Ethics

The Agenda for the BMA ARM was published on Saturday 14 June 2008 on the BMA website.

As with last year Evan Harris MP from the Oxford division has the lead motion once more.

The motion is primarily aimed at barring doctors with conscientious objection to abortion from seeing patients with unplanned pregnancies, forcing them to refer to other doctors, and reinterpreting the GMC guidance on personal belief and clinical practice to conform with this view.

*528 Motion by OXFORD DIVISION: That this Meeting:

(i) supports the rights of doctors and other health care professionals to conscientiously object to carrying out, or referring directly for, certain non-emergency lawful procedures, where:

(a) such conscientious objection is recognised in statute, as in abortion and IVF;
(b) the doctor recognises that s/he is not in a position to give balanced advice to patients considering that procedure and does not claim to do so;
(c) the medical practice makes every effort to inform patients in advance, for example through practice leaflets, which doctors are able to provide such advice and make appropriate referrals;
(d) in the event of seeing a patient seeking advice on such a procedure, the doctor must refer them to another doctor for such advice;
(e) in the event of seeing a patient seeking such a procedure, the doctor must, in line with GMC guidance, tell them of their right to see another doctor and ensure that the patient has sufficient information to exercise their right; but if the patient cannot readily make their own arrangements to see another doctor, the doctor must ensure that arrangements are made, without delay, for another doctor to take over their care.

(ii) calls on the GMC to ensure its guidance on personal beliefs and medical practice reflects this view;

(iii) calls on parliament to retain the statutory right of doctors and other health care professionals to conscientiously object in abortion and IVF services within the above limits.

In the context of the BMA ARM it will be a challenge to stop it going through.

The Abortion Act 1967 allows abortion only to be carried out by doctors in 'approved premises', on the authorization of two doctors who must be of the opinion in good faith that one of the four statutory grounds for abortion is fulfilled. In practice greater than 98% of abortions are carried on the ground that 'that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family.' In almost all of these (>98%) it is the mental health of the mother that is the determinant despite the fact that in a recent review the Royal College of Psychiatrists is uncertain whether in fact there is any evidence of psychiatric grounds for abortion.

Harris's entire abortion strategy is now apparent.

We always knew that his aims were:

1. Removal of the requirement for two doctors' signatures to authorize abortion – ie. Make it like any other procedure (eg tonsillectomy) with the requirement of informed consent only
2. Changing the whole medicolegal basis of the abortion law by removing the need for medical grounds for abortion
3. Nurses doing abortion
4. Relaxation of regulations on premises to allow medical abortions to take place in GP surgeries, polyclinics, cottage hospitals and family planning centres with completion at home.
5. Barring of prolife doctors from seeing patients with unplanned pregnancies
6. Extension of the Act to Northern Ireland
7. Resistance to any lowering of the 24 week upper limit

This is how he intends to achieve each of the above aims:

1. Removal of need for two doctors' signatures - Amendment to HFE Bill at Commons Report stage

His motion last year made this BMA policy when the following motion was passed by a majority of 67-33% at last year's BMA ARM:

'That this Meeting calls for legislation to be amended so that first trimester abortion would be available on the same basis of informed consent as other treatment and therefore without the need for two doctors' signatures'

The change will be achieved by an amendment to the HFEA Bill just tabled by Harris/McCafferty which will both remove the need for medical grounds for abortion and the requirement for two doctors' signatures.

2. Removal of need for medical grounds for abortion - Amendment to HFE Bill at Commons Report stage

Achieved by same amendment – see above. It will no longer be necessary for abortion to pose a risk to mental or physical health. It will simply be available on request from one doctor with informed consent only.

3. Nurse abortion - Amendment to HFE Bill at Commons Report stage

Harris failed to make this BMA policy last year when the following motion was defeated by 59-41%.

'That this Meeting calls for legislation to be amended so that first trimester abortion could be carried out by suitably trained healthcare professionals including midwives and nurses.'

The change will be achieved by an amendment to the HFEA Bill just tabled by Harris/Dobson which will allow healthcare professionals other than doctors to perform abortion.

4. Relaxation of regulations on Premises – Through regulations by Secretary of State

Harris failed to make this BMA policy last year when the following motion was defeated by 54-46%.

'That this Meeting calls for legislation to be amended so that the current rules relating to “approved premises” are relaxed with regard to first trimester abortions.'

However the Secretary of State already has statutory power to do this under a 1980 amendment to the Abortion Act by the Health Services Act and abortions in these settings are currently being trialed. Harris need do nothing more to achieve this aim.

5. Barring prolife doctors from seeing patients with unplanned pregnancies – through BMA motion

This will be achieved by a change in BMA policy with pressure then being put on the GMC to change either their guidance or their interpretation and implementation of it. Doctors who refuse to comply will then be reported to the GMC.

6. Extension of the Abortion Act to Northern Ireland – Amendment to HFE Bill at Commons Report stage

This is already BMA policy. Expect an amendment to the HFE Bill to this effect to be tabled very shortly. However negotiations over the 42 day 'detention without trail' proposal will help here. It was reported in the Telegraph on 12 June that the Ulster MPs votes which rescued the government were partly on the basis of a guarantee not to extend the Act to Northern Ireland: 'Shaun Woodward, the Northern Ireland Secretary, assured the DUP that the Government had no plans to end the ban on abortion in the province. Abortion has never been legal in Northern Ireland, and women and girls seeking a termination often travel to the England for the procedure.'

7. Resistance to any lowering of the 24 week upper limit – Already achieved by blocking amendments to HFE Bill

This is already BMA policy and was upheld by a vote of 77-23% at last year's BMA ARM. Attempts to lower the upper limit to 12, 15, 20 and 22 weeks were all defeated in the House of Commons debate on the HFE Bill on 20 May.

And finally…

One piece of good news is a motion from Cardiff acknowledging that abortion can be a psychologically traumatic process for women, and urging the BMA to campaign for increased counselling and support for women before and after this procedure.

This motion as designated 'A' meaning that the chairman of the BMA Medical Ethics Committee has recommended it as likely to be non-controversial and acceptable without debate. He will formally move that it be accepted (see attached standing orders)

This is in line with the recent recommendations of the Royal College of Psychiatrists and is being recommended in an EDM 1592 recently tabled by Angela Watkinson.