The Royal College of Obstetricians and Gynaecologists (RCOG) has today issued a statement saying it had revised its guidelines on abortion counselling. It now says that abortion counselling should be available for those who want it, but should not be mandatory. The new guideline also supports the safety of taking pills at home to induce an abortion – which is currently illegal.

It is interesting that the RCOG is so committed to the idea of abortion that they are not only willing to see their fellow professionals (well, “professionals”) suffer financially due to a lack of work counselling, but they are willing to hit their own hip pockets by allowing people to take home the Morning After pill. Even though it will be inevitably misused.

Bizarre.

SMFS/1: So, your complaint is that the RCOG are putting patients’ welfare above their own pockets? That there isn’t enough of a financial conflict of interest? Well, that makes a change, I admit, from the charges previously stated…

allowing people to take home the Morning After pill.

People have been able to take the Morning After pill home for quite some time. The RCOG are talking about medication that induces abortion – the Nine Weeks After pill, if you like. If you don’t know the difference between the two, perhaps you shouldn’t be commenting on the RCOG’s decision.

Even though it will be inevitably misused.

To do what, exactly?

Oh good – if RCOG are issuing revised guidance then the final outcome of RCPsych’s systematic review must also be due and I get another chance to put the smackdown on Peter Saunders.

@1 It’s only bizarre if you hold the opinion that all public bodies will only rule for things in their financial favour, rather than toward furthering the actual remit of their body.

Oh right, yeah, I forgot. You do hold that opinion.

Excellent.

A step in the right direction.

Now all we need is for the BMA to let us decide for ourselves whether we should smoke in our own cars.

For the million and first time, she isn’t anti-choice, that’s what you are Sunny. Most people define a choice to be a decision made with full information, and most people define full information to be that given to them by an impartial organisation whose financial interests are not served by one particular choice being made.

You defended, pretty vitriolically most of the time, a system that is the total opposite of that just described.

You’re pro-manipulated choice, pro-choice-so-long-as-it’s-the-choice-I’d-like-them-to-make, rather than pro-choice, pro the choice a woman would make if given fully impartial advice. An organisation that benefits from a “yes” rather than a “no” cannot be impartial, even if it’s not for profit.

But then, why am I wasting my time even writing this, when I’ll just get the usual abuse from the pro-manipulated-choice lobby out here, the most prejudiced, ill-informed, illiberal group of folk I’ve come across in a long time. Ironic given the name of this blog…

But the most shocking thing about all of this is the idea that counselling should not be compulsory – regardless of where you stand on abortions.

Healthcare decisions are remarkably important, life defining, yet we are not trained doctors. Those who are trained spend well in advance of 6 years of gruelling training to be where they are, which should tell us something – not that we know better (although I’m sure a few on here would like to think so in their own particular deluded way), but that it’s bloody complicated stuff.

To then allow women to make such a critical, life and death decision, without any guidance at all is really concerning. To ensure they are given advice is not depriving them of the liberty of making their own choice, it’s ensuring they are as best informed as possible about a choice that is life defining. It’s liberty enhancing, if you take off whichever set of ideological blinkers you have on.

@ 5 pagar

“Now all we need is for the BMA to let us decide for ourselves whether we should smoke in our own cars.”

Happily, that’s not their call to make. Although I have serious worries about whoever conducted that study without once realising that you can, in fact, open car windows.

@ 6 James Reade

“You’re pro-manipulated choice, pro-choice-so-long-as-it’s-the-choice-I’d-like-them-to-make, rather than pro-choice, pro the choice a woman would make if given fully impartial advice. ”

I don’t think the pro-manipulated choice thing applies here. It kind of breaks down when you realise that what you’re calling for is women being FORCED to take counselling. If Sunny was trying to force women not to get counselling, you’d have a point.

@6 Yeah, cos liberals and leftys all have a problem with women deciding they want to have kids…
Except that no, actually, they don’t, however some authoritarians and rightys do have a problem with women deciding they don’t want to have kids and thus that is why women have to have compulsory counselling after they’ve already decided on abortion. Plus why do we have to force a counselling session to ensure that the decision is “informed”? One would think that given the importance of such a decision that the pregnant woman concerned might have already taken steps to inform herself perhaps?

@Chaise Guevara #8:

Although I have serious worries about whoever conducted that study without once realising that you can, in fact, open car windows.

I think you’re being unfair. The study relied upon by the BMA for its (now) 11 times a smoky bar figure shows that opening all the windows limits the concentration of toxins to 4 times background.

@ 11 Robin

“I think you’re being unfair. The study relied upon by the BMA for its (now) 11 times a smoky bar figure shows that opening all the windows limits the concentration of toxins to 4 times background.”

What is “backround” in this context? Was the car moving?

The problem is that the BMA used the x11 figure to call for a ban on smoking in cars (doing that normal annoying thing where doctors think medical fact is the be-all and end-all of a moral debate: proving that smoking in cars is extra dangerous is not a complete argument for the banning of the practice). They seemed to ignore the possibility of recommending that people try to avoid smoking in cars, and that they open a window if they do.

The other problem, which in fairness I think is the fault of the media and the public rather than the BMA, is that everyone started conflating smoking in cars with smoking in cars containing children. So most of the people supporting the ban are banging on about endangering children, which is totally irrelevant to me personally, and again not a justification for a total ban on smoking in cars (for the record, I would tentatively support a ban on smoking in enclosed spaces with children assuming it was designed to minimise the negative effects of such a ban).

I appreciate the BMA’s efforts to discover this data and educate the public, but I don’t know what planet they’re on when they say I should be banned from smoking in my car purely for my own safety.

@Chaise (contd):

…and that’s from a single cigraette.

James Reade/6: An organisation that benefits from a “yes” rather than a “no” cannot be impartial, even if it’s not for profit.

Question for you: Do you, when you go to the dentist, ensure that whenever your dentist recommends dental treatment beyond routine cleaning, you always change your registration to a different dentist at that point, so that the new dentist is the one carrying out the work?

If not, why not? Your current dentist clearly has a financial motivation to carry out a wide range of unnecessary fillings on your teeth, since they get a greater income that way. (Even worse, most dentists are for-profit, where the financial interest is presumably even greater).

There are rare dentists, of course, who do recommend unnecessary treatment for profit. And when we find evidence of this, there are mechanisms within the medical profession to have those dentists treated appropriately. We do not, however, require by law all dental patients to have an separate assessing dental practice and treatment dental practice, with no financial link between the two, as we would if we believed all dentists were like this.

The mere possibility of a financial conflict of interest is not sufficient grounds to take action – action that would severely inconvenience both patients and the majority of honest medical staff – to ensure that there cannot be one at all. One would need evidence that almost all dentists – or abortion providers – were acting on the potential conflict of interest over and above their medical duty of care to their patients, such that there was a major systematic issue which could not be solved by dealing with individual cases.

You have provided no evidence whatsoever, in any of these debates, to go from “potential financial conflict of interest” to “actual, widely acted-upon financial conflict of interest harming patients’ interests”.

One minute right-wingers say people should be allowed to make own decisions on health, the next minute they’re condemning health practioners for saying women should be allowed to make their own decisions on health..

Hmmm… wonder why that is?

@Chaise #12:

What is “backround” in this context?

Equilibrium measurements taken with the car at rest with no cigarette being/having been smoked.

Note though that the other measurementswere with a single cigarette being smoked, and no build-up from multiple cigratettes/smokers in the car.

The other problem, which in fairness I think is the fault of the media and the public rather than the BMA, is that everyone started conflating smoking in cars with smoking in cars containing children.

Actually, that’s the BMA as I understood the segment on Today – the argument is that it makes enforcement easier if it isn’t necessary to identify a child in the car – since whatever age is taken as a cut-off, establishing the putative child’s age in moving traffic isn’t easy…

There is of course also the distraction issue; as well as the fact that if you’re using a mobile phone with one hand, and smoking a cigarette with the other, how do you steer/change gear safely?

@ 16 Robin Levett

“Equilibrium measurements taken with the car at rest with no cigarette being/having been smoked.”

That doesn’t tell us much about the amount of cigarette toxins. I have no idea what level of toxins are found in the air inside a car, but I would expect the answer to be “very little” if the car’s at rest (as presumably the exhaust isn’t an issue). So it’s hardly surprising that smoking a fag would make a big difference.

“Actually, that’s the BMA as I understood the segment on Today – the argument is that it makes enforcement easier if it isn’t necessary to identify a child in the car – since whatever age is taken as a cut-off, establishing the putative child’s age in moving traffic isn’t easy…”

Yeah, but that’s the same as saying “It’s easier to enforce the law if we don’t actually have to show that someone was doing anything wrong”. It’d be easier to confiscate alcohol off of underage drinkers (how can you tell by looking whether someone is 17 or 18?) if we just banned booze outright. It’s heavy-handed. I think it’s bizarre to create a law that would result in most of the people prosecuted being innocent of the action that led to the creation of the law in the first place.

“There is of course also the distraction issue; as well as the fact that if you’re using a mobile phone with one hand, and smoking a cigarette with the other, how do you steer/change gear safely?”

I can help you out here as a smoker and a driver. Smoking isn’t noticeably distracting except at the point where you light the cigarette, when it admittedly is. I honestly think I’d be more likely to crash because I was playing with the radio or trying to make sense of the sat-nav.

As for maintaining control: smoking doesn’t actually take up the use of one of your hands. If I’m smoking when driving, I still have all of the fingers of that hand on the wheel most of the time. You do have to move away from the wheel to inhale or stub out the fag, but obviously you don’t do that during a tight bend or when changing lanes or whatever.

(Where does the mobile phone come into it? Using a phone while driving is already illegal. And taking both hands off the wheel so you can talk on the phone and take a puff on a fag at the same time is just fucking stupid.)

I think that the possibility of smoking compromising your driving ability is a much more reasonable concern that the fact that you’re harming your own body by doing so. There’s another aspect you missed, too – the possibility of hot ash falling in your lap, which is obviously very distracting. But it would need tests of its own. I personally think it’s no more dangerous than things that are currently allowed, like using a radio or sat-nav, or even just chatting to your passengers.

@Chaise #17:

And taking both hands off the wheel so you can talk on the phone and take a puff on a fag at the same time is just fucking stupid

When did that become a criterion for judging whether a driver would nevertheless do it?

2. cim

So, your complaint is that the RCOG are putting patients’ welfare above their own pockets? That there isn’t enough of a financial conflict of interest? Well, that makes a change, I admit, from the charges previously stated…

Not complaint, observation.

People have been able to take the Morning After pill home for quite some time. The RCOG are talking about medication that induces abortion – the Nine Weeks After pill, if you like. If you don’t know the difference between the two, perhaps you shouldn’t be commenting on the RCOG’s decision.

My mistake. A Nine week after pill is actually worse. There are things that women go through which ought to be done in a hospital under proper medical supervision, or at least I tend to think so.

To do what, exactly?

Children will eat it by mistake. People will take the wrong dose. People will use at when they are at six months rather than nine weeks. Boyfriends will sneak it into their unwitting and unwilling girlfriend’s food. There are any number of ways that medication is routinely misused. Some deliberate, some not. Which is why sometimes medical supervision is a good idea.

4. Cylux

It’s only bizarre if you hold the opinion that all public bodies will only rule for things in their financial favour, rather than toward furthering the actual remit of their body.

Since when is more abortion in the remit of the Ob/Gyns?

Oh right, yeah, I forgot. You do hold that opinion.

Well I am on a Leftist site. I should observe the rules. It is the safe way to bet with professional bodies.

@19

Since when is more abortion in the remit of the Ob/Gyns?

It isn’t, and that’s not why they made the changes they did, patient care and all that jazz, however, is.
Generally, putting hurdles in the way of women who have already made their mind up achieves little but to piss them off, cause them unnecessary stress, and waste everyone’s precious time and money into the bargain. Those that are considering but haven’t made their minds up will have access to any counselling services they so desire in order to make up their minds one way or the other.

@ 18 Robin

“When did that become a criterion for judging whether a driver would nevertheless do it?”

It didn’t. But banning smoking to prevent people from smoking and using a phone at the same time is again using a hammer to crack a nut, even ignoring the fact that, as I pointed out, using a phone while driving is already illegal.

So, thus far, the supporting arguments for this ban seem to be:

1) In case the driver uses a phone at the same time, even though that’s illegal anyway.

2) Smoking will harm the children who may not actually be in the car.

3) Smoking MAY make you significantly more likely to crash.

The first two are frankly silly: 1 is already covered by the legal system, and 2 could be dealt with using a law that is actually appropriate to the issue. 3′s got potential, but you’d need data.

@1 – Yes, there are these foreign things to you like “professional ethics” …scratch that, “ethics”.

@5 – Oh absolutely. Also, you should be allowed to smoke weed in your car as well. (Waits for the explosion)

20. Cylux

It isn’t, and that’s not why they made the changes they did, patient care and all that jazz, however, is.

It is hard to see how less patient care amounts to more or better patient care.

@ 22 Leon

“Also, you should be allowed to smoke weed in your car as well. ”

As long as you’re not planning to drive it.

19/SMFS: Children will eat it by mistake. People will take the wrong dose. People will use at when they are at six months rather than nine weeks. Boyfriends will sneak it into their unwitting and unwilling girlfriend’s food.

These are all risks associated with allowing anyone to take any medication – prescription or over-the-counter – home with them. The exact same arguments could be used to say that the practise of allowing people to take paracetamol home with them is dangerous (never mind some of the anti-cancer or mental health drugs which have really severe side-effects). In practice, the risks you mention are actually considerably lower for abortion medication than for many other pills already available on prescription.

Children will eat it by mistake.

Certainly no greater risk than any other pill. Probably less, since as it’s rarely in the house and only going to be in the house for a very short time, they’re far less likely to get their hands on it than a pack of paracetamol or aspirin

People will take the wrong dose.

Generally the dosage is two pills, taken a few days apart. It’s not completely impossible from that to take the wrong dose, but there is both fairly limited scope for error – especially compared with many other prescription medicines – taking both at once, or forgetting to take the second one, wouldn’t be ideal, but wouldn’t be that bad either.

People will use at when they are at six months rather than nine weeks.

They’d have to have obtained it at (up to) nine weeks, then decided not to use it (but not returned it), then decided several months later to take it anyway. It’s not impossible, but it’s going to be pretty rare.

Boyfriends will sneak it into their unwitting and unwilling girlfriend’s food.

I’m not sure it’s proportionate to ban all patients from taking the pills home with them on the grounds that theoretically an abusive boyfriend, who was around 4-9 weeks pregnant, might get a doctor to give them the pills, take them home, and then give them to their girlfriend instead – especially given that there are plenty of other prescription medications, over-the-counter medications, and substances not approved for use as medication but available in many non-medical shops that they could already give their girlfriend without having some very traceable interactions with medical staff.

There are things that women go through which ought to be done in a hospital under proper medical supervision, or at least I tend to think so.

Sure – you won’t find me advocating for home heart transplant kits – but “taking a pill” is generally not considered something that requires full medical supervision. The point of allowing it to be taken at home is to allow the people taking it to be somewhere comfortable when the (unpleasant but generally not dangerous) side-effects start, rather than unnecessarily taking up space in a hospital, or having the side-effects start on the journey home.

23/SMFS: It is hard to see how less patient care amounts to more or better patient care.

Okay – well, still on medication – lets make paracetamol and other low-strength painkillers only available from GPs after a short consultation. Clearly patients needing painkillers are getting more medical care as a result, but I think it would be hard to argue that they’re getting better medical care as a result. (And everyone needing things other than low-strength painkillers also gets worse care, because the doctors are too busy handing out aspirin) So clearly less direct patient care can be better in some cases.

In this case, the “less is better” comes from allowing patients to deal with the side effects somewhere more pleasant than either a hospital or the journey home.

Sunny,

I’ll bite then…

One minute right-wingers say people should be allowed to make own decisions on health, the next minute they’re condemning health practioners for saying women should be allowed to make their own decisions on health..

Hmmm… wonder why that is?

Because they are different people. Would seem to be the logical explanation (OK – there are some inconsitent old-style big-state conservatives out there as well…). For example, I’ve been saying constantly that decisions about your health are up to you alone – and check back, I’m an advocate of any stage abortion as a result. I think this guideance is excellent – it recognises the fact that many people have made a decision and don’t want to have to discuss it with someone, and that the decision should be implemented as easily as possible.

I also believe the same thing about every other medical issue (and yes, pregnancy and abortion is purely a medical issue – ethics only apply to living people, and a foetus is by definition not a living person). I can’t see how we can have care rationed by the NHS which effectively selects doctors and treatments for us without consultation (or rather, with consultation with doctors but without choice to the patient), but can then support having abortion without the same problems. It is as inconsistent as saying that “people should be allowed to make own decisions on health,” then “condemning health practioners for saying women should be allowed to make their own decisions on health”.

This seems to be an straighforward issue. Either the health practioners know best, in which case we should submit to their judgements, or there should be freedom of choice with health practiconers acting when required to by patients. That far too many people can adopt one position on health and the other on abortion seems strange to me, but perhaps reflects the fact that too many on left and right parrot ideology without thinking it through.

So Much for Subtlety,

My mistake. A Nine week after pill is actually worse. There are things that women go through which ought to be done in a hospital under proper medical supervision, or at least I tend to think so.

Maybe, but passing an embryo in the first trimester is not one of them. Miscarriages at this stage are relatively frequent, and are not normally harmful (other than being traumatic obviously); this sort of pill would simply induce a miscarriage. Not a pleasant thing to think of, or perhaps experience, but (and I seriously hope I am correct here) probably no more dangerous than a cure for constipation.

Children will eat it by mistake.

Are you saying we might accidentally cut the teen pregnancy rate? Otherwise, I doubt this is serious – anyway, it is normal to keep medicine out of the reach of children (I think the danger of say paracetomal might be a lot greater myself…).

People will take the wrong dose.

Ah yes, that’s why people always have to go to hospital to be medicated. We have to trust people to follow instructions with medicine you see…

People will use at when they are at six months rather than nine weeks.

I suspect the effect would be minimal at that point, since this will not be a magic ‘flush the womb’ pill…

Boyfriends will sneak it into their unwitting and unwilling girlfriend’s food.

Simple case of assualt there – of course, the boyfriend might have a bit of trouble getting hold of it, considering he could not be, by definition, pregnant. So other than rather open Lesbian relationships (sorry – I’m doing my best to take these objections seriously) is this really an issue?

There are any number of ways that medication is routinely misused. Some deliberate, some not. Which is why sometimes medical supervision is a good idea.

Personally I think doctors and state-supervised medicine have too much of a role. As Sunny points out, you seem to have found a position which only logically works if you believe the NHS should be more centralised and more powerful. Otherwise, you are either clutching at straws or believe that this pill is far more powerful than it actually is.

Cylax @ 10 Plus why do we have to force a counselling session to ensure that the decision is “informed”? One would think that given the importance of such a decision that the pregnant woman concerned might have already taken steps to inform herself perhaps?

Well, perhaps, but perhaps not. Perhaps she thinks she knows all she needs to, but actually she doesn’t. When you’re prescribed medication (any medication) or even buy it over the counter, it comes with a printed list of possible risks and side effects, with which to inform yourself. When you’re going for any sort of medical procedure, even a minor one, the doctor will not only give you information about risks and side-effects, but get you to sign a piece of paper saying you’ve been informed and you understand, and still want to go ahead. Does this not happen in the case of abortion? Shouldn’t it, even if the woman says she’s made up her mind, wants an abortion and doesn’t want counselling?

@28 You’re comparing a counselling session with a quick medical run down of procedures and possible complications – they ain’t the same thing. Indeed that sort of information isn’t what those opposed to abortion usually mean when they say “informed choice”.

@8

It’s also worth remembering that it’s believed the most toxic chemicals from smoking stay in fabrics for a long time after the smoke has been cleared.

That and you’ll find some pro a ban on smoking in cars have been burnt by people throwing out stubs, or to much hilarity on our part, a ex partner of a friend of mine getting his crotch burnt while sitting in the back, as her mother threw out her cigarette stump just for it to blow straight in the back window…
Hilarious for us, not so much for him…

Cyclists have been known to get hit in the face by stumps, it’s happened to me on occasion when I used to cycle to college many many years ago.

I guess you could say, they should just ban throwing cigarettes out of windows, but that’s even harder to enforce than an overall ban. I personally think they are unlikely to bring a ban in at all anyway, as it’s so difficult to enforce and generally there are better things our police et al should be focused on right now. (Or most likely, ever.)

@ 30 Annarage

“It’s also worth remembering that it’s believed the most toxic chemicals from smoking stay in fabrics for a long time after the smoke has been cleared.”

I’ve heard about this, but I’ve yet to hear anything compelling about the health dangers. If they soak into the fabric, do they suddenly jump back out the moment a human is nearby and give them lung cancer? It just sounds sketchy based on the evidence I’ve been given.

“I guess you could say, they should just ban throwing cigarettes out of windows, but that’s even harder to enforce than an overall ban.”

It’s actually already illegal. Littering. And I think you get a harsher penalty for throwing away fags than, say, a crisp packet (seems unfair to me if the cigarette is extinguished, but there you go). And yes, I think banning smoking in cars to stop people throwing out fag ends is throwing the baby out with the bath water. Basically the same as banning eating in the street to make it easier to prevent litter, or banning music to prevent noise pollution.

The problem is that smokers are a small percentage of the population, and therefore it’s fairly easy to screw them over. I know some people who want all public smoking banned. Given that office smoking rooms are already illegal, that means forcing me not to smoke between leaving for work and arriving back home, i.e. for about 10 straight hours a day. This seems excessive.