Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I will get to that with the note. There is the matter of transfer of care. Section 17 of the Protection of Life During Pregnancy Act 2013 relates to conscientious objection, indicating that "A person who has a conscientious objection referred to in subsection (1) 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." I make this point because the phrase "transfer of care of a pregnant woman" already exists in Irish law. We have been discussing this quite a bit and when we make law in the health area, the regulators of those professions take the law, interpret it and legally proof what it means from their perspective as regulators before transferring it into guidance. This has already been done with that Act. Nobody in these Houses has the ability to discipline a doctor or strike off a doctor. Deputy Tóibín asked what would happen to a doctor and a doctor would want to know how the regulator is interpreting the law.

The regulator has already interpreted the law on that phrase on page 35 of the famous book, the Guide to Professional Conduct and Ethics for Registered Medical Practitioners. Section 49.1 of the book deals with conscientious objection, stating "You may refuse to provide or to take part in the provision of lawful treatments or forums of care which conflict with your sincerely held ethical or moral values." Section 49.2 states, "If you have a conscientious objection to a treatment or form of care, you should inform patients, colleagues and your employer as early as possible." Section 49.3 states:

When discussing these issues with patients, you should be sensitive and considerate so as to minimise any distress your decision may cause. You should make sure that patients' care is not interrupted and their access to care is not impeded.

Section 49.4, which is the nub of the matter, states:

If you hold a conscientious objection to treatment, you must:- inform the patient that they have a right to seek treatment from another doctor

- give the patient enough information to enable them to transfer to another doctor or get the treatment they want.

The next point is key. Section 49.5 states, "If the patient is unable to arrange their own transfer of care, you should make these arrangements on their behalf." The Deputy has correctly stated that nobody has a difficulty with section 49.6, which states, "In an emergency, you must make your patient's care a priority and give necessary treatment." That is the totality of the guidelines and it is helpful in answering the Deputy's questions on scenarios.

If a woman cannot arrange transfer of care, and remembering there are many heads and scenarios in this legislation, a medical practitioner must of course arrange the transfer of care. That is likely to happen in a hospital scenario. It relates to a very sick woman, who is perhaps unconscious and whose life could be at risk or who could potentially suffer serious harm to health. To be honest, the bulk of this conversation is coming from the GP community and I accept the legitimacy and bona fides in raising it. With a GP, a patient would be involved with a medical consultation. We have discussed the phrase "medical consultation" a lot. In such cases, the patient will be able to arrange her own transfer of care and the GP is only required to give her that information. I hope that genuinely helps the debate. I have discussed this with members of the Medical Council when I meet them in stakeholder forums and I will meet them again next week as part of a broader stakeholder gathering on the matter.

The Deputy mentioned pharmacists and a 24-7 helpline, and I glad he did. We discussed this yesterday. Everybody has been approaching conscientious objection from the doctor perspective but as the Deputy rightly says, we must also approach it from the woman's perspective. Nobody wants a woman to have to go around trying to find a doctor either. We have done much work on this outside of the legislation on the 24-7 helpline. The idea is that doctors will have the opportunity to opt in and have their information available to that service. A woman needing advice or a service would be able to pick up the phone 24-7, speak to a counsellor, nurse or midwife - a healthcare practitioner - and the woman could be directed to an appropriate place. I do not see a problem from a legal perspective for the reasons I outlined but there is also the practical perspective. This legislation should not, in any way, shape or form, be about discommoding women in accessing a legal service. Nor should it be about catching out doctors who have conscientious objections that they are entitled to have.

I genuinely believe the balance is right. What we are introducing in conscientious objection in this legislation is not new or a different construct. It is not more or less onerous than what has existed. It is exactly what has normally been done. I am concerned a little about some of the commentary from some medics raising the issue of conscientious objection because doctors know it is the regulator - the Medical Council - that makes the interpretation and they should be very familiar with what I have just read. I hope that answers the question.

The matter relating to pharmacists has come up a bit. In the primary care setting from an operational and service perspective, the intention is for the doctor to dispense medication to the woman, thus removing the need for the woman to have to make another trip to another healthcare professional, which would be the pharmacist in this case. In the hospital setting, I am sure pharmacists would be involved with dispensing and, in some cases, supplying the medication to the doctor. In that sense there is a role that pharmacists would have. They already have a code of conduct and it states that pharmacists must "ensure that in instances where they are unable to provide prescribed medication or pharmacy services to a patient, they must take reasonable action to ensure these medicine services are provided and that the patient's care is not jeopardised". Information is available on the Pharmaceutical Society of Ireland's website with respect to referendum in May and the next steps, stating:

The statutory code of conduct for pharmacists sets out the principles for professional practice and behaviour which patients, members of the public and other health care professionals and society generally require and expect of pharmacists who are registered with the PSI. The code of conduct is intended to provide support and guidance to pharmacists as they discharge their professional duties. The code requires pharmacists to ensure that in instances where they are unable to provide prescribed medicines or pharmacy services to a patient, they must take reasonable action to ensure those medicines and services and provided and that the patient's care is not jeopardised.

These are similar principles to what we have just discussed with respect to doctors.