Select Committee on Science and Technology Minutes of Evidence

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 time—i.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 from that?

  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 information?

  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 scientific evidence.

  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 area.

  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 making process.

  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.

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Prepared 15 November 2007