Guidelines seek to help doctors while minimising undue distress to women

In ordinary circumstances, it would seem strange for the Department of Health to be telling clinicians how they should fill out a form, in what sequence they might examine a patient, and how they must inform the minister every time they carry out a certain type of procedure.

But the Protection of Life During Pregnancy Act is no ordinary law. The culmination of a 20-year debate set in motion by a 1992 Supreme Court decision and pushed to the forefront of public consciousness by the death of Savita Halappanavar in Galway in 2012, the law that permits abortion for the first time – albeit in limited circumstances – was one of the most closely scrutinised and delicately worded pieces of legislation published here in decades.

It’s also extraordinarily detailed, which is why the 40-page guidance document prepared by the department, in collaboration with medical and legal experts, largely amounts to a more reader-friendly version of the Act itself.

It explains the distinct procedures that are to be followed when clinically assessing a pregnant woman in each of the three scenarios in which a termination may be carried out: where there is a real and substantial risk to the woman’s life from physical illness or suicide intent, or in an emergency situation where there is an immediate risk to her life.

But while the Act is tightly prescriptive on its key aspects, it is silent on some of the detail. For example, the law states that for a termination to occur where there is a risk to the life of the pregnant woman by reason of suicide intent, this must be certified by an obstetrician and two psychiatrists. But the Act does not specify that the three doctors have to examine the woman together, or at the same location.

The guidelines suggest how the doctors might examine the woman one after the other; if the first psychiatrist believes the test has not been met, the process may stop and the woman can be informed of her options from that point on. It also notes that the Act does not preclude women from seeking a second opinion in relation to the outcome of the clinical decision made by any members of their treating team, as per standard medical practice.

While the document sticks to the wording of the Act, it also shows a concern for minimising undue distress for the pregnant woman. It stresses that she should be told when to expect a decision on whether or not a termination will be certified, and that that decision should be reached expeditiously.

The doctors should agree between themselves on how to tell the woman of the decision, and should only contact her GP with her consent. The Act doesn’t say that the termination has to be carried out in the same institution where the certifying obstetrician examined the woman, or where he/she practises. “The woman’s own preference in relation to the appropriate institution where the procedure is due to be carried out should be sought and adhered to whenever possible,” it states.

The assessment process provided for in the Act comes to an end if and when a review committee, having re-examined the patient, comes to the view that her condition does not meet the legal test and that it cannot sign the certification form.

But, as the document reminds the reader, the story may not necessarily end there, as it’s the woman’s constitutional right to take a legal challenge to the decision.

In other words, the judges may well once again be asked for their say on one of the most contentious social issues of the past 50 years.