"I will do all government paperwork conscientiously" is not a clause in the Hippocratic Oath. Yet it is a significant aspect of an ethical doctor’s day-to-day work. Government red tape is an exasperating burden, but doctors have no special privileges before the law.
Politicians lose their jobs for falsifying their expenses. Accountants can be jailed for fudging audits. Scientists are stripped of their funding when they falsify data. Shouldn’t doctors feel obliged to follow the letter of the law, too – especially when lives are at stake?
Last week the London Telegraph revealed that doctors at many British abortion clinics were routinely falsifying their paperwork. The Health Secretary, Andrew Lansley, was outraged and vowed to crack down on clinics which were operating outside the law.
“I was appalled. Because if it happens, it is pretty much people engaging in a culture of both ignoring the law and trying to give themselves the right to say that although Parliament may have said this, we believe in abortion on demand.”
In the wake of revelations in February, also in the Telegraph, that some doctors were routinely approving illegal sex-selective abortions, the government regulator, the Care Quality Commission, raided every clinic offering abortions. Of about 250 clinics, both government-run and private, 50 were found to have falsified paperwork. Although abortion is a common procedure in Britain, it still requires the approval of two doctors. The main offense uncovered by the raid was that doctors were pre-signing the consent forms in bulk.
Mr Lansley was also disturbed that patients were not receiving adequate counselling. He pointed out that this was not just a matter of pettifogging paperwork:
“There is the risk that women don’t get the appropriate level of pre-abortion support and counselling because, if your attitude is that, 'You’ve arrived for an abortion and you should have one,’ well actually many women don’t get the degree of support they should…
“I completely understand the law doesn’t require the doctor to have met the woman concerned, but to pre-sign certificates when you don’t even know which woman it relates to and there hasn’t been an assessment, is completely contrary to the spirit and letter of the law.”
This seems like common sense, but the CEO of the British Pregnancy Advisory Service, the largest private abortion provider in the UK, Ann Furedi, was angered by the raids. She said that it was “absolutely wrong” for the CQC to abandon all of the important work on its agenda to persecute abortion clinics.
In fact, the sloppy paperwork seems to have been an open secret. In September 2007 a former medical director of the BPAS told a Parliamentary Committee that the paperwork was being done so badly, even illegally, that the two-doctor requirement should be abolished. Dr Vincent Argent wrote:
“The author has observed the following practices—some of these may be illegal and they need clarification: Signing batches of forms before patients are even seen for consultation; signing the forms with no knowledge of the particular patient and without reading the notes; signing forms without seeing or examining the patients; signing forms after the abortion has been performed; faxing the forms to other locations for signature; use of signature stamps without any consultation with the doctor.
“The HSA1 form is often considered to be just an administrative process where doctors make no attempt to form an opinion, in good faith, that the patient fulfils the grounds of section 1.”
Clearly these irregularities have been going on for years, ignored by practitioners and regulators alike. The outrage of the Health Secretary smacks of the mock indignation of Captain Renault in Casablanca – “I’m shocked, shocked to find that gambling is going on in here.”
It was only a few weeks ago that a Telegraph sting uncovered another abortion scandal: that some doctors were aborting children on the basis of their sex. The Health Secretary thundered then that abortion clinics would be investigated.
You would have thought that the clinics would have tightened up their procedures in preparation for a raid. Obviously they didn’t. Were they so smug that they thought that abortion would always be exempt from public scrutiny?
Perhaps so. Abortion in the UK, and elsewhere, is protected by post-modern chivalry founded on the principle that women who support abortion are channelling Florence Nightingale. A columnist for the Guardian, Zoe Williams, defended the BPAS over the paperwork scandal and described it as “a not-for-profit organisation staffed by women (I hope they won't be offended) for whom the term "do-gooder" was intended”.
This culture of deferential complacency has a familiar ring. It echoes observations made by the Pennsylvania Grand Jury which investigated the stomach-churning Gosnell abortion mill last year. It concluded that there had been “a complete regulatory collapse”. It said:
“Pennsylvania’s Department of Health has deliberately chosen not to enforce laws that should afford patients at abortion clinics the same safeguards and assurances of quality health care as patients of other medical service providers. Even nail salons in Pennsylvania are monitored more closely for client safety.”
Has there been a complete regulatory collapse in Britain, as well? It appears that doctors have ignored the law for years and regulators have deliberately chosen to ignore their arrogance. If the paperwork is not being done, what assurance do the government and the public have that far worse scandals – even by the standards of the law in England and Wales – are not happening? None at all.
More importantly, the doctors and the abortion clinics are throwing sands in the wheels of democracy. The abortion law was passed with promises by politicians that women who wanted an abortion would be protected by strict safeguards. Now it is clear that those safeguards are being treated as a joke.
The rule of law is vital in a democracy. Non-enforcement of the law by politicians and public servants out of loyalty to the higher ideology of abortion rights is profoundly anti-democratic.
This article is published by Michael Cook
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