A serious thought for the New Year

Face of 12 week foetus

If you have been reading any of the articles on NHS BLOG DOCTOR (and thank you if you have) you will have realised that Dr Crippen tends to approach NHS problems, and indeed life in general, in a light-hearted fashion.

I care deeply about the creaking, failing NHS and over the years I have done a lot of shouting. It did not help. These days, I find humour is more effective; that lampooning works better than lambasting.

I should warn you now, therefore, that this article is not going to be humorous.

I have a particular horror of the death penalty.

It makes me shiver. I had an epiphany on this. I read that when we had hanging in this county there was no difficulty in finding someone to do the job. It was not necessary to advertise in the situations vacant columns. The Home Office got hundreds of unsolicited applications each year from people offering their services for free. Sterling citizens all.

When I was reading law, the then very young law tutor I had (he is now an Oxford Professor) put David Steel’s new Abortion Act in front of us and said,

“OK boys, this is abortion on demand.”

What nonsense. We argued and argued. You have to get two doctors to certify. There has to be a risk to the mother’s life….. etc etc. He just smiled.

The legal criteria are that two independent doctors have to agree that:

• The woman's life is at greater risk by continuing the pregnancy than terminating it.
• The termination is necessary to prevent permanent injury to the woman's physical or mental health.
• There is a reasonable risk that if the child were born it would suffer from serious physical or mental handicaps.
• There is a reasonable risk that if the child were born, any existing children the woman has are more likely to suffer injury to their physical or mental health.

We can all enter into a debate about what constitutes serious physical and mental handicap, but are we not suddenly on the slippery slope to eugenics? Think back to Joanna Jepson, that feisty Anglican vicar, herself born with a cleft palate, fighting to prevent children similarly afflicted being aborted. I would not arrange a termination in those circumstances, but then is it for me to interfere with a woman’s “right to chose”?

Be aware that there are woman now who ask, indeed insist, on abortions when the scan shows the baby is the “wrong” sex. And they get them. Have a look at "Petition Spot - abortion is great" - that will cheer you up. So should we tell women the sex of their babies at ultrasound? Do we have the legal right not to? That is another moral minefield for a different day.

These medico-legal arguments may exercise the chattering classes at a dinner party but, in reality, in every day practice, they are totally irrelevant. Statistically, the mortality rate of a termination in early pregnancy is lower than the mortality rate of having a baby. Ergo, abortion on demand. The Oxford tutor was right. The first criterion above is the only one you need in the UK and it applies to all pregnancies.

Despite my passionate views against the death penalty, and my flat refusal to get involved with doctor-assisted euthanasia, I have never been too troubled by abortion. I read The Female Eunuch. It’s “right on”. It’s a woman’s right. It’s her body. And I go along with that. I think. Or do I? Maybe I have not thought enough. When you are very young, these issues are so much more clear cut.

In the UK, the abortion form two doctors have to sign is green. I was presented with a “green form” ten days ago.

“Bit of a rush, doctor” said her mother. We would like to get it done before Christmas.

Just so.

A 15 year old girl with a scum-ball boyfriend who would not use contraception and is now in borstal.

I signed.

I am told by the authorities, whoever they are, that I should never, save in an emergency, examine a child under sixteen without a parent or close relative present. Seems reasonable to me, and that is my practice. There is one exception. If a child under sixteen wants a termination, and feels she cannot tell her parents, then I am supposed to arrange it for her.

Talk me through that!

I think a lot about some of the views expressed on this blog. I started blogging just three short weeks ago. For a bit of fun, to relieve stress, to massage my ego, to… I don’t know, really…why do people blog? Is it therapy? Is it showing off? I suspect it is a bit of all that. But whatever it is, it suddenly puts you in touch with a lot of decent people around the world, decent people who often have different views.

I have never specifically expressed a view on abortion, in a way because I did not want to attract hundreds of rabid emails, but anyone reading through what I have written will, rightly, have gathered the impression that, strongly as I feel against doctor-assisted euthanasia and the death penalty, I have not been too troubled by abortion.

And then you read some of the views on Moof’s blog, and you read the debate on Chris Rangel, and you have to think a bit more, you have to re-examine things.

I asked for some of the medical or paramedical people involved in “lethal injections” to get in touch and make sure they had a copy of the Hippocratic Oath with them when they did. A heartfelt remark, I might say, but a bit pompous. Have a look at some of the comments from ARF in The Death Penalty and "Lethal Injections

When I signed that green form last week, should I have dusted off my Hippocratic oath?

My problem now is this. I have been thinking hard about my reaction to lethal injections and doctor-assisted euthanasia. It is easy. A gut reaction. The underlying morality is more difficult.

Sanctity of life is not a moral absolute for me. I would have had to fight Hitler, I would fight to try to prevent a holocaust. I would fight in self-defence of my family.

I also believe that it is a woman’s right to control her own body. I suspect that I will continue to sign these wretched abortion forms much as I hate them. Should I start enquiring into the woman’s reasons for requesting an abortion, and refuse to sanction ones that I do not like? The cleft-palate? The “wrong sex” baby? I’m damned if I will sign one of those, and yet as soon as I move into the woman’s personal moral territory, where do I stop? I would just be imposing my flawed morality on her flawed morality, and who is to say mine is the better?

There is a lot of cod philosophy around and I am not a philosopher nor a professional ethicist. It is commonplace for people, at the dinner party or whatever, to say, “Oh not that old chestnut again.”

Trouble is, out at the coal-face of medicine, these “old chestnuts” keep cropping up. Why do I not have gut reaction against abortion?

I am struggling to find a consistent moral framework that rejects capital punishment, rejects doctor-assisted euthanasia and yet can encompass abortion.

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