Ms. Mary McConalogue, Pharmacist
If the 8th Amendment is repealed, I do not know if I will be able to continue to work as a pharmacist. As is the case for other healthcare professionals, there will be huge implications for the practice of pharmacy in Ireland if the 8th amendment is removed from our constitution. The first principle of our code of conduct as pharmacists is directed to “maintaining and improving the health, well-being, care, and safety of the patient.” We are told that our primary focus is the health of our patient. In pregnancy, I have an ethical responsibility to two patients, the mother, and her unborn child, and both patients are currently protected under the 8th amendment.
Women are entitled to get all the medical and pharmaceutical care that they need to protect their life and health during pregnancy under the 8th amendment. As pharmacists, we treat women with health conditions in pregnancy all the time with the appropriate drugs, with due regard to the effects these drugs may have on the foetus, while not compromising the care of the mother. Under the 8th amendment, I’ve been able to treat mothers during pregnancy whilst doing my best to protect their babies also.
My duty of care to the unborn patient is manifested clearly in the current cautionary approach to the use of highly teratogenic drugs and the stringent measures in place around their prescribing, to avoid, as far as practically possible, the exposure of our unborn patients to these drugs. How do we reconcile our role of doing our best to protect not just the life but the health of the baby in utero, to dispensing drugs which will intentionally end the life of the baby in utero?
If the 8th amendment is repealed and the proposed legislation enacted, I may well have a direct role in ending the life of one of my patients. Never in my professional career have I been asked to disregard my duty of care to any patient in such a blatant manner. Indeed, up until now, were I to act professionally to deliberately end the life of one of my patients, I would no doubt have my licence to practice as a pharmacist revoked, and rightly so.
In the proposed legislation, Minister Harris states clearly that ”termination of pregnancy means a medical procedure which is intended to end the life of the foetus”. This entirely contradicts the current efforts and indeed the ethical responsibility of doctors to preserve life where possible, starting with the mother and making every attempt to save the unborn baby as far as practicable. Early delivery of a baby is sometimes medically necessary when there is a substantial risk to the mother’s life, even if there is little or no chance of the baby’s survival. The Medical Council guidelines are clear that this risk to her life need not be “immediate or inevitable”. In these cases, the possible or probable death of the baby is a foreseen but unintended consequence. However, there is no medical condition for which the intentional ending of the life of the baby is a treatment.
Medical abortion involves the sequential use of two drugs to end a pregnancy. The first drug, mifepristone blocks the action of the pregnancy hormone progesterone, resulting in the death of the foetus and subsequently another drug, misoprostol, is used to induce contractions to expel the dead foetus. Surgical abortion involves the use of drugs to dilate the cervix in order to allow for the passing of a suction tube or surgical instruments into the womb to remove the baby by vacuum aspiration or D&C (dilation and curettage). Finally, drugs are also used in abortions after 22 weeks gestation to ensure foetal death before delivery. Feticide normally involves the injection of a lethal dose of potassium chloride into the heart of the baby, resulting in cardiac arrest and death. Sometimes, a toxic dose of digoxin is injected into the amniotic fluid instead for the baby to ingest in order to stop the heart. This commonly used heart medication is given at a dose 4-8 times the safe dose for a fully grown adult, although this drug is not used as much as some babies have survived this method. Drugs are then used to induce labour and delivery of the dead baby. As a pharmacist who is committed to ensuring the safe and appropriate use of medicines, how can I endorse or dispense these medicines which are purposefully being used to intentionally end the life of a human being?
As a pharmacist, my focus has always been on obtaining the best possible health outcomes for my patients, born and unborn. Sometimes drugs used in pregnancy are not just to maintain the mother’s life and health, but to maintain the life and health of the baby in utero. A classic example of this is the use of progesterone support in early pregnancy in order to maintain the pregnancy if the mother’s progesterone levels are compromised. This treatment has helped many women who have previously suffered miscarriages to carry their babies to term. If the 8th amendment is repealed and the use of abortifacients becomes legal, how will I reconcile the use of one drug to help protect the life of certain developing babies, whilst on the other hand, another drug will be used to deliberately end the life of other developing babies. Will I have a selective duty of care to some patients and not others? Surely, either all babies are worthy of my care and consideration, or none.
Conscientious objection
Removing 8th amendment will not only remove the right to life of unborn, but will also remove my right as a healthcare professional to endeavour to preserve life. The right to conscientious objection has been eroded for the most part in the majority of countries where abortion is legal. If we repeal the 8th amendment, the most fundamental human rights of our youngest patients will be no longer be recognised and there will be a direct conflict between the law and my ethical responsibilities as a pharmacist. Will I be forced to act against my ethical obligation to protect and preserve the life of one patient, and to protect and preserve the health and wellbeing of the other? Of interest, pharmacists are not mentioned at all in the proposed legislation when it comes to the right of conscientious objection.
Online drugs
Some say it is necessary to legislate for these medications as presently they are being purchased online, imported and used illegally. As a pharmacist, I absolutely discourage the use of medicines that have been procured online whose quality, safety and efficacy has not been verified or can’t be guaranteed. It is important that any woman who has taken these drugs seeks medical help, regardless of the circumstances in which she has obtained or taken them. Our health system will never turn away a woman who needs medical help after an abortion. In fact, the Medical Council guidelines are very clear with regard to the obligation of doctors to care for and support these women and to respect their right to confidentiality. In jurisdictions where abortion is legal, abortion pills continue to be imported and bought online so legislation does not eradicate this problem. More importantly, how can we legislate for a drug that deliberately sets out to end the life of a human being? Again we have to remember these drugs are illegal for a reason.
The law is in place to protect each of us from deliberate harm by another person.
It seems to me that removal of the 8th amendment will directly contradict some important aspects of my code of ethics as a pharmacist, especially in relation to my duty to “not supply any product, which may impose a hazard to a patient’s health or wellbeing ”, to “ encourage the rational and proper use of medicines ”, to “ ensure discriminatory practices are not demonstrated towards any class of patient or sector of the community ” and perhaps most importantly to “ensure the patient is at all times acknowledged as a person ” . If the 8th amendment is removed, we’ll have to reset the goalposts when talking about ethics.
Bodily autonomy
The pro-repeal idea of choice and bodily autonomy is an interesting one. Of course, a woman has right to bodily autonomy as far as it affects her body. However, there are two bodies involved in pregnancy and once a person’s right of bodily autonomy starts affecting another person’s body, there has to be a limit. The unborn baby has a right not to have their bodily autonomy violated through abortion. Bodily autonomy is limited to a certain extent when it comes to medicine and healthcare. We are not given free reign over what prescription medicines we can take for instance. These measures are in place for our safety and protection. In fact, it is stated in our code of conduct that we must “endeavour to ensure the safety of the patient in all circumstances by decision-making, which may at times conflict with the stated requirements of the patient .” It is not always the patient’s choice that takes precedence. The concept of choice is superseded by the professional duty of care in this instance.
Therefore, why should we deny this same protection to our youngest patients in the name of choice? Again, to quote the Code of Conduct…we must “safeguard society as a whole by ensuring that the protection of vulnerable individuals is given due significance ”. Who can be more vulnerable than the baby in the womb?
Finally, the pharmacy profession has always shared a key value with most other healthcare professionals, that is, an innate desire to protect life and health as far as practicable. The future of healthcare looks bleak indeed as we reflect and consider the implications of removing the most fundamental of human rights from our unborn patients, namely, the right to not have their lives harmed or ended deliberately by the very people who should be caring for and protecting them.
