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in the myometrium and relaxation of the
uterine cervix. Misoprostol (GyMiso), used
in a sequential regimen after mifepristone,
has been used in a number of countries for
medical termination of pregnancy.1,2
The sponsor, Marie Stopes International
Australia, is introducing the product
in a 'controlled' manner, including a
tailored educational package available
for medical practitioners who wish to
What may have been administered within
the confines of a clinic or hospital in the
past, is now being made available in the
community setting, thereby thrusting
pharmacy to the forefront of administration
and counselling about this product.
The availability of RU486 is to be arranged
by the sponsor entering into arrangements
with pharmacists prepared to stock
mifepristone for the recognised prescribers.
To date, no training has been on offer for
pharmacists, limited educational material
available and no standard pharmacy
practice guidelines have been developed.
A perplexing issue associated with the
supply of this product is the complexity
of the legal framework in each state and
territory. According to Petersen K. [MJA,
2010], over time, all state and territory
laws have been repealed, reformed or
modified by parliaments and courts to
make provision for some form of lawful
abortion.3,14 Abortion laws vary between
jurisdictions and can be divided into two
main categories: 'reform' jurisdictions and
'offence/defence' jurisdictions. To help us
as pharmacists understand some of the
legal framework in this matter, it is helpful
to refer to two comprehensive tables
provided in the medico-legal article by
Table 1 refers to the legislation governing
EMA throughout Australia. Table 2 shows
the grounds for EMA in both reform and
offence/defence jurisdictions. In the
reform jurisdictions -- Australian Capital
Territory, Victoria and Western Australia
-- the decision to have a first-trimester
abortion is essentially a matter to be
decided between the woman and her
In the offence/defence jurisdictions, where
laws vary, there are concerns about legal
boundaries. Statutes in South Australia,
the Northern Territory and Tasmania
impose various requirements, such as
the need for two medical signatures
or statutory informed consent, but
generally abortions are lawful if medical
practitioners act in good faith and
comply with the conditions set out in the
In New South Wales, the Menhennitt
ruling, that was established in the Victorian
case R v Davidson,  VR 667; .followed
(NSW) 25; and upheld in CES v Superclinics
(Australia) Pty Ltd (1995) 38 NSWLR 47,
provides a defence if a doctor forms a bona
fide belief that an abortion is necessary
to preserve the woman's life, health or
wellbeing. Abortions are not always
unlawful, and case law demonstrates that it
Table 2. Grounds for EMA in Australia3
Jurisdiction Grounds for early medical abortion
Request of woman -- all abortions must be carried out by a doctor in an
approved medical facility.
Request of woman -- if the doctor has a conscientious objection to
abortion, the woman must be referred to another doctor who does not
hold a conscientious objection.
Informed consent or for medical, psychological or social reasons.
Dependent minors under 16 years of age must have one parent informed
and given the opportunity to participate in medical consultation, unless
Children's Court makes an exemption order
Defence: lawful if two doctors form a bona fide opinion that the
pregnancy would involve a greater risk of injury to a woman's life or
physical or mental health than terminating a pregnancy; or where there
is a substantial risk that the born child would be seriously handicapped.
Social factors may be taken into account. Abortions must be performed
in a prescribed facility.
Similar to SA, but one of the medical practitioners must be a
gynaecologist or obstetrician unless impracticable. Legal guardian must
give consent if the woman is under 16 years of age or lacks capacity
Similar to SA, but statutory informed consent required.
Defence: lawful if a medical practitioner honestly believes on reasonable
grounds that termination is necessary to preserve the woman from
serious danger to her life or physical or mental health, taking economic
and social grounds into account.
Queensland Two defences: under the common law, an abortion may be lawful if
necessary in similar circumstances to those in NSW. A statutory 'surgical/
medical benefits defence' applies where a person performs in good
faith and with reasonable care and skill a surgical operation or medical
treatment to 'preserve the mother's life' when reasonable, having regard
to the patient's state at the time and her circumstances.
Jurisdiction Early medical abortion
Health Act 1993 ss. 80--84
Crimes Act 1900 ss. 82--84
Amendment Act 2006 s. 11
Criminal Code Act 1899 ss.
Consolidation Act 1935 ss.
81, 82, 82A (3)
Criminal Code Act 1924 ss.
134, 135, 164
Abortion Law Reform Act
Criminal Code Act 1913
s. 199; Health Act 1911
Table 1. Legislation Governing EMA
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