The American answer to the abortion problem is seen by many to be: remove all legal restraints and leave the matter a personal one between a woman and her doctor. Several states have already revised their laws in this direction.
We in Britain were so mistaken about the results of our liberal abortion legislation that a timely warning may be in place. Just prior to the act a publication of the (Anglican) Mothers’ Union stated: “It is unlikely that there will be more than the marginal increase in the number of abortions.” A few months later T. L. T. Lewis, a senior gynecologist, was saying: “All in all, we did not expect a very great change in practice from that obtaining before the act. We thought there would be a slightly more liberal attitude to the problem, for that, after all, was the purpose of the new law. How wrong we were. I am afraid that we did not allow for the attitude of, firstly, the general public and secondly the general practitioner.”
The fact for which we British had not allowed was that of climate of opinion. Prior to 1968, among legitimately pregnant women, it was only the desperate who thought seriously of paying a furtive visit to the back-street abortionist, or, if rich and avant-garde, of going for a “West End Legal” abortion. The vast majority might hope, and even pray, for a spontaneous miscarriage, might even take a double dose of castor oil; beyond that they gave abortion no thought. Now all that has completely changed. It is no longer “How can I cope with this pregnancy?” but “Why should I cope with this pregnancy?” The decent woman who by her planning and toil has made a good home and has done the best for her family will eventually see the end of the tunnel in sight. At last she is beginning to re-establish her identity as a person in her own right, outside the confines of her home. Then, finding herself pregnant, she says, “Why should I go through with this—back to the diapers, back to the drudgery, back to the scratching and scraping of twenty years.” So she picks up her handbag and makes for her doctor’s consulting room.
With each abortion granted, the circle of women demanding abortion grows. Before the passage of the abortion act, I may have been asked to perform an abortion twice a year. By December, 1969, there was a referral every second working day. The Christian physician finds himself caught between two pressures. There is, on one hand, pressure from his church and from friends who cannot understand why he has anything to do with therapeutic abortions. (As part of my research into abortion as a Christian option, I sent twelve “fictional” case histories to groups of evangelical Christians: gynecologists, general practitioners, ministers, laymen, laywomen, and medical students. It is fascinating to note the decreasing permissiveness through these groups, although probably only the distinction between the views of the trained medicals and those of the youngest age group—the clinical medical students—is statistically significant.) On the other side there is the pressure from his patients and their relatives and his colleagues urging him to greater and greater involvement. It may be instructive for American Christians thinking about abortion to know of some of the problems that face the British Christian doctor in his everyday professional life.
London has been called “the abortion capital of the world” but is quite atypical of the rest of the country. From April, 1968, when the abortion act took force, to the end of that year, 8,601 private abortions were performed in the whole of England and Wales; of these 8,091 were performed in the North-West district of London. There it can be a very lucrative business: a Christian colleague of mine was invited to help at a private clinic in the area with the information that she could thereby expect to increase her present earnings by 400 per cent. There conditions are frequently poor, the patient’s stay is a matter of a few hours, and there is often no adequate pre-operative assessment or post-operative care.
Outside this tiny area, conditions are completely different. Of the remaining 12,300 abortions performed during the same months, 11,700 were performed in the National Health Service hospitals, which means that the patients were referred by their general practitioner to a consultant gynecologist, were admitted (usually for forty-eight hours or longer), were anesthetized by a trained anesthesiologist, with all the resources of the Blood Transfusion Service available, and all without any financial cost whatever to the patient herself. Even so, financial considerations are not absent. The patient whom one refuses not infrequently says, “Could I come and see you privately, Doctor?”—a remark guaranteed to enrage any conscientious physician. Many of my gynecologist colleagues in private practice refuse to take any fee when seeing a private patient about abortion. If in our situation the temptation to make very large sums of money quickly has to be resisted, it may well be that this is a factor the American physician, in his different circumstances, should consider beforehand.
All gynecologists find abortions repugnant, and in Britain one who, for whatever reason, fails to do his share of the dirty work tends to lose popularity with his colleagues. The junior doctors specializing in gynecology are in particular difficulty. They may be expected to provide unquestioningly the second signature required on the statutory form; they may find that their share of the operating list consists of a string of abortions of which they do not approve. So much is this so that some Christian men, now ready to reach consultant status, find that emigration may be the only option for them, as it could be that appointment boards may not be sympathetic to candidates not prepared to “pull their weight.” At a more junior level, numbers of Christian doctors are deciding that the abortion act has closed the door to a gynecological career for them.
In the day-to-day working of an outpatient clinic, the abortion case plays havoc. Whereas my outpatient appointments are made at ten-minute intervals, the abortion request case will take three to four times as long. It is not unknown for there to be four or more such cases at one outpatient session. Some consultants have decided to say “yes” because it is too time-consuming to say “no”. In this situation the Christian doctor must take refuge in the knowledge that he is seeking to do God’s will, that his hands are Christ’s hands and this day he is to “perform those good deeds which God had before ordained that he should walk in them.” Unfortunately, it is far from easy to know what is God’s will in the case of a woman sitting there in tears.
Most of us at the time of the passage of the act decided to hold firmly to abortion on medical indication only, but as the women come and go by the scores, it becomes clear that there is nowhere at which a predetermined line can be drawn. The woman with renal failure, early in pregnancy, must, obviously be aborted; then what about the cardiac case who could be nursed through her pregnancy, but would then go into failure on arriving home with the baby to care for? If she is accepted, then what about the woman with a history of hospitalization for mental disease who has recently improved but whose pregnancy is reactivating her problem. If she should be aborted, then what about the woman with a severe depression, now cured, whose social or economic conditions are going to deteriorate so because of this pregnancy that she will sink, once again, into a depression, leaving her family life in ruins and her children bereft of care?
Perhaps the extramarital pregnancy leaves us with little sympathy—until we remember our Lord with the woman taken in adultery. Of course, this does not mean that we are prepared to terminate the pregnancy of girls whose morals have gone to the wind, but it is here that climate again has its affect. Had her doctor sent this girl to another gynecologist, she would have been aborted. Is her reward for meeting the servant of Christ to be told that her career is ruined, that she must bring up her illegitimate child, without help, in some lonely slum, or that she must abandon her elderly parents, whose sole breadwinner she may be, in order to complete this pregnancy? This may well be what one has to say to the girl, but in a legal situation where abortion for a less deserving woman is very readily obtained, one needs strong grounds for one’s opinions. Debates on the timing of the entry of the soul into the fetus have kept philosphers happy since before the Christian era; they seem irrelevant to the gynecologist who sees a large number of spontaneous miscarriages. The sanctity of life is a useful concept, but its biblical basis proves singularly elusive. Psychiatric opinions on the aftermath of therapeutic abortion are so divergent as to prove useless. The gynecologist can only pray that the decision in this case would be that which the Lord would have taken had he been sitting in the same chair.
Something of our present tension can be seen in the papers given by evangelical gynecologists at recent Christian Medical Fellowship conferences. Dr. Elsie Sibthorpe said:
It is when we think of the future of the unwanted fetus, its potential for becoming a normal, healthy human being blighted almost before it has even assumed a human form in the uterus, that we begin to question whether our self-righteous adherence to the sanctity of fetal life is not misplaced. Sometimes we feel like withdrawing from controversy, just opting out as our Catholic colleagues are able to do, and refusing to see patients requesting abortion, but would this be right? Surely it is essential for Christians to face up to their problems, not to escape from them.
Another doctor, W. Y. Sinclair, said:
Most changes which might apparently undermine the morals of the Christian in particular, and the community in general, are at first generally frowned upon. Even in the past year I have seen many gynecologists change from an attitude of strict conservatism to one of partial or complete liberalism. I rather suspect that as time goes on even Christian doctors will find more and more indications for performing abortion with little adverse effect on their conscience. Often I ask myself the question: If this were my own teen-age daughter that was pregnant, what would I want for her benefit? I rather feel I would choose abortion if that was what she also wanted and especially if her career was at stake. If this is my attitude, who has no daughter, I wonder how the mothers of such would react. We should seriously consider this before condemning others. At present my attitude is strict, as I find the performing of abortion distasteful but more and more I feel these decisions much more difficult to make and a more liberal frame of mind prevailing [“In the Service of Medicine,” April, 1969].
In view of our British experience, it would be wise for Christians in America to give very careful thought to their stance in abortion reform. In an excellent booklet “The Problem of Abortion” published by the Board of Social Ministry of the Lutheran Church in America, Doctors Wertz and Witmer end up suggesting that the ideal should be compassionate abortion and suggest grounds very similar to those in our British abortion act. It is the drafting of such an act that is so difficult. As one practitioner in the notorious London sector stated: “This may not have been what Parliament intended but they put up the umbrella and we are sheltering under it.
Despite these difficulties, in my judgment some legislation is essential; faced by the anguished patient, one keeps thinking, “What am I hoping to achieve by making this unwilling woman go through with this pregnancy, which can have a deleterious effect on her whole future, when I could so very easily lift the whole burden from her?” On such occasions or when patient pressure becomes excessive, it is tremendously valuable to pull out a copy of the act and read it to the patient. I then add: “I have to make a detailed statement to London on each case. What could I say about you?” This often evokes the reply: “I don’t really fit in.” Without such a lifeline to grasp, one would find the pressures even greater than they currently are.
In seeking to keep our feet on the rock, we must search for hard facts. One such is the question of guilt. Psychiatric series tend to discount this if it is not so serious as to manifest itself as a symptom. This is not a sufficiently fine criterion. I have seen women who put on a bold face to the world while suffering deep remorse over a therapeutic abortion in the past. As part of my study of all aspects of abortion, I am eager to hear from any committed Christian woman who has had a therapeutic abortion, or any pastor who has counseled such a woman, in order to learn her true feelings. It is obviously important to know of those who are happy and thankful, as well as those who suffer pangs of conscience.
