Whose life is it anyway?

The UK government, in May 2008, voted to keep the limit on abortions at 24 weeks during an early reading of the Human Fertilisation and Embryology (HFE) Bill. The bill was positioned such that at the final reading abortion laws could be liberalised in the UK for the first time in 40 years. MPs were expected to vote on proposals to make it easier for women to terminate pregnancies. Said Dr. Evan Davis MP: “I am as confident that we would win any votes on these as I was that we would retain the 24-week upper time limit.”

Instead, on October 22th, the vote was blocked by a “procedural motion” tabled by Alan Johnson, the Health Secretary, which effectively denied MPs time to discuss abortion. Abortion legislation in the UK is informed by ethical and moral positions as well as scientific evidence. The committee that presented to both Houses did so, not to suggest how they should vote (“science can tell us only one of many factors that are taken into account when legislating on the issue”), but to comprehensively inform: “scientific developments can alter the balance of opinoin on ethical and moral issues.” The debate must now find a new platform in parliament. Phil Willis, chairman of the committee, discusses some of the proposals of the failed vote.
 
Nick Laurance: The ‘threshold of viability’ has been widely interpreted. Particularly problematic is the definition of viability itself and at what age a foetus can be assuredly ‘viable’. What developments have there been since 1990?

Phil Willis: When my committee examined the issue of late termination it looked at the question of viability as a determining factor as had been the case in 1967 and 1990. We found that although there were a small number of babies born at 22 or 23 weeks there was little difference in survival rates between 1990 and 2008. What has changed is the ability of medical science to keep alive the small number of surviving babies, but such intervention has not prevented the very significant incidence of disability as the child grows or of premature deaths.

NL: The report cites three ways in which it is possible to infer if a foetus feels trauma. You distinguish between conscious and subconscious pain. How important is this distinction?

PW: The fundamental issue concerning sentience remains an issue of significant scientific debate. However, the bulk of scientific opinion, including that of the Royal Society of Obstetricians and Gynaecologists, is that the ability of the foetus to feel conscious pain arrives well after the 24th week. It is, though, important to stress that without invasive experiments to actually inflict trauma on a foetus it is impossible to prove conclusively exactly when the brain cortex is connected to the rest of the nervous system whereby we can be sure about the sensation of pain. What is without doubt is that the ability of the foetus to react to various physical stimuli in the womb is well known.

NL: There seems to be some ambiguity in what constitutes ‘foetal abnormality.’ Inconsistency in some cases has encouraged controversy. Should the law better define what we mean by ‘handicapped’ or ‘abnormal’?

PW: The joint committee of both houses of Parliament which looked at the draft bill in June 2007 recognised this as an issue and recommended that the Royal Society of Obstetricians and Gynaecologists should provide a clearer definition about foetal abnormality. However both committees, which included eminent lawyers and scientists such as Lord Mackay of Clashfern and Lord Winson, respectfully, agreed that a tight definition was virtually impossible but what we should encourage was that clinicians take great care before advising on what was a foetal abnormality, particularly if it concerned termination.

NL: The majority of abortions are approved for a social reason or a psychiatric reason, not a medical one. You dispute the need for two doctor’s signatures in the first trimester. Does the two signature requirement not preserve, somewhat, against the lack of psychiatric expertise among many doctors?

PW: Whether abortion is right and under what circumstances is a matter of law as defined in statute. The committee could find no compelling evidence that value was added to the process by requiring two doctors’ signatures; indeed this is the only medical procedure that requires such a condition. We were concerned that the second signature, often received via fax without the woman being present seemed to confirm that this was a bureaucratic rather than a health condition. What the committee did not recommend was that there should be any loosening of the rigour with which a doctor supported a termination nor did we rule out the need for a second opinion where this was thought appropriate.

NL:  “Subject to usual training and professional standards [we conclude] nurses could be permitted to carry out early surgical abortions”.  How will patient safety and quality of care remain?

PW: The reality is that “appropriately qualified” and “appropriately trained” nurses carry out a significant number of clinical procedures now including some invasive procedures. For the first trimester terminations using misoprostol involve taking medication and it seemed to us perfectly logical to allow nurses to carry out this procedure once a doctor had agreed that the procedure should take place.

NL: How did the pro life lobby react to the report?

PW: Inevitably when a report does not meet the aspirations of a lobby group it is not surprising that a negative response is forthcoming. I was, however, deeply impressed with the very sincerely articulated views of many pro-life organisations particularly the demand for higher quality counselling of women. I agree totally with their view that every child should be a wanted child and to that objective we should all strive.