1. How Can a State Control Swallowing?’ Medical Abortion and the Law Project One nurse’s journey Joanne Fletcher Consultant Nurse Gynaecology Sheffield Teaching Hospitals Foundation Trust

3. 1st NP in England to manage a NHS abortion service MVA for miscarriage and RPOC Qualified as registered nurse UK multicenter trial <63days UK multicenter trial >12 wks EMA introduced 2008 BMA, RCN, RCOG, RCM - HoC S&T committee 1999 Qualified as a sonographer Introduced numerous ‘extended’ roles for nurses 1967 The Abortion Act RCN Abortion Care guidelines RCOG Abortion Care guidelines 1990 1997 2005 Mifepristone & Misoprostol WHO essential medicines 2010 2011 2016 1988 1993 BSACP 2015

4. NURSING DEVELOPMENTS Administration of abortificant drugs Vaginal & speculum examination Sonographic assessment Consent for abortion procedures Nurse prescribing, Patient group directions (PGDs) Contraception counselling & initiation (including LARCs) MVA (RPOC & miscarriage)

5. ‘Two registered medical practitioners must be of the option, formed in good faith….’ Nurse led services: Minimal medical intervention Still implications for practice 3. It is lawful for doctors to choose to exercise their legal decision-making responsibilities under the Abortion Act in a way that, in practical terms, results in abortion on request.

6. 4. The requirement that abortions be performed by doctors has been potentially rendered redundant by the broad judicial interpretation of this provision. ‘…increasingly significant role… played by nurses…. who should be appropriately skilled ……, DoH accepted in judicial interpretation of the Act, provided that a doctor remains in overall control of the abortion procedure’ Supreme Courts view of RCN ruling: ‘when the abortion was a team effort carried out under the doctors direction, with the doctor performing those tasks that are reserved to a doctor and the nurses and others carrying out those tasks which they are qualified to perform’ Still not ‘allowed’ to perform MVA for abortion

8. Thank you for listening