Whose choice?

The difficult decision whether to abort a fetus with a cleft palate should lie with the pregnant woman, not a vicar or a judge, says the chief executive of the UK's leading abortion and advice charity.

Ann Furedi

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Topics Politics

Reverend Joanna Jepson says that she was shocked to discover that, last year, a woman ended her six-month pregnancy because the fetus was affected by cleft palate.

I was shocked to find out that the Reverend had tried to bring a legal case against the police for failing to prosecute the doctor who performed the procedure. And I was outraged to discover that she was prepared to initiate a judicial review to determine whether this condition was a sufficiently serious handicap to permit a legal abortion.

Late abortion is a contentious issue, especially when fetal abnormality is involved. In 1990, a legal limit of 24 weeks was established for most abortions, but not when there ‘is a substantial risk that the child if born would suffer from such physical or mental abnormalities as to be seriously handicapped’. In such cases there is no legal time limit, and every year about 100 pregnancies are deliberately ended when, those who oppose abortion like to remind us, the pregnancy could result in a live birth.

A particular bone of contention is that the law does not define what it means by ‘substantial risk’ or ‘seriously handicapped’. Reverend Jepson’s complaint is that an abortion was justified by a diagnosis of cleft palate, which she asserts is a relatively trivial condition that can be corrected by surgery.

It helps, at this point, to understand that she is wrong. In some cases, a fetal diagnosis of cleft palate indicates a cosmetic condition that can easily be corrected by surgery. In others, as fetal medicine expert Kypros Nicolaides explained on BBC Radio 4’s Woman’s Hour, cleft palate can be one symptom of serious genetic conditions incompatible with life. Sometimes cleft palate is taken to mean simply a hare lip. On other occasions, it can describe a failure of the skull to fuse in a way that does not allow brain function.

No one knows the circumstances of the woman who requested the ‘cleft palate late abortion’ that has been debated on TV, radio and in the newspapers. Reverend Jepson and her supporters have been quick to condemn the woman who sought the abortion, the doctors who approved it, and those involved in the termination of the pregnancy.

Perhaps, as a provider of abortion services, I have in my mind what an abortion at this stage in pregnancy involves. Remember, what is being ended was originally a ‘wanted pregnancy’. The woman requesting the abortion was at least six months pregnant. She was already feeling robust fetal movements, she was visibly pregnant, possibly her family and friends had already rejoiced that she was ‘going to have a baby’. Yet, for reasons we do not know – perhaps to do with the severity of the condition – she decided to end the pregnancy.

Could this have been an ‘easy option’? At this gestation, she would have known that abortion involves a procedure to stop the fetal heart. She knew she would have endured labour, understanding that her once wanted ‘child’ will be born dead.

None of us knows this woman’s specific circumstances. So how can we judge her?

Reverend Jepson and her supporters suggest that she is having an abortion for a ‘trivial reason’. Jepson finds the abortion ‘offensive’. Her interviews on TV have provoked all manner of people to write and email condemning morally the woman involved. I wonder just how she is feeling, right now, as she reads speculations about her motives, her justifications.

I would like to suggest that we suspend our judgement. I am not an official of the church who aspires to become a vicar. I’m an abortion provider, yet I do believe there is wisdom in the Christian tenet of ‘Judge not, lest you be judged’. Or as my rather more secular mother puts it, ‘Don’t judge a man until you have walked a mile in his shoes’. None of us knows the circumstances that persuaded this woman and her doctors that abortion was the best option for her.

The real issue that underpins this debate is, ‘whom do we trust?’. Should politicians, doctors, women or outside observers decide whether or not a woman’s circumstances are such that abortion should be an option? Or should it be the family that will be affected and those involved in their care?

My own view is that women and their doctors should make the decision. They will, after all, live with it. It is on their individual consciences. Politicians, advocates and interested parties may have their views – but, at the end of the day, we go home. I walk away believing the decision should rest with a woman and her doctors. Reverend Jepson goes home believing that the decision should rest with herself and her supporters. But we do not have to wake up every morning knowing that we requested or carried out that abortion. So how, in our ignorance, can we condemn those who do?

In 1967, parliamentarians deliberately left the law on abortion in relation to severe risk of serious abnormality vague and open to interpretation. When the issue was revisited in 1990, parliament similarly left the issue loosely defined. It believed that that the definition of ‘serious risk’ and ‘severe abnormality’ was best determined between a woman and her doctors. It was a wise and humane decision and it would be wrong now to reverse this decision.

Ultimately, this matter comes down to whom one thinks should decide. I trust women to make decisions about their own pregnancies, and doctors to carry out only those procedures they believe to be lawful and ethical, rather more than I trust opinionated outsiders with abstract moral opinions.

Reverend Jepson, I respect your opinion that abortion on grounds of fetal abnormality is wrong. That’s fine, don’t have one. But allow others to make their own painful choices for themselves.

Ann Furedi is chief executive of bpas

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Topics Politics