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Q&A: Approving abortions

This Q&A page provides the O&G perspective on reasons to do away with two doctors’ signatures in approving abortions. It was published by the RCOG in May 2008 to accompany the passage of the Human Fertilisation and Embryology Bill through Parliament, and updated in May 2010.

What is the current legal requirement for the approval of an abortion?

Currently, the law in England, Wales and Scotland states that two doctors must approve a woman’s request for an abortion before it is allowed to proceed.

Why are two doctors required to approve an abortion?

When the law was drawn up in 1967, it was believed that having two doctors to approve an abortion meant that the decision to have an abortion was considered seriously by medical professionals and women.

Under this system, a woman seeking an abortion must have two doctors who have to agree that her physical or mental health and wellbeing are at risk if she carries on with the pregnancy. They confirm this by signing the Department of Health HSA 1 form.

So why are there calls for a change in the law so that only one doctor’s signature is needed?

In recent years, there have been several developments in health service provision which have meant that the requirement to obtain two doctors’ signatures causes unnecessary delays in women’s access to abortion services.

The widespread closure of community family planning clinics across the UK has resulted in limiting women’s access to abortion services. Delays experienced by some women during GP referrals, and the refusal by some GPs to forward these requests directly on grounds of conscience, have resulted in further delays.

The RCOG recommends that women requesting an abortion are provided with adequate information and advice by healthcare professionals prior to the abortion.

This should be augmented by specialist counselling if requested or required.

Systems in place in clinics and hospitals should ensure that women are given the information and support they need to decide on whether to continue their pregnancy or not. The need for information for informed consent is a separate issue from the legal need to obtain two doctors’ signatures.

The RCOG believes that the current need for two doctors’ signatures to certify that a woman is approved to undergo an abortion is anachronistic. There are no other situations where either competent men or women require permission from two third parties to make a personal healthcare decision. Individual doctors are able to provide the assessment in the same way as when they treat their patients without the need to consult another doctor.

What is the current situation regarding abortion law in other countries in Europe?

In Denmark, France, Germany, Greece, Italy and the Netherlands, abortions are available on request up to the first trimester. There have been calls for the law in Great Britain to be liberalised alongside the current practice in these European states.

Are there any special instances where it may be good to have the opinion of two doctors?

The RCOG believes that in some special cases, such as when the woman is very young, or when complications arise, such as a late diagnosis of a severe fetal abnormality or if the woman has very challenging personal circumstances (eg. a history of substance abuse or learning difficulties), then it will be desirable to have the opinion of another doctor.


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