Doctors who perform abortions for social reasons are social technicians

EDITOR,—Richard L Berkowitz's editorial on multifetal pregnancy reduction describes a phenomenon that has been in evidence since abortion began but that has received little attention.1 Referring to reduction abortion procedures that are performed for social reasons, Berkowitz uncovers something at the heart of the debate on abortion.

Social abortions have nothing to do with the prevention, healing, or palliation of diseases. They have little in common with medicine or surgery except in so far as medical or surgical techniques are used as a means to some socially desirable goal. The requirement of evidenced based medicine that the procedure is therapeutic and not harmful is ignored.2

“Psychological stress” may be what Berkowitz cites as a reason for performing an abortion, but the practitioner is obliged to prove that abortion will be psychologically therapeutic to the woman in the long term, not merely a temporary relief of stress. Despite the enormous numbers of abortions carried out in the world each year, abortion is the most underresearched intervention. Most abortions in Britain are carried out under the clause in the Abortion Act relating to mental health,3 yet almost all abortions are performed by gynaecologists who have little or no training in psychiatry. The Canadian Psychiatric Association stated in 1981, “Justification of a decision to terminate a pregnancy under pseudo-psychiatric rubrics is to be deplored.”4

The original principle in medicine—healing—has been replaced here by that of manipulation. The profession should recognise this because the implications are enormous, economically as well as ethically. Such a commitment to making people temporarily happier without evidence of long term therapeutic benefit is not what medicine is for. Doctors who continue to carry out and recommend abortions for social reasons are not exercising professional judgment. They are social technicians and should be regarded as such.

It is right that these issues be discussed just now. This year marks the 50th anniversary of the Nuremberg tribunals. Little attention has been paid to this, presumably because of embarrassment at how the profession has lost sight of the ideals that were evoked at that time. The BMA council's own statement of principles included “The duty of curing, the greatest crime being co-operation in the destruction of life by murder, suicide and abortion.”5