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October 2007 is the 40th anniversary of the Abortion Act. The original Act was based on a desire to end backstreet abortions and protect women against the potential harm of undergoing them. Today, access to abortion in Britain is perceived by many as a woman's reproductive right over her body, although the notion of “rights” is not reflected in the current legal framework. Public attitudes towards abortion are changing, and the anniversary has prompted calls for revision of the law.
Under the current legislation, in order to obtain an abortion, a woman must have a medical justification; two doctors must confirm that she meets the medical criteria, and the abortion must be administered in NHS approved premises. Suggested amendments to the original Abortion Act focus on removing the restrictions women face in accessing abortions in the first trimester of pregnancy and on reducing the current 24‐week time limit.
Although some public opinion polls indicate support for removing restrictions to accessing first‐trimester abortions,1 there is some evidence of reluctance in the medical profession to further liberalisation of access. For example, in May 2007, the general practitioners' magazine Pulse published the results of a survey of 309 general practitioners showing that one in five did not believe abortion should be legal and one in four would not sign referral forms for women seeking an abortion.2
Discussion concerning abortion featured heavily at the British Medical Association's (BMA's) Annual Representative Meeting in June 2007, including the discussion of a motion calling for the removal of the requirement for women to have a medical justification for abortion in the first trimester of pregnancy.
Abortion is a sensitive issue in virtually all cultures, and the disparity in views about it is not exclusive to Britain. In 2007, Mexico City legalised abortion in the first 12 weeks of pregnancy, and Portugal passed legislation allowing abortion on demand up to 10 weeks.3 Conversely, Nicaragua has outlawed all abortions, and in the USA partial birth abortions are no longer permitted.4
Articles are written by Veronica English, Danielle Hamm, Caroline Harrison, Rebecca Mussell, Julian Sheather and Ann Sommerville, BMA Ethics Department: firstname.lastname@example.org
In May 2007, a 17‐year‐old pregnant woman from the Republic of Ireland was finally permitted to travel to Britain for an abortion in her second trimester, on the grounds of serious fetal abnormality. The fetus had anencephaly, a condition in which part of the brain and skull is missing. Most such babies do not survive birth, and those that do usually live for not more than a few hours.
Abortion in the Republic of Ireland is legal only if the pregnancy poses a serious risk to the mother's health. Around 7000 women are estimated to leave the Republic each year to undergo the procedure overseas. In this case the woman, known as Miss D, was under the care of the Health Service Executive, which had originally prohibited her from travelling to Britain to have an abortion. However, on 9 May the Dublin High Court ruled that there were no legal grounds to stop her from travelling abroad to procure an abortion.5
On 25 April 2007, the United States House of Representatives voted overwhelmingly in favour of the Genetic Information Nondiscrimination Act. The Act will prohibit insurance companies from using a person's genetic information in setting insurance premiums and from requesting or requiring individuals to undergo genetic tests. It will also ban employers from using or requesting genetic information in relation to employment decisions. The Genetic Information Nondiscrimination Act is supported by the White House and is expected to be passed by the Senate; it is likely to come into force by the end of 2007.
The Act has been welcomed, by politicians and patient groups alike, as much‐needed legislation. The fear of genetic discrimination in employment and insurance is thought to deter people from taking predictive genetic tests and, as a result, to have a detrimental effect on both clinical care and genetic research.6
In the UK, a moratorium in place until 2011 restricts the use of genetic information in insurance. If insurance companies wish to use genetic information in setting premiums for life insurance policies above £500000 or for critical illness policies above £300000, they must apply to the government's Genetics and Insurance Committee (GIAC) for permission. At the time of writing, the committee has approved only one such application, for the use of genetic test results for Huntington's disease in life insurance policies over £500000. The Association of British Insurers is reported, however, to be considering seeking permission from the GIAC to use the results of predictive test results for breast and ovarian cancer.7
Many patient groups have called for statutory legislation similar to the US Genetic Information Nondiscrimination Act to be implemented in the UK.
In March 2007, the UK's Joint Committee on Human Rights published a report on the treatment of asylum seekers in the United Kingdom.8 The report made a number of recommendations in relation to the provision of healthcare for asylum seekers and failed asylum seekers in England. The committee was particularly concerned about the plight of asylum seekers whose claims have been refused and whose entitlement to free healthcare is extremely restricted. The more significant recommendations in relation to this group are summarised as follows:
In June 2007, the BMA, in association with the Commonwealth Medical Trust, launched a toolkit for international health professionals on the right to the highest attainable standard of health. The BMA has been increasingly interested in the potential impact of this right on both the delivery of health services and the underlying public health infrastructure, particularly in developing countries. It has been looking at ways of translating this high‐level right into concrete proposals for health professionals in their daily practice. Working with a grant from the Department for International Development, and drawing on assistance from international health and development non‐governmental organisations, the BMA and the Commonwealth Medical Trust put together a short, practical toolkit outlining both the content of the right and its impact on health professionals and their associations. Copies of the toolkit are available from the BMA's medical ethics website (http://www.bma.org.uk/ethics).
London's Metropolitan Police Service, in conjunction with the Local Safeguarding Children Board and other partners, has re‐launched its ongoing awareness and prevention campaign to inform parents, carers and professionals that it is illegal to participate in any sort of arrangement for female genital mutilation (FGM) either inside or outside the UK. The British Medical Association fully supports the campaign.
FGM is an extremely painful procedure with both immediate and long‐term health risks, including haemorrhage, tetanus, septicaemia and even death. It can cause long‐term sexual and reproductive problems and has been shown to increase mortality during childbirth.9 FGM is typically performed on girls from 4 to 15 years of age, although it is sometimes carried out on new babies and women prior to marriage. The procedure is often performed in unsterile conditions without anaesthesia.
The main thrust of publicity in 2007 is timed for the summer because the long school holidays have been identified as a time when girls are particularly vulnerable to mutilation either by being flown to countries which openly practice FGM or by having the procedure conducted at home. The holiday provides a long recovery time, when absence from school will not be noticed.
London's Metropolitan Police has developed Project Azure to tackle the practice of FGM. The aims of the project are to:
The BMA has ethical guidance on FGM for health professionals, available on the internet (http://www.bma.org.uk/ap.nsf/Content/FGM).
In May this year, the BMA published a discussion paper outlining an alternative approach to health service reform in England.10 The document was produced in response to widespread anger among doctors about what they saw as the incoherence of government reforms. It reiterates the BMA's commitment to an NHS funded out of general taxation. Although it states that services should be provided on the basis of need, it nevertheless calls for an acknowledgement that some degree of rationing is inevitable and that this must be discussed openly. As a result, a “core” of services should be nationally available, with priorities set across the whole service, thereby eliminating the so‐called postcode lottery in healthcare as far as possible. In order to separate national politics from the day‐to‐day running of the NHS, an independent board of governors should be established, appointed by and accountable to Parliament. The discussion paper is designed to initiate a period of consultation with a broad range of stakeholders, which will run until September 2007, when a fuller report will be published.
The Ethics department of the BMA has published guidance on the Mental Capacity Act 2005 for health professionals, which is available from the ethics section of the BMA's website (http://www.bma.org.uk/ethics). The act clarifies the law regarding the treatment of adults who lack the capacity to consent to treatment and has broad implications for health professionals who work with adults without such capacity, or who may lose it.