Girls aged 15 and under will be able to get an abortion without the involvement of their parents or another adult "in exceptional circumstances", according to the Health Service Executive guides to the termination of pregnancies.
A doctor offering the abortion to the young woman who chooses not to involve an adult is required to complete an assessment, the as-yet-unpublished guides state.
The provision has caused unease among some doctors who are otherwise in favour of the new service. “To receive this 10 days before the service is introduced is deeply disturbing. This has not been widely discussed by clinicians,” one doctor said.
“The concern relates to not having an adult involved in the decision, not the termination of pregnancy,” the doctor stressed.
Another clinician questioned whether Minister for Health Simon Harris had "taken leave of his senses. No doctor in his right mind would undertake a termination in these circumstances without getting a legal ruling. There has been no significant discussion of these issues."
The doctor must report to Tusla if the girl is 14 or under and has engaged in sexual activity
Girls aged 16 and 17 who want an abortion and choose not to involve an adult will be able to get one, the guides say, without any restriction as to circumstances. Doctors can proceed “only if they are confident that you understand the information and you can give valid consent”.
“Young people, aged under 18 years, are encouraged to involve their parents or another supportive adult,” according to a question-and-answer section of the documents.
As per existing law, the doctor must report to Tusla if the girl is 14 or under and has engaged in sexual activity; if she is 15 or 16 and has had sex with someone who is at least two years older; or if she is 17 or younger and the doctor suspects she is at risk of being, or has been, sexually abused or harmed.
HSE guides
The information is contained in two separate but overlapping HSE documents, Your Guide to Medical Abortion, covering terminations with abortion pills, and Your Guide to Surgical Abortion, for terminations performed using a suction method in a hospital.
The guides say a doctor may “in some circumstances” not provide an abortion service. “A doctor who has a conscientious objection must, as soon as possible, refer you to another doctor who does provide abortion services.”
They point out if an abortion fails and the woman has an ongoing pregnancy exceeding 12 weeks, it is illegal under Irish law to have further treatment except where continuing the pregnancy places her life or health at risk; in an emergency; or where there is a condition that is likely to lead to the death of the foetus.
Doctors who carry out abortion after 12 weeks in any other circumstances face fines or imprisonment for up to 14 years, newly published interim guidelines from the Institute of Obstetricians and Gynaecologists make clear.
It is of utmost importance that doctors comply with the certification process as legally required by the Act
The institute sought clarification from the Department of Health on the 12-week rule and was told "12 weeks plus one day exceeds 12 weeks. Therefore, 12 weeks is 12 weeks + 0 days".
A termination that begins before 12 weeks can be lawfully completed, but a repeat course of treatment – which could be required where an initial termination failed to end the pregnancy – cannot be instigated, the guidelines say.
“It is of utmost importance that doctors comply with the certification process as legally required by the Act. At the time of finalising this interim document, no information was available from the department regarding how this certification process would occur.”
Ethical guidelines
Further detail is also being awaited from the Medical Council about its updating of ethical guidelines for doctors in relation to the new service, the guidelines note.
Abortion is due to be introduced on January 1st. Only 106 of the State's 4,000 GPs have signed up to provide the service via a helpline, and only nine out of 19 maternity units say they are ready to offer terminations from the start of next month.
Speaking to journalists, Taoiseach Leo Varadkar said the service would be available in the new year – “not the full service in every part of the country but it will be available and phased in and stepped up as the year goes through”.
