Examination of Witnesses (Questions 60-79)|
15 OCTOBER 2007
Q60 Dr Turner: There are three areas
which really do matter where there may have been significant changes
since 1990. Firstly, the diagnosis of abnormalities at varying
stages of gestation, predicting the level of disability and treatment
of disabilities. Can any of you with a view please comment on
whether anything has moved in these fields that relates to the
time limit of abortion, the 24 weeks?
Jane Fisher: Yes, screening for
certain abnormalities has moved on in that timei.e., we
now have a programme of screening for Down syndrome that can be
performed earlier in pregnancy. That is one condition. Still we
deal regularly with women who are given information at their mid-pregnancy
scan, which can be as late in some centres as 22 weeks, about
a potential problem. They almost always have to have further testing
beyond that, so we would say no, it has not moved on. The technology
has moved on certainly but our ability to give clear, accurate
prognoses from what we diagnose has not.
Q61 Dr Turner: Does anyone dissent
Professor Marlow: I think diagnosis
is considerably more accurate now than it was before. Often when
I am invited to speak to parents who are contemplating a decision
as to whether to continue with the pregnancy or not, it allows
me to give parents much more accurate information. Often, that
information is not available until 22/23 weeks, often after an
MR scan or something similar. Apart from the accuracy of diagnosis
and thereby the accuracy with which one can counsel parents, I
see no major change.
Q62 Mrs Dorries: Professor Wyatt,
given your comment a moment ago about the link between induced
abortion and preterm deliveries, the Royal College of Gynaecology
guidelines 2004 do not make any mention of this whatsoever. Do
you not think that women deserve to be fully informed of this
particular aspect of scientific evidence? Do you think the RCOG
guidelines need to be updated to reflected this so that women
are better informed when they go to a doctor to request a termination?
Professor Wyatt: I think on first
principles it is absolutely vital that women are fully informed
about the information that is available if they are considering
having an abortion. Therefore, I think that guidelines do need
to be constantly updated as evidence accumulates. I think it is
very important that appropriate attention is paid by those who
counsel women, abortion providers and so on, to make sure that
fully informed consent is obtained. In terms of other medical
and surgical procedures, we go to great lengths to ensure that
people are fully informed about potential consequences.
Mrs Dorries: Is that a yes? You do think
that the RCOG guidelines 2004 should be updated to reflect this
Q63 Dr Harris: Could you explain
your expertise in this area when you answer that question?
Professor Wyatt: I do not have
expertise in the RCOG. It is for the RCOG to amend its own guidelines.
The principle is that guidelines should reflect the best available
Chairman: I do not think we would disagree
with that as a Committee. That is how Parliament works.
Q64 Graham Stringer: All the witnesses
have been very precise about a 23, 24 or 25 week gestation period.
Are you absolutely certain when you are dealing with a premature
birth that the baby is 24, 23 or 25 weeks? How do you know?
Professor Marlow: As someone faced
with this from time to time, it is a very relevant observation.
The dating of pregnancies has become very much more accurate over
the last 10 to 15 years and certainly over the period between
1995 when we did our first study and last year the confidence
intervals around what a gestation is on an early scan have come
down quite dramatically. Nonetheless, you are quite correct. It
is often difficult to be sure of the exact gestation age of a
baby and of course the exact gestation might make a lot of difference
in a delivery room decision. That is why in general terms we always
suggest that someone is present at the delivery to make an assessment
of the baby. If the baby is showing greater signs of vitality,
our standing instructions are often to intervene unless the parents
have asked otherwise. That is a completely different issue from
survival and disability. This legislation is a practical, pragmatic
solution to this level of uncertainty that we see around that
Q65 Graham Stringer: How does that
uncertainty affect the statistics that you are presenting to us?
Professor Marlow: The statistics
can only go on the best available dating evidence that we have
and in this country we are very lucky in that our obstetric services
are very good at picking women up early and offering early scans.
The accuracy with that is to within a few days. Given that, I
feel much more confident. 15 years ago it was not uncommon for
us to be faced with a woman where we did not know what the dates
were with any certainty and that was a much more difficult decision
Q66 Graham Stringer: The accuracy
really depends on an early scan?
Professor Marlow: It does depend
on an early scan.
Dr Harris: To the two neonatologists:
we have been given two types of evidence in this session and in
written evidence. When Parliament makes its decision, in so far
as it relates to viability, next year on what the limit should
be would you recommend first, Professor Marlow, that it based
it on data from UK law, national studies in peer reviewed, published
papers like EPICure or anecdotal reports that have not yet been
published from individual hospitals as the best way
Chairman: That is leading.
Dr Harris: Let him answer the question.
Chairman: I am not taking that.
Dr Harris: Let me ask a wider question.
I did not realise in our standing orders there was a rule about
Chairman: There is because I am chairing
this Committee and I am the king.
Q67 Dr Harris: Can you give us advice
on what sort of evidence parliamentarians should rely on when
making decisions on nation-wide law about where viability lies?
Professor Marlow: I think they
should be aware of the totality of the evidence but carefully
conducted population studies do show us very clearly the prevailing
outcome in this country and do not in any way detract from centres
of excellence trying to push further the ground rules of scientific
activity which we need if we are ever going to make any advances
in this area.
Chairman: Professor Marlow, you will
make a politician yet. That was a very neat way of being able
to finesse that question. On that note, could I thank our panel,
Professor Fitzgerald, Jane Fisher, Dr Guthrie, Professor Neil
Marlow and Professor John Wyatt? Thank you very much indeed.