Dear Mr Emerson, pt 2

And onto Northern Ireland as the next subject of controversy. Those evil doctors preventing people from exercising their right to take the Morning After Pill!

  1. the MAP is legally restricted in the same way that other prescription only medicine is restricted. The guidelines on conscientious objection apply to its prescription, just as much as any other prescription. Access to the MAP is not a big problem for most people – it can be bought over the counter in many pharmacies (assuming that the pharmacist does not conscientiously object to dispensing it, which their code of conduct allows them to do). Professional staff are no more forbidden from withholding it than we are forbidden from withholding any other medications. Despite the clear ethical concerns about the inappropriate use of post-coital contraception on a wider societal basis, and the mode of action which is potentially abortifacient (prevention of a fertilised embryo from implanting in the womb), this medication is easy to access. Any Family Planning Clinic will willingly provide emergency contraception to whoever comes through the door, because that’s kind of their job. There’s an FPC any given day of the week within easy reach of most places around NI. Access to MAP is not a problem. Quoting data from 1997 and 2004 about access to MAP is not relevant nor useful. Are we seriously suggesting that people should access Accident and Emergency to get the morning after pill? Seriously? It may be an accident, but it’s no emergency.
  2. Contractual grounds for declining the MAP. Whether you may realise it or not, contraception services are not part of the core contract that GPs hold with the Health Board. They are additional and opt in services, which come with an additional payment. Some strands of contraception provision are subject to further opt-ins, like coil fitting or contraceptive implant insertion. It is quite possible for a GP practice to opt out of providing any contraceptive services at all, and still be fulfilling their contractual obligations. How many practices opt out of this, I don’t know. Within a practice, any given GP can choose to not provide a service, on grounds of conscientious objection; the patient will then deal with another doctor who does not share that objection. In the rare position that no other doctors are available, they will be directed towards an alternative service. That is how the system works, that is how the code of conduct works. It is not broken, and does not require fixing (unlike many other aspects of healthcare in NI).
  3. Those Scandinavian countries! Utopias of healthcare! Where all medical professionals must comply, on pain of punishment. Which is what happened to Norwegian doctor Katarzina Jachimowicz, who was fired for refusing to provide abortifacient services. But wait! Isn’t it interesting how the courts upheld her appeal under European Human Rights legislation? Pointing out how Norway is member of the Council of Europe, which holds the statement “no person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion.” Might it be that the Scandinavians are out of step with the rest of Europe on this one?

Mr Emerson, I must ask that you reconsider your outspoken position on this matter. Medical professionals are humans too, and have a broad range of deeply held beliefs which drive them on to clinical excellence. Demanding, like a totalitarian ruler, that we must comply with a noxious dictum which goes against 2000 years of medical practice and thought, on the whim of a progressive liberal tidal wave whose long term effects we are yet to see, is unreasonable and intolerant, and, indeed, illiberal.

 

Give doctors a choice.

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