This seems to have gone under the radar for a while until the past few days. Royal College of Midwives issued a statement in February supporting the campaign of BPAS (British Pregnancy Advisory Service) to decriminalising abortion and calling the current time limit of 24 weeks to be scrapped. It is also calling for the procedure to be regulated at the discretion of doctors. Why the doctors again? Do they really know best?
Of course, women's right is important. However, the general consensus is that once the foetus is compatible to a life outside womb (generally agreed to be 24 weeks), he/she has a right to live. It is for this reason that a current limit of 24 weeks is applied. Terminations beyond 24 weeks should be for the baby's benefits rather than the mother's. For example, if a baby is going to suffer immeasurable pain or distress once it is born, termination can be allowed as this is to reduce the suffering of the baby. If a mother's life is in danger, the law also allows termination but as I have argued previously, this is rarely necessary and in most cases, the woman or the family will rather have the baby delivered and get support from the neonatal unit.
If we allow terminations up to the time of birth, it implies that the woman has absolute right over the baby's life and hence, should we also allow infanticides? How can it be right that when a baby is born at 39 weeks old will be granted the right to life immediately after birth and he or she does not have any right just minutes ago while in the mother's womb?
RCM also made a mistake by not consulting members on this issue before making such an important statement. In addition, the role of RCM should be to support its members in their work and help them to support women through their pregnancies and make sure babies are delivered safely. This campaign goes against all these and politicises the organization. Of course it does not help when the chairman of RCM is also on the board of trustees of BPAS. Whatever the ethical persuasion of the chairman, she should not let this affect the policy of RCM, just as if the chairman of RCM happened to be pro-life, he or she would not be allowed to change the policy without consultation of its members. I am glad that after going under the radar for 3 months, it has come out in the press and there is currently a petition against it.
Monday, 16 May 2016
Monday, 9 May 2016
Give it up and Try again!
Today my friend shared this on Facebook: http://hk.apple.nextmedia.com/news/art/20160508/19602690
In case you do not read Chinese or understand Cantonese, it is about a mother who gave birth to a girl with Down Syndrome 16 years ago. There were a lot of problems at the beginning, including heart defects and lung infections. The doctor told her to give the child up as 'bringing a child with Down Syndrome up is extremely difficult and you are still young and you can try again'. She refused to give up despite being abandoned by a husband who gambled away all the money, leaving her in debt, and having to give up a high pay job. She started another career while juggling with the demand of bringing up a child and now she has a business of her own. I really applaud this woman's perseverance but also lament the attitude of the doctor.
Give it up and try again! He was not the only one who say that. Remember Richard Dawkins? I am glad that so many people spoke out against that when he said that about a hypothetical case. I am not saying that parents should not be allowed to give their child up for adoption. The circumstance of each family is different. However, to give up and try again does carry the notion that babies or children are commodities and if he/she does not fit our need, we can just give it up and try again. Children, whatever the disabilities or abilities, are human beings. Yes, if the situation is difficult, adoption may be the best choice. However, as professionals, please do not say give it up and try again. Remember, you are dealing with humans.
In case you do not read Chinese or understand Cantonese, it is about a mother who gave birth to a girl with Down Syndrome 16 years ago. There were a lot of problems at the beginning, including heart defects and lung infections. The doctor told her to give the child up as 'bringing a child with Down Syndrome up is extremely difficult and you are still young and you can try again'. She refused to give up despite being abandoned by a husband who gambled away all the money, leaving her in debt, and having to give up a high pay job. She started another career while juggling with the demand of bringing up a child and now she has a business of her own. I really applaud this woman's perseverance but also lament the attitude of the doctor.
Give it up and try again! He was not the only one who say that. Remember Richard Dawkins? I am glad that so many people spoke out against that when he said that about a hypothetical case. I am not saying that parents should not be allowed to give their child up for adoption. The circumstance of each family is different. However, to give up and try again does carry the notion that babies or children are commodities and if he/she does not fit our need, we can just give it up and try again. Children, whatever the disabilities or abilities, are human beings. Yes, if the situation is difficult, adoption may be the best choice. However, as professionals, please do not say give it up and try again. Remember, you are dealing with humans.
Wednesday, 4 May 2016
Improving Late Term Abortion
Most people will agree that one should avoid late term abortion if possible as it is traumatic to the woman involved. As I mentioned in another post, currently the law is lax about late term abortion and it relies on the 'good faith' of doctors. That potentially results in babies being aborted for minor disabilities. So what should we do about it?
I don't think it is right for an outright ban on late term abortion. However, we should put in safeguards so that it only applies to extremely serious malformations that:
1. carries a grave prognosis
2. are not treatable medically or surgically
3. the baby will suffer, eg. in constant pain.
The BMA is right to say that the following should be taken into consideration while assessing the seriousness of the handicap:
1. the probability of effective treatment
2. the child's probable potential for self-awareness and potential ability to communicate with others
3. the suffering that would be experienced by the child when born or by the people caring for the child.
While doctors are well qualified to assess the first factor, not every doctor has up to date knowledge of disabilities and so are not usually well placed to assess the ability to communicate or whether the child or the family will suffer. The first doctor who is likely to make the decision to offer termination as an option is probably an obstetrician. However, obstetricians do not often see how children with disabilities grow up. I will argue that this should be assessed by a community paediatrician, an educational psychologists or a professional who deals with children with disabilities day in and out.
The third factor relates to the quality of life of the child and his or her family. This is even more difficult. As medics, we often look at it from the medical point of view. We often consider someone who is bed-bound or paralysed to have a poor quality of life but is it true? Have we met enough people with all sort of disabilities to make that judgement? We see that over the years, babies with spina bifida, cleft lip or palate, Down Syndrome, Turner Syndrome and others being aborted because the parents, who often do not know much about these conditions and how living with these conditions are like, make the decision based upon the medical profession's assessment of the potential poor quality of life. In the process of developing good and accurate information to prospective parents, have the medical profession asked people who live with the condition to see if they are happy with their lives.
To someone who was born 'without disabilities', I used to think it would be awful to be paralysed or to be wheelchair bound. However, after meeting families of disabled children, I realized that it may not be true. Yes, their child needs a wheelchair but they are happy and they are not miserable all the time.
Yes, we need to consider these factors but who is best placed to make the assessment? Another aspect is the accuracy of the predicted prognosis. We hear parents given really grave prognosis and their children survive into adulthood. Therefore, the medical profession should give the parents an indication of how accurate these predictions are.
I will suggest the following changes to late term abortion:
1. A separate form should be used and on the form the doctor needs to put in the reason(s) that he feels the baby has a serious handicap including the three factors above.
2. An assessment is required from another profession or specialty that regularly manage children with that particular disability.
3. Referral to national charity about the condition or to local parents support group.
4. Cooling off period of at least 48 hours unless the mother's life is at risk.
5. Mandatory post mortem to document the list of malformation.
I don't think it is right for an outright ban on late term abortion. However, we should put in safeguards so that it only applies to extremely serious malformations that:
1. carries a grave prognosis
2. are not treatable medically or surgically
3. the baby will suffer, eg. in constant pain.
The BMA is right to say that the following should be taken into consideration while assessing the seriousness of the handicap:
1. the probability of effective treatment
2. the child's probable potential for self-awareness and potential ability to communicate with others
3. the suffering that would be experienced by the child when born or by the people caring for the child.
While doctors are well qualified to assess the first factor, not every doctor has up to date knowledge of disabilities and so are not usually well placed to assess the ability to communicate or whether the child or the family will suffer. The first doctor who is likely to make the decision to offer termination as an option is probably an obstetrician. However, obstetricians do not often see how children with disabilities grow up. I will argue that this should be assessed by a community paediatrician, an educational psychologists or a professional who deals with children with disabilities day in and out.
The third factor relates to the quality of life of the child and his or her family. This is even more difficult. As medics, we often look at it from the medical point of view. We often consider someone who is bed-bound or paralysed to have a poor quality of life but is it true? Have we met enough people with all sort of disabilities to make that judgement? We see that over the years, babies with spina bifida, cleft lip or palate, Down Syndrome, Turner Syndrome and others being aborted because the parents, who often do not know much about these conditions and how living with these conditions are like, make the decision based upon the medical profession's assessment of the potential poor quality of life. In the process of developing good and accurate information to prospective parents, have the medical profession asked people who live with the condition to see if they are happy with their lives.
To someone who was born 'without disabilities', I used to think it would be awful to be paralysed or to be wheelchair bound. However, after meeting families of disabled children, I realized that it may not be true. Yes, their child needs a wheelchair but they are happy and they are not miserable all the time.
Yes, we need to consider these factors but who is best placed to make the assessment? Another aspect is the accuracy of the predicted prognosis. We hear parents given really grave prognosis and their children survive into adulthood. Therefore, the medical profession should give the parents an indication of how accurate these predictions are.
I will suggest the following changes to late term abortion:
1. A separate form should be used and on the form the doctor needs to put in the reason(s) that he feels the baby has a serious handicap including the three factors above.
2. An assessment is required from another profession or specialty that regularly manage children with that particular disability.
3. Referral to national charity about the condition or to local parents support group.
4. Cooling off period of at least 48 hours unless the mother's life is at risk.
5. Mandatory post mortem to document the list of malformation.
Tuesday, 3 May 2016
Time limit for abortion
When I was a medical student in Hong Kong, the legal limit for abortion was 24 weeks unless the mother's health was in danger. I assumed that in UK was similar. As I normally opted out of involving in these procedures, I wasn't really aware of any change in the law. Therefore, I was surprised and outraged when I learnt a few months ago about abortion on Ground E in UK.
The 1967 Abortion Act set a time limit of 28 weeks for abortion. However in 1990, Section 37 of the Human Fertilisation and Embryology Act made changed to the Abortion Act to introduced a time limit of 24 weeks to grounds C and D but removed the time limit on Ground A, B and E. So what are Ground A, B and E?
Ground A is when the woman's life is at risk by continuing the pregnancy. Ground B is when grave permanent injury physically or mentally can result if the pregnancy is continued. Ground E is that the child will suffer physical or mental abnormalities as to be seriously handicapped. However, the law did not give a definition for the phrase 'seriously handicapped'.
For years, babies with cleft lips, spina bifida, Down Syndrome and a range of disabilities were aborted beyond the 24 weeks limit and women were offered abortion as late as 38 weeks or even at term. As the foetus can potentially survive outside womb at this stage, the procedure often involves injecting potassium into the foetus' heart in utero before delivery.
I do not understand how someone can offer to take the life of a baby away when he/she can live a healthy and fulfilled life into the 60's or 70's or has something that is surgically treatable. The 24 weeks limit was set for Grounds C and D because babies can survive outside womb beyond this limit and so are considered viable and hence, they are offered rights to survive. The keywords in Ground E include 'suffer' and 'seriously handicapped'. What is suffering? What is seriously handicapped?
The problem with such loose definition is that over the years, there had been babies being aborted for not really serious disability as most would understand such as cleft lip or club foot. In addition, as long as the doctors acted in good faith, they cannot be prosecuted by law. That means it is difficult to challenge the medical profession. I would like to ask, are all doctors perfect and do doctors know everything?
Although BMA laid out a few factors that should be considered while offering late term abortion in a document, it also immediately quoted the case of Rev Joanna Jepson's case about cleft palate and went on to say that it opposes any tightening of the definition of serious handicap. What message is it sending to the doctors who read the guidance? They can continue to advise women to abort at late term on any disability as no one can challenge that in the court?
As for Ground A and B, in most cases, if the pregnancy is beyond 24 weeks and the mother's life is in danger (e.g. pre-eclampsia or cancer requiring treatment), wouldn't most if not all mothers choose to give birth and hope that the baby will survive with all the help in the neonatal unit? That actually make these grounds unnecessary.
The problem with such loose definition is that over the years, there had been babies being aborted for not really serious disability as most would understand such as cleft lip or club foot. In addition, as long as the doctors acted in good faith, they cannot be prosecuted by law. That means it is difficult to challenge the medical profession. I would like to ask, are all doctors perfect and do doctors know everything?
Although BMA laid out a few factors that should be considered while offering late term abortion in a document, it also immediately quoted the case of Rev Joanna Jepson's case about cleft palate and went on to say that it opposes any tightening of the definition of serious handicap. What message is it sending to the doctors who read the guidance? They can continue to advise women to abort at late term on any disability as no one can challenge that in the court?
As for Ground A and B, in most cases, if the pregnancy is beyond 24 weeks and the mother's life is in danger (e.g. pre-eclampsia or cancer requiring treatment), wouldn't most if not all mothers choose to give birth and hope that the baby will survive with all the help in the neonatal unit? That actually make these grounds unnecessary.
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