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Abortion remains a live issue.

With this issue we are pleased to welcome as a regular correspondent to the Report Richard H. Nicholson, a pediatrician who qualified at Oxford University but no longer practices, and now edits the Bulletin of Medical Ethics. Dr. Nicholson's commentary on bioethics in Europe will appear twice annually.

When going into hospital to have an abortion, Dorothy Parker is reported to have said:

It serves me right for putting aH my eggs in one bastard. " A few women on both sides of the Atlantic may still regard abortion as lightly as Miss Parker, but for most it remains a subject of great concern and debate. While developments since the Webster decision may have attracted most American attention, the situation in Europe has been no less confused and volatile.

Abortion laws in various European countries vary from complete prohibition to almost total license. While one might have expected the predominantly Roman Catholic countries all to have strict laws, the Republic of Ireland is the only one to have total prohibition. There is also total prohibition in the six counties of Northern Ireland, an attempt to extend English law thither having failed last year. Other Catholic countries are relatively liberal in their laws on abortion. France permits it on demand up to ten weeks' gestation, and Italy up to ninety days; neither sets any limit to abortion for medical reasons. Spain legislated in 1985 to permit abortion up to twelve weeks for rape, up to twenty-two weeks for genetic reasons, and, with no limit, to prevent a serious threat to the life or physical or mental health of the pregnant woman.

The most liberal regime is probably that of the Netherlands, where abortion is available on request up to twenty-four weeks. One result in the mid-1 980s was that as many women from abroad had abortions in Holland as Dutch women. That illustrates what has been quite a significant European trade, as women from countries with strict abortion laws have traveled to those with more lenient laws to purchase abortions. About 2,000 women from Northern Ireland come to Great Britain each year for their abortions. In the early 1980s, more than 22,000 abortions were performed each year in Britain on Spanish women. Since the change in Spanish law, that figure has dropped to about 3,000. German Confusion

At present the most confused position is probably that in Germany. Failure to produce a common abortion law between the former halves of the country last year seriously jeopardized the unification contract. A compromise was reached that each part of the country should retain its abortion law until the end of 1992, by which time a new law for the whole country is to have been formulated. Since the former West Germany has less permissive laws than the East-where abortion is available on demand in the first trimester-this situation encourages "abortion tourism." That existed previously within West Germany, since no abortion clinics have been licensed to operate in Bavaria and Baden-Wurttemberg, in the predominantly Catholic South. Now women who could not obtain a legal abortion in the former West German states can obtain one in the East.

Before the Eastern option became available many German women went to Holland to obtain abortions. Some still do, giving rise a few months ago to a bizarre situation: West German abortion law applies to German women outside the country, so that a woman obtaining a legal abortion in Holland may still be breaking German law. Last March, several dozen German women returning from Holland were arrested and medically examined on suspicion of having had illegal abortions. (See "Crossing the Line," HCR [July-August 1991]: 45.) It is not yet clear whether they will be prosecuted.

Such difficulties may well hold lessons for the United States. As different states enact laws against abortion of varying severity, so "abortion tourism" is bound to develop. Since the basis of the change in the laws will be a weakening of the right to privacy, will that weakening lead to the position that American women may be forcibly examined as they cross state borders to see whether they have had abortions? Permission or Prevention

Legislative developments show no overall pattern. Until last year Belgium was one of the few countries to retain total prohibition; that has now been partly relaxed. The Human Fertilisation and Embryology Act passed in the United

Kingdom last year contains one clause making some significant changes to our abortion law. There have been many attempts since the Abortion Act was passed in 1967 to tighten up the law. In one respect that happened in the 1990 amendment, which set a limit of twenty-four weeks, rather than twenty-eight weeks, on the length of gestation within which abortions for most common indications could be performed. But at the same time the amendment removed any time limit on abortions carried out: "to prevent grave permanent injury to the physical or mental health of the pregnant woman," when continuance of the pregnancy would put the woman's life at risk, or when there would be a substantial risk that the child would be severely handicapped. The Act as amended also permits selective reduction of multiple pregnancies under the same conditions as for termination of a pregnancy.

Attitudes to abortion in eastern Europe have sometimes changed in several countries at about the same time. Thus in the early 1950s a third world war was thought inevitable in most of the communist countries and abortion was almost completely banned so as to replace the future loss of life. In the mid-1950s those laws were mostly relaxed, and in several countries abortion became the principal method of birth control. Many women in the USSR still have ten or more abortions in their reproductive careers.

Now, attempts are being made in several of those countries to restrict abortion once more. In Hungary Pacem in Utero, an antiabortion group, was set up in 1989 by physicians and lawyers to campaign for abortion to be available only when pregnancy threatens the life of the woman, is the result of a criminal act, or would result in a severely handicapped infant. The group has appealed to the constitutional court to repeal the present law. A similar group in Lithuania issued an "Appeal to the nation" last year seeking that the abortion law "imposed on the Lithuanian people" by the USSR be repealed.

In the USSR there has already been some tightening of the law. At the end of 1987, a directive was issued limiting abortion for nonmedical reasons to the first twenty-eight weeks of pregnancy, and limiting the indications for it to: * death of the woman's husband or divorce from him during pregnancy; * imprisonment of the woman or her husband, or loss of maternal rights" as a result of alcoholism, prostitution, or drug addiction; * the woman's already having five or more children; * pregnancy resulting from rape.

Poland is the country whose attempts to tighten its abortion law have drawn most publicity. The campaigns frequently quote the figure of 600,000 for the number of abortions carried out each year. Recent figures from the Ministry of Health and Social Welfare, however, record only 59,400 abortions in Polish hospitals in 1990. Officials suggest the true figure is three times that amount, but it is still a lot lower than the propaganda figure. Discussion of proposed changes in the law designed to restrict abortions was deferred in May, new proposals were made in July, but have yet to be debated in Parliament. An executive order issued in April 1990 by the Minister of Health has already greatly restricted the number of abortions by requiring doctors to discourage women who want abortions for social reasons. Such women also have to obtain a certificate confirming that they have been counseled by a qualified psychologist-only one gynecological ward in Warsaw has a full-time psychologist. Mifepristone

Recent developments in Europe have been technical as well as legislative. The principal technical advance has been the introduction of RU 486, mifepristone, the "abortion pill. " It is an antagonist of progesterone, which is essential for the maintenance of a pregnancy. Given in conjunction with a prostaglandin to induce contractions, it is 95 percent successful at terminating pregnancies. Over the last three years at least 80,000 women in France have used RU 486 to induce abortions, and few have had serious side-effects. There has been one death in a heavy smoker who had had twelve previous pregnancies.

Since July this year RU 486 has been licensed for use in the United Kingdom during the first nine weeks of pregnancy. Its use will be tightly controlled, however, and it will be available only in hospitals or clinics and not to general practitioners. This has led already to calls from eminent women such as Lady Warnock for the National Health Service to speed up its referral procedures. At present England and Wales have the lowest proportion in Europe of abortions performed before eight weeks and the highest proportion performed after thirteen weeks. Role Reversals

This brief sketch of abortion in Europe allows a few conclusions to be drawn. One, curiously, is that western Europe is slowly becoming more liberal toward abortion, while the former communist countries are becoming less liberal. Whereas twenty years ago one might have supposed that the balance in a particular country between permitting and preventing abortion might be determined by the prevailing religious view, that seems no longer to be the case. Recently attempts have been made within the European Community to harmonize views on euthanasia; some similar attempt may be made for abortion. If that happens, it may well be that next year's attempts in Germany to produce a unified abortion law will give as good an indication as any of where the balance between permission and prevention might lie in the European Community. Further reading

1. J. Gunning, Human IVF, Embryo Research, Fetal Tissue for Research and Treatment, and Abortion: International Information (London: Her Majesty's Stationery Office, 1990).

2. D. Morgan and R. G. Lee, Blackstone's Guide to the Human Fertilisation and Embryology Act 1990 (London: Blackstone Press, 1991).

3. Bulletin of Medical Ethics, nos. 61, 62, 66, 67,69.
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Title Annotation:ethical aspects of abortion in Europe
Author:Nicholson, R.H.
Publication:The Hastings Center Report
Date:Sep 1, 1991
Previous Article:Sons and lovers.
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