Termination Procedure 2018

Table of Contents

Application for review of medical opinion

Where a medical practitioner, who has been requested to give an opinion in respect of a pregnant woman in relation to the risk to life or health or fatal foetal condition circumstances

does not give an opinion, or
gives an opinion but not such as would be required for the purposes of risk to life or health/ fatal foetal condition certification, as the case may be,

he or she shall inform the pregnant woman in writing that an application may be made ito review the relevant decision. A pregnant woman, or a person acting on her behalf, may make an application in the prescribed form and manner to the HSE for a review of a relevant decision.

Establishment of review panel,

The HSE shall establish and maintain a panel of medical practitioners, for the purposes of the establishment of a review committee in relation to the above decision.

The membership of the review panel shall consist of medical practitioners who are registered in the Specialist Division of the register, and medical practitioners of relevant specialties.

The HSE shall revoke the appointment of a member of the panel who ceases to be a medical practitioner.

As soon as may be but, in any event, not later than 3 days from the date on which it receives an application , the HSE shall establish and convene a committee, the membership of which shall, drawn from the review panel to review the relevant decision that is the subject of the application.

A review committee shall consist of an obstetrician, and in the case of—

a review of a relevant decision which relates to the risk to life or health circumstances an appropriate medical practitioner, or
a review of a relevant decision which relates to the fatal foetal condition ircumstances , a medical practitioner of a relevant specialty.

A medical practitioner shall be disqualified from sitting on the review committee where he or she has previously been consulted by the pregnant woman in relation to the matter that is the subject of the relevant decision to be reviewed by the committee.

Review of relevant decision

The review committee shall complete its review of a relevant decision as soon as may be but, in any event, not later than 7 days from the date on established and convened. Where the review committee, having examined the pregnant woman, has completed its review of the relevant decision and is of the reasonable opinion formed in good faith that—

there is a risk to the life, or of serious harm to the health, of the pregnant woman,
the foetus has not reached viability, and
it is appropriate to carry out a termination of pregnancy in order to avert the risk or
there is present a condition affecting the foetus that is likely to lead to the death of the foetus either before, or within 28 days of, birth,

the committee shall jointly certify their opinion as to the relevant matters as the case may be, and, as soon as may be, give notice in writing of its determination to the pregnant woman (or, if the application under section 13 (2) concerned was made by another person on behalf of the woman, to that other person and the pregnant woman) and the HSE.

Where the review committee makes a certification it shall make such arrangements as may be necessary for the carrying out of the termination of pregnancy to which that certification relates (risk to life or health/ fatal foetal condition) as the case may be.

Where the review committee has completed its review of the relevant decision and is not of the required opinion, it shall, as soon as may be, give notice in writing of its determination to the pregnant woman (or, if the application under section 13 (2) concerned was made by another person on behalf of the woman, to that other person and the pregnant woman) and the HSE.

Review committee

The review committee may, for the purposes of its review of a relevant decision, by direction in writing require a medical practitioner or former medical practitioner at such time and place as may be specified in the direction—

to produce to the committee such documents or other records in his or her possession or control as the committee may reasonably require and as are specified in the direction, and / or to attend before the committee and to give to the committee such assistance and answer such questions as it may reasonably require.

A person who fails or refuses, without reasonable excuse, to comply with a direction shall be guilty of an offence and shall be liable on summary conviction to a class C fine. Summary proceedings for an offence u may be brought and prosecuted by the HSE.

The pregnant woman shall be entitled to be heard by the review committee and, where the woman or a person acting on her behalf informs the committee that she wishes to be heard, the committee shall make such arrangements as may be necessary in order to hear the woman or a person acting on her behalf.

The review committee may, subject to the provisions of the legilation, determine its own procedures. The HSE shall provide, or arrange for the provision of, such administrative facilities as may be necessary to enable the review committee to perform its functions.

Report by HSE on operation of reviews

The HSE shall, not later than 30 June in each year, prepare and submit to the Minister a report on the operation of reviews under this Part in the immediately preceding year, and the Minister shall, as soon as may be after receiving the report, cause copies of the report to be laid before each House of the Oireachtas.

The report, in respect of the year that is the subject of the report,shall include information on—

the total number of applications for review u received by the HSE
the number of reviews carried out,
in the case of the reviews carried out, the reason why the review was sought, and
the outcome of the reviews.

In preparing a report under this section, the HSE shall exclude from the report information that identifies, or that could reasonably lead to the identification of—

a woman who has made an application for review , or in respect of whom such an application has been made by a person acting on her behalf,
a person who has made an application for review on behalf of a pregnant woman, or
a medical practitioner who has—
- made a relevant decision,
- carried out a review,
- complied with above direction or otherwise assisted a committee in a review, or
- carried out a termination of pregnancy following a review.

The HSE shall arrange for a report laid before both Houses of the Oireachtas into be published in such form and manner as it thinks appropriate as soon as practicable after copies of the report are so laid.

Form of certification etc.

A certification shall be made in the prescribed form and manner. It ontain the prescribed information which shall include confirmation of whether the termination of pregnancy to which the certification relates was the subject of a review, and the clinical grounds for carrying out the termination of pregnancy to which the certification relates shall be stated.

Notifications

Where a termination of pregnancy is carried out on one of the above bases, the medical practitioner who carried out the termination of pregnancy shall keep, a record, in the prescribed form and manner, of—

the carrying out of the termination of pregnancy, and
the Medical Council registration number attached to the registration of the medical practitioner who carried out the termination of pregnancy;
whether the termination of pregnancy was carried out pursuant to one of the certified conditions and the Medical Council registration number attached to the registration of the medical practitioner, or each of the medical practitioners, who made the certification concerned;
the county of residence, or in the case of a woman who resides outside the State, the place of residence, of the pregnant woman in respect of whom the termination of pregnancy was carried out;
the date on which the termination of pregnancy was carried out.

Not later than 28 days after the termination of pregnancy has been carried out, he or she shall forward, or cause to be forwarded, a copy of that record, or such part of that record as may be prescribed, to the Minister in such manner as may be prescribed.

The Minister shall, not later than 30 June in each year, prepare a report on the notifications received by him or her under this section during the immediately preceding year, and shall, as soon as may be after preparing the report, cause copies of the report to be laid before each House of the Oireachtas.

The Minister shall arrange for a report laid before both Houses of the Oireachtas to be published in such form and manner as he or she thinks appropriate as soon as practicable after copies of the report are so laid.

In preparing a report under this section, the Minister shall exclude from the report information that identifies, or that could reasonably lead to the identification of ) a medical practitioner and a woman referred to.

Consent

Nothing in the legislaiton affect any enactment or rule of law relating to consent to medical treatment.

Conscientious objection

Nothing in the legislation is to be interpreted as obliging any medical practitioner, nurse or midwife to carry out, or to participate in carrying out, a termination of pregnancy in accordance with th3 2018 Act to which he or she has a conscientious objection. This does not affect any duty to participate in a termination of pregnancy where there is a risk to life or health in emergency

A person who has a conscientious objection shall, as soon as may be, 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 termination of pregnancy concerned.

Offences

It is an offence for a person, by any means whatsoever, to intentionally end the life of a foetus otherwise than in accordance with the provisions of the legilation.This is not to prevent or restrict access to services lawfully carried out in a place outside the State.

It is an offence for a person to prescribe, administer, supply or procure any drug, substance, instrument, apparatus or other thing knowing that it is intended to be used or employed with intent to end the life of a foetus, or being reckless as to whether it is intended to be so used or employed, otherwise than in accordance with the provisions of the legilation.
The above offences do not apply to a pregnant woman in respect of her own pregnancy.

It is an offence for a person to aid, abet, counsel or procure a pregnant woman to intentionally end, or attempt to end, the life of the foetus of that pregnant woman otherwise than in accordance with the provisions of the legilation.

A person who is guilty of the above offfences is liable on conviction on indictment to a fine or imprisonment for a term not exceeding 14 years, or both. A prosecution for such an offence may be brought only by or with the consent of the Director of Public Prosecutions.

Key Definitions

“appropriate medical practitioner”, in relation to a medical practitioner and his or her assessment of the risk to the life, or of serious harm to the health, of a pregnant woman, means a medical practitioner appropriate to the care or treatment of the woman in respect of the risk;
“HSE” means the Health Service HSE;
“health” means physical or mental health;
“medical specialty” means a medical specialty recognised by the Medical Council
“obstetrician” means an obstetrician and gynaecologist;
“obstetrician and gynaecologist” means a medical practitioner who is registered in the Specialist Division of the register under the medical specialty of “Obstetrics and Gynaecology”;
“relevant specialty”, in relation to a medical practitioner and his or her assessment of the presence of a condition affecting a foetus that is likely to lead to the death of the foetus either before, or within 28 days of, birth, means a medical specialty—
- in respect of which the medical practitioner is registered in the Specialist Division of the register, and
- relevant to the diagnosis, care or treatment of such a condition;
“review”, in relation to a relevant decision, means a review under section 16 ;
“review committee”, in relation to a relevant decision, means the committee established to review that decision;