ACT women crossing border for medical termination


Caroline Le Couteur
Caroline Le Couteur. Image: ACT Greens

The ACT Greens are tabling legislation to improve access to medical abortion in the territory, a move welcomed by the Guild’s ACT branch

While abortion has been legal in the ACT since 2002, current legislation requires that they be performed in an “approved facility,” which is currently limited to the Marie Stopes clinic and the Canberra Hospital.

However Greens MLA Caroline Le Couteur, who is set to introduce new legislation this week, says that limiting medical termination to these facilities raises issues around discretion and practicality.

In 2016, new laws were brought into effect to stop pro-life protesters from intimidating or filming women who were attempting to access the Marie Stopes clinic in Civic.

Three men later faced court over the issue after they continued to attend the area – without most of the props they had previously used, such as religious symbols and a box containing a model foetus – and engaged in “silent prayer”. A magistrate dismissed the charges against the men earlier this month.

The Canberra Times reports that Ms Le Couteur has learned women were crossing the ACT/NSW border to access mifepristone and misoprostol (RU486), at a cost of around $250 – compared to $500 for a medical or surgical termination at Marie Stopes.

In NSW, QLD, WA and Tasmania, women can access medical abortion services to terminate a pregnancy.

“It’s not acceptable that Canberra women are forced to travel interstate to access medical abortions,” Ms Le Couteur says.

“No matter where a person lives, they should be able to exercise their reproductive health rights.

“We welcome contributions from both the ALP and the Liberal Party on this important public health issue, and hope that they too will back women’s rights in the Territory in voting for this Bill.”

The Greens said in a statement that, “Medical abortion provides a safe, accessible and private means of terminating an early pregnancy with medication.

“Medical abortions are prescribed in other states and territories by licenced medical professionals, including GPs and nurses. Women can have a professional consultation by phone without a need to visit a clinic.”

According to the Times, the new legislation will allow pharmacists and other health professionals the right to conscientious objection, “unless it was a life or death situation”.

Simon Blacker, president of the Pharmacy Guild ACT Branch, told the AJP that “Any change in legislation that allows female patients greater choice and flexibility for their own choice is a good thing”.

“It would be great to see the ACT fall into line with other laws and regulations as I understand them,” he says.

“It’s a sensitive issue and it takes courage for someone to present a prescription like that. So it should be something community pharmacy is happy to help with.”

Mr Blacker said that while it’s currently rare that RU486 is presented on prescription, this may change in the future, so it was important for pharmacists to consider how they would manage stocking and dispensing the drug – as well as gaining registration to do so.

He also said he was looking forward to seeing how scripts would make their way to the pharmacy.

“Obviously if there’s going to be a teleconference or phone consultation, and a prescription is written, it won’t be handed to the patient physically.

“So consideration needs to be given to how that is communicated to a community pharmacy to dispense, and if the pharmacist feels it’s been done appropriately, the next step is whether they carry the stock, and are they registered.

“I think as we go down this path they may be more likely to carry it.”

He says he also supports consideration for conscientious objection.

“It comes down to personal beliefs,” he says. “The way I see it, if a person has beliefs where they can’t fulfil their professional obligations at that moment, they need to know where to refer to.

“My personal view is that it’s my job to help people, but I’ve worked with pharmacists who are not comfortable handling this, and in those instances the pharmacist needs to know how to refer to another supply point so patients aren’t disadvantaged.”

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8 Comments

  1. Rod Scaife
    20/03/2018

    Mr Blacker makes some claims that really can’t go unchallenged. He states that any pharmacist who refuses to dispense RU486 is, at that time, “not fulfilling their professional obligations”, and goes on to say ” it’s my job to help people”, implying that everyone else who doesn’t hold to his views, is not.
    I would ask Mr Blacker just one question. When does life commence? If it is not at conception, then when? 10 weeks, 20 weeks, or is it not till birth? For those of us who are convinced that life begins at conception, then we are indeed fulfilling our professional obligations and helping to fulfill the first and primary requirement of medicine which is to do no harm. That applies to all life, no matter how young or old.

    • PeterC
      20/03/2018

      I would have thought it was fairly well-established that personal moral/ethical beliefs are not the same as – and do not trump – professional moral/ethical obligations. A pharmacist (or other professional) faced with a professional situation that challenges their personal morality always has the option of refusing to be part of that professional relationship (in which case they are indeed ‘not fulfilling their professional obligations’ even though they might be fulfilling their personal moral obligations) PROVIDED THAT they refrain from judging the patient, or being seen to do so, and direct them in a calm, non-judgemental and professional manner to another pharmacist who does not have such a moral objection. The bit about not judging people is important and includes not assuming – for example – either that our personal moral code is necessarily superior to that of the patient or that the patient’s decision is somehow not fully morally informed. Nor do we have the right to interrogate them about it. We would be failing patients professionally if we left them feeling that THEY are paying a personal price for OUR moral beliefs. In this sense, arguments such as the one about when life begins would – professionally speaking – only be relevant at a general (non-personal) level and then only in deciding whether or not to participate in ANY care relationship that involves RU486 (for example). Or so it seems to me.

    • Karalyn Huxhagen
      21/03/2018

      If you refuse supply based on moral beliefs and there is no alternative supply available in a reasonable distance for the patient to access then we will see you at AHPRA if the consumer or Doctor files a complaint.

      Be very careful when applying moral beliefs above ethical and professional responsibility as you have no idea why the Doctor and patient have made this decision.

      You will lose the case as we have seen many times before.

    • Jarrod McMaugh
      21/03/2018

      I think Peter has covered the issue of personal morals vs professional ethics quite well, and Karalyn has addressed the consequences quite well too.

      My only addition is to keep in mind these two things:

      1) Your professional obligation is to the person who is presenting to you for treatment. That would be the adult female in this situation. Your moral objection may be in relation to the consideration of whether an unborn person is entitled to your protection – but they aren’t your patient.

      2) Professional ethics state that you put the expectations of your professional role above your own personal morals, and that you don’t hold another person to your moral standard. It is unethical to hold a person to your own personal morals.

      Just remember that your morals say what you do; they don’t prevent another person doing what they wish to do. While you are not obligated to participate, you can’t prevent a person from continuing; therefore a referral is your obligation.

      • Rod Scaife
        21/03/2018

        So,Jarrod, if someone presents with a prescription that you know is going to harm them, your argument would mean that you just go ahead and dispense because you ” can’t prevent a person from continuing” ? Clearly that is ridiculous, and presumeably you exercise your professional role in this way all the time and refuse. But why? Don’t they also have the right to get what they want?
        I think things become clearer if, instead of a mother and an unborn child, we consider what to do if conjoined twins were to present at your pharmacy and one of the twins didn’t want to live with their twin any longer and had a prescription for something that would kill their other twin. According to your argument, you have no right to refuse supply because the person’s rights who are presenting with the prescription over-ride all other considerations, including the rights of the other twin.
        When regulators impose expectations of my professional role that contravene the supreme fundamental professional ethic of medicine, ie. first and foremost, do no harm, then I have every right , and even a duty of care, to refuse, not just on moral grounds, but because it is breaking such a basic requirement of medicine.

        • Jarrod McMaugh
          22/03/2018

          Firstly, pharmacists don’t make that oath as part of registration, but you do agree to adhere to the ethical standards adopted by AHPRA, which includes the expectation to refer in the situation described in the original article.

          The idea of doing no harm is about as relevant to modern medicine as the Bible’s interpretation is to modern life…. These things were written at a time when people had very limited understanding ogmf the impact of what they write. “First do no harm” becomes invalid the first time you give a medication that has a narrow therapeutic index or even a high incidence of minor side effects…. Let alone when you start considering surgery.

          • Rod Scaife
            22/03/2018

            Jarrod, I am really sorry you think the concept of doing no harm is obsolete and the Bible is irrelevant to modern life. Have you ever read the New Testament and looked at the life of Jesus and what he said, did and taught? You may be surprised if you did, because I challenge you to find one thing he said, did,or taught that would not result in a better society if more people followed his examples and teachings.
            Negative side affects, be they from medications or surgery, where the goal is to help and heal the patient, are hardly the same as deliberately giving or doing something that has the sole goal of taking a life. The only real issue is when does life start? If at birth, then whatever exists in a mothers womb before birth is not a human life, but just an accumulation of cells. But this is a nonsense, as thousands of premature births testify otherwise. So, I again ask, if not at conception, when does life start? And if it starts at conception, then that life should have as many rights as my example of a conjoined twin, should have.

          • Jarrod McMaugh
            22/03/2018

            Rod, I advise you to be very very careful in how you represent what I say.

            I’m happy to have the debate on ethics, but do not try and represent what I say in a way that distorts my point – in other words, quote specifically what I say or don’t refer to it at all.

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