Arguments against further clarification
76. The difficulty with further clarifying 'handicap'
or 'abnormality' is that they are nonlinear continuums: it is
impossible to create an exhaustive list of abnormalities that
are considered serious enough to warrant the termination of a
pregnancy. The Faculty of Sexual and Reproductive Healthcare (FSRHformerly
the Faculty of Family Planning and Reproductive Health Care) gives
two reasons for this:
a) we do not have sufficiently advanced diagnostic
techniques to always be able to precisely define the abnormality
and predict the seriousness of its outcome; and
b) defining the word 'seriously' (as in the Act,
which says 'seriously handicapped') is problematic: do we mean
'serious' for the foetus in terms of viability or residual disability
(which can be physical, intellectual or social) in the child;
or serious to the family into which the child would be born; a
family which rejects a child who is unwanted due to disability
can result in poor outcomes in the child (see the Czech Study).
77. The FSRH suggest an alternative:
you cannot put a scientific definition on 'serious
abnormality' but you can put a medical one based on what is agreed
between the mother of the pregnancy and the consultant in charge
of her case, taking into account all clinical information available
(obstetric and with information from other pertinent specialists
e.g. paediatrician) and the wishes of the mother (ideally parents
but ultimately the decision lies with the mother). This situation
would benefit from having national clinical guidelines/ standards
set, laying out what information should be available and what
staff are involved.
78. FSRH and RCOG are concerned that there are many
serious foetal abnormalities that manifest or become diagnosable
late in the second trimester. For example, foetal cardiac scans
are frequently done at 22-23 weeks in women with a suspicious
prior scan. This is because the images of the foetal heart anatomy
are better at the later gestational age. It may be that women
whose foetuses have abnormalities like mild ventriculomegaly can
continue their pregnancy until the prognosis becomes clearer.
Further, Dr Fiona Adshead, the Deputy Chief Medical Officer, told
us that "it would be technically very difficult to define
serious abnormality in terms of scans [since] what can appear
to be not very serious abnormalities on a scan can actually mark
a wider syndrome and serious complications and abnormalities".
79. We do not consider that an exhaustive list of
abnormalities is feasible or desirable, although guidance for
professionals who are seeking to determine 'serious handicap'
may be feasible and of some use to the medical profession.
80. We invite Members of Parliament, when considering
whether a clarification or a definition of 'seriously handicapped'
is desirable and/or feasible, to consider our conclusions.
81. The Department of Health should commission
work to produce guidance that would be clinically useful to doctors
and patients, and look at who is best placed to do so.
82. We believe that consideration of these matters
and the production of guidance would be enhanced by better collection
of data relating to the reasons for abortion beyond 24 weeks for
foetal abnormality, and appropriate analysis of such data, with
due regard to the need to protect the confidentiality of patients.
81 S1(1) of the Abortion Act 1967 Back
in a 1996 RCOG Report on Termination of Pregnancy for Fetal
SDA 13 para 10 Back
SDA 01 para 28 Back
SDA 29 para 1.5 Back
SDA 03 p 2 Back
SDA 35; see also the Lejeune Clinic for Children with Down Syndrome,
SDA 03, and David Randall, SDA 29. Back
SDA 29 Back
Q 57 [Professor John Wyatt] Back
David HP, "Born unwanted, 35 years later: the Prague Study",
Reproductive Health Matters, vol 14 (2006) pp 181-90 Back
SDA 19 section 1(b); see also SDA 09, para 1.1.1 Back
SDA 19 section 1(b) Back
SDA 30 para 1.1.2 Back
Q 384 Back