The Pharmaceutical Journal
Vol 279 No 7479 p585
24 November 2007

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• Abortion
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• Ethics
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Letters to the Editor

Abortion

A patient group direction too far?

From Mrs L. C. Titcomb, MRPharmS

Discussion at the House of Commons Science and Technology Committee resulting in the report “Scientific developments relating to the Abortion Act 1967” and Pope Benedict XVI’s advice to Roman Catholic pharmacists to avoid any involvement, whether direct or indirect, in the supply of medicines used for abortions or euthanasia have raised the profile of issues surrounding abortion once again.

Whether we class ourselves as “pro-life” or “pro-choice”, the extremely high number of abortions carried out in England and Wales — 193,700 in 2006, an average of 3,725 per week — is a sad reflection of our society’s attempts to educate its members in the premise of “prevention is better than cure”.

While we are having some success with “stop smoking” campaigns , the Government’s answer to the increasing numbers of abortions is to make abortion more accessible by ending the need for two doctors’ signatures, allowing midwives and nurses to carry out first trimester abortions, including the administration and supply of abortifacients, and letting women have their abortions at home.

If the latter two proposals become law, pharmacists will need to become involved in the abortion issue once again in the preparation of patient group directions for the supply of gemeprost or misoprostol.

They must consider the scenario where a woman, who could well be in an emotional state, is sent home with a supply of misoprostol, the prostaglandin preferred by the Royal College of Obstetricians and Gynaecologists, with a patient information leaflet explaining that the drug is an anti-ulcer agent which protects the lining of her stomach which she will have been prescribed to heal or prevent ulcers in her stomach or duodenum. She will also read that she should not take the drug if she is pregnant, or trying to become pregnant, because it may cause a miscarriage.

Although patient group directions are permissible for drugs used outside their licensed indications, the Royal Pharmaceutical Society’s guidance on this states: “In certain, exceptional circumstances, medicines with a marketing authorisation could be used outside the summary of product characteristics.

Areas for consideration might include paediatrics where no licensed version exists. National Institute for Health and Clinical Excellence guidance should be followed to ensure that a medicine used in this way is justified. The PGD must clearly state that the product is being used outside the terms of the SPC and state the reasons why its use is necessary.”

With the ever-growing number of abortions, a 4 per cent rise between 2005 and 2006, this will be anything but an exceptional circumstance. Will we have to tackle this PGD too far? In June 2007, 100 members of the British Medical Association voting at their annual general meeting (the whole membership was not balloted) while supporting abortion on demand in the first trimester, did not support allowing trained nurses and midwives to perform abortions nor relaxing rules on approved premises to allow abortion at home.

However, the House of Commons Science and Technology Committee (or should I say the majority of that committee?) has supported the proposal that midwives and nurses be permitted to carry out first trimester abortions.

It has also suggested that there is no evidence relating to safety, effectiveness or patient acceptability that should serve to deter Parliament passing regulations which would enable women who chose to do so taking the second stage of early medical abortion at home, or that should deter Parliament from amending the act to exclude the second stage of early medical abortion from the definition of “carrying out a termination” to enable a trial to take place.

In George Orwell’s ‘1984’, it was intended that “oldspeak” was to be completely eclipsed by “newspeak” before 2050. This Committee is certainly helping to keep the Government’s version of newspeak right on track.

Lucy Titcomb
Stratford-upon-Avon

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