Iwanttotreatallpatientswithcare andcompassion
ON May 25 Ireland will decide if I can treat all my patients with care and compassion or only some; if I am trusted to discharge my duties responsibly or if I must continue – out of fear of prosecution, jail time or potentially losing my medical license – in refusing to help a patient in distress. I’m an Irish woman in my 30s. This is my sixth year working as a doctor, and my first year of GP training, based in the South East.
In many ways I feel lucky to be working as a doctor in Ireland today. We’ve changed how we practice medicine for the better. We use the idea of ‘shared care’ when deciding on how to treat our patients. We talk through treatment options with patients and involve them in decisions about their own health.
Patients make decisions themselves with advice from doctors about the risks and benefits of each choice. The patient can rely on the doctor for support, expertise and advice but ultimately they make their own decision.
This is not the case for pregnant women. A woman pregnant as a result of rape, a woman with a much-wanted pregnancy who has learned the devastating news of a fatal fetal abnormality, a woman pregnant with a diagnosis of cancer, or a woman in a crisis pregnancy. These women have no doctor to counsel them appropriately; no support; no care. Instead, the courts tell me what I must do, and not do. They tell me how much I can, or more accurately cannot, do my job.
People worry, understandably, what a new system would look like in practice. I can tell you, because I’ve worked in such a system. In 2015 I was part of an Obstetric and Gynecology team in an early pregnancy clinic in New Zealand, a country where women are permitted access to abortion services. In the early pregnancy clinics we saw women up to the twelfth week of gestation. Most of the women I saw were experiencing miscarriages (up to 20 percent of pregnancies end in miscarriage). Others had been diagnosed with fatal fetal abnormalities such as anencephaly (where the fetal head fails to develop). Some were in a crisis pregnancy in need of support and compassion.
I spoke with all of these women, listened to their concerns and talked them through their options, every week for six months. These options were:
Conservative medical management — wait it out and see if the woman completes her miscarriage without intervention;
Medication management — an abortion pill taken in a safe, medical setting with advice to return if any complications occur, and complications did occur (one woman required multiple units of blood after a severe hemorrhage);
Or surgical management — where a women undergoes general anesthetic and a surgical termination. All women could go home and think about their decision.
Unsurprisingly, every woman was different. Close to home and with no Ryanair flight to rush
“It is the cruellest experience as a doctor not to be able to help someone in distress”
off to, women could and would change their mind. There was no pressure, no stigma, and no shame. No woman I encountered ever visited the clinic treating termination as a contraceptive. No woman ever visited the clinic flippantly. This is the reality. Real women, in real circumstances— mothers, sisters, aunts, partners, daughters—being cared for appropriately and with compassion.
The Irish medical council guidelines on ethical practice for doctors state that:
Doctors must always be guided by their primary responsibility to act in the best interests of their patients, without being influenced by any personal consideration. They should act independently in the service of their patients and have a responsibility to advocate with the relevant authorities for appropriate healthcare resources and facilities.
Ethically, we are obliged to do something that legally may put our patient and us at risk of prosecution. It is the cruellest experience as a doctor not to be able to help someone in distress. I will qualify as a GP in 2021 and I hope by then I will be allowed to treat all my patients with care and compassion. On May 25 I’m voting Yes.