Conscientious objection is an important issue and this section of the Bill is vital, as shown by the number of Deputies contributing on the debate. Doctors' individual rights and beliefs are not absolute. They should not trump the legal rights or beliefs of others and certainly should not trump the beliefs of doctors' patients. That also goes for all nurses, midwives and allied health professionals. Doctors do not have an absolute right to object. This is the central issue.
The Medical Council is clear on the question of conscientious objection and its medical guidelines have not changed, nor will they. They read:
[A doctor] may refuse to provide or to take part in the provision of lawful treatments [...]
If you have a conscientious objection to a treatment or form of care, you should inform patients, colleagues and your employer [...]
You should make sure that patients' care is not interrupted and their access to care is not impeded. [This aspect is important to our debate.]
If you hold a conscientious objection to a treatment, you must:
inform the patient that they have a right to seek treatment from another doctor; and
give the patient enough information to enable them to transfer to another doctor to get the treatment they want.
If the patient is unable to arrange their own transfer of care, you should make these arrangements on their behalf.
In an emergency, you must [prioritise the patient above the doctor's own objections] and give the patient all the necessary treatment.
The relevant section in the Protection of Life During Pregnancy Act 2013 is the mirror image of the section in this Bill. It reads: "A person who has a conscientious objection ... 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." I am not aware of this provision in the 2013 Act having caused any problem and I cannot see how it would cause a problem if this Bill were enacted.
Thus, the obligations of those who have a conscientious objection to the termination of pregnancy have not changed. What has changed is the fact that the termination of pregnancy will be provided in Ireland and will no longer be transferred to another jurisdiction. What has also changed is the fact that medical professionals will now have to face this reality in Ireland and work out how best to accommodate the new, lawful termination of pregnancy. This new reality will take some time for people to accommodate and for the medical profession to develop the accommodation that the new law will introduce. The conscientious objection requirements have not changed. They are not going to change. However, the reality of the provision of termination of pregnancy in Ireland is changing, and the medical and nursing professions will have to accommodate that. The Medical Council guidelines allow them to do so. Now that terminations will take place in Ireland, doctors must ask themselves the question. They cannot avoid the medical guidelines laid down by the Medical Council, as their beliefs do not trump those of patients who access a legal service.
Some general practitioners, GPs, will provide this service, but it will eventually be delivered in clinics or hospitals. GPs are self-employed. They have a contract with the General Medical Services, GMS, scheme. The provision of termination of pregnancy services in general practice will have a separate, opt-in contract. If a GP wishes to provide the services, he or she will take out the contract. If he or she does not wish to provide them, the GP does not take out the contract. If a GP is a conscientious objector, the GP places a notice in his or her waiting room saying that he or she is not participating in the service. A GP does not need to include an explanation if he or she does not want to, but the GP should inform patients that he or she is not participating in the service. If a patient should seek the service from the GP, though, he or she is obliged to help the patient and give that person information on where to access the service, be that by directing the patient to a helpline, a HSE website or a colleague. Conscientious objection does not absolve a GP of that requirement. In summary, GPs have an opt-in contract and the only requirement on them is to provide information.
The Minister says that arrangements can be accommodated by just providing information. It will soon become quite obvious to people who is providing the service and who is not. People will not subject themselves to the humiliation of going to a doctor knowing that the doctor is not going to assist them but the doctor does have an obligation to provide them with information.
However, there is an issue relating to employees of the HSE. They are in a slightly different situation because there is the possibility that they could be forced or pressurised to participate or assist in abortion services. This must be clarified by the Minister. It should not affect their employment, employment prospects or promotion prospects. The Minister must make it clear that should a conscientious objector be an employee of the HSE, it will not affect his or her career in any way.
To go back to my fundamental point, the rights of a doctor do not trump the rights of a patient. The beliefs of a doctor do not trump the beliefs of a patient. The doctor must assist his or her patient and I believe the Medical Council guidelines on conscientious objection cover that.