Abortion guidelines provide for induction or Caesarean section

Guidelines on the circumstances for abortion provide for early induction or Caesarean section as a suitable alternative means of terminating a pregnancy where the woman’s life is at risk.

The guidelines on implementing the Protection of Life During Pregnancy Act were published by the Department of Health yesterday. They were drawn up by the department and are intended for all clinicians who involved in caring for pregnant women.

The guidelines appear to go further than the Act in prescribing C-section and early induction.

Act in force

The Act came into force on January 1st, setting out for the first time the circumstances in which a woman may legally access an abortion. It refers to a “medical procedure in respect of a pregnant woman . . . in the course of which, or as a result of which, an unborn human life is ended”.

The guidelines were written by a committee appointed last year by the department. They outline procedures to be adhered to by clinicians, including GPs, midwives, psychiatrists and obstetricians, when there is a real threat to a pregnant woman’s life that can only be averted by a termination of pregnancy. The threat can be physical, a physical emergency or by suicide.

A version of the 40-page Implementation of the Protection of Life During Pregnancy Act 2013: Guidance Document for Health Professionals was published and circulated to a limited number of clinicians in early July. It was seen and reported on by The Irish Times.

Changed emphasis

The document published yesterday, with the same title and number of pages, differs substantially in a number of respects, most starkly in the changed emphasis that should be given to the unborn’s gestational age, and in what it says about interventions where the unborn has reached viability.

The July guidelines, under the heading “gestational age” on page 31, say: “If the unborn has reached viability and the woman’s life is in danger, the best course of action may be deemed to be an early induction or Caesarean section. In such cases, the medical procedure would not fall under the Act as it is not a medical procedure during which or as a result of which, an unborn human life is ended.

“Once delivered medical staff should ensure the necessary care for the neonate in accordance with clinical guidelines and best practice.”

In the guidelines published yesterday, at page 31 this paragraph is removed. In its place the text omits a reference to such interventions falling outside the terms of the Act.

“Once certification [for termination] has taken place a pregnant woman has a right to a termination of pregnancy as soon as it can be arranged. The ++clinicians responsible for her care will need to use their clinical judgement as to the most appropriate procedure to be carried out, in cognisance of the constitutional protection afforded to the unborn, ie a medical or surgical termination or an early delivery by induction or Caesarean section,” it reads.

“Following certification, if the pregnancy is approaching viability, it is recommended that a multi-disciplinary discussion takes place to ascertain the most appropriate clinical management of the case.”

Make a difference?

It remains to be seen whether the changes will materially affect decisions that would be made where a pregnancy is approaching viability. They fail to spell out that interventions where the unborn’s life is not ended do not come within the terms of the Act, and may be seen to add to it.

Minister for Health Leo Varadkar said yesterday the case of Ms "Y" did not "feed into" the guidelines. Ms "Y" was suicidal but was denied a termination as her pregnancy had reached 22 weeks. The baby was delivered by C-section last month at about 26 weeks.

“One thing I know as a doctor,” said Mr Varadkar, “is that medicine is never black and white. And I know as a legislator that legislation can never be black and white. It is never going to be possible to create guidelines that provide absolute clarity.”