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'Abortion is not part of routine general practice. 85% of GPs are of this opinion'

The provision of abortion services in Ireland must be an-opt in service, writes Dr Maitiu O Tuathail.

Dr Maitiu O Tuathail GP and President, NAGP

I AM A pro choice doctor, and voted yes in the recent referendum. I am willing to provide medical termination of pregnancy services to patients, but I equally respect both the views and rights of my colleagues who would not be willing to provide such a service.

Being pro choice is one thing, but providing an abortion service is another. It is vital that we respect one another’s views, both that of GPs and patients.

Equally, as a doctor I would prefer my patients to see a doctor who was willing to provide a medical abortion than one who was forced to do it. Again, as a pro choice doctor I fully respect the views of my colleagues who conscientiously object. I respect everyone’s right to hold an opinion, beliefs and moral views.

We are a broad church

I do not believe that any member of society, whether a doctor or not, should be forced to do anything they do not want to do. To threaten them with jail on the grounds of conscientious objection is wrong on many levels.

There are workable solutions to this challenge for example the legislation on conscientious objection in New Zealand, which respects the views of all.

We are a broad church and must respect the beliefs and viewpoints of all of society, whether we agree with them or not. I would prefer my father to be seen by a surgeon who wanted to operate on him, rather than one who was forced to do so. I would want the same for my sister, should she wish to access abortion services in Ireland.

An opt-in service

We know the majority of GPs in Ireland prefer an-opt in service, as this finding has been replicated in three polls of GPs to date.

We also know that 20% of GPs would be willing to provide an abortion service when required. This is enough to provide a service to the women of Ireland in their own locality.

We must respect the right of the remaining 80% who do not want to provide this service, the vast majority of whom will facilitate their patients through onwards referral to those who will.

There has been much discussion surrounding the difference between and opt in, opt out service. I believe this has lead to huge confusion. At the National Association of General Practitioners Emergency General meeting on Saturday, it was decided unanimously by GPs that the provision of abortion services in Ireland must be an-opt in service.

Already commonplace

An opt-in system – which is already commonplace for many skills in general practice- such as joint injections, the provision of long acting reversible contraceptives – means that a doctor has additional training in this area but also the knowledge, skillset, supports and resources to safely deliver that service.

It allows patients to self select to see that doctor or be referred on to this doctor by their own GP.

Medical abortion is not part of routine general practice. 85% of GPs are of this opinion. This has again been replicated in several polls consistently. By equating abortion to the management of asthma, heart disease or diabetes people are being disingenuous and I believe disrespectful to women.

I can manage a diabetic patient within ten minutes without any ancillary supports. If a patient comes in to me in a crisis pregnancy requesting a termination she deserves as much time as she needs, and also, to be able to see that doctor again in a short period of time.

It is safe, but there are complications

The provision of a medical abortion encompasses far more that the prescription of a pill. It is safe, but there are complications, although rare. There are both contraindications and side effects to the medications.

It is safe up until 12 weeks gestation, and this is why it is important to ensure that gestation is assessed properly. Which may require ultrasonography.  These are highly emotive times for patients, and they must be met and treated with the utmost of sensitivity, respect and compassion, in an environment which can facilitate that without the constraints of time or resources.

I am not involved in the provision of long acting reversible contraceptive services, such as the insertion of coils for contraceptive purposes because I do not perform enough of these procedures, nor see enough women requesting it so that I could keep my skills up and perform this safely.

The same is true for the provision of medical abortion services. It has been repeatedly stated that if every GP in the country provided the service, an average GP would assist in 1-2 abortions a year.

Minimum number of cases

I would ask those same people if they would be willing to attend a surgeon who only performed two operations that year. The answer would be no.

In order to keep one’s skills up to date, it is crucial that doctors see a minimum number of such cases or procedures to ensure they remain competent and safe in the provision of that service. Medical abortion should be no different.

An opt-in service would ensure that a set number of GPs would regularly assist in the provision of abortion services, and hence remain skilled in the provision of this. As stated, we have enough GPs to provide a safe, effective and local service.

We must do this right

We must do this right. Ireland has let its women down repeatedly in the past. This month alone scandals involving both the Magdalene laundries and cervical check has reinforced this. We need to make sure that women get the best service possible, one they have long waited for.

This is not scaremongering, it is fact. Our health service moves from one scandal to another. Let this be a point where things change, that the best possible service is designed from the outset.

The provision of abortion in Ireland will require structures to be put in place. Guidelines are currently being drawn up by the colleges of GPs and Obstetricians. GP Unions have yet to be consulted.

It would seem both logical and sensical that all stakeholders would be involved from the start in this process, as it is the doctors on the ground that will be delivering this service, and their opinions and input regarding any such guidelines is vital, and should be part of the drawing up of guidelines.

Respect

We then must ensure that all the supports and resources are in place for doctors to safely and effectively provide an abortion service. Some women will not require ultrasonography, but some will, and we must ensure that this can readily be accessed.

Some women will require counseling, some will require it as a one off and some will require a course of counseling. Again we must ensure that this is in place. We must do things right in this country for once, and put the structures in place first. Not retrospectively.

We must respect each other. The General Practitioners of Ireland will continue to provide women in crisis pregnancies with the compassionate, respectful and holistic care they have always done.

What will now change, is that those women who will request a termination will be able to avail of this in their own locality, and not have to travel without support like they have done to date.

We have come a long way in a short period of time. The world is watching us. Let’s set an example of how a world class, safe, and importantly, respectful service can be delivered for others to follow.

Dr Maitiu O Tuathail is President of the National Association of General Practitioners.

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About the author:

Dr Maitiu O Tuathail  / GP and President, NAGP

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