Medical Council recommends changes to abortion legislation

Saturday 18 May 2013 14.41
The Oireachtas Health Committee heard from medical representative groups and experts
The Oireachtas Health Committee heard from medical representative groups and experts

Medical Council President Professor Kieran Murphy has told the Oireachtas Committee on Health and Children that the council is seeking changes to the Protection of Life during Pregnancy Bill 2013.

He was speaking on the first of three days of committee hearings to review the draft abortion legislation.

The committee is to report ahead of the measure going before the Dáil and the Seanad next month.

Prof Murphy said the council believes that two psychiatrists would be sufficient to determine whether a woman is at risk of suicide that can only be averted by a termination.

The legislation provides for two psychiatrists and an obstetrician.

The council also said there should be the same process for deciding on a termination in the case of women with mental or physical symptoms.

It believes the two sections of the bill should be combined.

The State's Chief Medical Officer Tony Holohan said he does not expect the number of women seeking terminations on suicide grounds to be significant.

The issue of suicidal ideation was mentioned several times with doubts raised by some as to its diagnosis.

But Mr Holohan defended the ability of psychiatrists to conduct assessments in relation to claims of suicidal ideation by women under the proposed legislation.

He told the committee that psychiatrists were capable of making a valid clinical assessment.

He said: "It is a clinical science, psychiatry, and it is a science, and it is based on scientific method and endeavour.

"There is a genuine clinical method and evaluation. And simply the assertion that there is uncertainty over clinical evaluation doesn't in any way negate the science behind the practice of psychiatry."

Earlier, Mr Holohan told the committee that the first guiding principle underpinning the legislation is to provide legal clarity on the circumstances where a termination is permissible - where the life of the mother is at risk.

The second principle is that the State will uphold the right to life of the unborn child and the third is that termination of a pregnancy must be necessary to save the woman's life.

He said the fourth principle deals with the issue of suicide, the fifth deals with the issue of consent which is enshrined in ethical standards for doctors and the sixth provides that there must be an ability to monitor the impact and operation of the legislation.

Mr Holohan said it was vitally important that guidance is developed for doctors on the appropriate operation of the legislation, which is best done by the doctors themselves through the professional colleges and the Medical Council.

Master of the National Maternity Hospital Dr Rhona Mahony said it was difficult to estimate the instances of suicide in maternal death.

She said the legislation will provide legal clarity for doctors to do their jobs.

She said that doctors will always try to save a life where possible but this gives them legal protection.

Professor Fionnuala McAuliffe of the Institute of Obstetricians and Gynaecologists told the committee there have been no cases of a suicidal woman for whom the only treatment was medical termination.

However, she said this was not to say that such a situation will not arise. She said the loss of even one woman's life is an absolute tragedy.

Dr Matthew Sadlier of the Irish Medical Organisation said that the 14-day period for decisions to take place seemed long.

On the issue of conscientious objections, he said the IMO was of the belief that it is down to employers to have a system where there would be professionals in place who did not have a conscientious objection to protect those who did from engaging in difficult practices.

Committee hears from maternity hospitals

Dr Peter Boylan of the National Maternity Hospital said the situation in Ireland pertaining to the right to abortion where there is risk to the life of the mother remains unclear.

He said it is down to the doctors to decide, which is wholly unfair on both them and the woman.

Therefore, he said he welcomed the plan to legislate in this regard.

Master of the Rotunda Hospital Dr Sam Coulter-Smith said he welcomed that the legislation provides for termination of pregnancies in emergency situations in any one of the country's 19 maternity hospitals, but said this should be broadened out.

Dr Coulter-Smith said it is appropriate to note no gestational limit in cases where a woman's life is at risk, which in his opinion is correct.

He said it would be good practice for an obstetrician to seek a second opinion in case of emergency.

Dr Coulter-Smith said the fact there is no gestational limit in the case of suicide poses a great ethical dilemma for obstetricians.

Delivering a baby at 25 weeks could lead to serious developmental issues for baby in later life, a source of serious concern, he said.

Dr Mahony said the bill is about saving women's lives and sets out to provide clarity in a number of cases.

She also said she felt that the number of hospitals where terminations could be carried out should be extended.

Several Oireachtas members spoke about the committee's hearings back in January.

Some even went so far as to suggest they had been pointless, as none of the information gleaned regarding suicide appeared to have influenced the Bill.

A number of committee members said they had concerns about the pace at which the legislation was being processed.

Senator Rónán Mullen likened it to an express train.

One obstetrician said he extremely unhappy with being a "mindless terminator".

Dr John Monaghan of Portiuncula Hospital, Ballinasloe said unlike the previous session's obstetricians, he was not happy to take the expert advice of a psychiatrist on the issue of suicide.

Dr Gerard Burke of the Mid-Western Regional Maternity Hospital said the suggestion that a patient would arrive into an obstetricians office "with two abortion tickets from random psychiatrists" was ridiculous.

He called on members of the Oireachtas Health Committee to determine, as legislators, what is meant by the "real and substantial risk to the life of a mother".

Dr Máire Milner of Our Lady of Lourdes Hospital in Drogheda told the committee that she and her staff deal with mental health issues all the time, but in the case of pregnancy, the team of midwives and obstetricians are all involved the support of the mother.

She said occasionally labour has been induced slightly earlier, albeit near the due date, on the grounds of mental health.

Reilly's early departure criticised

A Fine Gael politician has criticised the decision of Minister for Health James Reilly to leave this morning's meeting after his opening statement.

Senator Paul Bradford said it was bizarre, while Wicklow TD Billy Timmins said he could not think of a more appropriate place for the minister to be.

But Mr Reilly’s spokesman said the Chief Medical Officer and the secretary of the department were well placed to answer any questions and that Minister of State Alex White would be present later.

Mr Reilly this morning provided an overview of the draft heads of the Bill and described the issues at stake as "extremely complex".

The minister said in an emergency situation the opinion of one medical practitioner would suffice and the medical practitioner who carries out the procedure will have to stand over their opinion.

Mr Reilly said this would not apply when the risk to life was associated with suicide.

He said the risk to life via suicide was more subjective and required more safeguards.

The minister also explained that the right to conscientious objection was a human right, but that it cannot be conferred to institutions.

RTÉ's Fergal Bowers previews the hearings