This week has seen some important voting on abortion and assisted dying when the British Medical Association held its Annual Representative Meeting in Bournemouth. The ARM provides the primary opportunity for BMA policy and professional practice to be debated and voted on by its members. Motions are put down several weeks in advance, a few are chosen for debate, then voting takes place amongst all members who attend the conference as to whether they should become BMA policy or not.
As well as voting to maintain their opposition to legalising assisted dying (which was a great result, covered in more detail here), doctors and medical students also voted ‘overwhelmingly in favour’ of supporting the universal availability of non-directive counselling for women considering abortion.
Along with universal counselling being available, the conference also voted on whether counselling should be in accordance with NHS standards and independent of the abortion provider. These parts were a little more complicated and are explained in more detail below.
The motion that was put down and proposed by Dr Mark Pickering, a GP and CMF member is as follows:
That this meeting:
i) supports the universal availability of non-directive counselling for women considering abortion; – passed as policy
ii) believes that any counselling provided for women considering abortion should accord with NHS standards; – passed as a reference
iii) believes that women considering abortion should be able to access counselling that is independent of the abortion provider; – passed as a reference
iv) deplores picketing and intimidation around abortion services. – passed as policy
The motion was an ‘agenda committee composite’, which means that more than one separate motion was combined into one composite. In this case, parts i)-iii) were originally separate to iv), hence the differing nature of the two sections.
To set the context for the voting, Dr Pickering made it clear in his speech to the conference that the first part of the motion:
‘…is designed quite simply to increase choice for women.’ He explained: ‘On an issue that is often heated, emotive and controversial I’ve tried to put forward a proposal that people from all viewpoints can support.’
He made it clear at the outset that if a woman is certain she wants an abortion: ‘this motion would not affect them’. However: ‘other women may be less certain, and perhaps be looking for a safe space to think through the options and the implications for them. We owe each one of them a duty to ensure this opportunity is available.’
Dr Pickering drew on his own experiences: ‘When I’ve seen women as a GP …one of the most common phrases I’ve heard is ‘I feel I have no choice’. Instead, any woman should know that, if she wishes, she can get counseling through the NHS.’
He also added that he was not proposing to bring in enforced counselling, or introduce an imposed cooling off period.
This part, part i), was passed as policy and was largely uncontentious primarily because it was calling for optional counselling. Any call for mandatory counselling would have been resolutely rejected at the ARM.
Moving on to part ii of the motion, Dr Pickering made it clear that any such counselling should be non-directive and he would like the BMA to work with the Department of Health to develop national guidelines, as there are currently none on this. He explained to the conference that when he originally drafted the motion he thought there were some guidelines already, but had since become aware that they do not (yet) exist. This point is important to note.
Parts ii) and iii) were both passed as references to Council. This essentially means that the meeting was supportive of the spirit of the part, but was unable to pass them as policy, usually due to technical reasons of wording or implications. The BMA is still mandated to take the motion and do what they can to enact it, but would strive to work within the spirit of the motion and is not bound by the exact wording.
- Part ii) was passed as a reference because it mentions NHS standards, whereas these standards do not yet exist. The spirit of the debate was that the BMA would work with the Department of Health to produce such national guidelines.
- Part iii) was passed as a reference because, whilst it was acknowledged that there should be optional NHS counselling provided separate to the independent abortion providers, the wording as it stood might imply that NHS hospitals (who provide around 30% of UK abortions), would have to offer NHS counselling that is independent of the same NHS hospital. This was not the intention of the motion and was the only reason it could not be passed as worded.
In his speech, Pickering explained that the aim of part iii) was simply for the option of counselling to be provided separate from the abortion itself: ‘By no means would all women want this separation for them but it should be an option. If women may feel more comfortable discussing her situation elsewhere then surely this should be offered…this motion is about extending choice to women, not limiting it.’
Finally, part iv) had been drafted to reflect concerns from some about demonstrations outside abortion clinics. This was not commented on extensively in the debate although Dr Pickering made a distinction between ‘information’ and ‘intimidation’.
There had been an attempt to amend the wording of parts ii) and iii) before the debate to resolve the issues raised above, but for procedural reasons this amendment was not accepted; hence the original wording stood and therefore parts ii) and iii) were taken as references. Thus although not official BMA policy, the BMA would normally work within the spirit of the parts as indicated in the debate.
Some readers may have read a brief news report on this motion in the BMA conference review. This states that: ‘doctors and medical students were not convinced enough by the arguments that counselling for women should be independent of the abortion provider.’
However this is not an entirely correct reading of the debate because, as explained above, there was real support in principle for the whole motion, including independent counselling, even though this specific part was not adopted as currently worded as policy.
For those interested in listening to the debate, there is a further good speech in support of the motion by Dr Jenny Cheung.
Overall, this is a great result in view of the recent debates on counselling in Parliament, in the media and the promised public consultation by Parliament on independent counselling provision.
Many people assume that women considering abortion have access to independent counselling and advice. In fact there is no legal guarantee that they do. The drive to make abortion swift and easily accessible has meant that many women enter the process rushed, confused and panicked. Abortion is not always a fully informed, rationally made decision.
Many women are unaware of, or unable to access, truly independent counselling from providers who are not tied into the abortion industry and many feel they have been placed on a conveyor belt towards just one option, abortion.
Shadow Minister for Health, Diane Abbott has said that: ‘the decision to seek an abortion may be the most serious and difficult that many women face in their lives.’ With this in mind, it is right that independent counselling is offered to all women experiencing an unplanned or unwanted pregnancy.
As Dr Pickering reiterated, this is a motion that simply aims to extend and increase choice for women. It is a ‘pro-choice’ motion that rightly received the support it deserved.