The part played by the Royal College of Obstetricians and Gynaecologists in the framing of the Abortion Act is familiar. The College aimed to make it legal to terminate a pregnancy only on medical grounds . . . Moreover, we wished to preserve the right of a doctor to refuse to participate in the treatment of any case to which he had an objection on grounds of conscience: hence the famous “conscience clause.” . . . we did not expect a very great change in practice . . . How wrong we were….
Lewis TLT. The Abortion Act. Br Med J. 1969 January 25; 1(5638): 241–242
Extract . . .at the present rate and with no further increase in demand the annual number of abortions in England and Wales would be at least 35,000. He compared this demand with an estimate from the Ministry of Health and Registrar General’s Office of 1,600 therapeutic abortions in 1958 and 2,800 in 1962. The public have thus endorsed the Act and are asking doctors to implement it in a liberal way. . . . It is apparent that the Abortion Act has brought many people what they wanted-namely, a more liberal attitude towards the termination of pregnancy. . . The number of unwanted pregnancies indicated by the latest figures underlines the need for all doctors working in the National Health Service to provide adequate and accurate advice on contraception.
Extract [Notes increase in abortion since change in law. Discusses abortion methods.] “In summary, when the decision has been taken to terminate pregnancy it is best carried out in the first fourteen weeks by a conventional one-stage evacuation or by vacuum suction, and later in pregnancy by abdominal hysterotomy. But therapeutic abortion is not a simple operation. Those who would extend the scope of legal abortion on purely social grounds would do well to remember that no method of terminating pregnancy is entirely devoid of risk. The operation is only as safe as the surgeon who performs it. Mishaps will occur, and they will be kept to a minimum only when operations are performed in well-equipped hospitals by skilled gynaecologists who are well aware of the dangers.”
Extract [suggests] the establishment of abortion clinics staffed by personnel adept at processing all cases referred. Doctors who claim conscientious objection could be assigned compensatory work in the present infertility clinics.
Extract patients requesting abortions are taking up considerable outpatient time, sidestepping our long waiting-lists, and occupying valuable hospital beds-all these at the expense of the genuine gynaecological patients. . . At a recent count, one in five of the patients in our wards are cases for termination of pregnancy. Their increasing numbers have been an embarrassment to many medical and nursing staff who have conscientious objections, especially those working in the operating- theatre.
Extract Although the Royal College of Obstetricians and Gynaecologists considers that most cases will be referred to N.H.S. hospitals and will come under the care of consultant gynaecologists, it is nevertheless probable that some will be admitted to ” a place approved for the purpose by the Ministry of Health or the Secretary of State,” and additionally may not come under the care of a trained and experienced obstetrician. Therein to my mind lies a danger to these women, as the numbers seeking abortion continues to increase and as hospital beds become so severely taxed as to necessitate delay in admission. The difference between the risks of the operation in the early weeks and in the weeks between the ninth and the fourteenth is considerable, and after this point an abdominal approach must be considered. . .
For these reasons, in my earlier letter I feared the possibility of panic measures leading to unethical surgery in inadequate surroundings (apart from authorized units) and stressed the need for the hospital consultant to be directly concerned in all cases.
Extract It is difficult for the ordinary doctor like myself to understand the role of the G.M.C. as regards medical ethics. Its change in attitude over abortion would suggest that the law of the land takes precedence over medical ethics, for the present law permits abortion for non-medical reasons. Does this mean that the G.M.C. will maintain only those medical ethics which do not conflict with the law, and that laws permitting euthanasia and sterilization of the unfit would receive similar sanction ? There is surely a conflict here not only between the G.M.C. and individual doctors but between the G.M.C. and those medical ethics which have international recognition..
Extract Surely a decision by Parliament in a democracy cannot be described as sinister ” superior orders” echoing Nuremberg 20 years ago (or rather what ended there and then). The boot could be argued to be on the other foot-namely, that doctors are prepared to dictate to the nation.
Extract It will be interesting to learn, when the Representative Body takes its decisions, whether this ” official ” medical ethics will concede the right, sometimes even the duty, of the convinced dissenter to adopt the stand of conscientious objector. Or will the moral empire be essentially totalitarian in nature ?
