Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 280-299)


17 OCTOBER 2007

  Q280  Dr Spink: Is it arbitrary and misleading to consider vitality, looking at this upper age limit, considering, of course, that almost all babies would have been viable had they not been aborted?

  Rev Dr Fleming: Absolutely. I see considerations of viability and vitality as without moral significance to the fundamental question that you are addressing. There are many, many human beings who have become less vital because of accidents that they have had into life beyond birth. If a committee is purporting to say we are going to stick to the science then you are moving into immediate moral territory once you raise the eugenic question of whether or not a certain human being has too many disabilities or too much disability to be allowed to be born. Secondly, the viability question seems to me to be again supremely irrelevant because by and large unborn children left to gestate in the normal way will come to viability.

  Q281  Dr Spink: They are all viable, most of them.

  Ms Quesney: I think, again, we have to make a distinction between what happens when abortion is illegal. I think everyone will remember what happened in this country before 1967.

  Q282  Dr Spink: I am asking about the specific issue of viability. Is it misleading to look at viability since almost all babies that are aborted would have been viable had they not been aborted?

  Ms Quesney: I think what is really prevalent about this is women making decisions about their bodies, about their futures, about their fertility and about their reproductive lives. I think that is probably the key for abortion rights especially. Let me just come back to those 4D pictures.

  Q283  Dr Spink: We have moved on from there.

  Dr Saunders: My view is that the law on this in this country is based on a moral or ethical presupposition that the status of a human life is contingent upon its capacity for communication, consciousness, self-awareness and so on. I do not think that viability—I would agree with John Fleming—is a morally relevant parameter. When we are moving to that position and saying that it is all right to abort a foetus which does not have this degree of self-awareness, consciousness and so on we are moving out of science and into ethics.

  Q284  Dr Spink: Let us put the morality on one side and let us look at just the science. Do you accept that the vast majority of those babies that were aborted were viable had they not been aborted, from the science viewpoint?

  Dr Saunders: You are absolutely right that the vast majority of first trimester abortions would have resulted in live babies had we not intervened.

  Ms Weyman: I think it is a completely irrelevant question to the debate. What we are talking about is an issue for women about what happens to them when they are pregnant. The beliefs that obviously some people have about life and when life starts and how it should be regarded are not those that are shared totally within our society. We live in a society in which women are able, fortunately, to be able to make a choice.

  Q285  Dr Spink: Did you mean it was an irrelevant question or an inconvenient question?

  Ms Weyman: No, I think it is irrelevant. It may be a relevant one in your beliefs system, but that is not the beliefs that are held by everybody in society about the question of life and when life starts and the relative position of a woman and a foetus. I realise we are not on the ethical issues, but this question has been very much more about ethical questions.

  Q286  Chairman: The whole issue of viability as far as the Committee is concerned is that in 1990 the issue of late terminations was reduced from 28 weeks to 24 weeks on the basis of scientific evidence and viability. Whether you agree with that or not—

  Ms Weyman: I accept that.

  Q287  Chairman: —that is what the Royal College of Obstetricians advised the Government.

  Ms Weyman: I answered the previous question about that, which was about the viability question and whether that has changed and we have expressed our views about that.

  Q288  Chairman: Dr Saunders, when you talked about the Epicure study you mentioned, first of all, about the lowest common denominator study and then you talked about the average. Lowest common denominator study, was that really what you meant to say? Which is right? Did it average the information it received or did it in fact take the lowest common denominator?

  Dr Saunders: I concede your point. I think I am overstating the case by saying lowest common denominator. It is an average we are talking about between the best centres and the others.

  Chairman: I really want to get on to mental health.

  Q289  Dr Iddon: Could I ask you each to give your opinion on whether you believe that abortion increases the risk of mental health and whether the restriction of access to abortion also has an effect on a woman's mental health? Perhaps you could also comment on any evidence of causal factors or confounding factors.

  Ms Weyman: As far as the evidence is concerned affecting women's mental health, there is no evidence to show that an abortion has an adverse effect on women's mental health. Where there is a mental health outcome this is quite often the result of previously existing circumstances and condition of the woman. We do not have much current evidence about the impact of abortions if women are denied abortions. However, the evidence that does exist shows that that can have very severe consequences for a woman if she is forced to continue with her pregnancy. Overall, being able to make her own decision is in fact beneficial for a woman and there is no evidence for there being any detriment.

  Dr Saunders: There are a considerable number of robust peer reviewed studies strongly suggesting that women with a prior history of mental health problems are especially vulnerable to further mental health problems following an abortion. I do not think this is really disputed at all by anyone in psychiatry. However, the question of whether women with no pre-existing mental health problems are at greater risk from mental health problems has been contentious. I think it would be fair to say, looking at all the evidence, that the Ferguson study is the first methodologically robust longitudinal study that has confirmed a link there. It needs to be repeated in other areas to see if that link is confirmed. I do think there is now robust evidence suggesting that link.[3]

  Ms Quesney: Over the last 40 years one in three women on average has had an abortion in this country. If there were major psychological sequelae related to abortion I think we would probably know about it. Most women would really show some serious problems. There is a huge amount of taboo surrounding abortion. It is an issue that women are not likely to talk about and it is an issue that women are made to feel guilty about. I think we also need to take that into account. Most of the women that we would come across and most of the women generally are women who feel an enormous sense of relief after being able to access the abortion safely and that is a really important point.

  Rev Dr Fleming: I agree with every word that Dr Saunders said. I want to add to it my own research which has been published in the last month in which we find—this is a two-year study—that Australians generally are morally opposed to abortion in almost all circumstances but they are pro-choice at the same time. This deep conflict within the community is highly suggestive of reasons why it would be that women who seek abortions or feel that their situation is so oppressive to them that it can only be relieved by an abortion at the same time will later feel significant distress, anxiety, guilt and so on from the abortion. It is not something that is heaped off on them by others but it is a deep conflict within the human psyche, ie we want choice yet we do not feel good about abortion. Just as in a deeply conflicted society like Australia, if I was to replicate the study I have done I think that would be found to be the case in Britain as well.

  Q290  Graham Stringer: Dr Saunders, you gave a vivid explanation about the difference between cause and correlation before. Can the panel tell us where there is established cause between abortion and death following an abortion by the woman, where there is an established relationship with breast cancer, an ectopic pregnancy or infertility? In what areas has causality been definitely established?

  Dr Saunders: I think this relates to the whole question of the safety of abortion. A lot of evidence has quoted the Confidential Enquiry into Maternal Deaths as showing that an abortion is safer than normal childbirth. The evidence that would lead us to doubt that is, first of all, the evidence about the link between abortion and mental health which I have mentioned. Secondly, there is now very robust evidence linking abortion with subsequent pre-term delivery, in particular in the Thorpe Review of 2001, in the EPIPAGE multi-centre study in France and in the EUROPOP multi-centre study in ten countries in Europe. It is quoted by the FPA in their evidence and by Sam Rowlands in his that a previous abortion raises your chance of having a premature delivery by between 30 and 100%. If we are talking about multiple abortions, there is a "dose" effect in that the more abortions you have the more likely you are to have a subsequent pre-term delivery and the more likely you are to have a very pre-term infant. The data about breast cancer is far more controversial. I would agree with John Fleming in that I think the jury is still out. In our own submission on this we refer to the RCOG guidance of September 2004. If you read not their one line conclusion but actually the body of evidence within the guidance, they reviewed two large analyses of all of the studies, one by Wingo and one by Brind. In the Brind study, which shows a link between abortion and breast cancer, they say in this guidance it does not have methodological problems with it. I would commend the Committee look at the criticisms of the 2004 Lancet study from Oxford which contradicts Brind's findings and I commend that the Committee look at Brind's own critique of this and also the critique by Greg Gardner which you also have in the evidence before you. Having said all that, at CMF we are still sitting on the fence. We think women, in order to be properly informed, should be told that the jury is still out, that there may be a link but that more research is needed. There are two other issues. These linkage studies from Finland and California which show a significant association between abortion and death from suicide, homicide, accidents and so on cannot be discounted. The final thing I would say is that because the HSA1 form, which does have a space to record complications, is filled in either at the time of the abortion, shortly after or, as we have heard from Vincent Argent, beforehand it will only record complications which occur within the immediate time-frame of the abortion itself. A lot of publicity has been given to the complications of haemorrhage, infection, subsequent infertility and so on that happen after the form is sent in. There was a case recently in London of a 14-year old girl who needed a hysterectomy after an abortion and that will not appear in the statistics simply because it will not appear on the HSA1 form. So we have got reservations about the Confidential Enquiry into Maternal Deaths for all of those reasons.

  Q291  Graham Stringer: Do any of the other witnesses believe in causality in any of these conditions?

  Rev Dr Fleming: I am reminded of the analogy with smoking. When I was a student at university I regret to say that in the Sixties it was more association/correlation between health outcomes and smoking and over time we moved from association to causality. I think the submission that I am putting before you here suggests that there are significant increased risks of premature delivery. There are infections resulting from abortion. On the breast cancer thing, as I have said before, the jury is still out. I think it would be foolish not to imagine that there is enough there to suggest, at least in some areas, there is a connective relationship between abortions and outcomes.

  Ms Quesney: There is always more evidence needed to establish those links. If you make abortion illegal, which is what some people are really trying to achieve, then there will be huge amounts of women dying as there are around the world. I think that is a very important point of consideration for everyone.

  Ms Weyman: We have obviously examined the issues around the risks in our submission so I will not go into that. Clearly it is important that we have good evidence and on the basis of that evidence women are advised, but in the end the situation for a woman is making the decision for her in the circumstances she is in as to what she wants to do. The risks for her associated with continuing with the pregnancy in the end, if she chooses to have an abortion, are going to completely outweigh any other risks, the extent to which they are proven and the hypothetical risks that are also suggested as well. I think it is fundamentally important that women should be given the best information that is available so that they can make the decisions that they would want to make and we know that that is what good services do and we know that women choose to make the decision to have an abortion.

  Q292  Mrs Dorries: We know that at between 20 and 24 weeks a foetus is anaesthetised and yet we had evidence on Monday from Dr Maria Fitzgerald saying that she believes that a foetus does not feel pain until much later. Dr Saunders, what is your take on foetal pain? At what point do you think the foetus feels pain?

  Dr Saunders: I have difficulties with the evidence given by Maria Fitzgerald and that given by Stuart Derbyshire in written form to the Committee over foetal pain because I think there is a lot of disagreement between physiologists who work in this area about when the foetus first feels pain. Both Derbyshire and Fitzgerald work from the presupposition that pain cannot be felt until cortical connections are established between the thalamus and the cortex. That is highly contentious. I would refer the Committee to a paper which is not in our evidence because it was published this month by KJ Anand. It is a major review of this whole issue in Seminars in Perinatology, October 2007 which makes this point very strongly that pain is in large part a thalamic sensation and that we cannot draw conclusions about whether or not foetuses feel pain from the presence or absence of advanced thalamic cortical connections.

  Q293  Dr Spink: But there is scientific evidence from 4D imaging that foetuses smile and cry at 24 to 26 weeks, is there not? Would you agree with that?

  Dr Saunders: We know a foetus from a very early stage in pregnancy will withdraw from inoxious stimulus. If you put a needle into a 22 weeker on a neonatal unit it will cry. If we measure stress hormones like catecholamines and cortisol, they are present at an earlier stage than 20 weeks. The neural connections there to the thalamus are present at 19 to 20 weeks. So the jury is still out on this issue and I think we should give the foetus the benefit of the doubt.

  Q294  Chairman: Are you saying that a quadriplegic feels pain when you stick a pin in their foot?

  Dr Saunders: No, I am not saying that, but I am saying—

  Q295  Chairman: Is that not the reason it does not feel pain, because there has been a severing of the spinal cord?

  Dr Saunders: With all due respect, a quadriplegic will feel pain if you stick a needle into his face, but we are talking about a lesion occurring in the spinal cord. If you look at adults who have lesions in their sensory cortex—and Anand goes into this—they still feel pain. Why is that? It suggests that the cortex is not the only part of the brain that is involved in conscious pain sensation. If that is true for adults then surely we should be giving foetuses the benefit of the doubt. Bertrand Russell once said that a fisherman told him that fish had neither sense nor sensation but how he knew that he could not tell him. I think we need to ask people like Fitzgerald and Derbyshire how they can be absolutely sure. Given that the RCOG itself recommends anaesthetics for babies being operated on or for fetal surgery and late abortion—

  Chairman: The evidence that Dr Fitzgerald gave this Committee was very clear, she said she did not know; that was her absolute starting point. There is a fundamental difference there.

  Dr Harris: I would like to move on to areas where you have expertise rather than areas where you are commenting on others' expertise.

  Mrs Dorries: That is not a precedent.

  Q296  Dr Harris: I would like Anne Weyman to have the chance to comment about the issue of premises and so forth, but before I do that I wanted to ask two short questions. Firstly, just for my clarification, Dr Saunders, you quoted a Greg Gardner as an authority in respect of his evidence. Is he research active in this area?

  Dr Saunders: Dr Harris, you and I both know that any doctor with proper medical training can go to peer reviewed journals and look at the evidence and draw conclusions and that is the beauty of evidence-based medicine, it is that a houseman, an FY1, can challenge a professor on the basis of the written evidence.

  Q297  Dr Harris: I just asked you who Dr Gardner was.

  Dr Saunders: He is not a researcher in this area. He is someone who has looked at all the evidence. I think your implication that someone who has not had hands-on research experience in a certain area is not qualified to look at the data—

  Q298  Dr Harris: Let us try and find some consensus. Conscientious objection is within our subject area today. Would you agree with me that it is going to be necessary for doctors and health professionals to have the right to conscientiously object? Would you agree that that conscientious objection has to include the right not to have to refer a patient for an abortion so that someone else does it for you?

  Dr Saunders: Chairman, is that a question about the science? Should I answer it?

  Q299  Chairman: I run this inquiry. I am ruling that question out of order. I am going to finish with one final question and it is really about the two doctors' signatures. Why do you feel that two doctors' signatures are necessary for a termination when they are not needed for any other medical procedure?

  Rev Dr Fleming: I think you can argue both ways on having one doctor's signature being sufficient to refer. I think that the complication, if I may say, Chairman, in relation to the abortion issue is that if an abortion is being referred on the basis of a psychiatric condition you would think it would be sensible for a psychiatrist to attest to that, that would be the other signature. The initial referring doctor may not have sufficient expertise for the reasons why the abortion is being referred under law and it may therefore be thought very prudent that there should be a second signatory and that the second signatory should have expertise in the reasons why this referral is being made.

3   Note from the Witness: with the Fergusson Study. Back

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