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.