Decriminalisation of abortion
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1485 (Published 23 March 2017) Cite this as: BMJ 2017;356:j1485
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The contended issue of abortion is riddled with terminology that is contradictory, obsolete, ambiguous and misleading [1]. In an otherwise informative article about proposals for the decriminalisation of the safe decisions made by women to end unwanted pregnancy, it was disappointing that the BMJ eschewed crystal-clear language; regarding two recent prosecutions of vulnerable women who obtained pills to carry out abortions, these were described as “late-term” [2]. The obstetric phrase makes no sense here (excepting for its propaganda value) [3]: ‘Term’ is the period of gestation between 37 and 42 weeks, and ‘late’ is a value judgement. ‘Late-term’ can only refer to a delivery or comparison of induction of labour at, say, 41+ weeks compared to ‘early-term’ before 39 weeks [4]. If one woman expressed a wish for an abortion at 7 weeks but didn’t obtain it until 15 weeks, that might be considered ‘slow’, and certainly ‘later’ than needed. If another was only aware she was pregnant at 15 weeks, but made a settled decision and obtained an abortion by 16 weeks, that might be consider ‘prompt’. Gestation can, and should, simply be described as a length of time of pregnancy, whether in days, weeks or trimesters.
[1] Grimes DA, Stuart G. Abortion jabberwocky: the need for better terminology. Contraception 2010; 81:93-96
[2] Dyer C. Abortion decriminalisation. BMJ 2017;356:j1485
[3] Stein R. Slaying of George Tiller Focuses Attention on Late-Term Abortions Friday, June 5, 2009 http://www.washingtonpost.com/wp-dyn/content/article/2009/06/04/AR200906... (accessed 14 April 2017)
[4] Walker KF, Bugg GJ, Macpherson M, McCormick C, Grace N, Wildsmith C, Bradshaw L, Smith GCS, Thornton JG. Randomized Trial of Labor Induction in Women 35 Years of Age or Older N Engl J Med 2016; 374:813-822
Competing interests: No competing interests
Dyer produces a cogent account(1). However it is not sufficient merely to state that opponents to the decriminalisation of abortion have a particular religious affiliation or belong to anti-abortions groups. Indeed, as a profession it is not clear which arguments we can proffer to support the decriminalization of abortion. It is wholly inconsistent with medicine to suggest that the fetus or embryo is not alive. Anyone making such an assertion would have to invent a new physiological state. UK law indirectly implies the fetus is not alive. This however was and remains exclusively a political decision, made following a legislative process. It is not the result of medical evaluation. As a profession we cannot responsibly argue that the medicines which women use achieve extra-iatrogenic abortions are safe and the process is itself it without risk, when there is no such evidence. Indeed there is evidence to suggest that “abortion pills” carry with them significant potential for harm(2). Further the Offences of Against the Person’s Act 1861 which prohibits abortion also prohibits introduction of foreign bodies into the uterus with aim of procuring abortion(3). As a profession we cannot legitimately argue that such practices do not represent a significant hazard. Responsible governments throughout the world regulate and prohibit the use of agents and practices which hold the potential of causing significant harm. They are generally supported by medical bodies in this endeavour(4).
If medical evidence is adduced, in any consultation, on the decriminalization of abortion, as a profession, we cannot argue the fetus is not alive neither can we endorse the safety “abortion pills” or mechanical means described in the 1861 act. It is not clear how we can support this cause. The desire not to criminalise vulnerable and desperate women is laudable and worthwhile. However we cannot contort the truth and engage in post-truth medicine to achieve this objective.
(1)Dyer C. Decriminalisation of abortion. BMJ. 2017 Mar 23;356:j1485.
(2)I Nivedita K, Shanthini F. Is It Safe to Provide Abortion Pills over the Counter? A Study on Outcome Following Self-Medication with Abortion Pills. J Clin Diagn Res. 2015; 9:QC01-4.
(3)http://www.legislation.gov.uk/ukpga/Vict/24-25/100/crossheading/attempts...
(4)Wise J. Increase in reports of toxicity from fat burning supplement seen in UK. BMJ. 2014 Jun 23;348:g4188. doi
Competing interests: No competing interests
Madam, Sir,
Considerable numbers of people believe that the clump of cells in the uterus is no more that that. Considerable other believe that it is life from the moment of conception. There is no evidence to say when life truly starts, therefore should the default position be that to avoid harm to life we should not damage the cells from the earliest moment?
The clump of cells has no legal status until birth. This is truly odd given the efforts we make to create it, nurture it, avoid damage to it; unless it is inconvenient.
Being pregnant carries huge responsibility. Caring for the mother and baby is a huge responsibility. This action would allow us medical professionals to toggle our legal responsibilities off, simply because the mother decides that the pregnancy is inconvenient, right up to birth.
It is illogical to be spared the consequences of our actions as health professionals because of the decision of only half of the mother/baby pair.
Competing interests: No competing interests
Words to confuse and hurt, or words to help and heal ?
Professor Bewley is correct to ask for clearer terminology in the BMJ, an improvement that will cause other readers to rejoice . Perhaps Professor Bewley is ideally suited to judge what is “contradictory, obsolete, ambiguous and misleading” in your journal ?
After she and a few professorial colleagues labelled me and my homeopath colleagues as “bogus “ and practising “ naked quackery” (1) in your pages, I pointed out to her that such terminology made us unsuitable to be registered with the GMC, and that she had a clear professional duty to report us to the GMC, or to our employers. (2) None of us have been struck off the Register, so we must assume that, for charitable reasons, or a lack of evidence, she chose not to fulfil her professional duty to report us.
Readers may wonder if this historical allusion is relevant today, when we are surrounded by examples of double standards and hypocrisy in public and professional life.
We should acknowledge that the BMJ has lately reminded us, how destructive and dangerous, to ourselves and to patient care, is the tendency of medical professionals to be rude and dismissive to colleagues. (3, 4)
Public discussion about homeopathy in the UK is notable for the misinformed views,or ignorance of most people. They are influenced by a tiny minority of equally ignorant but denigratory people, with disproportionate media influence, who cannot abide anything that conflicts with their world view.
Homeopaths every day see people who can be always comforted, often relieved, and sometimes cured, when conventional medications have failed, or cause problems. Homeopathy is relatively inexpensive, and very safe. There are multitudes of adults and children out there who could benefit, and who deserve to be educated, and able to make an informed choice. They fail to do so partly because the nature of public and media debate has been distorted and debased by the misleading terminology so disliked by Professor Bewley. Perhaps she has moved on since she and her colleagues used similar terminology ?
1 http://www.bmj.com/content/343/bmj.d5960?sso=
2 http://www.bmj.com/rapid-response/2011/11/03/rethe-clinical-evidence-spe...
3 http://careers.bmj.com/careers/advice/Editor’s_Choice%3A_The_importance_of_being_civil
4 http://careers.bmj.com/careers/advice/A_third_of_doctors_experience_rude...
Competing interests: NHS and peripatetic homeopath, no private practice.