Tuesday, 3 February 2009

Abortion Part 1 - The Law

Well, my friends, it has been a while since I last did a proper post.  I'm not on the wards at the moment so, without any practical examples, I thought we'd all benefit from a bit of theory! Hurrah I hear you cry!  But then...Abortion? Why such a whopper of a subject?  Let me explain.  

I believe, right down in my deepest darkest parts, that ignorance is the scourge of mankind, to quote Derek Bok (former President of Harvard University):

"If you think education is expensive, try ignorance"

and German playwright Goethe:

"There is nothing more frightful than ignorance in action"

Abortion, for reasons that I can't quite explain, is a subject that interests me.  It is the source of so much tension and sadness in the world.  Sadness of those who are personally experiencing it and tension between people who have such passionate views on it.  It is a subject on which I have seen and heard such phenomenal ignorance and this invariably leads to more of that sadness and tension I mentioned.  I have talked about my experience of it in the hospital before but I thought that I might elaborate on more of the technical issues, so that, in my own small and insignificant way, I might erase some of that ignorance.  I am not a lawyer, or a medical ethicist, neither am I an obstetrician or, as you may have noticed, a woman.  However, I do not believe you have to be any of those things to have a sincere and well thought-out position on this issue, and that my friends is the right path to start down.  Because, in the end, knowing more and more about these complex issues is only a means to the end, that end being an opinion.   It is here that I should add a caveat, I am hoping to do a number of posts on different facets of Abortion and in doing so I will try my hardest to remain neutral.  This will be easier with some posts than others!  I do this so as not to cloud the opinion that might be forming in your mind, but also, because I don't believe that in the end my opinion, whatever it is, should make much of a difference.  At the heart of all this is a pregnant woman and a foetus who need kind counsel, patronage and support, neither of which I can see being given adequately with any pre-existing bias.
So, anyway, in my mind I see three posts.  One on the legal side of things, the medical side of things and one going over the main philosophical/sociological side of things.  I don't think they'll be too intense but enough for you to know the key details.  First off...the law.

We must start, as always, with the Offences Against the Person Act of 1861.  This is the definitive law in England, it states that abortion is a crime and punishable by life imprisonment, unless future legislation provides protection against prosecution.

That is what happened in 1967 when the Abortion Act was introduced.  It provided protection from prosecution, not to the mothers, but rather to the doctors carrying out the abortions.  It was later amended by the 1990 Human Fertilisation and Embryology Act.  So, when is it legal to have an abortion?  There are seven conditions under which abortion can be performed, two of which must be in an emergency situation.  Two doctors must agree that one or more of the following options apply:

A - Continuation of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated

B - The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman

C - Continuation of the pregnancy would involve risk, greater than if it were terminated, of injury to the physical or mental health of the pregnancy.  As long as the pregnancy has not exceeded 24 weeks

D - Continuation of the pregnancy would involve risk, greater than if it were terminated, of injury to the physical or mental health of any existing children of the pregnant woman

E - There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Or, in an emergency, if one Doctor decides that:

F - The termination is necessary to save the life of the pregnant mother

G - The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant mother

So, there are the conditions under which abortion can be performed legally in the UK. Essentially in the UK when faced with the decision of whether to terminate the pregnancy or not the Doctors must decide whether or not it is safer for the woman than continuing it.  If a woman approaches the doctors before 24 weeks she must demonstrate that continuing with the pregnancy would could cause her more physical or mental damage than if it were terminated. Legally, it doesn't get much more complex than that.  There are different issues with younger women but those are to do with the legal concept of competence.  Where someone who is legally a child (under 18) but is able, or demonstrates that they are able (competent) to make decisions about their own treatment.  You can also see that only options C and D make a statement about a gestational age limit (24 weeks - more about this in the second post), for the other options it is possible to get an abortion right up until birth.

Another important point to remember is that the foetus does not have any legal rights until it has been born.  It does not have the right to be born and it does not have the right not to be born.  The law only recognises the gestational mother only.

It think it would be worthwhile to look at some statistics, all of these are from 2007.
  • There were 205,598 abortions (179,746 in 1997 and 133,004 in 1977)
  • 89% of these NHS funded and 11% privately
  • 98% of abortions were carried out under option C above, less than half a percent of which were due to the risk to the physical health
  • 1% were under option D and the rest of the options made up the final 1%
  • 90% are performed under 13 weeks gestation, 0.1% were greater than 24 weeks
  • Most abortions were carried out on women aged 20-24 yrs, then 15-19 yrs, then 25-29 yrs
  • 1,171 abortions were carried out on women under 15 yrs, 163 under 14 yrs
  • 81% were carried out on single women
  • 32% of women had one or more abortions previously
  • 1005 women had had 4 or more abortions previously
Phew, that's a lot of numbers!!  I don't think any of that would be a great surprise to anyone, most abortions are to young, single women who use option C, where the pregnancy would cause greater risk to their mental health than if terminated.  It's staggering to see how young some of these women are and that there are many who have had previous abortions.

Well, I'll leave this post at that point.  I can't tell you how much I want to waffle on about all this but there would be opinions all over the place and we wouldn't want that would we....