Abortion: Are two doctors better than one?

May 24, 2012, 9:39 AM GMT+0

Should two doctors have to sign off on an abortion? We breakdown the debate that took place here in PoliticsLab…

Currently the law in England, Wales and Scotland states that – emergencies aside –two doctors must approve a woman's request for an abortion before it is allowed to proceed. Under this system, a woman seeking an abortion must have two doctors who agree that her physical or mental health and wellbeing are at risk if she carries on with the pregnancy.

Controversy was sparked recently when surprise inspections on more than 250 abortion clinics found evidence of blank forms being pre-signed in anticipation of patients seeking a termination.

This discovery called into question the ‘two doctors’ process, where critics felt the incidence of pre-signed forms effectively bypassed a second medical examination, and implied that some healthcare professionals believe this process to be redundant.

When we invited you to discuss the necessity of having two doctors sign off an abortion in Labs, we could have expected the debate over this emotive issue to be polarised.

Labs participants were split on this topic for varying reasons, from whether this process is beneficial to women and healthcare in general, to whether it is an outdated and onerous method that should be abolished.

Those who said they were against the law tended to believe that obtaining two doctors' signatures is condescending to the woman and anachronistic, as there are no other situations where a patient requires permission from two third parties to make a personal healthcare decision.

Many of those who were opposed to the process said that procuring two signatures causes an unnecessary hindrance to abortion services, with delays experienced by some women during GP referrals (and the refusal by some GPs to forward these requests directly on grounds of conscience).

However, participants in favour of the law said they saw the need for two doctors as a safeguard to protect the interests of both the patient and the doctor.

They added that in the event of a woman being coerced into an abortion, seeking a second opinion will allow the patient more time to consider her options, with the additional support of two healthcare professionals for guidance.

Others taking a pro-life stance, felt that a second doctor will help prevent bias and ensure terminations are carried out for reasons other than contraceptive or illegal purposes.

Here's what our PoliticsLabs participants had to say...

1. Should two doctors have to certify an abortion, or not?

Yes, abortions should have to be approved by two doctors

Argument 1: It prevents coercion and rash decision making

“To ensure that the woman is not being pressured into the decision by someone else” Anon, London

“It does mean that the support is there to ensure the woman needing one isn't being coerced by partner or family into having it” Anon

“At a time of desperation and in deep stress, the applicant may require more time or just be able to talk her situation through with two different people with two different aspects of looking at the same end result” Anon

“I think it gives women a chance to fully understand and discuss their options. I do not agree that doctors should be able to refuse to sign off on an abortion on moral grounds, only if they believe the process could have a seriously detrimental impact on the patientAnon

“An abortion should be signed off by doctors who have ascertained that the woman in question has been made completely aware of procedures, options, effects, etc. of the abortionH, Edinburgh

Argument 2: It safeguards doctor and patient

“It provides a safety net for doctors in case a couple change their mind later, and claim they were pressuredAnon

“It is an intensely complex and emotional decision that needs to be verified and approved by more than one voice/opinion, to safeguard life and the position of the mother, who is in an intensely vulnerable position personallyAnon

“Whilst it is possible that one doctor may not care enough to make sure that the woman is fully ready or that the termination is right for her, with two doctors one can be more certain that these precautions have been takenH, Edinburgh

“Otherwise it could be argued that one doctor acting alone was not in working in the best interests of a woman. The anti-abortion lobby would seize this and use it to reduce the availability of abortion. They think it a safeguard, so to go along with them and negate their argument there should be two doctors” Anon

Argument 3: Two heads are better than one

Two heads are always better than one. It may be that the second doctor spots something that the other missed” Anon

“There do need to be enough checks and balances in place to make sure that the adoptive parents are not in a position to be looking after a child. One opinion may not be enough to do thisDarrenK, Auckland

It's good to have a second opinion in the case of any health risks – either mental or physical” Matt G, London

“To ensure the safety of all concerned is cared for; to allow the woman to speak to more than one person about her decision; to help the woman feel supportedKathryn C, Dorset

It’s best to have a second opinion from another doctor other than your own GP. As this doctor can look at the situation through different eyes and hopefully help the person come to a decision that they will not regret in the future” Anon

Argument 4: It prevents bias

“It is possible for an individual to be compromised by their own religious beliefs and customs. By using two doctors it is more likely that the appropriate decision will be made depending on the circumstances” Anon

“A single doctor could abuse their position or become overly sympathetic towards a potential patient” Dave, Glasgow

“A second opinion creates more transparency and prevents any foul-playAnon

“Because there is less chance of personal interest getting in the way of what’s best for the mother/baby” Bruce L, North West

“Being approved by two doctors indicates to any third party that the decision was reached out of clinical need, rather than by bribing, favouritism or any other method where a doctor who knows a patient well might approve the abortion for reasons other than clinical needSWR, Chippenham

“Two signatories lower the chance that any bias by one doctor results in the abortion going ahead, rather than considered opinion” Anon

Argument 5: It ensures abortion isn't 'too easy'

To ensure credibility and accountability; if more than one doctor has to sign off an abortion then it is reasonable to assume that this is not taking place for comparatively trivial reasons. Abortion should not be used as a method of birth control” Keith R, Stockport

“I think it should be checked and double-checked that the abortion is necessary, that having a child would be severely detrimental to mother or baby... and not as a form of contraception or on a whim that will be regrettedAnon

“In my opinion abortion should only be allowed if the pregnancy is the result of rape or the child will be born with disabilities so severe that he/she will have no quality of life, or the pregnancy puts the life of the mother in grave danger. Therefore the more doctors that sign off the abortion the better” Darren N, Rotherham

“It allows a second, independent doctor to be satisfied that

all the implications

of an abortion have been discussed and understood by the woman applying and

is confident that the reason for the abortion is a reasonable/legal one

Ali, Dundee

No, abortions should NOT have to be approved by two doctors

Argument 1: One doctor is enough

“If it is the wish of the patient, then surely only one doctor should be required to sign the procedure off as being appropriate, that the timescales are in accordance with law, and that the patient is fit to undertake it” Anon

“The need for a second opinion is almost unheard of in normal medical practice. There's no medical reason to make a second opinion compulsory, this is just a sign that politicians don't trust the trained medical professionals” ED, Northampton

It is incredibly patronising when the agreement of two separate doctors is not required for other medical procedures that are much more radical and invasive than abortion” Anon

“If all doctors are considered reliable professionals (which they should be if they are allowed to practice medicine), then why should two be required?” Laura, Cambridge

“It is patronising to doctors to suggest that a trained individual cannot assess the situation on their own. No other medical procedure needs two doctors, why this one?” Janvier P, London

Argument 2: It is a pointless hurdle

“It seems unnecessary – people will generally get one if they want one and are within the time limits” Anon

“The NHS is under pressure, asking two doctors to look at anything (unless it is a life-saving emergency) is a waste of time. I'm not in favour of abortion; I favour a woman's right to choose. In essence, I see it as the least bad option” Chris, Yorkshire

“I think it's a painful enough process, without making it more complicatedRose, Somerset

“Because it is unnecessary bureaucracy, forcing a woman to jump through hoops” Anon

“I assume that by this stage, abortion is a relatively routine procedure, so it seems excessive, expensive and time-consumingLaura, Cambridge

“The requirement for two doctors to sign off an abortion is a sop to the anti-abortionists, and serves no other purpose, especially as neither doctor needs to have met the woman applying John A, Llanelli

“It's an unnecessary formality that was introduced in part by people motivated by a desire to make abortions as difficult as possible to obtain” Dave, Cardiff

Argument 3: It's the woman's choice!

Why should the state tell women what to do with their own bodies?” Anon

“Because one doctor should be able to do it; if a woman decides that she wants an abortion she must have a good reason and it is her body not the doctorsAnon

“Abortion should be as simple to obtain as a prescription, only the woman's request and state of health should countPam B Suffolk

We should respect that women are able to make the right decision for themselves’ and then the professional judgement of one should be enough” Alison, Merseyside

“Because I think that the right of a woman to have an abortion is absolutely justifiable and it should only really require one professional to make the judgment as to her motives” Anon

“This is a relic of a time when it was thought a woman couldn't make her own decisions. It should be dumped forthwith” Anon

“An unwanted child should never be brought into this world. If abortion is legal, why do we need individual cases to be assessed by someone with God-like authority? Women should have the right to do what they want with their body and their futureAshley, Nottingham

Argument 4: It's a time-sensitive matter

“The need for two doctors adds an extra delay to a very time-critical medical procedure. In order to reduce the risk of complications, the procedure needs to be carried out as early as possibleAnon

“Adding in a layer of bureaucracy isn't going to stop people who want to have abortions, it's only going to further introduce doubt and delay into the process John, West Midlands

It wastes time, both for hard-pressed doctors and for the patient herself (early abortions being safer and simpler than later ones)” Lia R, London

“Encountering biased doctors against the procedure will mean delays in the provision of care, which will in turn increase the problems associated with an unwanted pregnancy” Rose, Portsmouth

“If an abortion is to take place, it should take place as soon as possibleAnon

Argument 5: The law should only apply in 'grades'

“There should be some grading of need. So within say 8 weeks of pregnancy and no complications – 1 doctor; anything else 2 doctors” Jim, Christchurch

“I don't think it's necessary unless it's beyond a fairly late stage in the pregnancy (but still less than 24 weeks)” Anon

“I think there needs to be a change for very early abortions – i.e. within the first six weeks. After that there should be two doctors involved. Anyone signing forms for use by others should be struck off the medical register” Sandra, Northumberland

“I don’t think it necessary for 2 doctors to sign if an abortion is to take place in the early stages – in a more advanced pregnancy when surgical intervention is required then two doctors need to agree to safeguard both the doctors and the patient” Anon

2. Should a doctor be able to refuse to certify an abortion if they morally object?

The law also states that a doctor can refuse to certify a woman for an abortion if they have a moral objection to it.

The NHS informs patients that if this is the case for them, their doctor should recommend another doctor who is willing to help. PoliticsLabs participants weighed in with their views on whether a doctor should have the right to refuse an abortion based on morals.

Some said they felt doctors do have the right to refuse, as delicate matters such as religion and taking a life can affect the doctor as well as the patient, while others felt that the decision for abortion lies with the mother alone, and if the doctor is not able to carry out the duties without judgement and morality, they are simply unprofessional.

Yes, doctors should have that right

“Doctors are supposed to save life and should be allowed to refuse to do anything that contravenes that principleJohn N, Liverpool

There should be no compulsion on any aspect of an abortion other than the length of time allowed for a termination” Stewart, Bridge of Earn

“As long as no one is prevented from going to a different doctor, it's such a common issue that I can't see why anyone would want to try to force a doctor to do something they genuinely feel is wrongAnon

Nobody should be forced to do anything they morally oppose… However those doctors who do oppose should be banned from working in any areas that this might present itself (including a GP)” Anon

“We pride ourselves as a country in being respectful of anybody's opinions and beliefs. If a doctor morally objects to abortion their belief should be respected as everybody else's” Anon

Nobody should be forced to act against their own moral beliefs. Provided the doctor handles this with sensitivity (no judgement being made of the woman for example) he/she should be allowed to recommend a different doctorJim, Christchurch

It's personal conscience. As much as I believe that it's a woman's right to choose, I must therefore believe that it's a doctor's right to choose tooChris, Coventry

“They have a right to practice their beliefs, and there are a number of doctors who don't have a moral objection and can therefore provide the service. This also prevents the doctors against abortions from acting prejudicially against patients seeking abortionAnon

You can't expect a doctor to act morally if you ignore their morals in the first placeIain, Portsmouth

I don't like the idea of forcing them to do something that is really not in accord with their honestly held beliefs because such legislation could just be 'the thin end of the wedge' and lead to doctors being required to do other things they disagree with” Ruth, Notts

No, it's not a doctor's place to morally object

“I think a doctor's job is to think about the patient not about themselves. It is not illegal therefore they should do whatever they can medically. It must be horrible thing for a woman to go through and a doctor should not make their patient feel even worseAnon

“There may be circumstances when the best interests of the foetus are served by an abortion. Just because a doctor is morally opposed to abortion does not mean they are correct in every case” Anon

“The law around abortion has been on the books since the 1960s. Anyone who trained as a doctor in the last 40 years knew that this would be part of their job when they signed up. Anyone else who suddenly refused to do part of their job would be sacked. Any attempt to accommodate or work around this piece of self-righteous posturing will only cause further delay and mental anguish for a group of vulnerable patients” ED, Northampton

“If they felt they could not fulfil the duties of medicine, then they shouldn't have become doctors. I can't say to my boss ‘sorry Guv, matter of conscience, can't help this client.’ Well I could, but I'd be in Mister Osborne's workfare programme on Monday morning” Anon

Can't do the full duties, don't join the service. If they are opposed to abortion, they are of course free not to have one themselves, but they shouldn't impose their beliefs on othersAnon

“In today's society, moral objections of this kind come from religious bigots. Doctors have a legal obligation to look after their patients; unfortunately this sometimes gets lost when the 'soul' (for which there is no evidence) of an unborn cluster of undifferentiated cells becomes the most important issue” Chris, Yorkshire

Their morals are irrelevant; they will be unaware of all the facts and circumstances so any moral objection would be lacking insightAnthony, Seaham

“They should not be allowed to refuse a woman access to medical care because of religious or similar beliefs held. They must prioritise their patient over their personal belief system. If they can't, they are in the wrong jobAngie, Cambridge

“If doctors were able to refuse such a treatment on the basis of a moral objection, the same could then set a precedent for doctors not treating homosexual patients on the basis of a moral objectionAnon

Do you think a woman seeking an abortion should have to obtain the signature from two doctors?

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