Examination of Witnesses (Questions 180-199)
DR VINCENT
ARGENT, DR
TONY CALLAND,
LIZ DAVIES
AND KATHY
FRENCH
17 OCTOBER 2007
Q180 Chairman: Could you please answer
the question? The question has been put in the inquiry.
Dr Calland: The reason that that
particular motion was chosen by the Agenda Committee—this
is the motion on first trimester abortion—was because we
did not have policy in that area. We knew that the Abortion Act
was going to be reviewed because of the 40th anniversary and the
opportunity was there.
Q181 Mrs Dorries: Dr Calland, that
is not the answer to the question that I am asking. The question
I asked you was: on the day that the motion was voted on, were
only pro-choice motions put to the floor of the BMA?
Dr Calland: No. There was a series
of motions. I can read them all out to you if you wish.
Q182 Mrs Dorries: There were three.
Dr Calland: There was more than
that. There was a series of motions. The first of those motions
was the motion on first trimester abortion and that was debated.
As I am sure you are aware, time is allowed for certain sections
and after that motion, because there were a lot of speakers and
it was a well-attended debate, time on that section ran out. Therefore,
we did not get to meet the other abortion—
Q183 Chairman: Are you Chair of the
Agenda Committee, Dr Calland?
Dr Calland: I have nothing to
do with the Agenda Committee whatsoever.
Q184 Chairman: For the record, who
is the Chair of the Agenda Committee?
Dr Calland: I am not sure if it
is not the Chairman of the whole conference.
Q185 Chairman: Could we have that
for the purpose of our records?
Dr Calland: Michael Wills.
Q186 Dr Harris: May I suggestion
that if you write to us with the correspondence that addressed
the question in the first place, then we can circulate it. It
is a procedural matter. I would also like to ask if you could
write clarifying, because I cannot find it in your evidence at
all, any reference to two signatures in the second trimester.
I would be grateful if you would take the opportunity to write
to say whether you have a policy on the second trimester and,
if so, on what that is based.
Dr Calland: The policy on the
second trimester is to maintain the status quo. It was
that we changed it for the first trimester.
Dr Spink: Kathy, in reference to two
doctors, talked about the need to get two signatures being a huge
burden—your words—on women and about it being very
inconvenient. There was no mention at all of the health impact
or the ending of a life and the moral impact of that. Dr Calland
has pointed out that the BMA is focused on the health risk to
the woman, not on the consequences of this unique procedure, which
is one to end life rather than to save and improve the quality
of life. Does the panel think that there might be other dimensions
to this decision on two doctors, other than just health, that
there might be moral and ethical questions as well and protection
for the doctor and protection for the parent who is looking to
abort, who may come across somebody with a particular view, and
if they have two signatures, that will make the probability of
them coming across a doctor with a particular view—
Chairman: I am not allowing any questions
which ask our witnesses for moral or ethical views. I am keeping
purely to the facts. I am sorry, Bob. I know you are trying to
get in there, but I will not allow it.
Dr Spink: I regret that, Chairman, because
for the record could I just state that I believe that science
must also look at the moral and ethical consequences and you can
do that.
Chairman: You can do but you are not
going to do it in my committee at the moment.
Q187 Chris Mole: Kathy French, what
evidence is there to back up the RCN's argument that nurses should
be given more responsibility in medical abortions?
Kathy French: We do not do it.
We have to work within the legal framework at the moment and we
know that our colleagues in other countries have a greater role
around abortion. In terms of early medical abortion, currently
nurses provide all of the care for the women, apart from prescribing
the medication needed. Many of our colleagues tell us that this
is a great disadvantage to them, that they could actually speed
up the process once that woman has decided that is her option.
This is not all our members within the College; these are nurses
who are specifically working in the field of abortion. It is not
asking for every nurse out there to take it up and we know that
every nurse will not want to, any more than they will want to
prescribe for other conditions.
Q188 Chris Mole: Can you be clear:
does the RCN actually have a view on what additional roles those
nurses working in abortion services could be taking on if there
was a change in the law?
Kathy French: Yes. Can I explain
to you? If you are looking after a woman who has decided to have
an early medical abortion, nurses currently provide all the care.
The one thing they cannot do is prescribe the medication. It is
that extra step that some nurses would like to take.
Q189 Chris Mole: But they can prescribe
most of the medication for other procedures?
Kathy French: If you are a nurse
prescirber, you can prescribe anything in the National Formulary
but not mifepristone.
Q190 Chris Mole: But they can prescribe
mifepristone for other procedures?
Kathy French: For other conditions,
yes, but not for abortion.
Chairman: Can we ascertain whether you
are you talking purely about medical abortions that you want nurses
involved in?
Q191 Chris Mole: That was the question.
The counter argument that is raised is that you require doctors
for reasons of safety and not nurses. Does the RCN have a view
on whether nurses could carry out surgical abortions safely?
Kathy French: Yes. Our view is
that nurses' roles have evolved over the years. I do not think
anyone in 1967 would ever have imagined what nurses are currently
doing now, or some nurses, not all nurses, in terms of prescribing,
hysteroscopies, colposcopies, fitting of intrauterine contraception
and subdermal implants. These are gynaecological procedures. There
is a small group of nurses within abortion services who would
like, with appropriate training, and it would have to be with
training, as part of the medical team to be able to do the very
early medical abortions. This is what they tell us.
Q192 Chris Mole: You said the one
thing they cannot do is prescribe. Another thing they cannot do
is take consent and sign the HSA1 form. Do you think a properly
trained nurse should be able to do that?
Kathy French: They can take consent.
That is very different. They can take consent for abortion but
they cannot sign the form.
Q193 Chris Mole: Do you think they
should be able to?
Kathy French: Yes, I think for
nurses who are appropriately trained and who want to and also
respecting those nurses who have a conscientious objection, that
must be respected. We are not talking about volumes of nurses
working in isolation in a portakabin. It is nurses as part of
a team who are trained and very experienced and it is not going
to be large numbers.
Q194 Dr Iddon: Could you spell out
in a little more detail what in practice nurses are actually doing
now? You have explained that with medical abortions but could
you go into a little more detail for surgical abortions?
Kathy French: In terms of nurses,
nurses do all of the counselling for women around abortion. They
will do ultrasound scans in many of the units, certainly in the
one that I worked in, take the bloods, discuss ongoing contraception,
get consent from the women, discuss the procedure. In day surgery
units, they care for the women in pre- and post-op procedures
in terms of pain relief if that is necessary, the complete package
of care. Clearly within the law nurses cannot perform abortion.
I know this needs clarity because some people still believe that
nurses can but we at the College believe under existing law that
we cannot.
Q195 Dr Iddon: Is it your view that
if nurses were allowed to carry out particularly surgical abortions
but also medical abortions, a doctor should be available in case
complications occur?
Kathy French: Absolutely. This
cannot be done in isolation. You would need a doctor there, in
the same way that we do now. If a registrar or a house officer
is helping out with abortions, there is always the lead consultant
or a very senior person within the premises. Yes, you would have
to have that.
Q196 Dr Iddon: Could I ask the panel
to comment on the phrase "registered medical practitioner"
which is in the current legislation? Some people believe there
is a lack of clarity in that. Do we regard nurses as registered
medical practitioners or should it be written in more strong language
in any further legislation that Parliament may bring in? Any member
of the panel could answer that.
Liz Davies: We took advice from
counsel. We sought legal advice on the term "medical practitioner"
as contained in the 1967 Abortion Act. The advice came back that
the term "medical practitioner" related a doctor registered
with the GMC, which effectively bars nurses from carrying out
these procedures.
Q197 Dr Iddon: So in your view we
would have to write in a phrase that clearly mentioned nurses
in some way?
Liz Davies: Yes, I think we need
to clarify the term "medical practitioner" or just call
it "practitioner" to enable nurses to be able to do
this.
Q198 Dr Iddon: Is that generally
agreed by all members of the panel? Do any members want to clarify
that further?
Dr Calland: I think the history
is that a "registered medical practitioner" has always
been taken to mean a doctor registered with the General Medical
Council. That was the implication I would think in the 1967 Act.
Q199 Dr Iddon: Dr Calland, can we
be quite clear on the view of the BMA with respect to nurses becoming
involved?
Dr Calland: The BMA does not have
a conference policy on this particular issue but generally speaking
I think if people in the BMA saw the term "registered medical
practitioner" they would assume that meant a doctor.
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