Therapeutic abortion, a problem in law and medicine (Part 1 of 2)

The lawyers like. To breed when they're the star or when the social problem. And illegals lose. One need only consider for example our failure to deal adequately with the problem of the life. And they're told by. The arcade time we did this will she. Be absurd complexity far. Off the length of the gap between criminal law and Ma's tiredly neighborhood view of the obvious failures of our legal system to respond to urgent needs offsite. It could include a great deal of these to guide. Our speakers this evening hours early pioneers in an area where the gap. Between the law on the books. And the wants the desires. And the practices of society are less than. Less understood and certainly was caught. In the area just referred to. Some time ago they began to suspect that there were problems here because the law.

Office life. Steadfastly refused to face up to. The two of them brought together for them. The background skills. In a survey and study. Of their attitude according to the state of California in the light of the longstanding law with regard to the sub. Were indeed credited to the city to be in on what is really a preliminary discussion. On the results of this study prior to publication and elated. I guess the words of Mark you see here is an island in the mouth of the north. Then. Dr. Ralph J. Gannon received his medical degree from the University of Manchester England in 1940. He is the gentleman to your left at. The following five years he served as a medical officer in the British Royal Air Force or anything on China. Burma India reaching the right squadron leader or maybe. After a departure. It seems that it's up to the war engaged in the general practice of medicine prior to coming to this country.

Just ten years ago this month. For two years a writer who worked with the national education campaign and the American Medical Association undertaking an extensive CD George threw out forty two of the 40 states of this country to fire a total of almost 200 miles. Since 1951. He has practiced medicine on them as well. And good for the deed and I acted. Out at least superficially. Is the. Professional career they would want to settle. Into was a highly significant exception. Between 1954 1957 Dr. Dan Quayle attended the Stanford Law School while still acting medical practice. We always existed before the world. Graduated top 50 percent of his class was better. Practice and. Practice law in the state in 90 sat. Needless to say this combination of the providing. Of course the opportunity to explore the subject

on tonight's discussion. This past year doc again will join the sand for loss of life and. Still maintain the prize. And will teach in the specialized Herriot medical legal process. Professor Herbert help laughter. Receded a lot of grief from Yale in 1949. Following a tour of duty with the United States Navy. As an Army brat where he was locked up with law clerk to Judge Thomas W. Swan of the United States Court of Appeals. And practice law here right here in Washington D.C. with one of the lead along the last bit. Despite excite. The manufacturing. Practice in the nation's capital. We succeeded in Tysons to pile. On the wackos. And more specifically to the Stanford Law School. Five three years ago now. In the brief period of time this is coming to San. Diego contributed significantly

in the field of criminal law and the publication of the site. Thank you thank you thank you very much. And ladies and gentleman this is Pakka. He is a professor in the law school then which they don't come any fall. I am a lecturer. It's

on the faculty. The next rank below that. The great thing about it is that it gives you a reserved parking sticker. So I will defend my faculty position with my 9. Now this evening we are going to talk about therapeutic abortion. The easiest way I think to describe therapeutic abortion is it's not the other sort. It's. It's it's not the sort of the men come with badgers and take you off to durance vile Zang quite knock around knock three times and ask for Alice and wear a blindfold and go to Tia Juana and things of that sort. By the way that anything that you've heard about what goes on. Under the illegal system the type of backyard

abortionist is true. It's horrifying to watch people go in these desperate straits I've had patients tell me of things which will truly raise your hair. However tonight we're not going to talk about that aspect. We're going to talk about therapeutic abortion the sort of abortion which is done in ethical hospitals by ethical practitioners ethical medical practitioners. And it seems to us the best way to kick off this discussion is to ask you to. Keep in mind for hypothetical medical cases. When I say their hypothetical for reasons which will appear clear to you later we made them up but they could be the case histories of women who might be right at this moment in the Palo Alto hospital or the Sequoia or any

hospital anywhere in the United States or in any other country for that matter. The first one that I would like you to keep in mind is. A case of a 28 year old woman who had an attack of rheumatic fever when she was nine years old and a second attack while she was in college. The reason will appear later for all is artistic very similitude. She had an attack when she was 9 over matic favor an attack when she was in college. Now Magic fever I should add by the way is not particularly common here on the West Coast. It is much more common in England. You may have detected faint traces of the accent. That's where I come from. I tell people who don't know that it's from the east from. That's the. That's the Stanford of the East.

But it's from a dramatic favor is a great deal more common both in England and the eastern part of the United States. Anyway. It's well recognized that in romantic fever you can get incidental heart damage. And she got this kind of damage. And about age 14 it was detected that she had a heart murmur. She had her first pregnancy when she was 23 and it was quite uneventful except that in the last part of her pregnancy she developed a brief spell of heart failure just at the time of delivery. Now heart failure in essence is something like this. If you regard the heart as a pump. And it goes pumping away for all your normal needs. And it has rather like a solvent bank account. A good deal in reserve. However that reserve is used at times of strain a foot race and things of that sort.

However if you have heart damage you're living on your reserves just for your ordinary day to day existence. And it could be that you eat into them so heavily that your heart will not do its job even for your normal household chores and so on. And this was a case in the woman whom we're talking about. Her heart would not do its proper job and that would be manifested by shortness of breath even in walking across the room by swelling of her feet around caused by congestion in her lungs and by swelling in her liver and so on this the doctors would call a spell of the compensated heart failure and that's what she had. She recovered quite quickly after bed rest and some medication. However she became pregnant again a year later aged 24 and this time the fact that our heart was not bearing up under the strain occurred much earlier. By the end of the seventh month

she had to be at full bed rest she was in bed not able to do anything and she continued that way up to the time that she was delivered. She had to have a reduction of sole medications to get rid of the fluid and finally she developed an instant an incident of what is described as a regular fibrillation the heart goes into total lack of rhythm. It's these medical textbooks always write these up in fancy language. They say it becomes irregular irregular. You can take that home and chew it over. It does actually mean something. And even with that a with a her labor had to be brought on at the 38 week two weeks before term. And it was obvious even after that labor that there was a good deal more heart damage than she had begun. She was now much more breathless. It was much more difficult to keep her body free of waterlogging with fluid. Now

this time she has become pregnant again and she is now eight weeks pregnant in her third pregnancy and that is all I'm going to say at this moment about her. The second case we would like you to bear in mind is a lady who is thirty two. She has three healthy children 6 4 and 1 year old respectively. She is now eight weeks pregnant. There is conclusive evidence that is it's not just a fake. There is conclusive evidence that two weeks ago she suffered a genuine attack of German measles. Well now German Measles is a perfectly uncomplicated complaint. It's the thing that you know how as three day measles it's characterized by a little bit of fever you feel vaguely of cholera. You have symptoms a bit like a cold. You have swelling of these little bits of

glands in the back of your neck and you get these funny little pinpoint type of reddish rash. By itself it's an absolutely inconsequential complaint. However back as early as 1941 there began to appear stuff in the literature indicating that if you got German measles in the first 12 weeks of pregnancy you were liable to bear a child more or less deform. And those deformities on malformations would particularly mark out. The brain so the child might be an idiot or have other kinds of brain damage. You might have a congenital defect in the heart such as chambers not closing off or the great vessels not coming off the way they should do.

Or alternatively the child could be born deaf. Or the child could be born blind. Or any permutation and combination of those four things. Now about 1952 there was material published in Australia. It's now a classic article in the Medical Journal of Australia indicating that the chance of you having this type of malformed child might range somewhere between 70 and 90 percent. That is if you had German measles in the first 12 weeks of your pregnancy you had somewhere between 70 and 90 chances out of 100 of having a malformed child. In more recent years these figures have been revised downwards quite drastically. Nowadays it's felt that the chance is somewhere between 12

10 or 12 15 or 17 percent according to what report you read. I should add parents radically the curse of medical literature is that they are. These reports are not vetted by statisticians before they are published. Anyway even now at somewhere between 10 and 17 percent this chance compares unfavorably with the rest of the population where the chances are bearing a malformed infant is at the most 2 percent. So you have on the one hand an incidence of somewhere between 10 and 17 compared with the incidence in the general population of something like 2. So much for that lady. The third one we want you to think about is a rather more complicated situation. And here you will have to forgive us for a lot of the artistic details. This lady miss our third problem is

unmarried. Her mother died when our patient was 11 years old. The mother having spent the previous three years as a patient in a state mental hospital. Her husband who was and is an extremely domineering man the father of our patient believed that the mother had been committed to the mental hospital because of illicit sexual activities on her part and as a result of this mind he thought had broken down. Because of that or at least ostensibly because of that he was extremely rigid in controlling miss A's upbringing. He wouldn't let her take part in social activities in school wouldn't let her go out on dates and things of that sort.

They idea being if you do you will get into the same kind of trouble as your mother did. Very restrictive indeed. Anyway she finally graduated from high school and she got a job as a typist in an insurance office. Without any justification of tall she came to believe that the manager of the insurance office was infatuated with her and she reacted in a rather bizarre psychological way. Her behavior became. You have to forgive these words there's no way of translating psychiatric jargon. Her behavior became extremely man eristic she became talkative and so on. You wouldn't believe that sometimes people do that are nuts. And eventually she was committed to a state hospital as a schizo phrenic one peculiar kind of so-called catatonic schizophrenia. And while in the mental hospital she had to have shock therapy

as a result of this she became morose and withdrawn. But she was back in contact with reality. In the meantime her nasty old domineering father remarried remarried a stepmother who was a pleasant outgoing woman who took an interest in this stepdaughter who is in a mental hospital. She arranged for her to be distraught and to undergo psychotherapy to get a job and to go out in the world. Her going out in the world meant something of the order of youth clubs. She went out to one of these. She went to a dance she met a man as a result of that intimacy. She became pregnant. She believes that hurts thought by looking in her eyes can tell the extent of what has happened to her that he will punish her. By having her sent back to the state mental hospital.

We have in our final the opinion of a psychiatrist who says that the only way we can avoid a schizophrenia breakdown in her case is to have an abortion. She is now eight weeks pregnant. That is the third case. The fourth. Is the authentic tear jerker. Miss A is A 15 year old girl. She is the daughter of the local minister. While on her way home from school wandering. She was at attacked and raped by an escapee from the State Institute for mental defectives. As a result. She has become pregnant.

She is now in fact eight weeks pregnant so we have four cases. Want a woman with a history of congestive heart failure. A patient with a history of German measles 3. An unmarried woman. Who has a history of schizophrenia and form a 15 year old girl who has become pregnant in the most disastrous of circumstances. At this stage. And leaving those with you I'll ask have a back or the care of the ball for a bit longer. Soon out with may if you will. Our hypothetical doctor has the four hypothetical cases for some hypothetical reason that we decided that he ought to have legal advice before proceeding to

perform an abortion in any of these four cases. What advice would a conservative lawyer not wanting to take very much of a risk on behalf of his client give our doctor who wants to perform these for abortion. Let's assume a few more facts about these cases. Let's assume that in each case the abortion if it to be performed will be performed by a reputable member of the medical profession. Let's assume that the operation will be performed openly in a hospital with the knowledge and consent of the obstetrical staff of that hospital. Let's further assume that our

intending doctor has obtained the approval of two or three of his colleagues as consultants. Let me start by saying that none of any of these facts that I've just asked you to assume makes the slightest bit of difference as to the why galaxy of these operations. If it's performed by a lamb or quack rather than by rocket positions. If it's performed in some filthy back room rather than under antiseptic conditions in a hospital if it's performed clandestinely rather than openly it is not a bit more illegal than these operations. Maybe you have performed in the manner that we suggest. In short let's clear the air nationally by making it perfectly clear that the

mode in which these operations are performed under the prevailing legal standard makes no difference at all. But. What is the prevailing legal standard in California. We have a statute Section 274 of the penal code which makes it unlawful to perform an abortion on a woman unless and now it is necessary to preserve her life necessary to preserve her life. We will talk in a minute or two about what those words mean. I don't want you to think California is unique in having a statute of this car and as a matter of fact the statute some 33 states are similar in import to the California

statute. Time was when this was not the case. Ironically enough when our medical knowledge was less further advanced than it is today the law took a more lenient attitude toward the performance of abortion. You see the view was at one time that. The fetus was not a long lived until it had quitted. Which of course doesn't take place until well long in pregnancy. The corollary of that was that so long as the fetus had quickened there was no objection on the part of the law to the fetus being removed. However once it became clear medically that this was not the case that the fetus was in any real sense alongside even though not viable before it quickened.

The legal standard tightened up and the. Blanket prohibition on the performance of abortions was pushed back literally to the moment of conception. Well coming back to the California statute what do the words me. Instead of trying to answer that question in the abstract. Let's consider for a couple of minutes really four cases that Dr. Gant all have suggested. And see what. They are the words of the California statute the exception. That the operation must be necessary to preserve life. Really me I should add. That unless the operation is necessary to preserve life section 270 for the penal code. Makes the performance of an abortion a felony punishable by up to five years in prison. You might keep that fact

in mind as we go along. Let's start with the case of a minister's daughter. There was a famous case named Rex against born back in 1930 known which presented a rather similar situation. In that case a young girl also I believe 50 years old was raped by a group of soldiers. And as a consequence of that rape she became pregnant. Dr. Alex Bourne who is one of England's prominent obstetrician who's decided that under the circumstances it was unconscionable this girl should be required to carry the child to term. And so he determined that he would perform an abortion on her. And in order to

test like galloping therapeutic abortions he informed the authorities that on a given day at a given time he proposed to perform an abortion. He did so he was arrested brought to trial prosecuted on a charge of performing an unlawful abortion. And he was acquitted after the judge gave the jury a set of instructions very favorable to. Well you may say at this point that should pretty much settle the matter should not for California. Unfortunately the English statute you know under which Dr. Horn was acquitted was very different from the prevailing statutory standard in California and indeed the problem standard in this country. I will go into great detail on the difference but what it comes down to is this. In England the legislature had used

language which left it pretty much up to the jury to decide on whether in a situation of this cone and where a doctor was confronted with a choice between even the evil On the one hand of taking the life of this unborn child the evil On the other hand permitting the child to be born with consequent ruinous affects on the life of the moment where the doctor made this choice. It was up to the jury to decide whether it made the right choice and in effect a judge simply tells the jury you're free to find that he made the right choice. We don't quite have the same situation here because here the legislature has made us a legislature has said you can't the song whether it's better for the mother to

bear the child with whatever consequent social and psychic damage that may do her. That question isn't open to you. The only question that's open to you is is this operation necessary to preserve her lawn. Unless white. Is to be taken in a highly metaphorical sense. Pretty obviously this operation isn't necessary to preserve her life. Unless we're going to say that preserving her life means preventing the kind of social disgrace and the kind of psychic damage that we're going through with this on wanted this literally forced pregnancy what untenable unless we're going to say that we can't really say the operation is necessary to preserve life. And of course if we said that under those circumstances. It was necessary. To preserve what we would then

metaphorically be referring to as lying. Why wouldn't the same be true of every unmarried mother who presumably will suffer a certain amount of social stigma on a certain amount of psychic damage as a result of being forced to bear a child which she may think she doesn't want or so pretty clearly we can't take that way out unless we pretty much wipe out the statute in its entirety. That being said Oh I think I'm not being unduly conservative when I say that. The advice that our hypothetical physician would receive about this hypothetical case as you better not do the abortion. You'll be violating section 270 for the penal code if you do. Next let's take the case of the lady with Germany's

now here we don't have to carry more than a moment. It's perfectly clear. That no matter what the chains this lady's bearing a deformed shot whether it's 70 to 90 percent chance as they saw in Australia in 1952 or a 10 to 17 percent chances the current medical literature suggests this operation is plainly on low. It has nothing to do by definition with the life of the mother. The mother isn't threatened. She has a white diseased German measles which she'll throw off in a couple of days with no ill effects to her at all. Where performing the operation if at all because of what is referred to in the literature as a fief an indication that is an indication for the operation that has to do with our prognosis about the

Chon not with our prognosis about the mother. And this is clearly was of the statutory Mark. So once again the advice very clearly was the operation would be illegal. Well how about our psychiatric case. How about the girl who has had one severe bout of schizophrenia who has been institutionalized and who when a psychiatrist tells us is likely to refer to her previous psychotic state unless she's aborted. Once again we have to ask what the rather inscrutable language of the statute means when it says necessary to preserve life. Granted if. This girl is forced to carry the child to term. And if the prognosis

turns out to be right she will revert to her psychotic state. She will have to be institutionalized. She will cease to be a useful happy functioning member of society. And I suppose in a sense many of us would say she will have ceased to live. Is that kind of life a life worth living. Many of us I suppose might come to the conclusion that it really isn't that it's just existence on a vegetable level but notwithstanding what we might think about Donna we're faced once again with the necessity for interpretating this statutory language. And unless we're going to stretch it in ways that would pretty much defeat the obvious intent of the legislature. I think we would have to come once more to the reluctant conclusion that the operation is illegal.

That brings us to our fourth case. I take them up in a rather different order from the order in which Dr Dan hell gave them to you but for reasons which I think will now become apparent up to this point we really haven't had to talk very much about what the statutory language me except to grapple briefly with the suggestion that life may have a metaphorical rather than the overall meaning. But now we really are up against it and we have some hard questions to answer. Think again about that statutory line necessary to for his or. Her life. Remember this is a woman who is suffering from a severe form of cardiac disease. It's the prognosis of her medical man that if she is

forced to carry this child to term the chances of her dying are. Much greater. I don't believe that the doctor told us how much greater but let's make it really extreme let's say 30 times as great turns that reasonable three times as great. She has 30 times as great a chance of dying if she is forced to carry this child to term. Then if she is aborted at this time I'm therefore relieved of the burden of this pregnancy. Well what do we mean by necessary to preserve her want. Do we know that she's going to die. Now we don't know that she's going to die. I would just think that the chances of 30 times greater. We can't be sure until after she's gone. Then presumably it's too late. What is necessary.

I suppose that Bush literally necessary would suggest that unless were absolutely sure we can perform the operation for reasons just suggested we're not in the position to make that kind of valuation. So I suppose we have to read necessary is meaning highly likely carrying a very substantial probability event and I'm going through this next to Jesus because we really don't know what the law is. The reason we don't know is by and large that reputable doctors don't get prosecuted under Section 274 of the penal code. So we pretty much got to feel our way as we go. Thought let's say that necessary means highly likely then we've got to say highly likely in whose songs. Does it

mean that it's really got to be highly likely doesn't mean that it has to be highly likely so far as a consensus medical judgement is concerned. Or does it mean that the particular doctor who is authorizing the operation and who presumably will be standing trial of the district attorney gets around to indicting him. Is it simply that he has to have a reasonable belief that the operation is necessary. Well let's take the view most favorable to our. Doctor potential defendant. Let's say that. The standard simply requires that he believe. In good faith and that his belief is thought to be a reasonable belief that there is a substantial probability that unless this operation is performed the woman is going to die.

What opinion would we give. Well I suppose that a conservative lawyer in this situation unable to find any real precedent and I can assure you that he would be unable to find any real precedent would say well I guess that if there is any detainees that can be justified under the statute and this case is it. I'm not really sure that there is any case that can be justified under the statute. But if there is such a case this one is it. So reluctantly and with. I think a good deal of self doubt about the validity of this conclusion and bolstered to a good extent by the feeling that probably nobody is going to file a complaint and the

probably you know district attorney would prosecute. I think that our intending lawyer might conclude in this case. That the operation is legitimate. So here we have four so-called therapeutic abortions offered for performance and I was the only one of them. Can we say that the operation is legal now at this point. I suppose the question becomes fairly apparent. What is a therapeutic abortion. I follow the therapeutic abortion was once legal. Well pretty clearly therapeutic abortion in the sense in which the term is usually use the sense in which doctor again Pel defined it a while ago. That is an operation openly performed by a reputable medical man in a reputable hospital. But not all such therapeutic abortions are illegal

if they include abortions of the type that we have just been discussing. The doctor and I became curious as to the extent to which abortions therapeutic abortions. COHEN We've been discussing with you tonight are actually performed in California hospitals and with the view in mind of finding out for ourselves first what the facts actually were. And second what if anything. Might be said about the disparity between legal norms and medical practice in this area. We embarked on the study which my colleague Dr. Kent described. Well look at that box score of the four that I

gave you. One legal three. Quite clearly illegal. And yet I'm sure that some of you know from your own personal knowledge that in least some of those cases most notably the German measles case people that you know possibly members of your family or people whom you've heard of have had abortions for that very thing. So there's no question that imperfectly reputable areas clearly illegal abortions were being done. Well we could have investigated this in all kinds of ways. I suppose we could have gone. We hear means it's you know the floor oh my I started that I had a classical out bring here man with a tape worm that's a horrible medical Jab we could have gone to or to a hospital or a

series of hospitals and asked the medical librarian to pull the appropriate files and let me read the cases of therapeutic abortion so I could have looked at the indications. This abortion was done for this mental disease this one was down for German measles and so on. However that has got a built in error. And the obvious error is no two medical cases are Onil for how bad is this case of schizophrenia how broken down is this nervous breakdown and so on. So we decided that like true research shows we were going to set up an apparatus. You can't do any research unless you have an apparatus. The only thing I think for which I envy the Soviet Union is they have one delightful word. I think a man who works in the system and is a good party functionary is call an apparatus Nick and

that's what. We decided we would set up an apparatus in the form of a very complicated cast Johnette reason why it was long and complicated is that it will go in the appendix of our paper. We'll spread it out it will make it look even more handsome. And the questionnaire was to be in two parts the first part was essentially a mechanical type of thing. How many abortions are done in your hospital in the last. Five years. How many live births Did you have and then wanted to little bit more detailed questions. Who approves them. Do you have to have consultations if so how many does an administrator have to approve them. Or maybe you have a new kind of device thing that's appearing more and more in hospitals about the state. Maybe you have a committee a committee of the past. Sit down is this important you mustn't laugh at this is the big pot. Maybe maybe you have a

committee that approves these things and if you do. When was it set up. And if you do have one how is it constituted as will appear later this therapeutic washing committee is a really quite important thing. But then to finish off that section we ask three extremely loaded questions and I should add in case you wonder what we did with this question whether we send it to law students or wot we sent this to 29 of the most prominent California hospitals both in this part of the state and in Southern California the result we got was little short of astounding. We got replies from 27 of the 29. However one of them was too light to include in our overall totals. So we are regarding it as a report from 26

out of 29. The most prominent California hospitals covering a series of live births of about a quarter of a million. So this is a fast study in-depth. From these 26 hospitals we asked these. I told you mechanical questions commit is methods of approval and so on. But then assuming they had a committee and more and more of them now do have one we asked this question. It's been suggested we wrote. That a therapeutic abortion committee might be set up for various reasons. Please state which of the following reasons in your opinion most closely applies to your therapeutic abortion committee and we suggested a bit to police the activity of service of a physician whose procedures might otherwise bring himself and his colleagues into disrepute. Or alternatively be we suggested

to insulate the obstetrician from the import unit is either his patients or his colleagues by transferring the onus of refusing a therapeutic abortion from himself to the committing of thirdly to act as a curve on the perfectly scrupulous but somewhat liberal obstetrician thus authorizing only those cases which are approved by the weight of obstetrical opinion. All the fourth possibility we suggested for a committee might be to prevent the performance of illegal abortions. Of the 26 replies we God. Only WAM. Thought it was the last. Only one thought it was to prevent illegal abortion of the remaining seven. Thought it was to police physicians and prevent guys bringing their colleagues into disrepute. 6 thought it was to stop the obstetrician being importuned by patients and 6 thought it was to prevent guys being a little too

liberal but only want for only one hospital. Thought it was to prevent illegal abortions. So in question 15 we said. Which of the following interests do you think your committee is primarily safeguarding. Who are you looking out for when you say this want and don't do that want. Whose welfare are you taking care of. We said Is it the hospitals. And eight hospitals thought it was. Is it the obstetricians. Three thought they were looking out for him. Was it the patient's age. Thought it was looking out for the patient. Was it the child's right to be born alive too. Was it society's interest in avoiding this means of birth control. 11. I was at society's interest in having the law

obeyed. Want. Some and then we put in question 40. We sat under California law and abortion may not be performed on a woman and we put it in quotes. Unless a STM is necessary to preserve her life the thing that Professor Packer was talking about when we wrote taking these words for what they convey to you as a doctor do you think that your committee has approved any cases which do not fall strictly within the provision quoted above 18 said yes they thought they had I 18 were quite sure they had broken the law and 6 thought they probably had. Well this was the mechanical side. Now to get down to the meat of the whole discussion we wanted to know what can you do what can't you do.

As far as doctors are concerned. It's quite obvious that the standard that they were following didn't seem to be the standard of the state of California had laid down. So what we then wanted to see was if there was a standard that the doctors had laid down was it a common standard that is good. Every doctor. Or every hospital purport to obey the same set of rules even though they might not be the rules of the state thought were good ones. And it was here that we decided a somewhat novel departure may remember I said. That. No case pulled out of the files is quite on all fours with another case pulled out of the files. So we decided that we would provide our own cases. We devised a lever on hypothetical cases. Four of them were four that I described to you. The remaining seven. All fell within those four groups.

Actually they fell within the three. The rate case was a way off by itself but the others fell into the so-called medical indications to heart disease Hodgkin's disease which is a form of. Blood and lymph cancer and a severe diabetes. We set up three psychiatric cases. The one I described to you one which was more serious in the woman was a proved suicidal problem and one which was so un serious as from our point of view to be a fake. Those of the three psychiatric cases. We set up three fetal cases. The one I described to you want of the so called RH incompatibilities that all you all know about in which the mother's blood fights with the blood of the infant the infant's blood becomes destroyed and there is a good possibility that as an act case if the mother

has bought a stillbirth she will go on having stillborn children. That was the second of the fetal cases and the third was an even more dramatic one in that this was a very obscure form of congenital idiocy in which as we laid down the woman and had one idiot child and you could virtually guarantee that succeeding pregnancies would produce further idiot children. The last of that of the whole group was another. Absolutely illegal one from the state standard where the woman was the sole support of her family. The husband was in a TB sanitarium and she was now pregnant again the five children would all starve if she had to go on with a pregnancy that was a series of 11 cases. We put them up to each one of these 27 29 hospitals and we said in effect this. What this case suitably documented with all the appropriate approvals from

consultants psychiatrists and so on would this case likely be approved in your hospital. If not and this was a built in gimmick if it was not approved in your hospital do you think it would have a chance to be approved in some other ethical hospital. And the last part of the question was Would you like to make any comment. The results in only the four that I mentioned to you were stopping you remember the present pack of said the hot one was legitimate 21 out of hospitals would do her. One would not. Now let's take the cases which we declared to be frankly illegal under the statute under the German measles wam six were quite willing to do harm. Six were not four said that they thought she could be done at another good hospital and six thought that she could not. If you bring all those

together and suitably unweighted it's probably about half the hospitals or a little less would be willing to do her and all the more than half would not. Take the woman who was the extreme psychotic problem the schizophrenia ate thought that they would be. She could be aborted in their hospital 13 thought that she could not. 6 thought she could be done elsewhere. And fully thought that she could not. That is about half what do our about half what not. What about the rape case and the rape case is the most flatly illegal. Because in the others you can spin an argument. If I was being indicted I know what I would like my attorney to sign. I would like him to say well this woman is going to be confined in a hospital. How life is at an

end all with the rubella won. The mother will be so disturbed that baring a malformed child but her mind will break down she'll go to a mental hospital. This is as good as being dead. But the rape case by definition the woman could bear the child that traumatic experience. But she's got no history of mental illness. There's no reason why she should be acutely damaged. Nevertheless. 15 hospitals were willing to do her. Seven were not three thought that she could be done elsewhere and too thought she could not. That is better than two thirds would get her done and one would not. Well if there was one thing that this study was beginning to show and I should add that the other seven cases produced equally startling results. If there was one thing that this study showed it was that

the answers were a bit like the heart that I described here. Not only were they doing so irregular but they were eating regularly regularly. I know one hospital and I tried out the whole study is most truly anonymous. I know one hospital which doesn't want abortion for about 5000 of live births and I know another hospital. Equally reputable equally ethical. But does want abortion for about 65 live births. Wild horses by the way won't get either name out of me. However in this state of the situation amongst perfectly ethical people and I must stress that this is a most

ethical situation amongst most ethical practitioners in the best Caliban hospitals in the state where those kind of findings. Maybe Mr Packer would like to go on further. What they say adds up to as a lot.