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Abortion and disability

Trust doctors on abortion, not lawyers
By Ann Furedi

This article appeared in The Guardian (2/12/03)

The Rev Joanna Jepson says she was shocked to discover that, last year, a woman ended her six-month pregnancy because the foetus was affected by cleft palate. I was shocked to find out that Ms Jepson, a Church of England curate, had tried to bring a legal case against the police for failing to prosecute the doctor who performed the procedure. I was outraged to discover that she was prepared to initiate a judicial review to determine whether this condition was a sufficiently serious handicap to permit a legal abortion. And I am extremely disappointed at the decision made yesterday by the high court to allow the case to be taken to a judicial review.

Late abortion is a contentious issue, especially when foetal abnormality is involved. In 1990, a legal limit of 24 weeks was established for most abortions, but not when there "is a substantial risk that the child, if born, would suffer from such physical or mental abnormalities as to be seriously handicapped". In such cases there is no legal time limit, and every year about 100 of these pregnancies are deliberately ended when, as those who oppose abortion like to remind us, the pregnancies could result in a live birth.

A particular bone of contention is that the law does not define what it means by "substantial risk" or "seriously handicapped". Joanna Jepson's complaint is that an abortion was not justified by a diagnosis of cleft palate, which she asserts is a relatively trivial condition that can be corrected by surgery.

She is wrong. In some cases, a foetal diagnosis of cleft palate indicates a cosmetic condition that can easily be corrected by surgery. In others, as Kypros Nicolaides, professor of foetal medicine at King's College Hospital, has explained, cleft palate can be a symptom of a life-threatening genetic condition. Sometimes cleft palate is taken to mean simply a harelip; on other occasions it can describe a failure of the skull to fuse - a defect that can impair brain function.

No one knows the circumstances of the woman who requested the abortion. Nevertheless, Joanna Jepson and her supporters have been quick to condemn her, the doctors who approved the request and those involved in the termination of the pregnancy.

As a provider of abortion services, I have in my mind what an abortion at this stage in pregnancy involves. Remember, what is being ended was originally a "wanted pregnancy". The woman requesting the abortion was at least six months pregnant. She was already feeling robust foetal movements, she was visibly pregnant, and possibly her family and friends had already rejoiced that she was "going to have a baby". Yet, for reasons we do not know - perhaps to do with the severity of the condition - she decided to end the pregnancy.

Could this have been an easy option? At this stage in the gestation, she would have known that abortion involves a procedure to stop the foetal heart. She would have known that she would have to endure labour, understanding that her once wanted child would be born dead.

I would like to suggest that we suspend our judgment. There is wisdom in the Christian tenet of "Judge not, lest you be judged". Or, as my rather more secular mother puts it: "Don't judge a man until you have walked a mile in his shoes." None of us knows the circumstances that persuaded this woman and her doctors that abortion was the best option for her.

The issue that underpins this debate is: "Whom do we trust?" Should politicians, doctors, women or outside observers decide whether or not a woman's circumstances are such that abortion should be an option? Or should it be the family that will be affected and those involved in the family's care?

My view is that women and their doctors should make the decision. They will, after all, live with it. It is on their consciences. Politicians, advocates and interested parties may have their views, but ultimately we go home. We do not have to look ourselves in the mirror every day knowing that we requested or carried out that abortion. So how, in our ignorance, can we condemn those that do?

In 1967, parliament deliberately left vague the law on abortion on the grounds of severe risk of serious abnormality. When the issue was revisited in 1990, parliament again left the issue loosely defined. It believed that the definition of "serious risk" and "severe abnormality" was best determined by a woman and her doctors. This was a wise and humane decision, and it would be foolish now to reverse it.

I trust women to make decisions about their pregnancies, and doctors to carry out only those procedures they believe to be lawful and ethical. I put less trust in opinionated outsiders with abstract moral views.

Ann Furedi is the chief executive of the British Pregnancy Advisory Service

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