February 20, 2024

Should doctors and nurses be disciplined for reporting illegal abortions?

Between 1861 and November 2022, only three British women had ever been convicted of having an illegal abortion. But, writes Zoe Williams in The Guardian, since December 2022, one has been convicted; six are awaiting trial; and dozens have been investigated for late term abortions. What is going on?

Abortion, while readily available in the UK, has not been decriminalised. It is still possible to have an illegal abortion.

Should doctors report women who have had an illegal abortion? This appears to be purely a hypothetical question, but the Royal College of Obstetricians and Gynaecologists has stepped in to clarify that it should never happen. “It is never in the public interest to investigate a patient who is suspected of ending their own pregnancy, a view endorsed by over 60 organisations and professionals.”

Writing in The Conversation, Dominic Wilkinson, a doctor and an ethicist at Oxford, says that the key issue is confidentiality, not legality of abortion.

Because it is so important, modern codes of practice for health professionals allow confidentiality to be breached only in truly exceptional circumstances. That could include notification of a serious infectious disease or prevention of terrorism. But it does not, in most circumstances, include reporting that a patient has committed a crime.

But if no doctor has ever reported a woman for committing an illegal abortion, why the flurry of paperwork? Perhaps Wilkinson and the RCOG fear that some pro-life doctors might be too zealous. Perhaps they need to be put in their place.

A doctor who does report a woman could end up being disciplined severely by the General Medical Council. “Providing information, without her permission, about a woman’s pregnancy and reproductive choices is a grave threat to patient trust and risks serious harm to vulnerable patients,” says Wilkinson.

However, the lobby group Right To Life UK paints a different picture of the increase in women being charged with illegal abortions. Spokesperson Catherine Robinson says:

“The actual cause of the, albeit small, increase in the number of prosecutions following an illegal abortions … is because of the ‘pills-by-post’ scheme which has led to an increase in illegal late-term abortions… Rather than making the situation worse and making our abortion laws even more extreme, Parliament ought to protect women by seeking the reinstatement of the requirement for in-person medical appointments to verify gestational age and assess a woman’s health before abortion pills can be prescribed”.

And what about coerced abortions as a result of sexual trafficking or abuse? Kevin Duffy, Executive Director for the Society for the Protection of Unborn Children in the UK, has an interesting perspective on this. He used to work with MSI Reproductive Choices (MSI-RC), one of Britain’s biggest abortion providers before changing sides. He says that the problem of more prosecutions could easily be fixed by reversing the pills-by-post legislation.

He tweeted: “RCOG knows that a small number of women obtain pills-by-post illegally from BPAS and MSI-RC, and that at least 13% will subsequently suffer an incomplete abortion and need medical help. Now RCOG wants to make sure that NHS staff do not report the illegal abortion. Disgraceful.”

As well, there could be a conflict of interest in the new RCOG guidelines, Right to Life UK alleges. Dr Jonathan Lord is the co-chair of RCOG’s abortion taskforce which drew up the guidelines. But Dr Lord is also the Medical Director of MSI-RC.