Abortion Act

Lord Beith Excerpts

Wednesday 9th October 2013 Westminster Hall

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

In her distinguished medical career, did my hon. Friend think, at any time, that because she could be taken to the General Medical Council for a failing of practice, she was exempt from the law of the land on a matter such as this?

[Dr Wollaston]

Absolutely not, but I think that all right-thinking medical professionals, on viewing this form, would reject pre-signing it, and would find it completely abhorrent that someone could pre-sign it and allow an unnamed, undated form to be photocopied. That point is very important. We also saw the scale of this; it was happening at 14 locations, so it was not an isolated event.

The guidance from the BMA’s handbook of ethics and law, which my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) referred to, is also part of the problem. The guidance begins:

“The Association believes that it is normally unethical to terminate a pregnancy on the grounds of fetal sex alone except in cases of severe x-linked disorders.”

So far, so good. However, the guidance goes on to say:

“The pregnant woman’s views about the effect of the sex of the fetus on her situation and on her existing children should nevertheless be carefully considered. In some circumstances doctors may come to the conclusion that the effects are so severe as to provide legal and ethical justification for a termination. They should be prepared to justify the decision if challenged.”

That is wholly unacceptable. A woman may feel under huge pressure from her family to abort a fetus of the wrong sex, but doctors should not collude in the family’s point of view and assist in a termination just because the situation may be stressful for the woman. Rather, they should explore the reasons for that pressure with the woman and protect her from undue pressure from her family; they should certainly not just collude in such attitudes, which reinforce a misogynist point of view that daughters are of less value than sons. That harms not only women worldwide, but all societies where this practice is common, including the men in those societies. There is a straightforward, strong issue of equality here.

As has been said, there is no specific exclusion for gender-specific termination in certificate A. However, we have a precedent for such an exclusion in paragraph 11 of schedule 2 to the Human Fertilisation and Embryology Act 2008, which refers to sex selection when embryos are implanted. The Act makes it clear that, other than in cases where we are trying to prevent a severe inherited medical condition, gender selection is unacceptable in the implantation of embryos. I wonder whether now is the time for an amendment to the Abortion Act to make that explicit and to put the issue beyond any doubt.

Another issue with certificate A is the wording of category A, which refers to the possibility that

“the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated”.

The statistics for maternal mortality for 2006-08 show that 107 women died from conditions directly related to pregnancy, whereas two women died as a result of complications following sepsis after the termination of a pregnancy. Will the Attorney-General clarify whether it would be possible, on a technicality, for any doctor to carry out any abortion on demand because of that difference? Technically, it could be argued that every abortion could satisfy section A of certificate A.

It is perhaps time for us to issue greater clarification of what would constitute unacceptable grounds. It is perhaps time for us to have a wider debate about that. As I said, I speak as someone who firmly believes in a woman’s right to access safe abortion, but not to access it on grounds that, in my view and the view, I think, of the vast majority of the public, would harm women’s rights and make misogynist attitudes more acceptable.

In a number of cases, we have seen that people have a natural tendency to shy away from awkward situations. We saw that in Rochdale, in different circumstances. When we drill down and look in greater detail at the possibility that gender selection is happening in this country, we see that, although there does not appear to be a distortion in the gender statistics overall, that could be the case in certain communities. We should not, therefore, take the view that these things are not happening in the UK, because they could well be, and we need to put the issue absolutely beyond doubt in law.

--- Later in debate ---

[The Attorney-General]

I am sure that my hon. Friend has had an opportunity to read the full note produced by the DPP. It sets out in detail, which I do not have time to go into this afternoon, the evidence in the case of each doctor presented to the CPS. My hon. Friend will appreciate that it is important that the evidence in each case is looked at separately. The DPP goes through it in detail and explains that the issue is not gender-specific abortion. If somebody says to a doctor without more ado, “I want an abortion on gender-specific grounds,” and the doctor says yes, the case might be a clear-cut matter to prosecute because the grounds fall clearly outside the ambit of the 1967 Act. The section of the Act with which we are concerned is about the physical and mental health of the woman. It is about good faith, in that it is for the doctor to satisfy themselves that any abortion falls within the criteria. If my hon. Friend looks at the matter in detail, he will see why the director came to the conclusion he did, which I will address, but in briefer terms.

The CPS concluded, with some difficulty, that there was just enough evidence available in the cases to bring the good faith of the doctors into issue. I think that the hon. Member for Islington South and Finsbury was wrong when she said in her final statement that the position had changed. The DPP’s statement of reasons says, nevertheless, that the evidence was not strong in either case and the prospects of conviction would not in his judgment have been high on the facts as they appeared. The matter does not rest there. Even in a case that just about passes the evidential threshold, the CPS is obliged to consider whether a prosecution would be in the public interest. That is one of the tasks that we require it to do. The fact that an evidential threshold is passed—a point raised in the debate—does not mean that a prosecution has to, or indeed should, follow.

The decision was that prosecution did not pass the public interest threshold. It is that aspect of the decision that raises wider issues of public policy, some of which we have debated today, which I accept are an entirely legitimate topic of debate. The issue, as I see it, is this. Because the law makes the difference between lawful and unlawful abortion subject to a medical test, doctors have to be able to carry out that test on a case-by-case basis according to proper medical standards of care, skill and judgment. That is, effectively, what the test of “good faith” in the 1967 Act means. Doctors are required by law to make such decisions to a proper professional standard. If a question arises about whether a doctor has done so in any given case, a law enforcement agency must look to approved medical practice for assistance in identifying the proper standard. The same thing applies in virtually every case involving professional standards. Dare I say it, it would apply even in the case of a plumber who carried out some work that led to a catastrophic outcome.

[Sir Alan Beith]

It would surely not be right in such circumstances merely to demonstrate that other plumbers engaged in conduct that did not meet professional standards, and no more would it of doctors.

[The Attorney-General]

I reassure my right hon. Friend that that is certainly not the case. Ultimately, in any case, the jury decides, not the experts. One would normally expect a jury to be given some indication of the professional standards expected in a profession—there may even be rival professional views about what the standards should be—in order to help it decide.

Such a problem might not arise in an extremely clear-cut case. We might imagine a case in which a doctor behaved in a way in which no reasonable practitioner would behave, for example by arranging a medical abortion for a patient about whom he or she knew nothing and whom he or she had never met or spoken to. In any other circumstances, however, the CPS would need, and would expect to be able, to refer to medical consensus to determine whether a proper professional approach had been taken.

When they are looked at in the kind of detail considered by the prosecutor, the cases that we are debating are not extreme ones in which the doctors behaved as no reasonable practitioner would behave. Complicating factors were raised by both the patients and the doctors, who subsequently had to take the decisions. There were, as we have discussed, no detailed professional rules or step-by-step guidelines telling doctors how to take such decisions; the matter was left to general professional standards and ethics. The CPS, therefore, had no detailed consensus to help it to evaluate the matter.

To prosecute would have been to ask a jury to decide what steps a doctor should take. Juries take difficult decisions robustly, and sometimes they have to find their way through conflicting medical evidence. Is it right or fair, however, to ask a jury to arbitrate on a question of medical standards and ethics on which the profession has not published a detailed consensus, and on which a great deal turns for both doctor and patient? The CPS concluded in the recent cases that it would be contrary to the public interest to proceed.

Those who have the relevant policy and professional responsibilities are, no doubt, reflecting on the conclusions to be drawn. The Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), is present for precisely that reason. As the House will appreciate, these are not my responsibilities.