Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Senators for tabling these amendments as they highlight a very important area on which I was prompted to seek greater clarity. I have discussed this with Senator Ardagh and her party colleagues, Senator Ruane and others. Senator Gavan is correct that we moved in the Dáil to fix a practical challenge in the delivery of services in early pregnancy. While we do not all share this view, the practical difficulty arose from the fact that a three-day period had to elapse. This meant a woman could go back to her general practitioner and find a different doctor working because the GP has gone on leave. We have managed to keep the link with certification because no doctor can be forced to carry out a procedure based on another person's medical opinion. However, we have managed to do so in a way that does not restart the clock. I believe people are largely satisfied that we have dealt with this matter as it relates to early pregnancy.

The question that arises beyond the 12 week period is what does the term "medical procedure" mean. We had a meeting of all the relevant stakeholders this morning, including leading medics who are preparing to provide this service, the masters of the maternity hospitals, Dr. Peter Boylan who is clinically advising on this, officials from the national women and infants health programme, and representatives of the Irish College of General Practitioners and Institute of Obstetricians and Gynaecologists. To respond to Senator Ardagh's call for clarity on what this wording means, I refer Senators to the definitions section of the Bill in section 2. It states that "termination of pregnancy", in relation to a pregnant woman, means "a medical procedure which is intended to end the life of a foetus", while the term "medical procedure" is defined as including "the prescribing, by a medical practitioner, of any drug or medical treatment". Therefore, the prescribing of the drug is the medical procedure.

I have heard of real cases, which obstetricians and gynaecologists are right to highlight, where a woman could start a procedure that could take a number of days. It is not commonplace but could happen for a variety of reasons. The clinician will have discharged his or her duty in the prescribing of the medication. That is the procedure. I have sought legal and clinical advice on this and sought the understanding of those drawing up our clinical guidelines. The medical procedure includes the prescribing of any drug. The aftercare or care of the woman during that procedure is a normal matter for rostering. I am happy to provide clarity, including written clarity, to Senators who have a concern about this matter. The idea is not that the same obstetrician must be present for a period of days.

If Senators accept the definitions of "termination of pregnancy" and "medical procedure" in the Bill, we need to ensure we do not break the link between the responsibility of one doctor in caring for a woman and the continuum of care for that woman. I shared the Senators' concerns on this and I wanted to get it right. We amended the legislation where we believed it was not right. I think we have shown good faith and that we are not precious when we need to get something right. Where the legislation was not right in respect of early pregnancy, we amended it. However in relation to later pregnancy, health and life and fatal foetal abnormality, the person who certifies and provides the care must carry out the procedure. It is not the case, however, that this person cannot hand over aftercare or care monitoring of the woman. That is allowed for in the legislation. I will, before Report Stage, provide Senators and the clinical community with further clarity. However, I am satisfied that the excellent HSE engagement with stakeholders I attended this morning, at which Dr. Boylan and others had an opportunity to engage with clinicians, provided a degree of clarity that had been lacking. This has been very much welcomed.

I am happy to engage on this matter and tease it through, but I am satisfied that the legislation is robust in protecting the woman, ensuring that it must be a doctor's reasonable opinion and that the doctor must certify that opinion. I am also satisfied that it does not provide unintended consequences in respect of ongoing monitoring and aftercare.