Lessons from the Implementation of the Medical Council Regulations on the Criteria for Medical Termination of Pregnancy under Section 305 of the Penal Code B.E. 2548 It has been two full years since these regulations, which affect the reproductive health of Thai women, were enacted. I still find it necessary to join in sharing and learning with all members as usual. First, let me briefly review that Section 305, which we are trying to familiarize ourselves with, consists of 2 paragraphs. The first paragraph is about the termination of pregnancy that affects the mother’s health. Don’t forget that the term health, as defined by the World Health Organization, includes physical and mental health
The use of the Medical Council regulations states that in cases of mental health, doctors can make a diagnosis without consulting a psychiatrist (remember, we also graduated with a medical degree). In cases where the fetus has severe disabilities, the regulations also state that such severity affects the mother’s mental health as well. In this way, we can provide termination of pregnancy services to women who come for fetal diagnosis and find abnormalities. The second paragraph states that the pregnancy resulted from criminal offenses under 5 sections, namely 276 regarding rape, 277 regarding causing a child under 15 years old to become pregnant, whether consensual or not, and 282, 283, 284 regarding luring others for indecent acts, satisfying lust by trickery, coercion, or threats, which may eventually lead to consent. But if the cause is from the aforementioned reasons, the law permits it. I write this to remind everyone because there are still many who are unaware and do not provide care for our fellow Thai women, leaving them to suffer according to fate.
At this point, I have a story to share. Around March, I had the opportunity to care for a pregnant woman. She was receiving prenatal care at a private hospital under the insured rights from the Social Security Office (SSO). She underwent a fetal diagnosis with ultrasound before 23 weeks of gestation and found that the fetus had abnormalities, namely severe physical brain defects (porencephaly with ventriculomegaly) along with very low amniotic fluid and growth restriction (fetal growth restriction and severe oligohydramnios). After learning of the diagnosis, she received counseling and chose to request a termination of pregnancy. The hospital of origin informed her that she could not use her insured rights, so she was referred to the hospital where I work.
Subsequently, the hospital managed the termination of pregnancy successfully. I then discussed with the hospital’s benefits department to process the insured rights. They contacted and consulted with the provincial Social Security Office, to which I attached the Medical Council regulations on the criteria for medical termination of pregnancy under Section 305 of the Penal Code B.E. 2548. The provincial SSO confirmed that the insured could use their rights. We then sent the matter back to the hospital of origin to collect medical expenses.
The response received was that they were unwilling to pay, reasoning that the fetal abnormalities did not directly endanger the insured and were not complications from pregnancy. Despite the benefits department’s efforts to explain that we referenced the Medical Council regulations and the interpretation and confirmation from the provincial SSO, we informed the provincial SSO, and they further consulted the Medical Coordination and Rehabilitation Division and received the response:
“In cases where the insured needs to terminate a pregnancy due to the mental health issues of the pregnant woman, if it complies with the Medical Council regulations on the criteria for medical termination of pregnancy under Section 305 of the Penal Code B.E. 2548, the insured can use social security rights at the hospital according to the certificate of rights.”
Therefore, the hospital of origin must be responsible for all medical expenses incurred by the insured, totaling 4,641 baht. All of this is to say that we must always be aware of our patients’ rights. If we are unsure, we should inquire to get clarity. The patient benefits department is another unit that can help us. Don’t forget, we are doctors, we are obstetricians and gynecologists, helping women must be our work.
Source: https://www.gotoknow.org/posts/149602 by Assoc. Prof. Dr. Thanapan Chuboon