Issue link: https://maltatoday.uberflip.com/i/1248303
9 maltatoday | SUNDAY • 17 MAY 2020 INTERVIEW that there should be a law that states that if the mother's life or health is in danger, then she should have the right to decide her own management, including the option of abortion. Ireland recently legislated to legalise abortion, largely as a result of the Savita Halap- panavar case: where a young woman died as a result of preg- nancy complications, after hav- ing been denied an abortion in hospital. Under Malta's present legal set-up (which is similar to Ireland's, before the amend- ment) could the same thing hap- pen here? Yes, it could. The lack of a clear legal framework, as well as the lack of policy guidelines on when the 'double-effect' principle can be invoked, can have a huge im- pact on patient care. It may also lead to medical professionals be- ing reluctant to make clinically sound decisions to terminate a pregnancy which is threatening a woman's life. For example, the point at which the status of an ill patient chang- es from being 'very sick' to 'dying' is not only unclear, but entire- ly arbitrary. Waiting until the situation is considered serious enough before intervening to prevent a fatality, may well be too late. Just because we have not as yet had such a case (or at least, not to our knowledge), does not mean this could not happen. The most crucial aspect is that wom- en should be in a position where they are able to contribute to the management plan of their own pregnancy in a timely manner. If it happened in Ireland where there was (at the time) a legal ban on abortion, it can happen anywhere else with similar re- strictive laws. The only way to ensure that this does not happen is to eliminate the total legal ban on abortion. Malta's laws also threaten doc- tors with criminal sanctions for performing or assisting abor- tions. Can you give some practi- cal examples of how this provi- sion actually affects doctors in the course of their work? Clinical decisions that are based on attempts to quantify risk may result in harming women. One example of this situation is wide- spread infection in a patient with PPROM (pre-term premature rupture of membranes). This is particularly problem- atic if the pregnancy is less than 24 weeks, which is generally re- garded as the lower limit of fetal viability. Inducing delivery prior to this stage, say at 17 weeks, ba- sically amounts to an abortion. With our current laws, there is no option for such patients to decide for themselves if and when they wish to terminate the pregnancy. Instead, the medical team would use the 'principle of double-effect' as a loophole, wait until the situation worsens (such as the patient being in medi- cal shock), and then perform a life-saving termination of preg- nancy to try to prevent maternal death… when it may well be too late. In such cases, medical profes- sionals in Malta are technically performing a criminal act… even if, in practice, this does not lead to criminal conviction. Doctors For Choice argue that the lack of access to safe abor- tion does not stop abortions from happening, but makes them less safe for women. Is there any evidence of unsafe abortions taking place in Malta today? The complete ban on abor- tion not only impacts the pa- tient-doctor relationship, but al- so the advice provided to women with an unwanted pregnancy, or a pregnancy complicated by poor health of the woman or a fetal anomaly (even if wanted). This ban also affects the quali- ty of post-abortion care as many of those who do have abortions by travelling or using pills can- not obtain the same follow-up as women in countries where abortion is legal. This in itself is unsafe. If left with no options, some women will get desperate and may attempt unsafe abortions. However, since most women in this situation in Malta would ei- ther obtain abortion pills online or travel to another country, this is probably unlikely; but certainly not impossible. Needless to say this is not ide- al, as women who seek abortion face the risk of being criminal- ised and may therefore be reluc- tant to seek help in case of rare complications. We are also particularly con- cerned that some women are procuring medical abortion pills without receiving enough in- formation about potential com- plications. Furthermore, the current COVID-19 travel restric- tions further limit the options for women in Malta. There is also an argument that our total abortion ban results in discrimination among different socio-economic strata. Women with financial means can travel, while those without means have very limited options. Do you al- so see the pro-choice campaign as an issue of social justice, and not just health? Absolutely. There is no doubt that the total legal ban on abor- tion discriminates against wom- en in certain groups in society: e.g., those who cannot afford to travel, those who have mobility issues such as migrant women without visas and women in abu- sive relationships. With the COVID-19 travel restrictions, the distinction be- tween those who can and can- not afford to travel has become somewhat blurred; and this is also why so many more women are now resorting to ordering abortion pills online. However, the very poor, or those in mar- ginalised groups, will always in- evitably suffer more without the support of the state. Not only is this an issue of social justice, but also of human rights. Lastly: despite the recent emer- gence of lobbies such as Doctors For Choice, surveys continue to indicate a strong pro-life senti- ment in Malta, and government continues to treat the subject as taboo. Do you feel that it may be premature to expect any legal changes at this stage? Matters of essential healthcare, as recognised by the WHO and all other international medical bodies, should not be decided by any majority. We believe that in order to attain the best public health outcomes, women must have access to safe abortion, ir- respective of the views of various population groups. Not all Mal- tese are Catholic! With so many people in Malta opposing abortion, even in the context of essential healthcare, politicians will be reluctant to address this issue openly, as they see it as a threat to their political advancements. So we expect it will take time to see the decrim- inalisation of abortion in Malta. But there are, in fact, many more people in Malta who are pro-choice than you would think. A year ago, no one would have thought that a pro-choice Facebook page like Doctors for Choice Malta would get such a large following, with over 7,500 likes; 86% (i.e. almost 6,500 likes) of these being people residing in Malta. Based on scientific evidence, we have different views, and as doctors we believe we should be allowed to offer the option of abortion legally and safely to those women who share these views