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NOTIFYING RESULTS OF ABORTIONS
941 that termination should be done. These doctors sometimes work in liaison with each other and occasionally one of them may have an interest in the success of a private nursing-home approved under the Act. To obtain an abortion in this way is comparatively simple on paying the appropriate fees and relating a convincing story. In these circumstances the opinion of a family doctor, who may have known the patient and her relatives for some years, is of no value whatsoever; and whatever he may feel himself or say to the patient, she will get herself aborted quite legally, complying, on paper at least, with the terms of the Act. She is indeed encouraged to do so. Some women’s magazines advise their readers to search for the doctor whose views about the future of her pregnancy agree with her own. What, then, is the use of a careful doctor reaching an honest and considered opinion in this kind of case when, if it does not suit the patient, she will turn elsewhere ? Firstly, there may be little he can do, since we still retain the freedom of choice of doctor and patient in this country. If he feels that he has done his best, he can let the matter rest. Secondly, in order to save himself much time and heart-searching, he might agree to every request for abortion in the first place without necessarily considering whether or not his patient would be helped by an abortion or whether he is in all sincerity signing a certificate agreeing to abortion " in good faith ". It is stated that the Act of 1967 has created a situation where abortion can be done " on demand ". This era is well-nigh with us and a stock of green forms may soon become part of each doctor’s essential equipment. If we wish this to be so, then let us say so openly without any further expressions of qualms of conscience. The Act provides that any practitioner may indicate his conscientious objection to participating in any part of the abortion procedure. This may be a curtain behind which some troubled doctors may seek refuge, but for mostgeneral practitioners working in neighbourhoods with many young people whom he is regularly advising about family planning, pregnancies, and similar problems, such a solution is impractical. It is not feasible for a doctor to take an active part in many aspects of family medicine whilst putting up the conscientious shutter whenever the question of termination of pregnancy arises. The Abortion Act is destroying the conventional and timehonoured relationship between patient and doctor wherein the doctor advises his patient as to what he considers to be the correct means of alleviating complaints and medical conditions. The Act is bringing about a reversal of this traditional and probably correct practice. Ultimately we shall lose our capacity for objective clinical judgment, and, with it, our self-respect. D. S. NACHSHEN. London N.W.2.
DELINQUENT GIRLS annotation SIR, Your (April 5, p. 713) is interesting and the points made unexceptionable. Too many of our children come, unfortunately, from a disturbed or uncaring family background. Schools could, and certainly should, provide much more help than they are at present able to do. In view of the role of the school in transmitting and modifying our cultural heritage, it is little short of tragic that, for so many, school is merely a time of endurance. It discharges them semiliterate and uncommunicating. Many leave frustrated, lonely, and resentful, conditioned towards delinquency. They have lacked any sense of participation which gives significance and which in turn leads to a willingness to accept responsibility. Dr. Derek Miller was reported in The Times (April 12, 1969) as saying that schools should be looked at to see what social and psychological stability they could provide, and how they could meet adolescent emotional needs. This is indeed a matter for most urgent consideration. The medical and educational situation is here indivisible. Health and wholeness are one. What can the medical profession do, perhaps through a new
approach to the school health service, to play its part in meeting this need ? There is one point on which there is much muddled and dangerous talk. We speak too glibly of raising the schoolleaving age as though an administrative date-stamp could be applied to young people irrespective of quality of school or biological need. Dr. Miller is further quoted in The Times as saying it was tragic to remove children from school at 15 or 16 to work, because they needed stable relationships with adults or their teachers. Indeed they do, but schools often fail to provide this. It may be even more tragic to give them enforced detention in school in wholly unsatisfactory conditions and call it education. This certainly breeds delinquency. Surely we need new thinking in our approach to education. There should be no hard final line between school and work. We need a phasing-out process, learning while earning, a prelude to learning as a lifelong process. Rather than, as all too often happens, detaining in school, using the tutorial system, a counselling system should be greatly developed and extended This could as a specific system into the early years at work. be truly educational. It requires a totally new approach to the youth-employment service. What we need is more imagination, determination and a The sense of responsibility or the situation will get worse. article by Professor Gruenberg in the same issue as your annotation (p. 721) is relevant to the situation of young
delinquents, boy
or
Farnham Royal, Bucks.
girl. M. E. M. HERFORD.
NOTIFYING RESULTS OF ABORTIONS SIR,-It seems that the Ministry of Health form of notification to the Chief Medical Officer of an abortion performed under section one of the Abortion Act requests certain information which cannot possibly have any statistical value. On pages three and four of this document one is asked to state (a) the date of discharge from the place of termination of pregnancy, and (b) complications or death before notification; one is instructed to complete and post the form " within seven days of the termination of pregnancy ". For the latter information to be of use all practitioners would have to complete the form on the same postoperative day, and it would seem sensible for the day chosen to be at least two weeks after the operation has been performed. Thereby the great majority of complications would be recorded. Mile End Hospital, London E.1.
W.
J. MODLE.
CLINICAL HÆMATOLOGY SIR,-I believe that there is a need for haematologists with clinical experience and that the relationship of their training, responsibilities, and careers to that of the laboratory hasmatologist forms the main issue in the present controversy. The training of haematologists should be sufficiently flexible to enable laboratory hxmatologists to obtain further general medical experience, should they desire it, without necessarily prolonging their overall training, and to permit clinical haematologists to spend a year or more in the laboratory. It is unfortunate that the M.R.C.P. and the M.C.PATH. differ so fundamentally in their requirements. The former can be taken relatively early, and usually precedes the specialist training necessary to obtain a consultant post. Thus the holder of the M.R.C.P. can spend a variable amount of time in the laboratory gaining experience or doing research, and can often combine the latter with his or her clinical work. By contrast, the M.C.PATH. requires the candidate to have had not less than four years’ specified laboratory training before he can sit the part-II examination. This approach may discourage a person from obtaining additional clinical experience or becoming extensively engaged in research until after the M.C.PATH. has been
DELINQUENT GIRLS annotation SIR, Your (April 5, p. 713) is interesting and the points made unexceptionable. Too many of our children come, unfortunately, from a disturbed or uncaring family background. Schools could, and certainly should, provide much more help than they are at present able to do. In view of the role of the school in transmitting and modifying our cultural heritage, it is little short of tragic that, for so many, school is merely a time of endurance. It discharges them semiliterate and uncommunicating. Many leave frustrated, lonely, and resentful, conditioned towards delinquency. They have lacked any sense of participation which gives significance and which in turn leads to a willingness to accept responsibility. Dr. Derek Miller was reported in The Times (April 12, 1969) as saying that schools should be looked at to see what social and psychological stability they could provide, and how they could meet adolescent emotional needs. This is indeed a matter for most urgent consideration. The medical and educational situation is here indivisible. Health and wholeness are one. What can the medical profession do, perhaps through a new
approach to the school health service, to play its part in meeting this need ? There is one point on which there is much muddled and dangerous talk. We speak too glibly of raising the schoolleaving age as though an administrative date-stamp could be applied to young people irrespective of quality of school or biological need. Dr. Miller is further quoted in The Times as saying it was tragic to remove children from school at 15 or 16 to work, because they needed stable relationships with adults or their teachers. Indeed they do, but schools often fail to provide this. It may be even more tragic to give them enforced detention in school in wholly unsatisfactory conditions and call it education. This certainly breeds delinquency. Surely we need new thinking in our approach to education. There should be no hard final line between school and work. We need a phasing-out process, learning while earning, a prelude to learning as a lifelong process. Rather than, as all too often happens, detaining in school, using the tutorial system, a counselling system should be greatly developed and extended This could as a specific system into the early years at work. be truly educational. It requires a totally new approach to the youth-employment service. What we need is more imagination, determination and a The sense of responsibility or the situation will get worse. article by Professor Gruenberg in the same issue as your annotation (p. 721) is relevant to the situation of young
delinquents, boy
or
Farnham Royal, Bucks.
girl. M. E. M. HERFORD.
NOTIFYING RESULTS OF ABORTIONS SIR,-It seems that the Ministry of Health form of notification to the Chief Medical Officer of an abortion performed under section one of the Abortion Act requests certain information which cannot possibly have any statistical value. On pages three and four of this document one is asked to state (a) the date of discharge from the place of termination of pregnancy, and (b) complications or death before notification; one is instructed to complete and post the form " within seven days of the termination of pregnancy ". For the latter information to be of use all practitioners would have to complete the form on the same postoperative day, and it would seem sensible for the day chosen to be at least two weeks after the operation has been performed. Thereby the great majority of complications would be recorded. Mile End Hospital, London E.1.
W.
J. MODLE.
CLINICAL HÆMATOLOGY SIR,-I believe that there is a need for haematologists with clinical experience and that the relationship of their training, responsibilities, and careers to that of the laboratory hasmatologist forms the main issue in the present controversy. The training of haematologists should be sufficiently flexible to enable laboratory hxmatologists to obtain further general medical experience, should they desire it, without necessarily prolonging their overall training, and to permit clinical haematologists to spend a year or more in the laboratory. It is unfortunate that the M.R.C.P. and the M.C.PATH. differ so fundamentally in their requirements. The former can be taken relatively early, and usually precedes the specialist training necessary to obtain a consultant post. Thus the holder of the M.R.C.P. can spend a variable amount of time in the laboratory gaining experience or doing research, and can often combine the latter with his or her clinical work. By contrast, the M.C.PATH. requires the candidate to have had not less than four years’ specified laboratory training before he can sit the part-II examination. This approach may discourage a person from obtaining additional clinical experience or becoming extensively engaged in research until after the M.C.PATH. has been