Breda O’Brien: Abortion legislation will force GPs out of healthcare

If doctors are legally bound to act against their conscience they will leave

Photograph: Thinkstock

Photograph: Thinkstock

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If you put the phrase “GP crisis” into a search engine, stories from virtually every Irish county appear. Elderly or burnt-out GPs are retiring and young doctors cannot wait to emigrate. Doctors who have emigrated have no desire to come back.

A recent article in The Irish Times by Dr Niamh Humphries cited the views of one doctor who is currently working in Australia about the Irish work environment left behind: “Every morning I used to go in, I used to have this feeling of sheer dread in the pit of my stomach, every day, every day . . . until I left. Every day.”

But the Government is barging ahead with proposals for a GP-led abortion service, even though the National Association of General Practitioners (NGAP) has made it clear that not all their members want to provide abortion. The association is the representative body for the majority of Irish GPs and has 2,100 members.

If these conscientious, committed doctors are forced out of medicine, a potential half a million patients will be deprived of GP care

The NAGP research shows that 85 per cent of GPs do not think abortion should be part of routine general practice. Some 20 per cent of GPs are conscientiously committed to not taking human life and will not carry out abortions. Only 22 per cent of GPs are willing to provide medical abortion.

This was echoed by a gpbuddy.ie survey. (Gpbuddy is an online medical directory for GPs and you had to be a practising doctor to vote.) In the gpbuddy survey, only 11 per cent of doctors who took part said they were willing to provide abortions and 60 per cent said that having a GP-led abortion facility was unsafe.

Clearly, many GPs will continue to operate according to a two-patient model when a woman is pregnant. They will continue to serve both patients. They will not refer on a woman seeking abortion because they do not believe abortion is medically necessary or helpful to women. There are probably about 500 doctors in this category if you extrapolate the NAGP research to all 2,500 GPs.

The Health (Regulation of Termination of Pregnancy) Bill 2018, currently before the Oireachtas, provides for doctors and nurses to opt out of providing abortion, but requires them to refer the patient to a colleague who will perform the procedure.

Fear of the law

If the legislation is enacted these doctors will be subjected to the full rigours of the law for refusing to refer. One of the many ironies is that we were told before the referendum to repeal the Eighth Amendment that doctors were operating in fear of the law, which allegedly threatened them like the sword of Damocles. Now doctors know what it is really like to fear the retribution of the law, and all for wanting to preserve life.

On average, GPs have about 1,000 patients. If these conscientious, committed doctors are forced out of medicine, a potential half a million patients will be deprived of GP care.

Whatever people voted for, they did not vote for this.

There is a viable model in New Zealand legislation which allows doctors not to refer. Why not use that prototype?

The indecent speed with which the legislation for abortion is being pushed through the Dáil, the absence of any opposition among political parties and the complete lack of readiness in the health system means that a predictable disaster will ensue.

The extraordinary thing is that even abortion advocates recognise that the system cannot cope. The Southern Task Group on Abortion and Reproductive Topics says that if a cohort of patients who need a bed for one or two days for medical or surgical abortion after nine weeks enter the system, “some patients’ elective surgery will be cancelled”.

The group says that it has the potential to lead to “major workplace conflict” between gynaecologists, gynae-oncologists and specialists in urogynaecology, fertility and endometriosis. These specialists will all have patients who have waited for a long time to come in for planned surgery.

So women suffering from damage to their bladders after childbirth, pelvic organ prolapse, faecal incontinence, crippling endometriosis or incomplete miscarriages will have to compete for beds with women opting to have non-medically necessary, free abortions.

Nurses, midwives, pharmacists and even administrators and porters who do not wish to facilitate or participate in any way in the taking of life will all be affected by the lack of respect for freedom of conscience.

What place has conscience in the general decision-making of healthcare professionals? That which is legal is not always right and doctors, nurses and others have to reach decisions in pressurised circumstances where they have to balance symptoms, patient preferences, judgment, experience and a host of other factors.  

Perhaps the only hope lies in solidarity between healthcare professionals and the public. 

Otherwise, good people will be bullied out of nursing, midwifery, medicine and pharmacy. We have put up with an utterly dysfunctional health system for far too long. It is time to demand a decent service that protects all patients and treats healthcare professionals as human beings, not puppets whose strings are jerked by the Minister for Health.

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