ABORTION LAW reform has had a good Press. Lord Silkin's Bill, despite its manifest faults, has had wide support. Redrafted, there is every chance that it will become law soon.
Discussing the problem, the Bishop of Woolwich writes: "The problem has until recently tended to be pushed under the carpet by politicians and churchmen alike. Yet the statistics of misery—not to mention the farcical unenforcibility of the law—make it, now that the death penalty is abolished and the Wolfenden Report in sight of implementation, one of the most urgent causes of social reform."
This point of view is one which deeply disturbs many doctors. They do not feel that the problem has been pushed under the carpet. In a classic review of the indications for therapeutic abortion Jeffcoate, discussing the report of the B.M.A. Committee on the Medical Aspects of Abortiorr(1936) and the Interdepartmental Committee on Abortion (1939), says: "It was argued then, as it has been argued since, that the present situation leads to women being deprived of what is in the interests of their health because their medical advisers fear the legal consequences of terminating pregnancy. But I have never heard of a specific case in which .such a fear has operated when the medical indications were clear. Nor is it likely to happen, because the present characteristically British legal position provides for the greatest flexibility of opinion and for changes in opinion as medicine advances."
For the Bishop, the scandal and misery of the present situation is the number of illegal abortions performed in Britain and the damage which they cause to health and happiness. And he points out the inadequacy of the proposed reform to deal with this problem, "In the vast majority of these cases it would be impossible to indicate, as Lord Silkin's Bill requires, 'grave risk of serious injury to the patient's physical or mental health' however widely interpreted.
"Those determined on abortion would continue to get one. And the more formidable the safeguards—e.g., two medical opinions rather than one—the more people would be inclined to by-pass the whole process." The Bishop concludes, and one agrees with his conclusion, that with the Silkin reforms the "law would either be flouted as at present or whittled away into contempt".
THE ONLY REAL SOLUTION to the problem, so far as the Bishop is concerned, is abortion on demand. "In the last resort the right to decide must not rest with the doctor, or judge, or any third party, but with the mother herself. The mother may decide to let nature take its course . . ."
To my mind, this position is logical. It goes honestly to the root of the problem. And it is terrifying. It is completely contrary to the whole ethos of the medical profession. The social naivete which underlies it is extremely depressing.
No doctor I know would accept that abortion on demand would increase the sum total of human happiness. On the contrary, the doctors 1 know believe that abortion on demand could be disastrous for the patient, and almost equally disastrous for the profession.
What lies behind this belief Is reverence for life. It matters enormously for the mental health of the patient that this reverence for life be sustained and preserved. To destroy innocent human life for one's own personal convenience is to behave in a sub-human fashion. Such behaviour does the psyche no good.
The damage done to the doctor is perhaps even greater. Medicine is a noble profession. A vital part of this nobility is reverence for life. From Hippocrates onwards, the profession's reverence for life has been one of its most valuable contributions to the service of humanity. It is an essential part of a doctor's psychological make-up that in thinking of means to relieve suffering he has a complete mental block when it comes to direct killing.
Of course a doctor must often do something which might endanger, or shorten, a patient's life. So often there is no black and white in choosing a course of action, only rather worrying shades of grey. Risks are balanced; decisions must be made.
THE THREE THINGS which matter to the patient, the three qualities which the doctor must have, are compassion, judgment and right motivation. This last is our concern in the present problem. Once a doctor is given, or takes for himself, a licence to kill, then he oversteps the limit of his remit.
"Remember, young man, you are not God", I was told when I was a student. Once a doctor judges who shall live or die, in this way, he breaks through a major psychological barrier. His integrity is impaired.
Paradoxically, if death is caused inadvertently, as a side effect so to speak, the profession is nobler and our patients arc safer. But once we presumptuously decide that some life is not worth living, or is socially worthless, or is likely to cause distress or inconvenience to someone, and for one of these reasons may be terminated, then the profession is prostituted, and our patients are less safe. By assuming God-like powers, we debase the profession. As one group of gynaecologists wrote: "The frequent termination of pregnancy for social or inappropriate reasons, especially when extra-marital, may lead the public to question the regard of the medical profession for the sanctity of human life. There may even be some degradation of character among those who find themselves terminating pregnancies with undue frequency."
If we accept that we may destroy a foetus at six weeks, or 12 weeks, or 18 weeks, for whatever reason, then surely we must accept that we may, given the accepted indications destroy a foetus at 24 weeks, or 34 weeks, or even the day before it is due to be delivered. No intrauterine line may be drawn.
AND 1S THERE ANY DIFFERENCE between destroying a foetus one day before delivery and destroying a child one day after delivery? Silkin would make it legal to abort an "inadequate" mother. At what stage does this right end?
Presumably if she becomes inadequate at the thirtieth week of her pregnancy, abortion would be on. One can visualise, one has seen, a situation in which a mother is quite unable to cope two weeks after delivery. Should infanticide be legalised to solve this problem?
Of course infanticide horrifies, as does murder. But foeticide also horrifies, especially those who are expected to perform it.
The doctor who becomes "used to" abortion, or "used to" euthanasia is in danger of becoming brutalised. An important argument against hanging is its brutalising effect on the hangman. And once this process starts, the insidious inevitable progression occurs all too quickly. The evidence from the Nuremberg trials is witness to this. At its lowest value, reverence for life is a safeguard for society.
The protagonists of abortion on demand describe the mental distress which an unwanted pregnancy can cause, and the stress, work and worry a new baby brings to a household. They would have it that the mother should be able to avoid this "dis-ease" by having an abortion. In this way, the "health" of the woman, and the family, is preserved.
Consider then this picture. Parents with a growing family, "just getting on our feet, doctor"; coping with the problems of their teenagers, as well as their younger children; just keeping their heads above water when Grandma must come to live with them. She is a grandma who needs more attention than any baby, and who disrupts the family unit as no newborn ever could.
This is no hypothetical case, as any social worker would agree. And the stress one sees in such a situation is potentially far more damaging for the mental and physical well-being of the family than any of the many unwanted pregnancies I have had to cope with in general practice.
IT COULD BE ARGUED that no "aged person" should be allowed to do this. Surely the children and grandchildren have a right to avoid the "dis-ease" she will cause. Why not offer her a place in a home? If she refuses this reasonable offer. then the welfare of the family unit surely demands termination—compulsory euthanasia.
Of course there should be safeguards. A Board of Social Medicine would assess her social worth, her capacity for enjoying life, and the effect she would have on the family unit. if on balance her life is seen to be not worth living, then the problem should be passed to the Termination Medical Officer for a final solution.
Ludicrous, you say: but logical, surely?
Because if you accept that we may kill; if you accept that we may take innocent human life for personal convenience; then you have broken through the ethical barrier, and in the last analysis anything goes. Or, rather, what goes at any moment is what people will then tolerate.
THE PRESENT PRACTICE of the medical profession does not make me fear for the profession. My reason for saying so is this. The motive behind their actions is a healthy one; psychologically the situation is exactly the same as in cases involving the double effect principle. So far as my gynaecological friends are concerned, the last thing they desire is the death of the foetus.
On the contrary, they are striving the whole time to narrow the field of therapeutic abortion. In any particular case, if it were technically possible to remove the foetus and rear it in an artificial medium, they would do so. So they do NOT destroy a foetus to solve a problem : the problem is solved NOT through the death of the foetus, but through the emptying of the womb.
Psychologically there is all the difference in the world between this attitude and the • attitude of the reformers who would solve social problems by foeticide. Removing a pregnant cancerous uterus is morally licit if emotionally dreadful.
THE NON-CATHOLIC DOCTOR who performs a therapeutic abortion to save a mother's life has precisely the same motive, and precisely the same emotional reaction. He finds our double effect principle too subtle by half. His attitude to abortion is extremely responsible. He has a reverence for life which protects society. So far as he is concerned, the present law is adequate; and in fact he fears that the reformers may do harm, and hinder his freedom.
And he fears above all the social attitude which will make abortion a first line of "treatment", rather than a last resort in desperate circumstances. Many doctors would agree with Jeffcoate when he says, in defence of the law as it stands: ". . . no doctor need fear its consequences if after proper consultation with his colleagues, he terminates a pregnancy which he honestly believes is causing or is likely to cause significant harm to the physical or mental well being of his patient."
Most doctors would prefer, I think, that reform of the law should be limited to making it positively rather than negatively clear that abortion is not always illegal. Some would argue in favour of carefully defined eugenic abortion. But against this view there is the opinion of Lord Cohen, the President of the General Medical Council: "There are some who hold that if mentally defective and epileptic children were quietly put away, not only would there be a great saving of money which could be usefully devoted to the normal healthy child, but much domestic suffering would be avoided.
"But no doctor would subscribe to this view who cherishes a belief in the sanctity of human life, in the claims of the individual above those of the society in which he lives, and who has seen the love and devotion which brings out all that is best in man lavished on a mentally defective child . . . the doctor must not be the arbiter of life and death."
And of the hundreds of unwanted pregnancies which I have seen, the majority of which would have been terminated had there been abortion on demand, If have seen only two which did not bring great joy once the idea had been accepted, and the baby had arrived.
Schweitzer said: "Man accepts as being good: to preserve life, to promote life, to raise to its highest level life which is capable of development; and as being evil; to destroy life, to injure life, to repress life which is capable of development. This is the absolute, fundamental principle of morality.
"A man is ethical only when life, as such, is sacred to him."
• This article was written by a leading doctor and was first published in the June issue of Ampleforth Journal