Abortion already underway as the Court of Appeal overturned forced abortion ruling

Documents from the Court of Appeal which ultimately stopped a state enforced abortion from taking place last month, revealed that the first stage of a three day abortion procedure was being carried out during the Court hearing.

At the end of June, Justice Nathalie Lieven ruled that forcing a woman with a moderate learning disability to have an abortion against her will was in her “best interests”. In a last minute hearing the next working day (Monday 24/06), three judges in the Court of Appeal overruled this decision, forbidding doctors from performing an abortion on this woman.

The full ruling of the Court of Appeal has now been released and it reveals that the woman was already undergoing a “pre-operative assessment” for the abortion, which was in fact being carried out during the hearing at the Court of Appeal.

The “pre-operative assessment” formed what would have been part of a three day invasive process which would ultimately have ended the life of her baby.

The ruling also reveals that the judges overturned Justice Lieven’s decision because she gave insufficient consideration to the wishes and feelings of the pregnant woman, as well as the views  of the woman’s primary carers – including her own mother – who believed it was in her best interests not to have an abortion.

The Court of Appeal judge, Lady Justice King said Justice Lieven “made no mention of AB’s [the woman’s] wishes and feelings or of the views of CD [the woman’s mother], the social worker or the Official Solicitor. This was, in my opinion a significant omission.”

The Court of Appeal also brought to light the “well established” principle that “the court does not take into account the interests of the foetus but only those of the mother”.

Clare McCarthy from Right To Life said:

“Between the original ruling and the decision from the Court of Appeal, the life of the 22-week-old baby hung in the balance and was literally hours away from being aborted. In fact, the pre-operative assessment for the abortion was already underway. If this last-minute hearing did not take place when it did, this baby would not be alive.

“As the ruling from the Court of Appeal made clear, the right to life of the baby held no weight in court, as the “the court does not take into account the interests of the foetus but only those of the mother”. This is despite the fact that the baby, this late in gestation, would in some cases have been able to survive outside of the womb.

“Although it is a major relief that the Court of Appeal came to this decision, and that the forced abortion did not take place, it is a chilling case that demonstrates the power the court holds over life and death.

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

Collette Power

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.

Disability rights group condemns forced abortion ruling as ‘wholly wrong’

Disability Rights UK has condemned Justice Lieven’s ruling attempting to force an abortion on a woman with a learning disability, calling the decision “wholly wrong”.

The disability charity condemned the decision saying it was “in contravention of the UN Convention on the rights of People with Disabilities.”

“In our view, the issue here is to ensure that the woman concerned receives sufficient support to help her with her parenting role.”

This denunciation came during international outcry after an NHS Trust successfully brought a court case against a patient with a learning disability, resulting in the Court of Protection ruling that this woman must have an abortion against her will.

The woman is said to have a “moderately severe” learning disability, leaving her with the mental age of a six to nine year old.

Three Court of Appeal judges since ruled that doctors must not perform an abortion on this woman. The judges said that the circumstances of this case were unique and that their reasons for overturning this decision would be released at a later date.

Clare McCarthy from Right To Life UK said: “Disability Rights UK are absolutely correct to condemn this ruling.”

“This decision made by the judge speaks volumes about the attitudes and ignorance of not only the judge but also the NHS Trust both to people with learning disabilities and children in general.”

“As Disability Rights UK suggest, the response  to this woman’s situation should be support, not abortion.”

Doctors promised ‘new doll’ after forced abortion for disabled woman

After a Court of Appeal ordered that a woman with a learning disability must not be forced to have an abortion, it was revealed that the hospital had planned to give the disabled woman a doll as an apparent replacement for the baby whose life they were intending to end.

Barrister Fiona Paterson, who represented the NHS hospital trust with responsibility for the woman’s care, told the three appeal judges: “She 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.”

Miss Paterson said the woman had already been given a doll which she played with.

She added that it was “thought to be in keeping with her current level of understanding of the pregnancy” and that doctors believed “the prospect of a new one might be very appealing to her”.

This is consistent with the Justice Lieven’s original ruling saying that the woman must be forced to have an abortion.

The judge said she did not believe the woman understood what it meant to have a baby.

“I think she would like to have a baby in the same way she would like to have a nice doll,” Lieven said.

Clare McCarthy from Right To Life UK said: “There is no reason to think, from the information available, that this woman with a learning disability would not experience great distress and suffering were the life of her baby to be forcibly ended in the womb.”

“Children, and adults with learning disabilities, know the obvious difference between a baby and a doll – something which apparently Justice Lieven and the NHS Trust do not understand at all.”