Medicine and abortion law: complicating the reforming profession

Social Science and Medicine, 2018

The recent 50th anniversary of the 1967 Abortion Act provides the opportunity to revisit what has been termed the 'remarkable authority' this Act ascribes to doctors. This paper does so using as its starting point a seminal commentary on this question by the renowned medical sociologist Sally Macintyre, published in this journal in 1973 as 'The Medical Profession and the 1967 Abortion Act in Britain'. We revisit themes from that paper through an analysis of the findings of interviews with 14 doctors who, throughout lengthy careers, have provided abortions and led the development of the abortion service in England and Wales. We contrast our findings with Macintyre's, and argue that our interviews highlight the shifting meaning of medical authority and medical professionalism. We show that those doctors most involved in providing abortions place moral value on this work; uphold the authority of women (not doctors) in abortion decision-making; view nurses and midwives as professional collaborators; and consider their professional and clinical judgement impeded by the present law. We conclude that medical sociologists have much to gain by taking abortion provision as a focus for the further exploration of the shifting meaning of medical authority.

In the 1960s and early 1970s, policy-makers in Britain and the United States considered proposals to make abortions more readily available. The main doctors' associations in each country responded differently to these proposals. Doctors' associations in both countries initially sought to preserve clinical autonomy by ensuring that doctors could continue to "diagnose " the "medical necessity " of abortions. However, the American Medical Association (AMA) eventually changed its position to allow abortion on request. The study explains this difference by way of an "historical priorities " approach to analyzing the construction of collective political demands. It argues that "policy legacies" provide contexts in which collective actors prioritize among their policy desires. The study finds that because of differing health care policy legacies British doctors' associations viewed abortion clinical autonomy as a higher priority than did the AMA. Moreover, British doctors' associations were most concerned about patient infringements on clinical autonomy, while the AMA was equally concerned about state infringements on autonomy.

Social Problems, 2003

In the 1960s and early 1970s, policy-makers in Britain and the United States considered proposals to make abortions more readily available. The main doctors' associations in each country responded differently to these proposals. Doctors' associations in both countries initially sought to preserve clinical autonomy by ensuring that doctors could continue to "diagnose" the "medical necessity" of abortions. However, the American Medical Association (AMA) eventually changed its position to allow abortion on request. The study explains this difference by way of an "historical priorities" approach to analyzing the construction of collective political demands. It argues that "policy legacies" provide contexts in which collective actors prioritize among their policy desires. The study nds that because of differing health care policy legacies British doctors' associations viewed abortion clinical autonomy as a higher priority than did the AMA. Moreover, British doctors' associations were most concerned about patient infringements on clinical autonomy, while the AMA was equally concerned about state infringements on autonomy.

Journal of Law and Society, 2003

This article discusses policy and practice in abortion provision, paying particular attention to the provision of counselling before abortion. It discusses the way the Abortion Act 1967 constructs the woman seeking abortion, the reasons for the development of a policy about abortion counselling in the 1970s, and that policy's relationship to the assumptions about women underlying the statute. The ways in which policy has developed since 1977 are considered, and how policy and practice have come to view women seeking abortion in a way that contrasts with the construction of them that emerges from the law. Thus, the article argues, given that the 1967 Act and other rules that regulate abortion provision seem to rest on contradictory assumptions, the law should be reformed in line with policy and practice.

2022

Abortion is a medicalised problem in England and Wales, where the law places doctors at the centre of legal provision and puts doctors in control of who has an abortion. However, the sex-selection abortion scandal of 2012 presented a very real threat to 'abortion doctors', when the medical profession's values and practices were questioned in the media, society and by Members of Parliament. Doctors found themselves at the centre of a series of claims that stated doctors were acting both illegally and unethically, driven by profit rather than patient needs. Yet, the perspectives of those doctors who provide abortions has been under-researched; this thesis aims to fill that gap by examining the beliefs and values of this group of doctors. Early chapters highlight the ambiguous position of the abortion provider in Britain, where doctors are seen as a collective group of professionals motivated by medical dominance and medical autonomy. They outline how this position is then ...

2018

American journal of public health, 2003

The autonomy granted to physicians is based on the claim that their decisions are grounded in scientific principles. But a case study of the evolution of the American College of Obstetricians and Gynecologists' abortion policy between 1951 and 1973 shows that decisions were only secondarily determined by science. The principal determinant was the need to preserve physician autonomy over the organization and delivery of services. As a result, the organization representing physicians who specialized in women's reproductive health was marginal to the struggle for legalized abortion. But, the profession was central to decisions about whether physicians would perform abortions and how they would be done. This case study finding has implications for understanding the role that organized medicine might take in the ongoing debates about national health policy.

The Modern Law Review, 2019

UK abortion law remains unsettled, and is subject to ongoing controversy and reform. This article offers for the first time a comprehensive critique of the reforms which have been implemented or proposed since 2016. First, it will examine reforms proposed in both Houses of Parliament at Westminster. This article will contextualise these reforms within a wider public law analysis, showing both that the complex parliamentary processes relating to Private Members' Bills have frustrated reform attempts, and that these attempts have been contradictory in their aims between the two Houses. Secondly, it will examine the unique positions of Northern Ireland, Scotland and Wales. In doing so, it will show the extent to which the different devolutionary settlements have influenced both the reforms themselves and the nature of executive involvement. Finally, this article will examine the potential impact of the courts on abortion law following Re Northern Ireland Human Rights Commission's Application for Judicial Review [2018] UKSC 27. It will show that the Supreme Court's reframing of the debate in human rights terms is likely to affect abortion law, not only in Northern Ireland, but in the whole of the UK. The 50th anniversaries of the enactment and subsequent commencement of the Abortion Act 1967 fell in October 2017 and April 2018 respectively. This Act allows abortions to be conducted legally in England, Wales and Scotland in certain circumstances. These anniversaries have not been marked with complacency. Rather, the current and previous parliamentary sessions have witnessed several attempts to reform law and practice in this area in all three of the constituent nations affected by the Act. These reforms have been proposed both by primary legislation and through executive action; one of the latter reforms is now subject to an ongoing judicial review action. Meanwhile two judgements have been handed down by the Supreme Court within the last year in light of the comparative restrictiveness of the law in Northern Ireland. Calls have been made in Westminster to liberalise the law in Northern Ireland, following both these cases and the result of the referendum in the Republic of Ireland held in May 2018 which enabled the Irish Parliament to legislate on that nation's similarly restrictive abortion laws. The recent reforms and current proposals have received little acknowledgement within the legal community. Yet they are of considerable importance. Cumulatively the decisions of all three branches This article has been accepted for publication in the Modern Law Review, and is scheduled to appear in (2019) 82:1. of the state-executive, legislature and judiciary-will make considerable changes to the availability of abortion in the four constituent nations of the UK. The proposals also reflect some of the most prominent debates on abortion: medical paternalism versus patient autonomy, self-administration of misoprostol in a non-clinical setting, the number of weeks of gestation during which abortion remains appropriate, and protection of foetal rights. Therefore, whatever the outcome of these particular proposals for reform, it is likely that the three branches of the UK state will witness further debate on the issues advanced therein in due course. The changes also have importance for UK public law in several respects, only some of which can be examined within the scope of this article. First, the law of abortion has traditionally been one in which the Westminster Government has avoided legislating. Substantive reform has instead previously been achieved or proposed by backbenchers through the Private Members' Bills procedure, 1 or as amendments to an existing Government Bill which were inspired at least in part by a Private Members' Bill. 2 The recent proposals for reform highlight the inadequacies of these processes, which in turn raises questions about the democratic processes within Westminster. 3 Further democratic and constitutional difficulties arise in that backbenchers in both Houses of Parliament are seeking to reform the law in contrary ways. A liberalising agenda has found favour in the House of Commons in both the current and previous session: one Bill with this intended effect was introduced in the previous Parliament but did not progress into law, and another is shortly anticipated in the current session. However, a less liberal agenda has found favour in the House of Lords, where two Bills have been introduced in this current session which would restrict abortion services in England and Wales. 4 Secondly, the current reforms highlight uncertainties, inconsistencies and tensions in the devolutionary settlements of Northern Ireland, Scotland and Wales. The differences in the devolutionary settlements with respect to the law of abortion lack comparative study but are considerable. This could have a significant impact on the legal powers and political options available to the UK's four legislatures in the months to come. The most recent decision of the UK Supreme Court on the law of abortion in Northern Ireland, however, suggests that these differences may soon be subject to a judicially-imposed minimum standard to ensure compliance with the European Convention on Human Rights. 5 This may force greater uniformity to the law of abortion across the UK in the near future. This article will review for the first time the recent legislative proposals and executive actions, highlighting the reforms to UK abortion law that they intend to make. It will examine critically the rationale behind these reforms-both declared explicitly and inferable-as well as their potential impact and connection to wider constitutional change. This article, therefore, intends to contribute to Unless otherwise stated, all URLs were last accessed 22 June 2018. The authors would like to thank Roderick Paisley, Heather Green and Isla Callander of the University of Aberdeen for reading an earlier draft of this article, and to the Modern Law Review editors and the anonymous reviewers for their comments.

Management of Unintended and Abnormal Pregnancy

Physicians, as well as lay advocates, have always played an active role in social movement activity concerning abortion, sometimes promoting legal abortion, and less often, opposing it. r Today about two-thirds of the world's women live in societies where abortion is legal, but the bare fact of legality per se masks considerable differences among countries as to the availability of abortion services and the social climate in which they exist. r Compared to other advanced industrialized societies, the contemporary USA is the extreme example of a society in which an antiabortion movement arose in response to legalization and ultimately managed to become a leading force in domestic politics. r Currently, the movement for safe, legal, and accessible abortion has assumed a transnational character, with joint activities of physicians from both developing and developed countries having an important impact.

Legal Studies, 2006

In his Dimbleby Lecture in December 2002, the Archbishop of Canterbury examined the effect of the emergence of the market state on the legitimacy of government activity in areas of morality. He suggested that, while this is becoming limited, the continuing need to provide a moral context for social life provided an opportunity for religious communities to play a crucial role. This paper suggests that the increasing significance of market concepts in healthcare law poses a similar challenge to the moral basis of medical practice, threatening to drive moral argument outside the scope of the discipline, with the consequent effect of undermining the values that drive good healthcare. Thus, the de-moralisation of medicine is also demoralising for those within the health professions. To counteract this tendency, a strong sense of a common moral community needs to be maintained amongst those engaged with the discipline of healthcare law. This paper also examines the role of law in this are...