Seanad debates

Tuesday, 11 December 2018

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

 

10:30 am

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

I thank the Senators for their contributions. A total of six amendments to this section are grouped. I too am a defender of conscientious objection. I believe in it. People have the right to conscientiously object. It is a long-standing principle in medicine and has long been enshrined in the way we run our health service.

Senator Bacik and, to some degree, Senator Gallagher both hit the nail on the head when they talked about balance. It is about balancing the right of medical professionals to conscientiously object from this or other services in respect of which they have a conscience issue with the right of a woman to access a service that will be a legal part of the Irish public health service from January. What we are trying to do here is attain balance. I believe we have achieved that balance because section 22 states that where a medical practitioner, nurse or midwife has a conscientious objection, he or she shall not be obliged to carry out or to participate in carrying out a termination of pregnancy. The provisions set out are in line with section 49 of the Medical Council guide for professional conduct and ethics for registered medical practitioners. The provision obliges doctors to enable patients to transfer to another doctor for treatment in cases of conscientious objection.

Senator Gallagher asked the reasonable question of what that means and whether I could provide clarity. I am pleased to do so and I did so in the other House as well. It is described on page 35 of the Medical Council guidelines. Section 49 of the document relates to conscientious objection and states:

If you hold a conscientious objection to a treatment, you must:

- inform the patient that they have a right to seek treatment from another doctor; and

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

I am keen to make another point. No one wants a situation whereby doctors who are conscientiously objecting are coming into contact with women looking for a health service. That is not desirable for anyone. It is not desirable for the doctor and it is certainly not desirable for the woman. We have taken several measures. In particular we have provided for the 24-7 helpline. The first port of call for many women in a crisis pregnancy will be to pick up the telephone. Later in 2019 we will have an instant message service. Women will be able to check out websites like www.myoptions.ie, which will go live when this law passes and is enacted. Women will be able to receive all of the information about all the services available to them in a crisis pregnancy that are legal in Ireland, including termination, in a non-directional manner. The helpline will be able to signpost a woman to where those services are available. This should minimise the situations that no one wants to see, such as conscientiously objecting medical professionals coming into contact with women. It is not desirable and I have no wish to see women going from doctor to doctor in an effort to seek help, especially women who, by virtue of being there, are in a crisis pregnancy situation.

Balance could completely go out the window and the situation could become completely unbalanced if a woman presents in a crisis – it could be a difficult and traumatic situation for the woman – and is simply shown the door without being at least given the information to access the service. That is what transfer of care means. Everyone has acknowledged that it would be different in an emergency situation or in a situation where a woman is not in a position to transfer her care – perhaps she may be unconscious. The law is clear on this point. The Medical Council guidelines have been clear on it too. I am clear on this point. We need to avoid over-egging what is being done in the Bill. The bar is low here. We are simply asking that women are actually given information to access legal services in the country, no more and no less. Similarly, the Nursing and Midwifery Board of Ireland code of professional conduct and ethics in 2014 states:

If you have a conscientious objection based on religious or moral beliefs which is relevant to your professional practice, you must tell your employer and, if appropriate, tell the patient as soon as you can. If you cannot meet the patient’s needs because of this objection, you must talk with your employer and, if appropriate, talk to the patient about other care arrangements. Even if you have a conscientious objection, you must provide care to a patient in an emergency where there is a risk to the patient’s life.

Others have alluded to the fact that in the Dáil I brought forward amendments to ensure it was absolutely clear that student nurses and midwives would have the right to conscientiously object as well. Moreover, section 13 provides a specific duty on a treating physician who refuses certification to inform the woman that she has a right to apply for a formal review of this decision.

I have already mentioned that I have directed the HSE to put in place a helpline to help women navigate the services for termination of pregnancy. It is intended that medical practitioners will voluntarily consent to have their names released to women seeking the service so that women ringing the helpline will be assisted in contacting medical practitioners who do not have a conscientious objection to termination of pregnancy.

As I have already said, the Bill and existing medical guidelines make it clear that conscientious objection cannot be invoked in an emergency situation where there is a risk to a pregnant woman's life or health and where there is an immediate risk in that regard.As has been stated by some colleagues, the current code of conduct for pharmacists states that pharmacists must, "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 these medicines/services are provided and the patient's care is not jeopardised." The council of the Pharmaceutical Society of Ireland, PSI, which is the regulator for pharmacists in this country, has approved a new code of conduct for pharmacists. Part five of principle four on page nine of the proposed code of conduct makes provision for conscientious objection subject to a referral of a patient to an alternative provider if a pharmacist cannot provide a professional service or a medicinal product so that patient care is not jeopardised or compromised. A footnote to principle four also makes a specific reference to a pharmacist transferring the care of a pregnant woman availing of services in the termination of pregnancy, so it has already taken action as the pharmacy regulator in this country.

The approved code of conduct is required to be submitted by the PSI to the Competition and Consumer Protection Commission for approval before being submitted to the Department for ministerial approval. Conscientious objection is in place. It is about getting the balance right between making sure women can access legal services and providing for medical practitioners who do not wish to partake and conscientiously object. It is also about making those rights respect each other. We have taken a number of measures outside the legislation in terms of the roll-out of services, most particularly the 24-7 helpline, to support women and medical practitioners in this new reality.

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