Rónán Mullen (Independent) | Oireachtas source

My questions relate to where an abortion is requested by a woman and is not being proposed by doctors in the context of a necessary health treatment, that is, effectively on the 12-week grounds. I do not think any of my questions have been dealt with at any stage during the hearings this morning.

Much was said about conscientious objection this morning. I would be grateful for some assistance. When we talk about what healthcare professionals may or may not be required to do, are we talking about criminal sanctions that might face people as a result of how they exercise their conscientious objection? Are we talking about potential civil sanctions or litigation or are we talking about professional regulatory sanctions, employment consequences or protecting people from employment consequences? I would be grateful if that issue could be teased out. Are there examples of general practitioners, whether for conscience or capacity reasons - by conscience reasons, I mean anything such as religious or philosophical objection or their best judgment about authentic healthcare - who do not offer particular elective medical services but do not have a duty to transfer? I do not say that everything hinges on the answer to that question but I would like to know the answer to it. This is an unique issue, a life and death issue. This is an issue where there is a serious difference of opinion between healthcare professionals who regard abortion as a part of healthcare or alternatively as a human right versus a group of people who in good faith believe this is an unethical, harmful and possibly doubly harmful elective procedure. Are there existing examples of cases where people do not have a duty to transfer, notwithstanding that they are not offering elective medical services? Is there a difference in the view of the expert witnesses in the protection that should be afforded to nurses, midwives, other healthcare staff or professionals, including administrative staff, and people involved in teaching medical procedures compared with the protection afforded to doctors, who may have a conscientious objection? Do they stand in the same relation? Ought they stand in the same relation?

Turning to the question of the three-day waiting period, to be frank I note the ICGP and IOG representatives are clearly dumping on the idea of a three-day waiting period, yet they are telling us that not all of the people they represent are of the same opinion on issues relating to this. To what extent have the bodies consulted with members about the three-day waiting period? What is the state of opinion among the ordinary membership of their respective bodies and can the witnesses enlighten us as to the statistics on how people think about this issue? It is noticeable how sharply opposed to the three-day waiting period both bodies have been, yet they say at a different moment in the presentation that people have widely varying views. When the witnesses say that it is not "necessary" - this is a word that was used - may I ask what they mean about it not being necessary? Is there evidence that it facilitates some women in not choosing abortion in some cases? I have heard it suggested it does not often happen but can the witnesses be more precise in their information? Why is that condition provided in the Netherlands and in other places? Are they saying that it is their view that the same number of abortions will take regardless of whether there is a three-day waiting period?

In saying that the IOG and ICGP representatives have a clear opposition to it, I have not heard, and perhaps I should have been listening more carefully, what the Medical Council has to say on that, if anything. On the one hand, the Medical Council is saying that in its forthcoming guidelines, the doctor's view will be backgrounded and the patient's view will be to the foreground. Mr. Prasifka, on the other hand, draws a distinction between what the law might permit and what the Medical Council considers to be ethical at the same time. Is it conceivable that the Medical Council might take a view that there is an ethical dimension to the three-day waiting period?

Is it conceivable, for example, that even if the law does not effectively treat the unborn child as a patient where abortion is sought, the Medical Council might say that ethics require consideration of the unborn child as a patient be given? Might that touch on decisions, reviews or recommendations of the council in respect of the three-day period?

Does a waiting period ever apply in the provision of other kinds of elective medical services? Again, I am not saying the question of whether there ought to be one here hinges on the answer to that. Is it the case that with most serious medical services, it simply does not happen on demand and on the day anyway? The example was raised of a vasectomy. I do not know how that works. Is it rare for anything serious to happen on the spot or are there are examples of where waiting periods apply and are effectively prescribed, either by law or by regulation, such that people may not have immediate access to certain elective medical procedures? Is it the view of our guests that the removal of a three-day waiting period could, or would, cause an influx of women from Northern Ireland seeking abortions in our jurisdiction? Is it something any of the witnesses have discussed, or have there been submissions to that effect?

I will move to the third phase of my questions. There has been much talk this morning about preventing crisis pregnancies but no talk about preventing abortion when crisis pregnancy arises. I ask why that is the case. I accept the Constitution no longer protects the lives of unborn children as a fundamental right, but it gives full power to the Oireachtas to regulate this area in whatever way we, as legislators, see fit, including, I presume, that we might choose to encourage women not to choose abortion as a matter of good public policy, public health, ethics and welfare of the unborn child and so on. Why is there no talk of trying to prevent abortion in the context of a crisis pregnancy having arisen? I presume a three-day waiting period is partly about that with respect to the welfare of the mother and the unborn baby. I also presume it is one way of trying to keep the unborn child in focus as a patient deserving care, notwithstanding that abortion is permitted. Is that the understanding of the witnesses as to why a three-day waiting period is in play?

Are there other examples of how the Legislature might keep the welfare of the unborn child in view in the context of an abortion regime applying? Has any thought been given to how a woman requesting abortion might be engaged with? I stress this should happen respectfully and never with deception or coercion? For example, could there be a requirement for a woman to be offered an ultrasound and sight of the ultrasound to strike a balance? Has that been discussed within the organisations represented here?

Dr. Peter Boylan has said the number of abortions here is likely to mirror that of Scotland due to our similar populations. There were 12,100 abortions in Scotland last year. Accepting it is difficult to quantify the number of abortions taking place while also accepting that the best information we have from British and international statistics indicates a much lower figure, do the witnesses accept we are looking at a significant increase in our current rate of abortion on the balance of probabilities? In light of Dr. Boylan's expectation of 10% of cases resulting in admission, is it reasonable to speculate that we are talking about 1,200 additional hospital admissions in a year? Given that we have an admissions crisis in hospitals with trolley numbers recently hitting an all-time high, is it reasonable to speculate how the system will cope with this?

It was mentioned that once abortion is introduced, rates fall over time. I am open to correction but I understand that Scotland's rate has been increasing over the past three years, even as its birth rate has fallen steadily over the past ten years. In a sense, that lends some kind of urgency to my question about the impact on the health service.