Bow Group Research Fellow Dr. Jon Stanley responds to BBC News' article on Marie Stopes abortion services
There are moments in history where laws are passed that are seen as progressive and at the same time so perfect they are deemed beyond criticism and review.
We saw this in 2013 with the phasing out of the Liverpool Care Act. It was a project that filled many people in Liverpool with pride, and I worked with many of the professionals who first introduced it. It was developed because of an established sense of need; that something had to be done, that it would not be a slippery slope to euthanasia on demand, and that the health of the patient and their dignity came first.
Barely ten years went by and, without extensive review, driven by a relief and belief we the medics had sorted out an age old problem, the Liverpool Care Pathway (LCP) went off rail. I used it myself, many, many times. I was for my part clear what it was and why it was done. I saw aspects of it performed badly but then again no worse than many aspects of nursing and medicine.
It was found that it was not used appropriately all of the time, that hospitals were paid money for hitting their targets to deliver LCP, with the obvious result that the money now came first. Was any of this evil by intent? Were medics cackling and winking to the nurses that we’d found euthanasia legal by the back door and we could get on with relieving suffering by ending life? No, it was far worse than that.
Real evil emerges in clinical practice when checks and balances are not in place, where cultural drift becomes casual in its regard for life, where targets and terror compete with compassion, and where a don’t-ask-don’t-tell culture develops. If you can believe evil can simply be an absence of good it isn’t hard to work out why it went wrong.
The Abortion Act is 50 years old. In this time legal abortion has somehow morphed from a necessary evil to prevent catastrophic backstreet abortion to a perceived right for all women as a backstop for being unable to control their fertility ex ante.
It was introduced barely 5 years after contraceptive pills became available, when single motherhood was impossible and when sex education was risible. This is not where we are now, and the law we have should reflect society as it is, not as it was or how a vocal minority of activists wish to perceive it.
There is of course no legal right to an abortion in the UK. That this is not understood is worrying. The medical profession, mine, is almost entirely to blame in failing to self-regulate and the establishment of a rights culture prevents robust interrogation of this drift in practice.
Counselling ought to be provided to pregnant women. It is not and there is no duty in law to do so, certainly no duty for it to be independent of the abortionist.
98% of abortions in the UK are to "preserve the mental health of the mother". No mental health act, mental capacity act or record is kept of the woman's mental health so it is impossible to assess the impact on women's mental health prospectively. All studies on this have been published are retrospective.
There is no follow-up for women who may be presenting to an abortionist as the index healthcare worker for their mental illness: the blonde 25-year old who flirts at the office, has slept with half the office, has a reputation for being a party girl, was of course an undiagnosed bipolar sufferer compounded by drug dependence, but of course why should that be a care worker’s business?
It's clear that the don’t-ask-don’t-tell method of just assuming mental health issues as an excuse to blank cheque abortion forms leads to missing life changing diagnoses.
The profession is brought into disrepute by contrived declarations of mental health disorders that would not stand in a court of law and the fact doctors can and do pre-sign abortion forms for convenience only confirms this.
Alongside counselling there is no advocacy for prospective mothers. Why are they struggling to try a pregnancy? Is this simply a means of delaying maturity? Life is hard, children are an inconvenience and a joy at the same time. Are we confusing maternal anxiety for mental health disorders?
We must consider now to mandatory counselling, a cooling off period before an abortion, 24 hour notice to a psychiatrist if mental health disorders are suspected if a GP is unavailable, and removing all UK funding for abortions unless a diagnosis is made and abortion is part of a comprehensive plan to treat that mental health.
In all cases mental health follow up should be called for and prospective data gathered into what we are providing abortions on the NHS for.
There is to my knowledge, no other area of healthcare that would be funded on this deliberate lack of evidence. After 50 years, there is no excuse for not having a data set on which to base our funding and therapy.
In cardiothoracic surgery all manner of data is available. Complication rates, deaths rates, angina free years since surgery can be gained too. It is shocking there is no such data published for abortionists.
The best we have is a flawed but industrious attempt at meta-analysis by researchers that shows high rates of mental illness, drug use, alcohol misuse and post-traumatic stress following abortion.
There is evidence that is so often pointed out that these are not caused by abortion but by the underlying health of the women and the shock of being pregnant. This is not unreasonable but begs the question why a robust network of care is not in place for them.
Crucially there is as far as I can find, no evidence that having an abortion solves any medical problem for almost 98% of those carried out. The one positive outcome, and the one the Act intended for, is that unsafe abortions outside a regulatory framework have been banished from public life.
This is a very poor set of affairs. How can £120m of public money be spent on something with almost no measurable health outcomes, in a structure that would not be allowed to operate in any other area of clinical care?
Clinicians and feminists have both let women down and very badly for the sake of making abortion an issue of rights and entitlement, and not one of essential medical care on the basis that we must first do no harm. Sometimes we do make laws that are right for a season. They may deliberately or unfortunately be ambiguous in their scope and wording and we should as conservatives be prepared to interrogate such legislation, to review its effects and legacy, and tidy up accordingly.
There is no case for which evidence is available that can support state funded abortion for which there is no objective indication under the Abortion Act. A review of practice would require no change of the Abortion Act per se but would lay down clear lines of responsibility, bring the approach to mental health into the modern world and provide objective counselling to women who are in a very vulnerable state and should be presumed vulnerable adults in hoe they are handled.
We reviewed and amended the worst aspects of the Liverpool Care Pathway within a decade. A review of abortion in Great Britain is long overdue.
Dr. Jon Stanley is Health Research Fellow at the Bow Group, a Junior Doctor and a Member of the Royal College of Surgeons