Government Decision to approve the publication of the Protection of Life During Pregnancy Bill

The Government has today agreed to the publication of the Protection of Human Life during Pregnancy Bill 2013. The Bill can be viewed on the website of the Department of Health.

The legislation will now be debated in the Oireachtas. It is the intention of the Government to have the legislation enacted into law before the summer recess.

On the 30th of April the Cabinet agreed the Heads of the Bill. The published legislation is fully reflective of the Heads of the Bill with certain refinements and certain extra safeguards.

Between the publication of the Heads of the Bill and publication of the Bill itself, the Oireachtas Health Committee held hearings into the legislation and that process has also informed the Bill agreed today at Cabinet.

This Bill restates the general prohibition on abortion in Ireland. Its only aim is to place a legal framework on an already existing narrow provision – set down by the Supreme Court in 1992. Based on the tight parameters in which it is set, the Protection of Life during Pregnancy Bill 2013 outlines the circumstances in which a rare but life-saving termination may be permitted.

The bill is to provide legal clarity, by way of legislation and regulations, of the circumstances where a medical termination is permissible where there is real and substantial risk to the life – as opposed to the health – of a woman as a result of a pregnancy. This is as required by the European Court of Human Rights Judgement in the ABC case. The Minister for Health Dr James Reilly said “todays’ decision by cabinet, approving the Bill, comes in the wake of extensive work between the Government partners. We have produced what we consider to be a balanced set of proposals aimed at meeting the judgement of the European Court of Human Rights. I believe that pregnant women and their doctors will now benefit from the far greater legal clarity this Bill will bring”.

The Protection of Life during Pregnancy Bill 2013 remains strictly within the parameters of the Constitution and the Supreme Court Judgement in the X case. It covers existing constitutional rights only – it will not create any new rights.

The medical termination of pregnancy can only be legally permitted in situations where each of the doctors involved in the assessment have unanimously certified that it is the only treatment that will save the woman’s life by averting the real and substantial risk to her life.

Legal clarity
The bill is intended to give the greatest possible clarity to women and to their doctors as to the services legally available and the process by which access to such services can be evaluated.
· Processes are set out to establish the circumstances in which there is a real and substantial risk to the life, as distinct from the health, of a woman and where the only treatment that will avert that risk is the termination of her pregnancy.

· In a case of a medical emergency, where the risk to the woman’s life is immediate, one doctor may make the decision. In such emergencies, the doctor involved will be required to certify his/her actions within 72 hours.

· In a case of a real and substantial risk to a woman’s life arising from a physical health condition, the assessment process will require that an obstetrician/gynaecologist and a second relevant specialist must jointly agree and certify that the termination of pregnancy is the only treatment that will save the mother’s life. In addition, where feasible and with her consent, the woman’s General Practitioner will be consulted.

· In a case of a real and substantial risk to a woman’s life arising from suicide, additional safeguards will be put in place. The assessment process will involve three specialists; one obstetrician/gynaecologist and two psychiatrists must jointly and unanimously agree and certify that the termination of pregnancy is the only treatment that will save the mother’s life. In such cases also, where feasible, the woman’s General Practitioner will be consulted. In the provision of treatment and care for the pregnant woman due regard is given to the equal right of the unborn. (One of the psychiatrists shall provide or will have provided mental health services in respect of pregnancy, childbirth or post-partum care.)

· In cases where the assessing doctors decide not to certify that a medical termination is permissible, the woman will be entitled to a review of that decision and the composition of the review panel will mirror that of the original assessment.

Appropriate institution
19 public hospitals with obstetric units are listed as appropriate institutions where a termination can be carried out. Where a woman with physical ill health which may require intensive or critical care services to be available to allow her baby to be safely delivered, then a small number of large hospitals are enabled by this legislation as appropriate institutions. The inclusion of certain Teaching Hospitals is in recognition of the reality of the complexity of those cases who may present – critically ill pregnant women with illnesses that may require treatment by neurosurgeons, cardiologists, oncologists, etc in order to treat and save the lives of both patients. The State is obliged to ensure all treatments are at first sought which cannot be directly provided in the dedicated maternity hospitals.

Refinements
The Protection of Life during Pregnancy Bill 2013 has a number of refinements on the Heads of the Bill. The refinements, which are judged to enhance the legislation, have been informed by factors including the hearings at the Oireachtas Health Committee

These include: – The power to suspend. The Minister will have powers to suspend a service. Where the Minister believes that there may be a serious risk that there is a failure of the institution to comply with the provisions of the Act, the Minister may request HIQA to conduct an investigation. The Minister may suspend the service while HIQA investigates. The Minister may revoke the suspension if he/she is satisfied that there is no serious risk.

The Bill provides for the Minister to be informed with necessary information about terminations that occur. The legislation provides for a certain range of anonymised information to be recorded. This includes the date and location of the termination and the relevant section of the Act under which the termination has occurred. The Minister will, on an annual basis, prepare a report on the notifications received and publish such reports.

The Bill can be accessed on the Department of Health website using the following link: http://www.dohc.ie/publications/protection_life_pregnancy.html.