Abortion case study: Two doctors and their polar views on termination

Three years after legislation allowing abortion on request up to 12 weeks’ gestation was commenced, just 10 per cent of GPs are providing it.

There are, according to the Irish College of General Practitioners, 3,982 full- and part-time GPs. Of these, according to the Health Service Executive, 413 are contracted to provide early medical abortions (EMAs) up to nine weeks. From 10-12 weeks a woman must attend her nearest providing hospital.

Dr Niall Maguire, based in Navan, Co Meath, is in the majority. Having campaigned against repeal of the Eighth Amendment, he says it is “important to resist” the idea that abortion is “normal healthcare”. The Eighth Amendment effectively banned abortion and was repealed following a 2018 referendum.

However, Dr Madeleine Ní Dhalaigh in Castlerea, Co Roscommon, says it is important abortion care is seen as “healthcare, integrated into the health system”. She has concerns aspects of the legislation remain “prohibitive” and “stigmatising” for some women.

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One of just two GPs providing abortion in Roscommon – the other being her husband – at one time, she was seeing women from counties Mayo, Sligo and Leitrim, so sparse was the service.

“We had women coming from west Mayo, Sligo – maybe 80, 90km, for their two appointments. It was really difficult.” Two consultations, three days apart, are required under the legislation.

Dr Ní Dhalaigh sees this as “infantilising” of women. “By the time most women come to us, they have their minds made up, they know what they want. As GPs we are well-trained to discuss the whole process. If we detect any reticence or coercion, we would always advise them take a breath and maybe come back in a few days.

‘Control mechanism’

“We should trust women and GPs to do the right thing. I think the three-day wait is a control mechanism.”

The fact eight of the 19 maternity units still don’t provide abortion services, she says, “is not good enough … [Obstetricians working in them] should be told, ‘This is legal healthcare now’.” She believes more GPs would provide medical abortions if their local hospitals did too.

When a woman presents to Dr Maguire with a crisis pregnancy, “You can’t but have compassion,” he says, “but you have to have some consideration for the other patient in the room – who may be an unborn woman.”

If she asked for an abortion, he would tell her clearly he did not provide the service, and direct her to the HSE’s My Options website. “I would say there is a website and offer their medical notes. I would be clear, because patients ask my opinion, about my view. I would, and I have, encouraged women not to have an abortion.

“I don’t call it conscientious objection. I call it good medicine,” he says.

“There is a spectrum. I would have a very different attitude to an 18 year old who is looking for her third abortion than I would to a 38 year old woman with four children who is under huge pressure. You might say that is judgmental but doctors are leaders. We have an obligation both to the patient but also to the communities we work in, to lead and to point towards better solutions.”

He is happy the legislation accommodates doctors who don’t want to provide abortion, but enables them direct patients in crisis to accurate information. “There is a large body of doctors who don’t think abortion is good in any circumstances and a larger body who won’t be involved in it.”

A spokeswoman for the HSE said it was “working towards increasing the availability of abortion care for women under 12 weeks”.