The Ethics of Abortion

Is it legally permissible and medically ethical to abort a woman for "psychiatric reasons"? In Britain, as in most countries, physicians and surgeons have addressed themselves diligently to this problem. Though far from unanimous in details, they have arrived at a clear consensus on the main point. The consensus: such an operation is very rarely justified.

In Britain, abortion is legal only if performed to save the life of the mother, though by court interpretation this has been given a broad construction: "If pregnancy is likely to make the woman a physical or mental wreck . . . a doctor [who performs the abortion] is operating for the purpose of preserving the life of the mother."* The medical problem then is to decide whether letting the pregnancy take its course is "likely to make the woman a physical or mental wreck," and doctors find it far from easy to make an accurate forecast on this score. So most general practitioners call in a psychiatrist to share the responsibility.

One Got Worse. Trouble is that there have been virtually no comparative studies showing how many emotionally ill women got better and how many got worse after an abortion--or after a normal birth. In the British Medical Journal, Psychiatrist James Arkle of Reading reported the effect in 18 cases where abortion had been considered but not performed. Three women had become psychotic during previous pregnancies, five had psychoses unrelated to pregnancy, and ten were referred for symptoms usually considered less severe, though three of these had become hysterical in previous pregnancies. A year after giving birth, the mental state of three women was improved, and in 14 there was no change. In only one case was it adjudged worse--a schizophrenic, 18, who was unmarried. Concludes Psychiatrist Arkle: "In the vast majority of cases the decision not to intervene was the correct one as judged by the law in this country . . . It seems likely that, to an unbalanced woman, the stimulus of a normal pregnancy is less deleterious than [abortion] . . . The psychiatrist must not allow the sociologists and geneticists to deceive him into exceeding his duty as a physician."

Threats Are Warning. At a round table of the Royal Society of Medicine, doctors came to much the same conclusion. A mentally ill woman's desire for abortion is strongest, they agreed, in the first three months. After that, when the fetus "quickens," said Psychiatrist John D.W. Pearce, the desire to be rid of the baby usually subsides. The G.P., he suggested, can often coax a woman through those first three months. Suicide threats pose a knottier problem. They cannot be ignored. Yet often the woman who voices them most vociferously is using them to lash out at those around her and is not likely to carry them out. The challenge to the psychiatrist is to judge when the threats are a reliable warning signal.

Summed up Gynecologist William C.W. Nixon: "Of all gynecological operations, that of therapeutic abortion is the one that causes me most discomfort. Not only is there the destruction of the fetus--one can feel the shudder of the [operating room] staff--but also the constant vision of the coroner's court--deaths do occur."

*In the U.S., 31 state laws are virtually identical with the British, but interpretations differ. Three states (Maryland, Colorado, New Mexico) and the District of Columbia also permit abortions to protect the woman's health.

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