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Achieving excellence in abortion care (not)

An international meeting of professionals committed to ensuring women have access to abortions will be held in Spain on October 22 and 23. The title is “achieving excellence in abortion care”.

One of the speakers at the FIAPAC conference will be Melbourne-based ethicist Dr Leslie Cannold, who will describe the campaign that led to abortion being decriminalised in Victoria.

Such timing.

Cannold has this week been tweeting furiously on the trial of the young couple in Cairns on charges related to a medical abortion.

Meanwhile, Cairns-based obstetrician and gynaecologist Professor Caroline de Costa, who has written regularly on issues related to abortion law reform for Crikey, today provided this analysis of the case (this article was first published today in the Crikey bulletin).

Caroline de Costa writes:

After less than an hour of deliberation late yesterday morning, the twelve Cairns citizens appointed to the jury for the trial of Tegan Leach and Sergei  Brennan stood firm before Judge William Everson and delivered their verdict: not guilty on both counts.

Immediately there was sustained applause from the public gallery, which was filled with friends and supporters of the young couple and pro-choice activists, who had continued their vigil for reform of Queensland abortion law for nearly four days outside the Cairns courthouse.

Thus ended an ordeal of more than 18 months for Leach and Brennan, who have been hounded from their home, had Molotov cocktails flung at their apartment and most difficult of all, had details of their private lives widely exposed on the internet ever since these charges were first reported in April last year.

Leach was charged under section 225 of the Queensland Criminal Code of 1899, becoming the first woman ever to be tried under this section, and probably the first woman in any Australian jurisdiction ever to face such a charge.

Section 225 covers a woman who whether actually pregnant or not (since in 1899 there were no home pregnancy tests and women had simply to suspect or fear that they were pregnant) either permits another person to attempt to procure an abortion for her, or herself uses force or any “noxious” thing, or any other means, with the aim of bringing about an abortion.

Brennan was charged under section 226 of the Code with unlawfully supplying Leach with the means to procure an abortion – it was alleged that he had arranged for a relative in the Ukraine to post him tablets of the two drugs mifepristone (RU486) and misoprostol, together with instructions in their use; that he had then given these to Leach; and that she had used them to bring about an early abortion in the couple’s home in December 2008. These two drugs are those widely and safely used in many countries (and now to some extent used legally and safely in Australia) for the purpose of medical abortion.

These charges were not about the illegal importation of drugs into Australia. Brennan freely and frankly admitted that he had arranged their importation, pointing out that he knew the drugs to be legal in the Ukraine (where he was brought up) and in Russia; furthermore he believed that if they were not legal in Australia the Australian Customs would not have allowed the package into the country.

Nor were the charges about the dangers of using drugs for medical abortion without the supervision of a medical practitioner. Medical evidence was given to the court by Professor Nick Fisk of the University of Queensland, who explained clearly and concisely that both mifepristone and misoprostol are safe drugs but that there are occasional contra-indications to their use, and occasional complications from their use, and that a woman considering a medical abortion should have a consultation with an appropriate medical practitioner and access to emergency treatment if needed, as part of the procedure of medical abortion.

But as defence counsel eloquently pointed out on Wednesday afternoon, Tegan Leach did not find herself the subject of the close attention of the Queensland legal system because of concern on the part of the authorities about her health or safety. She was in court because she was charged with a crime apparently serious enough to warrant a penalty of seven years imprisonment.

The charges were initially brought by police, who were searching the couple’s apartment in Cairns in early 2009 on another matter (on which no charges have ever been brought against the couple).  Empty blister packs of tablets and material written “in a foreign language” were discovered. Detective Sergeant Adrian Worth testified that he took these items to the Cairns Police Station; evidence was given to the court by a forensic chemist, showing that subsequent testing had confirmed the presence of both mifepristone and misoprostol, consistent with the labels on the blister packs.

Some weeks after the search of the apartment, Detective Sergeant Worth interviewed Brennan and this interview was recorded. A DVD of the interview was played to the court on Tuesday afternoon, in the presence of Worth, the jury, both legal teams and members of the public. It lasted nearly an hour. Blinds were lowered to enable the screen to be clearly viewed, so we sat in a semi-darkness that gave a surreal and semi-pornographic quality to the scene as we watched Worth ask Brennan numerous pointed and detailed questions about intimate aspects of Tegan Leach’s health and life. Leach herself was obliged to sit, silent, in the dock, while this discussion ranged about her.

While I appreciate that all this was an integral part of the legal process that had been inevitably set in train by the initial police prosecution, I am appalled at the humiliation inflicted on this woman. Can the Queensland Premier and her government really believe that this was necessary, that the law should have been allowed to “run its course”, that the police and legal system do not have better things to do?

In their addresses to the jury, the defence counsel and the judge (and indeed the prosecutor) gave particular attention to the word “noxious” as used in section 225. The judge stated “that’s the trouble with these very old statutes” when he agreed with counsel that “noxious” may have had a particular meaning  in 1899 (when medical abortion was unknown) but that such meaning is no longer relevant, or at least so clear, in 2010.

Professor Fisk on Wednesday stated that both mifepristone and misoprostol are on World Health Organisation lists of essential drugs and that in no sense could they be described, in the 21st century, as “noxious.” The judge gave clear directions to the jury on the meaning of “noxious”, as “injurious or harmful” to the woman. He told them they would have to be sure “beyond reasonable doubt” that the drugs were “noxious” to return a verdict of guilty. After briefly returning to the court for a further direction from the judge, the jury re-appeared with their verdict.

While the verdict is good news for Leach and Brennan, what does it mean for reform of Queensland’s archaic abortion laws?

Twelve intelligent and thoughtful Queensland citizens have considered sections 225 and 226 of the Criminal Code and concluded that they are not relevant to women undergoing medical abortion in Queensland in 2010. I believe the jury’s decision reflects the opinion of the majority of Queenslanders that abortion should be a private matter for a woman, her partner, her doctor, and whoever else she may wish to involve, and not a matter for criminal prosecution. Abortion needs to be taken out of the Criminal Code and placed in the health regulations.

The Premier should seize this opportunity to explain to the people of Queensland that this very old law needs reform, and that she, the Attorney-General and the government will at once set about having new legislation drafted. If she feels she cannot do this herself, she should ask the Queensland Law Reform Commission to do so – that presumably is their job.

Quite apart from the irrelevance of the law to current views on women’s rights to access abortion, and to modern abortion practice, there is one very important medical reason emanating from the decision in the Leach and Brennan case that means this needs to happen, and soon.

We know that an unknown quantity of drugs for medical abortion already enter the country, undetected, on a regular basis. These drugs are freely available from numerous internet sites, as well as via relatives and friends in countries where they can be bought over-the-counter or otherwise easily obtained.

After this week’s case, sections 225 and 226 are unlikely to be used again soon in the event of such importations being discovered (although certain Commonwealth laws might be.) But unless these sections are removed from the Criminal Code and the law reformed to allow Queensland women legal and accessible medical abortion, the decision may have the indirect effect of encouraging or at least not discouraging clandestine import.

Medical abortion with these drugs though generally safe for the woman does need oversight from a medical practitioner. Moreover drugs bought overseas or on the internet are not subject to the quality control, required by the Therapeutic Goods Administration, of drugs approved for marketing in Australia; they may not contain what they are supposed to, or may not contain a sufficient quantity to be effective, or may actually contain harmful substances. But women may feel compelled to try to obtain these drugs from overseas if they are unable to access abortion safely and legally where they live in Australia.

At the moment few Queensland doctors provide abortions – and one of the reasons is the uncertain legal status of abortion in the state. We urgently need decriminalisation of the current laws and the inclusion of sensible regulations in the health acts that would allow general practitioners, sexual health physicians and others to provide early medical abortion to women making that choice for themselves in the event of unplanned pregnancy. This is particularly the case for women in rural and remote areas of Queensland. Safe accessible medical abortion should be a straightforward  option for  Queensland women in 2010 – they should not be forced into the clandestine importation of drugs of uncertain quality from overseas.

For three days I have watched this young couple in court, watched them each day leaving the court, their heads held high, supporting each other. I am personally glad that this trial, and all it has involved, is over for them, and I wish them well in the future.

I sincerely hope that the Queensland government will now move to ensure that never again is such a prosecution brought in Queensland, by decriminalising abortion and thereby making it possible for safe accessible abortion services to be provided to all Queensland women who are faced with making a decision about unplanned pregnancy for themselves, and who choose abortion .

• Professor de Costa is an obstetrician and gynaecologist at the James Cook University School of Medicine, Cairns   http://www.carolinedecosta.com/

***

Update, 18 Oct: In this Crikey article today, Professor Caroline de Costa argues that the outcome of the Cairns trial has effectively decriminalised the use by doctors of mifepristone and misoprostol for the purpose of medical abortion in Queensland (although at present practitioners still require approval from the Therapeutic Goods Administration for the prescription of mifepristone.)


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Federal Budget 2021-22
Global health and climate change
2019-20 climate bushfire emergency
asylum seeker and refugee health
Climate emergency
disasters
Ebola
extreme weather events
flooding 2011
global health
NHS
NZ Election 2017
WHO
health
Health workers
Healthcare and health reform
abortion
adverse events
aged care
allied health care
Australian Medical Association
cancer
cardiovascular disease
child health
Choosing Wisely
chronic diseases
co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
Health Care Homes
health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
gun control
health communications
health impact assessment
Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
physical activity
plain packaging
prevention
public health
public interest journalism
road safety
sport
sugar tax
tobacco control
transport
vaccination
violence
Web 2.0
weight loss products
Royal Commission
Social determinants of health
discrimination
education
housing
justice
Justice Reinvestment
NBN
Newstart
poverty
racism
social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17