LAST UPDATE | 18 Oct 2023
THE RISK OF criminalisation is having a “chilling effect” on doctors who provide termination services, while some doctors “actively obstruct” women from receiving treatment due to personal beliefs, the Oireachtas Health Committee has been told.
Barrister Marie O’Shea BL, who authored a review of current abortion legislation, said medical practitioners have “universally” told her that the impact of “having a criminal sanction there hanging over them, it has a chilling effect”.
“The criminal sanction on the providers is something that weighs very heavily on their mind,” she added.
The committee is today discussing O’Shea’s review of the Health (Regulation of Termination of Pregnancy Act) 2018, which was published in April.
In her review, O’Shea made a number of recommendations including the decriminalisation of abortion for medical professionals.
While women are decriminalised under the current legislation, it criminalises anyone who assists a pregnant person to obtain an abortion outside of the provisions of the Act – with a prison sentence of up to 14 years.
Dr Catherine Conlon, from Trinity College’s School of Social Work and Social Policy, told the committee that during the course of her research she encountered some women who were “actively obstructed in accessing care”.
In one instance, a young woman who had suffered sexual assault went to her GP and found out she was pregnant.
The GP encouraged the woman to engage with a pregnancy counselling service before making a decision about a termination, Conlon told the committee.
After engaging with both the doctor and the counselling service, the woman decided she wanted an abortion.
“She returned a third time to that GP believing that she would be cared for and, of course, the time is moving towards the 12 weeks,” Conlon said.
“That GP told her on her third visit that they did not provide the care nor did they agree with abortion care being provided, and they would not give her any information on where she could access it.”
The woman ended up going to a women’s health clinic in Dublin to receive an abortion.
Conlon said, as well as not providing abortion services for the woman in question, this particular GP did not refer her to a sexual assault clinic for follow-up support.
Conlon said it is “tragic” that some women still face such barriers to receiving medical treatment.
Three-day wait
O’Shea’s report also recommends that the three-day wait before a woman can access a termination should be made optional, as well as recommending changes to how fatal foetal anomalies are handled.
The committee heard the three-day wait is “patronising” and unique to abortion services.
Green Party TD Neasa Hourigan called this waiting period “condescending” and “demeaning”.
Fianna Fáil Senator Lorraine Clifford-Lee said it is “patronising”, adding that she is not aware of any other medical procedure where a person would be “told to turn around and reflect on it, if they’ve made their mind up on something”.
O’Shea said she was under “enormous pressure” to finish her report earlier this year, but there has been a lack of engagement from the Department of Health with her since then.
She said she hopes the department is currently examining her report, and how to implement its recommendations, even if it is not discussing its plans with her directly.
Fine Gael Senator Martin Conway asked O’Shea if she has confidence in the department, to which she replied: “I’d like to think so, I’m an optimist by nature.”
When her report was published in April, Health Minister Stephen Donnelly thanked O’Shea for her “dedication and hard work”.
“I would also like to acknowledge and thank the stakeholders, service providers, those who avail of these services as well as members of the public for their input into the report.
“Their knowledge, experience and views have contributed greatly to this important milestone in the development of termination of pregnancy services in Ireland,” Donnelly said.
12 weeks
Under the current legislation, a person is permitted to terminate their pregnancy for up to 12 weeks, and a GP or doctor must first certify that they are no more than 12 weeks pregnant.
Terminations can also be carried out where there is a risk to the life, or of serious harm, of the pregnant woman, or where there is a condition present that is likely to lead to the death of the foetus either before or within 28 days of birth.
O’Shea told the committee that in cases where a doctor is “trying to determine whether or not the foetus will demise before birth or within 28 days”, the medical science is not exact and it is “an educated guess”.
“There is no definitive list of conditions that are saying that this will lead to the death within 28 days, so a lot of it is educated guesswork,” she stated.
O’Shea noted that many women don’t know they are pregnant until well into the 12-week cutoff point due to health issues and irregular periods.
It was also noted that the 12-week timeframe starts from the first day of the last menstrual cycle – a time at which women realistically cannot know they are pregnant.
‘Deeply patronising’
Ahead of today’s meeting, the National Women’s Council said the three-day wait is “deeply patronising”. Poushali Kundu, NWC’s Women’s Health Officer, added that it is “unique to abortion”.
“Women have given a lot of thought to their situation by the time they get to their doctor. We also know that women in many rural areas do not have the same access to abortion as their urban counterparts, and this cannot continue.
“And we cannot continue to abandon women after the arbitrary 12-week mark. Many women make devastating decisions not to continue a pregnancy after a diagnosis of a life-limiting condition, or a change in their own life circumstances. They need care at home,” Kundu said.
Kate Mitchell, NWC’s Head of Development and Policy, added that women should not have to travel abroad for a termination, but many still do.
“In 2018, people voted to provide compassionate care for women at home. The O’Shea review clearly shows that serious gaps still remain in the provision of timely and effective abortion care.
“Women and pregnant people in heartbreaking circumstances are still being forced to travel – at least 860 travelled to the UK alone since the vote.”
Representatives from the NWC are attending today’s committee meeting.
A People Before Profit Bill providing for wider access to abortion passed its second stage in the Dáil on 31 May. A Government amendment to pause the passage of the Bill for 12 months was defeated.
The Bill seeks to abolish the mandatory three-day waiting period for a termination and to allow terminations on the ground of a fatal foetal abnormality that is likely to lead to death either before or within a year of birth.
The Bill also seeks to allow for abortion where there is a risk to the life, or of serious harm to the health, of the pregnant woman, and to decriminalise the provision of abortion.
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