Sir, – The Minister of Health has suggested that if abortion is legalised for up to 12 weeks of pregnancy it will be by means of a GP-led service.
Termination of pregnancy in a GP clinic is by way of two different medications taken at 48-hour intervals and is known as medical termination of pregnancy (MTOP). There is no country where MTOP is a GP-led service.
In 2012, MTOP became available in Australia. Two years later only 1,244 (1.5 per cent) of the 81,478 GPs were providing the service. Other than religious or moral objections many barriers to GP participation in providing MTOP in Australia have been identified. Demands on practice time and workforce needs is a primary issue.
While MTOP carries fewer risks than a surgical termination of pregnancy similar strict protocols must be adhered to in order to protect the patient. Such protocols have been reported as taking between 40 to 60 minutes to complete for the first of two consultations recommended in all guidelines.
Concerns by Australian GPs about the stigma and the impact it may have on perceptions of their practice, difficulties in referral to a local public hospital in case of complications and provision of surgical abortion if required are other issues that have been reported.
When MTOP was approved in the US in 2000, it was expected to broaden access to early abortion, because it could be prescribed by a woman’s own doctor no matter where she lived.
Five years later it was reported that family doctors accounted for only 11 per cent of MTOM prescriptions.
Harassment of staff and women is a significant barrier to providing non-hospital termination of pregnancy and has been reported by 57 per cent of providers.
Ultrasound is not a prerequisite for MTOM but in some countries such as Sweden and Australia MTOM will not be carried out without it. We will have to await guidelines from both the Institute of Obstetricians and Gynaecologists and the Irish College of General Practitioners before we know if is to be a prerequisite in Ireland. If it is required, it will have implications for any GP-led MTOM service.
I believe that it would have been more prudent of Simon Harris if he had engaged with the various GP bodies before he raised expectations that MTOP would be a GP-led service in Ireland. – Yours, etc,
Dr REGGIE SPELMAN,
Health Centre,
Bridgetown,
Co Wexford.
Sir, – The former dean of St Patrick's, Robert MacCarthy, focuses attention on the moral status of the foetus in his letter on abortion (February 9th).
“Person” is the commonly-used designation for moral status, denoting a subject of rights. To have “moral status” means that one is protected, or should be protected, by moral norms, that is, by principles and rules that state obligations and, correlatively, rights.
Rev MacCarthy is persuaded that personhood is grounded in self-awareness and the ability to relate to others. And as a foetus cannot demonstrate such attributes, then it is not a person and so the direct intentional taking of its life is ethically unproblematic.
This definition of personhood is open to challenge from another one, deriving from Boethius: “person” is a designation for an individual substance of a rational nature, composed of body and soul, which retains its psycho-physical unity from conception to death. This means that one’s identity as an individual is anchored in one’s organic existence, in one’s bodyliness.
Thus, foetuses, infants, children, adults, the physically and neurologically disabled as well as the able-bodied qualify as persons and therefore have moral status and moral rights. – Yours, etc,
Dr NOREEN O’CARROLL,
Blackrock,
Co Dublin.