British Medical Association Medical Ethics Committee on Access to Abortion

The British Medical Association's Medical Ethics Committee has issued a day or two ago a position statement on access to abortion in the UK. The organisation has been in favour of women's legal right to abortion since the 1970. I excerpt here the BMA's key opinions. In a number of key areas the organisation proposes to make access to abortion easier for pregnant women. This is quite significant, seeing that it comes immediately in the aftermath of public debate in the UK about the Roman Catholic Church's hierarchy clamouring to have abortion outlawed altogether. You can find the whole report here.

The MEC supports the revision of the Abortion Act 1967 so that, in the first trimester:
• women are not required to meet medical criteria for abortion
• the requirement for two doctors is removed
• suitably trained and experienced nurses and midwives may carry out both medical and surgical abortions
• as long as safety is ensured, premises do not need to be approved to carry out first trimester abortions.

The MEC believes:• that changes in relation to first trimester abortion should not adversely impact upon the availability of later abortions
• that health professionals with a conscientious objection to abortion should retain the right to opt out of providing abortion services, but should make their views known to patients and enable them to see another doctor without delay.

The MEC believes that the requirement for medical criteria should be removed for first trimester abortions.

The MEC believes that the requirement for two doctors’ opinions should be removed for abortions within the first trimester.

The MEC believes that the level of training and experience a person has is the most important factor in determining which procedures should be undertaken by which professions. The MEC has no objection, in principle, to nurses and midwives, with appropriate training and competence, carrying out abortions.

The MEC has no objection in principle to removing the requirement for premises to be “approved” for first trimester abortions and allowing medical abortions to take place at home where that is the woman’s wish.

Rethinking mandatory HIV testing

Bioethics expert calls for mandatory HIV testing


A Queen’s philosophy professor and expert in bioethics is calling for a public policy shift towards mandatory HIV testing of pregnant women in areas where the disease is rampant.

In a paper published on-line from the July issue of the American Journal of Public Health, Dr. Udo Schuklenk, a world leader in the study of health-care ethics related to policy, argues that a mandatory approach to testing and treatment could significantly reduce perinatal transmission of HIV – which results in babies with an average life expectancy of only two years. He also promotes the view that mandatory testing is morally necessary if a number of conditions can be met.

“The scale of the problem demonstrates individual tragedies on an overwhelming scale and a threat to the public health of the communities in question,” says Dr. Schuklenk, Ontario Research Chair in Bioethics. In 2004, this mode of transmission resulted in up to 2.8 million HIV-infected children worldwide.

Co-author of the paper is Anita Kleinsmidt, a human rights law expert from Witwatersrand University in South Africa. Dr. Schuklenk was a professor with Glasgow Caledonian University when the paper was written.

About 35 per cent of newborns born to HIV-infected women contract the virus from their mothers if efforts to prevent mother-to-child transmission are not in place. While research has focused on obstetric care of pregnant women in high-prevalence areas, “treatment is contingent upon the pregnant woman seeking antenatal care, being screened for HIV, and agreeing to medical intervention,” says Dr. Schuklenk. “The continuing high number of children born with HIV attests to failures at various stages of this process.”

The authors suggest several conditions that must be met before the introduction of any mandatory testing and treatment programs:

· The woman has voluntarily chosen to carry the fetus to term
· She would have had a reasonable alternative to this course of action (e.g. abortion
at least until the point of fetal viability)
· Continuing voluntary treatment with HAART (highly active antiretroviral therapy)
would be available to her
· Ideally, the confidentiality of the woman’s HIV status is maintained, during as well as after her pregnancy.

Dr. Schuklenk proposes pilot studies introducing mandatory testing and treatment programs at a number of sites in Botswana and South Africa, where the HIV antenatal prevalence rate is 30 per cent. “This would allow us to establish how such programs can best be implemented, and to investigate stigmatization as it affects women giving birth within these programs,” he notes.

While not a panacea for the “continuing pandemic” of perinatally-transmitted HIV, mandatory testing and treatment regimes should be considered, whenever feasible, by governments and other health-care providers, says Dr. Schuklenk.

Celibate man in dress continues to ramble on about abortion

Well, this bloke is Keith O'Brien, the Roman Catholic Church's CEO in Scotland. He also goes by the designation of Cardinal (which is an old word that translates loosely in modern English into CEO). Anyway, CEO O'Brien gave a sermon (that's a speech in modern English) the other day to his flog of supporters in Edinburgh. Having recently lost an important policy battle in the country (his organisation may not discriminate against gay people - pretty shocking to our dress wearing celibate), O'Brien turned his theological gaze toward another one of his company's favourite topics, abortion. He compared the number of abortions taking place on a daily basis in Scotland to the Dunblane massacre. In Dunblane, sixteen kids and a teacher were shot by a lone gunman. Obviously to the man who likes to wear red dresses in public there is no significant moral difference between abortion and the murder of children, teenagers and adults. All the same to him.
I have no intention to get into the pro's and con's of abortion again. In a way, being a card-carrying humanist, I don't mind O'Brien rambling on like this. The more hysterical, and, frankly, silly, his public utterances become, the greater the irrelevance of the organisation he runs in Scotland is likely to become. And that, probably, is a good thing. The less people listen to 'moral' pronouncements, and the kind of bullying and hectoring that emanates from characters like Mr O'Brien the better for our societies.
I am concerned, however, by the overwhelmingly negative response he received from the media. Many commentators suggested that he overstepped the mark and that he shouldn't try to influence elected politicians' views and votes on this issue. Here I disagree as a matter of principle. Mr O'Brien is essentially a lobbyist for a conservative organisation. The organisation is known to hold radical views on abortion, euthanasia and many other issues. Surely in a democratic society lobbyists like Mr O'Brien are entitled to campaign for their views. It is up to mainstream society to reject their message. End of story. It would be a sad indictment of our democracy indeed, if Mr O'Brien could not have his say.

Incest just isn't a good idea - unless you stop breeding

This German couple (brother and sister) has been living together for six years. They managed to produce a number of children, some of which are seriously disabled. There's a harrowing nasty family background to the story, but that's the gist of it. No doubt many Germans will bicker when they hear that the couple lives in the former East, but truth be told, that's neither here nor there. Incest is illegal in Germany and there's up to three years in jail on the books for the couple. The main reason for such draconian measures is, of course, that reproduction between brother and sister has a 50% chance of serious disability caused by genetic abnormality.
So, no doubt, legally and ethically, what they did was bad. Well, I should be a bit more precise, their decision to reproduce was clearly wrong. There's several things worth thinking about, though.
For starters, why should a sister-brother couple be prosecuted and possibly jailed if they decided to live together, engage in sexual intercourse but do not reproduce (in the case under consideration the 'husband' has undergone a vasectomy and won't therefore be able to impregnate his 'wife' and sister again). They, quite possibly so, should be punished for producing disabled children, but I am less certain that they should be prevented from living together if that is what makes them happy - as long as they do not reproduce any longer.
The other issues is that we do not punish parents whose off-spring suffers similarly high risks of genetic illness (ie a genetically not linked couple whose kids suffer a 50% or higher risk to develop cystic fibrosis will not be threatened with jail if they go ahead and reproduce anyway).
It seems to me that we are not consistent, as a society, in our response to the issue under consideration. If the primary reason against incest is that we're concerned (rightly so) about genetic abnormality and disease among the off-spring of a sister-brother couple, we should deploy the same yard stick in other cases where the risk of genetic illness is similarly high. We are not doing this at this point in time. This strikes me as inconsistent.