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INTERPRETING THE ABORTION ACT
590
Letters to the Editor FUTURE OF THE N.H.S.
SIR,-It is encouraging to read someone like Dr. Ashley (Aug. 30, p. 485) who believes in the essential rightness of a National Health Service, but finds himself somewhat dissatisfied with the one we have got after twenty-one years and wants to correct its deficiencies. Discouraging, however, are letters like Dr. Janet Aitken’s in The Times of Aug. 22 in which she said that as a visitor to various countries " in a semi-official position " she had never heard from doctors " anything but praise for our National Health Service ". Those who have also travelled and listened (and read) will conclude that she was either very selective in whom she met, or that her hosts had strong motives to please her. There followed that hoary untruth so dear to those who spend much time patrolling the corridors with our mastersi.e., that in the U.S.A. only " millionaires are free of the terror of being ill. "
Surely the time has come for less emotion, for an end to accusing every,critic of destructive intent, and for justifiable admiration of a concept to make room for a cool look at it at work. Only those who choose to remain so are unaware of the unacceptably low and deteriorating standard of medical care for many of our people, especially in parts of the Midlands and the North. With respect to Dr. Ashley I suggest there is more than enough information from inquiries, commissions, committees, and recent reports already gathering dust on the shelves, quite apart from the total experience acquired by those who have been in the front of this experiment but are consulted only when they have soothing words for those whose interest is in maintaining the status quo. Dr. Ashley’s suggested " think-tank " has made sense for some time, but I would have 10 in it and not 110, and I would give them six months rather than a year to ensure that they stick to fundamentals and avoid detail. I differ from Dr. Ashley over the need for " detailed analysis " or more " planning ". There is already too much of it by squads of men in distant places who lack the discipline of living with the offspring they conceive either administratively or in bricks and mortar. The result is that thousands more men and women all over the country either sit in committees or in any old odd corner turned office and frustratedly try to make sense of the tangled skein so ineptly imposed upon them, relieving their boredom with coffee, football pools, and how to wangle the extra bob on overtime. I suggest that with our limited resources we cannot afford this waste. On the larger questions Dr. Ashley is an optimist if he thinks he will get much better solutions from his statisticians, economists, demographers, and sociologists than if he took a pin. Of course, these major problems need to be met, and met effectively, but most of them are only soluble by creating a financial and administrative structure sufficiently flexible and responsive to need as it arises at local or national level. They are emphatically not soluble in advance with information that does not exist; attempts to solve them with existing information is about as unreliable as crystal gazing, and if acted upon by a monopoly such as the N.H.S. quite minor errors can become magnified into national disasters in terms of cost and misery. But the planners still plan. Nevertheless, I am confident that this great enterprise can be persuaded to sail better and more safely with some trimming of its cargo and better helmsmen. J. W. PAULLEY. Ipswich.
INTERPRETING THE ABORTION ACT SiR,ŃIt was apparent to many of us that any abortion law demanding a real risk of physical or psychological disorder to justify legal termination would fail to meet the demands of a large number of women whose only objection to their pregnancy is on grounds of convenience. It was inevitable and entirely forseeable that such women would seek illegal abortions. If Sir George Godber (Aug. 9, p. 312) hoped this situation would be solved by the present Act he must have ignored a large body of evidence from other countries. It is, however, disturbing that he now states that termination of an unwanted pregnancy is an N.H.S. service which women have a right to expect. He makes no mention of the criteria for termination laid down in the Act, and it is odd to hear the Chief Medical Officer advocating procedures some of which would clearly be illegal. If the Government wishes to establish abortion on demand it should induce Parliament to legislate accordinglythough it is unlikely to be successful. Meanwhile, it will be incieasingly difficult for those of us who try to interpret the Act in a conscientious way, if it says one thing, but according to yourself and your distinguished contributor, has a spirit which means something entirely different. Edgbaston,
Birmingham
16.
HOWARD WHITE.
*** This letter has been shown to the Chief Medical Officer, Sir George Godber, whose reply follows.-ED. L. SIR,-Dr. White must be unaware that a large proportion of the
women who die after illicit abortion have had four or children and an equally large proportion are aged over 30. Neither he nor I can say whether their only objection to pregnancy " is on grounds of convenience " or is such as would satisfy many gynxcologists under the present Act. They have been sufficiently disturbed by their pregnancies to risk their lives. It is surely wrong to conclude that the experience of countries which changed their laws before modern contraceptive methods were available will be repeated here, and equally so to compare Britain with Eastern Europe. We will soon know whether those areas in which a service is more readily given have reduced their numbers of such deaths. My lecture did not reiterate the criteria laid down in the Abortion Act since these are well known, but it explicitly stated that abortion on demand was not legalised. It did not say that any pregnant woman had a right to termination if she wished it, nor did it advocate any illegal procedure. I know well that the profession is trying to interpet the Act in a conscientious way, but we must surely, as a profession, face the fact that widely differing interpretations are being followed in different areas and even in different departments in the same area. The result is not only that some departments are overloaded because they are believed to take a more liberal view, but also that many women obtain treatment privately elsewhere, within the law, and others still seek illicit termination either by unqualified persons or by their own acts. more
Department of Health and Social Security, Elephant and Castle, London S.E.1.
G. E. GODBER.
VOLUNTARY STERILISATION
SIR,-The figures produced by Dr. Beazley and Mr. Fraser (Sept. 6, p. 531) show that out of 76 couples applying for surgical sterilisation 16 men requested vasectomy and in 12 cases the operation was performed. This is the situation when the whole problem is discussed with knowledgeable and sympathetic doctors, and it contrasts sadly with the
Letters to the Editor FUTURE OF THE N.H.S.
SIR,-It is encouraging to read someone like Dr. Ashley (Aug. 30, p. 485) who believes in the essential rightness of a National Health Service, but finds himself somewhat dissatisfied with the one we have got after twenty-one years and wants to correct its deficiencies. Discouraging, however, are letters like Dr. Janet Aitken’s in The Times of Aug. 22 in which she said that as a visitor to various countries " in a semi-official position " she had never heard from doctors " anything but praise for our National Health Service ". Those who have also travelled and listened (and read) will conclude that she was either very selective in whom she met, or that her hosts had strong motives to please her. There followed that hoary untruth so dear to those who spend much time patrolling the corridors with our mastersi.e., that in the U.S.A. only " millionaires are free of the terror of being ill. "
Surely the time has come for less emotion, for an end to accusing every,critic of destructive intent, and for justifiable admiration of a concept to make room for a cool look at it at work. Only those who choose to remain so are unaware of the unacceptably low and deteriorating standard of medical care for many of our people, especially in parts of the Midlands and the North. With respect to Dr. Ashley I suggest there is more than enough information from inquiries, commissions, committees, and recent reports already gathering dust on the shelves, quite apart from the total experience acquired by those who have been in the front of this experiment but are consulted only when they have soothing words for those whose interest is in maintaining the status quo. Dr. Ashley’s suggested " think-tank " has made sense for some time, but I would have 10 in it and not 110, and I would give them six months rather than a year to ensure that they stick to fundamentals and avoid detail. I differ from Dr. Ashley over the need for " detailed analysis " or more " planning ". There is already too much of it by squads of men in distant places who lack the discipline of living with the offspring they conceive either administratively or in bricks and mortar. The result is that thousands more men and women all over the country either sit in committees or in any old odd corner turned office and frustratedly try to make sense of the tangled skein so ineptly imposed upon them, relieving their boredom with coffee, football pools, and how to wangle the extra bob on overtime. I suggest that with our limited resources we cannot afford this waste. On the larger questions Dr. Ashley is an optimist if he thinks he will get much better solutions from his statisticians, economists, demographers, and sociologists than if he took a pin. Of course, these major problems need to be met, and met effectively, but most of them are only soluble by creating a financial and administrative structure sufficiently flexible and responsive to need as it arises at local or national level. They are emphatically not soluble in advance with information that does not exist; attempts to solve them with existing information is about as unreliable as crystal gazing, and if acted upon by a monopoly such as the N.H.S. quite minor errors can become magnified into national disasters in terms of cost and misery. But the planners still plan. Nevertheless, I am confident that this great enterprise can be persuaded to sail better and more safely with some trimming of its cargo and better helmsmen. J. W. PAULLEY. Ipswich.
INTERPRETING THE ABORTION ACT SiR,ŃIt was apparent to many of us that any abortion law demanding a real risk of physical or psychological disorder to justify legal termination would fail to meet the demands of a large number of women whose only objection to their pregnancy is on grounds of convenience. It was inevitable and entirely forseeable that such women would seek illegal abortions. If Sir George Godber (Aug. 9, p. 312) hoped this situation would be solved by the present Act he must have ignored a large body of evidence from other countries. It is, however, disturbing that he now states that termination of an unwanted pregnancy is an N.H.S. service which women have a right to expect. He makes no mention of the criteria for termination laid down in the Act, and it is odd to hear the Chief Medical Officer advocating procedures some of which would clearly be illegal. If the Government wishes to establish abortion on demand it should induce Parliament to legislate accordinglythough it is unlikely to be successful. Meanwhile, it will be incieasingly difficult for those of us who try to interpret the Act in a conscientious way, if it says one thing, but according to yourself and your distinguished contributor, has a spirit which means something entirely different. Edgbaston,
Birmingham
16.
HOWARD WHITE.
*** This letter has been shown to the Chief Medical Officer, Sir George Godber, whose reply follows.-ED. L. SIR,-Dr. White must be unaware that a large proportion of the
women who die after illicit abortion have had four or children and an equally large proportion are aged over 30. Neither he nor I can say whether their only objection to pregnancy " is on grounds of convenience " or is such as would satisfy many gynxcologists under the present Act. They have been sufficiently disturbed by their pregnancies to risk their lives. It is surely wrong to conclude that the experience of countries which changed their laws before modern contraceptive methods were available will be repeated here, and equally so to compare Britain with Eastern Europe. We will soon know whether those areas in which a service is more readily given have reduced their numbers of such deaths. My lecture did not reiterate the criteria laid down in the Abortion Act since these are well known, but it explicitly stated that abortion on demand was not legalised. It did not say that any pregnant woman had a right to termination if she wished it, nor did it advocate any illegal procedure. I know well that the profession is trying to interpet the Act in a conscientious way, but we must surely, as a profession, face the fact that widely differing interpretations are being followed in different areas and even in different departments in the same area. The result is not only that some departments are overloaded because they are believed to take a more liberal view, but also that many women obtain treatment privately elsewhere, within the law, and others still seek illicit termination either by unqualified persons or by their own acts. more
Department of Health and Social Security, Elephant and Castle, London S.E.1.
G. E. GODBER.
VOLUNTARY STERILISATION
SIR,-The figures produced by Dr. Beazley and Mr. Fraser (Sept. 6, p. 531) show that out of 76 couples applying for surgical sterilisation 16 men requested vasectomy and in 12 cases the operation was performed. This is the situation when the whole problem is discussed with knowledgeable and sympathetic doctors, and it contrasts sadly with the