Dáil debates

Wednesday, 28 November 2018

Health (Regulation of Termination of Pregnancy) Bill 2018: Report Stage (Resumed)

 

9:20 pm

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael) | Oireachtas source

I am not in a position to accept the amendments. They propose to delete lines in sections 11 and 13, which require an obstetrician to carry out the termination of the pregnancy concerned or, alternatively, propose to allow the certifying obstetrician to make arrangements for the carrying out of the termination of pregnancy. Sections 11 and 13 both set out four steps which must be carried out by two medical practitioners. These steps are carrying out an examination, reaching a reasonable opinion formed in good faith that the requirements set out in the section have been fulfilled, certifying the opinion and carrying out the medical procedure. These steps are linked and follow each other sequentially. If there is no direct link between each of these steps, there is potential for confusion or for a woman in a crisis situation wishing to access termination of pregnancy to face additional barriers before she can access the service she requires.

In both sections one of the medical practitioners must be an obstetrician. Section 11 provides that the other medical practitioner must be an appropriate medical practitioner, which refers to a medical practitioner appropriate to the care or treatment of the woman in respect of the risk of the life or serious harm to her health. In section 13, a medical practitioner of relevant specialty is required, which refers to a medical practitioner registered in the specialist division of the Medical Council.

Both sections provide that the termination of pregnancy must be certified by the certifying obstetrician. In cases where both certifying medical practitioners are obstetricians, which will often be the case, the medical procedure to terminate the pregnancy may be carried out by either of the certifying obstetricians. This requirement for the termination of pregnancy to be carried out by one of the certifying obstetricians is necessary to ensure the process for accessing terminations of pregnancy on these grounds is clear for women and their medical practitioners. Importantly, it also ensures continuity of care for the pregnant woman and places patient safety at the heart of the service.

I have discussed this matter with Dr. Peter Boylan and others. I accepted earlier in the debate that an issue arises in respect of early pregnancy - there was no doubt about that - and it had to be rectified. This is a different situation.

This is a situation concerning health and life, and it is important there is a continuum of care. In addition, there is not a time period that needs to elapse, as there obviously is in early pregnancy.

The requirement for the procedure to be carried out by an obstetrician is necessary in recognition of the likelihood that the terminations carried out under these sections are likely to take place at a more advanced stage of pregnancy and may require more complex care, particularly in the view of the fact they may involve co-existing medical conditions. It is my Department's view, given the medical expertise contained within it, that from a patient safety perspective it is essential the highest possible standard of care is provided in these situations, although I know Deputy Daly and others will not agree with that, and that such cases are supervised and services delivered by the most highly experienced and qualified medical personnel, in this instance, consultant obstetricians. We do not want to do anything unintentionally that would in any way jeopardise a woman's health or lead to less than optimal outcomes.

Amendments were also proposed on Committee Stage to allow the certifying obstetrician to make arrangements for the carrying out of the termination of pregnancy. However, if the Bill did not require the termination under this section to be carried out by a certifying obstetrician, it could lead to a situation where one obstetrician certifies that, in his or her reasonable opinion, formed in good faith, the pregnancy concerned has fulfilled the requirements, but the woman could then experience a delay at a critical point if a second obstetrician must then be found to carry out the procedure. There is a duty of care, which is the point in these situations. In the worst-case scenario, a woman could be refused a termination by a second obstetrician on the grounds that he or she has not formed the same opinion as the obstetrician originally involved, and this would create a barrier to access for a woman when time is of the essence, and it could cause considerable distress or confusion.

I am of the strong belief the law should not impose an obligation on a medical practitioner to carry out a medical procedure based on the opinion of another medical practitioner, as we discussed earlier. I genuinely do not believe these amendments are required. I believe the unintended consequence would be potentially to reduce the optimum level of care that a woman would receive, considering that, under these sections of the legislation, we are talking about a woman who might be very sick and at an advanced stage of pregnancy. There is a duty of care on the obstetrician. There is also a situation where no time period needs to elapse, unlike in early pregnancy.

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