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Abortion law and the treatment of pregnancy complications




I refer to the letter (24 December 2020) by Mark Formosa. If “life begins at conception,” as some would have us believe, then it follows that whether there is a heartbeat or not, the early pregnancy is protected from the moment of fertilisation. So, whether the embryo is implanted in the uterus or anywhere else, this pregnancy is considered sacrosanct by some.

It could therefore be argued that surgical removal of an ectopic pregnancy (necessary to save the woman’s life) might be considered the same as an abortion in the eyes of Maltese law, given that in both cases the pregnancy is terminated. The law, after all, does not define what “inducing a miscarriage” is. Moreover, although very rare, a fertilised egg may implant in the abdomen and may reach viability if not removed. Administering methotrexate in certain specific cases of ectopic pregnancy will cause an early embryo to stop developing. Is this an abortion or is it not?


If this is not an abortion, and the implantation of a fertilised egg in its proper place in the uterus is a prerequisite for an act of abortion, then why is there controversy surrounding the use of morning after pills?


Our position as Doctors for Choice is that, even though clinically we distinguish between a pregnancy within the uterus that fails (a miscarriage or spontaneous abortion) and an ectopic pregnancy which is implanted outside the uterus, the lack of a clear legal framework, as well as the lack of policy guidelines on when the ‘principle of double-effect’ can be invoked, can have a huge negative impact on patient care. It may also lead to medical professionals being reluctant to make clinically sound decisions to terminate a pregnancy which is threatening a woman’s life, for example in cases of sepsis in premature prolonged rupture of membranes.


This is why as Doctors for Choice we advocate for the decriminalisation of abortion. It would give medical professionals a freer hand in treating all kinds of complications in pregnancy and help them reduce the risk to pregnant women’s lives. It is inspiring to see the law students’ association (GħSL) endorse this position and call for the decriminalisation of abortion in Malta.


However, on one matter we will agree and that is that our respective stands reflect our personal moral beliefs and that these have nothing to do with science. It follows therefore that if we believe in freedom of conscience and personal autonomy, it should be the woman herself who decides on her pregnancy. This is at the core of the pro-choice movement.


By Dr Christopher Barbara