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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.
‘the vast majority of whom will facilitate their patients through onwards referral to those who will.’
Surely ALL GPs should be facilitating through referrals? Conscientious objection is fine, deciding that a patient of yours won’t get access to healthcare you think is immoral unilaterally is not fine… This new legislation must make onward referrals an obligation
@Chucky Arlaw: The law must also recognise that a referral to a doctor in Wexford is pretty useless to a patient in Bundoran.
@Larry Doyle: but a GP is not like a consultant- you don’t need a referral to see a GP.
@Chucky Arlaw: no it should be their CHOICE whether to refer or to do anything at all that they don’t agree with. Are you not pro choice?
@Greg Kelly:
The Repeal people are wearing the hat now. They want to wave the Big Stick and use the law to bully conscientious objectors into submission.
The empathy hashtag has been dismantled it would appear.
@Greg Kelly: the choice is; do your job in it’s entirety or find a new one.
@Greg Kelly: that’s not as clever a point to make as I reckon you think it is.
Ithought that doctors first and foremost were there to save lives,and as far as your comment that patients will not get access to health care is a nonsence,and that referrals be made an obligation,.This abortion was badly thought out and the head of this government should have known and consulted the doctors,if only to show respect for his fellow doctors,there is no need for the big stick and you will do as you are told,they should be trying to help any doctor who is a conscientious objector,or is this country becoming a dictatiorship and no one will have any rights there is not a thing about the cervical cancer patients,or those suffering mental health issues,that need to be addressed or the housing or hospital waiting lists these seem to have been put on the back burner
@Karen Wellington: I presume that taking life was not in the contract of employment. We’re not talking about removing a splinter from a thumb here.
@False 9: keep doing your best to make sure that desperate women suffer unbearably just so that you can bury your head in the sand while up on your “no abortions in Ireland” pseudo high horse. Abortion has been a fact of life for women since time immemorial, what we’re doing now is trying to make it legal and safe in a patriarchal society where women must beg on their knees to be allowed to care for one another. If you care about “unborn children” so much why don’t you get off your ar*e and start fostering children or fundraising for children’s charities.
@False 9: do you think a GP contract lists every single medical procedure or treatment available in practice today? Their job is to treat their patients’ health concerns and help them maintain a comfortable standard of health, ideally while exhibiting compassion.
@Veronica: it’s all about women to you though isn’t it. Women’s rights, downtrodden women, poor women…. What about the children, lost lives? Have you ever once mentioned them? No. Ending life is not healthcare.
@Karen Wellington: yes Karen and where do you think it may mention the premeditated ending of life of one of the healthy patients in a pregnancy case? See the problem?
@False 9: yes, it is all about the women to me, I’m actually quite vocal about that in case you hadn’t noticed.
Considering that you say you care so much for children, why haven’t I seen you commenting encouraging more people to foster children, or to adopt older children who are less likely to be adopted? Or promoting schemes to make sure that every child in Ireland does not go home from school hungry?
@False 9: if they’ve gotten all the way through medical school and subsequent GP training they’re probably not delusional enough to take the view that a foetus equates to an actual person.
This is about leverage for renegotiating their contracts.
@Karen Wellington: yes. These doctors are misusing the situation where a tiny minority of doctors are refusing to give healthcare to women, and using it to leverage a financial benefit. BTW, these (minority) of doctors claiming religious objection should be struck off. Their job is to provide a prescription for a health issue, not perform a DNC. Follow your medical council advice, or leave it. It was the same nonsense with pills, coils and morning after pills, and if I recall, smear tests. Leave your prejudices at the door. We have thousands of Muslim doctors in this country who have managed to do it, so stop thinking your Catholic bigotry against women makes you so special.
@False 9: psst, the woman is the patient.
@Chucky Arlaw: if you go to your GP and their medical opinion is that you’re in the wrong GP’s office should you still pay?
Abortion is just wrong
@Elvis Polkasalad: sorry for your troubles
@Elvis Polkasalad: next time you’re pregnant don’t have one then.
@Elvis Polkasalad: vast majority of the people of Ireland don’t agree with you
@Elvis Polkasalad: Maybe you should have campaigned in the recent referendum.
@Larry Doyle: i did, and my conscience is clear, u all give out about what the catholic church did in tuam but you all are doing the same .
@Barry Somers: vast majority of germans agreed with hitler , was what he done right?
@Chucky Arlaw: i would never harm a child outside the womb ,so why would i agree to harm a child in the womb.
@Francis Mc Carthy: thanks francis ,
@Elvis Polkasalad: but you would take a woman’s body and free will hostage without a thought.
@Elvis Polkasalad: WTF?
@Elvis Polkasalad: You just lost what little credibility you may have had.
@Elvis Polkasalad: And u just lost. Ha haaaa
@Elvis Polkasalad: If your conscience is clear then stop hiding behind a false name. You are a coward.
@Ian Phillip Creaner: triumphalist ?? Poor reflection of you as a person …
@Deborah Behan: you’re not implying that Elvis impregnated these women are you? THEY had sex. THEY got pregnant. They are a hostage unto themselves. The do everything for me for free right now generation of today need to accept some responsibility. Not everything can be dismembered, hoovered out of you and flushed down the toilet just because it is an inconvenience.
@Ian Phillip Creaner: oh dear Ian. I’d check in if I was you. The only thing “lost” is lives.
@Elvis Polkasalad: is good to hear that you’re looking after your womb then
@False 9: get a life you sad trolling sap
@False 9: more evidence that those against abortion are more into punishing women and girls for the sin of fornication than actually giving a sh!t about “the unborn”.
Like, that comment is almost so obviously woman hating its got to be a joke.
@Elvis Polkasalad: don’t have one!
@False 9: Elvis did not impregnate them, a man did. An irresponsible, immature, selfish man who does not have to deal with the physical, psychological or even financial consequences for the rest of his life. All he has to do after failing to contain his emissions and changing a woman s life entirely, is do a legger.
A man like many men who have just been a little lucky or perhaps not so much if the woman discovering the type of person she is dealing with does not bother informing him.I wonder how many little False 9 s have gotten flushed away? We will never know.
One of the main contentions of the Repeal movement was that the threat of prison for women accessing abortion pills online was heavy handed and totalitarian and lacked empathy for women. Pro life people agreed with them and argued that the law should not be applied in any instance.
Now the same Repeal people want GPs wo refuse to provide abortion services jailed.
Interesting u-turn isn’t it.
It’s true what they say: Power ultimately corrupts.
@Jack McGready: this is just purposeful obfuscation and not what anyone wants. a GP should be allowed to conscientiously object to providing an abortion, but it is there job to refer on to someone who will do it. otherwise, we’re just back to denying healthcare to women.
@Jack McGready: You are making stuff up again Jack.
No one wants GPs jailed. If a GP wants to opt out of providing any service, then they should be allowed to do that. If they refuse to refer a patient to another doctor, then the should be severely reprimanded by the medical council. This should not just apply for abortion services, but all medical services.
@Chrip Ramsay: what is the difference between the referral to another doctor and just prescribing the 10 week pill, or referral to a hospital/clinic. Doctors should not be able to object to following a process in their training manual because they view the patient differently as a woman, anymore than a bakery refusing to bake because they object to the customer being gay. Are doctors allowed to object against sending women for radiotherapy of they know it will damage an unborn foetus. The more logic that is applied to this, the weaker these (few) doctors position stands.
@Gulliver Foyle: The argument in the article is around how they can confirm the gestation period, do they need ultrasound equipment etc, and the need for psychological services. Who is going to fund it?
No one, within reason, should legally have to supply a service they don’t want to. Any service they do supply should be supplied to all irrespective of sexual orientation or sexual history
@CrabaRev: If they can’t confirm the gestation period with confidence, then they can and should refer the patient, without delay (!), to a consultant or practice with the facilities who can.
The principal issue is that some GPs are saying that they can’t even make an initial assessment of a patient and WON’T refer them to a place that can. That is utterly disgraceful, given the distress the patient may be under and the time-constraints within which a decision must be made. The more delay there is, the more danger to the patient – very unethical.
@Twitnoc: p.s. psychological services may be required for any patient who presents with any condition (even a pregnancy they intend to continue to term with!), so that argument is a red herring.
And with regard to cost, maternity care for a pregnancy taken to term would FAR exceed that of an early abortion. Another red herring. This is a minority of GPs seeking to exercise a totally inappropriate moral judgement on their patients and another cohort who are immorally using the introduction of this treatment to lobby for more money.
I agree that an opt-in service is best but the GP needs to be compelled to refer patients on…once again this doctor is suggesting that we return to an “ireland of nods and winks”….the impression he gives is that ppl will know where to go as we are a small country…this is unacceptable…
@Cal-Dog: I think there should also be a minimum number per district who will treat patients wanting an abortion- what if there’s some young one in the sticks of Donegal needing help? How many GP surgeries will she have to pass before she comes to one willing to help her?
@Cal-Dog: why? The state can supply a list that can be read. We have citizens information webpages, why can’t there be one on abortion? If a GP actual believes an 8-week old featus is a human being then helping in any way to end that life would go against his/her beliefs. How could you make it mandatory for that GP to participate in what to them is the taking of life?
@Rob Lyn: and if a GP believed dealing with gay patients was wrong for religious reasons would it be ok to refuse them medical treatment also?
@Barry Somers: where’s the moral dilemma in treating gay patients and is this against the moral code of any religion? I can’t remember all of the 10 commandments but I don’t remember anything about treatment of gay people. This is a critical moral decision, religion independent, about whether it is right to take another life. A large proportion of doctors don’t want any act or part in it it seems.
@Barry Somers: no, of course it wouldn’t. Such a GP shouldn’t be allowed to practice as a GP.
What is your point? If you are trying to draw a parallel I do not see it.
Would it not make more sense to have a list of GP’s who are willing to state pubically that they are offering Abortion assistance and those who state they will not, possibally an online list county by county and available on the citizens information website.
It would save a lot of unfruitful conversations.
@Andrew Connolly:
Common sense.
Unfortunately the Repeal movement wants to wave the Big Stick it would appear.
@Andrew Connolly: “pubically ”
@Andrew Connolly: yes, we can let those who object to providing healthcare call themselves non-general practitioners, or “religious doctors”, and they can let the church maintain their register, and manage their remuneration and contracts. All the other doctors will be managed by the medical council, and we will call them general practitioners, or doctors.
@Andrew Connolly: There is no reason why GPs cannot opt out of providing the service if they wish. Its as easy to opt out as it is to opt in. But for the doctors, by being allowed to opt in, they get negotiation power. we won’t opt in unless we get funding etc.
@Jack McGready: You are a p&thetic sh!t stirrer. The only “movement” involved in the referendum was the highly funded, highly organised, ultra catholic “Yes Campaign”. It was soundly defeated by normal right thinking people who came out in their droves. Get a life!
@Andrew Connolly: Because they will be targeted by Pro Lies lunatics. Their campaign managers have said as much.
It needs to be opt out to protect women and G.P.s
They can provide a list of those who do opt out…they will be under no threat from anyone.
Show me the money….
Why are people still writing these articles? There is NO ONE suggesting anyone be forced to provide them. And it is entirely reasonable to expect every GP to refer patients where necessary. Not most. Every single one.
@Gerard: should it not be their CHOICE whether or not they take part in any way including the choice to refer? Are you against choice ?
@Greg Kelly: no, we’re pro people doing their jobs, the jobs that they get paid very well to do
@Chrip Ramsay: or of interest, do the doctors who object really object? That hairy “mindfulness” gp from cork during the campaign provides well women clinics, including contraception, cervical screening, family planning and fertility referrals such as IVF, all of which one can claim are against their religion. What else will we allow them to object to that prevents them from doing their job
@Greg Kelly: Let’s say there was a Jehovas Witness doctor, he or she would be against blood transfusions, do you think it would’ be OK for the doctor to to withhold this service?
Why should any woman need a referral at all? Why not self refer? I think GPs are not trying to be obstructive, just saying their plate is already more than full and abortion services should be provided by other clinics. Just like they are in most other countries!
Where are the gps going to refer to? The legislation hasn’t past yet and the government are scaremongering all gps into thinking they’ll be performing 20 abortions a day all so they can use it as a negotiating tactic in the new Gp contract, how is a Gp going to date a pregnancy? Is Harris going to provide a state of the art ultrasound machine to every practice in the country along with the many weeks to months of training to be able to use one effectively, which can only give a rough estimate +/- 1-2 weeks? No, he’s not, there’ll be a few dotted around the country or in hospitals in which he n Leo will be falling over each other with a huge golden scissors to open, don’t see why women won’t be able to go to these ‘centres of excellence’ first without bothering their own Gp?#cartb4horse
I am OK with abortion provision being on an opt-in basis as long as proper protections are in place so that the patients healthcare is paramount. That includes that a GP that doesn’t want to perform abortions being required to refer their patient on. It could be as simple as “I don’t perform abortions in my practice. Here is a list of other GPs in the area that do perform them”. If a GP can’t even do that for their patient then I don’t think that they should be a doctor at all.
I see the fascists are out in their numbers again.. This time, they aren’t demanding women can kill their child for any reason, they’re demanding doctors must be made to do the killing or go to jail.. The irony of it all..
@Mark McAuley:
Mark if you had a coherent argument you wouldn’t have to lie and make stuff up. Nobody is asking for anyone to be jailed.
With regards to the fascists being out in their numbers, you really don’t see the Irony in your comments at all? Do you?
This article talks about opt-in, opt-out services for patients in this country.
This is the problem in general with health care and the way it is dispensed here. Doctors need to just do their fecking jobs.
@Ron O’Keefe: Interestingly the vaccine schedule for patients is opt out by default. So if you did not want your child to receive the swine flu vaccine that caused narcolepsy for example you had to write a letter/e mail in to the school noting your non agreement. If there was any clerical error your child could receive this vaccine or others without your knowledge or permission. It should have been opt in.
It is the reverse scenario with G.P.s…Opting out is the better course of action in order to protect patients (women and girls) and the many G.P.s who will provide this service, as the so called reasonable leaders of Pro Lies have in effect said that they will target such services as their next plan of action. The spurious objections in the high court is only the tip of the iceberg. They intend to take their dirty tricks manual back to the streets and we know where they will focus their attention this time.
Excellent article. Prob the very first one that stated v clearly the pro’s and con’s of the many angles to all of this- angles that many people either don’t consider or WANT to address.
Opt in or out, whatever. All GPs must be made to have their stance available somewhere public and easily accessible to paitients. Firstly so no woman is potentially humiliated or lectured in a time of crisis by a prolife doctor who won’t even have the decency to refer them on to someone who will help. Not to mention, have the opportunity to charge the woman a fee for the non ‘service’. Secondly so people can make an informed decision on who provides their healthcare. I know I wouldn’t feel comfortable being treated by a GP who considers my life and situation less important than an embryo or 12 week feotus.
No legislation has been passed to even make abortion legal as of yet, and with at least one challenge in the courts against the referendum result it could be another 3 years before any law is passed to even allow abortions to be performed in the country. They still have time to thrash out the details or the who, how, where and when.
I thought if you were a GP (same as a Solicitor) you don’t really get to pick and choose who your clients are? You can’t refuse them as such, however that said, I think a GP should be allowed to choose whether or not to offer this ‘service’ as such
NO – it should be an opt out service
Doctors that murder and use violence and tyranny against the weak. Indoctrination is a powerful thing!
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