Anner Angulo Leiva is the director of the La Anexión hospital and he defines himself and his team as pro-life, a term that suggests that a fetus has the same right to live as a mother, regardless of the conditions.
According to Angulo, he and other obstetrician-gynecologists from the hospital decided, after several clinical sessions, that the La Anexión hospital will not perform any type of abortion, not even therapeutic.
They also reached another agreement. If a pregnant woman requests that her pregnancy is terminated for therapeutic reasons, the case will be transferred to specialists at another hospital. They won’t make the decision.
For Angulo, neither he nor his team will pass any moral judgment and will stick to medical criteria.
Permissible abortion in Costa Rica, known as therapeutic, has been allowed since 1971. Article 121 of the criminal code states that a pregnancy can be terminated in cases where the health or life of the mother is at risk.
Article 121, Costa Rica Criminal Code: Abortion performed with medical consent of the woman or by an authorized obstetrician is not punishable when it is done to prevent danger to the life or health of the mother when the mother cannot be helped by other means”.
In practice, doctors and specialists refuse to carry out the procedures to perform an abortion and insist that there is no clear legal framework the defines the necessary parameters. In other words, they are afraid of performing one or breaking a law in some way by doing so.
The government of Luis Guillermo Solis (2014-2018) passed technical regulations in Costa Rica to clear up any doubts. But doctors don’t use them because the former president didn’t sign the rules.
Now, President Carlos Alvarado is responsible for signing the technical regulations. Several weeks ago, he said that he was focused on fixing other “more serious” problems such as the fiscal deficit and that he will sign the regulations “when I decide it’s a good time.”
This is an extract of the interview, requested by The Voice of Guanacaste to speak about the rights of pregnant women. In this first edition, we present a conversation about the right to therapeutic abortion.
- In your opinion, on the issue of guaranteeing the dignity of pregnant women, is there room for therapeutic abortion?
We are pro-life and it still hasn’t been determined whether or not therapeutic abortions can be given, but the specialists that we have here in the hospital, at least in clinical sessions where we have discussed the issue, are not willing to perform a therapeutic abortion. We don’t foresee the hospital doing these types of procedures.
- Everyone from management clears down to those who may have to eventually make the decision are against it?
When we talk about therapeutic abortion, someone has to determine that the mother is at risk and that abortion is the only option. Of the four of us specialists who have analyzed the issue of therapeutic abortion, none of us have expressed a willingness to perform it if required to because there has to be a legal aspect that defines it. Right now, we don’t see having procedures of that type here. Generally, we transfer them to another hospital.
- Would you still be against performing it and send cases to other hospitals or clinics if the technical regulations were signed?
Yes. Right now our tendency is to say, we aren’t going to practice a therapeutic abortion in this hospital, because the nursing staff and the medical staff are pro-life.
- You prefer to not make the decision and transfer the case?
The woman would have to have a very complex condition and the conditions at this hospital aren’t apt for that, so we would have to transfer that patient to another level of attention (another hospital) because its a woman that isn’t walking or that isn’t in good health, physical or medical condition.
- The woman will always have to say whether or not she accepts a therapeutic abortion, but according to what you are telling me, that wouldn’t be a recommendation that a specialist at this hospital would make because you are all pro-life. Is that what you are saying?
Yes. We are pro-life and if the mother’s condition tells us that her health is at risk and that the patient’s medical condition is critical, that patient should be at the third level of medical attention (a better-equipped hospital) so that a therapeutic abortion can be performed.
- I understand that the doctor can say ‘I don’t want to perform it and pass the case on,’ but….
As a medical specialist if you come to me and say, ‘I want an abortion,’ then I am in within my rights to say that I am not going to perform it from an ethical and medical point of view. According to the professional association of doctors, I can do everything in my purview and if my doctor-patient relationship puts me in a difficult situation, I can pass that decision on and say that, according to my medical ethics, I am no going to perform it.
- Don’t you believe that, in that argument, a woman’s right is being violated?
I am not violating patient rights because I am offering them other alternatives and guaranteeing their right to other opinions.
- Even though that means the woman must be transferred to another hospital, for example?
Yes, because I am guaranteeing that she has another opinion, not just mine as a doctor. She can hear other opinions.
- Wouldn’t you be forcing personal decision onto a doctor?
No, because I have my medical opinion, not a subjective opinion. I am saying to the patient that there is a condition of living, there is a possibility. Like when you say to me, ‘what’s the possibility that, if I have an operation, that I can beat this cancer?’ And I would say to you, ‘yes, there is a five percent chance of living and I want to play with that five percent.’ With the issue of therapeutic abortion we can say, let’s play with that five percent and that life could benefit.
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