The Abortion Act: Fundamentally Anti-Feminist?

Abortion has long been a contentious subject that has divided opinions – in both Parliament and the general public – into two conflicting camps, with each placing greater emphasis on one of two interrelated issues: the foetus’s moral status and a pregnant woman’s autonomy. Whilst the UK is deemed to be reasonably progressive in its attitudes towards abortion, the Abortion Act 1967 does not in fact grant women the right to terminate a pregnancy – it is technically at the discretion of registered medical professionals alone. Although this is largely a better set-up than that recently demonstrated in Paraguay – where a ten-year-old was denied the right to end a pregnancy forced upon her by her sexually abusive stepfather – it is fast-becoming obsolete in a society, which has shunned paternalism from the doctor-patient relationship.

In R v Bourne (the bedrock of modern abortion legislation), a surgeon was acquitted of the criminal offence of ‘intending to procure a miscarriage’. He was justified in assisting a fourteen-year-old victim of rape, as the judge observed that the young girl would be spared of ‘great mental anguish’ by terminating the pregnancy. This unprecedented ruling provided a defence, under which abortions could be carried out lawfully: for the greater good of preserving a woman’s mental health.

It would be incorrect however to assume that the founding spirit of the Abortion Act 1967 was to empower women in asserting their reproductive rights. Following R v Bourne from 1939, doctors were given a loophole in common law that partially decriminalised abortion, however the extent to which a doctor perceived an unwanted pregnancy to threaten a woman’s mental health varied greatly. The fees for ‘legal’ abortions were consequently unaffordable to most, as there was still a perceptible risk that doctors may face criminal charges, and thus access to safe abortions was restricted.

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The lack of accessibility to abortions resulted in a dangerous rise in the number of ‘backstreet abortions’. David Steel, who first introduced the Abortion Act 1967 as a Private Members’ Bill, has since admitted that the introduction of the legislation was motivated by ‘revulsion at the damage caused by criminal and self-induced abortion and the hypocrisy of available subterfuge abortion on payment’. This was confirmed by the Lord Chief Justice in R v Scrimaglia, where he stated that the purpose of the Abortion Act 1967 was to ‘get rid of the back-street insanitary operations’ and reduce the associated mortality rates, which placed a heavy burden on the young NHS.

The 1967 Act was further based on two assumptions, that doctors: (1) will act in the best interests of their patients and (2) are most able to determine a woman’s best interests. Harold Shipman infamously succeeded in disproving the former assumption, whilst the latter has been criticised by ‘pro-choice’ advocates for its intrinsic paternalism and indeed, patronisation. In 1967, both Parliament and the medical profession were dominated by the male species, and thus the Abortion Act was conceived on archaic social constructs of women and doctors. Women were depicted as irrational, selfish or desperate; whereas doctors were responsible figureheads of society – i.e. everything a woman was not.

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Thus the purpose of the 1967 Act is arguably to provide ‘registered medical professionals’ with lawful grounds to perform abortions, if they are shown to form an opinion ‘in good faith’ that an abortion meets the set requirements. Interestingly, it is difficult to prove instances in which a doctor has not acted ‘in good faith’, as there has only been one successful prosecution under these charges since the Act’s introduction. There are however dubiously vague grounds on which an abortion may be carried out, as more specific definitions were rejected by medical professional bodies in the 1960s. The wording of the statute would also suggest that even if the grounds for abortion do not exist in reality, the abortion remains legal if the doctors honestly believed that the grounds had been satisfied. This leaves the legality decidedly at the doctors’ discretion – creating ‘medical control of abortion’.

Female autonomy has thus been trivialised to a strong degree in both statutory and common law. Although there are concerns that misinterpretations of autonomy have created a healthcare system in which ‘the doctor must deliver what the consumer-patient demands’; it has long been accepted that the negative freedom to refuse treatment, as entitled by the principle of autonomy, cannot be translated into a positive freedom to demand certain interventions (despite the wishes of the patient). This was echoed in the case of R v Sarah Louise Catt, in which a judge stated that it was wrong to assume that the provisions of the 1967 Act made abortion ‘available essentially on demand prior to twenty-four weeks with the approval of a registered medical practitioner’.

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I have failed rather spectacularly in hiding my distaste towards the Abortion Act’s ethos. Not only does current legislation neglect the changing role of a doctor in medical practice but it fails to acknowledge the medical advances, and subsequent changes to fetal viability, that have occurred since the Abortion Act 1967 and Human Fertilisation and Embryology Act 1990 were each introduced. Reform is long overdue; whilst there is no harm in continuing to preserve the integrity of doctors, a woman’s right to self-determination is now equally deserving of legal validation.

This post was based on a law reform proposal I wrote this summer. If you’re interested in reading about the changes I would implement, my justifications for these changes and/or have time to read a 5000 word essay, feel free to get in touch!

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Organ Donation: the Ultimate Service to Others?

The prospect of having your organs harvested within moments of your death isn’t a particularly pleasant thought, so it’s a hardly a surprise that conversations about organ donation don’t crop up regularly around the dinner table. It is normal and natural to become preoccupied in the daily minutiae of life and I think most people would be concerned if ideas of death frequented your thoughts. However human nature is such that our responsibilities as members of society can often be disregarded in favour of our responsibilities to ourselves. Considering organ donation is therefore challenging for two reasons: (1) you need to think about dying and (2) you need to think selflessly.

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I am a fierce advocate of organ donation for many reasons, a few of which I’ll touch on here. Trying to acknowledge all the moral, ethical, religious, scientific and philosophical arguments in support of or against organ donation would however take far too long, so instead my focus will be on a statistic that fits in better with what I understand:

“66% of Black, Asian and some Ethnic Minority (BAEM) communities living in the UK refuse to give permission for their loved ones organs to be donated compared to 43% of the rest of the population.”

This is fairly logical if you take organ donation to be a Western concept. In first world countries, where access to healthcare is presumed rather than fortuitous, organ or tissue transplants are within the realm of possibility for patients in whom other treatment options have failed. In less developed healthcare systems however, diagnosing the severity of a disease and assessing a patient’s prognosis are not as easily achievable and opportunities for transplantation are as rare as surgical resources; hence those of BAEM nationalities are less likely to have previously encountered organ donation. Indeed a lack of knowledge about something so ‘unnatural’ would possibly inspire fear rather than altruism and thus, this statistic can in part be explained.

The diversity of religions within BAEM communities may also account for the lack of enthusiasm towards organ donation. As such surgical techniques are modern revelations, significantly older religions did not specifically address the issue, leaving holy scriptures open to interpretation. The idea that your material body is merely a vessel for the immortal soul applies in both Sikhism and Hinduism, as does the notion of service to others; both of which strongly support organ donation. Buddhism states that whilst great care should be given to a dying person, if it is that person’s wish to relieve someone else’s suffering, there is no injunction against organ donation. It is less clear in Islam, as the human body is seen as inviolable both in life and in death; however the idea that ‘necessities override prohibition’ (al-darurat tubih al-mahzurat) may be applied in this sense to promote the preservation of other human lives, if the personal cost is bearable.

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Although it is therefore easy to assume that following a natural course of death is what your religion would permit you to do, in some cases scripture arguably suggests that the principles of selfless giving and conservation of life should play a greater role in your deliberation. Donating your organs is ultimately a personal decision but the lack of debate within religious forums, coupled with a wider lack of education on organ donation across the country, has prevented well-informed opinions from being constructed. Organ donation is also far from glamorous and a British preoccupation with propriety has (more often than not) blunted awareness of important issues. I am confident however that if you approached a doctor or religious leader with your questions or concerns, they would be more than willing to help. Not only would you be equipped with the knowledge to formulate your own opinion but you would be in a better position to help others come to a decision they’re also comfortable making.

And why is it that I think organ and tissue donation should be something that everyone considers? I am the first to admit that I can be selfish and spoilt but there is a quote by Muhammad Ali that encompasses the ethos I want to live by: “service to others is the rent you pay for your room here on earth”. I imagine that every person reading this blog, if given the choice, would do what they could to alleviate suffering and help those in need. It is however difficult to think of things in an abstract way; I have seen from my own experiences that it is not until we are forced to deal with disease in the context of someone we love, that we consider how we could prevent others from bearing the same burden. Yet we forget that we are all composed of materials that could save another person’s life. Donating your bone marrow could save a leukaemia patient. Donating your blood could save a mother from fatal complications during childbirth.

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Without wading too far into the murky waters of bioethics, there’s also a strong socio-economic argument to be made. I would never condone the Hunger Games-esque organ lottery proposed by the consequentialist John Harris but I do believe that our contributions to society should extend beyond the taxes we pay. We are fortunate enough to live in a time where medical advances have rendered many diseases obsolete and in a society where access to healthcare is free. We do not hesitate to use that which is available to us, so it seems fair to ensure the same is available for others.

Instead of rounding this post off myself, I’ll leave you with a few links so you can draw your own conclusions:


On 2nd May 2015, I’ll be taking part in the Isle of Wight Challenge with members of my Bhangra team. We’re fundraising for Delete Blood Cancer UK, a charity which aims to find a bone marrow donor for each person in need of one. Any donations would be much appreciated, no matter how large or small – thank you!

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Let’s Talk About S**

Yoga, the Kama Sutra and Bollywood are three of the sexiest products of Indian culture; actresses in the film industry thrive off their internationally recognised sex appeal and ancient Hindus had penned a guide to maximising sexual experiences long before many other civilisations had discovered the written word. In theory therefore, Indians should be as sexually liberal as their culture portrays them to be. Yet earlier this year the Indian Health Minister, Dr Harsh Vardhan, suggested a new values-based approach to sex education which removes sex (or the more ‘culturally acceptable’ s**) from the picture almost entirely. Not only does his vision repudiate the emotional and social importance of sex but it brushes over basic scientific principles, virtually closeting the topic altogether.

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Thankfully his proposal was almost immediately dubbed as ridiculous and young professionals across the country formed a strong opposition. Parodies of ‘government approved’ initiatives appeared online and newspapers openly mocked his Victorian mentality. What many failed to acknowledge however was how poor the current level of sex education is. Here in England, children aged ten or eleven years of age are taught about the reproductive system and more information is disclosed each academic year regarding sex and relationships, based on what the Department of Education has deemed age appropriate. Although this in itself is controversial, this scheme was introduced in response to alarming (and now well known) statistics which showed that the UK has one of the highest teen pregnancy and teen abortion rates in Europe, thereby warranting a drastic intervention. It was justified to conservatives with the argument that if teenagers cannot be trusted to abstain from sexual activity, it is surely more sensible to prepare them for a healthy sex life by equipping them with trusted knowledge on contraception and answering their questions in a safe environment.

In India, this permissive approach couldn’t be further from reality. There are clear discrepancies in the delivery of sex education across schools in India; whilst some schools have followed the World Heath Organisation’s advice that sex education should be taught to children from the age of twelve in order to prevent increasing HIV transmission by promoting safe sex, very few engage in the same level of teaching that has been adopted in the western world. A common theme, which unifies the various Indian sub-cultures and traditions, is the importance of chastity before marriage. This underlying value helps sustain the rationalisation that sex education is wrong, as it may spur the youth to believe pre-marital sexual relations are morally acceptable.

This leaves the future of Indian society in a precarious position. It would be unreasonable to suggest that all of India’s current issues result from an aversion to discuss sex openly but it is interesting to consider just how many problems it might explain. Would the population grow as rapidly if women knew how, where and why to access contraception? Would women be seen as inferior to men?

Adolescence is as awkward a time in India as it is in Europe, however the difference in India is that there is a severe shortage of responsible adults willing to explain the changes your body undergoes. I presume it is still uncomfortable for parents and teachers here in England but there is at least an understanding that by holding these positions of power, you are morally obliged to prepare children for what will be an incredibly vulnerable time, both physically and psychologically. This does of course include that favourite talk about ‘the birds and the bees’ that every parent and secondary school teacher thinks of with fondness.

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Pornography, unlike reliable counsel on sex and relationships, is easily accessible and downloadable; and therefore the only source of information for many young Indians. It usually shows a woman (or women) following the whims of their partner and submitting herself to his every need, which can be crass, aggressive and undignified. Feminists would not object so heavily to porn if it depicted both the male and female parties as having equal power as they engage in whatever sexual activities that take their fancy. What porn actually does is add fire to the pre-existing gender stereotypes that tarnish social mentality.

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Pornography does not demonstrate real life but as we are often told here in the west, it provides an escape. It is by its nature a chance to live out fantasies. In a country where sex and the reality of relationships are not openly discussed however, should crude fantasies be the only way sex is portrayed? Women are exhibited as submissive sex objects, so young men are deluded into believing that women should embrace that role. Young women are not told anything different and are therefore deceived into embracing it. Porn is made by men, for men, and the lack of assertive females in the industry is painfully apparent. Even in mainstream Bollywood, Emran Hashmi – an actor with an infamous reputation for producing smutty films for the general audience – will star in film after film and engage in risqué scenes with a different C-list actress, who is taking her first shot at the big screen. Each actress eventually withers away following a torrent of controversy but Hashmi continues to pave his career, relatively unscathed from the negative PR that shrouds his films.

Pornography does not only entrap young women but it also fails to liberate young men, who spend more time alone in front of a screen than interacting with other human beings in a sensate dynamic. Both genders are allocated unhealthy roles in relationships and because there is little alternative guidance available in India, they may unknowingly adopt the example pornography gives. We often speak of the advances made during the digital age. It is possible however that instead of shifting towards gender equality, a fundamental lack of sex and relationship education is further engraining archaic gender clichés into today’s youth and consequently delaying social progression.

How Good Are Your Sperm?

I learnt a fair few life lessons during my visit to India. Hot water is a luxury (most of my morning showers could fulfil ice bucket challenge requirements), you should never start watching a three-hour Bollywood film on the TV as a power-cut is guaranteed ten minutes before the end and a deck of cards will provide universal entertainment for days on end. Some of the most interesting advice I’ve picked up however was during a clinical placement with a leading IVF specialist and, incidentally, applies worldwide. Both citywide and rural studies have shown that changing lifestyles have been detrimental to public health and sperm counts specifically are suffering as a consequence. Male infertility is becoming an issue of increasing concern in the Punjab – so why is it that in an overwhelmingly testosterone-driven state, this fundamental measure of virility is being neglected? Stereotypical punjabi men rarely shy away from opportunities to demonstrate their superior masculinity and in this agricultural province, it may often be the number of whiskey bottles you devour or the kabaddi tournaments to your name that will help you garner respect.

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For women, infertility is usually a mechanical problem that can’t be helped. Although lifestyle factors (such as promiscuity, smoking and extremities of BMI) may significantly impair a women’s ability to reproduce, the most common causes are diseases of relatively unknown origins, with endometriosis and uterine fibroids being common examples. Increasing age also severely limits a female’s reproductive capacity as women are born with a finite store of eggs, which is depleted with each menstrual cycle, and eventually concludes with the menopause. Men however could theoretically procreate from the onset of puberty until their death as there are no such restrictions on the male reproductive organs. Whilst rarer mechanical causes exist (undescended/absent reproductive organs, hormone imbalances), male infertility can essentially be considered as a dysfunction of one of two processes: sperm production and sperm delivery. The following factors (many obvious and some unexpected) may interrupt either of these processes temporarily or permanently:

  • Alcohol – drinking within the recommended limits of 3-4 units per day is unlikely to affect a man’s fertility. Drinking in excess however increases your risk of diabetes and diseases which effect your blood supply, both of which can lead to erectile dysfunction.
  • Obesity – again, a BMI of greater than 29 predisposes men to an array of diseases, many of which may lead to hormonal imbalances and, yes, erectile dysfunction.
  • Smoking – cigarette smoke places your body’s cells under oxidative stress (including those of your reproductive system) which, in other words, increases the risk of cell death due to oxygen starvation. Other mechanisms also reduce the production of nitric oxide (NO), which is responsible for dilating your blood vessels… including those which men hold most dear.
  • Unprotected sex – many STIs (chlamydia and gonorrhoea being the main culprits) are responsible for infertility in both sexes and as they can often be symptomless, lasting damage may occur long before you seek treatment.
  • Tight clothes – those sick skinny jeans in Topman may be sicker than you think and should perhaps carry a “genital-crushing” health advisory warning.
  • Poor diet – the unhealthy fats in fast food clog your arteries through a process called atherosclerosis and high sugar levels contribute to a risk of diabetes – both of which can reduce the blood flow to your reproductive organs, leading to reduced sperm production and more erectile dysfunction. Fruits and vegetables on the other hand are rich in antioxidants which stop cells from dying prematurely.
  • Mobile phones – a recent study carried out at the University of Exeter suggested that the electromagnetic radiation produced by mobile phones kept in trouser pockets can impair sperm production, thus reducing sperm counts by as much as 8%.
  • Hot water – sperm develop optimally in a cool environment, hence why a man’s testicles are situated outside his body. Too much time in hot baths, jacuzzis and hot tubs may relax sperm production as well as your muscles, leading to reduced fertility.

skinny-jeans-on-men1 Thankfully, breakthroughs during the last few decades have allowed miracles to occur on a daily basis; embryos are conceived for couples who would have once been told they had little hope of birthing their own child. As many as one in seven couples seek advice or treatment for infertility but despite this, it remains a sensitive topic that can be difficult to broach for either sex. Indeed, in 100 cases: 30 would be due to problems with the father, 30 due to problems with the mother, 27 due to problems in both parents and the remaining 13 cases would be ‘unexplained’. It is fair to say therefore that infertility is a reasonably common problem for both genders. With an expanding circle of clinicians taking the view that lifestyle plays a significant role in fertility, perhaps a fresh approach to infertility therapy is needed. invitro2 Prevention is undoubtedly the best remedy for any medical problem, hence the billions of pounds that are invested annually into research for vaccinations and public health campaigns. If this same concept was applied to educate the public on how to preserve fertility, the quantity of couples approaching their GP for fertility advice could slowly decrease and fewer members of the public would be subject to the financial and psychological burdens contiguous with infertility.

Although this is ideal in principle, too often we neglect our own bodies and discard own health in favour of the easier, gluttonous option. We make ourselves unnecessarily vulnerable to a host of ailments which, with a little self-motivation, could be entirely avoided. What is the point in government initiatives if no one pays attention? The slogans “use a condom”, “smoking kills” and “drink in moderation” have been plastered across schools, hospitals and social media – yet STIs continue to rise, smokers still go through a pack-a-day and alcoholics find themselves in emergency rooms unable to recall how they got there.

The next time you receive advice for your health or come across an NHS poster, take thirty seconds of your day to pay attention. You will soon realise that healthcare professionals understand that abstaining from guilty pleasures is usually unachievable and will only ever recommend it if they consider it to be worthwhile. The tools necessary to preserve every aspect of your health are widely available. Instead of ignoring them, utilise them and remember that by taking care of yourself today, you have taken care of your future self and perhaps avoided the loneliness of a doctor’s waiting room years down the line.

Musings of a Fannibal

Part of the application process for Medicine involves memorising the definition of “empathy” and being able to offer several scenarios in which you’ve demonstrated your inherently empathetic nature. It is a concept that we are constantly reminded of during our studies and in practise, it is difficult to feign. Antisocial personality disorder – more widely known as psychopathy or sociopathy – is the antithesis of what one would expect of a healthcare professional. The Psychiatry Bible recognises characteristics such as “callous unconcern for the feelings of others”, “gross and persistent attitude of irresponsibility” and “incapacity to experience guilt” as the basis of diagnosis; i.e. an intrinsic lack of empathy.

A recent study published in Time magazine reassuringly identified most members of the healthcare profession as having the least psychopathic traits. I say ‘most’ because surgeons were conversely recognised as one of the top-five professions to which psychopaths are attracted, placing them in the same bracket as CEOs and lawyers. This doesn’t suggest that all surgeons are psychopaths (despite the popular beliefs of countless medical students) or that all psychopaths choose to become surgeons. As with every psychiatric disorder, it is not a case of “you are” or “you aren’t”, it is more about how far along the spectrum you sit. A profession, which relies on purely clinical judgement in stressful situations, requires individuals who are able to make decisions uninfluenced by emotion. A moment’s hesitation could cost a patient their life and in such circumstances, a self-assured, impulsive surgeon may be just what the doctor ordered.

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Feeling emotion is something I have never struggled with and years of crying over John Lewis Christmas adverts are testament to this. Psychopathy, to most people, is therefore an absolute enigma. It is understandably difficult to feel sorry for psychopaths – is it even possible to feel pity for someone who shows no remorse? I am intrigued however by the notion that psychopaths are born, not made. A psychiatrist I encountered on placement theorised about three types of crying-baby:

  1. The physiological crier – this baby will only cry when they need something basic, such as food or a nappy change. This is the calm, docile baby that all parents pray they’ll have.
  2. The attention-seeking crier – this baby will also cry when they want love or affection. This baby is generally amenable and can be easily placated, once they’ve received a little focus from their carer.
  3. The pathological crier – this baby cries relentlessly despite the better efforts of their carers.

Of course, every baby is different and crying is a purely subjective measurement. It has been suggested however that the ‘pathological crier’ that may grow up to be a psychopath. An absolute deficiency of emotional understanding prevents these babies from responding to their carers’ attempts to pacify them. As toddlers, they may exhibit violent or cruel behaviour with a remarkable disregard for punishment. The film adaptation of We Need To Talk About Kevin portrays the journey of a sociopath from birth to adolescence by revolving around the strained relationship between a reluctant mother and her very disturbed son. It is unnerving, coarse and perhaps over-stylised – but its premise fuels the ongoing debate of “nature vs nurture”, making it near impossible to stop watching. Research suggests that reduced activity in the amygdala – the part of your brain responsible for emotional response and fear conditioning – gives rise to psychopathy. The “nurture” camp would argue that negligent parents do not give their children enough attention, eye contact or love and therefore prevent the amygdala from developing. Team “nature” suggest that it is a congenital amygdalal deficiency, no different from Type I Diabetes or cystic fibrosis, and these children have no hope.

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Horror has been making a big comeback to the small screen. Shows like The Walking Dead, The Vampire Diaries and American Horror Story have surprised audiences with their success. My newfound favourite is Hannibal and whilst I am terrified by the prospect of watching it by myself (I wait until my brother’s around to do a series catch-up), I am hooked. It is an exquisitely haunting and unexpectedly witty visual marvel and I challenge you to find a drama on TV with a more captivating cast. Although Hannibal has received universal critical acclaim, it has failed to be as commercially successful as shows like True Blood. Indeed parts of episodes were banned in America for being brutally graphic but wouldn’t that only attract more viewers, desperate to see what all the fuss is about?

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Vampires may sparkle in the sunlight but they are essentially serial killers that use exsanguination as their preferred method of murder. As former humans themselves, their choice to drink human blood makes vampires reminiscent of cannibals. The difference is of course that vampires are a supernatural entity, which explains why it is more than acceptable for your 13-year-old daughter to lust after the Salvatore brothers. Hannibal is a psychological horror that deals with reality, a much scarier place than the paranormal world. Psychopathy lies at the heart of Hannibal and every week, the writers laugh at your darkest nightmares and offer you a murderous Grand Design that is at least ten times worse.

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Hannibal is no more gory than its supernatural counterparts but it centres on a highly stigmatised mental health disorder and pays little heed to social convention. It is therefore conceivable that Hannibal’s failure to reach a mass audience stems from a deeper societal fear of mental health issues and the realities psychopathy presents.