USA: Abortion electioneering

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2 years, for a hospital bed. In the summer the managers were told their performance-related pay would be judged on

whether they had eliminated all patients from their 2-year list by March, 1992. Then in August they were instructed to make the Government’s structural changes, due in April, their first priority. Both waiting times and the Government’s other key priority, reduction of infant deaths, were downgraded even though the waiting list has now exceeded one million and the UK’s infant mortality rate is far higher than in Holland, West Germany, and Sweden. No one should accuse the Conservatives of not trying to raise standards, however. The latest gimmick to emerge from ministers is a suggestion that hospitals should raise funds by inviting patients to pay for optional extras such as wine, manicures, personal TVs and stereos, secretarial assistance, better food, telephones, and dry cleaning. The junior minister both denied and confirmed the intent to create a two-tier health system: medical services would be one-tier, hospital "hotel" services two-tier. But the drawback of introducing upmarket bistros into every acute hospital is that bistros have a habit of going bust. Over half the restaurants in the Good Food Guide of a decade ago are no

longer functioning. The main achievement of ministers so far has been to reduce public satisfaction in the NHS. In the annual poll on the NHS conducted for the Health Service Journal, the proportion who are satisfied dropped from 72% last year to 65% this year. However, those who received hospital treatment remain as satisfied as ever-84% (ranging from 77% among the 16 to 24 age group to 91 % of the over 65s). Labour, which is still maintaining a large lead in the opinion polls, is due to set out its alternative to the Tory plan next month. It has already said it will bring all opted-out hospitals back under health authority control and clear some of the businessmen out of the new executives. The test for opposition parties is to demonstrate that they will protect the fundamental principles of the NHS-a tax-financed service that is free at the point of delivery-while tackling inefficiency, ineffectiveness, and inequality. There are already several initiatives to make the NHS more efficient and effective--the new cost information system to make staff more cost conscious; clinical budgets to make doctors more management minded; the prescribing monitoring agency which is already reducing the drugs bill; wider use of medical audit as well as the Audit Commission, whose study of day surgery is to be followed by reports on pathology and estate management. Together they point up the irrelevance of the Conservatives’ internal market with its intimidating computer needs and army of extra accountants, finance directors, computer billers, and data processors. An extra 4000 administrative staff this year, but many more than that when the system is in full flow at an estimated cost of C3 billion. Where there has been no progress in the past decade has been on the inequalities of health. Reducing the social causes of health inequalities, as the Black Report noted, requires far more than just an NHS response. Inequalities in income, housing, and education have all widened in Britain under Mrs Thatcher through a combination of tax cuts, social security reductions, and public expenditure squeezes. The proportion living in poverty (60% below average earnings) is now twice as high as 30 years ago. The past decade has seen the biggest increase in relative deprivation in Britain for a century.

Malcolm Dean

Round the World New Zealand: Cervical cancer at National Women’s Hospital and Medical Council

disciplinary inquiry On Saturday Oct 13, the Medical Council of New Zealand called a press conference in Auckland to release the findings of its disciplinary inquiry into a complaint against Prof Dennis Bonham; the charges against Professor Bonham arose out of the 1988 Cartwright inquiry into the management of carcinoma-in-situ (CIS) of the cervix at National Women’s Hospital (see Sept 29, p 801). Professor Bonham was Head of Postgraduate School, Department of Obstetrics and Gynaecology, University of Auckland Medical School, and chaired the senior staff meeting at National Women’s Hospital in 1966 at which Dr Herbert Green presented his controversial proposal for a research programme into the natural history of CIS. Professor Bonham was in charge of the hospital’s obstetric and gynaecology department for many years, during which there was increasing concern about Green’s unconventional management strategy; similar charges against Green were stayed on the grounds of ill-health. The Medical Council (three women and seven men) announced that it had found Professor Bonham guilty in various degrees to most of the charges laid against him. Cumulatively, he was found guilty of the most serious charge—disgraceful conduct. There is a right of appeal to the High Court, and the Medical Council has not yet announced penalties. This verdict completely vindicates the Cartwright report and should effectively silence critics who had deemed the affair a feminist witch-hunt. A correspondent

USA: Abortion

electioneering

The questioning of Judge Souter by the senators did not elicit how the Judge, if confirmed as a Supreme Court justice, would vote when the question of reversing the Roe v Wade decision came before the Supreme Court. This 1973 decision established the legal right to an abortion and has been under constant attack ever since. Judge Souter agreed that there are rights which are not specified by our written constitution, and this and other stated views have upset the conservatives and anti-abortionists, especially since he supported the Griswald decision, which upheld the marital right to use contraceptives--the lead to the Roev Wade decision. From the other side, Judge Souter is criticised because he did not openly support abortion rights, though as a hospital trustee he upheld the hospital’s right to perform abortions. Abortion rights are certainly going to be a factor in the forthcoming Congressional election. But suppose Roev Wade is overturned. Would it make all that difference? For such a decision, as the Webster decision indicated’, would put the abortion issue back into the hands of the separate state legislatures. The states in which abortion rights have been protected by their constitutions would not be affected by the overturning of Roe. Seven states, including some with the largest populations, have ruled that abortion rights are

protected.

One such state, New York, pays for abortions for women who receive Medicaid but not for the working poor who are not so covered. This is now being challenged in the courts.

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New York

City is supporting the case, as are many organisations that support abortion rights. The latter are raising large sums of money, both for state legislators and congressional candidates who openly uphold abortion rights. Those who so favour abortion seem to be succeeding, and at the expense of the

anti-abortionists, who seem to be

mostly republicans. A 1. Anon. Abortion USA. Lancet

correspondent

1989; i: 879-80.

Poland: New legislation

on

abortion

Poland’s Senate has taken the first steps towards new legislation outlawing abortion. After a stormy three-day debate, which removed or toned down the most draconian clauses of the original proposals, it eventually approved a draft which has been passed to the Sejm (lower house) for further debate. The "lex Ceaucescu", as it has been dubbed by its opponents (in reference to the compulsory pregnancy policies of the late Romanian dictator) is generally assumed to have been rushed forward on the urging of the Catholic hierarchy. Yet among those who spoke against it were such prominent Catholics as Senator Zoigniew Romaszewski (former head of underground Solidarity’s human and civil rights panel) and Dr Zofia Kuratowska, vice-marshal of the Senate, who during the martial law period of 1981-83 headed the Church’s medical relief to internees. Opponents of the Bill did not, they made clear, advocate abortion in any but the most extreme circumstances. Even the feminist pickets outside the Parliament building accept as self-evident the traditional Polish lifestyle in which spinsterhood is virtually unknown outside convent walls and a childless marriage is a tragedy. But the majority of Polish women who seek abortion do so as a last resort under pressure of inadequate and crowded housing, lack of social security support and day-care facilities for children already born, low rates of pay (making the wife’s wages essential), and queues, and-an unwelcome endemic shortages side-effect of the collapse of socialism-galloping inflation and the ever-growing threat of unemployment in a system where, as yet, there is no proper dole. The people have little knowledge of contraceptive techniques, even of the rhythm method advocated by the Catholic Church. Artificial means of contraception are difficult to obtain and for the most part either unreliable (if of eastern-bloc provenance) or impossibly dear (in the case of western items bought on the black market). Put the economy in order, opponents of the Bill argued, get a proper social security system with adequate support and facilities for expectant mothers, whether married or single, and the vast majority of abortions will simply become unnecessary. Moreover, as Dr Kuratowska pointed out, if the Bill was intended to "protect the life of the conceived child", then logically it ought also to apply to the thousands of pregnancies which annually end in miscarriage as a result of industrial pollution and the harsh working conditions to which women in Poland are exposed. Some senators queried whether delegalisation would reduce the number of abortions or would simply drive them underground or abroad and whether the proposed mandatory two-year prison sentence for both the women and the medical personnel was the most appropriate penalty. In the event, the Senate decided that the mother herself should not be liable to legal penalty and that although "persons bringing about the death of a conceived child" will still be liable to two years’ imprisonment, the courts should be able to waive this penalty in exceptional circumstances:

abortion should still be permitted in the case of a serious threat to the mother’s life or if the pregnancy resulted from rape, while in the case of miscarriage resulting from violence or the threat of violence to the mother, the penalty should be five years’ imprisonment. In addition, interference with the genetic material of an unborn child for purposes other than treatment or for saving life should carry a lesser penalty of up to two years’ "limitation of liberty" (eg, community service, or restrictions on leaving one’s place of abode). The civil code, the Senate recommended, should be amended to grant the unborn child the status of a legal person, but its property rights (including the right to sue for damage sustained in utero) should become operative only if it was born alive. Local-government bodies, community organisations, and the churches should be urged to promote social support for pregnant women in fmancial or social hardship, and-in the event of the Bill passing the Sejm-a six-month moratorium was recommended before it came into force, during which a public education campaign should be mounted. Whether the Bill will pass the Sejm, even in its amended form, is, however, uncertain. For the Senate is a creation of the 1989 "Round Table Accords", elected on fully democratic principles, with 99 of its 100 members returned to the Solidarity ticket. But the Sejm still has a built-in majority of members from the former ruling Polish United Workers’ Party, who have now regrouped into two "socialdemocratic" parties but who still preserve their old hostility to the Catholic Church. Meanwhile, in the correspondence columns of the press and on the placards of the pickets, the campaign against the Bill continues.

Vera Rich

Medicine and the Law Product

liability proposals, Sweden

The Swedish Ministry of Justice has lately circulated a draft Product Liability Act to public and private organisations for comment. The legislation would be strict, and the proposals have not been welcomed by trade and industry, who want legislation that conforms with that adopted by most European Community (EC) countries, including retention of a development risk defence. Consumer groups, on the other hand, strongly support the proposals. The draft Act borrows much (but not all) from the EC directive.

Compensation is payable if damage is caused by a product which, "when it was put into circulation, was not as safe as could reasonably have been expected at that time". The safety of a product "shall be assessed with regard to the use to which it may be expected to be put, the marketing of the product, instruction for use and all other circumstances". "If damage arises due to lack of safety of a product that constitutes a component part of another product, both products shall be deemed to have caused the damage." Liable will be anyone who has manufactured or produced the product, who has imported it, or has marketed it by affixing his own name or trademark to it. The Act offers little comfort to the potential defendant. Defences available are that the product was not a commercial one; that, on a balance of probabilities, the lack of safety complained of did not exist when the product was put into circulation; or that the product (eg, a drug or a medical device) has a use-by date or has to be stored under certain conditions which, arguably, were not met by the supplier or consumer. The limitation periods generally are (as in the UK) that proceedings must be instituted within three years of learning that a claim might be invoked, but the outside limit is 10 years for property (as in the EC) and, most controversially, 25 years for personal injuries.