Aplastic Anaemia
Aplastic Anaemia
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DOI：
10.1136/bmj.1.5441.1010
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发表时间：
1965-04
影响因子：
--
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中科院分区：
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残疾或身体或精神异常，在某种程度上需要终身不断地住院治疗或特殊照顾。虽然这项提案没有什么新意，但值得注意的是，自1936.6年英国医学会的一个特别委员会提出这一想法以来，对风险性质的强调可能已经改变。当时，该委员会主要关注遗传缺陷，包括智力缺陷，并建议例如，如果父母双方都被证明为智力缺陷，或者如果父亲和一个孩子是，或者如果父母显然是正常的，但已经出生了两个经证实的智力缺陷儿童，则可以认为堕胎是允许的。如今，人们的注意力更多地转向环境中可能损害胎儿的因素，如母体风疹、猕猴血型不合和x射线。在任何一种情况下，无论是遗传风险还是环境风险，要估计其对胎儿的严重性在个别情况下都可能是极其困难的。医学界肯定会反对任何赋予妇女在特定情况下堕胎的规定权利的立法，因为这样的决定必须留给医务人员。但是，如果议会因为胎儿暴露在有害物质中而允许医生应患者的要求进行人工流产，那么其他问题就会出现。在某些情况下，可能不容易获得怀孕日期和胎儿的实际风险的证据。同样，医学上的进步--例如，在预防Rh疫苗方面--将必须被考虑在内。1961年的法案中还包括了另外两个截然不同的终止怀孕理由--即患者因强奸而怀孕或她是“精神不健全的人”。值得注意的是，B.M.A.委员会提请特别注意未经同意年龄(16岁)的强奸可能对女孩造成的严重精神伤害。但是，当堕胎问题部门间委员会开始审议这一问题时，它找不到一个法律公式来区分真正的强奸和默示同意，即使是在16岁以下，尽管它承认出于人道主义理由可以找到修改法律的广泛支持。将“精神不健全”列为堕胎理由的提议似乎可能会给已经导致精神病学家和其他医生之间存在巨大分歧的论点带来进一步的混乱。与1961年的法案相比，人们通常会讨论更多激进的变化。例如，著名律师、堕胎法改革协会主席格兰维尔·威廉姆斯主张采取一项措施，规定注册医生可以合法终止怀孕，但不得在怀孕第17周结束后进行堕胎，除非是为了保住母亲的生命。8他指出，如果这样的法案获得通过，“如果妇女能够在没有正式程序的情况下以正常方式进行适当的手术，她就不会去江湖医生。”换句话说，这是在怀孕的前17周按需堕胎。尚未提交议会的任何法案都没有提议对医疗实践进行如此彻底的改变，而且它也不会得到医疗行业的同意。当然，让主要靠已婚妇女的痛苦为生的后街堕胎者倒闭的正确方法是通过廉价而可靠的避孕措施。
deformed or with a physical or mental abnormality which would be of a degree to require constant hospital treatment or special care throughout life." While there is nothing new in this proposal, it is worth noting that the emphasis on the nature of the risk has probably changed since the idea was put forward by a Special Committee of the British Medical Association in 1936.6 At that time the Committee was concerned mainly with genetically inherited defects, including mental, and it suggested for instance that abortion might be thought allowable if both parents are certified mental defectives, or if the father and one child are, or if two certified mentally defective children have been born though the parents are apparently normal. Nowadays attention has turned more to agents in the environment which may injure the foetus, such as maternal rubella, rhesus incompatibility, and x-radiation. In either case, whether the risk is genetic or environmental, to estimate the gravity of it to the foetus can be exceedingly difficult in the individual case. The medical profession would certainly oppose any legislation which gave a woman a prescriptive right to an abortion in specified circumstances, in that such decisions must be left to the medical attendant. But, if Parliament were to give a permissive right to doctors to induce abortion at the patient's request because the foetus had been exposed to a harmful agent, other problems would arise. Evidence of the date of conception and of the actual risk which the foetus had run might not be easy to obtain in some cases. And again medical advances-for example in preventing Rh-immunizationwould have to be taken into account. Two further and very different grounds for terminating pregnancy were included together in the 1961 Bill-namely, that the patient is pregnant as the result of rape or that she is " a person of unsound mind." It is worth noting that the B.M.A. Committee drew special attention to the severe mental injury that may be caused to a girl by the birth of a baby resulting from rape under the age of consent (16 years). But when the Interdepartmental Committee on Abortion came to consider the question it could not find a legal formula which would distinguish genuine rape from implied consent, even under the age of 16, though it acknowledged the widespread support on humanitarian grounds that would be found for a change in the law. The proposal to include " unsound mind " as grounds for abortion would seem likely to introduce further confusion into arguments that already lead psychiatrists and other medical men to differ greatly among themselves. Much more radical changes are commonly canvassed than those embodied in the 1961 Bill. For example, Glanville Williams, a distinguished lawyer and president of the Abortion Law Reform Association, advocates a measure that "would provide that a registered medical practitioner may lawfully terminate pregnancy, except that such termination shall not be performed after the end of the seventeenth week of pregnancy save for the purpose of preserving the life of the mother."8 He points out that if such a Bill were passed " no woman would go to a quack if she could get a proper operation performed without formality and in the usual way." In other words, this is abortion on demand in the first seventeen weeks of pregnancy. No Bill that has yet reached Parliament has proposed such a sweeping change in medical practice, and it would not have the assent of the medical profession. Surely the proper way to put out of business the back-street abortionist, who flourishes mainly on the distress of married women, is through cheap and reliable contraception.