Sir: With very few exceptions few gynaeco- logical surgeons in
the NHS will operate on healthy girls or women to terminate a preg- nancy for social or environmental reasons. The new Act was designed to permit a doctor or nurse to opt out of abortion except when the patient's life was in imminent danger, for example, in rupture of the pregnant womb. I cannot imagine a certificate signed by two doctors being presented to a surgeon demanding an operation, but I can imagine all three sitting over a cup of coffee discussing what is best for the patient. I feel sure Dr Rowan Wilson is being unduly apprehensive on this issue (26 April).
The decision is seldom a matter of medical ethics weighing the scales but rather what weight should be given to the social pressure on the patient. In the Midlands my colleagues and I tend to ask, 'Is it absolutely vital to end this pregnancy? Is there no alternative?' We are in fact answering the question posed by Mr Roy Jenkins in the initial debate on the Abor- tion Bill. He asked as Home Secretary if Mr Robinson would persuade his gynaecologists to take in the women who try to abort them- selves (or have it done in the back street) into the NHS.
We are doing our best but of course we cannot accept the ethical standards of the back street nor prcivide the secrecy, so the back street will flourish as a 'service,' while we in the NHS will continue to offer what we think is the best medical treatment for our patients—but that is not abortion-on-request. The era of the dispos- able pregnancy has not yet dawned.
H. C. McLaren Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Birmingham 15
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