Autonomy and the UK’s law on abortion

Summary of a chapter by Laura Riley and Ann Furedi in the new book Regulating Autonomy: Sex, Reproduction and Family, published by Hart.

The chapter notes that ‘UK abortion law has changed remarkably little since 1967, although accompanying regulation is updated regularly’: the most significant change being the amendment, via the Human Fertilisation and Embryology Act 1990, which reduced the ‘time limit’ for abortions for reasons other than fetal abnormality from 28 weeks’ gestation to 24.

In discussing the question of autonomy in abortion care, the authors envisage autonomy as ‘decision-making by a competent individual which may affect various aspects of their life and physical self, in some aspects potentially for an indefinite time’. Within healthcare, ‘autonomy is compromised unless offered in a[n] … environment respectful of self-determination, which offers practical support for autonomous decision-making’; and facilitating
this environment in abortion care ‘requires (for example) accurate, appropriate and timely non-directive information from healthcare professionals to enable each individual to fully explore their options, with a commitment to appropriate confidentiality, and for a choice of appropriate treatment methods to be offered in order to maximise the acceptability and accessibility of each option’.

Discussing the way in which BPAS clients make autonomous abortion decisions, Riley and Furedi note that such decisions ‘tend to take into account far-reaching considerations far beyond the risks to life and health involved’. These decisions are often taken with a partner, in the context of the woman’s relationship; in relation to a woman’s ideas about how she may or may not make a ‘good parent’ to the potential child; and by ‘weighing burdensome pragmatic issues’ such as ‘the woman’s current or prospective economic, relationship and housing situation’.

Examining current problems with the UK abortion law, Riley and Furedi argue that ‘autonomy is currently fettered in some areas by over-restrictive statute, and in others, autonomous decision-making is offered little support or protection by law or regulation’. The authors list several aspects of the abortion law where this is the case:

• The Abortion Exception: the fact that ‘access to abortion in the UK remains legally detached from a competent woman’s decision-making, setting abortion apart from the process of informed consent used with other medical treatment’;

• Conscientious Objection: which leads some women to experience barriers to accessing abortion because their GP has obstructed or delayed their referral;

• Misinformation: as provided by some ‘crisis pregnancy counselling’ agencies in the UK;

• Choice of Methods: where access to abortion is impeded by unhelpful regulation – for example, the insistence that women return to a clinic for their misoprostol dose when undergoing an Early Medical Abortion, instead of permitting home use of this drug;

• Identity Discourse: where ‘contemporary rights and “identity” discourse is being increasingly co-opted into the abortion debate in order to argue for restriction on abortion for fetal abnormality’;

• ‘Postcode Lottery’: where inadequate resource allocation and local eligibility criteria for abortions can result in long or unnecessary waiting times;

• Staffing of Services: where a shortage of doctors and nurses can sometimes pose a problem;

• Northern Ireland: where the 1967 Abortion Act does not apply, leaving women in a position where, formally, abortions can only take place as medical emergencies in NHS hospitals, and no funding is available for women who travel to the UK to terminate a pregnancy.

Aside from the problems facing women in Northern Ireland, the current situation, argue the authors, is one in which ‘there has never been a greater likelihood of women receiving accessible, NHS-funded abortion care’, and as such ‘the practical gains from the “public health” approach [to abortion] must not be underestimated’. However, they continue, if this approach ‘is the sole direction of advocacy, this risks leaving abortion provision vulnerable and misunderstood’. One example of this is provided by the media debate around the 24-week time limit for abortion, which has been argued out with reference to ‘non-evidenced claims about improved survival of extremely premature babies and detailed ultrasound images of fetuses claimed to “walk” in the womb’, countered with scientific evidence about fetal viability, ‘which in fact does not indicate that preterm survival under 24 weeks has significantly improved in the UK’.

As Riley and Furedi note, ‘Policy makers rarely emphasise the point that advances in neonatal care are good news, but irrelevant to the needs of women for abortion. When no ethical case is made for late abortion, a fundamental part of women’s healthcare is left vulnerable’. They conclude the chapter with a discussion of how the law could better facilitate autonomy in abortion care.

Regulating Autonomy: Sex, Reproduction and Family, edited by Shelley Day Sclater et al, is published by Hart. Find more information about the book, and buy it, here.

Laura Riley is Press and Policy Manager of BPAS. Ann Furedi is Chief Executive of BPAS.

This article is published in the Summer 2009 edition of Abortion Review. Download this edition here.