Thursday, 13 December 2018
Health (Regulation of Termination of Pregnancy) Bill 2018: Report and Final Stages
This amendment would insert a new section 22 concerning the provision of foetal ultrasound imaging and auscultation of foetal heart tone and would provide that at least 24 hours before the carrying out of a termination of pregnancy in accordance with sections 9, 11 or 12, the relevant medical practitioner or a qualified person assisting the relevant medical practitioner would be required to perform ultrasound imaging of the foetus and auscultation of the foetal heart tone.
The first thing to notice is that it is in respect of sections 9, 11 and 12 procedures only that this obligation on doctors, not on women, would apply. This amendment could be characterised as obliging the doctor but offering to the woman. The active ultrasound image referred to would have to be of a quality consistent with standard medical practice, should contain the dimensions of the foetus, and should accurately portray the presence of external members, body parts and internal organs of the foetus, if present or viewable. Likewise, the auscultation of foetal heart tone would have to be of a quality consistent with standard medical practice. The requirement in subsection (4) is that, before or during the imaging and auscultation services, the relevant medical practitioner would offer the woman, orally and in person, the opportunity to view the active ultrasound of the foetus and hear the heartbeat of the foetus, if the heartbeat is audible.
Other amendments on informed consent were not accepted on Committee Stage, to my sorrow. If there was a sincere desire on the part of the Minister or the Government that abortions would be rare, as with the question of notification dealt with earlier this afternoon, there would be a desire to see women not manipulatively or coercively informed but fully informed, respectfully and sensitively, of the surrounding facts of their pregnancy.
On the hiding away of ultrasound, I highlighted on Committee Stage how abortion counsellors - I criticised the Irish Family Planning Association, Marie Stopes and others - have had the practice of telling women to turn away while they carry out their routine ultrasound. That is a disservice to women. I do not see how that could be in any way seen as respectful of women's agency. It is paternalistic and goes against the idea that what one should be trying to do here is to give the full informed consent in the way that is normally done with patients for their welfare so that they can have the information they need. As I pointed out earlier, it often occurs that women say: "If only I'd been told. If only I knew that this was what a baby looked like at the stage of pregnancy I was at. If only I knew that there would be support for me if I decided to keep my baby. If only my parents had been notified when I was a minor." Those are all the "if onlys" this legislation leaves us with because, once the request for an abortion is made, the desire is to put the person seeking an abortion on an express train and not to allow the requiring of information that might help them make a life-affirming decision for their own future happiness and certainly for the welfare of their unborn child.
This amendment is about offering women in a respectful way information that may be relevant to the decision. I would be happy were it to be the case that it might cause them to change their decision. Anybody who says they believe abortion should be rare should be happy. Anyone with a scrap of humanity would be happy that a decision would be changed in favour of giving life, but this legislation is a stranger to such feelings, a stranger to such sensitivity and a stranger to such humanity. The amendment, however, was criticised on the grounds that, by definition, if we were to offer a woman a chance to see an ultrasound image, that was somehow requiring an ultrasound and was therefore intrusive. I would have thought that the balance of good could surely be served, as I said, in the provision of information respectfully. These criticisms, which surprised me, caused me to look a little bit deeper at ultrasound. I still have questions because I am not a medical person, some of which I hope the Minister can answer.
It was Dr. Peter Boylan - no friend to the unborn in this context - who talked about the need for ultrasound before the Joint Committee on Health in September. Speaking in advance of that, and this quote is from The Irish Timesof Wednesday, 19 September, he stated: "The operation of abortion services in the State without adequate ultrasound availability will be fraught with risk". If that is the case, that begs the question whether it is known with certainty when ultrasound is needed and when it is not. If a major abortion proponent says the absence of ultrasound availability means that the operation of abortion services will be fraught with risk, is somebody criticising the requirement of ultrasound in each case, saying that we can know with certainty that there is no risk in the absence of ultrasound? I would like a very specific answer to that question from the Minister.
I also want to know whether it can be disputed that there could be a risk to the health of the mother in circumstances where an ultrasound is not used. I would like information. I am not making statements on it because I am not a medical person, but if a woman has an ectopic pregnancy, can that be clinically diagnosed without an ultrasound? I understand how most ectopic pregnancies present, but could it happen that abortions would be sought by women before the presenting symptoms have occurred? I understand that ectopic pregnancies can happen from six weeks or they can be later. Is it possible that an ectopic pregnancy could be involved even though the presenting symptoms have not occurred? Is it possible, therefore, that there could be a danger in that situation because of the non-recourse to ultrasound? I am concerned about women's health as well as the health of the unborn child and, regardless of whether an abortion takes place, I am concerned about women's health. I want a very specific answer to that question. If a woman has been told she could have pain from having had an abortion but, in reality, that pain could be from an ectopic pregnancy rupturing, they might not seek appropriate help. Is there any basis for what I am saying to arise?
I would also like to know whether this question and these related questions have been brought up with medical insurers. Has the Government had contact with the Medical Protection Society or with medical insurers about the question of what arises where abortions might take place in the absence of the use of ultrasound? I raise all these questions because it has been suggested that ultrasound is unnecessarily onerous and intrusive, and I would not want that, but I want the good of the potential saving of the unborn baby's life and the good of leaving absolutely no risk to the mother's life. Has the question of the consequences of not using ultrasound in the case of an ectopic pregnancy that might not yet have presented but does exist, or indeed any other situation, been raised with medical insurers?
Can a pregnancy be accurately dated without an ultrasound? Is there another way of clinically dating a pregnancy aside from asking the woman to clarify the dates? The Minister suggested there was but I understand an ultrasound is needed for accurate dating and that if the doctor wants to know dates accurately, it is good medical practice to do an ultrasound to ensure the pregnancy is not at 14 or 16 weeks, for example, instead of under 12 weeks.
A related question to that, which I would be grateful if the Minister answered, and I will listen carefully for the answer, is that if a pregnancy is later than a woman says and an abortion pill is administered, could that be detrimental to the woman's health? I understand it could be and that she should be under medical supervision if her pregnancy is more than 12 weeks and that she should be in a hospital.
If that is the case, is there absolutely no risk? Is there never a possibility that there could be a mistake which an ultrasound, and only an ultrasound, would allow to be detected? I understand that ultrasound is near-universal, although not entirely universal. This has been the practice in Scotland. I gather that there is a move or a push not to use ultrasound now. I would be interested to hear what the Government has discovered about that. Marie Stopes carries out ultrasound although, as I have said, it does not encourage women to look at it. That has been the experience of women going to abortion-friendly counsellors in Ireland. I would like specific answers to the questions I have asked in the context of this amendment. I stress again that this amendment would not subtract from the legal abortion service. It would not put any duty on a woman to look at ultrasound, but it would oblige the doctor to carry it out and to offer it. I submit that it is not just for the sake of the welfare of the unborn child that it would be appropriate for an ultrasound to be carried out.