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The legislation, which was commenced in January 2014, provides for an initial assessment by an obstetrician and two psychiatrists to determine risk of loss of life from suicide. Termination is lawful where the three doctors certify that this risk to the woman is “real and substantial” and can only be averted by carrying out the procedure. At least one of the two psychiatrists must have provided mental health services to women around pregnancy-related issues.
According to a paper prepared for the HSE Directorate and Leadership teams in February 2017, “difficulties” had arisen in “getting psychiatrists to undertake the required second opinion locally in the initial assessment”.
The paper, which was authorised by HSE National Director for Quality Improvement Dr Philip Crowley, reported that some consultants “are referring to the review process before exhausting all opportunities to get the required second opinion locally. This may be due to conscientious [objection] issues which are allowed for in the Act. However, it appears that sometimes it is seen as an easier option for a Consultant Psychiatrist/Executive Clinical Director to refer to a review panel.”
The paper also stated that “some issues have arisen with getting the procedure undertaken when the woman does not wish to have the termination undertaken in her local healthcare institution following the review process”.
It outlined that “difficulties” had been experienced “when trying to transfer care to another hospital within a Hospital Group or transfer of care to another Hospital Group. Further clarity is required regarding responsibility for accepting transfer of care protocols in this regard.”
A “potential risk” was also cited in terms of being able to access consultants to undertake a formal clinical review and/or undertake the necessary procedures following certification, given clinical commitments, etc, within the required timeframe under Section 10 of the Act. However, the paper stated that “this has not happened to date”.
Issues arising from the gestational age of the foetus when the mother’s life is at substantial risk “can pose significant clinical issues for consultant obstetricians and all involved”, it also underlined.
The HSE had not responded to queries by press time.