Review by Philippa Taylor, CMF Head of Public Policy
The Department of Health has been steadily loosening its guidelines on abortion, without announcements, public consultation or discussion in Parliament. Our suspicion is this change is part of a process culminating in a nurse-led abortion service, predominantly in private clinics, paid for by the tax-payer funded NHS.
One key change is the removal of the requirement for a pregnant woman to see two doctors.
The Abortion Act 1967 requires that a pregnancy can be terminated by a registered medical practitioner only '...if two registered medical practitioners are of the opinion, formed in good faith...' that it fulfills one of the specified legal grounds. The ability to form, and subsequently defend, an opinion on a woman's need for an abortion, and her health, surely requires that a doctor has at least met her beforehand?
Induced abortion is an invasive medical procedure with known contraindications and complications. Only a registered doctor will have the required training to ensure that a woman seeking an abortion is fully informed of the medical risks of the procedure, is properly cared for and that her request meets the requirements of the law. Now all this is under threat.
The previous Secretary of State for Health, Andrew Lansley, issued interim guidance for abortion clinics in summer 2012 but never published it.
However, around this time, the Department stated – for the first time – that 'there is no requirement that both doctors must see and examine the woman' (1). This was a significant change from guidance issued in 1999 which said that: '...medical practitioners must give their opinions on the reasons under the Act for the termination following consultation with the woman.' (2) (emphasis mine).
When the 2012 interim guidelines were finally published on the DH website in January 2013 they said 'We consider it good practice that one of the two certifying doctors has seen the woman, though this is not a legal requirement.' (3) By November 2013, the eventual public consultation paper included a further addition, that members of a multidisciplinary team (a nurse or other member of a team) can seek the necessary information from the woman, instead of the doctor.
Interestingly, recent polling found that most women (92%) agree that a doctor should always need to see the woman, in person, to approve abortions. The polling highlighted fears that women's health would be put at risk if the requirement to see a doctor is watered down. (4)
The DH will shortly release definitive new guidance for both private abortion clinics and for doctors. At that point the new interpretation of the Abortion Act – that no doctor need see a woman before authorising an abortion – could be set in stone, without Parliament ever having debated it. Such a move would fly in the face, not only of women's wishes, but of the Act itself.