Select Committee on Science and Technology Twelfth Report


3  Abortion for foetal abnormality

71. Ground E for an abortion in the Abortion Act 1967 is "there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped".[81] However, 'physical and mental abnormalities' are not defined, and neither is 'handicapped'.

72. The British Medical Association (BMA) and Royal College of Obstetricians and Gynaecologists (RCOG)[82] have laid down guidelines by which the seriousness of a handicap should be assessed. The BMA's recommendations are based on RCOG's and stipulate that the following factors be taken into account:

  • the probability of effective treatment, either in utero or after birth;
  • the child's probable potential for self-awareness and potential ability to communicate with others;
  • the suffering that would be experienced by the child when born; and
  • the impact on the family.[83]

Arguments for tightening the definition

73. The decision to terminate a pregnancy is currently left to the mother (preferably parents) and the doctor in charge of her case. Evidence suggests that this may be leading to some inconsistencies. Some of the more controversial examples include:

74. The Christian Medical Fellowship has recommended that a legal definition be introduced so that abnormalities are treated in the same way across the medical profession.[87] David Randall, a final year medical student at Barts and The London Medical School, comments that:

Currently it falls on two doctors alone to assess a foetus's future level of disability, leading to an unacceptable risk of subjective decision making […] it is therefore essential that a full evidence-based review is carried out by parliament to work towards a robust definition of the level of disability deemed to render a foetus worthy of termination.[88]

75. At the very least, as Professor Wyatt told us, "the wording [of the Act] could be made more precise to give [the profession a clearer understanding of] what Parliament's intention is as to what these words should mean".[89]

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 (FSRH—formerly 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[90]).[91]

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.[92]

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.[93] 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".[94]

Our conclusions

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

82   in a 1996 RCOG Report on Termination of Pregnancy for Fetal Abnormality Back

83   SDA 13 para 10 Back

84   SDA 01 para 28 Back

85   SDA 29 para 1.5 Back

86   SDA 03 p 2 Back

87   SDA 35; see also the Lejeune Clinic for Children with Down Syndrome, SDA 03, and David Randall, SDA 29. Back

88   SDA 29 Back

89   Q 57 [Professor John Wyatt] Back

90   David HP, "Born unwanted, 35 years later: the Prague Study", Reproductive Health Matters, vol 14 (2006) pp 181-90 Back

91   SDA 19 section 1(b); see also SDA 09, para 1.1.1 Back

92   SDA 19 section 1(b) Back

93   SDA 30 para 1.1.2 Back

94   Q 384 Back


 
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