The Abortion Act. Br Med J.
1969 January 25;
- 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-that is, because of risk to the physical or mental health of the
mother, or because of substantial risk that the child would be born
deformed. We thought that it was a part of good medicine to take into
account the patient's total environment when assessing the risk to her
health of the pregnancy continuing. 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 consciencehence the famous
"conscience clause." . . .
McRedmond LJ. The
voice of conscience. Ir Med Assoc 1969 May;62(383):189-90 PMID:5770867
Baird D, Crawford JP, Ferguson RS.
Ethics and abortion (Letters). Br
Med J. 1968 April 20; 2(5598):
Dugald Baird, J.P. Crawford, R.S. Ferguson
- Baird: I think it most unfortunate that your leading article,
Ethics and Abortion (6 April, p. 3), should use such an extravagant and
emotionally charged phrase as " sinister echo of something that ended 20
years ago at Nuremberg " in relation to the recent Abortion Act. . .
- Crawford: As a practising psychiatrist at present who has to face the
various dilemmas and new problems in this field so admirably discussed
by Sir Roger Ormrod (6 April, p. 7) may I comment on your leading article
? (p. 3). 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). . .
- Feguson: The word ethics is apparently capable of a number of
different interpretations. Your leader writer (6 April, p. 3) uses the
arresting phrase, " Medical ethics are the collective conscience of the
profession." A generalization of this order makes it obligatory for
the profession (B.M.A. ?) to state its moral standpoint. . .
Gerber JC. A question of conscience.
Cathol Nurse 1968 Dec;17(2):23-9 passim. PMID:5188983
- Dr. Myre Sim in his letter on. abortion
and conscience (4 November, p. 297) complains that doctors have no
reliable evidence to guide them in their interpretation of the various
clauses of the new Abortion Act. The World Health Organization'
defines health as follows: " Health is a state of complete physical,
mental, and social well-being' and not merely the absence of disease or
infirmity." This definition is surely relevant when one is considering
whether or not to advise termination of pregnancy. . .
J. Letitia D. Fairfield
- In view of the approaching reappearance of Mr. Steel's Abortion Law
Reform Bill in the House, I would like to draw attention to a very
debatable point in the excellent report of the Medical Women's
Federation on the Bill (17 December 1966, p. 1512). Their committee gives
good reasons for strongly opposing "any rigid codification of
indications for terminating pregnancy." . . .
- I have now spent twenty years in general practice.
During the whole of that time I have proudly shouldered both the duty
and the responsibility of being permitted to carry out any medical or
surgical treatment needed by any of my patients, even abortion, albeit
this latter only subject to certain reasonable legal safeguards. In fact,
I have not carried out a single abortion, or even felt tempted to. . .
Abortion and conscience. Br
Med J. 1967 December 9;
- Dr. Myre Sim (4 November, p. 297) exhorts those of us without
religious objections to abortion to heed our medical consciences. He
is so convinced of the rightness of his views that he brands any doctor
who acts differently as lacking in conscience. I do not agree with this
assumption. Many highly conscientious doctors favour abortion on
social grounds. In the present state of knowledge it is still open to
question whether in a particular family the addition of an unwanted
child will endanger the health of the other children. . .
Sim M, Lloyd G, Leyton GB.
Abortion Bill (Letters). Br Med J.
1967 May 20; 2(5550):
Myre Sim, Gareth Lloyd, G.B. Leyton
- Sim: Dr. W. J. Stanley (22 April, p. 247) raises a most
important point which has not been sufficiently appreciated by the
medical profession. A law which lays down the vaguest criteria for
abortion, including the mother's " well-being," and which permits
doctors (and presumably nurses) the right to refuse to participate on
grounds of conscience makes the decision not to abort on clinical
grounds a more actionable one. . .
- Lloyd: Dr. W. J. Stanley (22 April, p. 247) raises the question
of the legal position of the doctor refusing to accede to the termination
of a pregnancy on medical grounds. Let us be clear in our minds that,
once the Bill becomes law, any doctor refusing to consider abortion on
medical or social grounds could be liable to be prosecuted for
negligence. . .
- Leyton: As a reader of the British Medical 7ournal for more than a
quarter of a century I feel compelled to write and say how much I
deplore the recent trend in your leading articles of allowing other
considerations than the welfare of the patient to influence your
reasoning and conclusions. . .
- The Abortion Act has now passed its final stage and is law. Because of
the determination of the sponsors to have the law changed before there
was a full inquiry into the facts there is still no body of reliable
evidence to guide doctors or the public in the interpretation of the
various clauses. One point seems clear, and that is the new law will
permit a doctor to refuse to recommend or perform an abortion on grounds
of conscience. This clause was intended to protect those doctors (and
nurses) with strong religious objections to abortion. There are,
however, conscientious objections other than religious. . .
- Dr. P. Darby (2 December, p. 549) puts forward the pregnant woman's "
wellbeing " as a medical consideration for abortion. He appears to
have forgotten that the " well-being " clause which was included in an
earlier stage of the Medical Termination of Pregnancy Bill was withdrawn
by its sponsors and is not in the new Abortion Act. That the W.H.O.
includes such a phrase in their definition of mental health does not
give it legal validity. Neither does it give it medical sanction, for
W.H.O. definitions are notoriously unstable and liable to change, as
is evidenced by those on alcoholism and drug addiction. . .
Abortion Bill (Letter). Br Med
J. 1967 April 22; 2(5546):
- It appears that, whatever the members of the medical profession feel
on the subject, this Bill will shortly become law. Having followed the
debates in Parliament one is left with the alarming impression that
the protagonists do not have the slightest idea of the serious
implications of the Bill, particularly for the medical profession. Until
very recently it appears to have been assumed that, provided the
grounds for termination of pregnancy laid down in the Bill existed, some
doctor would automatically carry out the operation. It has gradually
dawned upon the politicians that a doctor might have objections, and
at a very late stage a " conscience clause" has been included, but only
against strong opposition. . .
J. Martyn Thomas
- I wish to support those of my colleagues (28 January, p. 236) who
wrote in protest at the rather curt communication which was sent to
general practitioners in this area by our three consultant obstetricians
stating that they did not recognize either social or psychiatric reasons
for termination of pregnancy. It seems to me lamentable that any
doctor, in any branch of the profession, should prejudge issues to the
extent of refusing to consider cases on their individual merit. . .
A.M. Rankin, W.M. Capper
- Rankin: The B.M.A. Council' was not unanimous in approving the joint
B.M.A./ R.C.O.G. report on Mr. Steel's Bill. I for one spoke against
and voted against acceptance on precisely the two grounds which Dr. P.
A. T. Wood (4 February, p. 299) finds objectionable. . .
- Capper: Dr. Evelyn Fisher (28 January, p. 236) suggests that the
post-abortal guilt complex can be assessed "about six weeks after the
abortion." I have during recent years encountered two patients who when
asked about anxiety recalled abortions that had been carried out 20 or
more years before. . .
Avellar GR. Nurses, family planning and
conscience. Cathol Nurse 1966 Mar;14(3):38-42 PMID:5182054
R.E. Bowden, A.M. Pantin
- . . .A Bill seeking to reform the law governing abortion is now in the
committee stage. The apparently increasing requests for abortion, the
legal anomalies, and the practice of abortion by unskilled persons
dictate the presentation of this interim report, despite the present
dearth of factual information. . .Matters on which the Committee is Agreed .
. . (8) No doctor or patient should be required to act against conscience
in this matter of termination of pregnancy. . .
D. M. Brain
- The statement in the leader in the British Medical Journal (5 March,
p. 559) that Lord Silkin's Bill on the medical termination of pregnancy
was " an example of Parliamentary muddle seldom surpassed" is fully
justified. A partial explanation, however, is that a private peer
introducing a Bill cannot obtain the help of parliamentary draughtsmen,
nor can he get the advice of the Government departments most concerned.
He must do the best he can without these aids, and it is generally
admitted that Lord Silkin's Bill, as originally introduced, was little
more than the embodiment of the aims of the Abortion Law Reform
Association. . .
Browne R, Kirk DL.
Abortion law reform (Letter).
Br Med J. 1966 June 18;
Robert Browne, David L. Kirk
- We understand that Mr. David Steel, M.P. for Roxburgh, Selkirk, and
Peebles, is to introduce a Bill in the House of Commons to reform the law
on abortion.' It will be similar to that already approved by the House
of Lords-grounds for legalized abortion being the health of the mother,
the results of rape, and the capacity of the mother to care for the
child. The B.M.A. has appointed a committee to consider the subject of
therapeutic abortion and to prepare a comprehensive report. . .
- I have read Mr. Wilfrid G. Mills's letter on abortion law reform (5
February, p. 355) with interest, and would like to comment on one
statement made in the memorandum. I refer to the assertion that " many
gynaecologists feel an instinctive repugnance for the procedure often
coupled with some measure of guilt...." I would question the use of
the word instinctive, as surely it has now been shown that the human has
very little instinctive behaviour, and that in fact he is almost
entirely motivated by his cultural conditioning . . .
D.G. Wilson Clyne
- In recent weeks there has been a mass of correspondence on this
subject, but very little clear thinking, or so it seems to me. A number
of contributions, however, merit attention. First, three important
statements were made at the Hastings Centenary Clinical Meeting at
Worcester (30 April, p. 1105). Mr. Oswald Lloyd believed that "Many
doctors were not clear about the present law on abortion. . . It was
enough if he acted in good faith, and similarly any specialist
recommending the operation was likewise protected. . . Today there are
few cases with physical grounds for therapeutic abortion.". . .
- In view of the report which you printed (Supplement, 22 January, p.
19) of the Special Committee on Therapeutic Abortion, the following
points may be of interest: (1) The Abortion Law Reform Association
strongly opposes any special procedure of notification of medical
termination of pregnancy . . .
de Soldenhoff R, Rhodes P, Hewetson SF, Hetherington RJ, Kerslake DM.
Abortion law reform
(Letters). Br Med J. 1966 May 7; 1(5496):
Richard de Soldenhoff, Philip Rhodes, S.F. Hewetson, Robert J.
Hetherington, D.M. Kerslake
- de Soldenhoff: After reading the memorandum on legalized
abortion by the council of the Royal College of Obstetricians and Gynaecologists
(2 April, p. 850) and also the points put by Lord Brain (19 March, p.
727) and the answer to these by Professor Philip Rhodes, I would like
to endorse wholeheartedly the letter which was written by the latter (2
April, p. 859). Without wishing to appear pompous, as a senior
obstetrician who has been in charge of an obstetrical service in a
large provincial district for 20 years, I think that to bring in
legalized abortion would be a terrible mistake. . .
- Rhodes: I am sorry that Dr. K. S. Jones (23 April, p. 1050) found some
of my words potentially offensive. They were not intended to be so, and I
agree with him that relations between gynaecologists and psychiatrists
should be good, so that patients who need them both shall not suffer. . .
- Hewetson: I would like to draw attention to two fallacious contentions
made by and on behalf of gynaecologists in recent correspondence.
The first is that only gynaecologists can perform abortions, and the
second that gynaecologists are the only people in a position to judge
the issue in a particular case. . .
- Hetherington: The admirable report by the Council of the Royal
College (2 April, p. 850) presumes knowledge of the present law, but since
Lord Silkin's Bill itself misstates the present law some clarification is
needed. . .
- Kerslake: With regard to the subject of legalized abortion, there are
two aspects for decision: (a) what are the indications ? and (b) under
what circumstances and with what method is the operation reasonably safe
? The indications may well be considered as social as well as medical.
The operation is obviously medical, and here I would cross swords with
the Council of the Royal College of Obstetricians and Gynaecologists (2
April, p. 850). . .
Abortion law refor (Letter).
Br Med J. 1966 May 28;
- It is surprising that in the discussion on abortion law reform
paediatricians have so far taken only a small part. Yet their work
will be profoundly influenced by the change in moral attitudes which is
behind the pressure to alter these laws. If it becomes generally accepted
that any foetus that has, say, a 20% chance of being abnormal is
killed, it may become difficult to defend the preserving of life in very
premature babies, where the risk of abnormality is similar. . .
A.F. Lushby, K.S. Jones
- Lushby: Following the recent correspondence in the B.M.7., I
would like to comment on some of the proposed changes in the law with
regard to abortion. I feel that too little respect is being shown to
the gynaecologist, who will be the person to perform the operation. The
concept of " medical certificates " is distasteful. . .
- Jones: Whether or not one agrees with the points made, Professor
Philip Rhodes's letter on abortion law reform (2 April, p. 859) is
clearly a responsible contribution, and it is therefore particularly
unfortunate that the references to psychiatrists in the final paragraph
should carry a potentially offensive implication. . .
R. M. Marquis
- I was very interested to read the excellent report on legalized
abortion by the Council of the Royal College of Obstetricians and
Gynaecologists (2 April, p. 850). TTwo questions, however, arise. . .
McLaren HC, Wright LH.
Therapeutic abortion (Letters).
Br Med J. 1966 July 23; 2(5507):
H.C. McLaren, Liam H. Wright
- McLaren: The Abortion Law reformers will not be pleased with the
moderate proposals put forward by Dr. E. A. Gerrard and his Special
Committee (2 July, p. 40), although the proposals will be greeted with
relief by most gynaecologists. The recommendations amount to the
giving of power over the life of the foetus to two practitioners, one of
whom should be a gynaecologist, both, of course, acting in good faith.
- Wright: Dr. D. G. Withers (16 April, p. 978) questions the right
of a gynaecologist to " refuse to do the work he is employed to do on
the grounds of moral prejudice." I would question Dr. Withers's knowledge
of the current medical status of termination of pregnancy. I would
question, too, his use of the words " moral prejudice." . .
- The controversy regarding reform of the laws relating to deliberate
termination of pregnancy has not yet been resolved within the medical
profession, nor does there appear to have been any statement from a
body of practising gynaecologists on their personal attitude to this
matter. It was in order to test such an opinion that my colleague Mr.
G. S. Lester and I circulated the memorandum which appears below to the
practising gynaecologists among the Fellows and Members of the Birmingham
and Midland Gynaecological and Obstetrical Society asking for their
comments. . .
Paintin DB. Burns R.
Abortion law reform (Letters).
Br Med J. 1966 February 19;
D.B. Paintin, Robert Burns
- Paintin: Mr. Wilfrid G. Mills was right when he stated (5 February, p.
355) that the present law permits the medical profession to perform
all necessary abortions. But I think he was wrong when he inferred that
there was no need for reform of the law. . .
- Burns: Most doctors in the U.K. know that as a result of the large
number of resignations from the N.H.S. there will be in the not too
distant future an insufficient number of doctors to look after the whole
population of this country in the N.H.S. Most doctors also know that
an increasing number of patients prefer to have private treatment, and
that private medical insurance schemes are being patronized more than
ever. It seems reasonable, therefore, to conclude that an increasingly
large number of therapeutic abortions will be dealt with privately in
the future. . .
Pells D, Diggory P.
Abortion law reform (Letter).
Br Med J. 1966 February 26;
Denis Pells Cocks, Peter Diggory
- Cocks: As a practising gynaecologist I, like I am sure many of
my colleagues, have read accounts of the debate in the House of Lords
on Lord Silkin's Abortion Bill (12 February, p. 430) with great interest
yet with a good deal of genuine disquiet. Mr. W. G. Mills's letter on
abortion law reform (5 February, p. 355) has rightly drawn attention
to the fact that the controversy on the deliberate termination of
pregnancy has not yet been resolved within the medical profession. . .
- Diggory: I wish to call attention to a very important and fundamental
threat to the liberty of the medical profession which has arisen
following amendments to Lord Silkin's Abortion Bill (12 February, p.
430). Lord Dilhome's accepted amendment to Clause 1 now reads that
certification of the need for termination of pregnancy has to be made by
two doctors who must be "the pregnant woman's regular doctor and a
registered medical practitioner employed in a hospital under the
N.H.S., or two registered medical practitioners so employed." . .
- Dr. M. Sim points out (29 January, p. 294) that the report of the
B.M.A. Committee on Abortion has been brought forward with " indecent
haste " in order to deal with the problems posed by Lord Silkin's
Bill. Dr. Sim suggests the B.M.A. should press for delay in legislation
on this important subject, and a leading article (29 January, p. 248)
makes the same point. I do not think it is right to plead for
postponement in a matter which so deeply affects the health of a very
large number of women. Abortion is not a new condition like some
previously unknown virus or unreported drug reaction. . . .
- I am grateful to Lord Brain (19 March, p. 727) for putting the points
in this matter so clearly. Since you ask for wide discussion I put my
personal answers to the questions. . .My answers to the questions are
necessarily brief for the considerations of your space. A general
comment would be that the law needs reform for the sake of the law and
not medicine. I have performed abortions for what I and my
colleagues have considered to be good reasons. I do not like to perform
the operation, and those who assist me like it even less. . .
Robinson TG, Withers DG.
Abortion law reform (Letters). Br
Med J. 1966 April 16;
Terence G. Robinson, D.G. Withers
- Robinson: I feel myself in broad agreement with the answers
given by Mr. Philip Rhodes (2 April, p. 859) to Lord Brain's points, with
the exception of his categorical " No " to the question, " Should the
fact that a pregnancy is the result of rape be a ground for its legal
termination ? " . . .
- Withers: With reference to the present discussion on the
proposed changes in abortion law, and in particular to the report by the
Royal College of Ohstetricians and Gvnaecologiists (2 April, p. 850), I
should like to make the following point: Even if more liberal measures
were introduced, the individual patient may well be faced with a
gynaecologist not prepared to perform the operation because of personal
moral misgivings. . .
- The B.M.7. of 17 December shed a welcome ray of hope over what has
otherwise seemed a dismal Christmas scene. I refer to the contibutions from the Medical Women's Federation (p. 1512) and Mr. D.
Pells Cocks (p. 1531) on abortion law reform. The excellent memorandum of
the Medical Women's Federation puts the problem in proper and humane
perspective and provides an ideal rallying point for medical opinion. . .
- The Royal Medico-Psychological Association issued last month a
memorandum on possible changes in the law relating to therapeutic
abortion. Emphasizing that it would be opposed to legislation which might
bring pressure on an individual doctor to act contrary to his conscience,
the memorandum states that the Royal Medico-Psychological Association has
approached the problem of therapeutic abortion with the firm view that,
in addition to traditionally accepted medical and psychiatric criteria,
all social circumstances should be taken into account. If, after
considering all these factors, a psychiatrist should form the opinion
that the mental health of the mother and the whole family would be
promoted by termination, then it should be lawful for him to recommend
- Mr. James Campbell (5 March, p. 613) makes an important point when he
states that the " instinctive repugnance " felt by many gynaecologists
for the operation of abortion is a result of our " cultural
conditioning." No doubt we could eventually be so conditioned that
abortion, or the destruction of any other life too for that matter,
gave no concern to our professional consciences. . .
- In this country persons who by reason of religious training and
belief conscientiously object to participation in any war are exempted
from military service. This immunization, however, is not derived from
the constitutional "freedom of religion" right but "arises solely
through congressional gTace, in pursuance of a traditional American
policy of deference to conscientious objection. ' To understand the
problems that arise in this area, it is necessary to be familiar with
the procedure by which a person may take advantage of this immunization.