ethics of TOP Flashcards
define abortion
an abortion is the medical process of ending a pregnancy so it doesn’t result in the birth of a baby
how many women will have an abortion in their life?
1 in 3
what is happening to abortion rate in developing countries and why
decreasing due to improved access to contraception
what % of TOPs were done before 13w
92
what age had the highest TOP rate
22
what % were done on grounds of disability?
2
abortion rules in India
: abortion is permitted on the basis of consent of the women. Opinion of one HCP – needed for abortion under 12 weeks, opinion of two HCPs needed for 12-24 weeks. Limit for abortion increased from 20-24 in 2020, which also included other liberalising provisions. Estimated 15.6 million of abortions annualy (2015 estimate). While abortion is legal, access to safe abortion is a problem. Unsafe abortion is the third largest cause of maternal mortality leading to death of 10 women each day and thousands more facing morbidities.
law in england and wales
ToP is a crime under the Offenses Against the Person Act 1861
The Abortion Act 1967 created an exception, making ToP lawful if it is carried out on licenced premises and under specific conditions
If a ToP is carried out on an unlicensed premise and/or outwith the specific conditions described in the Abortion Act 1967 it is unlawful and is punishable by a (maximum sentence) of life imprisonment.
basic principles of the Abortion Act 1967
TOPs must be notified to CMO and statistical data are recorded/analysed
There have been a few amendments to the Act (e.g. Human Embryology and Fertilisation Act 1990) and the main changes have been to gestational stages at which TOPs can be performed
The 50th ‘anniversary’ of Act led to widespread calls for reforms. Some people argued for more restrictions and/or harsher penalties; others argued for fewer restrictions and/or decriminalization
The interpretation of the statute has prompted significant case law, including the decision by the DPP not to prosecute where a ToP was allegedly performed on the basis of the sex of the foetus.
legal criteria for a lawful TOP
Approved by two doctors (save in emergencies)
Performed by registered doctor and carried out on an approved site
ToP is justified (<24 weeks) on the grounds that:
the continuance of the pregnancy would involve risk, greater than if the pregnancy was terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
ToP is justified (with no time limits) on the grounds that:
there is a risk to the life of the pregnant woman, greater than if the pregnancy were terminated
the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
proposed legislative changes
The following changes have been proposed:-
Removal of the medical criteria for pre-13 week ToP, including the requirement for 2 medical practitioners
Wider range of healthcare professionals performing ToP
Reduction in statutory time limit
Introduction of a ‘cooling off’ period for women who want a ToP
Requirement for ‘independent counselling’ of women seeking a ToP
Greater clarity for the interpretation of the criteria e.g. in relation to disability and to the impact on mental health
Decriminalisation (i.e. repeal of section 58 and 59 of the 1861 Act (which make ToP outside the
exceptions in the 1961 Act a crime punishable by life imprisonment)
ley cases on abortion
R v Bourne [1939] - doctors must perform abortion ‘in good faith’
Royal College of Nursing v DHSS [1981] - nurses have a right of conscientious objection
Paton v BPAS [1979] - husband failed to stop wife’s TOP
Janaway v Salford AHA [1989] - secretary under s 4(1)
Attorney General v X [1992] - allowing 14 yr old rape victim to travel from Ireland to UK for ToP
C v S [1988] applied Paton v BPAS - boyfriend failed to stop TOP
describe the Jepson case
Rev Joanna Jepson sought judicial review of decision by police not to prosecute doctors in West Mercia who had conducted a ToP using s 1(1)(d) criteria for a cleft lip and palate
The court referred the case back to CPS to reconsider
In March 2005, CPS decided not to prosecute clinicians involved in the ToP
describe the Sarah Catt case
Sarah Catt self administered medication purchased over the internet at 38 weeks gestation.
She was charged with administering poison with intent to induce a miscarriage
She pleaded guilty in 2014 and was sentenced to eight years in prison (which was reduced to three and a half years on appeal)
The case reiterates that a ToP that is not authorised under the Abortion Act 1967 is unlawful.
ethical considerations for TOPs
Concept of personhood
- Are fetuses human beings that deserve recognitions of moral/social/legal value and our moral considerations?
- Diversity in terms of approach, culture, religious traditions
Reproduction autonomy & rights
Pro-life arguments
- Human life begins at conception; abortion is tantamount to murder.
- Unless the woman’s life is in danger, a woman has the duty not to kill an unborn baby
Pro-Choice arguments
- The fetus is not a “human” until born.
- Women do not have obligation to be pregnant against their will.
- Women have the right to choose to control what happens to their bodies and end their pregnancy
