“Doctors signing off abortions for women they have never met” Daily Telegraph on 24th March

So the care quality commission (CQC) has found that there are widespread violations of the process that should be followed when considering a termination of pregnancy. The findings  suggest malpractice is rife in many termination clinics. Recently the Daily Telegraph also wrote that doctors allegedly were agreeing terminations on the grounds of the gender of a women’s baby. Now this is an uncomfortable issue – because sometimes failing to produce a male child may lead to significant psychological or even physical harm to the women concerned. Although terminating a female baby is unthinkable to most people, in these circumstances it may well be within the act to agree to do so. This is a grey area and very hard to police. Carrying out an audit of how and when consent forms are signed in clinics is an easy clear cut thing to look at – hence the actions taken by the CQC.

The issue of termination is emotive and always difficult. However if a women wants to terminate her pregnancy it seems an anomaly that it requires two professionals of any kind – doctors or not – for her to in effect have permission to go ahead. Clearly it is important than anybody contemplating such a serious life decision must be fully informed of the potential physical and emotional problems that might follow. However once everyone is satisfied that the women is fully informed of the issues – the wording of the law means that almost any women can have a termination, furthermore unless there is a physical contraindication to the contrary, one must question what business is it of one, two or any number of doctors to tell her whether she can go ahead. Whether it is morally right to terminate a pregnancy is a larger issue and outside the remit of this article. However once society takes the view that termination is acceptable, then the rest is window dressing.

Doctors and clinics should not be breaking the law. However the behaviour described in these clinics reflects the reality that very often doctors do not feel in a position to make a value judgement on how damaging continuing with a pregnancy may be to a women. If a women wants a termination they will sign the form. This approach reflects the modern development in medicine that puts the patients at the centre of any decision making about their care. As the fetus rightly or wrongly has no rights, the responsibility for deciding if a women has a termination should be the women herself. It is time to stop the patronising farce of forcing women to persuade two doctors to agree to what should be her own decision and nobody else’s. If society, parliament or the media commentators take the view that termination should not be permitted or have more strict indications then of course this debate must take place. However have the courage to openly debate the issues and don’t have a proxy battle over the smallprint.

Professor Tom Bourne

Professor Tom Bourne is Adjunct Professor at Imperial College London, and Consultant Gynaecologist at Queen Charlotte's and Chelsea Hospital. He is also visiting Professor at KU Leuven, Belgium. He has extensive clinical and research experience in early pregnancy care as well as gynaecological ultrasound. He has published over 300 academic papers with an H-index of 63. He advises NICE, is trustee of the ectopic pregnancy trust, President of the UK association of early pregnancy units (AEPU) and on the board of ISUOG. He has a private practice at The Women's Ultrasound Centres at 86 Harley Street and Parkside Hospital in Wimbledon.

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About Professor Tom Bourne

Professor Tom Bourne is Adjunct Professor at Imperial College London, and Consultant Gynaecologist at Queen Charlotte's and Chelsea Hospital. He is also visiting Professor at KU Leuven, Belgium. He has extensive clinical and research experience in early pregnancy care as well as gynaecological ultrasound. He has published over 300 academic papers with an H-index of 63. He advises NICE, is trustee of the ectopic pregnancy trust, President of the UK association of early pregnancy units (AEPU) and on the board of ISUOG. He has a private practice at The Women's Ultrasound Centres at 86 Harley Street and Parkside Hospital in Wimbledon.
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