Wednesday, 15 December 2021
Health (Regulation of Termination of Pregnancy) (Foetal Pain Relief) Bill 2021: Second Stage [Private Members]
I move amendment No. 1:
To delete all words after “That” and substitute the following:“Dáil Éireann declines to give the Health (Regulation of Termination of Pregnancy) (Foetal Pain Relief) Bill 2021 a second reading in order to allow for the review of the operation of the Health (Regulation of Termination of Pregnancy) Act 2018 to conclude and for its recommendations to be considered.”
I thank the Deputies for tabling their amendment and acknowledge their legitimacy and genuine views. As for the current approach of allowing this review to progress and make recommendations back to me, the Government, the Oireachtas and the Joint Committee on Health, I would be applying the same approach whether this was a Bill seeking to make the Act more conservative or more liberal. That is important.
I will explain why the amendment is necessary at this time. Following the referendum in 2018, the Health (Regulation of Termination of Pregnancy) Act 2018 was signed into law in late December 2018 and commenced on 1 January 2019. Services for termination of pregnancy are delivered in both community and hospital settings and are designed to provide a safe and effective service for both service users and service providers. The Private Member's Bill before the House today proposes to amend the Health (Regulation of Termination of Pregnancy) Act 2018 to direct the model of care for service delivery. A first reading of the Bill appears to suggest that the obligation on the medical practitioner to administer anaesthetic to the foetus would apply mainly for terminations after 20 weeks' gestation. However, the new section 12A(1)(b) appears to apply to terminations at any stage of pregnancy.
I need not remind the House of the result of the referendum held on the 36th amendment of the Constitution on 25 May 2018. The provisions set out in the Act also reflect recommendations made by the Joint Committee on the Eighth Amendment of the Constitution, based on its consideration of the report produced by the Citizens' Assembly on the issue. No recommendations were made by the joint committee or by the Citizens' Assembly on medical procedures or clinical practice around termination of pregnancy. The purpose of the Health (Regulation of Termination of Pregnancy) Act 2018 is to set out the grounds on which termination of pregnancy is lawful in Ireland. Its purpose is not to dictate clinical practice on the area nor to set out the medical procedures to be used by medical practitioners carrying out a termination of pregnancy.
Detailed work was undertaken by the relevant medical colleges during late 2018 and early 2019 to develop comprehensive clinical guidelines to assist medical practitioners in the clinical decision-making involved in dealing with these cases. This clinical guidance was a key component of the delivery of an integrated service. I am advised that the medical colleges are working on reviewing the clinical guidance documents and where necessary, they will update them according to the latest evidence and international best practice in the area. Care pathways, treatment plans and best medical practice in these sometimes complicated cases are best developed by medical experts and set out in these clinical guidance documents. It would not be appropriate for legislation to dictate clinical practice in a medical or healthcare setting. However, section 7 of the Health (Regulation of Termination of Pregnancy) Act 2018 requires the operation of the Act to be reviewed. I am pleased to be able to tell the House that this review commenced last week on 8 December. The review clause was included in the 2018 Act in order to facilitate monitoring of the impact, operation and effectiveness of the legislation in practice, as well as on the delivery of services in this area. Deputy Nolan asked an important question in the context of this morning's debate as to whether all the issues being raised by her and those tabling this Bill and any of those participating in today’s debate can be considered. I acknowledge these issues are important to the Deputies and all can be raised within the review which is being commenced.
Phase 1 of the review will capture the information on the effectiveness and operation of the Act from the perspective of the women who access the service, health professionals who deliver the service and the public. The latter may also include service users and service providers. The review will be informed by three important streams of information in order to examine whether the operation of the legislation is appropriate and effective. First, and I think most importantly, women's experience of termination of pregnancy services and their views on how the system has operated since 1 January 2019 will be a critical source of information for the review. This stream will draw on the large-scale qualitative research study commissioned by the HSE's sexual health and crisis pregnancy programme. This is to investigate unplanned pregnancy and abortion care. The research is being led by Dr. Catherine Conlon, assistant professor in the department of social studies in the school of social work and social policy in Trinity College Dublin.
The study will generate an indepth understanding of the experiences of women who have accessed unplanned pregnancy support services and abortion care services since the implementation of the Act. Other relevant peer-reviewed research on women's experiences published since 2019 will also be considered.
Second, the review will gather the views of those involved in providing termination of pregnancy services in community and acute settings in Ireland. Independent qualitative research on the service provider perspective was uploaded on eTenders, the Government procurement process, last week. The service providers' research will include input from hospitals and GP services providing termination of pregnancy services. It will include input from individual medical practitioners, medical colleges, midwives, counsellors and other relevant service providers who may wish to partake and be identified. The review will also draw on other relevant peer-reviewed research on service providers' experience of implementing the Act since 2019.
Third, a public consultation was launched to provide an opportunity for members of the public, interest groups or other interested parties to submit their views for consideration in the review. The second phase of the review will be led by an independent chair who will assess the extent to which the objectives of the Act have been achieved, analysing in that regard the findings of the three strands of information on the operation of the Act. The chair will assess the extent to which the Act's objectives have not been achieved and make recommendations to address any barriers identified.
The chair will also draw on the findings of other relevant peer-reviewed research and consult further with stakeholders as necessary before providing conclusions and any recommendations to me later next year. I will share that with the Government. I have already discussed it in detail with the Joint Committee on Health and will share it with colleagues in the Oireachtas too.
In conclusion, I think and hope we can all agree that the best people to make decisions about the most appropriate treatment in healthcare are the treating medical practitioners. Notwithstanding this, as I recently commenced a review of the operation and effectiveness of the provisions of the Health (Regulation of Termination of Pregnancy) Act 2018, at this point, it is necessary to decline to give this Private Member's Bill a Second Reading. We need to allow the review to be completed and for its recommendations to be considered. Let us see what those recommendations may be. They may be operational. There may be recommendations relating to regulation or the Act itself. Those who would seek to change the Act or service provision in any direction, whether to be more conservative or more liberal, need to give the review the space it needs to do its work and report back to us so that we can take appropriate action.