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Abortion drugs closer to being subsidised but some states still lag

The drugs mifepristone (RU486) and misoprostol are on the threshold of being listed on the Pharmaceutical Benefits Scheme (PBS) after the body that assesses whether medicines should be subsidised gave…

Women throughout Australia are entitled to the benefits of affordable medical progress without the threat of criminal sanctions. Ken Johnson

The drugs mifepristone (RU486) and misoprostol are on the threshold of being listed on the Pharmaceutical Benefits Scheme (PBS) after the body that assesses whether medicines should be subsidised gave it the green light late on Friday. The drugs are used to terminate pregnancy. Listing on the PBS would make them available across the country at an affordable price.

RU486 has been on the World Health Organization’s list of essential medicines for years and available to women internationally since the 1980s. But it was only placed on the Australian Register of Therapeutic Goods (ARTG) in August 2012, which allowed general practitioners to prescribe the drugs.

There are no reliable figures on abortions in Australia but at least 80,000 abortions are performed here each year. The inclusion of the drugs on the ARTG meant medical (as opposed to surgical) terminations were available to more women through trained general practitioners. This was a welcome development - particularly because of the history of political intervention in this area of reproductive health.

In 1996, former conservative independent senator Brian Harradine successfully moved an amendment to the Therapeutic Goods Act 1989 (Cwlth) that gave the Minister for Health and Ageing the power to reject applications to import and market mifepristone. At the time, Tony Abbott, who is anti-choice, was health minister.

No applications were made because it was an expensive process and the possibility of approval was minimal. In 2006, legislation to remove the Harradine restriction was passed after a cross-party vote, but until mifepristone could be registered on the ARTG, the drug wasn’t available.

Now, the Pharmaceutical Benefits Advisory Committee (PBAC) has recommended the listing of mifepristone and misoprostol on the PBS. If this recommendation is approved by the federal government, or more specifically, the Health Minister Tanya Plibersek, the cost of the drugs will fall dramatically and an early medical abortion will be much cheaper than a surgical abortion.

Plibersek has said on television that the cost of the drugs would be reduced from between $300 and $800 to $12 (for low income earners with concession cards) or $35. The cost of a surgical abortion is much higher but varies as most abortions are performed in private clinics, which decide how much to charge for procedures individually.

The availability of these drugs at a reasonable price will be an improvement to Australia’s reproductive health services, but there’s still an unresolved problem around abortions in some Australian jurisdictions.

While changes are taking place at the federal level, New South Wales, Queensland, South Australia and the Northern Territory have retained criminal abortion laws that don’t reflect the values of the majority of Australians. These 19th century laws have been modified through case law and legislation but the legal status of abortion is still unclear.

In Queensland, a woman who used mifepristone and misoprostol to self-abort and her partner who imported the drugs from overseas via the postal system were prosecuted under the Criminal Code 1899 (Qld) in 2010. The court found that the drugs were not “noxious” as required by the legislation and they were acquitted.

The Australian Capital Territory, Victoria and Western Australia have repealed and reformed their criminal abortion laws and the new regimes recognise a woman’s right to self-determination and her capacity to make reproductive decisions. Tasmania is currently in the process of reforming criminal abortion laws with the Reproductive Health (Access to Terminations) Bill, which has been passed by the House of Assembly.

Criminal abortion laws are legal and health hazards that have no place in a modern, advanced health-care system. Women throughout Australia are entitled to the benefits of affordable medical progress without the threat of criminal sanctions. And doctors should be able to provide reproductive health services without the threat of criminal sanctions.

The PBAC recommendation to subsidise RU486 is a welcome move for advocates of women’s reproductive rights. But the struggle is not over yet.

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58 Comments sorted by

  1. Jack Arnold

    Director

    Thank you Kerry for an informative evidence based article. Women should always have the right to determine what happens to their bodies.

    RU486 is an easy and safe method for women to protect themselves from harm inflicted by unscrupulous members of the medical profession.

    The opinions of celibate clerics like Cardinal Pell (Australian head of Child Abuse International) and his lap dog Tony Abbott have no place in PBS funding decisions.

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  2. Mick Mac Andrew

    Rev Father

    I'm celibate, I'm a Catholic Priest, I'm not a sex abuser - of children, teens or adults, I'm a male. I'm also a citizen of this nation and a taxpayer. The latter two criteria entitle me to my say on this article. The former four criteria demonstrate my integrity. Where is the money going to come from to subsidise these abortion drugs? As I understand it, it won't only be the cost of the drug that will be a difficulty for our nation. As I understand the process, the administration of the drug will…

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    1. Peter Fox
      Peter Fox is a Friend of The Conversation.

      Medical doctor

      In reply to Mick Mac Andrew

      I suspect you're out of touch with your flock, Father.

      The cost of these drugs and associated medicare billings are negligible compared to the cost to society of teenage pregnancies (think welfare, social dislocation, inability to access higher education, decreased productivity in one's prime).

      A 16 year-old from the 'wrong side of the tracks' isn't thinking about individual choice and responsibility when they get pregnant. They often come from a fractured environment, are bored and unstimulated…

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    2. Olivia Hibbitt

      Medical Writer

      In reply to Mick Mac Andrew

      I'm not convinced that being a male, celibate priest who doesn't abuse children is really evidence of integrity!

      As Peter has said, your argument that the availability of these drugs on the PBS is going to cost YOU money is ill thought out. The cost to the government, and therefore the taxpayers, of raising unwanted children far exceeds any cost that might be incurred if a woman decides not to continue with a pregnancy.

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    3. Jack Arnold

      Director

      In reply to Mick Mac Andrew

      Well Mick, as we told Father Fitz all those decades ago; "You don't play the game, you don't make the rules".

      As for a bonus scheme for being responsible, the Roman church ( and others) should have a lot of responsibility to account for regarding the handling (read protection) of abusive priests.

      Perhaps it is time to remove the tax free status from the churches, including land tax and council rates, so that the churches may take a full part in our community and be held accountable by selling off their real estate portfolio for the benefit of victims of abuse by priests.

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    4. Jack Arnold

      Director

      In reply to Peter Fox

      Hi Peter, why do allegedly celibate priests believe that they have to God given right to determine what women do with their own reproductive health? Indeed, there is considerable evidence that celibacy in either gender is detrimental to both physical and emotional health.

      Then, priestly celibacy is a 'recent' invention to protect the property holding of the priestly congregation at the historical time before property trusts prevented an Abbott from settling the Monastery property on his off-spring by right of male primogeniture succession.

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    5. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Jack Arnold

      Jack, why would you believe that anyone has the right to terminate a child because its inconvenience?

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    6. Peter Fox
      Peter Fox is a Friend of The Conversation.

      Medical doctor

      In reply to Jack Arnold

      Thanks Jack,

      Very interesting - I wasn't aware of the recent history of celibacy in the church. Completely agree on the hypocrisy of celibates dictating society's sexual mores.
      The judgemental rhetoric of accusing others of lacking "individual responsibility" in a realm that the accuser has no experience really takes the cake.

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    7. Mick Mac Andrew

      Rev Father

      In reply to Jack Arnold

      The only "tax free" status the Catholic Church enjoys is held by the organisation, not the members. Any priest, brother or sister in receipt of what may be called a 'wage' pays taxes. the Church, like other organisations, and businesses, is allowed to claim back the GST on inputs required for the running of the organisation, but must pay GST on income derived from the commercial activity of its assets - in our case, the rental of a house and a convent building. On any property that is rented out…

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    8. Peter Fox
      Peter Fox is a Friend of The Conversation.

      Medical doctor

      In reply to Mick Mac Andrew

      I'm not going to get drawn into the old religious tax deductible debate - it's a side issue, although I disagree with you.

      In answer to your question, PBS listing of mifepristone/misoprostol has the potential to SAVE the health budget money since these agents are much cheaper than surgical termination. For a more detailed answer of "how our society is going to pay", I refer you to the excellent recent articles in The Conversation about health economics.
      https://theconversation.com/explainer-what-is-health-rationing-13667

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    9. Peter Fox
      Peter Fox is a Friend of The Conversation.

      Medical doctor

      In reply to John Phillip

      Yes. Precisely.

      Just like other lifestyles that we "fund" as part of a pluralistic society:
      - IV drug users requiring treatment for hepatitis C
      - horseriders/motorcross riders and risk of spinal injury
      - smokers and risk of cancer/heart disease
      - dog owners and risk of dog bite

      The sensible way to fund a health budget is not to deprive or stigmatise vulnerable people. We may not all agree with the above "lifestyles", but to deprive funding for any one of them contradicts our society's values.

      The French Health Minister was decades ahead of his time when he stated in 1988:
      "I could not permit the abortion debate to deprive women of a product that represents medical progress. From the moment Government approval for the drug was granted, RU-486 became the moral property of women, not just the property of a drug company."

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    10. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Peter Fox

      Dont agree with them either - isnt that what medical insurance is for? I think the French Health Minister was playing the political appeasement game and was wrong.

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    11. Henry Verberne

      Former IT Professional

      In reply to Mick Mac Andrew

      I don't want religions to be exempt from taxes since I am an atheist. Sounds fair on your logic?

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    12. Jack Arnold

      Director

      In reply to Mick Mac Andrew

      HI Mick, so Sydney City Council could fill a hole in their budget if the Church paid rates on the St mary's Cathedral site? How about the Anglicans pay rates on St Andrews Cathedral?

      I don't need to denigrate any church because too many clerics are doing that for themselves in this matter of covering up child abuse.

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  3. Peter Fox
    Peter Fox is a Friend of The Conversation.

    Medical doctor

    Thanks for the article, and congratulations to Tanya Plibersek for pushing this through.
    I work in a rural centre, where women currently have to travel to Sydney to have 'non-medical' terminations. Like a lot of rural areas, there is a strong conservative core who would make life very difficult for anyone performing terminations. Amongst local lower socioeconomic demographics, teenage pregnancies are rife, and the cost and logistics of a trip to Sydney are beyond many people.
    Likewise, after mifepristone/misoprostol are PBS-listed, it appears no local GPs are likely to be offering this service due to the damage to their reputation by being the 'abortion doctor'. This is tragic, since our community has enormous need for such as service. I suspect many other country towns are likely to be the same.

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    1. Olivia Hibbitt

      Medical Writer

      In reply to Peter Fox

      Peter, that is such a depressing state of affairs!

      I struggle to understand why medical professionals would rather force a women to undergo an unwanted pregnancy than facilitate their patients right to choose.

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    2. Peter Fox
      Peter Fox is a Friend of The Conversation.

      Medical doctor

      In reply to Olivia Hibbitt

      Completely agree, Olivia. I'm not a GP myself, so am not in a position to administer mifepristone/misoprostol. But, in a country town, word gets around quickly. And the conservative types can be pretty harsh in labelling a doctor as 'The Abortion Doc'. Not good for the doctor's reputation, business or mental health. Doctors in the city are a lot more anonymous (eg. live in different suburb to area of work), and are more able to avoid this phenomenon.

      Furthermore, I don't have any stats to back this up, but anecdotally, there seem to be more GP practices in the country that either name or market themselves as 'christian' practices. These practices refuse to even refer patients to city-based termination services. It's a very sad situation, because often these patients are the ones most in need of the right to choose.

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    3. Jack Arnold

      Director

      In reply to Peter Fox

      Well said Peter. Tanya Plibersek is looking more like Prime Minister material with every public appearance and Health policy announcement.

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    4. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Olivia Hibbitt

      Olivia, maybe it's not a case of a medical professional forcing a woman to do anything. Perhaps they find the concept of terminations used as post fertilisation birth control in breach of their of their moral values.

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    5. Olivia Hibbitt

      Medical Writer

      In reply to John Phillip

      That may well be the case, but I believe that a medical professional should be above those kinds of base moralisations!

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    6. Dianna Arthur
      Dianna Arthur is a Friend of The Conversation.

      Environmentalist

      In reply to Olivia Hibbitt

      @Olivia

      I agree with your sentiments. But would replace "base moralisations" with 'judgmental authoritarianism'.

      One person's morals is another's chains.

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    7. Olivia Hibbitt

      Medical Writer

      In reply to John Phillip

      Because medical professionals provide essential sevices to the poplace. Why should a woman be denied the right to choose because a HCP decides that they are the gate keeper? Is that same HCP going to be there doing 2 am feeds? Taking time off work when that child is sick? Paying for childcare/schooling/university?

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    8. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Olivia Hibbitt

      Olivia, it's not about people deciding to be the gatekeeper, as you put it. It is about freedom of choice. If people have a moral objection to providing a particular service, why should you be able to force them to do so.

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    9. Olivia Hibbitt

      Medical Writer

      In reply to John Phillip

      HCPs have a duty of care to their patients, this duty of care supercedes personal morals.
      HCPs need to be directed by best practice, not by what makes them feel the most warm and fuzzy.

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    10. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Olivia Hibbitt

      You're talking bullshit there, Olivia. It's not up to you to impose your worldview on others which is EXACTLY what you are doing.

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    11. Jack Arnold

      Director

      In reply to John Phillip

      Grumpy John, I don't want to lead this discussion down a side track by raising the point about "When is a clump of cells defined as a person?" debate. However, it has relevance at this point of this discussion. A clump of say eight cells can hardly be described as a foetus unless you are imposing church based 'philosophy' on scientific reality.

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    12. Jack Arnold

      Director

      In reply to John Phillip

      Oh dear Grumpy John, you have swallowed the Liberal party propaganda hook, line & sinker.

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    13. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Jack Arnold

      Jack, I havent raised ANY issue around abortion. I've only raised my concerns over two points. Firstly, that it is not the responsility of HCPs to subjugate their moral beliefs in order to meet Olivia's. Secondly, I dont believe it is the role of the taxpayer to fund people's lifestyle choice. Dont deflect, as Olivia hass attmepted to, from these points.

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    14. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to John Phillip

      Sorry, Jack, pressed the button before I was done. Olivia states that HCPs have a duty of care. On that point she is correct. My argument is that that duty of care does not extend to rejecting their own moral code in order to facilitate someone else's choices - remember, we are talking about a totally elective procedure - it is no different, for example, to a surgeons who refuses to perform elective cosmetic surgery on patients because they believe the patient 'has gone too far' or suchlike. I am not saying that all HCPs fee this way by any stretch of the imagination only that those for whom post-fertilisation termination is an issues should not be compelled to assist it. Again, let's be clear that we arent talking about circumstances where carry through to term is life threatening or the mother - that is certainly morally supportable by the taxpayer.

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    15. Sue Ieraci

      Public hospital clinician

      In reply to John Phillip

      John, if it's not " the role of the taxpayer to fund people's lifestyle choice", should people who have never had children have to pay taxes to educate the children of people who made the "lifestyle choice" to reproduce?

      Can all the self-righteous amongst us deduct from our taxes every time we see someone smoking, driving too fast, being too grumpy?

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    16. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Sue Ieraci

      Sue, I agree wholeheartedly with your first paragraph. I'm wondering about the self-righteous accusation though - is it not self-righteous to force the community at large to live with costs and or consequences of your actions?

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  4. Safeera Hussainy

    Lecturer in Pharmacy Practice at Monash University

    Thanks Kerry, this is a significant step forward for Australian women. It's unbelievable how most of the opposition women face to making life choices comes from men, politicians or otherwise people who just don't give a thought to what the consequences on health and wellbeing are for an unwanted pregnancy.

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    1. Dianna Arthur
      Dianna Arthur is a Friend of The Conversation.

      Environmentalist

      In reply to Safeera Hussainy

      I agree, Safeera

      The appalling irony of those in opposition to a woman's right to control her fertility, is the complete lack of support after an unwanted child is born.

      Between Labor's attack on single parents via transition to Newstart and the current Lib leader's previous history of attempting to thwart any assistance women need when making life-long decisions - add to this, the idea that a tax exempt clergy believe they have a right to debate an issue that should remain between a woman, her doctor and partner (where applicable), leaves me wondering if we are still living in the Dark Ages.

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    2. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Dianna Arthur

      Jeez Dianna, maybe you could provide a list of those who you believe do 'have a right to debate an issue that should remain between a woman, her doctor and partner (where applicable). This is a societal issue and it doesnt just 'belong' to those of whom you approve.

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    3. Dianna Arthur
      Dianna Arthur is a Friend of The Conversation.

      Environmentalist

      In reply to John Phillip

      It is about my body, my future and my abilities to care for a child.

      It is, therefore, none of your business.

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    4. Dianna Arthur
      Dianna Arthur is a Friend of The Conversation.

      Environmentalist

      In reply to John Phillip

      Fine.

      Then you can choose to fund the upbringing of a child until they reach independence.

      I don't have a problem with that.

      Nor do I have a problem with paying taxes for many social necessities that I do not necessarily need, but others do.

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    5. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Dianna Arthur

      So it's now the transfer of a personal choice onto society - ie the abrogation of responsibility. Why should society have to pay for your choices? Why cant you, as part of a couple who have taken the course of action that have led to pregnancy, accept responsibility for those choices?

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    6. Olivia Hibbitt

      Medical Writer

      In reply to John Phillip

      I find this sort of argument hilarious! Every single one of us engages in behaviour that my not be the best choice for our health and may lead to long term issues and therefore cost to the government (and tax payer).

      The ONLY way your argument has any traction is if we also deny healthcare to smokers/drinkers/the sedentary/the obese/bike riders/car drivers/those who do not eat enough veg....do I need to go on?

      The abortion debate is not about cost to the taxpayer, it is about people trying to impose their own morals and values on others.

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    7. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Olivia Hibbitt

      Olivia it is about people trying to impose their own morals on the taxpayer. I have no issue if you choose to terminate. I do have an issue if you expect me to subsidise that choice. The drug is there. You can use it. Why on earth would you expect the rest of society to pay for your choice?

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    8. Olivia Hibbitt

      Medical Writer

      In reply to John Phillip

      I have a moral objection to smoking, therefore all COPD medication should be removed from the PBS forthwith...it was their decision to smoke, why should I foot the bill.

      Please stop trying to dress up your objection to listing mifepristone/misoprostol as anything other than you objecting to abortion. Whether you believe abortion is moral or not should have absolutely no bearing on this argument.

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    9. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Olivia Hibbitt

      Your assumptions about my views on abortion are rubbish and a distraction. Not everyone who disagrees with the listing of the stated drugs fits neatly into your preconceived ideas. As to your first point, I agree with you. WHy should I, or anyone else, pay for a couple's decision to get into the position of being pregnant. What you are proposing is simply for people to cease to take personal responsibility for their actions at the public expense.

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    10. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to John Phillip

      Olivia, have you got costings as to how much including this drug on the PBS will cost the taxpayer? What has to go to fund it or is the public purse just an endless supply of money to suit your moral stance?

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    11. Jack Arnold

      Director

      In reply to John Phillip

      Thank you for raising this red herring, Grumpy John.

      Similarly, I don't believe that smokers should get any medical benefits because there is now sufficient credible replicated scientific evidence that smoking is a voluntary behaviour that causes medical problems that abstinence avoids. Therefore all smokers alone should be made to pay for their medical expenses without the benefit of medical insurance, so that all non-smokers may enjoy lower health insurance premiums.

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    12. Jack Arnold

      Director

      In reply to John Phillip

      And, Grumpy John, with this point you demonstrate your circular illogic on this matter.

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    13. Dianna Arthur
      Dianna Arthur is a Friend of The Conversation.

      Environmentalist

      In reply to Olivia Hibbitt

      Olivia

      Good on you for calling out this "grumpy old man" on the truth of his disagreement with RU486.

      There are many PBS listed drugs that we, as taxpayers, contribute to - Methadone being but one.

      John - you disapprove of abortion, don't give a toss about the well being of an unwanted child and shroud your objections under a furphy.

      Fact: RU486 and similar drugs are far less costly than the long term cost on society and on the well being of people who may not have the funds or ability to raise children, let alone the misery of being an unwanted child.

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    14. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Dianna Arthur

      Diann, I dont 'disapprove of abortion' - as I said to Olivia dont put words into my mouth or make asssumptions about my views to fit your world view. The truth of my disageement with ru486 is not about the drug or its use - it is only about the funding of it by the taxpayer. If you want to access the drug, I dont have a problem with it but dont expect me to pay for it - why would you think that it's ok to expect that?

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    15. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Jack Arnold

      Nothing circular about my logic, Jack. It's really simple. If you want to access a drug dont ask me to pay for it. Be responsible for your own actions and pay for it yourself.

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    16. Dianna Arthur
      Dianna Arthur is a Friend of The Conversation.

      Environmentalist

      In reply to John Phillip

      Then why are you not protesting other medications which have no value to you but benefit others such as the previously mentioned methadone, or insulin for type 2 diabetes, cancer treatment for smokers?

      As I, and many others, have demonstrated it is far cheaper for society to pay the cost of RU486, than the burden of ruined lives.

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    17. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Dianna Arthur

      Because, Dianna, they are ALREADY on the list. This is one that's going to be added. No punns intended but prevention is better than cure.

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    18. Dianna Arthur
      Dianna Arthur is a Friend of The Conversation.

      Environmentalist

      In reply to John Phillip

      "No punns (sic) intended but prevention is better than cure."

      RU486 prevents an unwanted pregnancy from going to term.

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    19. John Phillip
      John Phillip is a Friend of The Conversation.

      Grumpy Old Man

      In reply to Dianna Arthur

      Yea, I thought you might see it that way. :) Seriously though arent you sick to death of folks not taking responsibility for their actions and then expecting 'the government' (ie the taxpayer) to bail them out?

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    20. Sue Ieraci

      Public hospital clinician

      In reply to Dianna Arthur

      "RU486 prevents an unwanted pregnancy from going to term."

      As an aside, I'm surprised the termination-of-pregnancy-and-breast-cancer brigade haven't found their way to this thread yet.

      But in case they do, let's point out in advance that termination of pregnancy has essentially the same effect as spontaneous miscarriage, which happens in a large percentage of pregnancies. The hormone levels are dependent on the length of gestation, not the cause of the miscarriage. There, got it in first.

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    21. Dianna Arthur
      Dianna Arthur is a Friend of The Conversation.

      Environmentalist

      In reply to Sue Ieraci

      Sue

      Shhhh. I was hoping that the termination-of-pregnancy-and-breast-cancer brigade wouldn't get wind of this conversation and muddy the topic with their repetitive supply of pseudo science.

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  5. Janeen Harris

    chef

    If you don't want to support the child, support the abortion. The single parent has had a recent reduction to their income and that means we, as a society, we don't support the child. The least we can do is give the mothers of these babies a way out of watching their children suffer and flounder through life without adequate education, acceptance or love.( dole bludger).

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