Abortion services would be ‘risky without health investment’

The operation of abortion services in the State without adequate ultrasound availability will be "fraught with risk", an Oireachtas Health Committee will be told on Wednesday.

It is one aspect of overall investment concerns which, the Committee will hear, will be required for everything from the provision of MRIs and ultrasound, to the establishment of a 24-hour phone line and providing for the treatment of patients in hospitals.

Doctors' groups will address TDs and Senators today about the development of clinical guidelines in light of the impending introduction of abortion services in Ireland.

It comes as the Eighth Amendment to the Constitution was officially repealed yesterday when President Michael D Higgins signed the Thirty-Sixth Amendment of the Constitution Bill into law.

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It gives effect to the referendum result so there is no longer a constitutional ban on abortion and the Oireachtas is free to legislate. However, until such legislation is passed, the existing laws will remain in place, even though the constitutional ban has been removed.

Doctors’ groups will tell today’s Committee they believe abortion services should be free for women.

The need to expand ultrasound availability will also be raised by chairman of the Institute of Obstetricians and Gynaecologists (IOG) Dr Peter Boylan.

He will say while routine pre-termination ultrasound scanning is not recommended as mandatory, it is generally done where available, and certainly where there are concerns about dates or ectopic pregnancy.

“In Ireland, however, we are only too well aware of the well-documented infrastructural deficits in access to ultrasound in pregnancy,” he will say.

“Introduction of a TOP (termination of pregnancy) service without adequate scanning facilities is fraught with risk, and IOG therefore recommends that appropriate and immediate investment in ultrasound is an integral element of TOP services.”

Dr Boylan will also call for investment in MRI (magnetic resonance imaging) services, currently only available at one maternity hospital, to assist in cases of potential fatal abnormalities.

MRI is used in other countries to examine complex anomalies and can change diagnoses from a fatal to a life -limiting condition, and vice versa. Its accuracy is 93 per cent as compared to 68 per cent for the ultrasound alternative.

The IOG will also request the establishment of a 24 hour helpline.

Speaking ahead of the Committee hearing, Dr Boylan told The Irish Times service funding would be required but that this was an issue for health authorities. The IOG's primary focus is on the development of clinical guidelines.

“I think in general it’s pretty well acknowledged that there are capacity constraints in the system. There will need to be investment,” he said.

Dr Boylan will also point out that there is no evidence to support a proposed three day interval between when a women has her first consultation and having the termination. “It makes unwarranted assumptions about women’s ability to make their own decisions,” he swill say.

On the issue of conscientious objection for doctors who disagree with abortion, the IOG points to existing Medical Council ethical guidelines which state that while a doctor may refuse the service, he or she must give the patient information for alternative care.

The Medical Council is currently updating its guidance to doctors on the provision of abortion services in the aftermath of the referendum.

Separately, the Irish College of General Practitioners (ICGP) will also raise investment in services, flagging the need for a 24 hour helpline, counselling and ultrasound. In consultation, its members have expressed concerns around “capacity and resourcing challenges”.

It will tell the Committee that GPs would prefer an “opt in” approach “by which they choose to provide this clinical care pathway”.