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College joins abortion debate

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THE COMMONS science and technology committee inquiry into termination of pregnancy has prompted a landmark move from the RCN.

THE COMMONS science and technology committee inquiry into termination of pregnancy has prompted a landmark move from the RCN.

The college has called for an amendment to the Abortion Act 1967 to allow nurses to carry out medical and early surgical terminations. It is also calling for the abolition of legislation that requires the signatures of two doctors before a termination can legally take place.

But, until very recently, the RCN was steadfastly non-committal on the role of nursing within termination ( NT News, 3 July, p8). Why after years of silence has the college decided that it is now the right time to take a stance?

RCN sexual health adviser Kathy French, who gave evidence to the inquiry two weeks ago, said: 'The committee gave us the best chance to have that discussion on a wider scale. It felt like the right time to bring it forward for nurses working within the field.

'The committee put the idea forward, it was the first time we have seen it in writing. We have never been formally asked our opinion in this way before,' she said.

The RCN position, according to Ms French, was formed with the interest of service provision and advancement of nursing practice in mind.

Termination before nine weeks can be carried out medically but in some areas of the country women are being denied this option because of long delays in services.

The Commons committee received a total of 50 submissions to its inquiry from a cross-section of organisations, ranging from the fpa (Family Planning Association) to the Christian Medical Fellowship.

Most submissions have been based on clinical or service-based grounds but some have found it hard not to include ethical arguments.

In one written submission, BUPA nurse Sally Carson said: 'There [is] a need for the nurse's role to continue as a supporting role, with a positive image.

Terminating life has, and is, a negative image. This will have a psychological and [or] emotional effect, not only from the realisation that they have terminated an innocent human life but also by the knowledge of the traumatic long-term effect on their client, especially if there are complications.'

Ms Carson is seemingly not alone in her views - 90% of the 1,066 nurses who responded to an NT survey in April felt that surgical termination was not a job for nurses. This followed claims that academics had identified a legal loophole that already allowed nurses to play a greater role in termination of pregnancy - an idea denied by ministers (NT News, 3 April, p4).

A second poll, carried out last week by nursingtimes.net, suggests nurses are also divided on whether the college should even have adopted a position on the issue - 41% of 554 respondents said the RCN was right to take a stance.

Ms French said she realised the RCN's position may prove divisive, not least because the college only consulted its sexual health nurses on its decision.

'If this was a matter of ethics, then we would have consulted all of our members, but it will only affect a very small number of nurses,' she said. 'It's a very emotive topic - everyone has a right to their opinion but our decision was not a moral one.'

Interestingly, the medical profession is also divided on extending the role of nurses in termination of pregnancy.

At its AGM in June, the British Medical Association voted against a change in the law, particularly regarding surgical terminations, and this was the view it put forward to MPs.

Dr Tony Calland, chairperson of the BMA's medical ethics committee, said: 'You can never be sure what is going to happen in an individual operation and, unless you have someone suitably qualified who can take further emergency measures if needed, it would increase the risk to the patient.

'So the argument is that it should only be done by a doctor or surgeon who is going to be able to cope in a situation where that might arise.'

But this was disputed in evidence to MPs given by the Royal College of Obstetricians and Gynaecologists, which gave nurses its backing.

'Many hospital-based abortion services already rely on nurses to run their medical abortion units,' the college stated. 'Allowing nurses to take consent for abortion, medical or surgical, would help to make these services run more efficiently.'

Citing a trial that was recently published in The Lancet, it added: 'First-trimester abortion using manual evacuation can be provided safely by appropriately trained nurses.'

Changes to the law, if any, will not be brought in until at least next year. But the intervening debate on termination looks set to be a long and difficult one.

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