Ethics at the beginning of life

Question 1

What does ToP stand for?

Answer 1

Termination of pregnancy

Question 2

What country has a different abortion legislation from Great Britain?

Answer 2

Northern Ireland

Question 3

What 2 categories can the clinical aspects of termination be divided into?

Answer 3

Less than 14 weeks and 14 weeks or more

Question 4

What are the surgical and medical options from ToP in those less than 14 weeks pregnant ?

Answer 4

Surgical;
- Manual or electric vacuum aspiration (carried out under local or general anaesthetic)

Medical;
- Mifepristone (a progesterone antagonist which changes the lining of the womb), followed 24-48 hours after by misoprostrol (a prostaglandin which increases contractions and dilates the cervix to pass out foetus

Question 5

What are the surgical and medical options from ToP in those that are pregnant 14 weeks or more ?

Answer 5

Surgical;
- Vacuum aspiration or dilation and evacuation (D&E)

Medical;

• Mifepristone (a progesterone antagonist which changes the lining of the womb), followed 24-48 hours after by misoprostrol (a prostaglandin which increases contractions and dilates the cervix to pass out foetus
• Its administered in medical facility as its like a miscarriage

Question 6

What is the ethical debate about allowing misoprostrol in those less than 14 weeks pregnant to take it at home?

Answer 6

Some argue it will benefit the welfare of women as it;

1) . Saves the patient having to come back into the clinic for a second time (acts as a barrier if they have to come back again)
2) . Many women also experience the distress of bleeding and cramp pain on their journey home

Question 7

What does WHO state are the characteristics of abortion procedures via Medical abortion?

Answer 7

Medical abortion (pills only);

• Avoids surgery
• Mimics miscarriage
• Controlled by the woman and may take place at home (at less than 9 weeks of pregnancy)
• Takes time (hours to days) to complete abortion, and the timing may not be predictable
• Women experience bleeding and cramping, and potentially some other side effects (vomiting, nausea)
• May require moire clinic visits than surgical abortion

Question 8

In what situations may Medical abortion be necessary ?

Answer 8

Medical abortion may be necessary in the following situation;

• For severely obese women
• If the woman has uterine malformations or fibroids, or has had previous cervical surgery
• If the woman wants to avoid surgical intervention
• If a pelvic examination is not feasible or is unwanted

Question 9

What does WHO state are the characteristics of abortion procedures via Surgical abortion?

Answer 9

Surgical abortion;

• Quick procedure
• Complete abortion is easily verified by evaluation of aspirated products of conception
• Takes place in a healthcare facility
• Sterilisation of the woman or placement of an intrauterine device (IUD) may be performed at the same time as the procedure
• Requires instrumentation of the uterus
• Small risk of uterine or cervical injury
• Timing of abortion is controlled by facility and provider

Question 10

In what situations may Surgical abortion be necessary ?

Answer 10

Surgical abortion may be necessary in the following situation;

• If there are contraindications to medical abortion (drug shouldn’t be used as may affect patients other health conditions)
• If there are constraints for the timing of the abortion

Question 11

How many abortions in Scotland (2018) are done under 9 weeks and over 18 weeks?

Answer 11

80% of abortions are done under 9 weeks

Less than 1% are done over 18 weeks

Question 12

What percentage of abortions in Scotland (2018) are Medical abortions?

Answer 12

86.1%

Question 13

What are the different reasons and codes for abortions under the Abortion Act 1967 (1990)?

Answer 13

1. A - ‘Social grounds’ (up to 4 weeks) - The pregnancy has not exceeded the 24th week and the continuation of the pregnancy would involve a risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
2. B - ‘Grave permanent injury’ - The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
3. C - ‘Risk to life’ - The continuance of the pregnancy would involve risk to the life of the pregnant woman, grater than if the pregnancy were terminated
4. D - ‘Fetal abnormality’ - There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Question 14

What are the statistics for abortion reasons in Scotland (2018)

Answer 14

98. 8% were for reason 1.A - Social grounds

1. 2% were for reason 1.D - Fetal abnormality

Question 15

What percentage and number of abortions worldwide are carried out unsafely, and where does the majority of the occur?

Answer 15

Almost half of abortions worldwide are unsafe (25 million)

97% of these unsafe abortions occur in developing countries

Question 16

What are abortion laws in countries not associated with?

Answer 16

Restrictive abortion laws are not associated with less
abortions

“In countries where abortion is completely banned or permitted only
to save the woman’s life or preserve her physical health, only 1 in 4 abortions were safe; whereas, in countries where abortion is legal on
broader grounds, nearly 9 in 10 abortions were done safely. Restricting
access to abortions does not reduce the number of abortions.”

Question 17

What generally happens with abortions in countries where they are legal and illegal ?

Answer 17

In general, where abortions are legal they are safe.

Where illegal, mostly unsafe
— 7.9% of maternal deaths worldwide due to abortion

Question 18

What year was the Abortion Act first passed?

Answer 18

Abortion Act 1967

Question 19

What was the Abortion Act 1967 set up to prevent?

Answer 19

Unsafe and illegal abortions

Question 20

When was the Offences against the person act passed?

Answer 20

Offences against the person act 1861

Question 21

What was included in the Offences against the person act ?

Answer 21

That any pregnant woman or anyone else who administers a woman poison, noxious things, unlawfully use instruments or whatever other means to produce the miscarriage of any woman, shall be guilty of felony and will be kept in penal servitude for life

Under sections 58 & 59 of 1861 Act

Question 22

What legislation was passed in 1929?

Answer 22

1929 Act of Parliament;

- Abortion was not a criminal act if it was performed in order to save the life of a mother

Question 23

What happened in 1990?

Answer 23

The abortion act 1967 was updated and became The Abortion Act 1967 (1990)

The update brought in statutory defence against sections 58 & 59 of 1861 act

“(1) Subject to provisions of this section, a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered practitioners are of the opinion, formed in good faith;

a. Social Grounds (24 weeks)
b. Grave Permanent Injury
c. Risk To Life
d. Fetal Abnormality

• Must take place on an approved premises

Question 24

What was changed about Section 1.A in 1990?

Answer 24

Section 1.A used to have to be before 28 weeks but was lowered to 24 weeks

Question 25

How does abortions work for females under the age of 16?

Answer 25

Females under the age of 16 may acquire an ToP without parental consent iff competent (Under Gilick’s competence / Frasers guidelines) and able to understand risks and procedures involved

Question 26

What does a doctor have the power to do in a case with someone wanting a ToP and what dos the GMC state about this?

Answer 26

A doctor can conscientiously object to directly participating in ToPs (but not to associated tasks and patient care)

Contentious objection exists for some of the grounds (and note that its not a yes/no answer)

The GMC states;
“You may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients. This means you must not refuse to treat a particular patient or group of patients because of your personal beliefs or views about them. And you must not refuse to treat the health consequences of
lifestyle choices to which you object because of your beliefs.”

Question 27

What does the Abortion act 1967 (1990) not give the patient the right to do?

Answer 27

The Abortion act 1967 (1990) does not give the patient the right to demand a ToP

Question 28

What rights do foetus’s have ?

Answer 28

Foetus’s have no legal right to life however once a foetus is alive and outside the womb it acquires legal protection of a new born

Ethical argument on geography of baby inside mother 10 seconds before being given birth and rights being dramatically changed

Hence too late a termination of pregnancy has the foetus protected by law

Question 29

What happened in the case of Janaway vs Salford health area authority ?

Answer 29

Janaway was a catholic lady who worked as a receptionist in a practice, Janaway refused to file abortion papers under the conscientious objection and abortion section. However the court stated how she wasn’t having any direct contact with the abortion and therefore the statutory act didn’t apply to her case

Question 30

What are the moral questions for the status of the embryo?

Answer 30

When does a person become a person?

What are the necessary qualifications for being a person?

Question 31

What are peoples beliefs on the timescale in the topic of abortion?

Answer 31

1) . The foetus has full moral status from the moment of conception or implantation
2) . There is a specific time point and change in moral status
3) . Its a gradual process (thus more serious reasons needed as time progresses)

Question 32

What are the 4 main arguments for anti-abortion?

Answer 32

1) . Identity is important: the embryo is the same entity as the child will be (note: 14 days & twinning - before 14 days a foetus can split off into twins and 1 identity could become
2) . The embryo has the potential to be a person

3). Moral value is accorded when the embryo has the
properties of a person

4). The embryo has value given by others (conferred moral
status)

Question 33

What happened in the case of Jepson vs The chief constable of West Mercia Police Constabulary in 2003?

Answer 33

A termination of pregnancy was carried out after 24 weeks as the child was diagnosed to have a bilateral cleft lip and palette under section 1.d

• Is a cleft lip really a serious handicap the child was going to have?

Question 34

What does feticide to to a foetus ?

Answer 34

Feticide involves a fatal injection of potassium chloride so the child will not be born alive, also sometimes done to reduce the number of embryos and the foetus will be passed out along with the alive ones

Question 35

What happened in the case of Paton vs BPA’s (1978): Evans vs Amicus healthcare ltd 2004

Answer 35

Fathers tried to prevent the mother having an abortion and took them to court but it was ruled that the decision was for the mother as she is the one to carry and look after the foetus

Question 36

What is miscarriage ?

Answer 36

The termination of a miss implantation to the uterus

Question 37

Why is the morning after pill not considered to be a form of abortion in law?

Answer 37

As pregnancy occurs when the fertilised egg implants into the woman uterus and the morning after pill prevents this

• Although some disagree with this