Monday, 10 December 2018
Health (Regulation of Termination of Pregnancy) Bill 2018: Committee Stage (Resumed)
I would be happy to meet the Minister on this matter and take up his offer to provide written assurances in this regard because this is an area of concern. I support amendment No. 20, which makes clear recommendations in relation to obstetricians. The language used for making arrangements for the carrying out of the procedure is reasonable. The Minister referred to prescription. Are arrangements envisaged in the same sense as they are envisaged for prescription?
My specific concern, on which I have proposed an amendment, relates to early pregnancy. I have proposed to delete the words "carried out" and substitute them with the word "initiated". I am sure the Minister will be able to reassure me on this. A significant concern arises regarding persons who may be within the 12 week period and for whom a medical termination may be initially indicated. A doctor may take appropriate steps and prescribe medication for a medical termination. However, it can be the case that, following the first dose of Mifepristone, a miscarriage is not successfully induced although there may not be foetal life. This is similar to what happens in the case of missed miscarriages. It could be some time later, perhaps a week afterwards, that the person, who will not be carrying a viable pregnancy, must move from what would have been a GP setting to a hospital setting.With due respect, the Minister caused some alarm with the language of chain of causation and so forth because we are looking at situations where persons in a GP's office being prescribed medication and taking steps with regard to a medical termination may then find themselves in a situation where aftercare takes place in a different setting - a hospital setting with an obstetrician who may not have been involved. We mentioned rostering and gaps. The GP may no longer be in the country and may have travelled, which would have been a reasonable expectation. This circumstance does arise. We know it already happens in terms of missed miscarriages whereby foetal life ends but the pregnancy effectively continues to manifest and a miscarriage does not occur. We know this situation arises, that misoprostol does not always work in terms of inducing a miscarriage and that there is time when surgical intervention is needed. None of that should be an issue except for the fact that the Minister has used language like chain of causation. People will wonder where it fits in and what the concerns are. Should somebody in the hospital be concerned that they are dealing with aftercare in respect of a process that was started in a GP's surgery? Should the GP be concerned because the process continues? The Minister has given some clarity by referencing the prescription and the medication but I would appreciate getting this in writing. The Minister can understand the concern because situations also arise where people are potentially moving between one part of the Bill and another part. That is what I mean by chain of causation. It might be worth reconsidering because this language caused considerable alarm.