involved. In
1990, a legal limit of 24 weeks was established for most abortions,
but not when there "is a substantial risk that the child,
if born, would suffer from such physical or mental abnormalities
as to be seriously handicapped". In such cases there
is no legal time limit, and every year about 100 of these
pregnancies are deliberately ended when, as those who oppose
abortion like to remind us, the pregnancies could result in
a live birth.
A particular bone of contention
is that the law does not define what it means by "substantial
risk" or "seriously handicapped". Joanna Jepson's
complaint is that an abortion was not justified by a diagnosis
of cleft palate, which she asserts is a relatively trivial
condition that can be corrected by surgery.
She is wrong. In some cases,
a foetal diagnosis of cleft palate indicates a cosmetic condition
that can easily be corrected by surgery. In others, as Kypros
Nicolaides, professor of foetal medicine at King's College
Hospital, has explained, cleft palate can be a symptom of
a life-threatening genetic condition. Sometimes cleft palate
is taken to mean simply a harelip; on other occasions it can
describe a failure of the skull to fuse - a defect that can
impair brain function.
No one knows the circumstances
of the woman who requested the abortion. Nevertheless, Joanna
Jepson and her supporters have been quick to condemn her,
the doctors who approved the request and those involved in
the termination of the pregnancy.
As a provider of abortion
services, I have in my mind what an abortion at this stage
in pregnancy involves. Remember, what is being ended was originally
a "wanted pregnancy". The woman requesting the abortion
was at least six months pregnant. She was already feeling
robust foetal movements, she was visibly pregnant, and possibly
her family and friends had already rejoiced that she was "going
to have a baby". Yet, for reasons we do not know - perhaps
to do with the severity of the condition - she decided to
end the pregnancy.
Could this have been an easy
option? At this stage in the gestation, she would have known
that abortion involves a procedure to stop the foetal heart.
She would have known that she would have to endure labour,
understanding that her once wanted child would be born dead.
I would like to suggest that
we suspend our judgment. There is wisdom in the Christian
tenet of "Judge not, lest you be judged". Or, as
my rather more secular mother puts it: "Don't judge a
man until you have walked a mile in his shoes." None
of us knows the circumstances that persuaded this woman and
her doctors that abortion was the best option for her.
The issue that underpins this
debate is: "Whom do we trust?" Should politicians,
doctors, women or outside observers decide whether or not
a woman's circumstances are such that abortion should be an
option? Or should it be the family that will be affected and
those involved in the family's care?
My view is that women and
their doctors should make the decision. They will, after all,
live with it. It is on their consciences. Politicians, advocates
and interested parties may have their views, but ultimately
we go home. We do not have to look ourselves in the mirror
every day knowing that we requested or carried out that abortion.
So how, in our ignorance, can we condemn those that do?
In 1967, parliament deliberately
left vague the law on abortion on the grounds of severe risk
of serious abnormality. When the issue was revisited in 1990,
parliament again left the issue loosely defined. It believed
that the definition of "serious risk" and "severe
abnormality" was best determined by a woman and her doctors.
This was a wise and humane decision, and it would be foolish
now to reverse it.
I trust women to make decisions
about their pregnancies, and doctors to carry out only those
procedures they believe to be lawful and ethical. I put less
trust in opinionated outsiders with abstract moral views.
Ann Furedi is the chief
executive of the British Pregnancy Advisory Service