January deadline for abortion service dangerously unrealistic
Rushed introduction will pose serious threat to health and wellbeing of women
One of the first things you learn in medical school is “primum non nocere” – firstly, do no harm. Then you are taught to learn from your mistakes.
I wonder what Dr Gabriel Scally would say – if he was asked to comment on what is happening at the present time.
A little over a week ago, a national conference was held on the lessons learned from his report into the harm caused to women by CervicalCheck. Minister for Health Simon Harris spoke frankly at this conference on “the dangers of demands for action and decision-making in an information vacuum” .
Yet here we are on the verge of introducing a new termination of pregnancy service, which, if rushed into operation on January 1st as scheduled, will pose a serious threat to the health and wellbeing of women, precisely for the reasons highlighted by Mr Harris – compounded in addition by inadequate planning and insufficient resources.
I say this as a doctor who is working with others to introduce this service as quickly and as safely as possible – acutely aware of the medical risks, inhumanity and distress associated with unregulated self-medication and travel abroad. I am not a conscientious objector.
I will participate in the provision of this service – but only when it is safe to do so. At present, I am operating in an “information vacuum”.
It appears that the alarm bells are not yet ringing in the Department of Health or the HSE
It is “frightening” – there is no other word to describe it – to consider that with less than a month to go, there are no agreed models of care, published clinical guidelines or updated Medical Council ethical guidelines, no clarification regarding feticide or failed medical termination presenting beyond 12 weeks, no substantive engagement with paediatricians in relation to life-limiting anomalies, and no satisfactory responses to many other clinical concerns that have been highlighted, time and time again.
Little or no training
In addition, doctors have had little or no training and there are serious concerns about the availability of scans for GPs.
The recent appearance of an anonymously authored official document, dealing with important aspects of clinical practice, caused bewilderment among clinicians expected to roll out such as service and was just another example of poor communication and clinical governance.
In addition, there are problems relating to staffing, clinics, accommodation, theatre and the current clinical workload in both primary care and in hospitals - as well as the co-ordination of the service at a national level and governance.
It may be worth remembering, that notwithstanding any issues that arose from audit, with a month to go before the introduction of CervicalCheck in 2008, we were miles ahead in terms of preparation, compared to where are now in relation to termination of pregnancy.
Irish women deserve a lot better than this. We must learn from our recent mistakes – and firstly, we must do no harm
The headline “HSE ordered to ensure abortion availability from January 1st” (Irish Times, December 3rd) sadly reflects the type of pressurised environment we are working in now – in which legitimate clinical concerns are, more often than not, equated with obstructionism and delaying tactics – and so brushed aside in a frenzied attempt to meet a dangerously unrealistic deadline.
In an unprecedented departure from normal clinical practice, we may well have a situation in January in which those of us, who are not conscientious objectors, may find ourselves under pressure to undertake certain medical procedures for which we have received little or no training.
Healthcare managers and politicians appear to have little interest in this. And once the legislation is passed, well then it is over to the doctors.
We have been repeatedly told by those rolling out the service “let not the perfect be the enemy of the good.” In this instance, there is a starker choice – between expedience and safety. Less discriminatory instructions include to “just get on with it.”
At this very late stage, it appears that the alarm bells are not yet ringing in the Department of Health or the HSE. If history is anything to go by, they may yet toll along the corridors of Hiqa and the State Claims Agency.
In the context of the introduction of new abortion services, special adviser to the Minister, Dr Peter Boylan, looks to a future of “open and honest conversations between doctors and patients, with no hypocrisy involved” (Irish Times December 4th).
With this in mind, I have added my name to a letter to the chairwoman of the Institute of Obstetricians & Gynaecologists requesting that an extraordinary general meeting be convened to defer the implementation of new legislation until the risks to patient safety have been dealt with.
Meanwhile, Dr Boylan tells us that abortion will be available “in some form” in all 19 maternity units in January and seeks to reassure the public that “the pieces are falling into place” while at the same time cautioning that “inevitably, there will be problems.” This is not language that inspires confidence.
Irish women deserve a lot better than this. We must learn from our recent mistakes – and firstly, we must do no harm. One Scally report is enough.
Chris Fitzpatrick is a consultant obstetrician and gynaecologist at the Coombe hospital