Abortion law reform and conscientious objection in the United Kingdom
Nucleus, October, 2004
Christian Medical Fellowship (United
Reproduced with permission
Abortion Law Reform
author Jacky Engel reviews the legal history of abortion in the United
Kingdom from 'Lord Ellenborough's Act' of 1803, though most of her attention
is directed to developments beginning with the Bourne case of 1939.
Ms. Engel's discussion of the parliamentary debates in 1967 is reproduced
below because of its references to conscientious objection. [Administrator]
. . . Luck of the draw
Each year at the start of the parliamentary session, a ballot is held and
the twenty Members of Parliament (MPs) whose names come out top are allowed
to introduce a Private Member's Bill to the House of Commons on a subject of
their choice. In June 1966 David Steel drew third place in the ballot and
introduced the Medical Termination of Pregnancy Bill to the Commons.
Steel's bill underwent considerable discussion and amendments before it
successfully passed into law as the Abortion Act 1967. Its passage was
helped by two previous bills that had passed through the House of Lords. In
1965 and 1966, Lord Silkin introduced bills to legalise abortion - the first
time Parliament gave significant attention to the abortion laws. The Lords
discussed the bills in depth and amended them extensively to try and find a
law that would be acceptable. The ALRA assisted Silkin and when Steel agreed
to take up their cause, Lord Silkin dropped his bill so they could focus
their energy on the Commons. Silkin's bills meant that those in favour of
reform already knew the hurdles they would need to overcome to get a bill
passed into law.
Parallels could be drawn with recent attempts by Lord Joffe to get a bill
legalising assisted suicide through the Lords. Whether he is successful or
not, he has done a lot to raise awareness of the issues, promote debate and
provoke public sympathy. If a supportive MP was fortunate in the ballot for
Private Members' Bills, we could see a euthanasia bill successfully pass
through the Commons.
Debate in the Commons
A number of lines of argument were used to persuade Parliament that
abortion should be legalised. These focussed primarily on the hard cases:
rape, extreme poverty, grave risk to the mothers' life and serious fetal
abnormality. The concerns voiced and the assurances given are interesting in
light of the way medical practice has developed since.
The social clause
The 'social' clause in Steel's bill first appeared the previous year in
Silkin's bill. A main argument for the clause was 'backstreet abortion' and
the dangers inherent in cheap, illegal terminations. Tragic cases were cited
and annual numbers ranging from 14,600
to 250,000 estimated. Set against
the image of the 'overstrained wife' was the injustice of a different rule
for the rich - an amenable gynaecologist could always be found to carry out
a safe, sterile termination, providing the price was right.
The intention of the social clause was to enable safe and free access to
legal abortion for women in difficult situations. Steel asserted that it was
not his intention to 'leave a wide open door for abortion on request.'
Rather he saw this clause as a just response to a social problem.
There were predictions that abortion on demand would inevitably follow.
The BMA, Royal College of Obstetricians and Gynaecologists (RCOG) and other
professional bodies were concerned that the doctor's role would shift from
medical decision-maker to arbiter of social issues. It was suspected at the
time that this would prove unworkable and the woman's attitude to pregnancy
would be the ultimate determinant of whether she received an abortion. The
bill's supporters rebuked these fears: 'it is only in extreme cases that a
woman wants to terminate her pregnancy.'
David Steel recognised the logical force of the two extreme views and
argued that the role of legislation was to 'find a balance between' the
extremes. Perhaps this is inevitable in a society with diverse beliefs.
However, when the pro-abortion side continue to lobby for increasingly
liberal laws, we must strive for positive law reform, whilst recognising
practically that we may never reach an ideal situation.
The social clause was eventually dropped from the bill, but effectively
reappeared in section 1(1)(a) of the 1967 Act: 'continuance of the pregnancy
would involve riskâ€¦ of injury to the physical or mental health of the womanâ€¦
greater than if the pregnancy were terminated' with the section 1(2) proviso
that 'account may be taken of the pregnant woman's actual or reasonably
The passage of time demonstrates that abortion is effectively available on
demand. About 98% of the annual 181,600
abortions in England and Wales are carried out under this clause. The
RCOG now views abortion as a 'healthcare need',
in their About Abortion Care booklet for women using abortion services they
state, 'Most doctors feel that the distress of having an unwanted pregnancy
is likely to be harmful and so will refer a woman who does not want a baby
for an abortion.'
Section 4(1) of the 1967 Act permits that 'no person shall be under any
duty, whether by contract or by any statutory or other legal requirement, to
participate in any treatmentâ€¦to which he has a conscientious objection.'
This does not apply to emergency procedures. This was not in the original
bill, but was introduced in response to concerns that doctors would be under
pressure to perform terminations against their beliefs. Interestingly, one
amendment that didn't make the final Act proposed that, 'no person [shall
be]â€¦deprived of, or be disqualified from, any promotion or other advantages
by reason of the fact that he has such conscientious objection.'
The experiences of doctors practising in this area are difficult to gauge
beyond individual reports of discrimination,[14,15]
but professionals accept that one of the Act's consequences is to
'discourage doctors with certain convictions from attempting to follow a
career in hospital obstetrics.'
CMF surveyed its members in 1996 and found that 9% of 372 doctors
thought they had been discriminated against in obstetrics and gynaecology or
anaesthetics because of their views about abortion.
Whilst the BMA 'abhors' discriminatory behaviour,
others will argue that physicians have a duty to provide socially sanctioned
procedures. If there truly is a
rising tide among junior doctors against overuse of the Act,
this issue will become increasingly salient.
In the 1966 debates one reformer said that, 'it is quite wrong for any
doctor to put his
ethical reasons before the consideration of his patient.'
However, the conscientious objection clause was a concession that had to be
made in order to get the legislation passed. The ALRA website todaystates
that, 'The 1967 Abortion Act was a huge step forward, but it does not go far
enoughâ€¦Women should not be forced by law to rely on the decision of their
doctors who are sometimes influenced by moral rather than medical
judgement.' Their intention is clear. However much philosophers may try to
deny the 'slippery slope', and reformers assert that regulations will
prevent it, it seems to me they must be either profoundly naïve, or
6. Royal College of Obstetricians and Gynaecologists,
Report on Legalised Abortion, BMJ 1966; 2 April
7. A National Opinion Poll at the time estimated it at
31,000 a year since the war, based on questionnaire replies from 2,100
women. They calculated a total of 600,000 abortions from 1946-66, mostly
illegal. Cited in Simms M, Hindell K. Op cit: 32
. Hansard, 22 July 1966. 832:60 Mr David Steel at 1075
9. Hansard, 22 July 1966. 832:60 Dame Joan Vickers at
. Abortion Statistics, England and Wales: 2003.
Department of Health
11. The Care of Women Requesting Induced Abortion.
London: RCOG, March 2000
. About Abortion Care. London: RCOG, May 2001:4
13. Standing Committee F. 18 January 1967. NC2
. BMA News Review 1999; September:18,19
15. Social Services Committee Tenth Report. Abortion Act
1967 'Conscience Clause'. 1990
Letter from the Association of Anaesthetists of Great
Britain and Ireland, March 1975
17. Burton E, Fergusson A. Christian Medical Fellowship
Members' Attitudes to Abortion: a survey of reported views and practice.
London: CMF, 1996:12
The Law and Ethics of Abortion: BMA Views, 1999
19. Meyers C, Woods RD. An obligation to provide
abortion services: what happens when physicians refuse? JME 1996, 22:115-
21. Hansard, 22 July 1966. 832:60 Dame Joan Vickers at