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.”
