'Don't ask, don't tell' - Royal College of Midwives advise health staff treating women who have taken abortion pills
Doctors and nurses have legal obligation to report activity they know to be unlawful, says Department of Health
Northern Ireland's health care professionals should adopt a policy of "don't ask, don't tell" if a woman seeks help after having taken abortion pills bought over the internet, the Royal College of Midwives has said.
It comes after a 21-year-old woman bought drugs on the internet to induce a miscarriage after failing to raise enough money to travel to England for a termination.
A barrister for the woman told Belfast Crown Court that had his client lived in any other region of the UK, she would "not have found herself before the courts."
On Monday she was handed a suspended prison sentence after her former housemates reported her to the PSNI.
In an exclusive interview with the Belfast Telegraph, her housemates revealed details about the tragic case and why they reported the woman to police.
The case has reignited a furious debate over Northern Ireland's abortion laws.
'DON'T ASK DON'T TELL'
Ambiguity surrounded the legal obligation on health professionals if women confirm to them they have used abortion pills bought online and are seeking medical attention.
The Department of Health said that a woman who feels she needs medical treatment should not be deterred from seeking help.
Breedagh Hughes from the Royal College of Midwives told the BBC Stephen Nolan Show that - while it was "unsatisfactory" - a "don't ask don't tell" policy should be applied by health professionals.
Essentially women are required to "lie by omission", she said.
"That's the crux of it, that they 'know' it to be unlawful," she said.
"The American army used to have this saying. 'Don't ask, don't tell'. I think that's exactly the same principle that's going to have to be adopted here. It's not very satisfactory.
"The alternative is stick your two fingers in your ears and sing very loudly.
"Take your fingers out of your ears and look at the women and say 'you are telling me you have been pregnant, you are no longer pregnant and are bleeding. How can I help you?'
"That's not satisfactory. Because any relationship between any health care professional and the people they are caring for is built on mutual trust Where you are requiring the woman to lie to you by omission.
"It's almost, 'don't tell me what you've done because you will put me in a position where I have to do something about it'."
'HEALTH CARE PROFESSIONALS AND WOMAN IN UNTENABLE POSITION'
The Health Department stated that unless a woman tells the professional she has taken the pills, a doctor is "unlikely" to be able to tell if the miscarriage occurred naturally or with the drugs.
Ms Hughes said it was not a good way to start a very "intimate" relationship that health care professionals have with those they are caring for.
"That's where the 'I won't ask you and you won't tell me and we will go from there' comes from."
Ms Hughes said that ideally doctors would rather know as much information as possible from their patients but that this puts both people in an "untenable position" in this scenario.
"Because the law is quite clear that you must report any crime which attaches to it more than five years of a prison sentence or you yourself face criminal proceedings," she added.
"It's like someone coming into casualty and they have been shot, you have to report that. It's in that sort of arena. But it's wider than just nurses and midwives working in hospitals.
"If you are a school nurse, for example, and somebody comes flying through the door saying 'nurse quick my friend is bleeding to death in the toilet, she bought these tablets on the internet'
"That isn't even the woman herself giving that information, that's somebody else and once you know it you can't unknow it, it's a very difficult circle to square and the guidance doesn't help."
'ALWAYS SEEK MEDICAL HELP DESPITE RISK'
However despite the risk of prosecution, the Royal College of Midwives has urged women to seek medical help if they require it, no matter how they have found themselves in that position.
Ms Hughes said: "The guidance talks about the need to provide professional care to the woman and that is obviously everyone's first priority and despite all risk of prosecution I appeal now to anyone woman or girl in need of attention, no matter what she's done, please go and seek that help from the most relevant person whether it's your GP or Emergency Department or maternity admissions unit.
"Please go and get that help and if you can remember not to say anything when you get there that would be even more helpful."
'LEGAL OBLIGATION TO REPORT UNLAWFUL ACTIVITY'
The Department of Health has said it is important for women not to be deterred from seeking medical treatment.
A Department of Health spokeswoman said: “It is important that any woman who feels she needs medical treatment is not deterred from seeking it.
"Women who are in need of medical assistance should always seek advice and treatment from their health professionals.
“Unless the woman herself provides the information, a health professional is unlikely to be able to tell whether a miscarriage has occurred naturally or has been caused by abortifacient drugs and if it has been, whether the drugs were administered lawfully (in Great Britain, for example) or otherwise.
“All health professionals have a legal and professional obligation to practice within the law and have an obligation to report activity they know to be unlawful.”
On Thursday night pro-choice activists took to the streets to protest against the prosecution of a woman who induced a miscarriage with tablets bought online.
Around 80 people gathered outside Belfast's High Court, chanting: "Keep your rosaries off my ovaries. We say pro-choice, they say no choice."
The demonstration was organised by the Alliance for Choice and the Belfast Feminist Network, and attended by members of the public, trade unions and Amnesty International.