Providing genuinely non-directive healthcare: imagine being a GP in Ireland in 2019

Imagine you are a GP. You are pro-choice, and strongly believe that women who want abortion should access it, and so you have signed up to provide medical abortion through your practice. You have received training on the medical aspects of this from the HSE, and on how you regard abortion and how this might influence you in your work (with no training offered on how you regard women in various circumstances continuing with their pregnancies). As a GP, you have some training on how to respond to a patient with empathy, but you have no formal training in psychology or counselling.

Imagine a woman has come to your surgery. She is six weeks pregnant, and she is distressed. The pregnancy is completely unplanned and unexpected. She explains that she never would have even considered an abortion before, but she also never even considered being pregnant at this stage of her life. She has absolutely no idea what to do. She asks you for help. She asks you what you think she should do.

As a GP, it’s not your place to tell this woman what to do. You know that, and you certainly don’t intend to consciously do so. However, you also know that you will definitely see this woman again, at least twice. You may see her in two days’ time. At that time, you may give her the first of two pills that will cause an abortion, and send her home with instructions on when to take the next pill. You will then see her one more time to check that she is well after the abortion. If there are any complications you will refer her to the local maternity hospital. Either way your role will most likely be finished. For these three visits, you will receive €450 from the HSE. Any further visits will be covered by your normal GP fee.

Alternatively, you may see her again in twelve weeks or so, for the first of at least five routine antenatal appointments. This is assuming, of course, that she doesn’t have any difficulties before then or doesn’t otherwise require your assistance. If she turns out to have a medium or high risk pregnancy, or suffer from complications, you will see her more frequently. You will also check the baby two weeks after birth, and will perform another full check on both the woman and the baby six weeks after birth. For all this, you will receive €215 from the HSE. You will then almost certainly provide unlimited free GP care to the baby until he or she is six years of age, for €125 per annum.

You want to do the right thing. You want to help this woman. You don’t want to make her decision for her. But your practice is in crisis, your resources are stretched, your waiting lists are growing and you’re finding it hard enough to keep the show on the road as it is. You’re working longer hours for less money and you’re sick and tired with how general practice is treated. Can you be sure that none of that will influence you, either overtly or covertly? Can you be sure that you can definitely leave every bias, every impulse behind? Can you be sure that this woman can make a free choice? Or might the fact that you view abortion as a normal part of reproductive healthcare, along with the general pressure you’re under, lead you to inadvertently steer this woman towards a course of action she may live to regret?

Muireann

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