Thursday 1 July 2010

It's true - truth is stranger than fiction

On Friday I was asked to respond to the publication of a report on fetal  awareness produced by the Royal College of Obstetricians and Gynaecologists. I welcome the conclusions that scientific evidence does not support any revision of the time limit on abortion. In almost every Parliament the current 24 week time limit is challenged. Legislative challenge is normally spearheaded by those who would see abortion outlawed altogether - some of whom would even want to see contraception restricted - but have given up all pretence they can ever get it banned. This tactic of attacking the outer margins of abortion (only 1.6% of all abortion takes place after 20 weeks) is aimed at creating generalised anxiety about abortion amongst ordinary people who are, largely, supportive of safe legal abortion provision.

So where does this anxiety come from? Most of the arguments about abortion time limits have focused on the issue of viability and the question ‘at what point in pregnancy could this fetus survive outside of the womb?’. This may seem like a neat formulation for deciding on abortion time limits, but it is imperfect. Viability is not a fixed concept because survival rates of extremely premature neo-nates will vary widely around the world (even around the country) depending on the skills, resources, equipment and experience of those providing them with care. I don’t think anyone would say that a fetus in Timbuktu  is morally less worthy, than one in Birmingham, and yet the chances of survival outside of the womb for babies born in one city are totally different to the other. 

Assuming we could pinpoint viability with any certainty what would it look like? Many extremely premature neonates survive birth but may never leave the hospital alive despite intensive and expert care. Some who leave the hospital may have a poor chance of long time survival or may suffer mild to serious developmental problems. This is not – as I’m sure some anti-abortion advocates will imply – a comment on the relative value of children with or without disabilities, it is merely an observation that viability is not a fixed measurable concept, but one that is open to interpretation and therefore not the gold standard criterion for deciding on abortion time limits some may wish it were. 

Even assuming it was, there is currently no scientific evidence for reducing the time limit on abortion. Despite the best efforts of paediatricians to support infant survival at earlier and earlier points in pregnancy, they seem to have hit a wall at around 24 weeks. At this point in pregnancy increasing numbers of premature babies are being kept alive successfully, but before this although rates of survival for hours or days are growing (reflecting vast investment of resources and expertise) even this level of intervention often ends in infant death.

This week, with the publication of the RCOG guidance, the argument on viability has been superceded by one about fetal pain and awareness. When asked to comment on the conclusion that new evidence about fetal awareness shows that the current time limit is appropriate, I was baffled. Fetal pain has often been used as an argument against abortion. Yet in all other areas of medicine, mismanagement of pain rather than the potential for pain per se would be considered the problem. A consultant wouldn’t refuse appropriate surgery to a patient on the basis that surgery hurts. They would ensure their patient was cared for properly, including – where appropriate – anaesthesia or pain medication.  Without wanting to be flippant, the human race would have rapidly diminished had we outlawed labour on the basis that it is painful. I am satisfied with the RCOG’s conclusions, and happy especially if it is reassuring to women who will go on to experience later abortion, but I am concerned that this is a red herring. Abortion does result in ending the life of a fetus and there is a legitimate argument to be had about whether that is ok or not. Moving from arguments about viability to arguments about fetal awareness or pain seem to me simply another disingenuous and desperate way to attack safe legal abortion 

This week, commenting on the RCOG guidance, a spokesperson for the Society for the Protection of the Unborn Child (SPUC) said he too felt that all this discussion of abortion time limits is a red herring because abortion is just wrong whenever it takes place. How refreshingly honest. Never mind the conclusions of the RCOG report, now SPUC and I are singing from the same hymn sheet (truth is stranger than fiction), and agreeing that the time limit is a red herring, maybe it’s time to call a halt to the incessant attacks on our current abortion law.


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