“Medical abortions take place in two stages. First, a single dose of mifepristone is given
orally, which blocks the pregnancy hormones so that the pregnancy ceases to be viable.
Upto 48 hours later—and conventionally 24–48 hours later—a second drug, either
misoprostol or gemeprost, is then administered vaginally or is swallowed. It causes the
uterus to contract and to expel the pregnancy much like a miscarriage. Women are now
offered the option of going straight home after taking the second pill, which most do, in
order to make themselves comfortable before this process starts. In the UK misoprostol is
treated as an abortifacient, and therefore women must visit a clinic to obtain the second
pill. In the USA, the second stage of a medical abortion is frequently self-administered by
the woman in her own home.”

They’ll take your word for it – this is a health service not a fascist state!

“someone who doesn’t want their partner to know – an immigrant without legal access to the NHS”

Both of those could just go to a GP, the NHS doesn’t really try very hard to keep out immigrants for obvious reasons.

“someone who is too far on to use that treatment legitimately”

Then they’d need more than just mifepristone and misoprostol, that baby ain’t coming out! If they’re distressed enough to do that what will stop them trying something infinitely more dangerous?

“Or you could administer it to a pregnant woman without her knowledge”

And how many other drugs could that be said of? How widespread do you think deliberate poisoning of people is? Should we restructure the entire NHS to have supervised administration?

“I mean, look at the unintended consequences of bi-weekly refuse collection”

Yeah, why didn’t those doctors think of that?!

It is a faculty possessed by human beings. It’s fairly futile to try to draw a line on the foetal development chart, and to say, “After here, this is one of us”, but at the other end of life, the rare persistent vegetative state, consciousness in the philosophical, going on about it for hours in bizarre abstract terms, sense, is a notable issue. And so I regret not really knowing how such patients do in such tests. We don’t worry about switching them off… well, we do, we agonise about it at length, but we do it.

I had in mind a test with distinct stimulus A followed by painful stimulus B, and whether the foetus learns to react to stimulus A by anticipating stimulus B. Difficult to do ethically if there is no real definite purpose, I suppose, even if the foetus isn’t a person. It isn’t an animal either, I assume… unless an animal foetus is used, I suppose. And yes, of course humans are animals, but mostly not in the eyes of the law.

And I’m suspicious on principle of an argument that a function is in one particular part of brain anatomy. After all, ontogeny recapitulates over a hundred years of speculative and often fallacious arguments. The other day I was hearing about an aperture in the foetal heart which allows the bypass of the lungs. This matters because quite a lot of us have it for the rest of our lives and it can end up causing trouble. It was in fact BBC’s [Case Notes] upon headache that I was listening to, where plugging the thing with one of those cocktail umbrella jobs and letting it heal was tried for migraine, a lot of whose sufferers have the hole. The repair doesn’t seem to help with it, though, they said.

The point of bringing that up was that the foetus is constructed differently from the mature human being in that respect. (Except when the mature human being is one of the many who still have the foetal heart thing.)

Let’s suppose that only one doctor is involved now – that makes sense. The abuse of the system that I am imagining involves administering the drugs to someone other than the patient who presents to the doctor. It needs method and motive. Well, I imagine that if you set out to bamboozle a pregnancy test at a family GP, it’s not more difficult than getting past the performance-enhancing drugs tests in sport, the Olympics or Tour de France, read Matt Seaton. You bring someone else’s urine sample, for instance. Someone unscrupulous somewhere will be bottling and selling the stuff.

And what do you do with an off-licence abortion drug? Sell it to someone who doesn’t want to see the family doctor about their abortion – someone who doesn’t want their partner to know – an immigrant without legal access to the NHS – someone who is too far on to use that treatment legitimately, but wants to, for any of these reasons. Or you could administer it to a pregnant woman without her knowledge – say your rich and elderly father’s young girlfriend. Make sure the inheritance doesn’t go astray.

And, I mean, look at the unintended consequences of bi-weekly refuse collection and the proposal to charge for rubbish collection by weight. We should be careful about this. Asking the patient to pop into the office isn’t too much, gives the process some dignity… home births are one thing, home terminations – I don’t quite see the point. Well, I suppose if it’s up the doctor’s, your mind might not be on the road driving home afterwards, I wonder if there are statistics. Of course when we bring in my other pet idea, robot cars, it won’t be an issue. (Except for my other other idea when the robots decide to wipe us out for frankly obvious reasons.)

I think you need to be clear about the differences between the ‘morning after’ pill, and medical abortion. Emergency contraception is now available from pharmacists, and prevents implantation, so isn’t abortion as such, and isn’t being discussed in the changes mentioned. The use of two drugs to terminate an early pregnancy is different, but infinitely preferable to a later surgical procedure, and therefore anything that removes hurdles to early termination seems a very good thing to me. I think black market diversion would be rare, because you would have to prove you were pregnant, then get (currently )2 doctors to certify you suitable for an abortion, before any drugs were given.

I quite agree that there is a disconnect between words and practice regarding when an abortion is allowed, and that can cause problems because different doctors (for example who ethically oppose abortion) can interpret them differently, and delay a woman’s access to an early abortion. However the law will not be changed – I believe the government have basically indicated they’re not going to put forward anything that contentious. What will be interesting is whether the emminently sensible suggestions made by the Select Committee make it into practice.

One line of evidence is that the pain pathways haven’t developed yet.

“I do not agree with the last, that if there -is- sentience then it is of no interest to Parliament.”

Me neither, but then I don’t eat animals either.

“Of course the importance of this question depends on whether the drugs are available black-market anyway.”

Do you mean the morning after pill? Since it is available over the counter at pharmacists for £20, and obviously it is also taken at home as well.

“It seems that “damage the physical or mental health of the woman” means in practice “she doesn’t want it””

Yep, although you’d think we’d change the law to actually say that wouldn’t you?

One thing I can clear up for you: the morning after pill isn’t the same thing as an abortion pill.

As I understand it, it prevents implantation of a fertilised egg, rather than getting rid of it once it is already in the womb. That is why it becomes less effective the longer the gap between unprotected sex and taking the pill.

You can buy it from pharmacies, too. So not the same as an early stage abortion at all.

Cheers,

Lucy

I also suppose that the main non-clinical risk of taking the “morning after pill” at home, if that’s what they’re talking about, is that the pill is not taken by the patient but passed on to someone else to be misused. Like having a friend sit your driving test. Of course the importance of this question depends on whether the drugs are available black-market anyway.

Let’s see if I’ve got this straight, officially you don’t get to have an abortion just because you don’t want to have a baby – yes? A BBC News Online story says “Almost all (abortions) are permitted on the grounds that pregnancy would damage the physical or mental health of the woman. Only 1% of abortions are carried out on the grounds that the child would be born with a serious disability.” It seems that “damage the physical or mental health of the woman” means in practice “she doesn’t want it”, plus I suppose risk of diabetes, high blood pressure, fallen arches, possible grave complications and subsequent profound sleep deprivation, all liable to appear during or after any normal pregnancy, and not to be belittled.

And I’m not sure how I feel about it. But if and when it intimately involves someone else’s body and isn’t my business in any way, fine.

I would have suspected these sort of views would have been a bit embarrassing to “Citizen Dave”, though.

Another of the ironies here is that the Daily Mail readers frothing at the mouth about “Dr Death” and the Select Committee will no doubt be the same people shocked and appalled by the idea of classes to try and give kids realistic (continental-style) sex ed instruction… one of the “interventions” which might actually do something to reduce teenage pregnancy and termination rates.

I was really quite shocked by the level of ad hom vituperation the Mail directed at Evan Harris. I used to be solidly with the late Dennis Potter (who of course named his cancer “Rupert”) that Mr Murdoch and The Sun were the greatest blight on both UK journalism and reasoned public debate, but I’m coming around to the conclusion that the Mail is worse, if only because it seems to think it is a “serious” paper.

As for the minority report – well the world has room for other opinions, but I would be interested to know how much they are informed by religious belief, how much by the sort of populist Daily Mail view and how much by the need to cultivate a particularly backwoods constituency.

Talking of Dr Harris, I read Amanda “F*!kwit Harpie” Platell’s Daily Mail diatribe about him that Ben mini-blogged. It made me genuinely angry, and I penned a suitable trenchant “comment”, which (surprise surprise) hasn’t appeared. In fact, NO comments on Platell’s “opinion” have appeared, which suggests to me that any commenters all thought she was flatly bonkers, or “channeling” the ghost of Private Eye’s Glenda Slagg. On reflection, these days Platell and Glenda Slagg appear to be wholly indistinguishable.

As a general point, from my own experience, and that of people on the BadScience Forum, most comments on the Mail’s website that point out the Mail’s idiocies never make it past the paper’s “moderators”.

www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=490815&in_page_id=1770

Responding to the Science and Technology Select Committee Report on Abortion, Dr Evan Harris*, Liberal Democrat MP on the Committee said,

“This thorough report – after a rigorous enquiry into a set of very narrow scientific issues – sets out clear conclusions on what the scientific evidence can tell us about abortion law reform.”

“The medical evidence is stark about how the threshold of viability has not reduced below 24 weeks, and that is why our conclusions are so firm. For many parliamentarians – like Lord David Steel himself and Gordon Brown – who have said they will follow the science on this question, this will make to a difference to how they vote on the question of the upper time limit.”

“The Committee had no alternative – given the medical and scientific facts – but to argue for the end of the 40 year requirement for two doctors signatures, the old-fashioned ban on nurses performing abortions, and the unnecessary restriction of choice for women about where they have early medical abortion.”

“I am pleased the Committee argues for the GMC to make clear that doctors who conscientiously object must alert their patients in advance and ensure another doctor takes the consultation if abortion is a possibility”.

“The so called “minority report” is a amusing mish-mash of paranoid conspiracy theories, pseudo-scientific clap-trap and anti-abortion zealotry. The few recognisably scientific arguments it makes are completely dealt with in the Committee’s report and rebutted by the totality of the scientific literature”

I now totally badly want a copy of the “minority report”.