The Department of Health has reminded clinicians that pregnant women who are refused terminations under the Protection of Life During Pregnancy Act have a constitutional right to challenge the decision in the courts.
A forthcoming document on the operation of the Act, prepared by the department in collaboration with a committee of medical and legal experts, outlines the provisions of the legislation and offers guidance for health professionals when providing care for pregnant women with life-threatening conditions.
It sets out the process of clinical assessment required by the Act, which permits terminations where there is a real and substantial risk to the life of the pregnant woman from physical illness or suicide intent, or where there is an immediate risk to her life.
The document includes checklists and suggests practical procedures for clinicians to adhere to the law, which came into force in January.
Two specialists
In cases of a risk to the woman’s life from physical illness, the law says two specialists, including an obstetrician, must jointly certify that there is a real and substantial risk of loss of the woman’s life, that this can only be averted by a termination, and that they have, “in good faith”, had regard to the need to preserve unborn human life where practicable.
As the law does not specify that the two doctors have to examine the woman together, or in the same location, the guidelines suggest the woman might be examined by either specialist first and then, if that doctor deems the requirements of the test have been met, he/she shall refer her on to the second specialist.
The document states that, if practicable, at least one of the specialists must consult the woman’s GP so as to obtain information that might be of assistance. However, this consultation can only take place if the woman consents to it.
“Decisions to certify or otherwise should be reached expeditiously and communicated to the woman. Patients should be informed of when to expect a decision,” it states.
Emergencies
In emergencies, the reasonable opinion of one doctor is sufficient to certify that a termination is necessary to save the woman’s life, but the document stresses that the risk must be immediate. Consultation with the GP is not required in such cases.
The guidelines go into great detail on cases of suicide intent, where an obstetrician and two psychiatrists are required to certify the procedure.
Where it is decided that a woman’s condition does not meet the test set in the Act, the guidelines say, she shall be informed of the decision and told that she may explore other treatment options under the care of the existing treating team, seek a referral to another specialist or apply for a formal medical review.
If the review committee believes the test has not been met, it is required to give its decision in writing to the patient or a person who applied for the review on her behalf, and to the HSE “as soon as possible” after the review.
“The woman can then review her options as generally indicated [in] this document. In addition, the woman has a constitutional right of access to the courts.”
It adds that members of the review panel will be indemnified by the State against the costs of defending legal actions in cases of alleged negligence in the performance of their work, and against any damages awarded as a result of such action “provided the duties are carried out in a bona fide manner”.
