Abortion regulator, RCOG, looks into foetal pain… but who looks into them?

James Evans
Biology teacher with a background in genetics

For months we have been aware of the discriminatory disparity in patient care: that unborn babies aged 20-24 weeks gestation undergoing spina bifida surgery receive foetal painkillers, but that babies of the same age being aborted are not given painkillers. 

MPs have been lobbying the Department of Health and Social Care who have finally raised the issue of the use of foetal painkillers in late term abortions with the Royal College of Obstetricians and Gynaecologists (RCOG). 

This would be welcome news because one would assume that the RCOG would recommend that all babies from a gestational age of 20 weeks onwards would receive painkillers prior to any invasive procedure.

However, RCOG’s track record suggests otherwise.

When they were first asked by the Department of Health to investigate foetal pain in 1997, they concluded that consultants should consider the need for the use of painkillers for ‘diagnostic or therapeutic procedures’ on foetuses in utero. Indeed, the Department of Health admitted that foetal painkillers are used in cases of in utero surgery from 20 weeks gestation. But what about in cases of abortion? If an unborn child needs painkillers for ‘diagnostic or therapeutic procedures’, surely they need them all the more in an abortion? Perhaps unsurprisingly, the RCOG omitted to raise or answer these awkward questions.

To do so would risk humanising the unborn baby our society has worked so hard to dehumanise, at least when it comes to abortion. This is why we witness this curious doublethink whereby unborn babies in need of ‘diagnostic or therapeutic procedures’ are given painkillers, but babies to be aborted are not. In the former case, the baby is (presumably) wanted, and therefore acknowledged to be a baby capable of feeling pain and entitled to pain relief. In the latter, the unwanted baby, destined to be aborted, amazingly enough, can feel no pain (according to RCOG at least).

How do we know that the baby destined to be aborted can feel no pain? Well, in 2010, the RCOG looked into this question confidently announcing that before a 24 week abortion,   “No, the fetus does not experience pain”.

In fact, the RCOG go even further than this. In their 2010 Guidelines on Fetal Awareness they assert that the unborn baby is in an unconscious state and does not reach consciousness until birth. This conclusion is based on, in the words of RCOG 2010 ‘good’, ‘increasing’ evidence, but this evidence was one paper from 1986: an experiment on sheep foetuses exposed to low oxygen levels. As a result, they concluded, and ever since have advised mothers accordingly, that there is no requirement for foetal painkillers prior to an abortion at any gestational age even up to the point of birth. 

Again though, this does not square with practice in relation to in utero corrective surgery on unborn babies.

Sadly this is not surprising given the varied lengths RCOG has gone to in dehumanising the unborn baby whose life will come to an end in abortion. For example, specifically using language which ignores the humanity of the child such as ‘products of conception’, a ‘pregnancy’ and, by the president of the RCOG, likened to a bunion

Moreover, the RCOG, who author all clinical guidelines for the UK abortion industry and have many members who benefit from this, are effectively unaccountable without checks or oversight. The Department of Health does not let the tobacco industry govern itself, but it does allow this freedom to the abortion industry, worth an estimated £118 million annually in 2011. They also use their position of unchecked authority to advise parliament and publish their version of abortion advice to schools.

RCOG clinical guidelines are more untouchable than the law itself. Our law is made by elected representatives in the open to serve the country; their clinical guidelines are made by an unaccountable body behind closed doors to serve themselves.

So, based on their past form and knowing that they can publish unaccountably, what advice will they come up with for these babies being aborted without painkiller? Unless their hand is forced, anything they wish.

Until RCOG say otherwise, around ten mothers a day* continue to proceed with a very late term abortion (post 20 weeks) under the assurance that their baby will feel no pain and so does not need painkiller. Yet in the same hospitals, mothers with babies of the same age are assured that their baby will feel no pain because foetal painkillers will be given.

*In 2018, there were 3,602 abortions after 20 weeks. Therefore, there were approximately 10 late term abortions (post 20 weeks) every day in 2018. (See Abortion statistics 2018: data tables T5)

All opinions expressed here are the author’s own and do not necessarily represent the views of Right To Life UK.

All opinions expressed here are the author’s own and do not necessarily represent the views of Right To Life UK.

Forced abortion: is it really in anyone’s “best interests”?

Collette Power
PhD candidate in Human Rights Law at the centre for Rights and Justice, Nottingham Trent University.

Last week the Court of Appeal unanimously overturned a ruling forcing an abortion on a 24-year-old, mentally disabled woman (hereafter, AB), by Justice Lieven in the Court of Protection. The original judgment was released this week and it is worth examining to understand how we almost arrived at that horrific point where the state can force one of its own citizens to have an abortion. There is a lot to say but I would like to consider just two points of interest: the woman’s disability and the application of the “best interest” test. 

Firstly, in considering the “best interests” of AB, Justice Lieven comments that she has “to focus on AB as an individual and her best interests, not societal views in termination [nor] the rights of disabled people in general.” Yet disability cannot simply be disregarded in favour of focusing on an AB as ‘an individual’; her disability is a fundamental part of who she is and ironically the crux of the judgment rests on this.  There are specific human rights obligations which arise here.

In 2018, the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) and the Convention on the Rights of Persons with Disabilities (CRPD) released a joint statement mapping out a human rights based approach to the sexual and reproductive health needs of women with disabilities. Particular emphasis is rightly given to the obligation of a state to ensure that women with disabilities are protected against forced abortion.  States should also ensure that women have access to evidence-based and unbiased information.

While the Justice believes AB cannot fully understand the decision at hand here, questions should be asked about the nature of information given to her. The Barrister leading the NHS legal team in this case, told the Court of Appeal that AB “…was told she would go to sleep. She would have an operation and when she woke up the baby would no longer be in her tummy. But she would get a new doll.” This is both patronising and deliberately misleading information. The Justice herself said that “as the pregnancy has developed AB has more understanding that she is pregnant, and that means she has a baby inside her, and that it will be born.”

CEDAW and CRPD are clear that women should not be forced to undergo an abortion against their will, or without their informed consent, though I appreciate that even with unbiased and evidence based information, by virtue of her disability,  AB still might not be able to give informed consent.

All parties were unanimous in their agreement that AB did not have capacity and therefore the judgment focused on the application of the ‘best interests test’ to determine the best course of action.  The purpose of this test, as summarised in Aintree University Hospital v [James], is to focus on the individual and not just medical conduct.  A ‘best interest test’ must contain “a strong element of substituted judgment” taking into account: past and present wishes/feelings of the person, other factors he would consider, beliefs and values likely to influence their decision if they had capacity, and full consultation with carers and other interested parties. Justice Lieven feels weight cannot be given to AB’s feelings/wishes as she considers them unclear and subject to change. 

However, she is clear in her judgment that AB “is happy that she is pregnant and likes the idea of having a baby. I think that it shows if she was making the choice, at this moment she would not want a termination.”  

Whilst it is felt she cannot make ‘the choice’, the most surprising element of this judgment for me is that no weight is given to the opinions of carers and interested parties.  Alongside AB, her mother (a midwife by profession), her social worker and the official solicitor strongly felt the continuation of her pregnancy was in her best interests. Although the local authority adopted a neutral stance, they still laid out their plans for care of the child should AB continue with her pregnancy.

If the purpose of the best interests’ test is to focus on the individual and not solely medical conduct, why was only medical opinion given weight in this case? And why was there so little apparent focus on “the individual”? The Supreme Court is clear that “decision-makers must look at…welfare in the widest sense, not just medical but social and psychological…and they must consult with others who are looking after [them]…in particular for their view of what [their] attitude would be.”

If Justice Lieven feels harm is inevitable whichever path is taken here, surely the opinion of those who have worked closely and extensively with AB over a number of years are therefore best positioned to advocate for her and make this judgment.  Consideration, yet no weight, was given to their views and in my opinion, this was a dangerously narrow and partial application of the ‘best interests’ test.

It is difficult to fully analyse just what has gone on here, the details are still incomplete and the full picture will not be clear until the Court of Appeal judgment is released. However, it is a judgment riddled with contradictions and with little regard for the rights of disabled people. The Justice herself recognises how immensely intrusive a forced abortion would be and the draconian nature of a state ordered termination on a non-compliant woman, yet proceeds in this manner anyway, preferring to rely on tentative psychological speculation as opposed to the voices of those who, professionally and personally, are best placed to make this decision.

Thankfully overturned, this judgment feeds into wider debates about the role and reach of the State in such medical decisions and questions have to be asked as to what weight, if any, Courts are giving to those closest to the person in question. We must continue to be vigilant as this area of law develops, as forced abortion might just be the tip of the iceberg.

All opinions expressed here are the author’s own and do not necessarily represent the views of Right To Life UK.

All opinions expressed here are the author’s own and do not necessarily represent the views of Right To Life UK.

Forced Abortion, Eugenics and the ‘Right to Choose’

Ann Farmer
Author of 'By Their Fruits: Eugenics, Population Control, and the Abortion Campaign' (CUAP, 2008), Ann is also a contributor to The Conservative Woman, The Life Institute, Mercatornet and The Imaginative Conservative

As someone with a genetic disability – and two mentally disabled brothers – but also as a student of eugenics, I am keenly interested in the case of the young mentally disabled woman ordered by the Court of Protection to undergo an unwanted abortion. Her mother, a former midwife, offered to look after her grandchild, but the Judge ruled that abortion was in her ‘best interests’ – that it would be less harmful than having the baby removed after birth.

As always in such cases, all parties are anonymous, but it has emerged that as a lawyer Mrs Justice Lieven represented the abortion lobby in several court cases, including challenging the parental right to be notified of an under-age daughter’s abortion.

Even more worrying, this secretive Court – supposedly established to protect the mentally impaired – has ruled that artificially-delivered food and fluids may be withdrawn from the brain-injured without coming to court if both family and care provider agree, signalling that it is in the ‘best interests’ of people with mental disabilities to be dead.

Sadly, seemingly the most vocal champions of human rights – left-liberal progressives – also champion abortion and euthanasia, apparently based on the subjective ‘I wouldn’t want to live like that’ approach; at the same time they oppose the death penalty – for compassionate reasons, naturally. 

The old worldview on which our laws are based, which prized free will and under which those who cannot help themselves are treated more compassionately, is being overthrown by a new, ‘human-centred’ worldview; but the new laws are made by the strong for the strong, and in practice further disadvantage the disadvantaged, reintroducing the ‘survival of the fittest’ in the guise of autonomy.

The framers of the new laws would sweep away the protections offered by the old laws to the vulnerable because they feel that if they were ‘like that’ they would want the ‘easy out’ of death, either for themselves or for any offspring conceived at the wrong time or with the wrong characteristics. In the name of choice, they have introduced a new kind of Darwinism – DIY eugenics – and although the mentally impaired cannot give authentic consent to life-or-death decisions like abortion and euthanasia, the Court is unlikely to have become involved if she had ‘chosen’ abortion. 

Indeed, she herself would have been targeted for abortion had her condition been detectable in the womb. It seems her own baby has no such impairment, but judging by the muted response from liberal commentators, anything that shows abortion in a negative light – especially when it flatly contradicts ‘the right to choose’ – must be ignored, lest it also contradict the new feminist orthodoxy that abortion is always a ‘good thing for women’. 

The early eugenicists thought it was a good thing for the race, and openly campaigned for abortion for ‘unfit mothers’; all early abortion laws were based on eugenics sterilisation laws, and the concept survived the Holocaust, lasting into the 1960s; indeed, it was only when David Steel’s bill dropped the term in favour of allowing abortion for ‘mothers who could not cope’ that their campaign finally succeeded

Abortion is now the officially preferred solution to poverty and immigration – significantly, the young woman’s mother has Nigerian origins – and also for disability. With the introduction of the more accurate non-invasive prenatal testing (NIPT), people with Down’s syndrome may become an endangered species; but unlike wild animals there will be no David Attenborough to save them.

Would we create a perfect society if we succeeded in eliminating disability? It could only be done by eliminating all disabled persons, as with the Nazis, who despised weakness and tried to create a superior race by eradicating ‘inferior’ types with birth control, sterilisation, abortion, euthanasia and of course the concentration camp. 

Influenced by the horrors of Nazism, the Left promotes personal autonomy in reproductive matters along with the ‘right to die’; but with death so much cheaper than life, especially in a welfare state, inevitably the last resort swiftly becomes the first for the poor and weak, who become not just nuisances but expensive nuisances. And poor women, for whom more money would mean real choice, often see abortion as their only choice; but, far from a positive choice, it is a type of self-harm that involves harming those who are even weaker – the unborn.

The Nazis succeeded in creating Hell on earth, but although the current trend for killing may be motivated by the best of intentions – the eradication of suffering – it leads to the same place, because it involves eradicating the sufferers. The road to Hell is indeed paved with good intentions, but while this Court ruling failed in its objective, it may actually have succeeded in damaging the campaign to decriminalise abortion by exposing the hollow reality of the ‘right to choose’.

All opinions expressed here are the author’s own and do not necessarily represent the views of Right To Life UK.

(Image credit: AdobeStock - Alexander Raths)
All opinions expressed here are the author’s own and do not necessarily represent the views of Right To Life UK.

The Politics of Foetal Pain

James Evans

On the 6th of February this year, the Department of Health and Social Care admitted that an unborn baby aged 20-24 weeks gestation receives painkillers prior to surgery in the womb to treat spina bifida.

In a parliamentary question, Sir Edward Leigh MP asked the obvious follow-up question: will it be made “policy to provide pain relief to unborn babies of a similar age undergoing a termination”. The answer from the Department of Health? No.

Picking up on the contradiction, Fiona Bruce MP asked why there was this variance in clinical practice. Why did babies at 20-26 weeks undergoing spinal surgery receive painkillers, but babies at the same age undergoing termination receive no painkillers? The answer from the Department of Health? Not our job; no.

So whose job is it? Ms Bruce asked. The answer from the Department of Health? It may as well have been white noise.

In the meantime, while the Department of Health avoids it’s responsibilities, around ten mothers a day continue to proceed with a very late term abortion under the assurance that their baby will feel no pain and so does not need painkiller. Yet in the same hospitals, mothers with babies of the same age are assured that their baby will feel no pain because a painkiller will be administered.

This political avoidance has been happening since the late 1980s when the then MP, David Alton, raised the issue in parliament. It was only following the inquiry into foetal sentience that the RCOG formed a working party who published their paper in 1997. They recommended that consultants should consider the need the use of painkillers only for diagnostic or therapeutic procedures on foetuses in utero. Since then, in 2018 alone, 3602 women underwent an abortion at 20 weeks or later without the use of foetal painkiller; many of these will be following the diagnosis of a disability.

Many of these late term abortions will have been a D&E procedure in which, according to RCOG, the ‘fetus is removed in fragments’. In third trimester abortions, babies receive an injection of potassium chloride to effectively induce a heart attack – it can take minutes to several hours to work according to abortion provider BPAS.

Why is there this discrepancy? Why do we provide painkillers for an infant about to undergo spinal surgery in the womb but do not do the same for an infant about to lose his/her life through abortion? Perhaps it is because over time many Obstetrician and Gynaecologist consultants who conscientiously object to abortion have migrated to other medical fields, resulting in a group of polarised mindset without dissenters.

Or, most obviously, perhaps it is because to provide painkillers to a child that is about to have his or her life ended would bring home the reality of what’s going on. It would have a deeply humanising effect on the unborn child, and this is something that abortion supporters are keen to avoid. It would be to acknowledge that there is another human being here who is hurt by abortion. And to admit this might help cause the whole abortion edifice to collapse.

(Photo credit Adobe Stock:MoiraM)

All opinions expressed here are the author’s own and do not necessarily represent the views of Right To Life UK.