This article appears in the Aug 2006 edition of the Catholic Medical Quarterly
The Abortion debate
Everybody knows somebody who has had an abortion. Indeed, they may have had an abortion themselves. It is estimated that around 185,000 women have terminations in the United Kingdom each year; this figure shows no sign of falling. In view of recent medical advances the BMA has considered lowering the maximum gestational age allowable for abortion to 20 weeks, but following heated discussion this proposal was rejected. Unfortunately proper resolution of this issue is nowhere in sight; the decision not to lower the limit merely postponed the inevitable debate. In fact, lowering the limit would also have only postponed the debate, albeit for a little longer.
The truth is that maintaining the system as it currently stands is both medically and ethically unsound, but for the most part the medical profession is happy to bury its head in the sand and refuses to draft a better alternative. From a medical perspective abortion is associated with well known side effects at the time of the procedure itself, such as haemorrhage, uterine perforation and cervical injury for surgical abortion and pelvic inflammatory disease for both medical and surgical abortion; it also affects subsequent pregnancies. In a study published last year exploring the incidence of premature birth in 2,219 women who had previously had an induced abortion, it was found that there was a significantly increased risk of preterm delivery, the relationship becoming more significant as the gestational age decreased(1). Additionally, in a study comparing 40 women who had suffered miscarriage to 80 who had chosen abortion, the incidence of mental health problems in those choosing abortion was found to be significantly increased (2). Other sequelae are too numerous to mention, but even the BMJ's own `ABC of Subfertility' lists induced abortion as a cause of subsequent tubal subfertility. Taking all this, and the exceptionally large number of women undergoing abortion in the UK each year into consideration, we simply cannot allow this to continue with no end in sight.
The whole discussion surrounding lowering the gestational age limit for abortion has also highlighted the flawed ethics behind the current thinking. The rationale for lowering the age limit is based purely on medical advances and the few, rare, instances of very preterm babies surviving before the crucial 24 week limit. If it suddenly became possible for babies born at twenty or fifteen weeks to survive, where would we then stand? Under current thinking we would alter the age limit for abortion accordingly, because keeping it the same would admit that killing babies capable of surviving independent of the mother was morally acceptable in our society. Where would we then stand if it became possible one day to satisfactorily recreate intra-uterine conditions and managed to rear embryos to term in-vitro? Would it be fair to foetuses in the meantime if we denied them rights that would otherwise have been assigned if the necessary breakthroughs in medicine had been reached? There are a whole host of other ethical questions that are inadequately answered using the current rationale, and it is this fudge in current thinking that is causing such consternation in the United States at present and to which we are efficiently turning a blind eye to in Britain.
Taking these ethical arguments to their logical conclusion there can only be two long term sustainable answers in devising a new abortion policy. The one obvious answer is realising that all life, from the fertilised cell to the term foetus, is one and the same and should be treated equally. Emphasis should be placed on the prevention of pregnancy through responsible behaviour, maturely dealing with the consequences of an unwanted pregnancy, and the treatment of inherited conditions. The other conclusion is that abortion of an unwanted pregnancy is acceptable, but is performed on the understanding that the ethical burden of ending the life of an unborn foetus or embryo is equal to that of a term baby and indeed an adult human being.
As medical professional we should at least have an opinion on this matter. We are centre stage players in this drama: the situation would not have been allowed to continue unchallenged for so long without our co-operation. We need a proper informed debate about abortion, and we need to devise a policy which is both medically and ethically sound. The current policy, as discussed, is neither; and the hundreds of thousands of procedures that take place each year make holding this debate an absolute priority.
Moreau C, Kaminski M, Ancel PY, Bouyer J, Escande B, Thiriez G, Boulot P, Fresson J, Arnaud C, Subtil D, Marpeau L, Roze JC, Maillard F, Larroque B; EPIPAGE Group. Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study. BJOG 2005 Apr 112; 430-7.
Broen AN, Mourn T, Bodtker AS, Ekeberg O. The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study. BMC Med 2005 Dec 12;3:18
Gwyn Samuel Williams MBBS BSc MRCS Cardiothoracic SHO, New Cross Hospital, Wolverhampton
Chetan Suresh Modi MB ChB MRCS Cardiothoracic SHO, New Cross Hospital, Wolverhampton
Talvinder Singh MBBS MRCS Cardiothoracic SHO, New Cross Hospital, Wolverhampton