The debate on emergency contraception in Malta : an ethical appraisal

Abstract

The emergency contraceptive tablet has been envisaged as an advancement over regular contraceptive methods as it was considered to open up the choices that individuals may take. Emergency contraceptive tablets (ECTs) are most often considered as a quick fix solution, which can remove all risks of pregnancy. However, this is far from the real implications and in turn, ECTs present a major ethical debate as they compromise human life. In Malta, prior to 2016 only regular contraceptives were authorised, as ECTs were always considered as abortifacient until then. However, in 2016 following a judicial protest, a debate was initiated to authorise ECTs on the Maltese market, which eventually led to their authorisation within the same year. The first chapter on the scientific perspective explores the biological reproductive process, methods of emergency contraception and focuses on the modes of action of ECTs. The second chapter on the legal aspects focuses on the national, European and international legal considerations related to the use of ECTs in Malta. A comparative analysis with another two EU countries, namely the Netherlands and Poland, is undertaken. The third chapter on ethical issues considers the scientific and legal findings and discusses the various relevant ethical considerations to the use of ECTs. It is concluded that scientifically life stats at fertilisation and ECTs may work through post-fertilisation effects, which are abortifacient. Such findings contrast positions adopted by international, European and local bodies. From a legal point of view, the authorisation of ECTs on the Maltese market is contradictory to the prohibition of abortion as provided for by the Maltese Criminal Code. The raison d’etre of Maltese legislation was always to protect life; however, recent legislative changes go against the spirit of Maltese law and down-graded life at its early beginning. Ethically, whilst ECTs aiming at pre-fertilisation effects may be permissible, the difficulty to determine the exact mode of action that stops a pregnancy renders the use of ECTs as ethically unacceptable. The possible post-fertilisation abortifacient effects of ECTs, complicate the role of healthcare professionals and the position of women. Therefore, it is vital that competent authorities provide transparent information for healthcare professionals and women to take informed decisions. Ultimately, healthcare professionals and women have a salient role in determining possible use of ECTs and in protecting the rights of the unborn child.