Sir: It is not surprising perhaps that because the issue
is not simple many commentators have failed to grasp the true significance of the decision of the BMA Council to recommend no change in the Association's ethical policy. I was somewhat taken aback that someone as well informed as Dr John Rowan Wilson (26 • April) should also have taken the stick firmly by the wrong end.
He writes that the arvirt Council resolved that its objection to social abortion involves a fundamental question of ethics. No reference whatever was made by the Council to 'social abortion' at any time in this context. Indeed, ever since the words were devised by the Church of England Committee in 1965, the BMA has supported legislative authority for doctors to take note of the patient's 'total en- vironment' in assessing the risk to her health of continuing pregnancy. This is nothing new. It says no more than have generations of medical teachers—'It is people and not cases which doctors should treat.'
The Council's decision sprang from its wish to adhere to the principle that medical advice given to anyone must depend fundamentally upon concern for the health of that individual alone—taking account as necessary of his or her total environment. If decisions are to be made solely in the interests of another person or persons as the Act provides, a new prin- ciple is established capable of extension. For example, before a psychiatrist returns to his home a treated patient, the total environment must be carefully considered, but is such a patient to be denied a return to the community solely because that return might hazard the health of one of his family? If euthanasia is on the way, and its supporters are naturally encouraged by ALBA'S success, is the health of those caring for the incurable to be the criterion for decision?
According to Wilson it may well be : 'If the country wants the Act . . . the medical pro- fession will have to operate it [my italics] as efficiently and gracefully as it can.' This is a frightening statement, or at least it should frighten all of us. What the country wants— abortion, euthanasia, sterilisation of the unfit or racially inferior—that is enough. Vox populi . . . and let the doctors get on with it and stop fussing about ethics.
We are often told that this is the permissive society; seemingly doctors are to be exempt and will still enjoy the privilege of doing what they are told.
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