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In the three years since the law on adult deceased organ donation consent in England changed to include an opt-out system, there has been no discernible change to donation rates. The lack of a positive impact on donation rates was predicted by many of those who took part in debates before and during the passage of the Bill through Parliament. This invites the question as to why England moved to an opt-out system for organ donation despite equivocal evidence of likely benefit and opposition from expert health professional organisations. To address this question qualitative analyses of Parliamentary debates on organ donation was undertaken. This revealed a shift from a dominant position, which gave primacy to the evidence of likely effects, towards a more normative position where a deemed consent option was viewed as the ‘correct thing to do’ and the limited and conflicting evidence viewed in a positive light. By 2017, following Wales's move to an opt-out system, together with continued lobbying for similar changes for England by professional and patient groups, alongside sustained public popularity for organ donation, the balance of opinion had shifted towards a system where deemed consent would become the default position for most English adults
The concluding chapter sets out some of the key themes to emerge from the book. It recalls the influence of the various groups of actors who gave meaning to the Abortion Act, emphasising how the Act was shaped over time in a complex process of negotiation, dispute, revision and consolidation. We locate the Act within the shifting contours of a country undergoing a demographic revolution, exploring how it shaped and was shaped by processes of secularisation, the decline of discursive Christianity and an enhanced role for science in ordering understandings of the world, changing norms of gender, family and disability, shifting ideas of medical authority and changing technologies.
Chapter 3 explores a series of attempts to restrict the Abortion Act fought between 1974 and 1990. The early attacks were led by men, most of them Tories, and framed in terms of defending family values, personal responsibility and moral standards. We show how the Women’s Movement now claimed and defended the Act, itself being importantly shaped in the process. We describe how, over the course of two decades, the centre ground for debate would gradually shift, with attacks coming to be framed in a language of social justice, civil liberties and scientific advance. The chapter ends when Parliament is finally given the opportunity for a meaningful vote on theAct and uses it to endorse the Act’s broad framework.
Chapter 2 traces the Act’s early, formative years. We explain how its meaning was negotiated as women arrived in doctors’ surgeries seeking services that they now believed to be lawful and how doctors worked to understand and apply the new law. We explore how, over time, different interpretations of the Act coexisted, fell out of use or became entrenched in professional codes, internal policy and procedure documents, official guidance and medical curricula. The chapter ends in 1974 with the publication of two important texts discussing the workings of the Abortion Act in these early years: the sensationalist media expose Babies for Burning and the highly influential and authoritative Lane Report.
Chapter 4 explores how the Abortion Act became embedded in daily life: abortion for non-medical reasons became gradually more widely accepted, services were embedded and streamlined and abortion technologies became safer and less technically demanding. We consider how dispute would now come increasingly to turn on the ‘normalisation’ (or ’trivialisation’) of abortion. While these disputes would find focus in contestation regarding the meaning of the Abortion Act, they were always also about far more, lying along a fault line between competing visions of gender, family, religion, science and society.
This introdutory chapter describes events leading to the introduction of the Abortion Act. It explains the use of ’biography’ to frame the analysis, offers a brief synospsis of each chapter, discusses the sources used in the research and explains the choices made regarding terminology.
Chapter 6 focuses on that part of the UK that was omitted from the Abortion Act: Northern Ireland. We show that, notwithstanding this formal exclusion, the Abortion Act has played an important role in the region such that a biography of the Abortion Act necessarily offers the story of not just a British law but, rather, of a UK one. Over the past five decades, Northern Irish women have travelled in large numbers to access legal abortions in Britain, with the Act offering a ‘release valve’ that would limit the numbers of dangerous backstreet abortions and the mortality and morbidity that have driven reform elsewhere. Further, the Abortion Act would form a key focus of campaigns for and against abortion law reform within Northern Ireland; when reform eventually came, the Act would play a role in shaping it, and the reform of Northern Ireland’s abortion law has given significant momentum to the campaign for the decriminalisation of abortion.
Chapter 7 considers parliamentary debates regarding the reform of the Abortion Act from 1990 to 2021. Those leading the fight for restrictive reform would now be mainly Tory women who placed particular emphasis on Christian faith in driving parliamentary work and made the case for narrowly focused reform measures in a language of clinical advance, female empowerment and civil liberties. Pro-Choice MPs would move off the defensive and argue for further liberalisation of the law. Reflecting a significant shift in the centre ground of the debate, each side would now claim to be defending the interests of women, and each would claim to be supported by clinical science and medical opinion, with the gulf between them more than ever presented not as a moral but an empirical one. Above all, each would claim to be offering necessary modernisation of an outdated Abortion Act, whilst relying upon radically different visions of what such modernisation required.