The Law and ethics of Post Viability Abortion
By Dr. Andrew Fergusson and Ann Furedi

Introduction

What follows is a transcript of papers given at a seminar held at Kent University Law School in the Autumn Term 1997. The seminar was organised by Ellie Lee, a student at Kent University and Co-Ordinator of Pro-Choice Forum, to give staff and students the opportunity to discuss issues surrounding fertility, ethics and the law.

Dr. Andrew Fergusson:

To begin with I would like to say something about myself to explain why have an interest in this subject. I qualified in medicine at St. Thomas's Hospital in London in 1975 and I worked in hospital medicine in both acute and intensive care with adults and in chronic geriatric medicine for four years. I spent 10 years as a GP in a roughish area in south-east London and I had particular interests personally in the elderly and in young people with chronic physical disabilities.

In the course of that ten years I probably sat with around about 100 women requesting abortion, (roughly one a month) for ten years, and I have signed the green forms for abortion (that is the colour they were then). For the last eight or nine years I have been working full-time with an organisation called the Christian Medical Fellowship. 4 500 British doctors all over the United Kingdom, in general practice and in all sorts of different specialities, are members. I also write, teach and broadcast about ethics. I am not an expert on abortion and it may well be there are details in the legal situation that I am not up to speed with, but I think that my contribution tonight should be on the 'big picture'. Since I work for Christian Medical Fellowship I am a traditional 'Bible believing Christian'. We have to recognise without tension that our own particular view is what makes the world 'tick' and what makes human beings tick are going to colour our discussion for this evening.

The law and ethics of post viability abortion is our subject. In this introduction I thought that I would run through the legal indications for abortion in the UK since the law was changed in 1990. I am going to use the terminology which is actually on the certificates which the doctors sign.

There is a form called certificate A, which has five clauses, (a)-(e), and there is certificate B for emergency treatment which has got two clauses, (f) and (g). With certificate A, clause (a) says it is lawful for termination of pregnancy to be performed if two doctors forming their opinion in good faith before the surgical procedure is done, and looking at the circumstances of that particular case only, believe that the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated.

Under clause (b) the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman. So we are talking about health risks to the woman.

Clause (c) says that the pregnancy has not exceeded 24 weeks 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. So we are not talking about grave permanent injury, we are talking about injury to the physical or mental health of the pregnant woman but the pregnancy has not exceeded its 24th week.

Clause (d) says that the pregnancy again has not exceeded its 24th 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 any existing child or children of the family of the pregnant woman. Again, there is that 24 week limit there in the Act. It is this next clause of Certificate A that is really our subject now, because we do not here see the 24 week limit.

Under Clause (e) abortion can be performed legally if there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped. There is no reference to 24 weeks and in law this clause operates to term of the pregnancy.

For the sake of completeness there is the other certificate, certificate B for emergency treatment only. This says termination is immediately necessary under clause (f), to save the life of the pregnant woman and under clause (g) to prevent grave permanent injury to the physical or mental health of the pregnant woman.

There are then seven clauses in total, two of them are restricted to the first 24 weeks, five of them operate to term. In 1990 the law was changed to bring the upper limit for termination in two of those categories down to 24 weeks of gestation. Why pick on 24 weeks? There was an understanding before 1990 that 28 weeks was the viability point. This came from the Infant Life Preservation Act. There was no specific limit set in the 1967 Abortion Act but a previous piece of legislation led to a concept that you could do abortions up to 28 weeks. So why the reduction to 24 weeks?

There are two reasons and the main one is that of neo-natal care. This is about the ability of doctors, nurses and other health professionals to look after very small babies who were born naturally but early. The ability of doctors to preserve life in those situations developed rapidly as the technology came along. If you spend enough money, if you have got paediatric intensive care neo-natal beds, you can get children born at 26, 25 and 24 weeks surviving, leaving hospital a long time after with a good medical outcome in terms of physical and mental abilities later. So now we have got down to 24 weeks in terms of what is called viability, hence our topic heading, the law and ethics of post viability abortion.

The other issue which is important is the issue of sentience and awareness. Over the last year or so and particularly in the last couple of weeks that there has been discussion about at what point a fetus feels pain. The Royal College of Obstetricians and Gynaecologists tell us that it is 26 weeks. However because we cannot be sure about gestational age we ought to allow a couple of weeks earlier and use particular kinds of anaesthetics.

These two if you like technical developments, that is the ability to provide care to small neo-nates and the awareness of sentience, led to a feeling that 28 weeks was too high a limit. Without recapitulating all the Parliamentary legislation process of 1988 to 1990, there was an outlawing of post viability abortion accept in situations where the life of the pregnant woman was threatened, and where there was grave permanent injury to the physical or mental health of the pregnant woman.

The subject tonight I think is likely to be around the other category where post viability abortion is legal, that is abortion for abnormality. To be precise, the wording of clause (e) of certificate A says that abortion up to term is legal if: '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'.

There is a review at a level and where we are at the moment. What about ethics? Let me run fairly rapidly through some International Oaths and Codes. In 400BC (although you might say that is a fairly dated reference), Hypocrates or the School of Hypocrates led to the Hypocratic Oath. I have chosen two different translations, they are both widely accepted English translations but we need to recognise that we are looking at rather old Greek documents here. One of them says: 'I will give no deadly medicine to anyone if asked, nor suggest such counsel and in like manner I will not give to a woman a pessary to produce abortion.' Arguably, here we have the euthanasia and the abortion debates in that paragraph. A mid 1930s translation: 'I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect, similarly I will not give to a woman an abortive remedy'. Perhaps the second translation was looking a little wider than pessaries.

I am now going to jump forward 2,500 years to the Declaration of Geneva 1948.We need to set this in historical context because of course, this was in response to various atrocities performed by the Nazi medical profession between 1933 and 1945. The Declaration of Geneva 1948 was adopted by the General Assembly of the World Medical Association. The context is the post-Holocaust situation and it uses this expression: 'I will maintain the utmost respect for a human life from the time of conception even against threat'. A little later on, the International Code of Medical Ethics adopted by the Third World Medical Assembly in 1949 states: 'A doctor must always bear in mind the importance of preserving human life from the time of conception until death'.

48 years ago in 1949 the International Code of Medical Ethics adopted the last Code. To give a further couple of quotes: 'everyone has the right to life' is enshrined in the United Nations Declaration of Human Rights and Freedoms of 1948. Here we have the same historical context of the aftermath of the Nazi experience. 'Legal protection before as well as after birth' is mentioned in the United Nations Declaration of the Rights of the Child 1959 talks (and clearly this is a short quote from a long document) referring to the importance of legal protection before and as well as after birth.

I imagine that most of are aware that it is about this point in history that more liberal abortion policies came along. Russia was first, followed by the Scandinavian countries. Britain was the first Western European non-Scandinavian country to bring in liberal abortion legislation in 1967. There was therefore a big gap between what codes of ethics for doctors were saying and what doctors in some countries were doing. There were two choices. They could stop what they were doing and go back to what the codes of ethics were saying, or they could change the codes of ethics. Indeed it was this latter category that was followed. As a result we get to another yardstick or milestone in the Declaration of Oslo, 1970 adopted by the 24th World Medical Assembly. It uses this sort of language: 'Where the vital interest of the mother conflict with those of the unborn child, [therapeutic] termination of pregnancy is admissible according to a doctors individual conviction and conscience'. This was approved as the case provided that the law and the local medical association allow it.

I think that if you can follow the essence of those codes, there is a pretty major shift by Oslo 1970. Then we get to the 35th World Medical Assembly in Venice in 1983. They looked at the words of the Geneva Convention and that talks about 'from the time of conception'. This was amended to 'from its beginning', which obviously begs the question: When does life begin? At the same meeting the words 'from the time of conception until death' were just deleted from the International Code of Medical Ethics. So there was Oslo in 1970 and Venice in 1983 when some pretty major shifts in ethical codes took place.

I now want to come up to date with the British Medical Association (BMA) draft revision of the Hypocratic Oath, which was published earlier this year. It was not popular when its was presented to the BMA's AGM, mainly because people felt unhappy with the language. The relevant paragraph for the issue of abortion says: 'I recognise the special value of human life but I also know that the prolongation of human life is not the only aim of health care'.

I think this touches on the balance of responsibility in euthanasia, just as Hypocrates touched on euthanasia before abortion. The BMA document goes on to say: 'Where abortion has been permitted, I agree it should only take place within an ethical and legal framework'. I do not know what the final version of this document will say, but the words 'only within an ethical and legal framework' bring us to the issue at hand.

I think we need to keep the question of post viability abortion in some sort of numerical framework. There were 177 225 abortions in England and Wales in 1996, up by 8.3 per cent compared to the previous year. This increase has been attributed to the poorly handled pill scare at the end of 1995. One in five pregnancies in England and Wales now ends in abortion. Out of those 177 225 abortions, 653 were performed at 23 or 24 weeks gestation, and only 92 at 25 weeks or over. It important that we bear these statistics in mind to have a proper perspective.

What problems does this raise for medical services? A colleague of mine, John Wyatt sets out some of the issues in a booklet titled Survival of the Weakest. He sketches the issues we have to consider when we relate to new born babies, but by implication also the pre-term baby. He refers to the Greeko-Roman tradition where babies which looked weak were left out of doors overnight and if they were still alive the next day they would be adopted into the family. If they were not then the problem was solved anyway. He contrasts this approach with the Judeo-Christian tradition where there was special care for the most vulnerable and disadvantaged. There is a lot of extra documentation about the people who looked after pre-term babies.

John Wyatt compares this with the present, and considers the scenario where it is possible to have one operating theatre in a hospital where highly complicated technical procedures is being performed on a fetus in the womb in order to correct abnormality, whilst in an adjacent theatre, there is a post-24 week abortion being performed because of substantial risk of serious abnormality. It is the juxtaposition of those two operating theatres that makes John ask questions. There was a Panorama programme recently when a doctor, sitting in the shadows, talked about having performed an abortion at around 35 weeks gestation because there was a missing forearm. It was interesting to hear that doctor reflecting on the feelings that he had.

We need to keep the numbers in perspective, and there are not many abortions at this late stage. There are still issues however, raised by the following kind of story. There was an article in the Independent newspaper from May 1996, called 'Aborted baby lived 45 minutes'. It says: 'A women who agreed to have an abortion after being told that the fetus was severely handicapped gave birth to a normal baby who lived some 45 minutes after the termination. Jacqueline James consented to the abortion at 27 weeks of pregnancy after doctors told her that her routine ultrasound scan had revealed that her baby had severe physical abnormalities.'

Regarding that case which occurred in 1994, Richard Blunt the medical Director of the Dudley Group of Hospitals NHS Trust said that: 'No attempts to resuscitate the baby had been made despite it appearing healthy because Mrs James was undergoing a termination'. The last paragraph of this article says that: 'The coroner at the inquest concluded that none of the usual verdicts were appropriate in the circumstances and recorded death due to legal termination'.

There are factors that need to be discussed in analysing the ethics of these situations. There is the issue of the ethics of abortion in general. More specifically in late term abortion we need to look at the question of sentience. Here we are considering the question 'What does it mean to be human?'. Then there is the issue of the ethics of our attitudes to disability. What is the medical definition of a healthy person. Is it a person who has not been adequately investigated yet? If we do enough tests we can find something wrong, and that could apply to any one of us. I say this to flag up the question 'Which of us is not disabled?'

We are hearing in the news all the time now about the explosion in genetic testing. The world ahead of us is one where we will have the ability through genetic testing to predict diseases, carrier states and probability of disease. Technology is going to give us a growing problem here. This pertains to the ethics of our attitude to abortion for disability.

I want to quote from a recently published book Ante Natal Screening and Abortion for Foetal Abnormality published by Birth Control Trust, and reviewed by Dr Stuart Derbyshire in the British Medical Journal. In his review, Dr Derbyshire refers to a comment in the book made by one of Britain's leading bio-ethicists, Dr Raanan Gillon. Gillon insists: 'If embryos and fetuses are not yet people then there is simply no logical connection between making abortion available to prevent the creation of a disabled person and discrimination against disabled people'. His sentence began 'if' and it seems to me to be a big if. The ethical concept of justice means treating like alike. Why discriminate against a fetus on the grounds of a probability of disability.

We should not make ethical judgements according to opinion polls, but I am as tempted as the next person to quote them when it suits me. A recent opinion poll carried out by Gallop for the Sunday Telegraph, carried out on October 23 and 24, 1997 asked this question: 'Now thinking of abortions where there is a suspected abnormality at present there is no upper time limit in the UK. Do you think that it should remain without a limit or be changed to 24 weeks?'

The question was setting out what the law says and it was asking several thousand people whether the law should remain without a time limit. The answers given were 33 percent of the women questioned thought it should remain without a limit. 40 per cent of the men questioned thought it should remain without a limit. 57 per cent of women and 52 per cent of men thought it should be reduced to 24 weeks.

In conclusion, I have laid out the legal and ethical issues around post viability abortion, and I hope indicated that public opinion is not comfortable with the current approach being taken.

Ann Furedi:

It was interesting that Andrew referred to the work of John Wyatt, one of Britain's leading experts in fetal medicine in Britain. Wyatt, together with others has put the discussion about very late abortion at the centre debates on medical ethics and clinical practice in Britain. He is a very sensitive and caring doctor who is doing some exciting work with severely premature babies. I have on a number of occasions discussed these issues with him and I know that he is deeply troubled by precisely the issues that have been raised. The fact that he may be called upon to save the life of a very much wanted child that has been prematurely born at 23, 24 or 25 weeks, and yet his colleagues are occasionally engaged in the abortion of pregnancies at the same gestation does seem to him to be ethically problematic.

However, he sometimes seems to forget that there is a very real difference between these two situations. If you take the focus of attention away from the fetus and instead focus on the woman, then things are clearer. In the one instance a woman has requested that the pregnancy is terminated because, for whatever reason, she believes it is best if her potential child is not born. In the other the woman is desperately unhappy because she is fearful for the life of a child that she very much wants.

When considering the ethics of abortion, it is crucial to consider the circumstances in which the request for the procedure take place. It is not an issue that is susceptible to complete ethical and philosophical abstraction. Abortion is not merely an idea or principle it is a practical physical procedure the need for which is regretted by the women who request it. Abortion is a perceived solution to a pre-existing problem.

Late termination is invariably and inevitably distressing for all who are involved - for the woman and the medical team whose role it is to support her. A woman whose pregnancy is aborted after 24 weeks will almost certainly endure a labour in very much the same way that they would be if they were giving birth at the end of a pregnancy that was intended to result in the birth of a child.

To assume that women request such abortions without seriously considering the issues involved is insulting to their intelligence and integrity. Andrew has explained the restricted legal circumstances in which abortions at this stage can be permitted - they are almost always because a fetal abnormality has been detected. The pregnancy has probably been wanted prior to this discovery and the woman may already identify strongly with the fetus regarding it as her 'unborn baby'. This means that the decision is likely to be even more distressing.

There are ethical inconsistencies with the Abortion Act as it operates at the moment. This is the case precisely because it does allow abortions late in pregnancy for certain reasons, but restricts them for others. From the point of view of ethical consistency we have to consider why it is moral, right and just to deny a woman an abortion at 24 weeks gestation in circumstances where the procedure woiuld have been permitted at 22 weeks or 18 weeks or 12 weeks. What is it that occurs at 24 weeks so as to necessitate the imposition of greater restrictions on the behaviour of women and their doctors?

It is clear that both legally and socially that we take a different view of pregnancy at different stages of gestation and there is absolutely no doubt that most pregnant women regard their pregnancy very differently as it progresses. Even women with unambiguously unwanted pregnancies sometimes find that their views change as the pregnancy develops. The language used by women to describe their condition often changes as the pregnancy progresses. They start by saying they have missed a period, they then say they are pregnant, then that they are going to have a baby.

There is much anecdotal evidence to support the claim that even women who are quite determined that their pregnancy was unwanted at the beginning may find, where access to abortion is delayed to the point when they can feel fetal movements, that they become more ambivalent in their attitude to abortion. This is completely understandable from the point of view of the pregnant woman. Pregnant women are not passive vessels containing a fetus. Even where at the beginning a woman is oblivious to the fetus developing inside her, her body changes in a whole number of ways and at a certain stage, at around 16 weeks, she may begin to feel quite vigorous movements. At this point she can become very conscious that there is something that is 'not her but not separate from her'. Today, no one can be ignorant of what a fetus looks like. We are surrounded by images of fetus, blown up, back lit, looking very cute with a thumb in the mouth.

This forces us to consider how women must feel when they request late terminations. One is forced to speculate that they must either be the most brutal, desensitised, amoral monsters or alternatively they must be desperate individuals making the most difficult decision of their lives. Perhaps one's conclusions are shaped by how one generally regards women.

The law changes at 24 weeks because it assesses that at this point the fetus is viable. It is generally accepted that this is the time at which the baby, if born, would have a fighting chance of survival outside the womb. This introduces an ethical distinction between second and third trimester abortions which is essentially fetus-centred. The circumstances of the fetus are allowed to take priority over the circumstances of the woman issue.

Yet the viability distinction is not something that can be precisely defined. It is determined not only by the state of the biological being of the fetus, but also the way society can provide the mechanism to enable the severely premature baby to survive. In this sense it is not that at the point the fetus is a life, but rather that medical technology can intervene.

The reason why I make this point is because I would argue that making viability a point of great moral and ethical significance is in some ways arbitrary and random. You could easily point to a number of other particular points in the progress of a pregnancy which you could load with as much moral weight. In fact the Human Fertilisation and Embryology Act, which governs certain procedures to do with infertility treatment and regulates experimentation on embryos, highlights a very much earlier point as being of great moral significance. It draws attention to the development of the primitive streak. This is the point at which certain cells in the embryo differentiate, at about 14 days after conception. There are in fact a whole number of points that could be loaded with great moral significance. Traditional Catholics pinpoint the point of conception. They see this as when a human life develops in the sense that the fertilised ovum is human, and it is alive. It is genetically distinct and therefore in their eyes has great moral significance.

In some ways it could be argued that even within the abortion law the point of implantation is given weight, which is usually a couple of days after conception. If you consider the difference between abortion and contraception, it is legally accepted that contraception is something that prevents pregnancy before implantation. This is not seen as a matter for legal regulation. In contrast abortion ends pregnancy after implantation, and this is subject to regulation.

If we wanted to we could find a whole number of points that could be seen as significant. We could say at what point can the heart be seen on a scan?At what point does the woman feel fetal movement? This was the time earlier in history that was accorded moral significance. A lot of anti-abortionists might agree that there is a difficulty to lay claim to mortal worth at some point in pregnancy. Ultimately pregnancy is a progression, and what we see is a continuance of life forming and many points of development can be identified. This could even be projected back to the point of the sperm and the egg. It is not just the fetus that is a potential human being, which is genetically distinct. Of course the sperm and egg are potentially fetuses. It is therefore difficult to draw lines.

Arguably, there are three defining moments in pregnancy. The first is conception, which is where something genetically distinct emerges. The second is implantation which is really the point at which the woman becomes pregnant. It is at this point that her body starts to change and respond to the pregnancy. The third is the point of birth, which I think is the one that is morally significant. This is the case for the simple reason that at this point action can be taken that could not before. The woman and baby are separated and that means that society can act on that child. It can be looked after and care for without in any way imposing on the autonomy of the woman.

Having argued that there really is no moral or ethical distinction between early and late abortion when the issue is considered from the perspective of the woman rather than the perspective of fetal development and that there is no more reason to attach moral significance to viability than to other 'moments' in pregnancy, I want to look at the issue from another point of view. I would argue that one of the reasons why it is unethical for late abortion to be restricted is because it undermines an important principle which I think has to be accepted in any civilised society. This is the principle that no woman or man should be forced to undergo medical procedures against their will. It is upheld by the idea of bodily autonomy which means we cannot be forced to be party to clinical procedures for the benefit of other human beings. That is the way clinical practice in general is organised and it is problematic that people argue that a woman should

remain pregnant and undergo childbirth out of an obligation to maintain the life of the fetus. It is in fact an obligation we do not impose even in respect of born children.

It seems curious that if I was 28 weeks pregnant and presented to my doctor saying there was no way I wanted to continue with the pregnancy, the doctor would not be able to refer me for termination unless I met the restrictive criteria which have been outlined. It would be assumed I had an obligation to the fetus because it was potentially viable and I had passed the point of viability. I therefore would be compelled to maintain its life and deliver the child. In contrast I have a two year old, and if he suddenly became ill, and needed me to donate an organ to survive, I would probably consider myself a heniously immoral woman if I did not concede to that demand. However there is no law in the land that could oblige me to do so. In effect we impose greater obligation to women to preserve the life of their fetuses than we impose to preserve the life of their born children.

In abortion law we are therefore distinctly privileging the life of the fetus over the wishes of the woman in a way we do not do in any other form of medical practice. I would therefore argue that the current abortion law is ethically inconsistent in the way it permits abortion in some circumstances but not in others and that it in denying abortion it undermines the basic principle of individual autonomy which is accepted in the rest of medical practice.

Finally I want to pick up on the point about abortion for fetal abnormality and consider the argument that acceptance of abortion on this ground is unethical in that it encourages discrimination against people with disabilities. I do think this point is fundamentally wrong. There is an absolute distinction between in how society treats someone who is sentient, or someone to whom society believes it has a particular obligation, and how we should regard a fetus which is not yet a person. It is not even aware of any sense of being alive, let alone having any sense of rights which we should notice or feel obligation to.

I regard abortion for fetal abnormality as a way of society being able to address the problem of genetic illness. I think it is important to recognise that a woman may have a very strong feeling that she wants to have a child that does not suffer from a genetic defect. Allowing her to make that decision and end a pregnancy is entirely different to suggesting we might condone the chastisement of people already alive with the same defect. I find no inconsistency in arguing that a woman should be allowed to have abortion on the grounds of fetal abnormality whilst defending strongly access to resources for people with disabilities.

I firmly support the idea of a woman being able to end a pregnancy simply because it is unwanted. No other reason is needed. I do not think that because of this anyone would say I must therefore believe that a woman must be able to kill a child because it was unwanted or kill her husband, for that matter, because he is unwanted. We simply do not carry that logic through with abortion in general, and we accept we are capable of making distinctions.

I believe the overwhelming majority of people are responsible and sensible in the judgements they make. I disagree with the fears about genetics and new discoveries about our genetic make-up that suggest it will end in horror. I think it ludicrous to assume that women would put themselves through the process of abortion on grounds that are, to them, trivial. We have to be careful about passing judgement about what people might do, with no evidence to sustain that judgement.

In particular we have to be careful about suggesting that a woman's reasons for abortion are trivial. They may seem so to us, but to her they may have a different meaning. I listened to a very senior expert in fetal abnormality about the distress he felt when presented with a request for abortion on the grounds that the fetus had a cleft palate. This expert made the point that he was horrified because he thought this to be a rather trivial abnormality, until he looked at the woman sitting in front of him and noticed she had a severe cleft palate herself. What he regarded as a quite trivial disability, this woman honestly regarded as being so serious that she was willing to put herself through the process of late abortion and end what she already saw as the life of a child that she wanted.

To conclude, the discussion of ethics and abortion seems to me to focus unreasonably on looking at the interests of the fetus. I think the abortion debate should be resituated to focus on the ethical treatment of the pregnant woman. I think we should accept that women are ethical, moral beings with conscience and the law should treat them accordingly.

The law is an inappropriate and inadequate means to regulate abortion. Abortion should be subject to no more constraints than any other clinical procedure. It is questionable whether more post-viability abortions would be sought even if there was no law to restrict them. Prior to 1990 there was a time limit of 28 weeks on abortions in England and Wales but no time limit in Scotland. Yet there was not a greater proportion of late abortions in Scotland, despite the fact that they would have been within the law.

Pregnant women do not like to seek late abortions, doctors do not like to perform them. An abortion is not an abstract issue for the woman who seeks it. Her pregnancy is a pressing practical problem and seeks an abortion because she has reasons for wishing to end it. You may not agree with that reason and you may think it wrong for that woman to end her pregnancy. But your agreement and approval is of no consequence. The issue is: should you have the right to force a woman to endure pregnancy and labour because you disapprove of her reason.

In society at the moment there is a tolerance of abortion in early pregnancy because we understand it to be necessary. Contraception fails and sometimes we fail to use it effectively. We recognise that in order for women to control their fertility they need access to early termination. I agree that public opinion in respect of late termination is more ambivalent and people are uneasy about it. Perhaps one of our tasks is to educate people about why late termination is necessary. It struck me particularly recently when I was looking at the abortion statistics for 1996. I looked at the gestations of some of these late terminations and was shocked to discover the latest termination was of a pregnancy of 37 weeks. My own son was born at 37 weeks and he was not regarded as a premature baby. There are two ways you can think about the woman who had this abortion. You can see her as the most callous, brutal woman whoever existed, or you an think of her as the most desperate woman on earth to have requested abortion at that stage. My view is that she would be the most desperate woman on earth to consider that her child would be better not born alive. I think the last thing women need is the law dictating and restricting choice and making judgements about their decisions. Women are the people who have to live with the choices they make and they should decide, regardless of the stage in pregnancy.