The silly reason why every abortion requires two signatures


by Unity    
9:40 am - March 24th 2012

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In his ongoing war on abortion rights, yesterday Andrew Lansley said:

The rules in the Abortion Act are there for a reason – to ensure there are safeguards for women before an abortion can be carried out. To protect women, the right checks and balances must be in place.

Lansley is referring specifically to the rule that two doctors are required to sign off a request for an abortion, which is the only medical procedure in which the law requires a second medical opinion before the procedure takes place.

The idea that this requirement has anything at all to do with providing ‘safeguards’ for women is complete crock of shit.

It is a medico-legal fiction that was deemed necessary and expedient at the time that the-then Abortion Bill was making its way through Parliament in order to secure sufficient support to ensure that it passed into law.

For the truth behind the origins of the ‘two doctor rule’ we need to go all the way back the case of Dr Aleck Bourne, a gynacologist who, in 1938, performed an illegal abortion on a 14 year girl who had become pregnant after being raped and sexually assaulted by a group of five officers from the Royal Horse Guards.

The termination took place at St Mary’s Hospital, London, after the girl had approached doctors at St Thomas’s Hospital only to be turned away on the grounds that she might be carrying a future Prime Minister*.

Bourne was tried at the Old Bailey in July 1938 and was acquitted on a charge of procuring an abortion after successfully defending his actions on the grounds that S58 of the Offences Against the Person Act 1861 permitted a defence of justification where an abortion was undertaken before 28 weeks gestation in circumstances in which the woman’s physical or mental health was in danger.

The Bourne judgement set an important legal precedent which allows doctors to perform abortions in limited circumstances however the risk of prosecution remained a very real threat if it could be argued that doctor had been too lax in their interpretation of the threat that the continuation of a pregnancy posed to a pregnant woman when they performed an abortion, prompting doctors to adopt the practice of obtaining a second opinion as defence against this threat.

The ‘two doctor rule’ was nothing more than a means of covering a doctor’s arse if they did perform an abortion and had nothing whatsoever to do with providing any kind of ‘safeguards’ to women.

Things have, of course, changed considerable the 74 years since the Bourne judgement, and the 45 years since the Abortion Act became law, such that its long past time that the two doctor rule was dispensed with as an unnecessary anachronism.

If, as is being alleged, some doctors have been pre-signing their ‘second signature’ on abortion consent forms it only because they recognise the ‘two doctor rule’ for what it is – an archaic medico-legal fiction which serves no useful purpose.

This fact that appears to be entirely lost on Andrew Lansley.


*It appears that the ‘You’ve killed Beethoven’ fallacy has been around for rather longer that I’d previously imagined.

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About the author
'Unity' is a regular contributor to Liberal Conspiracy. He also blogs at Ministry of Truth.
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Reader comments


Perhaps. But that is how so much law and practice is developed; by common practice, tradition and formalising of work practices.

The fact is its the law. You challenge laws within the legal framework, or risk prosecution. That is *particularly* true in the workplace where we all have to follow counterintuitive legislation and restrictions.

Clearly an outdated stupid law, fancy requiring a countersignature before committing murder to accommodate someone’s lifestyle choices.

I thought this was all changed in the 2005 Election,well it was in the manifesto

4. the a&e charge nurse

“Lansley is referring specifically to the rule that two doctors are required to sign off a request for an abortion, which is the only medical procedure in which the law requires a second medical opinion before the procedure takes place” – there are other medical procedures which require a ‘SOAD’ (second opinion appointed doctor).
http://www.gpnotebook.co.uk/simplepage.cfm?ID=-1268056060

Most abortion fall into a wider category of ‘problems in living’ that have become medicalised – in other words the patient does not have a health problem per se, rather a problem in getting access to the appropriate technology.

Wouldn’t it be far easier to introduce over the counter medical abortion kits with details of a few websites highlighting possible complications – surely this is the next logical step given that post coital contraception is now well established?

5. So Much For Subtlety

If, as is being alleged, some doctors have been pre-signing their ‘second signature’ on abortion consent forms it only because they recognise the ‘two doctor rule’ for what it is – an archaic medico-legal fiction which serves no useful purpose.

This fact that appears to be entirely lost on Andrew Lansley.

That may be true. It may not be. I am not sure you have some special insight into the workings of Parliament at the time. But for the sake of the argument, let’s agree it is true.

It is irrelevant. The law says two doctors are required to give a good faith opinion. Those pre-signing the forms are breaking the law. For which they ought to be charged and probably struck off.

If you don’t like it, lobby Parliament to change the law. Don’t insist that the rule of law is only allowed to operate when it agrees with your prejudices.

so if requiring two doctor’s signatures is there to cover the doctor’s arse, what happens if the requirement for them are removed? Does it make more prosecutions more likely?

I have a lot of sympathy for this argument. And I’m not an opponent of abortion or a supporter of making women have babies they don’t want because I think an old man with a beard says so.

But this really was pretty stupid of them.

8. the a&e charge nurse

[7] “But this really was pretty stupid of them” – it only seems stupid because of the millions of abortions performed since the act came in.

Back then there was probably a belief that abortion would not become quite so commonplace, and would require some sort of medical assessment (rather than the perfunctory rubber stamp system we are all familiar with).

The legislation amounted to abortion on demand although not too many would openly admit, or accept this in the ’60′s.

9. James Reade

So again, another writer on here tells us we can break laws because we don’t like them. Interesting. The rioters didn’t like particular rules and broke them, but that was wrong. What kind of a society will we have if we advocate breaking laws we don’t like?

Also, I just still don’t get why the woman’s rights are trumped at every stage here (on LC) over those of the unborn child – why is that? Just don’t understand it.

So was the law actually broken by the existence of pre-signed forms? Or is it in fact within the rules but going against what was intended?

“…ongoing war on abortion rights” shouldn’t that be “…ongoing war on abuses of abortion rights and criteria”?

Cylux/10: Arguably not, no. The relevant bit is section 1.1 of the Act:
[...] if two registered medical practitioners are of the opinion, formed in good faith
…and then four alternative conditions, which are, as amended:
1) Before 24 weeks, if there is a risk of injury from proceeding with pregnancy to the woman’s (or existing childrens’) mental or physical health greater than that of not proceeding.
2/3) At any time, if grave permanent injury or death is risked from proceeding.
4) At any time, in the event of serious physical/mental abnormalities in the fetus.

Given that the risk of health effects from abortion is always less than the risk from pregnancy and childbirth, I think it would be quite possible for a medical practitioner to form the good faith opinion that the time limit is the only part of condition 1 which might not be true, and that the first doctor can check that easily and reliably enough, so they might as well sign the form in advance.

Whether a judge would accept that argument I don’t know, but in terms of a literal reading of the law and current medical science, it makes some sense. (And given that that part of the law is clearly utterly pointless as it stands, the courts might well be persuaded to rule that way)

13. So Much For Subtlety

12. cim

Arguably not, no. The relevant bit is section 1.1 of the Act:
[...] if two registered medical practitioners are of the opinion, formed in good faith
…and then four alternative conditions, which are, as amended:

Sorry but yes. The bit you quote requires a doctor to form an opinion is good faith. Signing a form for a patient that the doctor has never seen cannot be a decision made in good faith. In fact if you look it up in a dictionary it would be almost the definition of bad faith.

1) Before 24 weeks, if there is a risk of injury from proceeding with pregnancy to the woman’s (or existing childrens’) mental or physical health greater than that of not proceeding.
2/3) At any time, if grave permanent injury or death is risked from proceeding.
4) At any time, in the event of serious physical/mental abnormalities in the fetus.

Given that the risk of health effects from abortion is always less than the risk from pregnancy and childbirth, I think it would be quite possible for a medical practitioner to form the good faith opinion that the time limit is the only part of condition 1 which might not be true, and that the first doctor can check that easily and reliably enough, so they might as well sign the form in advance.

Except the doctor is not being asked to make a statistical prediction of the risks to women generally. He is being asked to make a prediction about the patient in front of him. So he cannot use that argument. He does not know from the case he is dealing with whether or not there is a risk, unless there is a risk in this case. Claiming that there is some nebulous risk to all women is not the same as saying there is a risk in this case. It is simply not possible for a doctor to claim in good faith that because x% of pregnancies go wrong, this specific one in front of him will go wrong and poses a risk.

Whether a judge would accept that argument I don’t know, but in terms of a literal reading of the law and current medical science, it makes some sense. (And given that that part of the law is clearly utterly pointless as it stands, the courts might well be persuaded to rule that way)

No it does not make sense. It is a deliberate twisting of the law’s words and intent. I agree there is no way to know what a judge would make of it. It is only utterly pointless because we have all quietly agreed to ignore the law being flouted on a regular basis. These doctors ought to be charged and struck off.

14. Abdul Abulbul Emir

Mrs A says

We are jolly lucky that abortion is easy to get over here Abdul.

That’s why they have a growing too old population and need lots of 3rd world immigrants like us.

The West is changing quickly thanks to the wonderful 60s legislation.

They are so clever by half Abdul.

Hahahahah

Peace

SMFS/13: Signing a form for a patient that the doctor has never seen cannot be a decision made in good faith.

So you would contend on those grounds that a doctor, for instance, could not form a good faith opinion without seeing the patient that, where a patient had both a broken leg and a stubbed toe on the other foot, the broken leg was the more serious injury?

I’m not talking about statistical chances that the pregnancy could go wrong – those would be covered under subsections 2 or 3 anyway. I’m talking about the health of effects of pregnancy+childbirth compared with the health effects of abortion. Even if everything goes exactly right in a safe low risk way then pregnancy is extremely physicallly and mentally draining and life-affecting for several months, and childbirth similarly for hours to days. (Oh, and then you have a child to look after)

Conversely, an early term abortion involves taking a couple of pills and a few days of side effects, and even the (rarer) later-term surgical abortion is over relatively quickly.

I think it’s an insult to a doctor’s intelligence and training to say that they can’t form a good faith opinion of which is the greater health risk – bearing in mind that subsection 1 does not even require the increase in risk to be in any way substantial – without going through the patient’s medical record in detail, given that another highly-qualified doctor has already just done that.

For that matter, it’s equally insulting for some of the subsection 2 and 3 stuff. Do you really need two doctors to determine that an ectopic pregnancy is going to be fatal if untreated, for instance? As the original post said, the idea that it’s a difficult assessment is a consequence of ancient legality – and, also, advances in medical care: safe chemical abortions postdate the original legal precedent, for instance.

16. Chaise Guevara

“the girl had approached doctors at St Thomas’s Hospital only to be turned away on the grounds that she might be carrying a future Prime Minister”

And what if she had, and it had turned out to be an EVIL prime minister? What then?

Stupid bloody argument.

17. Planeshift

“And what if she had, and it had turned out to be an EVIL prime minister? What then?”

We’d need to send a robot back in time to perform the abortion and offer bad sci-fi writers the opportunity to explore the contradictions we’d have created.

18. James from Durham

chaise at 16

Is there another kind?

“an early term abortion involves taking a couple of pills and a few days of side effects”

and a huge dose of artificial hormones, which in the case of some women is repeated any number of times, and the long-term effects of which are still to be discovered.


Reactions: Twitter, blogs
  1. Liberal Conspiracy

    The silly reason why every abortion requires two signatures http://t.co/CKzq6jmG

  2. Jason Brickley

    The silly reason why every abortion requires two signatures http://t.co/fTZHrGLO

  3. BevR

    The silly reason why every abortion requires two signatures http://t.co/48TNqIda #saveournhs #GPs #wrb #braveheart #democracybroken

  4. Paul Crowley

    If doctors are sidestepping the "two doctor rule" on abortions, it's because they can see it's a silly anachronism http://t.co/ofxOFXPs

  5. Patron Press - #P2

    #UK : The silly reason why every abortion requires two signatures http://t.co/YCLiuXcp

  6. Kim Blake

    The silly reason why every abortion requires two signatures http://t.co/CKzq6jmG

  7. Kim Blake

    High time this was got rid of! RT @libcon: The silly reason why every abortion requires two signatures http://t.co/fgVXZHOn #prochoice

  8. Rachel Surtees

    The silly reason why every abortion requires two signatures http://t.co/CKzq6jmG

  9. Neo Street King

    #UK : The silly reason why every abortion requires two signatures http://t.co/YCLiuXcp

  10. Paul Wood

    Interesting RT @libcon: The silly reason why every abortion requires two signatures http://t.co/PpPIKa8W

  11. Siren of Brixton

    “@libcon: The silly reason why every abortion requires two signatures http://t.co/0cJWzYc2” as usual, women's issues have different rules

  12. Jill Hayward

    The silly reason why every abortion requires two signatures http://t.co/CKzq6jmG

  13. Neil Courtman

    The silly reason why every abortion requires two signatures http://t.co/CKzq6jmG

  14. Jane Phillips

    The silly reason why every abortion requires two signatures http://t.co/CKzq6jmG

  15. leftlinks

    Liberal Conspiracy – The silly reason why every abortion requires two signatures http://t.co/GVWnIThi

  16. Stephanie Brooke

    “@libcon: The silly reason why every abortion requires two signatures http://t.co/0cJWzYc2” as usual, women's issues have different rules

  17. Justine Ossum

    The silly reason why every abortion requires two signatures http://t.co/CKzq6jmG

  18. Paul Nezandonyi

    RT @libcon: The silly reason why every abortion requires two signatures http://t.co/yNR9SnfH

  19. Martin Campbell

    The 74-yr-old rape case behind the silly 2-doctor rule in #abortion. @Unity_MoT blogs. http://t.co/smFZvyNh

  20. Richard Hemming

    RT “@libcon: The silly reason why every abortion requires two signatures http://t.co/xRq5FMum”

  21. Chris Boyle

    If doctors are sidestepping the "two doctor rule" on abortions, it's because they can see it's a silly anachronism http://t.co/ofxOFXPs

  22. OccupyWomen

    #WomenRights The silly reason why every abortion requires two signatures (Liberal Conspiracy): Yest… http://t.co/BeRlFuRr #OccupyWomen

  23. Scriptrix

    The silly reason why every abortion requires two signatures | Liberal Conspiracy http://t.co/NJOrDiFW via @libcon

  24. Alison Charlton

    Kind of glad this 'two doctors' abortion rule has come up for debate. It is a ridiculous anachronism: http://t.co/lRlG8Jh6

  25. Moonbootica

    Kind of glad this 'two doctors' abortion rule has come up for debate. It is a ridiculous anachronism: http://t.co/lRlG8Jh6

  26. Lola Betts

    The silly reason why every abortion requires two signatures http://t.co/CKzq6jmG

  27. Warren Peace

    The silly (and patronising) reason why every abortion in the UK requires two signatures http://t.co/ibO1O0Lp

  28. Dominic Jones

    The silly (and patronising) reason why every abortion in the UK requires two signatures http://t.co/ibO1O0Lp

  29. Tomos Heise

    The silly (and patronising) reason why every abortion in the UK requires two signatures http://t.co/ibO1O0Lp

  30. Megan Radclyffe

    RT @libcon: The silly reason why every #abortion requires two signatures http://t.co/o5U8Khgf #wordsailme

  31. Tom

    The silly (and patronising) reason why every abortion in the UK requires two signatures http://t.co/ibO1O0Lp

  32. Lynne Jones

    The silly (and patronising) reason why every abortion in the UK requires two signatures http://t.co/ibO1O0Lp

  33. itsnotme

    The silly reason why every abortion requires two signatures | Liberal Conspiracy http://t.co/gBb0ZpGG via @libcon

  34. Jamie McPherson

    interesting article about origins of the "two doctor rule" for uk terminations http://t.co/lUpQaFKB

  35. ellen

    The silly reason why every abortion requires two signatures http://t.co/qVAR2nno via @libcon

  36. Sharan Gill

    Lansley should study more history #lansley RT@nellefant: The silly reason why every abortion requires two signatures http://t.co/KTTKDS9C

  37. Paul Southworth

    "The idea that this requirement has anything atall to do with providing safeguards for women is complete crock of shit" http://t.co/rEgSkU96





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