The Queensland Health,
Communities, Disability Services and Domestic and Family Violence
Prevention Committee has been tasked with looking into the Health (Abortion Law Reform) Amendment Bill, put to Qld parliament in August 2016 by MP Rob Pyne. It's a private member's bill, and can be found at. It followed his introduction of a simple bill to decriminalise abortion, which the committee recommended against passing alone.
A summary of the second bill from the committee's website shows it includes provisions to legislate that:
Below is the submission I made (half at the deadline, and half, just afterwards in the hope that it would be considered).
Submission to the Queensland Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee regarding the Health (Abortion Law Reform) Amendment Bill
A summary of the second bill from the committee's website shows it includes provisions to legislate that:
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only a doctor may perform an abortion: a person who is not a doctor (or a registered nurse administering a drug to perform an abortion under the direction of a doctor) would commit an offence.
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a woman does not commit an offence by performing, consenting to or assisting in an abortion on herself
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an abortion on a woman who is more than 24 weeks pregnant may be performed only if two doctors reasonably believe the continuation of the woman’s pregnancy would involve greater risk of injury to the physical or mental health of the woman than if the pregnancy were terminated
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conscientious objection: no-one is under a duty to perform or assist in performing an abortion; however a doctor has a duty to perform an abortion if it is necessary to save a woman’s life or prevent serious physical injury. Also, a registered nurse has a duty to assist in such circumstances.
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patient protection or ‘safe zones’: a protected zone of at least 50 metres must be declared around an abortion facility; certain behaviour, e.g. harassment and intimidation, is prohibited within a protected zone. Publishing images of a person entering, leaving or trying to enter or leave an abortion facility is prohibited.
Below is the submission I made (half at the deadline, and half, just afterwards in the hope that it would be considered).
Submission to the Queensland Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee regarding the Health (Abortion Law Reform) Amendment Bill
Dear committee members,
I am writing as a woman who grew up on
the Sunshine, Gold and Tweed Coasts, and as a doctor who has worked
as a junior doctor in obstetrics, gynaecology and paediatric
emergency, and as a general practitioner with over 20 years'
experience working in women's health, sexual health, family planning
and abortion services, in NSW, Tasmania and Western Australia.
I did not make a submission to the
committee regarding the associated Abortion
Law Reform (Woman's Right to Choose) Amendment Bill. However,
I read the committee's report with interest and was disappointed with
the decision not to recommend immediate passage of the bill to
decriminalise abortion.
My
daughter and I will be moving to Queensland next year, and these two
bills, important for all Queensland women of reproductive age, will
have a bearing on us, on my patients and on my medical practice.
Like
so many who gave written and oral presentations to the committee, I
am in favour of immediate complete decriminalisation of abortion.
I am
writing this submission to give qualified support to the passage
of the Health (Abortion Law
Reform) Amendment Bill 2016, only in conjunction with
passage of the Abortion Law
Reform (Woman's Right to Choose) Amendment Bill.
I
believe this bill is too
restrictive, however, I believe that on balance it would be better to
be passed (in conjunction with passage of the Abortion Law Reform
(Woman's Right to Choose) Amendment Bill), rather than having the
Abortion Law Reform (Woman's Right to Choose) Amendment Bill not pass
at all. I believe this bill makes substantial concessions to
alleviate concerns raised in the committee's report,
and should be seen as an attempt to introduce legal reform that will
be generally workable, introducing legal protection for Queensland
women seeking abortion and for health care professionals providing
abortion-related services to women in good faith.
I
would like to address each of the key elements of the bill in turn.
Only
qualified health practitioner may perform abortion
This
section of the legislation must be understood to be intended to
protect women from unsafe procedures, and
as such, is laudable.
Read
in conjunction with the conscientious refusal provision, however,
this section restricts abortion provision (apart from medication
administration) to doctors only,
while allowing doctors to refuse to perform a
service that a substantial number of women in Queensland require
(whatever figures we rely on for that estimate).
Experience
from abroad indicates that first trimester aspiration abortion can
safely be performed by appropriately
trained nurse practitioners, physician assistants and nurse
midwives1.
Although I am not aware of any jurisdiction in Australia where first
trimester aspiration abortion is carried out by nurse practitioners
or nurse midwives, there is no reason why, if proper training were
introduced for willing clinicians, such an initiative should be ruled
out in Queensland
by a ban with a ten-year imprisonment penalty. Many
women in remote and regional centres are unable to access first
trimester abortion close to home. A
new law shouldn't make it
impossible to implement an
initiative to reduce the
number of late abortions by improving access to early abortions.
It
has taken over a hundred years of the operation of criminal law
restricting abortion for abortion law to be seriously revisited in
Queensland. Medical, nursing and midwifery practice is continually
evolving. It makes most sense for regulation of who can perform
abortion, to ensure public safety, to be overseen by the medical and
nursing/midwifery boards and by existing general laws restricting
health care
practice to only those who are properly qualified.
It
would be preferable for this section to be
amended to include reference to other appropriately trained
clinicians, or to be omitted
altogether, on the understanding that Queensland
already has effective laws
prohibiting untrained people from providing
health care for which they
have not undergone proper training.
Those
objections notwithstanding, if this section is passed as it is, it
would not restrict existing practice and would provide legal
protection to doctors and nurses currently providing abortion-related
services. If it's the best that can be achieved, I support it.
Abortion
on woman more than 24 weeks pregnant
The
notion that decriminalising
abortion without restriction as to reason and gestation
will result in a rash of third trimester abortions overtaking
Queensland is an invention of those who are opposed to abortion on
non-scientific grounds.
The
experience of the ACT, where there is no gestation limit in law bears
this out. The only free-standing clinic where abortion is available
in the ACT provides procedures under 16 weeks' gestation only.2
In
Canada, where there is also no legal gestation on abortion, it is
estimated that abortion after 20 weeks makes up 0.86%
of all abortion.3
The
vast majority of pregnant
women seeking abortion do so as early as they can. Reasons
for presenting late for termination have been explored in the medical
literature and may be complicated. They represent a tiny
minority of abortions, but
the women undergoing abortion late are no less competent to make
decisions about their pregnancies than women requiring abortion who
are able to present for medical care early. Late abortion is
generally harder for women to undergo and clinicians to perform;
no-one directly involved in the decision-making process does so
lightly. There is no need for the additional restriction of law, in
the way of restrictions as to reason beyond 24 weeks' gestation. If a
woman 24 weeks pregnant or later determines that she requires an
abortion – whether because in the opinion of her doctors it is
necessary for her physical or mental health – or whether she
determines it is in the best interest of the foetus, or for some
other reason or set of reasons – there shouldn't be a legal
restriction preventing her doctors from performing it for her.
As
with the previous section, if the law will only be passed with this
proviso, it is better than not decriminalising abortion. However, it
represents an unnecessary interference in a woman's right to decide
how and whether to proceed with her own pregnancy.
Patient protection
I support this section of the bill. I
believe the protection zone should be greater, probably 150m, in
keeping with the ACT legislation.
Protesting and expressing minority
views about the morality of abortion can have a place in a democracy,
but there is no absolute right to such political communication that
outweighs women's right to privacy in seeking medical care. I have
witnessed the impact of distressing, hostile protest actions outside
abortion facilities on women seeking care and am in favour of
measures to prevent harassment of patients and staff.
Duty of care
Most health professional codes of
conduct recognise a right to conscientious refusal of care. The
impact of this on restricting reproductive health care is not well
documented, though an attempt to begin this work has been
undertaken.4
What is important to note is that in
general, where a right to refusal of care is acknowledged, it is not
considered to outweigh the right of women to access needed
healthcare. This generally includes an obligation of practitioners
refusing to perform abortion to refer women to others who will
provide services.
Again, it seems to me unnecessary to
include this assertion of the right to refuse care in the law when it
is already accepted in practice, but particularly without the
inclusion of the complementary obligation to refer to a practitioner
who will provide care. As I outlined in the section on who can
perform abortion, when only doctors may lawfully perform or prescribe
abortion medication, but they may refuse, if this is not combined
with a safeguard obliging referral to a practitioner who will provide
services, it could operate as a practical barrier to access.
In Western Australia where I currently
practice, and where there is a restriction requiring a woman seeking
abortion to be given information by a doctor not participating in the
abortion, it is not unusual for women to see more than one
practitioner; I have had patients who've needed to see 3, 4, even 5
doctors before being appropriately assisted to obtain an abortion.
This clearly results in delay and later procedures. It is not known
whether it ever results in women being unable to obtain abortion at
all, but this possibility can't be discounted. I am concerned that
the uneven emphasis on the right to conscientious refusal of care in
the bill, if not balanced with the internationally recognised
obligation to refer to a practitioner who will provide care, will
result in unnecessary and unfair difficulties for women seeking
abortion services, depending on the availability of clinicians who
support women's access to the full range of reproductive healthcare
services.
These are the concerns I have about the
Health (Abortion Law Reform) Amendment Bill. I believe the bill
should only be passed in conjunction with the passage of the bill to
decriminalise abortion, that its provisions don't represent the best
for the women of Queensland, but that they should be supported as
concessions to enable recommendation of decriminalisation of
abortion, which would certainly be a step towards the 21st
century.
1
Safety
of Aspiration Abortion Performed by Nurse Practitioners, Certified
Nurse Midwives, and Physician Assistants Under a California Legal
Waiver
Tracy A. Weitz, Diana Taylor, Sheila
Desai, Ushma D. Upadhyay, Jeff Waldman, Molly F. Battistelli, and
Eleanor A. Drey. American Journal of Public Health 2013 103, 3,
454-461
2http://www.shfpact.org.au/sexual-health/pregnancy-options
accessed 6/10/2016
3http://www.arcc-cdac.ca/backrounders/statistics-abortion-in-canada.pdf
accessed 6/10/2016
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