Monday 15 October 2007

Dispatches on abortion

I intend to use this post to keep track of the coverage that the Dispatches report on abortion is going to generate, as well as the Commons enquiry:

Sounds like Deborah Davies has been doing the rounds, promoting her Dispatches programme.

The Today programme had a discussion between Prof. Campbell (who wants to reduce the age limit for abortion) and David Steel (who also wants to lower the limit) so was obviously very balanced - and, contrary to gimpy, the debate was again framed in terms of viability and 4D ultrasound images. To the credit of the interviewer she at least challenged the scientific merit of 4D ultrasound over the emotive aspects. Also reported by the Mail on Sunday.

Yesterday's news contained the revelation that members of anti-abortion campaign groups have been asked to declare their affiliation when they give evidence to the Commons committee:


"Evan Harris MP, the Liberal Democrats' science spokesperson, said:
"This inquiry is specifically about the scientific evidence not moral or religious arguments and our witnesses need to be evidence-led not ideologically or theologically driven. The CMF [Christian Medical Fellowship] risk undermining the inquiry by getting people called as expert scientific witnesses when they are not."

Two witnesses who will give evidence today, Chris Richards, a paediatrician and honorary clinical lecturer at Newcastle University, and John Wyatt, a neonatal paediatrician at University College London, are members of CMF, but did not disclose that on their original submission."

As with a number of outlets the Observer focuses on the Dispatches programme showing footage of abortion, as well covering calls for nurses to perform early stage abortions.

The Telegraph reports that:

"A row has broken out over the 24-week time limit for abortion after conflicting scientific studies clashed over the survival rate for babies born at that stage.

Epicure 2, a nationwide report from a Government-linked organisation, revealed that the chance of survival lay between 10 and 15 per cent, according to evidence submitted to the Science and Technology Committee at the House of Commons.

But other evidence given to the committee - which will make the decision whether to recommend a change in the limit - contradicted the findings and claimed survival rates were as high as 42 per cent at 23 weeks and 72 per cent at 24 weeks gestation."

The Guardian reports that the RCOG (in line with the BMA) want to keep the 24wk limit and abolish the need for 2 doctors to approve.

The Times reports that:

"Marie Stopes International, which carries out 60,000 abortions a year at its nine clinics in Britain, says the 24-week limit ought to lowered to 20 weeks because of evidence that the foetus is “potentially viable” before 24 weeks. This shift in policy leaves opponents to a reduction in the time limit, who include Tony Blair and many Labour MPs, increasingly isolated.

"As part of any reform, however, Marie Stopes would also want women to be eligible for abortions up to 12 weeks without having to gain permission from doctors — two must now give their written consent for the procedure. It says women seeking a termination between 13 and 20 weeks should have the signature of one doctor."

The Telegraph likewise, also saying:
"A Telegraph poll last month showed that most
people, including a large majority of women, agree with him that the upper limit
should be cut back. It found that 55 per cent of voters of both sexes would
welcome new laws reducing the time limit."
According to Channel 4:
"The survey by Marie Stopes International (MSI), the leading abortion services provider outside of the NHS, found 52% of GPs want women to be able to request an abortion in the first 14 weeks of pregnancy.
Currently, two doctors must give written consent before a woman can go ahead with an abortion.
The poll of 1,000 registered GPs across Britain found 80% described themselves as broadly "pro-choice", while 20% said they were "anti abortion".
Almost two thirds of doctors (65%) thought the current 24-week time limit for abortion should be reduced. Of those who wanted a reduction, 62% agreed with a 20 to 23-week limit.
Three in five doctors (62%) said current guidelines allowing under-16s to have an abortion ithout the consent or knowledge of their parents were satisfactory.Findings from the survey will feature in Channel 4's Dispatches: Abortion: What We Need To Know, which screens on Wednesday. The documentary will also look at scientific research into foetal pain and pre-term infant viability."

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There have been some fairly divergent figures reported for foetal viability at 20 weeks plus (25% have a normal life according to the Today programme, whereas I reported 30% survival at 24 weeks) so I though I'd have a look at the literature (these are articles listed as related by medline to the Belgian source I used in the previous post, and where the abstract looked relevant, and I could get data for 24 weeks or less, and it came up before I got bored - remember that infants born premature may conceivably be less viable than aborted infants at the same age):

Belgium 1999-2000 (previously mentioned study): 22 wks 0%; 24wks 29% survival to discharge (hmm, looks like it may include some late abortions though!)
22-23 wks 7%; 24wks 35% of NICU admissions discharged alive
24 wks 4% NICU admissions survive with no major sequelae of prematurity ('intact')

German tertiary centres 1999-2003: 22-23 wks 52%; 24 wks 70% survival to 8 days
22-23wks 56-76%; 24 wks 74-88% survive to discharge with life support at all gestational ages 36% have no major complications of prematurity

Japan 1991-2000: 22wks 40%; 24wks 50% 1 year survival
22wks 0%; 24wks 74% free of handicap

Canada 1996-1997: 22wks 15%; 24 wks 54% survival to discharge

Austria 1999-2001: 22wks 17%; 24wks 57% 1 year survival
22wks 6%; 24 wks 14% survival with no major complications

This gives us a range of survival at 22 wks of 0%-17%, for 24wks 29%-88%; and a range of disability at 22wks of 94%-100%, 24wks 26%-96%.

4 comments:

Anonymous said...

"Yesterday's news contained the revelation that members of anti-abortion campaign groups have been asked to declare their affiliation when they give evidence to the Commons committee"

Why do you feel it is necessary for one to reveal his personal affiliations before he gives his opinion? It seem as though you are searching for an easy way to discredit someone whose views do not match yours. Demanding one divulge their personal affiliations serves no purpose in the debate; that is unless for some reason you have come to the erroneous conclusion that ones affiliations can determine credibility of their opinion, which is, by definition, an impossible task.

I suppose there is no emotive intent in doing so. Just, curious? And just disingenuous, more accurately.

In your previous post, The abortion debate II, you write:

"Note the distinction between a physiological response to noxious stimuli and feeling pain is elided here."

The part you quoted did not say there was a difference. You did. In fact the article mentioned with absolute certainty that the feotus could feel pain. So your question of physiological response to noxious stimuli or pain is not only irrelevant, since the simple fact that because a feotus does or does not feel pain bears no weight, at least from the "pro-choice" stand point, but moot.

"I wonder how many of the surviving infants could be considered 'intact'?"

Am I correct in thinking your solution is to extinguish those who are not 'intact.' Because my intact does not include disabled children, at whatever stage of life. Are they too expendable?



My last question, who are you? (education, career, locale, etc.)

pj said...

"Demanding one divulge their personal affiliations serves no purpose in the debate"

I don't think I made any claim that they should declare these affiliations. But as it happens I think they ought to because they are being called as semi-experts on a scientific matter, but they often seem to be affiliated with religious groups which take a non-scientific position on this issue. The concern is that they are giving flawed scientific evidence motivated by religious concerns to reduce the number of abortions.

In fact the article mentioned with absolute certainty that the feotus could feel pain. So your question of physiological response to noxious stimuli or pain is not only irrelevant, since the simple fact that because a feotus does or does not feel pain bears no weight, at least from the "pro-choice" stand point, but moot.

I'm afraid I'm not sure what you're saying here. The article I quote says:

"...the foetus is not aware and can't feel anything.

But we found disturbing research in America that directly contradicts this established view.

...he's been comparing how newborn babies and unborn foetuses react to any kind of stress, including pain.

He's found similar changes in their hormones and their blood flow, suggesting that foetuses can indeed respond to pain."

Which claims that physiological responses to noxious stimuli imply that foetuses can feel pain. In my post I point out that there is a distinction between a physiological response and the perception of pain (e.g. if you have surgery under an anaesthetic you'll still respond to being cut upon physiologically even if you can't feel pain), and this is a distinction the article avoids making.

Am I correct in thinking your solution is to extinguish those who are not 'intact.'

No, my intention is to point out the poor quality of life of those very preterm infants that do survive.

My last question, who are you? (education, career, locale, etc.)

Well I'm in the UK, and am trained in medicine and medical research. Who are you?

Anonymous said...

"But as it happens I think they ought to because they are being called as semi-experts on a scientific matter, but they often seem to be affiliated with religious groups which take a non-scientific position on this issue. The concern is that they are giving flawed scientific evidence motivated by religious concerns to reduce the number of abortions.

True, but I think we are just lying to ourselves when we try to turn this into a scientific matter.

If a 9-month-old baby in a mothers womb could not feel pain, would it be OK to kill it? What about an 8-month-old baby?

Of course not.

It seems some are debating this idea of feotal pain, when clearly the issue of pain has little, if anything, to do with the abortion issue.

This has always been an issue of morality, and I am wondering why the concerted effort to treat it as some scientific matter instead of just making the very unprecedented decision to base our actions regarding abortion on morality and responsibility.

I'm not sure how things go in the UK, but here in the States we do not have some tangible reason to treat people we know cannot pay their bill, but we do, because it is the right thing to do. I would assume that is also the case in the UK.

I also wonder out loud, if there was evidence to suggest that the foetus could feel pain at say, 1 week, would we then limit abortions to 1 week?

"No, my intention is to point out the poor quality of life of those very preterm infants that do survive."

OK.

"Who are you?"

USA.
Thinking about career in medicine.


Also, I saw a "documentary" titled "Torture: America's Brutal Prisons," by the same person who made the abortion one. It was astonishingly un-journalistic. Is that what passes as a documentary in the UK??!!

pj said...

"True, but I think we are just lying to ourselves when we try to turn this into a scientific matter.

If a 9-month-old baby in a mothers womb could not feel pain, would it be OK to kill it? What about an 8-month-old baby?

Of course not.

It seems some are debating this idea of feotal pain, when clearly the issue of pain has little, if anything, to do with the abortion issue."


I agree that for many, particularly the anti-abortion movement, but also some of the pro-choice movement this is not a scientific question. Unfortunately these same people are trying to fight this ideological debate using science as a cover.

"It was astonishingly un-journalistic. Is that what passes as a documentary in the UK??!!"

I haven't seen that one, but I commented before the current broadcast that the same journalist made a bad documentary for the same programme ('Dispatches') on liver disease.

Generally speaking all documentaries on scientific issues are bad. I think it is a universal law. Maybe I just don't know enough about other issues to see how bad the ones on other topics are.