No 'list' of conditions warranting late termination, experts advise

The UK's Royal College of Obstetricians and Gynaecologists (RCOG) has released a Working Party report, Termination of Pregnancy for Fetal Abnormality. The peer-reviewed report updates the previous report published in 1996 and reviewed relevant international scientific studies going back to 1990.

The report found that it was not 'realistic' to seek to produce a definitive list of conditions that constitute 'serious handicap' for clinicians to use in interpreting the legal grounds for abortion under the 1967 Abortion Act. The Working party found this problematic since 'accurate diagnostic techniques are as yet unavailable. Likewise, the consequences of abnormality are difficult to predict'. Under the 1967 Abortion Act, a 'substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped' forms a ground for legal abortion with no gestational time limit in England, Wales and Scotland [1].

The report also recommended that the NHS Fetal Anomaly Screening Programme becomes centrally linked, so that the outcome of pregnancies with specific congenital abnormalities can be monitored over time. The report was issued jointly and 'intended to be read together' with an RCOG working party report on fetal awareness. In line with previous evidence, this report concluded that before 24 weeks' gestation, fetal development was not sufficient for the experience of pain by a fetus. The legal limit for most abortions in Britain is before 24 weeks' gestation, with less than one per cent of abortions taking place beyond that gestation.

The RCOG's fetal awareness report was commented on by a Downing Street spokeswoman following David Cameron's pre-election comments to the media about proposals to lower the 24-week legal time limit for most abortions to 20 or 22 weeks [2]. She said 'The Prime Minister's view is that he will be led by the science. At the moment there are no plans to change the policy' [3] Both reports were commissioned by the Department of Health, following recommendations by the House of Commons Science and Technology Committee in 2007, as part of their Inquiry into scientific developments relating to the 1967 Abortion Act.

The Science and Technology Committee Inquiry recommended [4] that to create an exhaustive list of fetal abnormalities for doctors to use when considering the intention of the 1967 Abortion Act was not 'feasible or desirable', but that guidance on what 'serious handicap' meant would be helpful to professionals. They also recommended that data collection relating to the reasons for abortion beyond 24 weeks for fetal abnormality be improved [5]. 

The RCOG's Professor Allan Templeton, chair of the Fetal Awareness Working Party said: 'I believe we now have robust and updated guidance for healthcare professionals'.

Ann Furedi of the British Pregnancy Advisory Service (BPAS), a charity providing abortions before 24 weeks of pregnancy including on the basis of fetal abnormality, said: 'BPAS welcomes the decision not to produce a definitive list of conditions that constitute 'serious handicap'. Diagnostic tests can rarely determine just how severely affected a child will be, and no one other than those most intimately involved with the care and responsibility of a child can judge whether they can cope with what the management of a condition involves.'

Dr Evan Harris, who sat as a Liberal Democrat MP on the Science and Technology Select committee during the 2007 inquiry, said: 'The RCOG report reinforces the Select Committee's conclusion that a list of conditions is neither feasible or desirable. It rightly argues for this to be a matter for clinical judgment in consultation with the patient. However, the Select Committee also argued for better availability of data in order to quash the media myths of minor abnormalities- like 'club foot'- being used as a basis for post-24 week abortions. More work on this is still needed'.