Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 160-179)


17 OCTOBER 2007

  Q160  Chairman: He is actually responding on behalf of the BMA in terms of whether there is a scientific basis on which two doctors' signatures are required. That is the basis of the inquiry. I am trying to stick to that because if we move into ethics, we will be all over the place. Liz, what do you feel in terms of why we need two doctors in terms of the health of patients?

  Liz Davies: We certainly do not need two doctors' signatures to give women permission to have an abortion. Women are quite capable of making this decision. They do not need to be saved from themselves. At Marie Stopes we certainly have always advocated that the necessity for two signatures should be removed, at least in the first trimester. I cannot agree that two signatures are necessary in later abortions, purely because I think as long as the woman is being given full information regarding the risks of any procedures she undertakes, again she is quite capable of making that decision for herself. The reasons for women seeking an abortion in the later stages we see as equally valid to those in the early stages and so I see no difference between early and late abortion from that point of view.

  Kathy French: I think the two doctors' signatures made a lot of sense in 1967. We have moved on from there. For the autonomous individual, the need for two signatures is very cumbersome. It puts a huge burden on women when somebody cannot sign the signature. I do not think we need it in current practice.

  Q161  Chairman: Is that at any time during either the first or second trimester?

  Kathy French: I am not sure about the second trimester. I think two signatures is again excessive. There may be a need certainly one and that is about discussion with the woman and the doctor who is caring for her.

  Q162  Chairman: Dr Argent, in terms of the HSA1 form, is there any evidence that signing it without seeing the patient first is putting the patient's health at risk?

  Dr Argent: I am not sure there is any published evidence that addresses that particular factor. I have to say the practice of obtaining signatures in some units is somewhat variable. This has not been written up very much in journalism because obviously people would not like to talk about it.

  Q163  Mrs Dorries: Dr Argent, what proof do you have then to make that claim?

  Dr Argent: It is what I have observed over many years of practice in abortion services.

  Q164  Mrs Dorries: So it is anecdotal evidence then?

  Dr Argent: Yes.

  Q165  Mrs Dorries: It is not scientific?

  Dr Argent: Yes.

  Q166  Chairman: I am really quite anxious about this issue of doctors' signatures and the health of patients because we should have evidence of that. Is there any evidence at all to say that having two doctors' signatures actually improves the health outcomes of patients who are presenting for abortion?

  Dr Argent: I am not aware of any evidence that suggests that. Indeed, in many cases of course it does actually say in HSA1 form that the doctor has seen or not seen and examined the patient and sometimes the clinician does not actually see the client for a consultation. They sign the form on the basis of reading the clinical notes.

  Q167  Chairman: The RCOG said that that is an acceptable practice?

  Dr Argent: It would appear to be acceptable, yes. It has been discussed by academic lawyers. It does not state that in the Abortion Act itself but because of the wording of the HSA1 form, it is accepted.

  Q168  Chairman: It went to the House of Lords and the House of Lords supported the RCOG in that. Are they all wrong, in your view?

  Dr Argent: Academic lawyers look at the question of how a doctor forms an opinion in good faith that the abortion becomes eligible under the terms of the Act. Some would say it is difficult to form that opinion if you do not discuss the situation with the client. Others would say that they are supportive of women's choice and therefore that of its own is sufficient.

  Q169  Dr Harris: Continuing that point, is it your view that if a doctor is of the view that if a woman wants an abortion and it is early enough so that it is clear that, all other things being equal, it is going to be less risky for her to have the abortion than continue the pregnancy—full stop—even without her motivation, that would be a common reason for such a signing on Ground C, I think, in good faith? Is that a reasonable suggestion?

  Dr Argent: Yes, I think many medical colleagues and other health care professionals would take the view that if they believe that, that is sufficient to justify an abortion under Ground C.

  Q170  Dr Harris: Dr Calland, you will be aware that although I am on your committee I took no part in the formulation of your evidence to this inquiry. I want to ask you about the issue of two doctors in the second trimester. My understanding is that the BMA just has not taken a view on the second trimester. The Royal College has said that they can understand the need for a second clinical opinion as good practice in complex case perhaps of foetal abnormality. Could you explain whether you think that the need for a second opinion, which is good clinical practice, is separate from a statutory requirement to have two doctors' signatures on a form?

  Dr Calland: All I can do is reiterate BMA policy, which really is around the first trimester. I think it would be logical that where risk was increasing, it would be of benefit to have two signatures rather than one. The BMA position is quite clear about the first trimester. We do not consider the risks there are significant enough to warrant two signatures and therefore that is the position we have taken.

  Q171  Dr Harris: I am just asking whether it is better to have a second opinion—i.e. someone seeing the patient in a formal second opinion way—as opposed to just a second signature on a form "patient unseen"?

  Dr Calland: I do not think the BMA has a position on that.

  Q172  Mrs Dorries: I have a question to Dr Argent and then one to Tony Calland. Dr Argent, you are claiming anecdotally that every day doctors up and down the country are breaking the law because it is a legal requirement that two doctors sign the signature, one would hope after having both seen and consulted with the patient. You are telling us that doctors every day break the law by carrying out this procedure. The reason why we have two doctors' signatures is that this is not like going to have your appendix out or your tonsils out where you go to a doctor and you are informed of what is going to happen at the operation and then a doctor signs. This is actually taking a life. Are the two signatures not a requirement to protect the doctors also as well as the patient, given that we are talking about ending a life in abortion, not a procedure?

  Dr Argent: No, I am not saying that doctors are breaking the law. What I am saying is that there is a lack of clarity in the legal situation—

  Q173  Mrs Dorries: I am sorry, you said many doctors are not even signing the form—they are just reading the clinical notes I think you said—until after the abortion has even taken place. Is that not breaking the law?

  Dr Argent: It is a legal requirement to have two signatures on the HSA1 form before the abortion is performed but in a small number of cases sometimes it is almost actually signed in the operating theatre by the surgeon with the patient anaesthetised on the table.

  Q174  Mrs Dorries: It has gone from being anecdotal in your observation up and down the country to—

  Dr Argent: That is not necessarily illegal because academic lawyers do disagree on the interpretation of the Abortion Act. I think that some academic lawyers do agree that the Abortion Act is badly drafted and many of these situations are unclear.

  Q175  Chairman: Rather than pursue this, would you agree therefore, Dr Argent, and certainly Dr Calland, that there is a requirement in fact for the law to be clarified in this area? Is that what you are saying?

  Dr Argent: It would be helpful if there were clearer guidelines about such matters as whether the clinician or the health care professional actually needs to see the client and discuss the situation before signing the form. It would appear the logic at the moment is that they do not have to do that.

  Q176  Chairman: On the two doctors, before we leave this point, could you tell us, Dr Calland, why in the BMA's view this is the only procedure where two doctor's signatures are required. Why this and not anything else? If you could take somebody's lungs out and replace them or take their heart out and replace it, you do not need two doctors' signatures, but for this procedure you do. What is so special about it?

  Dr Calland: You are talking about second trimester and beyond?

  Q177  Chairman: The law as it stands at the moment says that you need two signatures.

  Dr Calland: It does. One would have to second-guess what was in the mind of Parliament in 1967 as to why two doctors' signatures were there. We could probably spend all morning trying to do that. I am sorry to repeat myself. All I would say is that because of the risk issue, the BMA feels that the first trimester is now such a low risk, particularly with medical abortion, that we do not need two signatures to do that. We feel that because the risk increases as you go through into second trimester abortion and later where they take place, it is not unreasonable to maintain the status quo for whatever the reasons were.

  Q178  Graham Stringer: Why is risk the issue? A heart-lung transplant is much riskier than a second trimester abortion. Why are you relying on risk?

  Dr Calland: It is because we have done. That is the argument that the BMA has used.

  Q179  Mrs Dorries: I say to Dr Calland that I would suggest it is because this is about ending a life. Dr Calland, could you confirm: the Ethics Committee of the BMA took its position after a vote at a recent conference that you held. Motions were put to the floor; you took your vote and this is where your position came from. Could you confirm that on that day only pro-choice motions were put to the floor to be voted on?

  Dr Calland: I think you have been in correspondence with the BMA on this issue and you have had it clarified how the BMA conference works.

  Mrs Dorries: I have. However, that does not change the facts, does it?

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