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The Role of Nursing Staff in Abortion Procedures: A Legal Perspective, Lecture notes of Nursing

The legal implications of nursing staff involvement in abortion procedures using the prostaglandin method. It explores the debate between the literal and mischief rules of statutory interpretation and their impact on the practice. The document also touches upon related cases and their outcomes.

What you will learn

  • What are the legal implications of nursing staff involvement in abortion procedures using the prostaglandin method?

Typology: Lecture notes

2021/2022

Uploaded on 09/27/2022

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The English Legal System
212
That dealt with the common law, but the statutory provision remained and was
dealt with as follows:
. . . in the end [it] comes down to consideration of the word ‘unlawful’ in the Act
of 1976 . . . The only realistic explanations seem to us to be that the draftsman
either intended to leave the matter open for the common law to develop in that
way . . . or, perhaps more likely, that no satisfactory meaning at all can be
ascribed to the word and that it is indeed surplusage. In either event, we do not
consider that we are inhibited by the Act of 1976 from declaring that the
husband’s immunity as expounded by Hale no longer exists. We take the view
that the time has now arrived when the law should declare that a rapist remains
a rapist subject to the criminal law, irrespective of his relationship with his
victim.
Such a radical decision could not but go to the House of Lords, which
unanimously followed the decision and reasoning of the Court of Appeal.
Their Lordships agreed that Hale’s pronouncement never was law; it was
always a fiction that had infiltrated the common law. What the present case did
was merely to put the common law back on its correct tracks. As for the
interpretation of the Sexual Offences (Amendment) Act 1976, the appearance of
‘unlawful’ in s 1(1) was mere surplusage.
Subsequently, the word ‘unlawful’ was removed from the definition of rape
under the Criminal Justice and Public Order Act 1994. Thus was the fiction of
marital consent removed forever: reality remains a more intractable matter.
5.5.2. The regulation of abortion
When the Abortion Act 1967 had been introduced, the termination procedure
had been surgical in nature, but in the 1970s, the surgical procedure was
replaced by the chemical induction of labour. This latter process was twofold
in nature: first, a catheter was surgically inserted into the woman and later, a
chemical, prostaglandin, was introduced through it. The prostaglandin
induced premature labour, which occurred some time, certainly a matter of
hours, later. In practice, the first part of the procedure was carried out by
doctors. The second part, the introduction of the prostaglandin, was carried out
by nursing staff.
Section 1(1) of the Abortion Act 1967 provided that: ‘. . . a person shall not
be guilty of an offence under the law relating to abortion when a pregnancy is
terminated by a registered medical practitioner.’
In a letter dated 21 February 1980, sent to regional and area medical officers
and regional, area and district nursing officers, the Department of Health and
Social Security purported to explain the law relating to abortion in connection
with the termination of pregnancy by medical induction. The Department’s
advice was that termination using the prostaglandin method could properly be
said to be termination by a registered medical practitioner, provided that it was
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5.5.2. The regulation of abortion

When the Abortion Act 1967 had been introduced, the termination procedure had been surgical in nature, but in the 1970s, the surgical procedure was replaced by the chemical induction of labour. This latter process was twofold in nature: first, a catheter was surgically inserted into the woman and later, a chemical, prostaglandin, was introduced through it. The prostaglandin induced premature labour, which occurred some time, certainly a matter of hours, later. In practice, the first part of the procedure was carried out by doctors. The second part, the introduction of the prostaglandin, was carried out by nursing staff.

Section 1(1) of the Abortion Act 1967 provided that: ‘... a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner.’

In a letter dated 21 February 1980, sent to regional and area medical officers and regional, area and district nursing officers, the Department of Health and Social Security purported to explain the law relating to abortion in connection with the termination of pregnancy by medical induction. The Department’s advice was that termination using the prostaglandin method could properly be said to be termination by a registered medical practitioner, provided that it was

decided on and initiated by him ( sic ) and provided he remained throughout responsible for its overall conduct and control. This was the case even if the acts needed to bring the termination to its conclusion were done by staff acting on the specific instructions of the registered medical practitioner, but not necessarily in his presence. Consequently, the Department stated that the first stage of the procedure, the insertion of an extra-amniotic catheter, must be carried out by a registered medical practitioner, but that the second stage, connection of labour inducing drugs to the catheter, could be carried out by an appropriately skilled nurse or midwife acting in accordance with precise instructions given by the registered medical practitioner.

The Royal College of Nursing, seeking to clarify the legal position as regards its members, sought a declaration that the circular was wrong in law.

At first instance, Woolf J, as he was then, refused the application and granted the Department a declaration that its advice did not involve the performance of any unlawful acts by members of the College. On appeal, the Court of Appeal unanimously reversed his decision, but on further appeal, the House of Lords, Lord Wilberforce and Lord Edmund-Davies dissenting, re- instated the decision of Woolf J. In reaching their various decisions, the judges made use of different approaches to statutory interpretation, some preferring the literal rule, whilst others preferred to make use of the mischief rule. In the first camp can be placed the three Court of Appeal judges, who saw no reason for reading s 1(1) in any other way than in the limited manner that would preclude the current practice. As Lord Denning MR expressed it ( Royal College of Nursing v DHSS [1981] 1 All ER 545 at 557):

Stress was laid by the Solicitor-General on the effect of this ruling. The process of medical induction can take from 18 to 30 hours. No doctor can be expected to be present all that time. He must leave it to the nurses or not use the method at all. If he is not allowed to leave it to the nurses, the result will be either that there will be fewer abortions or that the doctor will have to use the surgical method with its extra hazards. This may be so. But I do not think this warrants us departing from the statute [emphasis added].

There is a double irony in this particular judgment – Lord Denning, the great iconoclast and pusher forward of the legal boundaries, appears as a proponent of the essentially conservative literal rule. However, a reading of the rhetorical nature of his judgment also reveals how his reliance on the literal rule allows him to give support to his own personal, and certainly unliberal, views on abortion. Of equal, if not greater, concern is the almost malicious way in which he recognises, only to dismiss, the additional safety to women in the non- surgical procedure (see emphasis added in quotation).

In the House of Lords, the preferred approach, although only by the narrow majority of 3:2, was to adopt the mischief rule and to examine the purpose of the legislation and to read its provisions in line with that purpose. The minority followed the Court of Appeal and preferred to use the literal rule.