This article appears in the February 2001edition of the Catholic Medical Quarterly
......... AND THE OTHER GREAT ISSUE
This is the Statutory Instrument promoted by the government to permit the morning after pill to be sold without prescription to girls over the age of 16. This pill has been described as emergency hormonal contraception. It is not. It is another form of chemical abortion. RU 486 was the first: some members of the Guild will remember our efforts by visiting Hoechts in Frankfurt and Roussel in Paris in an effort to prevent its marketing in this country.
As every GP knows, this pill is designed for use up to 72 hours after intercourse. Its dose of hormones is equivalent to 10 doses of oral contraception and it prevents the successful implantation of the embryo by rendering the endometrium inhospitable. The Department of Health claims that it is not abortifacient as pregnancy only occurs once an embryo is implanted. No established scientist could be found to accept such a claim.
A similar dissimulation accompanied the launch, many years ago, of the contraceptive pill. It was widely marketed initially as a menstrual regulator. Many years elapsed before its action on the endometrium, confirming its abortifacient effect, was admitted. The side effects of this new form of chemical abortion are well known and readily available to practising doctors. Now their patients are to be given it by pharmacists who can have no current knowledge of the women's state of health or medical history which might make its prescription undesirable. Immense legal problems are being stored for the future.
Whilst the application is only for women over 16 how would this be verified? Many look more than 16; and it is unlikely that the pharmacist will insist on the production of a birth certificate. A black market is certain to develop. The over the counter license will increase promiscuity (since it is used after intercourse it could not reduce sexual activity). Equally it is unlikely to reduce the explosion of teenage pregnancies; we have already the evidence that the free provision of contraceptives has not done so. How could this further offering of official liberalism to teenage anarchy succeed any better? According to a paper in the Lancet (1998; 352:428-33), 1.1 women became pregnant despite using Levonorgesterol. This means that for every 100 women prescribed this pill at least 1 will become pregnant.
Despite nearly a million prescriptions for the pill being issued each year, the number of registered abortions was at its highest ever in 1998.
There is a rather vague suggestion that the pharmacist recommend follow-up with the GP whom the woman has already chosen not to consult and, having received the prescription, is most unlikely to consult, A gap is thereby introduced in the continuity of care and follow-up arrangements. If the woman suffered a problem - a ruptured ectopic pregnancy, a worsening migraine, or a thromboembolic complication - who would be legally responsible?
All is not entirely gloomy for it has been announced that William Hague has tabled a motion calling on the government to withdraw its order. It reads:
"That the Prescription Only Medicines (Human Use) Amendment (no.3) Order 2000, dated 8th December, a copy of which was laid before the House on 12th December, be annulled".
It has been signed, in addition to Mr. Hague, by the shadow health ministers and the opposition chief whip. This is probably the first time the leader of a major party has entered the bioethical fray: the intervention is to be greatly welcomed,