The first week of abortion services in Ireland will not go down as a model of good organisation, clear communication and open disclosure.
The very opposite: eight days into the new regime, health professionals are still operating with insufficient information and guidance, and little training. The rest of us have been kept in the dark about what services are available, and where.
This is not about whether you are for or against abortion. It is about whether the service is being introduced in a coherent and properly resourced way that is fair to patients and health staff.
No blame attaches to the HSE staff who have worked hard to introduce the service. In a short space of time, they have managed to put together guidelines and models of care that sketch the way forward – even if the omissions are glaring.
In contrast, Minister for Health Simon Harris’s decision to introduce terminations of pregnancy on January 1st has all the hallmarks of an exercise in political box-ticking.
Why January 1st, just days after legislation passed in the Oireachtas to give effect to the change in abortion law? When even pro-choice doctors have said they are woefully prepared to provide the service?
Operational units
At most, eight of the State’s 19 maternity units were able to provide a service last week. The suspicion is that the actual number of operational units is lower, but the Minister and the HSE have steadfastly refused to provide this information. Nor have they enlightened us on the availability of essential services such as ultrasound or blood testing, or even consultation rooms where women seeking terminations could avail of privacy.
In the community, just 3 per cent of GPs have so far agreed to take referrals from the MyOptions helpline, and none at all in four counties. Those that have opted in are already under siege from winter flu cases, in another reminder that January is the worst time to innovate in the health service.
What else? Some GPs received training last December 21st – for one day. There is no clinical lead for the service, because the closing date for applications was that same day.
The legislation hasn’t even been published yet online in the normal manner on the Attorney General’s website and so is not clearly available as guidance for doctors.
Meanwhile, there was little consultation about the guidelines for the service which, again, were distributed to doctors (but not published) days before the service went live.
Ethical decision
These allow a doctor to perform an abortion on a woman aged 15 and under without the involvement of a parent “in exceptional circumstances”. But what are “exceptional circumstances” and who makes that decision? Understandably, some doctors feel uncomfortable about the prospect of having to make such a huge ethical decision in the absence of clearer guidelines.
The same guidelines place reporting requirements on doctors dealing with minors that, at the very least, vary from the wording of the rules commonly used by Tusla.
The examples of ill-preparation abound. The Medical Council’s ethical guidelines have not yet been updated. The Irish College of General Practitioners’ consultations on the service are the subject of internal dispute.
Of course, many of these problems will be resolved with time. More doctors will sign up; geographical coverage will increase. Clarity and uniformity will be brought to the provision of services. Problems will be ironed out.
It is also likely, though, that doctors will face uncertainty and difficult ethical decisions because of the rushed manner in which the service was introduced – the very uncertainty the change was supposed to eliminate.
And all because a Minister made a promise he was determined to keep, despite the evidence in front of him.