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Protection of Conscience Project

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Introduction:

The Protection of Life During Pregnancy Act 2013 [full text] became law in July, 2013The protection of conscience provision is provided here in full within an abbreviated presentation of the entire act.  Paraphrased parts of the bill are in italics.  Mouseover the red text to see government comments that were provided in the "heads of bill" relevant to the text.  Links to other information relevant to the law are in the first column to the right.

Protection of Life During Pregnancy Act 2013


Part 1: Preliminary and General


Short title and commencement . . .
Interpretation

2.  (1)  In this Act -

. . . "implantation""This definition aims to exclude the treatment of ectopic pregnancies and emergency contraception from the scope of the bill." means implantation in the womb of woman; . . .

. . . "medical procedure" includes the prescribing, by a medical practitioner, of any drug or  medical treatment; . . .

. . . "reasonable opinion"". . .this opinion must be formed in good faith and must have regard to protect and preserve unborn human life where practicable. . .[places] a duty on certifying medical practitioners to preserve the life of the unborn as far as practicable. . ." in relation to a medical practitioner or review committee, as the case may be, means an opinion formed by the practitioner or committee, as the case may be, in good faith which has regard to the need to preserve unborn human life as far as practicable; . . .

. . . "unborn""The definition . . . is based on the Supreme Court judgement in Roche v. Roche [et al] which deemed that embryos acquire legal protection under Article 40.3.3 of the Constitution only from the moment of implantation. This definition. . .protects the foetus from implantation until birth. . ." in relation to human life, is a reference to such a life during the period of time commencing after implantation in the womb of a woman and ending on the complete emergence of the life from the body of the woman. . .

Appropriate institutions for purposes of Act

Section 3 of the Act provides that the Minister for Health may order certain classes of institutions providing obstetrical or in-patient care to provide procedures under the Act.

Regulations

Section 4 of the Act authorizes regulations to be made to give effect to it, but every regulation must be presented to the Oireachtas for review.

Repeals . . .
Expenses . . .

Part 2: Medical Procedure Lawful Under Act


Chapter 1:  Risk of loss of life of pregnant woman
Risk of loss of life from physical illness

Section 7 of the Act authorizes a medical procedure on a pregnant woman that may cause the death of an unborn child if two medical practitioners, one an obstetrician and the other of a relevant speciality, both certify that

"(i) there is a real and substantial risk"The Supreme Court judgement in the X case indicated that it is not necessary for medical practitioners to be of the opinion that the risk to the woman's life is inevitable or immediate, as this approach insufficiently vindicates the pregnant woman's right to life. . .In circumstances where the unborn may be potentially viable outside the womb, doctors must make all efforts to sustain its life after delivery. However, that requirement does not go so far as to oblige a medical practitioner to disregard a real and substantial risk to the life of the woman on the basis that it will result in the death of the unborn. Essentially the decision to be reached is not so much a balancing of the competing rights- rather, it is a clinical assessment as to whether the mother's life, as opposed to her health, is threatened by a real and substantial risk that can only be averted by a termination of pregnancy." of loss of the woman's life from a physical illness, and"

"(ii) in their reasonable opinion, that risk can only be averted by carrying out that medical procedure."

One of the practitioners must consult the woman's general practitioner if practicable.  The certifying obstetrician must arrange for the procedure, which must be performed by an obstetrician at an institution designated under the Act. 

Risk of loss of life from physical illness in emergency

Notwithstanding the Section 7 requirement for certification by two medical practitioners, Section 8 of the Act authorizes a medical practitioner to carry out a medical procedure on a pregnant woman that may cause the death of an unborn child when

"8(1) b.  the medical practitioner, having examined the pregnant woman, believes in good faith that there is an immediate risk of loss of the woman's life from a physical illness, and"

"8(1) c.  the medical procedure is, in his or her reasonable opinion, immediately necessary in order to save the life of the woman."

The medical practitioner must prepare a written certificate to this effect, before the procedure is performed, if practicable: otherwise, within 72 hours after the procedure.

Risk of loss of life from suicide

Where a woman is threatening to commit suicide if abortion is not provided, Section 9 of the Act requires that she be examined by one obstetrician/gynaecologist and two psychiatrists. A medical procedure on a pregnant woman that may cause the death of an unborn child may be performed if all three "jointly certify". . . the general scheme is silent on how the certification may come about. Clinical scenarios where the X case criteria might apply are bound to be complex. . .it was felt not desirable to provide in legislation for a specific referral pathway. Rather, it is deemed that standard medical practice will provide an appropriate mechanism for the process . . .[I]t is important that professional guidance is developed by the relevant professional Colleges for their members on the operation of this legislation. . ." " that:

"9(1)b(i) there is a real and substantial risk". . .It is not necessary for medical practitioners to be of the opinion that the risk to the woman's life is inevitable or immediate, as this approach insufficiently vindicates the pregnant woman's right to life. . ." of loss of the pregnant woman's life by way of suicide, and"

"(ii) in their reasonable opinion, that risk can only be averted by carrying out that medical procedure."

The Act also requires that at least one of the three medical practitioners must consult the woman's general practitioner if practicable.

The certifying obstetrician must arrange for the procedure, which must be performed by an obstetrician at an institution designated under the Act. 


Chapter 2:  Reviews
Application for review of medical opinion

Section 10 requires a medical practitioner who refuses to certify the need for a procedure to notify the woman in writing that she can have the decision reviewed, and authorizes the woman or her representative to file an appeal with the Health Service Executive.

Establishment of review panel, etc.

Section 11 of the Act requires that at least 10 medical practitioners be appointed to a review panel, from which members of review committees are to be drawn.

Establishment of review committee, etc. 

Within three days of receipt of an application for review, the Health Service Executive must convene a review committee comprised of members of the review panel.  Section 12 includes details about the composition of review committees. 

Review of relevant decision

Section 13 requires the review committee to complete its review of the case within seven days after having been convened.  The review must include an examination of the pregnant woman.  The committee must either unanimously certify approval of the medical procedure, or give written notice to the woman or her representative, as well as the Health Service Executive.

Procedures of review commitee . . .
Report by Executive on operation of Chapter . . .

Part 3: Miscellaneous


Consent . . .
Conscientious Objection

17.  (1) Subject to subsections (2) and (3), nothing in this Act shall be construed as obliging any medical practitioner, nurse or midwife". . . this right only applies to medical and nursing personnel and pharmacists." to carry out, or to assist in carrying out, any medical procedure referred to in section 7(1) or 9(1) to which he or she has a conscientious objection.

(2)  Subsection (1) shall not be construed to affect any duty to participate in any medical procedure referred to in section 8(1). 

(3) A person who has a conscientious objection referred to in subsection (1) shall make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the medical procedure concerned. 

Travel and information

Section 18 prohibits restrictions on travel to other countries for abortion or the provision of information concerning abortion legally available elsewhere.

Certification . . .
Notifications . . .
Destruction of unborn human life

22.(1)  It shall be an offence to intentionally destroy unborn human life.

(2)  A person who is guilty of an offence under this section shall be liable on indictment to a fine or imprisonment for a term not exceeding 14 years, or both.

(3) A prosecution for an offence under this section may be brought only by or with the consent of the Director of Public Prosecutions.

(4)  For the avoidance fo doubt, it is hereby declared that subsection (1) shall not apply to a medical practitioner who carries out a medical procedure referred to in Section 7, 8, or 9 in accordance with that section.

Offence by body corporate . . .