An abortive misuse of the GMC

Abortion is a subject that evokes strong feelings on both sides. It is an ethical minefield, and both sides (pro-life and pro-abortion) can be well and sensibly argued. Basically the pro-life side say that the fetus is a human being from conception, and therefore abortion is murder. The pro-abortion side say that the fetus is not fully alive until “viable outside the uterus” which is currently at about 24 weeks gestation. The pro-abortionists tend to see the decision as “the mother’s right to choose” and to give no rights to either the father of the baby (the sperm donor)or to the unborn child. (The foetus, just a collection of cells, not yet fully human etc) To many pro-abortionists the only correct medical response to a request for an abortion is for the doctor to say, “OK, when?” Some argue that the doctor is not a moral agent in such cases but merely a technician to deliver the mother’s "rights."

Therefore to some pro-abortionists a doctor like Dr Tammie Downes is a vile, unethical beast who should be struck off. She has the temerity to ask patients questions along the lines of, “Why do you want an abortion?” and “Are you sure it’s the right decision for you?” How awful. How dreadfully unprofessional and how clearly disrespectful to patient autonomy. Well, at least that seems to be the apparent basis of an unnamed doctor’s complaint to the G.M.C. about Dr Downes. The complaint seems to be based on what Dr Downes said in a newspaper interview rather than the complainant’s personal knowledge of a specific case, or any evidence of a specific patient having been harmed.

Now whatever your views on abortion, and whatever your actions in a particular case as doctor or patient, I hope we can agree that complaining about what a doctor has said rather than arguing the case positively is shitty behaviour.

Up until now both sides of the abortion have debated loudly, and the rest of us have tried to find a sensible way through it, and help women come to as good a decision as they can. Abortion is an act with consequences, and so is a pregnancy taken to term. In the old days you’d have women going through IVF next door to women having T.O.P.s on a gynaecology ward, and sometimes fights broke out between them. Women are both blessed and cursed by fertility, and of course they are the ones left holding the baby, or the after effects of the termination. Women often have very mixed feelings towards pregnancy especially in the early stages when they first discover it. Some are delighted, and some prefer their other roles at work or elsewhere and a child could ruin their career. Others re-evaluate their career when pregnancy comes.

To some extent women are damned if they do and damned if they don’t with a pregnancy. They may feel guilt and depression for ending the baby’s life, or they may feel guilt and depression for keeping a not fully welcome child. The decision to terminate or not is a permanent decision, life changing, responsible and made fast, often at a time of heightened emotions. Surely it is a decision to get as much help as possible with before making?

From the Mail interview it seems that Dr Downes is fully aware of all this and helps women review their situation and make the best decision they can. This is actually good medicine, helping patients to review and understand their predicament, and then make as good a decision as they can. She says, “I don't try to persuade anybody. I give them the facts and allow them space to think through the decision that they are making.”
She also says, “Some of my colleagues are happy to sign an abortion form without helping a woman to think the decision through, which is such a tragedy.” Dr Rant would agree with this. Abortion is not a minor decision, with no consequences. Treating it as merely a minor technical procedure is to diminish totally our respect for the value of each individual life.

She also says, “But I won't stand in a woman's way if she wants a termination.” So it appears that she is talking sensibly to women in early pregnancy about whether abortion is the right decision for them or not. The women think, and either keep the baby, or they go and see one of her colleagues if they decide to go for abortion. This is actually very fair medicine, and despite Dr Downes’s strong views on the issue it sounds that the women are getting a fair service, and the ultimate choice on whether termination is right for them or not. In other words the women’s autonomy is being respected, and Dr Downes is not imposing her moral views on the women she treats. Dr Downes says she is “pro-informed choice” and this is fair. Indeed doctors are usually criticised for giving too little information about procedures and their risks and consequences. It may be that abortion is currently being done in the UK with only partially informed consent.

In short there seems nothing in the interview to suggest Dr Downes is a bad or uncaring doctor, and nothing that suggests she is in breach of any G.M.C. guidance in Good Medical Practice. I think Dr Downes will see off any G.M.C. complaint easily.(with the usual caveats that this is said on basis of the data in the Mail and Observer reports and if G.M.C. finds additional evidence things could look different.)

To use the G.M.C. in this way, to complain about what a doctor has said, as opposed to what they have done, to the G.M.C. is shitty behaviour. It is a double edged sword. All doctors hold opinions and we all disagree with our colleagues on things. This is part of the fun of medicine (and life in general) It doesn’t indicate bad medicine. Taking part in the debate actually indicates commitment and engagement with our patients and our profession. Being on one side or another of a debate is not evidence of malpractice.

So to try and silence opponents by running off with whinges “She said the wrong things” and "She thinks the wrong things" to the GMC is shitty behaviour. It reeks of intolerance and heresy trials rather than reasoned debate.

The G.M.C. is there to arbitrate on bad behaviour by doctors, and whilst it tries to keep its procedures fair, robust and consistent, it doesn't always achieve this. The G.M.C. is no arena for arbitrating on general moral questions even if they are exemplified in one particular doctor. To its credit the G.M.C. is usually quick to spot agenda driven complaints and separate them from serious concerns about a doctor's performance in practice.

I hope that the unnamed pro-choice doctor who initiated this complaint will think again about his behaviour and drop the case. Dr Rant wishes Dr Downes well as she answers her accusers.

And he wishes doctors would not even think of using the G.M.C. to settle an argument with another. He regards that as very unethical and dangerous and disrespectful behaviour.