It's Time to Free the Pill

Back in the 1960s, when the Pill became available in Aotearoa New Zealand, the New Zealand Branch of the British Medical Association (the precursor to today’s NZMA) decided it would be unethical for doctors to let unmarried women get their hands on it. Doing so, it was argued, would be akin to doctors giving extra-marital relationships a stamp of approval, and the NZMA wasn’t about to do that.

If you thought doctors keeping us from the Pill for our own good was a thing of the past, think again. Sure, it’s no longer under the guise of protecting our moral purity – (most) doctors have (mostly) given up on that argument. Now, it’s all about protecting our health.

As recently as 1996, both the Royal College of General Practitioners and the NZMA opposed the reclassification of the Emergency Contraceptive Pill so it could be purchased in pharmacies. “We have concerns that in a pharmacy the patient may be disadvantaged from receiving the greater advice that would occur in a general practice consultation,” the college’s chairman, Professor Gregor Coster, was quoted as saying in an article in the British Medical Journal.

Fast forward to 2016, and a new front in this seemingly endless struggle is focused on efforts to get the Pill, aka oral contraception, liberated from doctors’ prescription pads and made available over the counter. The most recent round began in 2014, when Pharmacybrands Ltd (now Green Cross Health, which represents 300 community pharmacies and has an equity interest in 80) and Pharma Projects Ltd, (now Natalie Gauld Ltd.) made an application to Medsafe’s Medicines Classifications Committee to reclassify the Pill so it could be sold in pharmacies without prescription, though only by specially trained pharmacists, following the model that’s now used for the Emergency Contraceptive Pill.

 That application was turned down in the face of stiff opposition from general practitioners and the NZMA: the latter said they didn’t think prescription only access was a barrier to the Pill and wanted to make sure doctors continued to provide “the advice and counselling about its use and about sexual health in general”, while the College of GPs, apparently felt “as if they are being excluded from an important part of primary health care”. (Never mind that the actual users of this “important part of primary health care” were – and continue to be – excluded.)

On the plus side, the New Zealand Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (is that a long enough title for you?) backed the reclassification saying it was “strongly in support of any responsible development designed to improve access to quality contraceptive advice and service”.

Guestie: No Shame

By Terry Bellamak

Guest Post

It’s been a week since the MyDecision website launched. The response has been surprising and weird. The Dom asked lots of anti-abortion people for comment, though the site is not just about abortion. Most of those folks have tried to frame MyDecision as a ‘name and shame’ operation.

I find that mystifying. What exactly is shameful about having it generally known that you have taken a moral stance?

There are, however, a few possible reasons why a provider might actually feel defensive about ‘conscienciously objecting’.

First, it is impossible for a health care provider to tell a patient he or she will not provide a service on CO grounds without implying that the patient is morally inferior to the provider. That premise may have sounded reasonable back in 1977 when the law was passed, but in 2014 it’s just bizarre. Who thinks like that anymore?

Second, the way CO is applied here in New Zealand, the patient’s interest in getting care is sacrificed to the provider’s interest in leaving out the parts of their profession they find objectionable. Think about it. You make an appointment, ask for a service, the doctor tells you no. The doctor is not required to refer you to someone else, so you may have to start the process of finding a doctor and waiting for an appointment all over again, but you may be a few dollars poorer if you just paid for a consultation in which you received nothing of value. The doctor benefits but the patient pays the freight. How is that fair?

I would feel embarrassed if my exercise of conscience insulted and burdened my patients, so maybe CO health care providers feel that way too. If so, MyDecision can help. We have a page especially for providers who agree that ethical CO requires disclosure. Providers can put their names on the voluntary list, along with what services they do and do not provide. This list exists to support ethical CO providers who agree that the status quo is unfair.

Even providers who do not report themselves are not criticised. They are listed without comment. Patients need this information to avoid wasting their time and money on providers who won’t give them the services they need. I have yet to hear a convincing argument why patients should be kept in the dark about health care providers’ CO intentions.

The site’s ultimate purpose is consumer protection.

Some coverage so far:

Dominion Post: Database lists GPs opposed to abortion

Marlborough Express: Health Website Not 'Sinister'

SunLive (Tauranga): Anti-abortion listing stuns centre