Informed Consent

Although counselling in what alternatives and community support is available, it is not compulsory.

Some women are curious about the development of the foetus and ask questions. Counsellors involved in post-abortion healing report that they have been told by women seeking help that the clinic counsellors assured them: "it's just a bunch of cells", or "a blob." In several reported cases the "blob" was 12 weeks gestational age.

In some cases, the post-abortive woman has searched out, or come across, photographs of actual foetal development at eleven or twelve weeks, and been distressed at the discrepancy between what they were told and actual development.

Ultrasound technology
It is routine for the operating surgeon assisted by clinical staff to check the stage of foetal development by using an ultrasound scan. The surgeon places the transducer (the 'mouse') on the woman's stomach and looks at the screen. To spare the woman from seeing the foetus, the screen is turned away and the sound turned down or off, to prevent the heartbeat being heard. You can listen to the heartbeat by clicking here (Requires Windows Media Player)
3D/4D scanners provide a clear window into the womb and unprecedented moving pictures of human- looking foetuses as young as ten weeks.


"Considering an Abortion?" - an attempt to address informed consent
In the early 1990s, the Society for the Protection of the Unborn Child (SPUC) lobbied the Abortion Supervisory Committee to commission a booklet providing "informed consent" to women seeking abortion. SPUC argued that such a booklet could remedy the inadequacies they perceived in existing pre-abortion counselling at the clinics.

The ASC eventually passed the project to the Ministry of Health. The booklet was compiled by the leading abortion surgeon at Epsom Day Clinic, a Family Planning doctor and a secondary school teacher representing SPUC. Read more about the ASC here.

Eventually a draft was circulated to interested parties. The NZ Family Planning Association and the clinic counsellors lobbied for changes, later indicating they would refuse to use the booklet, claiming that the photos were a distortion. Read more about FPANZ here.

28,000 copies of "Considering an Abortion" were published by the Ministry of Health in September 1998, and distributed to GPs around the country. Counselling staff at abortion clinics returned their copies to the Ministry in protest.

The Ministry has repeatedly refused to publish any further copies in deference to opposition from clinic counsellors. Based on anecdotal evidence from post-abortion counsellors, some of their clients say that if they had been informed about the factual development of their foetuses, they might have changed their minds.

This conundrum with informed consent is outlined below:

"Professionally, we are obliged to give accurate, current and factual information to our patients, to assist them in making a fully-informed decision. This is the basis of informed consent. Yet nurses are advised to avoid showing pictures which explain the development of the unborn child because it may make them feel guilty. Even though it is often our patient who later question us as to why we did not give them more information." (Barbara Docherty, practice nurse educator, New Zealand GP, March 8, 2000)

"The counselling I received beforehand, consisted of one session where I was told that it was not a baby, just a few cells as big as my little finger nail. During the abortion, I remembered the doctor spoke across to the nurse and said 'This one must be four months.' I felt cold. I knew a four-month old foetus was a fully-formed baby, kicking and moving around - not just cells. I hated that doctor and I hated the counsellor who lied to me." (Auckland-based post-abortion counsellor, who had her abortion at the Medical Aid Trust, before the advent of ultrasound technology.
The Adelaide Women's and Children's Hospital introduced new compulsory counselling and time for reflection, which lowered the number of abortions by 25%.


The Adelaide experiment
The Adelaide Women's and Children's Hospital introduced new compulsory counselling and time for reflection, which lowered the number of abortions by 25%.

According to the Sunday Mail (25th July, 2004), the drop in abortions prompted calls for more comprehensive counselling, to ensure that women are fully informed of the financial and social support available, their options and the emotional impact of the decision.

"The Australian Medical Association also wants more post-termination counselling, warning that most women face unexpected grief." (Scoop Media)

Recommendations
A team of doctors from the University of North Carolina, after completing a review of the best studies of the long-term physical and psychological health effects of intentional abortions made the following recommendations for informed consent policies:
  • Before women undergo induced abortions, doctors should ? as part of the informed consent process ? offer them information about the subsequent small, but apparently real increased risk of pre-term delivery and depression.
  • Clinicians also should mention the possibility that their chance of developing breast cancer could climb slightly later in life.
A report on their findings and recommendations appeared in the January 2003 issue of Obstetrical and Gynaecological Survey. The authors were: Dr John Thorp, professor of O&G, Katherine Hartmann, assistant professor of epidemiology, O&G, University of North Carolina. Dr Elizabeth Shadigan, associate professor of O&G at University of Michigan School of Medicine.

The key passages said: "We find little evidence to support claims that elective abortions increase the risk of subsequent sub-fertility ectopic pregnancy and spontaneous abortion. Of more concern are the possibility of links to pre-term birth, placenta previa,breast cancer and serious mental health problems."

"Some evidence exits for links between induced abortion and the latter disorders, especially pre-term births and mental health problems such as depression. The one study that combined results from other research on breast cancer, suggested a small increase in that cancer because of abortion, but the finding remains controversial and unconfirmed."

"We think that given the undisputed protective effect of full-term delivery, early in one's reproductive life on subsequent breast-cancer development, that a young woman can, and should be informed of the loss of that protection, that would derive from a decision to terminate her pregnancy and delay having a baby."


How to be aware of and enforce your rights as a patient.
How to complain to the Privacy Commissioner
The controversy surrounding the New Zealand Ministry of Health booklet.