Mr. Peter Thompson:

To start with the last question, it would be safe to say that many clinicians in the UK do not understand that they can use more than one clause. In the UK, two people have to fill out a form to say this woman meets the ground of one clause and most people were of the opinion that she must meet one but she can meet the grounds of several clauses. The figures I have given are for E alone, and with any other clause.

I was not here to discuss clauses C and D. I no longer do any gynaecology whatsoever, so I do not get involved in cases such as clauses C or D. Cases such as clause D obviously impact on the family if there is a baby with a significant congenital abnormality. In reality I believe that in almost every case where I agree to a termination for a significant foetal abnormality, I should probably also circle clause C, and if there are other children already present, I circle clause D. I do not believe how it cannot have an impact on them. I believe that more people should have multiple clauses circled but people tend not to do that. If they hit one hurdle then that is all people tend to be concerned about. If I scan a patient and the top of the baby's skull is not formed, the baby has anencephaly and the brain is being destroyed. I would not think about the social scenarios so much with regard to whether I needed to circle that clause.

I will now turn to the dangers of sticking to strict definitions. With regard to relative guidelines, there is no doubt that people do things differently in different units. Everybody has to find their own way but in the UK one has to find what one believes to be significant and serious reasons. Nobody can define what is right, but there has to be a standard deviation within which people fall. In the UK, if we see a woman who has asked for a termination of pregnancy for a foetal abnormality and if I believed that it did not fulfil clause A, then I am duty bound to find her a second opinion. The person who finds the second opinion may also say that he or she does not believe it either. That would be one scenario. I have come across cases where we have declined after 24 weeks. Reference was made to the group and the people who refused in those cases were the people who actually do the procedure, the clinicians. The others in the group had felt that the cases complied with the law and the people who performed the procedure did not.

In one situation, for example, which was a psychiatric case partly, the women said that she would kill herself if something did not happen. We did not feel that it had been explained enough or that enough detail had been gone into at that stage. We felt that we were only part way. One of the interesting things I learned from that case was that we were put under a lot of pressure to do this and then we said, "Are you going to sign one half of the form?", but nobody was happy to sign the form. They expected that we would. It is very important that it is the relevant specialty person who signs in this regard. If a doctor believes that a woman has a psychiatric illness and that is the reason she should have a termination of pregnancy, then psychiatrists need to be involved in it. They should be giving the opinions in those cases. I am not a psychiatrist. They should sign half of the form and then I can be involved in meeting the woman and make a decision based on what they say. If I agree, then I can sign the other half of the form. Other relevant specialties need to be involved in the process also.