Abortion and the medical profession

The Irish Times (Letter)
Reproduced with permission

Dr. Noreen O’Carroll

Sir, –

Dr Mark Murphy states that doctors who are opposed to abortion are in no way affected by the new service and their conscientious right to objection is respected.

In fact, doctors who have a conscientious objection are legally compelled to make arrangements for the transfer of care of the pregnant woman concerned to someone who will terminate the pregnancy. For doctors who cherish human life from its origins, that is tantamount to making them accomplices in taking the life of a developing baby.

This is an abuse of conscience and contrary to the practice of medicine in the spirit of the Hippocratic oath which prohibits the direct intentional taking of human life.

Dr Murphy, who you omitted to mention is on the staff of the department of general practice at the Royal College of Surgeons in Ireland, is one of a minority of GPs in Ireland who have signed up to provide abortion services; the vast majority of GPs have not done so – 274 was the figure recently reported by the HSE.

I am not now, nor have I ever been, a member of a pro-life group; although as an ordinary citizen, I have consistently advocated for the life of the developing baby to be legally protected and have voted accordingly.

– Yours, etc, Dr Noreen O’Carroll, (Lecturer in Medical Ethics, RCSI), Blackrock, Co Dublin.

Indiana bill extends conscience protection to medical abrtions

Sean Murphy*

Indiana Senate Bill 201, proposed by Senator Liz Brown, has been amended in committee and is progressing through the Indiana General Assembly. Existing Indiana law protects freedom of conscience for physicians, nurses and institutional employees in relation to surgical abortion. Bill 201 amends the statute to include medical abortion and extends protection to physician assistants and pharmacists.

New doctors needing a medical residency in Canada face ‘match day’ with few available spots

Star Vancouver

Alex McKeen

VANCOUVER—Thirty-three medical residency positions the Ontario government created last April with a $23-million commitment were a one-time deal and are not on offer to 2019 medical graduates, according to the province’s Ministry of Health and Long-Term Care.

The funding was an attempt by the previous Liberal government to decrease the number of Ontario medical graduates going without work while people need doctors. . .

. . .For the last 10 years, as the number of medical students has gone up and the number of residency spots has stagnated, more and more Canadian medical graduates have not secured residency spots. . . [Full text]

Victoria’s voluntary assisted dying law: clinical implementation as the next challenge

Ben P. White, Lindy Willmott, Eliana Close

The Voluntary Assisted Dying Act 2017 (Vic) (VAD Act) will become operational on 19 June, 2019. . . . While some have written on the scope of, and reaction to, the VAD legislation, there has been very little commentary on its implementation. Yet, important choices must be made about translating these laws into clinical practice. These choices have major implications for doctors and other health professionals (including those who choose not to facilitate VAD), patients, hospitals and other health providers. This article considers some key challenges in implementing Victoria’s VAD legislation.


White BP, Willmott L, Close E. Victoria’s voluntary assisted dying law: clinical implementation as the next challenge. Med J Australia. 2019 Mar;210(5):207-209.e1

Euthanasia rollout challenges Vic doctors

Daily Mail

Australian Associated Press

Doctors will have to ensure Victoria’s complex voluntary assisted dying laws don’t prevent eligible candidates from accessing the scheme.

It’s one of several legal and ethical challenges doctors will face when the country’s first euthanasia laws come into affect in June, experts have said.

“Translating this complex law into appropriate clinical practice will be challenging,” lead author Professor Ben White and colleagues said in an article published in the Australian Medical Journal on Monday. . .[Full text]

Leading Irish hospital makes willingness to do abortions a condition of employment

BioEdge

Michael Cook

Only doctors who are willing to perform abortions will be considered for two consultant posts at Dublin’s National Maternity Hospital. The hospital is advertising for a consultant anaesthetist and a consultant in obstetrics and gynaecology.

According to a statement from the NMH the positions include the “provision of termination-of-pregnancy services, and are for individuals willing to contribute to the provision of these services”.

A source at the hospital told the Irish Times that conscientious objection guidelines for existing staff would remain as they were before.

Baroness Nuala O’Loan, of Northern Ireland, recently warned that the Republic would be entering “uncharted territory” if it made willingness to perform abortions a condition of employment. What if doctors changed their mind, feeling in conscience that they could no longer participate in abortions, she asked.

After a referendum last year which allowed abortion to be legalised, Ireland is expanding its services quickly to provide abortions. The health department’s budget provides €7 million in funding for abortion services this year and €12 million in 2020.


This article is published by Michael Cook and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees. Some articles on this site are published under different terms.

Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying

S. Sinmyee V. J. Pandit J. M. Pascual A. Dahan T. Heidegger G. Kreienbühl D. A. Lubarsky J. J. Pandit

Summary

A decision by a society to sanction assisted dying in any form should logically go hand-in-hand with defining the acceptable method(s). Assisted dying is legal in several countries and we have reviewed the methods commonly used, contrasting these with an analysis of capital punishment in the USA. We expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used.

However, the considerable heterogeneity in methods suggests that an optimum method of achieving unconsciousness remains undefined. In voluntary assisted dying (in some US states and European countries), the common method to induce unconsciousness appears to be self-administered barbiturate ingestion, with death resulting slowly from asphyxia due to cardiorespiratory depression. Physician-administered injections (a combination of general anaesthetic and neuromuscular blockade) are an option in Dutch guidelines. Hypoxic methods involving helium rebreathing have also been reported.

The method of capital punishment (USA) resembles the Dutch injection technique, but specific drugs, doses and monitoring employed vary. However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re-awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane, and we have used lessons from the most recent studies of accidental awareness during anaesthesia to describe an optimal means that could better achieve unconsciousness. We found that the very act of defining an ‘optimum’ itself has important implications for ethics and the law.


Sinmyee S, Pandit VJ, Pascual JM, Dahan A, Heidegger T, Kreienbühl G, Lubarsky DA, Pandit JJ. Legal and ethical implications of defining an optimum means of achieving unconsciousness in assisted dying. Anaesthesia. 2019 May;74(5): 630-637.

Health: The number of GPs who have signed up to provide abortion services has risen to 274, figures show

Pro-choice groups write open letter expressing fear people being left behind

The Irish Times

Paul Cullen

The number of GPs who have signed up to provide abortion services has risen to 274, according to the latest figures from the HSE.

Ten hospitals are also providing the service, which was introduced at the start of January.

However, pro-choice organisations have claimed a lack of progress in implementing abortion, as well as restrictions on services, means it is available only to “a select few”. . . [Full text]

Harris told of fear over abortion ‘barriers’ in rural areas

Irish Examiner

A “sparse” rural abortion service is forcing pregnant women to travel long distances for a termination, pro-choice groups claim.

They also describe the mandatory three-day waiting period for an abortion as “a significant barrier” for rural pregnant women.

The 35 pro-choice groups have written to Health Minister Simon Harris to express their “fear and disappointment” that some women are still unable to access timely abortion care. . . [Full text]

Chamber of Pharmacists warns professionals against incorrect dispensing of Morning After Pill

Malta Independent

Rebekah Cilia

The Chamber of Pharmacists (Kamra tal-Ispizjara) has sent an email to its members stating that there is a standard question protocol that pharmacists must follow when dispensing the Morning After Pill without a prescription.

These guidelines, the email said, are professional tools and should be kept confidential.

The Chamber also noted that pharmacists should avoid engaging in public discussions on social media. “The Chamber reprimands pharmacists who do not uphold such standards bringing the profession to disrepute.” [Full text]