Catholic Medical Quarterly Volume 69(3) August 2019
NICE’s Reputation is at Risk as a Result of its New Guideline on Abortion
From the President of the CMA(UK)
The recent NICE guidelines consultation on “Termination of Pregnancy” concluded on 31st May 2019. It was decided at the Catholic Medical Association (UK) Annual General Meeting in Hull on May 5th that a formal submission on behalf of the CMA (UK) would not be sent. It was feared that such a submission could be used by the consultation committee to grant respectability to the final published guidelines. Given the structure of the committee, it was suspected that any submission from the Catholic Medical Association (UK) or any other organisation opposing abortion would not receive a fair hearing or proper consideration. It was decided instead to send a letter of concern to the All-Party Parliamentary Pro-life group (via Ms Fiona Bruce MP) and to the current Health Secretary (Mr Nick Hancock), expressing our concerns. The essential content of those letters is reproduced here:
Reputation of NICE at serious risk
I write to you as a concerned citizen, a consultant medical physician and as President of the Catholic Medical Association (UK).
You may be aware that the National Institute for Health and Care Excellence (NICE) on 12 April 2019 published a draft consultation document relating to new proposed guidelines on “Termination of Pregnancy”. Having read the document, I am particularly concerned that it is, in essence, a manifesto for the promotion of extremely liberal abortion practices. A spokesperson for the organisation Life Charity has accurately described it as “a dream business plan for the abortion industry at the expense of vulnerable women”.
It is worth remembering that abortion remains a serious crime in this country, unless carried out according to the strict regulations laid down in the Abortion Act of 1967. The Chief Medical Officer, Dame Sally Davies, in 2012, reminded all doctors that “unless performed under the conditions set out in the 1967 Act, abortion remains a criminal offence under the Offences Against the Persons Act 1861”. The regulations are there for good reasons, specifically to protect vulnerable women, and they are a recognition that recourse to abortion should only be considered in specific and rare circumstances.
I recognise that the attitudes of many towards abortion have greatly changed since 1967 and that abortion in the UK is now performed essentially on demand, with the law largely ignored in the vast majority of cases. I recognise also that there is a current movement aimed at the total decriminalisation of abortion but that has not yet been realised. The current draft guideline seems to presume that abortion is no longer a serious crime but is rather something to be encouraged and to be provided without restraints. There is a presumption throughout that decriminalisation has already been approved. It is not the role of any NICE committee or NICE document to dictate what the law should or should not allow.
The draft guideline strongly advocates prompt referral of women for abortion and a number of the proposals are made to ensure that abortions are carried out without any delay. It specifically recommends that there should be no compulsory delay for psychological assessment and no compulsory delay to allow women time for reflection before proceeding with abortion. In the UK, 98-99% of all abortions are carried out on the basis that continuing with the pregnancy poses a greater risk to the mental health of the woman than if she chooses to have an abor¬tion. There is absolutely no evidence, anywhere in the world, to support a view that abortion is necessary for protecting mental health in pregnant women. In fact, there is evidence that women with pre-existing mental health problems are more likely to suffer a significant deterioration in their mental health if they have an abortion compared to women with pre-existing mental health problems who continue with their pregnancy to term. This fact alone supports the need for promoting a detailed psychological assessment prior to abortion.
A very serious consideration is the international evidence that up to 64% of all women presenting for abortion feel coerced or pressurised into making that decision.  This crucial safeguarding aspect of care is not acknowledged by the Committee promoting this draft guideline. Rushing women and healthcare professionals into abortion decisions and procedures is offering a great disservice to all concerned.
The draft guideline is clearly biased in many of the claims made about the safety of abortion. The references provided are totally from one side of the abortion debate and credible evidence presenting alternative opinions is ignored. In particular and specifically, there is evidence from many independent sources that abortion is associated with an increased future risk of premature births in subsequent pregnancies.[2-5] There is strong evidence that many women suffer serious mental health problems following abortion.[6-11]
Several studies demonstrate a link between abortion and subsequent development of breast cancer.[12-16] It is true that some studies demonstrate no significant risks of mental health problems, later premature births or breast cancer but the draft guideline should present a more balanced argument and studies demonstrating different results should be recognised. Those using a guideline from NICE deserve to be informed of the existence of conflicting evidence.
While it might seem to be pedantic, the actual use of the wording “termination of pregnancy” in the context of this draft guideline document is scientifically, medically and possibly legally incorrect. Every pregnancy, in fact, results in termination. Sometimes the termination is induced such as in deliberately induced abortion, but also in Caesarean sections for obstetric reasons with the intention of delivering a healthy child and protecting the health of the mother or in the induction of labour by pharmacological means to precipitate delivery of a healthy child. The guideline should, at least, be scientifically accurate in its terminology. Furthermore, in such a document, terms that may be open to varying interpretations should be clearly defined. For example, following the recent popular referendum in Ireland, leading to the repeal of the Eighth Amendment acknowledging the equal right to life of the unborn and the subsequent introduction of legal abortion in that country, abortion was clearly defined in the Irish Constitution as “a medical procedure with the intention of ending the life of a foetus”. The terms “medical procedure” and “foetus” were further defined to ensure that there be no doubt in any mind as to what is meant by the terminology used. Any document produced by NICE must contain clear and indisputable definitions so that the content is clearly understood by all who consult it.
Surprisingly, the words “foetus” or “embryo” do not appear in the draft guideline. Instead, the more abstract term “pregnancy” is used throughout when referring to what is actually removed from the wombs of mothers with each abortion procedure, whether by surgical or pharmacological means.
Nowhere in the draft document is there any consideration that the aborted foetus or “pregnancy” could be considered a living being. This is scientifically inaccurate and is potentially offensive to many mothers, especially to any mother who has lost a child through miscarriage. Regardless of the stage of pregnancy, women who suffer a miscarriage often grieve over the loss of their child. The language expressed in the draft guideline is totally insensitive to women (and men) who suffer such loss.
While the authors of the guideline go to great lengths to describe how abortions should be performed throughout all the stages of pregnancy, there is no recommendation as to what care should be considered for an aborted foetus who may be born alive (perhaps unintentionally if the abortion attempt has “failed”) and may have reached the stage of viability, especially if born after twenty-four weeks gestation. Not to provide proper care to a baby in such situations could be considered negligent and bordering on infanticide.
Many other concerns with the draft guideline could be expressed, including the lack of any reference to “abortion pill reversal” therapy. This has actually been requested by several women in distress, in recent years, in the UK when they have withdrawn consent and changed their minds after taking the first abortion pill (Mifepristone) in “medical abortions”. Evidence from around the world supports such “reversal” intervention to help them preserve their pregnancies.
I could also refer to the concerns over recommendations that abortion training should be considered an essential part of core training for more doctors. Such a policy would inevitably result in many doctors feeling pressurised to participate in procedures that they consider to be unethical and abhorrent.
I could refer to the recommendation to speed up the process of procuring abortion by allowing women to avoid having appropriate face-to face consultations with their doctors or midwives and allowing consultations to take place instead by video links or telephone calls.
Similarly, it is objectionable that the draft guideline should recommend that, if necessary, women should receive tax-payer funded financial support to cover travel and a ccommodation expenses to enable them to have abortions. Women, children and men who require more essential and life-saving treatments for genuine medical illnesses do not currently routinely receive such financial support from NICE or other healthcare bodies.
I recognise that an opportunity is provided for interested parties to register to enable them to make comments or suggestions to the Committee as this draft guideline is officially a “consultation” document. From experience, however, I have no doubt that the Committee in question will certainly not be influenced or persuaded by any of the arguments quoted in this address. The Committee is heavily biased towards promoting a very liberal abortion policy. Most, if not all, of the members of this Committee have a strong bias in favour of liberalising abortion availability and they have a vested interest in doing so. There is no possibility that any arguments that dispute the promotion of increasing abortion availability will be taken seriously. If I, as an individual, or if the Catholic Medical Association (UK), as an interested organisation, submit our concerns and suggestions as a registered participant in the consultation process, we will receive a response thanking us for our contribution with an assurance that our submission will be considered by the Committee. The final published guideline will not be influenced by our concerns and our name(s) will be included in the list of contributors, giving credence and a degree of respectability to the final document. There will be an acknowledgement that not all of the contributors necessarily agree with all of the content of the guideline but it will not be revealed which individuals or organisations disagree with specific points in the content. This would be unacceptable for me and for the Catholic Medical Association (UK) as our “contribution” could be interpreted by some as an endorse¬ment of the entire content of the published guideline. That explains why I feel the need to report my concerns directly to you.
NICE is, on the whole, currently respected by the medical profession and by the public at large. Recommendations from NICE are generally taken seriously by doctors and by commissioning health authorities. This draft document runs the serious risk of discrediting NICE. If the final document is similar to this draft proposal, as is very likely to be the case, the reputation of NICE will be seriously and irreparably damaged. Many hundreds, if not thousands, of doctors may never again consider anything published by NICE to be trustworthy. It is really that serious.
I ask you therefore, to please bring these concerns to the attention of Government personnel responsible for safe-guarding the reputation of NICE and the Department of Health and Social Care.
Dr Dermot Kearney
- Rue VM, Coleman PK, Rue JJ, Reardon DC. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Med Sci Monit, 2004; 10(10): SR5-16
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