assisted suicideAbortion is in the news again. The President of the Royal College of Obstetricians and Gynaecologists said that abortion should continue to be regulated and the 24 week upper limit retained but it should be decriminalised.

The Republic of Ireland has announced that voters will be asked to decide whether to change the Irish constitution under which abortion is only allowed if the life of the mother is in danger. The penalty for having an illegal abortion faces up to 14 years in jail. However thousands go abroad each year to obtain an abortion.The planned referendum could be held in May or June during or just before the planned papal visit to Ireland.

The Eighth Amendment of the Irish constitution, introduced in 1983, gives an equal right to life to a pregnant woman and an unborn child. This referendum is partly due to the death, four years ago Savita Halappanavar, an Irish dentist. The 31-year-old dentist was told that she was miscarrying, she asked for a medical termination a number of times of the nonviable foetus over a three day period, during which she was in severe pain. But her husband said these requests were denied because a foetal heartbeat was still present and they were told at one point: “This is a Catholic country.” Medical staff removed the dead foetus days later after the heartbeat stopped but Halappanavar died of septicaemia on 28 October 2013.

Northern Ireland has similar laws. Women are only allowed an abortion [termination of pregnancy] if there is a severe threat to their life.  Rape, incest and fatal foetal abnormalities are not circumstances in which they can be performed legally. This summer Parliament agreed to fund abortions for women in Northern Ireland coming to England but they still cannot have them in their own country.

The Abortion Act 1967 [UK but not Northern Ireland] makes abortion legal if one of the following criteria are agreed by 2 doctors.

[a] If the pregnancy has not  reached 24 weeks and there is  greater physical or mental risk of harm to the mother or her existing children and family by continuing the pregnancy.

[b]. At any stage if there is serious risk of permanent injury to the health of the mother

[c] that the continuance of the pregnancy would involve risk to the life of the pregnant woman.

[d]  At any stage if the foetus is likely to be born with severe physical or mental abnormalities.

Pregnancy and delivery are more dangerous than a termination so reason number one suggests that provided the pregnancy has not gone far there is effectively abortion on demand. However late terminations, beyond 12 weeks are rare. 90% are before 12 weeks in the UK.

Abortion is a very emotional subject. It is the only procedure that a doctor can opt out off. But the GMC advises that your personal beliefs should not affect your treatment of a patient. Even if you disagree with a patient who requests an abortion that patient should be treated with consideration and empathy. It may be reasonable to ask her to consider other options if she does not seem completely sure but that should not result in any significant delay. The patient should be quickly referred to a colleague who is willing to help her.

The major organs are formed by 12 weeks. The vast majority, 90% of abortions take place before 12 weeks in this country.  We think that the foetus may begin to feel pain at 20 weeks when the nervous system begins to mature.  When can they think, when does sentient life begin? Philosophers and ethicists and religious leaders have endlessly debated  when recognisably human life truly begins. The Pope and Catholic Church argue that even contraception is wrong because it prevents human life. The law in the UK argues that it is when independent life outside the uterus is possible. Medical science has advanced and many now argue that we should bring down the 24 week limit but the Royal College and BMA argue that while life outside the uterus is possible below 24 weeks babies born this young usually have  permanent disabilities.