The Federal Public Ministry (MPF) is working against Brazilian legislation, scientific evidence and recommendations of the Ministry of Health and Anvisa (the national health watchdog agency) to facilitate the practice of abortion at home in Brazil – so-called “remote abortion”, with the help of doctors through virtual means.
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At the beginning of the year, a hospital in Uberlandia (MG), with support from the Anais Institute, published a handbook that teaches women how to perform undisrupted abortions at home – as in cases of rape, infantile anencephaly, and the risks. The death of a woman – during a pandemic.
After months of conflict involving prosecutors and advocates at the municipal, state, and national levels, the MPF has taken on the official position in support of the handbook, as described in a recent report in People’s Newspaper.
In May, the Office of the Public Prosecutor of Minas Gerais and the National Defender of Human Rights requested action against the pamphlet. In June, the Ministry of Health issued an information note indicating that abortion is not part of the procedures in which, as an exception, the practice of telemedicine will be permitted during the pandemic.
In July, despite recommendations from the authorities and the laboratory producing the drug, the Federal Prosecutor for Citizens’ Rights (PFDC) – an agency of the Federal Public Ministry (MPF) – issued a technical memo that contradicted the attorney’s request. In favor of the mines and DNDH, the recommendation against the brochure was rescinded.
According to the specialists consulted by the newspaper, MPF’s support for telemedicine not only goes beyond the recommendations of the Ministry of Health, Anvisa and the drug package supplement, but also the Civil Code, Law No. 13,989/2020 – which deals with telemedicine during the pandemic – and scientific evidence In fields such as obstetrics and psychology.
How does the MPF’s stance on abortion at home conflict with Brazilian legislation
Jurist Afonso Celso de Oliveira, a civil law specialist and member of the Brazilian Institute of Law and Religion (IBDR), says it is only up to “the medical authority, with clinical and laboratory tests”, to prove the possibility of an abortion.
According to him, the practice of remote abortion “violates the right of the unborn child, which is supported by Article 2 of the Civil Code,” which states that “the law protects, from conception, the rights of the unborn child.” “Until a medical professional confirms that rape, a crime that underlies the legal right to abortion, advocates for the rights of the unborn child, if we reduce the abortion to such an extent that it is, now on the phone?”, Oliveira asks.
For him, the remote abortion handbook misinterprets Law 13989. “The law does not support abortion after rape. The procedures it supports are limited,” he says. “We are not dealing with migraines, headaches, common procedures that can be done via telemedicine, due to the pandemic, to avoid going to hospitals or clinics. It was the spirit of the law for this type of procedure. Now, abortion is a complicated procedure, even with the pill pregnancy,” Al-Faqih notes.
Another point that Oliveira emphasizes is the high probability of fraud, which can increase the chance of holding the doctor responsible for any wrongdoing. “In the case of rape, since it is not necessary to file a police report, all that is required is a declaration of the alleged victim, anyone can say that they have been raped without undergoing any clinical examination, or without a medical or medical examination. However, even if the woman is not obligated to file a police report, the attending physician is obligated to report the incident to the police authorities and must also keep the possible physical evidence of the crime of rape, to hand it over immediately to the police authority.There is a great responsibility on the shoulders of the doctor who will sign the prescription about this abortion. How could this happen by conference call?”, he asks.
The chance of deviation from the purpose of the drug also increases. Moreover, nothing guarantees that with the drug on hand, the patient will still be in virtual contact with the doctor. “In the hospital or in the clinic, the person will take the medication in front of the specialist who will be able to accompany them,” Oliveira says.
A bioethicist says that abortionists demand a type of abortion that they condemn
Liñez Garcia, retired professor at the Institute of Biology at the University of Brasilia (UnB) and president of the National Movement for Brazilian Citizenship for a Brazilian Life Without Abortion, points to an apparent contradiction in the rhetoric of supporters of the pamphlet, that abortion is often used as one of their main arguments is the fact that if abortion is legalized The procedure can be performed in hospitals, avoiding the risks to women from alternative forms of abortion.
“It is worth noting that people who have always called for legalization of abortion – saying that abortion would be unsafe – are now claiming the same methodology with this ‘distance abortion.’ It is a very big contradiction, which shows, in fact, that the safety of pregnant woman in mind,” she notes.
For Linase, there is no safe abortion, and a doctor is essential during the procedure, even in the case of misoprostol. If this practice is undertaken, the pregnant woman should be monitored at all times. It is not without risks. There may be a rupture of the uterus, and other consequences … there is no justification. So far, most hospitals have resumed elective surgeries. We are certainly not at a pandemic moment that would justify the application of remote abortion, suggesting that there is an ulterior motive. This is crystal clear. What is required is to make available to the public guidance on how to perform an abortion,” says the specialist.
Another problem with remote abortion, according to Linese, is the potential for greater psychological harm compared to an abortion performed directly by a doctor. “Without a doubt, abortion always has psychological effects on women. Now, the fact that she is doing it alone, making this decision regarding her child, is painful. It is a practice that, if a woman starts, she cannot stop. The possibility of regret even before the abortion is completed is real. Extremely “.
The argument for the needs created by social isolation does not hold
The main argument of the handbook’s proponents is that the pandemic makes it necessary to release home-delivered abortions, as social distancing measures may discourage going to hospital for the procedure.
However, the lab that produces misoprostol, a failed treatment indicated in the brochure, states that the drug can only be used in a hospital setting, an order also established by a 1998 ordinance of the Ministry of Health.
Playing with words, the brochure says that the “reservation of ‘restricted hospital use’ of the above decree can be understood as fulfilled,” since the drug can only be obtained through an approved hospital, which is possible even with telemedicine. But the booklet’s authors failed to quote an extract from the drug’s package leaflet, which states that “manipulation of misoprostol should be carried out by a specialist.”
A July technical note from the Federal Prosecutor for Citizens’ Rights (PFDC) – an agency of the Federal Public Ministry (MPF) – stated that restricting hospital use, “although it may be considered lawful and reasonable in normal situations”, is inconsistent with the difficulties it causes. epidemic to reach hospitals.
However, according to the data of the Ministry of Health, outpatient procedures and elective surgeries are already showing a tendency to return to normal life in Brazil. The number of elective outpatient procedures performed in Brazil in June 2020 was about 5.7 million; This year, the figure for June has already increased to 8.6 million – very close to the reality of June 2019, when 9.1 million outpatient procedures were performed in the country.
With regard to elective surgeries, the trend to return to normal is slower, but still clear. In June 2020, 371.3 thousand surgeries were performed in the country. In June 2021, it increased to 525.3 thousand. The number of surgeries performed in June of the year preceding the outbreak of the epidemic in Brazil reached 718.2 thousand.
In addition, the Federal Council of Medicine (CFM) stated in early September that it is preparing a “national strategy to encourage the population to seek medical care to prevent, diagnose and treat disease, while observing safety standards.” Thus, MPF approval of remote abortion is overdue.
After the PFDC technical memo overturned the recommendation of the Minas Gerais Public Prosecutor’s Office and the National Human Rights Defender’s Office, pro-life lawyers asked the Ministry of Health to take a position on the matter. Until the closing of this report, the folder had not spoken out against the technical note and had not responded to a question from People’s Newspaper about the reason for that.
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