Abortion

Abortion is another key ethical dilemma which often comes up in medical interviews. In this page, we have included the history and types of abortion (less commonly asked) as well as how to approach an ethical question about abortion. It is important you know the laws for the country of your university! Like with all these guides, the four pillars of medical ethics is a good starting point, but to really impress your interviewers, use the additional facts, NHS values and GMP quotes provided.

Definitions

Abortion: A pregnancy which is terminated so that it does not result in the birth of a child.

Pro-choice: People who believe that pregnant women should have legal access to abortion services.

Pro-life: People who believe that pregnant women shouldn’t have the freedom to choose an abortion.

Mifepristone: The first drug taken for medical abortions. This prevents progesterone production.

Misoprostol: The second drug taken. This induces contractions in the womb.

The History of Abortion

Law in England, Wales and Scotland

Under the 1967 Abortion Act:

“A person shall not be guilty of an offence […] when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith

(a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve 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; or (b) that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or (c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or (d) that 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.”

• “Formed in good faith” The doctors only have to believe there are beneficial grounds for the procedure to be carried out.

• “Continuance of pregnancy would involve risk, greater than if the pregnancy were terminated” Abortion always carries a lower risk of mortality than continuing with a pregnancy (and having an abortion is deemed less traumatic for the mother’s mental health than a pregnancy). Therefore, an abortion can always be carried out under this rule.

An abortion can be carried out after 24 weeks in very limited circumstances if:

• The mother’s life is at risk.

• The baby will be born severely disabled.

Law in Northern Ireland

Unlike the rest of the UK, in Northern island, abortion was only legalised in 2019. In 2018 there was an abortion referendum which favoured abortion by an overwhelming majority. In 2019, it was decriminalised and followed by the Abortion Regulations 2020.

Types of Abortion

There are two types of abortion: a medical abortion or surgical abortion. It is usually the patients decision, however, a surgical abortion is advised later in the pregnancy.

Medical Abortion

This involves taking two pills 1-2 days apart:

• Mifepristone: This prevents progesterone production and is taken in a hospital or clinic.

• Misoprostol: The second drug taken orally or inside the vagina. This induces contractions in the womb casing pain, bleeding and loss of the pregnancy. This can now be taken at home.

Both of these had to be taken in hospital until legislation in 2018 enabled patients to take misoprostol at home. During Covid, both pills could be taken at home following a tele-consultation. The Royal College of Obstetricians and Gynaecologists stated this was a “major step forward in women’s healthcare,” as it enabled the traumatic bloody experience to happen in the comfort of the women’s home. “Right to life” campaigners fear it trivialises abortion.

Surgical Abortion

This is an operation may be done with:

• Conscious sedation and local anaesthetic (the patient is still awake).

• Deep sedation or a general anaesthetic (the patient is asleep).

Up to 14 weeks a Vacuum Aspiration technique is used (a ten minute procedure where a vacuum tube is inserted through the cervix into the womb and the pregnancy is removed using suction).

After 14 weeks a Dilation and Evacuation (D&E) procedure is used. This is more commonly carried out under general anaesthetic and the pregnancy is removed by forceps through the cervix.

Should it be 24 Weeks?

The BBC wrote an article debating whether the 24 week period should be shortened. Some people argue it should be moved to 22 weeks.

• For changing it to 22 weeks - Case study

  In the late 2000s, babies were believed to be viable only after 24 weeks. Therefore, when mother gave birth at 22 weeks and the nurses and doctors couldn’t offer treatment, they left the baby with her to die. However, after 36 hours the staff decided the baby had potential and took him to the Neonatal Intensive Care Unit (NICU). He survived.

• Against changing it to 22 weeks - Case study

  A mother had a 20 week anomaly scan which identified that the baby had abnormalities not present in earlier scans. The family felt like they couldn’t support the baby due to existing children and personal circumstances. This was a very difficult decision, but they finally decided to have an abortion 22 weeks into the pregnancy.

If a pregnancy is terminated after 22 weeks the baby must be aborted within the womb of the woman to ensure it is born dead. Otherwise, it could be considered as murder.

The Ethics of Abortion

The Four Pillars of Medical Ethics

Other Arguments

FOR:

• Prevents backstreet abortions - dangerous, painful and traumatic abortions not performed in a hospital. These will increase in frequency if abortion is criminalised.

• 98% of abortions are carried out before 20 weeks when the baby is not viable. Many people argue they are not yet a living organism.

• The mother’s life should be prioritised over the babies. She is the patient and therefore has autonomy.

AGAINST:

• The child can be adopted when it is born, therefore it is wrong to kill them.

• It may be difficult to determine if the mother is under undue influence/coercion.

The Theories of Ethics

• Deontology: Killing is always wrong and can never be justified.

• Utilitarianism: We should prioritise the living over the not yet living. If the pregnancy will result in more difficulty for the mother and existing children, then abortion can be justified.

Values of the NHS Constitution

• Working together for the patient:

  • A doctor’s role is to be completely altruistic. They should act on the patient’s choice and if they have a religious or moral objection to it, must ensure the patient can see another doctor who can perform the procedure.

• Compassion

  • A doctor should never express disapproval of a patients actions or choices. They have to treat the situation with compassion, empathy and professionalism.

• Improving lives

  • Abortions are very difficult decisions and without them, could cause great difficulty for the mother.

  • To deny a patient of an abortion is to disregard this value of the NHS constitution.

Good Medical Practise Quotes

• “You must give patients the information they want or need in a way they can understand.”

• “You must explain to a patient if you have a conscientious objection to a particular procedure. You must tell them of their right to see another doctor and make sure they have enough information to exercise that right.”

• “You must not imply or express disapproval of a patient’s lifestyle, choices or beliefs.”