Issue link: https://maltatoday.uberflip.com/i/1378870
THE National Patient's Charter, launched in 2016, sets out the key rights and responsibilities of people receiving care within the Maltese health care system for the provision of safe, high qual- ity care. It is structured around eight principles that form the foundation for an equitable healthcare service. These rights and responsibili- ties explicitly define what users and healthcare providers within the Public Health Service can expect. For example, the Char- ter gives each of us the right "to receive all the information about his/her medical condition"; "to get support and enough infor- mation to participate in the management of one's condi- tion"; "to participate and discuss ethical matters that may arise in the course of one's care"; "to be treated as an individual, one should expect that healthcare providers demonstrate dignity, patience, empathy, tolerance and courtesy". Nothing could be further from the truth when it comes to the way some doctors and pharmacists respond when women try to access contracep- tion or the morning-after pill in Malta. Although the Charter focuses on a patient-centred approach and promotes patient partic- ipation in decision-making, it is also completely at odds with what is currently happening in Malta when it comes to women seeking help for an unexpect- ed pregnancy. Some of my col- leagues refuse to provide any in- formation about the healthcare options available to women who do not wish to continue with their pregnancy. Not informing women that medical abortion at home is a safe procedure until 12 weeks of pregnancy is a dere- liction of duty. Equally negligent is failing to provide information about parenting and adoption as options in these circumstances. Women need their doctors to respect their wishes, and if that includes a decision to end a pregnancy, then we are obliged to provide all the necessary in- formation to do so. Sadly, med- ical students in Malta are still being told not to mention the A word as it is illegal to do so. This is nonsense. The way the law stands at the moment, it is per- fectly legal for doctors to provide information about abortion. We do this at the Family Planning Advisory Service (27780037; 20341686) almost daily through calls, chats and messages with women in Malta who are des- perate for unbiased information about all their options. My pro- choice colleagues and I do the same in our clinics. Our own Pa- tient Charter demands that we do so. As expected, the law criminal- ising women who have abortions does the same for doctors who carry them out. Presumably this is meant to be a deterrent: do not open surgical abortion clin- ics in Malta! To the best of my knowledge, there are none, so this may not sound like an issue at all. But in reality it is, because approximately 300-400 women each year order medical abor- tion pills online, and take them at home. Many doctors in Malta are worried about providing abor- tion-related information, even when it is legal to do so. This leads to delays in receiving ac- curate information and can lead to the 'chilling effect' in women who may worry about medical abortion-related complications as well as potential legal reper- cussions, such as being report- ed to the police if they seek post-abortion care. Let's be perfectly clear about this. Not providing women hav- ing an abortion with any medi- cal guidance, if needed, is poor medical practice. Fortunately, abortion with pills is a very safe procedure. Nevertheless, prob- lems such as heavy bleeding re- quiring medical assistance are possible. In these cases, we sug- gest women go to hospital to be assessed. But women in Malta are terrified of this. They fear being reported, so they will not disclose they have taken abor- tion pills. This means that the doctors taking care of them are not given the full clinical picture that they need to provide effec- tive health care. It is not widely known that reporting to the police is at the discretion of the medical practi- tioner. Doctors are not obliged to report but to provide infor- mation if so requested to by the court. But most women do not know this, and in any case, since reporting is at the discretion of the doctor, there is no guarantee that any particular doctor might not pick up the phone and make the report. This is why decriminalisation of abortion is so important. Peo- ple who need and have abortions must be able to have open dis- cussions with family, friends, and their doctor without the fear of criminal punishment. Regardless of the risk of im- prisonment, women in Malta are deliberately breaking the law, making them criminals for ac- cessing health services available to practically any other wom- an in Europe. In case you are wondering whether this actually happens, yes it does. In 2006, a 23-year-old Maltese woman was sentenced to three years' proba- tion, and in 2014, a 30-year-old woman received two years' jail, suspended for four years. Anoth- er 28-year-old woman was sen- tenced to 18 months, suspended for two years. These women now have a criminal record. It is encouraging that in the recent survey published in this paper, a majority of people in Malta, and around two-thirds of those under 35, are against crim- inalising women who have abor- tions. However, the reality is that the fear of being criminally charged will make some women very reluctant to seek the medi- cal help or psychosocial support they might need. The law as it currently stands also prevents doctors from pro- viding the best possible care for their patients. Indeed, the recent survey published in this paper showed that when it comes to abortion, the Maltese public are less lenient with professionals than they are with women. On- ly 30% disagreed that doctors should be imprisoned for assist- ing women to have an abortion. This figure doubles from 22% to 48% between those with second- ary and tertiary education, and is highest among 18-35 year-olds (52%) and those who did not vote in the last election (45%). All women, and especially the most vulnerable ones, need their doctors to provide safe, com- passionate care, whether they intend to continue with their pregnancy or not. Decriminalis- ing doctors who support women having abortions has absolutely nothing to do with being pro- life or pro-choice. It is about safe medical practice, because abor- tion is healthcare. This issue demands empathy and solutions that are grounded in respect. Beliefs should not jeopardise pa- tient care. Reference: https://www.aca- demia.edu/s/d696224c65 Prof. Isabel Stabile is a member of Doctors for Choice isabel.stabile@gmail.com 13 maltatoday | SUNDAY • 30 MAY 2021 OPINION Criminalising abortion creates 'chilling effect' on healthcare providers Prof. Isabel Stabile