Bill provides for a termination on three grounds

The Protection of Life during Pregnancy Bill sets out the parameters for doctors to terminate a pregnancy if they deem that this is the only action that will save the life of the pregnant woman.

Published shortly after midnight yesterday, the 18-page Bill fleshes out the proposals in the heads of the draft law which were agreed in April by the Coalition.

Some new elements are added, including powers for the Minister for Health to suspend services under the law, but the essential thrust of the legislation remains the same.

The Minister can direct the suspension of services under the law in a particular hospital on grounds of a serious risk that there is a failure of the institution to comply with law.

Ministerial investigations
The Minister can ask the Health Information and Quality Authority to conduct an investigation, and can direct the suspension while Hiqa investigates. The suspension can be revoked if the Minister is satisfied there is no serious risk.

In another change, the Minister must be informed with necessary information about terminations that occur. The Minister for Health will be obliged under the law to prepare an annual report by June 30th each year on the notifications received and publish it as soon as practicable “in such form and manner as he or she thinks appropriate”.

Although mooted provisions for a direct report to the Oireachtas on the operation of the law were dropped from the final text, Minister for Health Dr James Reilly told the Fine Gael parliamentary party on Wednesday that he was open to proposals of amendments to the Bill on that front.

In a further change, the Bill narrows the scope of the offence for breaching the law. The Bill says “it shall be an offence to intentionally destroy unborn human life”, removing an earlier provision in which it would be an offence to carry out an act intended to destroy unborn life.

Any guilty person would be liable on indictment to a fine or imprisonment for a maximum of 14 years.

For the avoidance of doubt, the Bill declares that the offence shall not apply to a medical practitioner who carries out a medical procedure within the law.

The Bill provides for a termination of pregnancy on three grounds: risk of loss of life to the woman due to physical illness during an emergency; risk of the woman dying due to physical illness; and risk of dying by suicide.

Medical practitioners
The draft law gives a medical practitioner the power to carry out a termination after deciding in good faith there is an immediate risk of loss to the woman's life from physical illness.

The practitioner in question must form a reasonable opinion that the procedure is immediately necessary to save the mother’s life.

If there is a real and substantial risk to the mother’s life from physical illness, the Bill says the pregnancy can be terminated if two doctors jointly certify in good faith that the procedure is the only way to save the woman’s life. One of the doctors must be a practitioner of a relevant speciality. The other must be an obstetrician who works as such at any of 25 named hospitals, known as “appropriate institutions” in the draft law.

These institutions include 19 hospitals with obstetric units and the major teaching hospitals, the latter being a new addition to the Bill to avoid a situation in which a gravely ill woman has to be transferred from a hospital without an obstetric unit for a termination.

By circumscribing the list of “appropriate institutions” in this way, the Coalition was keen to avoid providing scope for private medical clinics to start providing services under the new law.

In line with the X ruling of the Supreme Court in 1992, the Bill provides for the provision of a medical abortion in light of a real and substantial risk of loss of the woman's life by way of suicide. In such cases, a panel of three specialist doctors must jointly certify in good faith that the risk to the mother's life can be averted only by carrying out the termination.

The Bill says the specialists must include an obstetrician and two psychiatrists, and one of the psychiatrists must have provided mental health services to women in respect of pregnancy, childbirth and post-partum care.

There is also provision for consultation with the mother’s general practitioner. A new element in the Bill is that this can be done only with the woman’s agreement.

The woman has the right to an appeal if the doctors decide that a termination is not warranted. The composition of the review committee would mirror that of the original assessment.

Conscientious objection
A new element in the Bill reduces to 10 days the maximum review period from the 14 days specified in the heads. The review committee would convene within three days of notification and must complete its work within another seven days.

Any medical practitioner, nurse or midwife would not be obliged to carry out any procedures under the law to which he or she has a conscientious objection.

“A person who has a conscientious objection . . . shall make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the medical procedure concerned.”

The Bill no longer includes measures to allow an institution to refuse a termination on grounds of conscientious objection. Mr Reilly said hospitals funded by the State will not have the right to object to treating a patient.