Sunday, 11 December 2011

Abortion and mental health: Christian Medical Fellowship changes its argument

In the face of the now overwhelming evidence that abortion has no effect on a woman's mental health, the Christian Medical Fellowship has been forced to change their argument in order to maintain their faith-based, pro-life position that abortion is a very bad thing.

The recent report by the National Collaborating Centre for Mental Health for the Academy of Medical Royal Colleges makes clear that any previous findings of adverse mental health outcomes of women having abortion were in fact due to the initial poorer mental health of women with unwanted pregnancies, and that women who choose to have an abortion have the same level of mental health problems as those who choose to carry their pregnancies to term. Indeed, such is the knockout blow inflicted on the myth that abortion has a negative effect on mental health (perpetuated by unsound studies and religious politicians) that the researchers who authored the new report state it would now not be fruitful to perform any more research on the matter.

This has prompted a major change in tack in the argument of the Christian Medical Fellowship. Dr. Peter Saunders, head of the CMF went on Radio 4's Today programme to air what he clearly feels is a clever new argument. He reiterates it here on his blog: he believes that the findings of the report now make 98% of abortions illegal in the UK. This is because 98% of abortion in the UK are carried out on mental health grounds (for which provision is made in the 1967 Abortion Act), specifically that continuation of the pregnancy would risk injury to the mental health of the woman.

Now that the new study has shown that the risk to the mental health of women having abortions is the same as women continuing with the pregnancy, doctors authorising abortions cannot do so on the grounds of mental health, and therefore by signing papers authorising abortion are acting illegally. Dr. Saunders states "If they continue to authorise abortions on mental health grounds from now on they will then be knowingly making false statements on legal documents". Their penalty? Dr. Saunders becomes even more hyperbolic here. Under the Offences Against the Person Act 1961, doctors could face life imprisonment as "making false statements on an abortion authorisation certificate is a form of perjury".

I'm sure most high school or university students with any training in critical thinking could spot the basic flaw in Dr. Saunders' new argument, which suggests he's either being disingenuous or doesn't understand some basic principles of logic: specifically, which comparison groups would enable us to make an evidence-based statement. It's pleasing, however, to see that he now accepts there is no link between mental health and abortion. Anyway, back to the fatal flaw in this shiny new argument; it's simply that those continuing with unwanted pregnancies (the comparison group in the new report) are a self-selecting group, of which a woman asking for an abortion is not a member. Let's imagine one such woman requesting an abortion; let's call her Julie. Dr. Saunders says I shouldn't sign the papers as it's now shown that there would be no damage to Julie's mental health if I failed to do so. He infers this from the report as it shows that giving birth to an 'unwanted pregancy' has the same effect on mental health as having an abortion.

Really? Would denying Julie an abortion and forcing her to have a child that she doesn't want not be prejudicial to her mental health? If I wanted to cause someone severe mental health problems, then high up my list of methods would be to force someone to carry a pregnancy and give birth to a child that they don't want. No studies have been carried out which compare the prospective mental health outcomes of those forced to have unwanted pregnancies versus those having abortion (because such studies would be highly unethical as commonsense tells us that they would be highly damaging to the women forced to carry unwanted pregnancies). Dr. Saunders' argument (that I am not doing Julie any harm by not signing the papers) could only be supported if we had such evidence. By asking for an abortion, Julie has placed herself in a different group to those women choosing to carry their pregnancies to term; she wishes to terminate her pregnancy.

Therefore, the new report tells us that by signing the documents, thereby authorising an abortion, I am not prejudicing Julie's mental health. The report (or any evidence) can never say that by failing to sign the documents I would not prejudice Julie's mental health, as Julie is by definition not a women choosing to continue with unwanted pregnancy (i.e. she is not part of the comparison group in the new report which provides the comparison group in Dr. Saunders' argument). The new report therefore does not tell me how I should behave when faced with a patient asking for an abortion (no report ever could, as to get a comparison group to answer the question, we would have to do a randomised trial of denying some women an abortion whilst allowing others to have one). I don't think anyone, even those opposed to abortion, would suggest we try that.

As the new report has nothing to say about the mental health effects of not signing the papers, doctors can of course continue to sign papers "in good faith" (as Dr. Saunders puts it) and could never be convicted under the Offences Against the Person Act. To reiterate: there is no evidence in this report or any other to suggest that refusal to authorise an abortion results in the same mental health outcome for the woman as if the abortion was authorised. To suggest doctors could thus receive life imprisonment for signing abortion requests is either obscurantist bunkum or a result of failure to understand basic logic and set theory. But logical argument never was a strong point amongst those of faith.

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