British scandal of abortion on request

The discovery that sexually selected termination of pregnancy is available in Britain should surprise no one; and if we are surprised, it can only be because we have not been paying attention for the past 40 years. Sexually selected termination is, after all, the natural result and logical extension of the way the Abortion Act has been interpreted during all this time.

Several consultants and what I suppose we must now call their customers have been caught in flagrante committing an illegal act that most people will find thoroughly distasteful. No doubt the doctors involved will now find themselves in hot water, and the chairman of the Care Quality Commission, the Orwellianly named organisation in charge of supervising the compliance of abortion clinics with the law, has already resigned.

The Chief Medical Officer is to write to all abortion clinics to remind them of their responsibilities, but it is a fair bet that what he writes will not be taken seriously and not deserve to be taken seriously. Perhaps now is the time to remind ourselves of the terms of Britain's Abortion Act:

"Subject to the provisions of this section, a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith -

(a) that the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or

(b) that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or

(c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or

(d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped."

With this in mind, it is clear that a very large number, and quite possibly the vast majority, of abortions carried out in this country are against the spirit, if not quite the word, of the law, and that practically all the doctors in this country who sign abortion forms are every bit as guilty as the reviled consultants who have offered sexually selected abortion.

If the consultants offering sexually selected abortions should be struck off the register, so should a probable majority of British practitioners. Their only extenuation is the fact that any termination of pregnancy is safer than a continuation of it: but this is surely sophistical, and not what the framers of the law intended. Besides, the argument would also cover the case of the consultants who offered abortion on the grounds of the sex of the foetus.

More than one friend of mine in the profession has told me that pregnant women have asked for terminations because they did not want their holidays spoilt by pregnancy - and they duly signed the forms. I have signed only a few forms in the course of my career, a long time ago, and I am not sure what part the desire to avoid an unpleasant scene with the patient, understandable perhaps in a young man as I then was, played in my decision-making. In this connection, I cannot help but think of the notice in old-fashioned shops: please do not ask for credit as refusal often offends.

Of course, it is not difficult for someone to claim that the continuation of a pregnancy will harm her: all she has to do is threaten to take an overdose if it is not terminated. But if we take a latitudinarian view of what constitutes harm to mental health, there is no way of distinguishing between permissible and impermissible termination. A woman who wants a male child but not a female one can claim that a girl will harm her mental health while a boy will improve it. Anyone can ruin his own mental health if he wants to do so. Indeed, the very notion of mental health makes us ever more fragile.

The Abortion Act provides, de facto, abortion on demand, and this has been so for many years. Certain people will rejoice at this: those, for example, who argue that women have an inalienable right to dispose of their bodies as they wish, and therefore to determine whether or not they continue with their pregnancy. According to this argument, women have the right to an abortion simply because they want it, for good, bad or no reason. If this is the case, the consultants who offered the sexually selected abortions did nothing wrong, morally speaking.

The Council of Europe has suggested that women should not be told the sex of their child before birth, precisely to avoid sexually selected abortions. But this in turn conflicts with another supposedly inalienable right: that of a patient to information about his or her condition. Now that doctors are supposed to withhold nothing from their patients, why should information about the sex of a foetus be an exception? After all, the vast majority of pregnant women who are told the sex of their baby do not, and never will, want an abortion on the grounds of its sex. By what common measure of moral priority does the right of a foetus not to be aborted on the grounds of its sex trump the right of the mother to be given information about her condition?

In fact, the whole sorry story illustrates the mess we get into when two notions become culturally prominent: on the one hand of rights and on the other of consumer choice.

Whatever the law says, most people now think that abortion is a right under all circumstances and not something that is permissible if certain conditions are met, as the framers of the law surely intended. That particular slippery slope has long been slid down. And the same people now conceive of life as an existential supermarket in which they are consumers, choosing the way they live much as they choose cranberry juice or the flavour of crisps that they want. And the customer in the existential supermarket, as in Tesco, is always right.

Into this poisonous mixture we must add the notion that any form of distress, or even the slightest frustration arising no matter how self-indulgently, constitutes an impairment of mental health: for the mentally healthy person is always happy and never experiences any difficulties in life. In short, inconvenience is the greatest of all threats to our well-being, and must at all times be avoided. It is our right to avoid it.

The Abortion Act was intended as a humane response to genuine hardship: the type of hardship that drove women to back-street abortionists. I supported it, not realising that its intentions would soon be subverted by a change in the character of the population, including that of doctors, who would easily affix their names to declarations they knew or suspected to be false. But now the genie is out of the bottle, and I fear there is no getting it back.