Dr Caroline Osborne-White and Dr Corina Lee, Medicolegal Consultants at Medical Protection, look at some recent changes to abortion law and what they mean for the professional expectations of clinicians. 

On 30 August 2022, new legislation came into effect in England and Wales to permanently amend the Abortion Act 1967, a continuation of temporary arrangements originally introduced during the COVID-19 pandemic.

Prior to the amendment, patients undertaking early medical abortion were required to attend a hospital or clinic for a medical consultation, following which two tablets were prescribed. The first tablet had to be taken at the hospital or clinic, and the second tablet could be taken at home. 

What has changed?

Following amendment of the Abortion Act, the legislation allows for the medical consultation to be undertaken remotely, and that both tablets can be taken at the user’s home. 

The amended Section 1 of The Abortion Act 1967 states:

‘’(3C) If the usual place of residence of the registered medical practitioner terminating the pregnancy is in England or Wales, the medicine may be prescribed from that place by the registered medical practitioner.

(3D) If the pregnant woman’s usual place of residence is in England or Wales and she has had a consultation (in person, by telephone or by electronic means) with a registered medical practitioner, registered nurse or registered midwife about the termination of the pregnancy, the medicine may be self-administered by the pregnant woman at that place.”

The Abortion Act 1967 also covers Scotland; however, the Scottish Government have still to decide about the permanency of legislation, which will follow the completion of an evaluation of the effectiveness and safety of the temporary measures. Northern Ireland is not covered by the Abortion Act 1967, however no temporary or permanent changes to the Abortion (Northern Ireland) (No 2) Regulations 2020 were introduced. Their legislation remains that the first of the two pills are required to be taken within Health and Social Care premises.

What does this mean for you?

With all the changes, it is vital that all doctors maintain professionalism at all times and work within GMC guidance. The GMC’s guidance Good Medical Practice provides some guidance to any doctor who has a conscientious objection to a particular procedure. 

Paragraph 48 states that “you must treat patients fairly and with respect whatever their life choices and beliefs”. If a doctor is approached by a patient seeking a termination of pregnancy, the patient must be treated with dignity and respect, even if the doctor has a conscientious objection to such a procedure. 

Additionally, paragraph 52 advises that “you must explain to patients if you have a conscientious objection to a particular procedure”. This paragraph goes on to explain that “you must tell them about their right to see another doctor and make sure they have enough information to exercise that right. In providing this information you must not imply or express disapproval of the patient’s lifestyle, choices or beliefs”. Your conscientious objection should not be a barrier to the patient obtaining care and treatment.

Finally, paragraph 52 also advises that “if it is not practical for a patient to arrange to see another doctor, you must make sure that arrangements are made for another suitably qualified colleague to take over your role”. Again, this ensures the patient’s care is not impacted by your beliefs even if the patient is unable to arrange ongoing care themselves.

In paragraph 54, the GMC states that “you must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress”. In discussing your conscientious objection with the patient, and explaining why you need to arrange onward care or a colleague to take over, you must not make them feel in any way judged, and instead remain compassionate and aware of their needs. 

Personal beliefs must not impact care

The recent changes to the law do not change these professional requirements. The changes have made abortion more accessible for patients, and those who disagree must not allow their beliefs to impact patient care. 

If you have any questions about the changes in the law or the professional expectations on doctors, please contact Medical Protection on 0800 561 9090 for advice and support.