NHS hot topics Flashcards

Question

Each categorys ideal response time for ambulance

Answer 1

Category 1: An immediate response to a life-threatening condition, such as cardiac or respiratory arrest. The average response time should be under 7 minutes and 90% of ambulances should arrive within 15 minutes. Category 2: A serious condition, such as stroke or chest pain, which may require rapid assessment and/or urgent transport. The average response time should be under 18 minutes and 90% of ambulances should arrive within 40 minutes. Category 3: An urgent problem, such as an uncomplicated diabetic issue, which requires treatment and transport to an acute setting. 90% of ambulances should arrive within 2 hours. Category 4: A non-urgent problem, such as stable clinical cases, which requires transportation to a hospital ward or clinic. 90% of ambulances should arrive within 3 hours.

Answer 2

- As of April/May 2022, while Category 1 calls see an average response time of 8:36 minutes (only 1:36 mins above the target average wait) - Category 2 calls see an average wait of 40 minutes. This is far above the target average of 18 minutes - Category 3 calls, with the average response time of 2 hours 9 minutes. The target states that 90% of ambulances should have arrived within 2 hours

Answer 3

1. The ambulance service is seeing unprecedented levels of demand post-Covid. There were 860,000 calls to 999 made in England in April 2022, up 20% on the previous April. 2. Post-2010 cuts to community services have resulted in greater pressures on the emergency services, as people previously treated in the community are entering the health system later and therefore with more acute issues. 3.Shortage of paramedics. The GMB union has found that 1,000 ambulance workers have left the service since 2018 to seek a ‘better work-life balance’. 4.A&E waiting times. Emergency departments have become overcrowded, and this slows down ambulance crews. Ambulances are having to wait with patients until space in the emergency department becomes available. This slows their ability to respond to other call requests.

Answer 4

has allocated £150 million to specifically address ambulance waiting times and has given NHS workers a 3% pay rise in order to incentivise retention. For context, the £150 million figure represents 0.1% of the overall NHS budget of around £150 billion.

Answer 5

There are currently 3.2 million people over the age of 80 living in the UK, and this number is expected to reach nearly 8 million by 2050. By this point, 25% of the population will be over 65. Although a longer life expectancy is a positive effect of good healthcare (and is therefore a trend commonly seen in more economically developed countries), an ageing population also increases the burden on healthcare systems.

Answer 6

Increased Life Expectancy: Advances in healthcare, medicine, and overall living condition Declining Birth Rates: The birth rate in the UK has been decreasing Improved Quality of Life: Improved socio-economic conditions and quality of life have led to individuals having fewer children and focusing on career and personal development, contributing to lower birth rates. Changes in Family Structure: Changes in family dynamics, such as delayed marriage and childbearing, have contributed to a decrease Economic Factors: Economic factors, such as the cost of raising children, housing expenses,

Answer 7

Increased Healthcare Costs: An aging population often requires more healthcare services, leading to higher healthcare costs for the government and individuals. Age-related illnesses and chronic conditions become more prevalent, placing a strain on healthcare systems. Economic Impact: An aging workforce may result in a decline in the overall labor force and productivity. This can impact economic growth as there are fewer people contributing actively to the workforce, potentially leading to a slowdown in economic development.

Answer 8

simultaneous use of multiple medicines by patients for various health conditions - ageing pop= more complex patients

Answer 9

The Charlie Gard case was a legal case of best interest, involving the paediatric patient Charlie Gard, who had a rare mitochondrial DNA depletion syndrome, meaning he had progressive brain damage and muscle failure. He was admitted to Great Ormond Street Hospital (GOSH) in London, where doctors determined that the condition had caused irreversible damage to his brain and organs.

Answer 10

- Charlie's parents sought permission to take him to the United States for an experimental treatment called nucleoside therapy, which was not available in the UK. - GOSH medical professionals argued that the experimental treatment would not benefit Charlie and could cause further suffering without a realistic chance of improvement. "futile and would only prolong Charlie’s suffering”.

Answer 11

- The hospital sought permission from the courts to withdraw life support and allow Charlie to die peacefully. This decision was based on medical assessments indicating that Charlie was in irreversible pain and suffering. - The case went through various levels of the UK legal system, including the High Court, the Court of Appeal, and the Supreme Court. - The courts sided with the medical professionals at GOSH, ruling that it was in Charlie's best interests to withdraw life support and allow him to pass away.

Answer 12

Charlie's parents appealed to the European Court of Human Rights, seeking permission to take him to the United States for treatment. The ECHR ultimately upheld the previous decisions of the UK courts, stating that further treatment would not offer a realistic chance of success and would prolong Charlie's suffering.

Answer 13

In July 2017, Charlie Gard's parents withdrew their legal challenge, acknowledging that his condition had deteriorated to a point where further treatment was not viable. Charlie Gard passed away on July 28, 2017, shortly after being moved to palliative care.

Answer 14

On 18th January 2011, six-year-old Jack Adcock had been feeling unwell – he was having difficulty breathing, as well as vomiting and diarrhoea. Jack had Down’s Syndrome and a known heart condition, and required long-term medication. He was admitted to the Children’s Assessment Unit (CAU) at Leicester Royal Infirmary following his GP’s referral. Jack’s condition deteriorated that day and he passed away. Junior Doctor Hadiza Bawa-Garba, a paediatric registrar in year six of her speciality training (ST6). Dr Bawa-Garba was taken to High Court and on 4th November 2015 was found guilty of manslaughter on the grounds of gross negligence.

Answer 15

Dr Bawa-Garba ordered a chest X-ray that showed an infection. The X-ray results were available from 12:30, but didn’t get seen until 3pm. Then prescribed antibiotics, which were administered at 4pm. Prescribing antibiotics earlier could potentially have led to a different outcome, but the ward was understaffed and Dr Bawa-Garba was extremely busy. Furthermore, she had not been made aware that the X-ray was available at 12:30. A blood test revealed high levels of C-Reactive Protein (CRP), which occurs due to infection and inflammation. This was reported over five hours late, due to failings in the hospital computer system. she stopped the medication for his heart condition. However, she did not document this in his notes, and subsequently, this medication was administered to Jack at 7pm by his mother. Jack’s mother was unaware that he was not to be following his usual course of treatment for his heart condition. Jack suffered a cardiac arrest at 8pm. Dr Bawa-Garba was one of the Doctors who attended the call and arrived when resuscitation was already taking place. Dr Bawa-Garba mistook Jack for another patient, whose notes were marked as DNAR (do not attempt resuscitation), and therefore Dr Bawa-Garba called off resuscitation. Resuscitation was re-continued shortly after the mistake was identified. Jack died at 9:20pm.

Answer 16

- Dr Bawa-Garba was carrying out the work of two Doctors and the hospital was extremely understaffed. - Senior consultants were not on-site and therefore Dr Bawa-Garba had no one to report to. There were not enough senior nurses on the ward, either. - The failings of the hospital computer system prolonged blood testing results. There was also no system in place to notify Dr Bawa-Garba that the X-ray was ready for analysis. -Nurses did not notify Dr Bawa-Garba that Jack was deteriorating. -The administration of medication for Jack’s heart condition was not carried out by Dr Bawa-Garba.

Answer 17

- Dr Bawa-Garba was taken to High Court and on 4th November 2015 was found guilty of manslaughter on the grounds of gross negligence. - This Court ruling resulted in Dr Bawa-Garba being suspended from 12 months from the GMC register. The GMC applied to have her permanently struck off the medical register. However, the Medical Practitioners Tribunal Services (MPTS) refused this application, stating “erasure would be disproportionate”. - January 2018. The GMC appealed against the MPTS decision in the High Court. The appeal was successful and resulted in Dr Bawa-Garba being struck off the GMC medical register -Crowdfunding. Following public outrage from Doctors

Answer 18

- given to medically stable patients who still require additional support and attention - used between transition between hospital and home

Answer 19

- patients discharged earlier the should - safeguarding risk to elderly -bed blocking - patients risk of falls

Answer 20

shoukd be 4 times

Answer 21

vacancies Lack of GP mean less emergencies come in Covid- resulted in more complex needs weather Bed Blocking

Answer 22

- use of technology to monitor disease progression - educate patients about alarming symptoms and when to seek medical help - increase NHS taskforce

Answer 23

-- responsible to treat illness and to educate patients on prevention - educate patients bout preventable causes of disease - collaboration with organisations to promote healthy disease

Answer 24

failure to take proper care missing vital symptom - negative impact on prognosis and disease

Answer 25

improper or illegal professional behaviour

Answer 26

The UK officially left the EU on 31st January 2020, with a transition period until 31st December 2020.

Answer 27

Leave campaign swayed the public’s opinion was by claiming (incorrectly) that leaving the EU would free up £350m per week to be spent on the NHS.

Answer 28

there is no guaranteed extra money from leaving the EU, as it is expected that costs associated with leaving will outweigh those that are being saved.

Answer 29

Stricter immigration laws, such as the new ‘settled status’ for EU citizens, may slow the UK’s population growth, and Leave campaigners in the referendum argued that the fewer people who are eligible to access NHS services, the greater the government spend per capita.

Answer 30

staffing crisis stockpiling medicine scientific research Student fees

Answer 31

-NMC show almost 5,000 nurses and midwives from EU countries left the NHS from 2017-2019, with many identifying Brexit as the reason - the number of nurses from the European Economic Area joining the Nursing and Midwifery Council register has fallen more than 90%.

Answer 32

- Harsher immigration laws being implemented. - The value of sterling and UK salaries decreasing. - The ‘seven-day NHS’ initiative deterring EU staff from signing up for longer hours

Answer 33

- in anticipation of Brexit negotiation deals, the UK built a stockpile of drugs and medical supplies but these were used up during the coronavirus pandemic. - rebuilding stockpiles could become an issue during the post-transition period, when we saw border disruptions and delays - driver shortages = deliveries to pharmacies reduced

Answer 34

- international scientists may choose to not work in the UK as the visa costs would make it a more expensive place to work - EU-UK trade deal stated that the UK can apply for top-tier membership of the forthcoming EU Horizon research initiative, but it will not be given access to funding for new technology projects. - British scientists were being removed from EU grant applications by European colleagues

Answer 35

2007 and 2013, the UK contributed €5.4bn to the EU science budget but received over €8.8bn –that’s a €3.4bn EU-sourced surplus

Answer 36

- EU/EEA students applying to study at UK universities were eligible for the same loans and grants as home students. In the future, students coming from the EU/EEA will be subject to the higher international tuition fees. - it’s likely students from the UK will no longer benefit from the cheap or even free tuition available at many universities across the EU to EU/EEA nationals.

Answer 37

the contract of employment for all NHS Junior Doctors, outlining pay scales and other details. The government tried to update the contract for 2016

Answer 38

in 2016 Overhauling the system of pay and hours for Junior Doctors. Protecting Junior Doctors from any unfair consequences that could come from whistleblowing. Designating a member of staff for each hospital to ensure that Junior Doctors are working rotas that are manageable and safe for patients.

Answer 39

sparked a dispute between the government and the BMA, resulting in Junior Doctor strikes.

Answer 40

began in 2013 when the Department of Health shared its proposals. It said that the updates would make pay fairer and wanted to spread emergency and elective services across seven days a week – but Junior Doctors felt the contract was risking patient safety and was unfair to them.

Answer 41

Junior Doctors were paid a standard rate for shifts where the hours fell between 7am and 7pm on Mondays to Fridays. If a FY1 Doctor worked these standard hours, they would have earned a basic salary of £22,862. This basic salary would go up as the Doctor progressed through their training and their time served increased. Junior Doctors are also required to do on-call shifts outside of sociable hours. This earned an extra supplement known as banding, which could add an additional 40-50% to their basic salary.

Answer 42

increased basic salary but drastically reduced the supplements for on-call shifts outside of sociable hours – effectively meaning they were being paid less.

Answer 43

the contract would increase stress, tiredness and burnout among their peers, and that patient care would suffer as a result. The new rotas were designed for a seven-day NHS, but did not account for additional staff. The increase in antisocial hours was also not reflected in an increase in pay. if a Doctor trained in one specialty, and later decided to retrain in another, the salary gained through their first specialty experience wouldn't be protected -> discouraging changing specialties Pay progression during maternity and academic research leave would be halted

Answer 44

- Explain why Junior Doctors might experience stress - Discuss the many different types of stress- working antisocial hours, dealing with psychologically and mentally challenging situations, balancing career with personal life, studying for postgraduate exams - Demonstrate how you’ve arrived at your example - Talk about how you’ve seen or read about Doctors dealing with these stressful work situations, such as creating job lists, delegating tasks to different team members, and asking for help when they recognise a problem out of their expertise. - Consider how Doctors relax outside of the work - Acknowledge how important it is to talk about stressful situations

Answer 45

In November 2015, 98% of Junior Doctors voted to reject the contract, and in favour of industrial action. four Junior Doctor strikes between January and March the following year. Each of the four strikes lasted 24-48 hours on 12 January; 10 February; 9-10 March; and 26-27 April.

Answer 46

During the 12 weeks of the study, there were 3.4 million admissions, 27 million outpatient appointments, and 3.4 million A&E attendances. Compared with the weeks preceding and following the strikes, there were over 9 percent (31,651) fewer admissions, nearly 7 percent (23,895) fewer A&E attendances, and 6 percent (173,462) fewer outpatient appointments than expected. April’s strike had the largest impact on services: there were over 15 percent (18,194) fewer admissions, including nearly 8 per cent (3383) fewer emergency admissions, and almost 20 percent fewer planned admissions. Hospitals scheduled 11 percent (109,915) fewer outpatient appointments during this strike, while patients kept 134,711 (just over 17%) fewer of them. The number of outpatient appointments cancelled by hospitals also rose by almost 67 percent (43,823). During all four strikes, hospitals cancelled nearly 300,000 outpatient appointments–52 percent higher than the volume expected for this period–possibly to protect more critical services, suggest the researchers.

Answer 47

The junior doctor strikes began this year (2023) and, following a recent announcement from the BMA, are due to continue into 2024. We have had 19 days of junior doctor strike action so far this year. Currently, the next strike dates are as follows: 20-21-22 December 3-4-5-6-7-8 January Both periods of industrial action involve a “full walkout”, meaning that as well as doctors not attending their scheduled shifts, there will also be no emergency cover. The January strike period of 216 hours is the longest strike in NHS history.

Answer 48

Fewer doctors present in A&E, meaning longer emergency wait times which can endanger patient safety. Cancellation of clinic appointments and theatre lists due to understaffing. Fewer doctors on the wards, meaning increased stress levels and possible errors (such as medication errors). Deterioration of the doctor-patient relationship.

Answer 49

An increase in doctor salary will mean doctors are less stressed and overwhelmed, leading to better patient care. Improved working conditions will reduce emotional and physical pressure on medical professionals, leading to better patient outcomes.

Answer 50

Doctors should follow the ethical principle of non-maleficence (do no harm), which is not followed when understaffing is a result of strike action. Strike action affects the doctor-patient relationship as well as public perception of the profession. Beneficence, or “doing good”, is not honoured by strike action as it is not morally good to delay a patient’s treatments/procedures when this is avoidable. Strike action has cost the NHS over £1bn since the start of the year, which is money that could have been used for medical equipment. The strikes are putting extra stress/pressure on the other members of the multidisciplinary team.

Answer 51

Doctors are human beings, and while they do a vocational job, this doesn’t mean they should accept poor working conditions. Better pay and working conditions will improve the quality of life of doctors, making them better clinicians. The literature shows that the mortality of patients either remains at the same level or decreases during strike action. While some would argue that full walkouts are negligent, industrial action must be impactful to be effective. UK doctors are leaving the NHS to work abroad for better conditions. If we continue to lose doctors at this rate, the understaffing crisis will get significantly worse meaning a much lower quality of care for patients.

Answer 52

The industrial action of the past year has cost the NHS over £1.5bn. The main reason for this is that the NHS is paying consultants to cover the shifts of junior doctors on strike days, which costs significantly more than paying the junior doctors to do their own jobs.

Answer 53

PrEP (pre-exposure prophylaxis) is a drug taken by HIV-negative people before sexual contact, usually with an HIV-positive person. ‘Pre’ – means taken before the ‘exposure’, which is HIV in this case. ‘Prophylaxis’ – something that is done to help prevent a disease, which in this case is taking a tablet. PrEP tablets contain tenofovir and emtricitabine which are medications commonly used to treat HIV. HIV can be transmitted through sexual as well as bloodborne contact.

Answer 54

if an HIV-negative person has sexual contact with an HIV-positive partner, providing they are taking HIV medication and have an undetectable viral load. If viral load is undetectable, HIV cannot be transmitted.

Answer 55

Regularly: one tablet per day. On-demand or ‘event-based dosing’: two tablets are taken 2 to 24 hours before sex, followed by one tablet 24 hours after sex and another tablet 48 hours after sex.

Answer 56

When taken correctly and daily, PrEP is more than 99% effective at stopping HIV infection. This reduces to 96% for those who take four tablets a week, and 76% for those who take two tablets a week. Criteria vary between countries, but generally, PrEP should be taken by an HIV-negative person who has an HIV-positive partner with a detectable viral load and sex without a condom is anticipated.

Answer 57

Sexual health clinics in Scotland and Wales provide anyone at risk of HIV with free PrEP. In England, PrEP was initially made available to 10,000 people as part of the two-year IMPACT trial. This trial ended in July 2020, and the drug was officially rolled out to England later that year. There is also currently a PrEP trial in Northern Ireland.

Answer 58

PrEP is effective at helping HIV-negative people to maintain their HIV-negative status PrEP has no side effects for the vast majority of people. PrEP is freely available in Scotland and Wales, and England followed suit in late 2020. PrEP allows people to have sex without using condoms without the risk of getting infected with HIV when one person is HIV-positive.

Answer 59

PrEP can have serious side effects on kidney function and bone health, making it unsuitable for some people who have existing bone or kidney conditions. Regular testing for those on PrEP (HIV status and kidney function tests). Real-world adherence is not perfect – therefore in reality, PrEP will not be as effective as the theoretical numbers concerns that PrEP may deprive HIV-positive people of the drugs that they need due to competition for the drugs which are also treatments for HIV-positive people. PrEP may lead to a greater rate of other sexually transmitted infections (STIs) due to misconceptions that it protects against STIs as well as HIV. PrEP may promote drug-resistant HIV if people take PrEP without knowing they are HIV-positive or become HIV-positive when they are on a break from taking PrEP.

Answer 60

Unequal representation amongst board members. Recruitment problems. - Lack of diverse representation at a senior level produces barriers for BAME staff Less likely to be supported Likelier discrimination

Answer 61

19.7% of the NHS workforce is made up of BAME groups just 8.4% of board members are from a BAME background.

Answer 62

15% of BAME staff reported experiences of discrimination from 2019 to 2020 compared to 6.6% of white staff.

Answer 63

The NHS People Plan has action points to increase BAME representation across the workforce, including at senior level – this should make the NHS more reflective of the patient population that it serves. Structural racism and unconscious biases still need to be addressed in order for equality to be truly achieved. The NHS is striving to engage further with staff and staff networks so that BAME staff can be heard and share their lived experience, and offer action points they feel need to be taken. Steps towards establishing a stronger network have been introduced in the form of webinars

Answer 64

- Death during childbirth. Black women are five times likelier than white women to die in childbirth. Women of mixed ethnicity are also three times likelier to die and Asian woman are two times more likely. - Detrimental health outcomes. The Marmot Report states that detrimental health outcomes associated with some ethnic groups are associated with their socio-economic, and sometimes economic, status. Save 20% on Interview Prep

Answer 65

Disproportionate mortality and morbidity. In the first month of the pandemic, 95% of NHS Doctors who died of COVID-19 were from BAME backgrounds. The disproportionate death rate in BAME staff is only partially explained by health conditions, age and socio-demographic factors.

Answer 66

Artificial Intelligence (AI) is “the ability of a computer or other machine to perform actions thought to require intelligence.” for a computer being able to make decisions. The way in which ‘it’ does this, how it gathers data, interprets and produces an output, is brought about in different ways. Many systems we use today have technology supported by AI infrastructures, which often go unnoticed. Amazon’s Alexa is an example. The computer recognises spoken word and can respond. AI is beginning to be used in Medicine and has many potential applications.

Answer 67

Medical Diagnosis- designed to accurately diagnose disease from medical imaging scans and microscope slides. Radiotherapy = an AI framework has been developed to use a patient’s CT scans and electronic health records to create a specific individualised dose. Virtual Nursing= Virtual nurses are robots designed to monitor health Robotic Surgery- Robots have been developed which are able to carry out routine operations. Recent research has shown that these surgeries can have up to a five-fold reduction in surgical complications. This, partnered with the decrease in staff required and time saved, could be a promising investment for the future. Information Services- The NHS is working with Amazon’s Alexa to offer health information by voice search.

Answer 68

Cancers and other diseases can be detected at earlier stages, offering better long-term outcomes. AI is also being used to assist in screening processes. This includes in IVF, to determine how likely a fertilised embryo is to result in a successful pregnancy.

Answer 69

Wearable devices offering advice and guidance to patients in their own homes, as well as reminding people to take their medications on time. There is a wearable device, called Current, which measures a patient’s pulse, temperature, respiration and oxygen saturation, giving doctors regular updates on their patient’s health, and can be used both in hospitals and at home. Researchers have also developed a way of incorporating AI into smartwatches to detect hypertrophic cardiomyopathy, which is often not picked up.

Answer 70

By integrating the NHS website content directly into Alexa’s core knowledge base, it is able to reach a far wider user base as users do not need to enable this skill in advance. The aim is to reduce demand on Doctors and particularly benefit elderly people, blind people and people who cannot easily search for health advice on the internet. Some people are concerned about how any confidential data relating to patient queries will be stored, but Amazon has confirmed all data will be kept confidential and encrypted.

Answer 71

A great deal of diagnosis is about recognising patterns. For example, radiologists will look at X-ray images to spot potential disease. However, if we spot subtler patterns earlier, perhaps the disease could be diagnosed at an earlier stage. This is where AI comes in – computers can be programmed to read data. Using algorithms, very subtle changes can be detected, either as the precursor of a disease or before it has propagated.

Answer 72

the medical process of ending a human pregnancy so it doesn’t culminate in the birth of a baby. A pregnancy can be terminated by taking medications or having a surgical procedure.

Answer 73

Under the 1967 Abortion Act, abortion is legal in England, Wales and Scotland up to 24 weeks of the pregnancy in most cases. An abortion may only legally be carried out if two Doctors agree that continuation of the persons pregnancy will negatively impact their physical or mental health, or that of their existing children. An abortion is legal after 24 weeks if the persons life is at risk due to the pregnancy, the child will be born with a severe disability or there is a risk of grave physical and mental injury to the person – although this is generally safer if carried out earlier in the pregnancy.

Answer 74

There are two main types of abortion – surgical abortion and medical abortion (using pills)

Answer 75

nvolves an operation to remove the pregnancy from the womb. In cases up to 14 weeks of pregnancy, vacuum or suction aspiration can be used. In cases after 14 weeks, dilatation and evacuation can be used.

Answer 76

If a person chooses to end their pregnancy within 10-weeks of gestation and have a medical abortion, they have to take two pills 24 to 48 hours apart. The first pill is mifepristone, which works to inhibit progesterone (the hormone that maintains pregnancy) and must be taken at a clinic. The second pill is misoprostol, which induces contractions in the womb to pass the pregnancy and can now be taken at home or at a clinic.

Answer 77

In August 2018, the government announced that women in England would be allowed to take the second early abortion pill at home. This came into effect on 27th December 2018 and has brought England in line with Scotland and Wales. Women are still able to choose to take the second pill in the clinic if they want, but this change prevents the risk of women miscarrying on their journey home, which was previously quite a common, painful and traumatic experience. Legalising use of the second pill, misoprostol, at home has been well received by gynaecologists, with the president of the Royal College of Obstetricians and Gynaecologists (RCOG) describing this as a compassionate measure which symbolises “a major step forward for women’s healthcare”, as it prevents the distress and embarrassment of pain and bleeding during their journey home from taking their second pill.

Answer 78

Human life begins at the point of conception. Therefore, abortion is tantamount to murder as it is the destruction of a human life. Instead of carrying out an abortion and taking an innocent human life, the child can be adopted if the parents are not able to cope with looking after them. Some woman may be pregnant as a result of rape or incest. The unborn child is innocent and should not be punished for this crime through an abortion. An abortion can cause psychological distress for the woman. All children have great potential and a woman could possibly decide to abort a foetus that may have been extremely important to society or to the world.

Answer 79

Almost all abortions are carried out in the first three months of the pregnancy, at which time the foetus cannot exist independently outside of the mother’s womb. Therefore it cannot be regarded as a living organism, and abortion is arguably not murder. Fertilised eggs which are used for in vitro fertilisation (IVF) are often thrown away or destroyed if not implanted and some would argue that these fertilised eggs are human lives – but destroying them is not considered as murder. In the case of rape or incest, forcing a woman to have the child is likely to be more psychologically damaging to her than having an abortion. Keeping abortion legal will prevent deaths and complications from unsafe backstreet abortions that are carried out in secrecy. An abortion may be necessary to save the woman’s life in certain cases and thus this option should be taken where necessary, rather than risking the mother’s life.