Abortion Act

(Limited Text - Ministerial Extracts only)

Wednesday 9th October 2013 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

Honourable Members, has it come to this? People in this country have spent 40 years fighting discrimination, but no action is to be taken when one of the most blatant forms of discrimination—the deprivation of life on account of being a girl—is highlighted. I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on bringing forward the debate, and I entirely agree with him that the time has come to review the moral, legal, ethical and practical framework in which the Abortion Act operates.

This is not the only form of discrimination against the unborn child in this country. Over the course of more than a year, the cross-party parliamentary inquiry into abortion on the grounds of disability, which I had the privilege of chairing and which published its report in July, took evidence from 300 witnesses. The full report can be seen at the website abortionanddisability.org. Just as people are shocked that abortion can be allowed on the grounds of sex, people we spoke to were shocked to discover, in an age when we go to extensive lengths to accept, support and respect disabled people, seeing them as wholly equal, that a child can be aborted right up to the moment of birth on the grounds that they may be disabled. In contrast to the situation for non-disabled babies, there is no 24-week time limit. Indeed, we heard that many expectant mothers felt funnelled into having an abortion when they were told that they were expecting a potentially disabled child.

The inquiry highlights the lack of clarity in the abortion regulations about what constitutes a serious disability. Some mothers who were told they were expecting a disabled child told us the diagnosis was wrong. Others were told that abortions would be allowed on the grounds of a cleft palate or a club foot, and indeed they can be. Those are minor disabilities, as I know, because I have a son with a club foot. In an era of enormous support for the disabled and their families, we cannot allow this form of discrimination to persist. We must take action to review it.

Equally, we must take action to prevent any hint of discrimination against an unborn child on account of their sex. We have had much more than a hint that this is happening; we have the investigation from The Daily Telegraph. The time it took to look into that investigation—19 months—is deplorable. In his statement of 7 October about the investigation, the DPP said:

“on balance, there is just sufficient evidence to provide a realistic prospect of a conviction.”

We are talking about conviction for a criminal offence, according to the Offences Against the Person Act 1861. What kind of message does that decision send? It sends the shocking message that authorities in this country will turn a blind eye to involvement in acts preparatory to the commission of an unlawful abortion—authorities in whom trust is vested to apply and uphold the laws made by this Parliament.

The reason the DPP gave for not proceeding with the prosecution was that it would not be in the public interest. Prosecutors have also pointed out that the issue has become sensitive and political. How can it not be in the public interest to state firmly and clearly that abortion on the grounds of a child’s sex is wrong? It is wrong morally and legally, and if the law is not sufficiently clear on this point, it is our duty as parliamentarians and politicians—I see nothing wrong in politicians being involved in this issue—to make it clear.

The grounds on which an abortion is legal have never included the sex of the child, and that is true not just in this country. The UN convention on the elimination of all forms of discrimination against women, which the UK has ratified, is a legally binding treaty in UK law. The convention recognises the right to choose the “number and spacing” of one’s children, but not the sex. International law is very clear: sex-selective abortions are not legal.

We recognise that in this country when we fully condemn China’s one-child policy, which has resulted in a disproportionate number of young men, running into the millions. The ratio of young men to young women in many parts of China is now 30:1. This country prides itself on respecting human rights, and we cannot be so hypocritical as to condemn that policy and then do nothing when such things occur within our own borders. I said that there was more than a hint that that is happening; in January 2013 I tabled an early-day motion, citing

“recent confirmation by the Department of Health that there are discrepancies in the balance between the number of boys and girls born to groups of women from some overseas countries to an extent that”—

in the Department’s words—

“‘falls outside the range considered possible without intervention’”.

The motion called on the Department of Health to put procedures in place to address the issue, and it was supported by more than 50 parliamentarians. There are a number of parliamentarians here today, but I know from the EDM alone that there are far more who support the views that have been expressed today.

There is further evidence. Dr Vincent Argent, a former medical director of the British Pregnancy Advisory Service, has been quoted as saying that the practice is “fairly widespread” in the UK; and there are data from Dr Dubuc of the university of Oxford, who has studied the issue for 35 years, suggesting that sex-selection abortions are happening with increasing regularity among certain groups in the UK because of the increasing availability of technologies to determine the sex of an unborn child. The statistics show that the practice is particularly prevalent when a third child is expected.

[The Attorney-General (Mr Dominic Grieve)]

I should explain that I have only Department of Health statistics to go on, but this may be helpful. As far as the UK as a whole is concerned, the statistics on gender balance in births fall squarely within what are regarded as acceptable norms. As to mothers who were born in other countries, there is, with only one exception, no clear evidence of such a divergence from the norm. Interestingly, the country in question is Sri Lanka and, curiously, the birth ratio for mothers born there is 99.2 male children for every 100 female children, which suggests the opposite of what my hon. Friend is talking about. There again, however, there is nothing to suggest that the ratio is outside the statistical norm.

[Fiona Bruce]

If my right hon. and learned Friend will allow me, I shall send him Dr Dubuc’s data and research, which show figures that at least need to be looked into.

I ask for not only Ministers but the British Medical Association to take action. The 2012 third edition of its guide, “Medical Ethics Today”, does not clearly prohibit sex-selection abortions. The doctors we heard of in the investigation by The Daily Telegraph clearly felt uncomfortable. I should have thought it would help the many other doctors who might feel uncomfortable in such circumstances if the BMA medical ethics committee were to take a clear stance against the discriminatory practice in question, and support practitioners accordingly. As to the reference by the Director of Public Prosecutions to the General Medical Council taking action on the investigation by The Daily Telegraph, it is worth remembering that the GMC has no powers on criminal actions and cannot prosecute breaches of the law.

Finally, in April, I presented a ten-minute rule Bill on the very issue that we are debating. It was interesting to note that there was no opposition from any Member of the House. My purpose was to raise the issue and to remind the police and Crown Prosecution Service that abortions on the ground of gender are illegal in this country. My Bill called on the Department of Health to establish procedures to record the gender of babies aborted under the Abortion Act 1967, when the sex can be determined, and to consider a review of the penalties for anyone found to have facilitated the abortion of a child because of their gender. The United Kingdom prides itself on striving for gender equality and tackling discrimination in all its forms, and any indication of that most fundamental form of gender discrimination and violence against women must surely be investigated further.

--- Later in debate ---

[The Attorney-General (Mr Dominic Grieve)]

It is a great pleasure to serve under your chairmanship, Mr Pritchard. I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing the debate.

Investigative journalism plays an important part in a vigorous and healthy democracy. The Daily Telegraph has done a very important public service in bringing these issues before us today. The debate has been a characteristically thoughtful one, as befits matters touching on the criminal law, personal health and dignity, ethics and moral issues, professional standards and the wider public interest. I am grateful to the hon. Member for Strangford (Jim Shannon), my hon. Friends the Members for Gainsborough (Sir Edward Leigh), for Totnes (Dr Wollaston), for Congleton (Fiona Bruce) and for Tiverton and Honiton (Neil Parish) and the hon. Member for Islington South and Finsbury (Emily Thornberry), who have all made contributions, and to those right hon. and hon. Members who have intervened.

The cases highlighted by The Daily Telegraph were much debated at the time of the original CPS decision not to prosecute. The terms of that debate may have given the public the impression that this case was about medical practitioners offering abortion on the basis of the gender of the child. On that basis, it may well have seemed incomprehensible that the full force of the criminal law was not being brought to bear on a practice that most people would regard as abhorrent. I certainly do and I think that everyone in this room does. But as I hope to make clear and as I hope has been made clear by the DPP’s explanation, that is not in fact what these cases are at root about.

The DPP has recently published detailed reasons for the CPS decision. I urge all right hon. and hon. Members to read his account very carefully, if they have not already done so. It is absolutely right that prosecution decisions are taken by independent prosecutors on the facts before them and free from political influence. That is what entitles the public to have confidence in those decisions. However, it is also important that the public should be able to understand the decisions and, where that is not straightforward, that prosecutors make a special effort to explain them. This was obviously such a case, and I am particularly pleased that the director has taken the time and trouble to review—I requested him to do so—the decisions personally and to set out fully the reasoning that led him to endorse the conclusion that it would not be right to prosecute.

[Mr Burrowes]

Will the Attorney-General give way?

[The Attorney-General]

In a moment; I was going to answer the two questions raised by my hon. Friend. First, the director did not make the initial decision not to prosecute, but he was consulted, as is normal in complex and sensitive cases. The answer to the second question, on whether I was consulted on the decision before it was taken, is that I was not. The case was not raised with me by the director prior to the decision not to prosecute being taken. In my view, it should have been, and on reflection, the director accepts that he should have done so. Before that leads to an inference that therefore the decision might have been different, I simply make the point that as I asked the director to review the decision completely and I had ample opportunity to consult with him before he did so, I am satisfied that the decision that has now been reached, which I will come on to in a moment, would have been the same had that process taken place in the first case.

[Mr Burrowes]

Does my right hon. and learned Friend the Attorney-General agree that in hindsight it would have been appropriate for the DPP to be involved at an earlier stage, to respond to the question raised by the shadow Attorney-General, and should not all future investigations of allegations of contraventions of the 1967 Act involve the DPP at that earlier stage and proper consultation with my right hon. and learned Friend?

[The Attorney-General]

As my hon. Friend will appreciate, the DPP himself does not under the statute have to give consent. Nevertheless, I am sure that the DPP will have noted my hon. Friend’s comments—representatives of the Crown Prosecution Service are here. It is clear to me that this is an important issue in a difficult area, which I will come on to in a moment. I trust that his comments are noted, but he will appreciate that the decisions are ultimately for the DPP, not me.

The director’s reasons speak for themselves. I am satisfied that this difficult decision was taken properly and conscientiously. The responsibility of taking such decisions is a heavy burden, which few of us would relish. I would like to take the opportunity to pay tribute to the distinction with which the current director has fulfilled an onerous and difficult series of public duties over recent years, particularly as his term of office is drawing to a close.

The hon. Member for Strangford asked whether I agreed with the decision taken by the director. I emphasise the point I made: I am clear that it is not my role as Attorney-General to second-guess the decisions of independent prosecutors. These were difficult decisions on which different prosecutors could reasonably have come to different conclusions, but I am entirely satisfied that this difficult decision was taken properly and conscientiously.

I shall say a little more by way of context. First, abortion law in this country, in my judgment, is workable, but needs to be understood. I should perhaps emphasise that the law is not framed in terms of prohibiting gender-specific abortion or indeed listing any other forms of unlawful abortion. It works, or was intended to work by Parliament, by providing for abortions to be performed safely, by qualified medical practitioners, when those practitioners judge it to be in the medical interests of the patient and where that is the course that the patient herself agrees is right. Two medical practitioners must on each occasion have formed a view, in good faith, that the health risks of continuing with a pregnancy outweigh those of termination. That is our guarantee, as provided by Parliament, that we have a system of safe and lawful abortion provided by the 1967 Act.

[Neil Parish]

Is my right hon. and learned Friend saying that he believes the law to be correct as it is? If that is the case, why is abortion being allowed for gender selection?

[The Attorney-General]

I think my hon. Friend might misunderstand. We can have a long moral and ethical debate about the workings of the 1967 Act, as we have had in Parliament—I dare say that many in the room will express different views on the Act and all sorts of connected aspects—but that would be about an issue of policy. The question I am dealing with in this debate is whether, within the framework of what was intended by the 1967 Act, it is possible to enforce the law as Parliament intended it to be. I hope I will be able to develop that thought in a moment.

My hon. Friend the Member for Gainsborough asked about the statistics on those prosecuted under the 1967 Act. Since 2010, there have been 25 prosecutions, and he is right that none has been of medial professionals for failure to observe the terms of the 1967 Act.

[Jim Shannon]

As I asked the shadow Attorney-General, in light of the disquiet expressed by Members today and the disquiet outside the House, would the Attorney-General agree to a review of the case?

[The Attorney-General]

So far as this case is concerned, the decision is that of the CPS. For me to overturn or review somebody else’s decision in a case in which the decision does not fall on me would be wrongful interference in the independence of the prosecution and its discretion. As far as I am concerned, the function I have has been performed, in that there has been a review by the DPP of his decision and he has been able to explain it fully in the explanation he has provided. As I have already indicated, I do not consider anything to be in any way improper or unreasonable in that explanation or in how he has approached the matter. If the hon. Gentleman will let me develop my argument, he may understand why that is the case in a moment.

The question in this case is not about proving whether gender-specific abortion was being offered on demand. It was about whether the doctors had done what the law requires, which is to reach an opinion in good faith about the consequences for the patient of continuing with or terminating a pregnancy. I appreciate that abortion gives rise to strong views based on ethical and philosophical differences, and I have no doubt that it will continue to be the subject of much public debate, but the issue for the prosecutor is the law as it stands.

[Neil Parish]

Is that not semantics? Is the Attorney-General saying that doctors are not prosecuted because they took the decision that abortion due to gender selection was all right in theory because the mental health of the mother might be affected or based on some other grounds that are acceptable under the 1967 Act? That seems to be pure semantics.

[The Attorney-General]

I am sure that my hon. Friend has had an opportunity to read the full note produced by the DPP. It sets out in detail, which I do not have time to go into this afternoon, the evidence in the case of each doctor presented to the CPS. My hon. Friend will appreciate that it is important that the evidence in each case is looked at separately. The DPP goes through it in detail and explains that the issue is not gender-specific abortion. If somebody says to a doctor without more ado, “I want an abortion on gender-specific grounds,” and the doctor says yes, the case might be a clear-cut matter to prosecute because the grounds fall clearly outside the ambit of the 1967 Act. The section of the Act with which we are concerned is about the physical and mental health of the woman. It is about good faith, in that it is for the doctor to satisfy themselves that any abortion falls within the criteria. If my hon. Friend looks at the matter in detail, he will see why the director came to the conclusion he did, which I will address, but in briefer terms.

The CPS concluded, with some difficulty, that there was just enough evidence available in the cases to bring the good faith of the doctors into issue. I think that the hon. Member for Islington South and Finsbury was wrong when she said in her final statement that the position had changed. The DPP’s statement of reasons says, nevertheless, that the evidence was not strong in either case and the prospects of conviction would not in his judgment have been high on the facts as they appeared. The matter does not rest there. Even in a case that just about passes the evidential threshold, the CPS is obliged to consider whether a prosecution would be in the public interest. That is one of the tasks that we require it to do. The fact that an evidential threshold is passed—a point raised in the debate—does not mean that a prosecution has to, or indeed should, follow.

The decision was that prosecution did not pass the public interest threshold. It is that aspect of the decision that raises wider issues of public policy, some of which we have debated today, which I accept are an entirely legitimate topic of debate. The issue, as I see it, is this. Because the law makes the difference between lawful and unlawful abortion subject to a medical test, doctors have to be able to carry out that test on a case-by-case basis according to proper medical standards of care, skill and judgment. That is, effectively, what the test of “good faith” in the 1967 Act means. Doctors are required by law to make such decisions to a proper professional standard. If a question arises about whether a doctor has done so in any given case, a law enforcement agency must look to approved medical practice for assistance in identifying the proper standard. The same thing applies in virtually every case involving professional standards. Dare I say it, it would apply even in the case of a plumber who carried out some work that led to a catastrophic outcome.

[Sir Alan Beith]

It would surely not be right in such circumstances merely to demonstrate that other plumbers engaged in conduct that did not meet professional standards, and no more would it of doctors.

[The Attorney-General]

I reassure my right hon. Friend that that is certainly not the case. Ultimately, in any case, the jury decides, not the experts. One would normally expect a jury to be given some indication of the professional standards expected in a profession—there may even be rival professional views about what the standards should be—in order to help it decide.

Such a problem might not arise in an extremely clear-cut case. We might imagine a case in which a doctor behaved in a way in which no reasonable practitioner would behave, for example by arranging a medical abortion for a patient about whom he or she knew nothing and whom he or she had never met or spoken to. In any other circumstances, however, the CPS would need, and would expect to be able, to refer to medical consensus to determine whether a proper professional approach had been taken.

When they are looked at in the kind of detail considered by the prosecutor, the cases that we are debating are not extreme ones in which the doctors behaved as no reasonable practitioner would behave. Complicating factors were raised by both the patients and the doctors, who subsequently had to take the decisions. There were, as we have discussed, no detailed professional rules or step-by-step guidelines telling doctors how to take such decisions; the matter was left to general professional standards and ethics. The CPS, therefore, had no detailed consensus to help it to evaluate the matter.

To prosecute would have been to ask a jury to decide what steps a doctor should take. Juries take difficult decisions robustly, and sometimes they have to find their way through conflicting medical evidence. Is it right or fair, however, to ask a jury to arbitrate on a question of medical standards and ethics on which the profession has not published a detailed consensus, and on which a great deal turns for both doctor and patient? The CPS concluded in the recent cases that it would be contrary to the public interest to proceed.

Those who have the relevant policy and professional responsibilities are, no doubt, reflecting on the conclusions to be drawn. The Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), is present for precisely that reason. As the House will appreciate, these are not my responsibilities.

[Mr Burrowes]

I recognise that in such cases, because of the level of uncertainty, it is questionable whether a prosecution would serve the interests of justice. When more certainty has been achieved through the publication of guidance, will the Attorney-General undertake to review the matter and consider whether further guidance is required to provide clarity on prosecution?

My supplementary question is to ensure that the Attorney-General does not get off the hook without commenting on another issue. The CQC has provided evidence of 14 hospitals where—forget “good faith”—doctors were not even present when forms were signed. Surely the Attorney-General must ask why no prosecutions occurred in such cases, which go way beyond questions of guidance. They are malpractice and a flagrant abuse of the Abortion Act 1967, and they must lead to prosecutions.

[The Attorney-General]

I hope I may be able to reassure my hon. Friend. On the second matter that he raises—it is not germane to one of the cases, although it was to another—as he knows, the evidence revealed that the pre-signing of forms was quite widespread. I understand that that practice has now been stopped, and that clear guidance has been issued as to its undesirability. That is a policy issue, and I have no doubt at all that as a result, the requirements set down by professional standards have already been clarified.

I turn to the more general point. There are two ways in which we can move forward. We might take the view that the current situation is, overall, a satisfactory one, in which professional medical discretion, which must inevitably be relied on, is left at large, with the law enforcement agencies acting as a back-stop for the most egregious cases that flout any conceivable proper standards. The other view, which I understand that the Department of Health has accepted, is that such a situation allows law enforcement far too residual a role and that the balance needs to be redressed. The law enforcement agencies will need clearer and more specific guidance on how to distinguish between desirable and undesirable professional practice in making and recording decisions on the termination of pregnancy. I greatly welcome that, and I have no doubt that it will make the task of prosecutors much easier.

[Mark Durkan (Foyle) (SDLP)]

The Attorney-General has rightly said that we should not second-guess a prosecutor, the professional judgment of a doctor or the position of a jury when taking evidence. We can, however, second-guess ourselves as legislators. During the passage of the Human Fertilisation and Embryology Act 2008, we were assured that gender selection would not be permitted as a ground for abortion, and that a proposed amendment to that effect was redundant. I am sure that that was said in good faith, and the amendment was withdrawn on that basis, but do we not have cause for consideration in that area?

[The Attorney-General]

It is quite clear from a reading of the 1967 Act that gender selection alone is not grounds for the termination of a pregnancy. The debate has highlighted policy issues, which Parliament can debate further if it wishes, about how the question of gender selection may carry some weight in respect of, in particular, the impact on a woman’s mental health of continuing with a pregnancy. That is inherent in the drafting of the legislation, which places a great burden of responsibility on the medical profession to carry out a specific assessment, under the subsection that, as we know, is the most relied on as the justification for a termination.

It would be wrong of me, in the course of this debate, to start re-examining something that is a policy issue for Parliament. I have done my best to answer the question, which is whether the law as it stands is workable and can be made better. I have already indicated that if, as I understand to be the position, the General Medical Council produces such guidelines, they will be of immeasurable assistance in providing a benchmark for how doctors are expected to make the assessments required under the 1967 Act.

The Director of Public Prosecutions has informed me that he would be more than happy for his officials to comment on the practicalities, from a prosecutorial viewpoint, of any amended arrangements, should that be thought necessary. I can see that that might be of great practical value. I hope that I have been able to provide hon. Members with some reassurance.