Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 260-279)


17 OCTOBER 2007

  Q260  Dr Harris: You said yes for psychological sequelae. In the memorandum from the Society for the Protection of Unborn Children you say, at the top of page 8, "a major UK study did not identify a difference in total psychiatric disorders between aborting women and those who carried to term", and you give the reference as the 1995 Gilchrist study. You then say, "The same study did however identify an increase in deliberate self-harm, which includes substance abuse." Are you aware that the full sentence of the Gilchrist study says, " ... in women with no previous history of psychiatric illness deliberate self-harm was more common in those who had a termination"—which is what you are saying—"risk ratio 1.7, or who were refused a termination, risk ratio 2.9"? That is the group that you have agreed just now was the appropriate group for psychological sequelae. Can you explain why you think you missed out the second half of the sentence from the conclusions of that study?

  Rev Dr Fleming: I will have to ask the researcher who wrote that part of the study for the answer to the question. Was it number 34?

  Q261  Dr Harris: Paragraph 34, reference 51.

  Rev Dr Fleming: I will ask them.

  Q262  Chris Mole: Chairman, it would be interesting to hear some of the other answers from the other witnesses to that question.

  Dr Saunders: I think it is incredibly important in research to eliminate confounding variables in order to establish a proper causal connection. Every time I raise my arm someone in China drops dead but that does not mean there is a causal connection. In the same way, there are studies, for example, that show a link between abortion and subsequent suicide in the year following. It is a strong association which has been demonstrated in linkage studies, but it is not yet established that there is a causal relationship between abortion and suicide because when you correct for all the confounding variables, such as socio-economic status and so on, the connection is not as strong. However, if you do correct for all the confounding variables and you find that there is still a connection then it is strongly suggestive of a causal relationship. An example of that would be one of the most quoted studies this week the Ferguson study from Christchurch, New Zealand linking abortion with subsequent mental health problems in women, where they took great effort to remove all the confounding variables and a pro-choice researcher was surprised at his findings that the link still persisted.

  Q263  Dr Harris: Do you accept that the author said he recognised he could not adjust for the "wantedness" of the pregnancy as the factor there?

  Dr Saunders: Yes.

  Q264  Dr Turner: Both pro-choice campaigners and pro-life campaigners focus very heavily on the issue of viability and this becomes conflated with the upper time limit for abortions. I want to ask all of the panel what they feel is the connection between the upper time limit on abortion and the gestational age at which a live birth is considered viable?

  Rev Dr Fleming: It depends entirely on how you are going to ask this question. There is a factual base on the question of viability. You then have to move from that piece of information—let us suppose we could agree on what that viability is, 24 weeks, 23, 22, 21, whatever, and whether you can move from an "is" to an "ought", which is an ethical question. All I have heard around the table since I have been here pretty much is ethics and speaking as a philosopher, everybody is moving from "is" to "ought". The question is in itself a profoundly ethical question. As to a connection between the upper time limit on abortion, that is a piece of information and the gestational age at which a live body is considered viable, I do not make much connection with it at all. It seems to me that in principle there is no real difference between what you do to a pre-viable infant or a viable infant.

  Q265  Dr Turner: Before you finish your opinion, you have stated the gestational age of viability as an accepted fact or words to that effect. Do I take it that you are content with the opinion, which others question, that 24 weeks is the generally accepted limit of viability?

  Rev Dr Fleming: I accept that it is a controverted question and I think there will be those in a better position scientifically than me to answer that with greater precision. I am simply saying that from the point of view of abortion I think it is an irrelevant fact and your question implies an ethical response because you are talking about a piece of information, a fact that "is" and making it an "ought". Any philosopher knows that is fundamentally ethical. In my view the abortion issue does not turn on viability.

  Q266  Dr Turner: But ethics are informed by fact.

  Rev Dr Fleming: Absolutely, but that is my point, you are moving from "is" to "ought". You are necessarily engaging in a philosophical enterprise.

  Ms Quesney: I think the law in Britain is based on a connection between the time limit and gestational age. If you look at the last 17 years since that decision was made to have a time limit for abortions of 24 weeks, there have been very few changes in terms of foetal viability. One of the issues we have not really talked about much at all is women and their needs. This may not be purely scientific, but I think there is a growing body of evidence which shows that there is a need for the very few women who need to access abortions, for very complex reasons, to be protected by law. As a society we really need to make a choice about whether we need to protect the most vulnerable people in our society.

  Dr Saunders: This connection between viability and the abortion law has its historical basis in the Infant Life Preservation Act of 1929 which is still in force in Britain, at least in England and Wales. The Infant Life Preservation Act makes it a crime to procure an abortion involving a baby "capable of being born alive", that is the basis. I would submit that that is a different concept to viability, which has been the main concern of this Committee. When we consider viability there is a debate about when foetuses become viable based on the interpretation of evidence, the alleged inadequacies of EPICure, other studies from higher centres and so on which we will not go into further. If we were to look back at the original intention of the law makers, it was to make it illegal to procure an abortion for a baby "capable of being born alive", that is why the 28 week limit was chosen initially. It was modified in 1990 by the Human Fertilisation and Embryology Act because foetal survival had improved with good neonatal care. We would submit it has improved further in the best centres. So we are in an anomalous situation at the moment where, for example, the West Midlands region can publish in the British Journal of Obstetrics and Gynaecology, looking at the abortions anomaly between 1995 and 2004, as in the Pro-Life Alliance's evidence here, that there were 102 babies born alive after "botched abortions". Technically those are criminal acts under the Infant Life Preservation Act. I think I would like to question why the Committee is looking at the issue of viability rather than the one that actually has legal significance, which is capability of being born alive, which although similar is a different concept.

  Q267  Chairman: There is a fundamental issue between viability and vitality. Do you make a difference between the two or do you regard them as the same?

  Dr Saunders: There is a difference between a foetus capable of being born alive and, on the other hand, a foetus that, with the best neonatal and intensive care, is likely to live with or without handicap. I think that is a distinction that this Committee has not yet made and it is an important distinction in law.

  Ms Weyman: I just wanted to make a general comment first of all on this issue about the focus on viability and the fact that this is something that has interested both sets of organisations. My organisation is particularly interested in a whole range of other issues that this Committee is discussing and I would be disappointed if I am not able to comment on some of those things, particularly around improving early access and some of the things you were talking about in the earlier part of the session. I think the first answer you had to this question does rather reveal the important divide here in the discussion around the time limit between those who are fundamentally opposed to abortion in any circumstances and would like to have a time limit really which is zero and therefore would push down the limit and this difficult discussion around what is the appropriate time. When I consider this issue, it seems to me that making any woman continue with a pregnancy and have a child that she does not want is always a terrible thing to do and has very bad effects on that woman.

  Q268  Chairman: We are not discussing that. You were asked a question about viability.

  Ms Weyman: I understand that. I think the issue about the time limit is an issue about how you reconcile the differing views and concerns about abortion and the pressing needs of women. The discussion about viability is obviously important in that because that is something that very much matters to people and the discussion in society as we consider what is a controversial issue. On the question that you raised about vitality and viability and how you judge the fact that because one baby may survive at a particular gestation against the needs of women in that situation and the very few women—I think we have to recognise that—who have abortions at that stage of gestation, I think that that is where you are making judgments which are based on the scientific evidence and how you evaluate those different issues. Certainly our view as an organisation based on the evidence, which much more expert people have given to you on those scientific issues than I can and that you heard on Monday particularly, is that the evidence still maintains that 24 weeks, when you take all that into account, is the compromise that applies still today as it did when it was introduced.

  Dr Spink: The figure was 3,000 last year and that does not seem to me to be very few. Even one is too many.

  Q269  Dr Turner: Thank you for those answers which, as I anticipated, covered a range of views. The one thing which all of you clearly felt extremely important was the issue of viability. That was vital if you will pardon the pun! What medical progress do you think has been made in recent years in terms of improving the prospects for very pre-term babies, and do these advances, if you accept that they are significant, have an impact on upper time limits for abortions?

  Rev Dr Fleming: There has clearly been some improvement, that is undeniable from the literature. As to whether or not there is anything there to justify playing around with the time limits in the Abortion Act as it currently is constituted, I am not persuaded. It seems to me that of all of the issues we ought to be thinking about that is not really at the top of my agenda. I would say that it is such a controversial matter as to whether you move from 24 to 23 to 22 to 20. It seems to me that there are more dangers raised in trying to go down a pathway where there is as yet no clear answer to the question. So I personally think that it would be better to leave aside playing around with the number of weeks at this stage.

  Ms Quesney: I think it is undeniable that there has been some progress in medical techniques to keep premature babies alive, but that should not stop us from distinguishing between what is an unwanted and wanted pregnancy. Forcing a woman, as Anne Weyman pointed out, to carry on with a pregnancy is something that is of no benefit to society, to that woman or to her family. One of the issues that was pointed out in the written evidence is that in Holland for instance they have very clear guidelines about not resuscitating prematurely born babies below 25 weeks. It is probably a very pragmatic approach, but I think we should probably take stock of what is happening internationally on this issue as well.

  Q270  Dr Turner: So you are not convinced that the progress has meant that the gestational age of viability has gone down?

  Ms Quesney: I think there has been progress in terms of keeping prematurely born babies alive. The techniques that are being used in certain hospitals are enabling those prematurely born babies to live but sometimes at great cost to their personal health. I think what we need to take into account as well is that prematurely born babies born alive at that stage do not necessarily survive.

  Q271  Mrs Dorries: What I interpret your answer to be is that even though a baby may be viable and that baby may be able to live if born, as far as you are concerned viability has no bearing on whether or not an abortion takes place. Do you believe an abortion should take place at any stage during pregnancy?

  Ms Quesney: I am quite comfortable with the current time limit.

  Q272  Mrs Dorries: So you think 24 weeks is the limit?

  Ms Quesney: I think it is very difficult for a woman to make a very, very complex decision about whether or not to terminate a pregnancy at that stage or a woman who has a very wanted pregnancy and is going into labour very early.

  Q273  Dr Turner: Dr Saunders?

  Dr Saunders: The fact that there have been massive advances in neonatal paediatrics leading to the survival of infants at lower gestation is really undoubted. That was reflected, first of all, in the fact that the HFE Act changed the upper limit from 28 to 24 weeks. So there is no dispute that between 1967 and 1990 there was massive change.

  Q274  Dr Turner: Do you think there has been significant change between 1990 and now, that is the question?

  Dr Saunders: I do. My wife worked in neonatal paediatrics. In 1985 they had a 24-week old baby survive in probably one of the top neonatal units in New Zealand. It was so unusual that it became the subject of a grand round and all the doctors came. Now in the best centres of excellence, like Minneapolis, 81% of 24-weekers are surviving. At the risk of creating boredom, we must distinguish between the kind of lowest common denominator studies like EPICure which average across different centres and do not take into account the postcode lottery of neonatal care that exists in this country. When we do look at the centres of excellence it is undoubted that at the very best centres there has been a huge increase in the survival of infants at 23 and 24 weeks gestation between 1990 and 2007.

  Q275  Dr Turner: Since you want to focus on the centres of excellence, can you comment then on the issues of vitality of those babies that survive given that the number in the Epicure studies of those babies which have a degree of handicap from mild to severe is extremely high? Can you comment on that aspect of those that you consider show a greater survival rate in the centres of excellence?

  Dr Saunders: I would take issue with the statement that the level of disability of early survivors is unacceptably high. Even if you look at the EPICure figures for 23 weeks, I think it was two out of 11 babies in that category, which is just under 20%[2], were in the severe disability category; others were moderately disabled. I think then you are starting to verge on moral territory where you are saying that babies with disabilities should be resuscitated, which I do not think we should be doing in this inquiry. The figure that is usually banded about by neonatal paediatricians is that about 15-20% or so of early survivors will have a significant degree of disability and a larger percentage than that will have some disability and some will escape with no disability.

  Q276 Dr Turner: Is your answer then that in the centres of excellence the incidence of disability is not different?

  Dr Saunders: As far as I understand, yes. What I understand from my neonatal colleagues is that the percentage of babies surviving with disability at 24 weeks now is pretty comparable to the percentage of babies that survived with disability at 28 weeks 20 or so years ago. What has happened with advances in neonatal paediatrics is that babies who would have survived with severe disability are surviving with no disability, others who would have died are surviving with moderate disability, and some who had no hope are surviving with severe disability. We are simply moving the line as neonatal paediatric care improves.

  Ms Weyman: We have looked at the evidence from the various different studies and also what the expert bodies have been saying about this issue and we have been looking at it for a long time and our view is that there has not been such a significant change and therefore the present time limit would be the appropriate one to continue with.

  Q277  Dr Turner: There has been a lot of publicity and a lot of emotive response certainly to 4D images of babies in utero. What do you think that those images actually tell us? Do we learn anything new from them?

  Rev Dr Fleming: Very early on in the days of the abortion debate people were told that the foetus was a bundle of proplasm (?) and blood and I have many quotes to that effect. What the images do is to give us information about what it is that we are looking at. You have to add to that the data about the developing human being and then after that you move into the territory of philosophical reasoning, ie what do you make of that information. I think ordinary people who respond to the picture of an unborn child ought not to be dismissed as responding emotively. We are human beings. I respond emotively to a raft of things and which I am very well justified in responding to. It does a disservice to the community that we all serve to suggest that somehow or other people of the scientific or philosophical dent of mind are more to be trusted and believed in abstracting from an emotional response than ordinary people. Often times I have found the responses of ordinary people to be far more instructive to me than some of the nonsense I have heard from my fellow philosophers.

  Q278  Dr Turner: Do these images actually tell us anything concrete about the consciousness of a foetus, its viability and all of those things?

  Rev Dr Fleming: It tells ordinary people this is a human being who is alive.

  Q279  Dr Turner: But we knew that anyway.

  Rev Dr Fleming: We did not know that anyway because the opposite was being said earlier in the debate. I think the images have been effective for people who have been told certain things and they see that that is not true.

2   Note from the Witness: When I checked these remembered figures I realised I had quoted the percentages (2% out of the 11% that survived) rather than the absolute numbers (5 out of 22). The rounding off of percentages accounts for a change from just under to just over 20%. Back

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