A bid to relax the law on home abortions has been rejected by the High Court. The Government successfully argued that for an early medical abortion, the meaning of “treatment” under the Abortion Act 1967 included the use and administration of medicines and not just their prescription. Therefore, the 1967 Act still required women to take both first and second doses under supervision in a hospital or other medical premises - British Pregnancy Advisory Service v Secretary of State for Health 14.02.11
In 2009, around 70,000 early medical abortions (EMA) were carried out below nine weeks in England and Wales, accounting for about half of all early abortions. An EMA involves receiving pills in two stages. A miscarriage usually begins one to two hours after the second dose and is usually completed within four to six hours.
Countries including the United States, France and Sweden already allow women to complete terminations at home without having to go back to hospital.
The British Pregnancy Advisory Service (BPAS) sought a court declaration that in EMA, treatment should be defined as the prescribing and issuing of the necessary drugs, but not necessarily administration. The High Court had to decide on the meaning of the words “any treatment for the termination of pregnancy” under section 1(3) of the Abortion Act, and whether they covered both the prescription and the administration of the drugs used in abortion.
Mr Justice Supperstone ruled in favour of the Health Secretary and dismissed the BPAS's case. He upheld the Government's interpretation that the administration of both sets of abortion tablets amounted to “treatment” which must be carried out by a “registered medical practitioner” on premises approved under the 1967 Act.
In doing so, the Judge confirmed that it is Parliament's intention for the Health Secretary, not the medical profession, to have responsibility for approval of the place where the treatment may take place. Nevertheless, he made it clear that it was within the Health Secretary's powers to approve a wider range of place where an abortion could take place, including potentially the home.
Although the Department of Health has already indicated that there are no plans to extend an approved class of place to women's homes, we suspect that this debate is unlikely to go away quietly, particularly given the apparently safe use of abortions at home in the US, France and Sweden.
Maintaining the status quo does keep NHS trusts and private health providers in control of the administration of this treatment, reducing the possibility of a patient miscarrying in an uncontrolled environment. That said, patient groups may have concerns that freedom of choice is being restricted as a result of this decision. It also remains to be seen whether future GP consortia will attempt to pressurise the Health Secretary to allow more home treatment, freeing up resources and increasing patient choice.