It’s time to ditch the two-doctors rule

Eighty-five academics with expertise in medical ethics and law have joined together to call on the UK parliament to modernise the Abortion Act 1967.

Our letter, published in The Times, explains why modernisation of the Abortion Act is necessary and calls on parliament to update it now (read the letter here). An opportunity for reform is soon to be presented by the arrival of the Human Fertilisation and Embryology Bill at report stage in the House of Commons.

The signatories to the letter represent a sizeable proportion of the total body of academic experts in medical law and ethics and demonstrate a very real strength of opinion within that community that the current legislation is much too restrictive. Given that academics are an independently minded group of people, who generally agree on very little, the unprecedented weight of support behind this letter points to some very real problems with the law as it stands and a pressing need for change.

What is wrong with the Abortion Act? Our letter points out that it is now over 40 years old and reflects the values of 1967, when a ‘doctor knows best’ model of paternalism was dominant. This is reflected in the fact that, legally, it is two doctors who must decide that an abortion is appropriate for each individual woman.

Forty years on, the Abortion Act represents a striking anomaly in the context of the currently widely accepted ethical and legal principles which determine the parameters of good medical practice. Today, respect for patient autonomy is at the very heart of ethical medical practice and the legal framework within which it operates.

The law courts have made clear that the right to make one’s own healthcare decisions is not diminished by virtue of being a pregnant woman. Indeed, a series of cases in the 1990s established that a woman is entirely within her legal rights to refuse an unwanted Caesarean section, even where necessary to save her own life and that of a full-term fetus.

While many people find these cases difficult, the point is that autonomy isn’t worth much if it is only recognised in the context of those decisions with which we agree. And, as noted in our campaigning letter, while achieving fewer earlier abortions is a goal shared by all, there is no evidence that this is best achieved by placing obstacles in the path of a woman wishing to end her pregnancy.

It remains to be seen whether the House of Commons will respond to this call for reform or, indeed, to the recommendations of its own Science and Technology Sub-Committee (1). That committee found no basis for the current restrictions contained in the Abortion Act in terms of patient safety, but did find that it was possible that the requirement for two doctors’ signatures might be contributing to delays, thereby resulting in later terminations.

Sally Sheldon is a professor of law at the University of Kent and an adviser to the Pro-Choice Forum. For more information on her research work, click here.

(1) Scientific developments relating to the Abortion Act 1967, House of Commons Science and Technology Committee, 6 November 2007