Alice-Mary Higgins (Independent) | Oireachtas source

This is one area where we have effectively been asked to put our trust in the training that might be provided for doctors, in terms of clinical guidelines and how things unfold. I want to mark the real concerns in this area. It is not merely the case that the guidelines are there but there must be engagement on how the practice unfolds. We must ensure that, for instance, the word "serious" is not interpreted in such a way that it does have a chilling effect in practice. We must ensure we monitor what happens and that we listen, because it took a long time as a nation to listen to the stories of women, and doctors, as to how things tend to unfold in reality. Either these will go forward and be successful or we will have to revisit these issues. If "serious" is interpreted in a way that it was in symphysiotomy, and I hope that never happens, whereby something would be regarded as not serious so long as a woman could continue reproducing, it will be an issue. That has happened in Ireland and many of these issues are almost cultural. I accept that we may not want to deal with all of these in legislation but they are matters of practice.

We should be watchful of a pattern emerging in which people attend a first appointment but do not follow up three days later. There is concern that visiting the doctor can be a great effort for people in difficult living situations, particularly in situations of violence, insecurity or in which their attendance anywhere is attached to the care of many other vulnerable persons of whom they may be the carer. We should be careful that people need not look to alternative routes because this serves as an obstacle. I accept that the emergency provision in section 12 may serve in that regard but we may need to revisit it. There may be measures such as time-delay prescriptions or phone consultations. We may need to examine this in different ways to see that it is working. While I might not wish for a three-day delay, I understand that the principle is being enshrined in the legislation but we must monitor it carefully so that it does not block access to the most vulnerable.