DR MAX THE MIND DOCTOR shares his view on abortion laws
Grotesque proposal: Royal College of Midwives chief executive Cathy Warwick signed up the college to a campaign to repeal all legal limitations on abortion
When I first saw the headline, I thought I must have misread it. The Royal College of Midwives was calling for the 24-week cut-off for abortions to be scrapped, effectively legalising terminations until birth.
No, surely, surely, that can’t be right.
But it was. Chief executive Cathy Warwick — who also happens to be chairman of the country’s biggest abortion provider, the British Pregnancy Advisory Service — had signed up the college to a campaign to repeal all legal limitations on abortion.
She hadn’t consulted her members or put it to a vote. She’d just breezily committed all midwives to joining a tiny handful of countries such as China and Vietnam where abortion is legal on demand until birth.
Now, I don’t know about you, but when it comes to human rights, I’m never one to feel comfortable following China’s lead.
And I can’t understand how anyone who knows the full facts about abortion could countenance such a grotesque idea.
Cards on the table. I have no moral issue with abortion in the early stages of pregnancy and unreservedly support a woman’s right to choose.
I am aware that not everyone will agree with me, but I have thought long and hard about it. Indeed, while I was a medical student I assisted in terminations as part of my training. This was not compulsory. I volunteered.
Many of my fellow students opted out. But I felt that if I was going to say I was comfortable with abortion — and refer patients for it when asked — then I had to face the reality.
So what was it like? Frankly, not what I expected at all.
In my naivety, I’d assumed there’d be some special, sombre mood as a little life was snuffed out. Hushed voices. Perhaps a tear in a nurse’s eye. A sorrowful reverence as the remains of the foetus were removed.
Not a bit of it. It was all as emotionless, routine, and — after a while — boring as any other gynaecological procedure. Like cutting out a cyst.
After doing one abortion, we’d move on to a patient with endometriosis. Then, perhaps, another termination. There’d be worries about falling behind with our schedule, or someone dropping an instrument, but that was as dramatic as it got.
I’d expected an epiphany, but I just felt detached. It was only later that I realised this lack of emotion was precisely what made the experience so salutary.
The fact that ending a life can feel so routine is the most compelling reason of all to be very, very careful about the limits we place on it.
It’s so chillingly easy to treat abortions as being like any other operation — and the longer a pregnancy progresses, the more dangerous that becomes. In the developing foetus, each week of gestation brings a host of anatomical and physiological changes. But the only factor relevant to existing abortion legislation is when the foetus is capable of independent existence.
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The current legal limit for terminating a pregnancy is 24 weeks. Most terminations occur at 13 weeks or earlier, with only a fraction — less than 2 per cent — carried out after 20 weeks. Even so, that still means about 3,000 terminations a year at 20 weeks or later. That’s about ten a day.
If truth be told, many doctors are uncomfortable about the current cut-off. It’s not something we openly discuss because we know it’s so emotive. But, privately, many express discomfort that the current law is inherently inconsistent.
In the same hospital where we are trying to save a premature baby born at 23 weeks, a woman down the corridor is legally allowed to undergo a late-stage abortion on a foetus of the same gestation.
So on the one hand we throw money, resources and skill at trying to save a baby’s life, while on the other we sanction its destruction.
As medicine stands, babies can’t survive outside the womb at 21 weeks. At 22 weeks, there’s a 1 per cent chance of life. But just seven days later, at 23 weeks, this rises to between 11 and 40 per cent.
The fact that a small number of babies can survive at this stage — and that the chances are good enough for doctors to try to save them — undermines the basis on which the 24-week limit rests.
For a libertarian such as me, this is difficult. Any suggestion that the limit should be reduced is vociferously denounced as anti-choice.
There’s a feeling that the right for women to determine what happens to their body when they are pregnant has been hard won, and that any change to the rules risks an insidious erosion of women’s reproductive freedom.
But that understandable concern shouldn’t be allowed to silence discussion. And it seems to me — from a purely logical perspective based on current premature survival rates — that a cut-off of 22 weeks would make more sense.
If we wanted to be cautious, 20 weeks would give a clear gap between the upper limit for termination and the lowest biologically plausible age for a premature baby to survive.
But that’s up for debate. What the medical evidence doesn’t even begin to suggest is that the upper limit should be scrapped entirely.
Cathy Warwick’s proposals chill my blood. If I were a midwife, she would be the last woman on earth I’d want to speak in my name.
Let’s stop tolerating gluten allergy fantasists
The number of people claiming to be unable to eat certain foods — especially gluten — is rising at an astonishing rate.
Between 20 and 40 per cent of the population now believe they have a food intolerance or allergy. That is an increase of more than 400 per cent in the past 20 years.
Yet according to Allergy UK, fewer than 2 per cent of the population actually have a food allergy. Only 1 per cent are allergic to gluten — a form of protein found in wheat — while fewer than 10 per cent have a genuine intolerance to it.
Until recently this fad for claiming to have an allergy or intolerance was thought to be relatively harmless — all it did was inconvenience your hosts at dinner parties.
But research this week has shown that eating a gluten-free diet when you don’t have a real, medically diagnosed problem can actually cause obesity, diabetes and malnutrition.
That’s because gluten-free foods frequently contain more fat and sugar.
I’m sick of people claiming to have a food allergy when they simply don’t like something or want to feel special. It’s the bane of modern life.
And what’s worrying is that restaurants have started getting cynical about it.
A friend of mine has a genuine and very serious allergy to uncooked onions. His throat swells, he can’t breathe and he’s been hospitalised in the past when he’s eaten them.
Yet whenever we eat together, I see how waiters roll their eyes and patronise him when he asks them to check the recipe.
They then serve food that clearly contains raw onions anyway, because they no longer believe anyone when they say they have an allergy.
Similarly, doctors become more dismissive and reluctant to order tests because so many patients claim to have an issue with this food or that.
It’s a nightmare for those with genuine intolerances or allergies, which can be very distressing and profoundly affect their lives.
It’s crackers to neglect carers
There’s a group of people without whom the NHS would fall apart. They are not doctors, or nurses. The job they do is rarely acknowledged, yet they go about it with quiet patience and commitment.
I’m talking about the estimated six million individuals who dedicate their lives to looking after vulnerable loved ones.
An unimaginably precious resource: Carers’ unpaid work saves the UK £87 billion a year (file picture)
These carers are an unimaginably precious resource. Their unpaid work saves the UK £87 billion a year — not far off the total spent on the NHS.
And yet many of them are among our oldest and most vulnerable citizens. A report by the charity Age UK estimates that one in seven of the ‘oldest old’ — people in their 80s and older — are carers themselves.
That’s nearly half a million in their 80s and 90s. And the burden on them is immense.
People providing high levels of care are twice as likely to be permanently sick or disabled as the general population. The work they do is not just physically demanding, but emotionally draining.
Yet getting respite care for them is incredibly hard. They have to be near collapse first.
Indeed, studies have shown that the single most common reason cited as forcing carers to breaking point is the bureaucracy of accessing benefits and NHS care.
Given that the welfare state would collapse overnight without them, the way we neglect them is not just cruel, but crackers.
We all know the cliche: women are naturally open about their problems, while men bottle things up and rarely seek help until it’s too late.
Oh, really? Figures this week, showing half of women feel unable to talk to their GP about menopause symptoms, tell another story.
From my experience, women do tend to go to the doctor more than men, but in one very specific set of circumstances: when their condition unavoidably affects their ability to keep running their home and family.
The rest of the time, they don’t prioritise their health any more than men. In fact, they try to soldier on with all sorts of problems because they are simply too busy.
I suspect this reluctance to seek help with the menopause isn’t about embarrassment at all.
It’s just that women don’t think there’s much that can be done to help the symptoms (which isn’t true, by the way) and so stoically get on with juggling their lives, just as they’ve always done.
Sorry, chaps, but they’re a lot tougher than we are.