Pro-choice doctors call for abortion to be decriminalised in position paper

Abortion should be regulated as a health care matter, not under criminal law, pro-choice group Doctors for Choice said.

On Wednesday, the group, which is compromised of 25 doctors published their position paper on abortion, a first for Malta. They said that its primary legislative aim was to repeal Article 241 of the Criminal Code and any other such legislation that may be related to the criminal sanctioning of abortion.  

The group acknowledged that there are some women who would wish to continue with their pregnancy even in cases of unfavourable situations, and these should be well supported by social services. However, at the same time, it acknowledged that this is not everyone’s choice, and those who need access to abortion should be helped and supported.

“Abortion should be regulated under healthcare policy and not under criminal law. The lack of a clear legal framework and policy guidelines for when a woman’s life is at risk is particularly worrying and should be changed to clearly reflect the absolute protection of women in Malta,” the paper read.

Doctor’s for Choice said that due to the lack of abortion services, Malta’s medical authorities are falling short of best-practices and highest standards recommended by international guidelines which are based on evidence-based medicine.

“We have provided evidence that despite abortion being illegal, people in Malta still seek and obtain abortions both locally and abroad. Therefore, doctors inevitably deal with issues related to abortion and it is undesirable for them not to be well-informed and well-trained on these matters.”

The group highlighted that a recent study conducted in Malta found that out of 454 doctors the majority do not agree with a total ban on abortion and support its legalisation in limited circumstances.

“There were clear majorities favouring legalisation when a woman’s life is in danger and in cases of non-viable fetal anomalies. There was also support, albeit to a lesser extent, in other circumstances such as rape (or incest), to preserve physical and mental health.”

Doctors for Choice also detailed the limitations doctors are met with when it came to advising pregnant women on abortion as well as providing post-abortion care.

“Women in Malta do procure abortion either by travelling abroad, purchasing medical abortion pills online, or attempting unsafe non-recommended methods… these women are reluctant to seek medical help if they experience difficulties or complications (out of fear of being criminalised). If they do eventually seek help, they do so at a later than ideal stage, and even then, they are reluctant to disclose all the information which would normally help doctors manage the patient safely.”

The group also said it effected the relationship doctors were able to have with their patients. They argued that women’s reluctance to speak about having an abortion with their GP meant that more often than not they are left to take care of themselves. “The lack of accessibility to professionals who are willing to help them make their own informed decisions may lead to options of sub-standard or unsafe procedures.”

Abortion ban: a risk to women’s lives

The group said that the criminal code currently has no provision for abortion under any circumstances, not even when a woman’s life is imminently at risk of death as a result of pregnancy. This, Doctors for Choice said, puts women’s lives inherently at risk.

They criticised the current local medical practice that is generally applied, the ethical principle of double-effect – this principle originated in Catholic philosophy, it says that it is permissible to do something morally good that has a morally bad side-effect.

“Although it may be considered a guiding ethical principle, this does not provide clear grounds on how to act in certain sensitive situations. For example, it may result in treatment being delayed (as precious time can be wasted waiting for the condition of the woman and/or fetus to improve or deteriorate), thereby possibly endangering a woman’s life.”

The paper was prepared and written by Dr Christopher Barbara, Dr Gilbert Gravino, Dr Jamie Grech, Dr Natalie Psaila, Dr Elena Saliba and Prof. Isabel Stabile.