Issue link: https://maltatoday.uberflip.com/i/1122280
16 maltatoday | SUNDAY • 26 MAY 2019 INTERVIEW Recently, a group of medical professionals emerged to challenge the legal status of abortion in Malta. Can you tell us why medical professionals felt the need to form 'Doctors For Choice'? Why was it necessary to take a public stand on this issue? There are a lot of levels to that question; I think that every one of us has a personal reason, on some level: be it vaguely related to an experience they've had themselves, or someone they know. You could also look at it as an act of rebellion, in a sense. We've grown up in a country where, for all our lives, abortion has been a 'special subject' that we can't really talk about. And once we became doctors… we found that we could talk about it even less. We can't even dis- cuss it among ourselves. It's never mentioned. We were never taught about it at uni- versity: not a single lecture… in my experience, anyway. So in a way, it is an act of rebellion against this culture of omerta'. But the main reason, by far, is that we see a great need for ter- mination of pregnancy services in Malta… and, more broadly, for sexual/reproductive health services as a whole. Sex edu- cation, to be frank, is rubbish: everybody knows this. Access to contraception is minimal… and none of it is free. Added to all this, there is also a social jus- tice dimension. You hear stories about Mal- tese women who go abroad to terminate their pregnancy, for whatever reason. And then you see the other side of the coin. Other Maltese women who desperately ask for termination of pregnancy services locally; who are denied counselling; de- nied referrals… These are peo- ple who know next to nothing about sexual health. They know nothing about contraception. They do not have the money to go abroad. They do not have the education to make informed choices. In many cases they will not have the family support networks enjoyed by others. To me, this is a clear case of social injustice. Those who go abroad for an abortion, do so because they can. Those who don't have the money, the education, the support… they can't. It's unfair. Nonetheless, those who see abortion as an intrinsic evil will counter-argue that all abortions should remain illegal, for rich and poor alike. How would you respond to that? There is a lot of evidence that criminalising abortion does not stop abortions from happening, by any stretch. All it does is cre- ate a dichotomy; and it creates a major health risk for people who cannot access that service by going elsewhere. This is, in fact, a health issue, and I think It should be completely medi- calised. It should not be politi- cised. Religion should not be involved. Morality shouldn't be involved, in my opinion. It should be treated as a medi- cal issue: like having a knee- or hip-replacement, or being treated for hypertension… Sticking to that same perspective: some people might be shocked by the comparison between an abortion and, for instance, a hip-replacement operation. Isn't there also the issue of terminating a human life? I want to be clear: I am com- paring termination of preg- nancy services to other proce- dures and medications, solely in the sense that they should be available; they should be safe; and they should be treated as a medical procedure, and not as something else. I understand that there is much greater sen- sitivity surrounding this issue; I don't think it's an easy deci- sion for anyone to make. I sym- pathise with both the doctors performing or offering the pro- cedure; and with the women seeking it. It's a sensitive issue. Just as sensitive as trying to get pregnant and start a family. Just as sensitive, perhaps, as watch- ing a loved one pass away, slow- ly and painfully. All these sensi- tivities are there, embedded in this hot potato of an issue… You say it 'shouldn't be politicised', but – like it or not – it has. We're in the last week of an election campaign, which has been described as a 'referendum on abortion'. How do you react to political arguments about abortion? Can you also give an indication, from your experience, of how other doctors view this? With regard to other medi- cal professionals I have spoken to: I have to say that I am flab- bergasted – truly flabbergasted – by what I see and hear. Let me give a small preamble: we, as doctors, practise what we call 'evidence-based medicine'. This may not be obvious to everyone. But what it means is that: the way we manage patients is based on the hard graft of the tonnes and tonnes of research – conducted by thousands of people through- out history, and always ongo- ing – into the natural causes of disease; what treatments work best; what drugs or procedures to prescribe, and so on. This is the really hard work we do as doctors; this is what we base our entire practice on. If you were a fly on the wall in any clinic or hospital, and lis- tened to doctors talking among themselves, you would hear a lot of: 'But that doesn't follow the guidelines. The guidelines say…', or 'The evidence shows this, or doesn't show that…' That is the sort of discussion you would hear. It will be about 'what the latest evidence tells us'; what the best practice is, according to the latest research. Why are we not doing that with reproductive health? I cannot understand this. I cannot un- derstand doctors who say that they disagree with decriminal- ising abortion… but then, when I ask them, 'But how can you, as a doctor practising evidence- based medicine in every other sphere of your profession, sim- ply cherry-pick, and choose to disagree when it comes to this – and only this – issue?' How can they choose to ignore the evidence: when there is such a wealth of evidence, from all the major international health or- ganisations? What sort of reaction do you get to that question? Most of the arguments I've heard are, roughly, that 'life starts at conception'; that 'the human embryo, or zygote, is a human being, with its own DNA, and should be treated the same as a 12-year-old, or 30-year-old, or 80-year-old human being.' Now: person- ally speaking – I can't speak on behalf of anyone else, on this – yes. We all have the same DNA. Yes, the embryo has the poten- tial to go on to be born, and ide- ally live to a ripe old age. Life is a process; from the mo- ment the sperm meets the ova, the process begins. So, to arbi- trarily draw a line, as to 'where that life starts'… I don't think that's the issue here. The issue is not 'where life starts'. It is not 'what is a person?'. There is no definitive evidence to base any answer on. If anyone tells you, 'science has proven what a per- son is…', it's nonsense. Science doesn't even go into that: 'what is a person' is a philosophical question, not a scientific one. The background we come from is a medical background. What matters to us is the health of society. And the end goal of all medicine is public health, full-stop. So the question really is: what changes public health outcomes? There is plenty of evidence for this; we do know what changes the health of so- ciety. So why are we not im- plementing this knowledge in this area? It is a question I'd like to ask both to my fellow col- leagues in the profession, and also to legislators who legislate on public health. Why are we disregarding all this medical evidence, simply for the sake of… I don't know what? On the subject of legislation: Maltese law threatens up to four years in prison for any woman who terminates her pregnancy; and also for anyone who helps a woman achieve that goal. Technically, even referring patients to clinics overseas (for example) DR MATTHEW DRAKE, of the recently-formed Doctors For Choice group, argues that making abortion illegal not only fails to stop abortions from taking place, but creates serious health problems for women Abortion: a medical, not PHOTOGRAPHY BY JAMES BIANCHI Raphael Vassallo Raphael Vassallo rvassallo@mediatoday.com.mt