February 2018

In line with the recommendations of groups such as the Queensland Branch of the Australian Medical Association (AMAQ), Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Queensland Nurses Union, the Health Consumers Queensland submission, and Children by Choice submission to the Law Reform Commission Review, the Atheist Foundation of Australia supports and proposes the following answers to the questions provided by the QLRC Review of Termination of Pregnancy Laws 2018.

Who should be permitted to perform or assist in performing terminations.

Q-1 Who should be permitted to perform, or assist in performing, lawful terminations of pregnancy?

Due to the need for safe health practices and medical expertise to legally perform or assist in terminations of pregnancy, registered health and medical practitioners with appropriate qualifications and training should be mandatory in these cases.

In recognition of technological advancements and changes in the development of medication abortion, it should be acknowledged that mid-level providers of medication abortion (via health practitioners such as pharmacists and nurse practitioners) do exist in overseas practices. Such trends in healthcare, with medication supplied by medically trained and legal alternatives, should be considered by the commission (1).

This is particularly relevant considering the geographic isolation and limited access to providers that some women may face in the state of Queensland.

Q-2 Should a woman be criminally responsible for the termination of her own pregnancy?

No.

Under no circumstance should a woman be criminally charged for a termination they consented to. The state of Queensland should additionally support same national legislative consistency in that regard.

Gestational limits and grounds

Q-3 Should there be a gestational limit or limits for a lawful termination of
pregnancy?

The Atheist Foundation of Australia is not a medical authority body or governing group, and we suggest that adhering to the recommendations of groups such as the Queensland Branch of the Australian Medical Association (AMAQ), Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Queensland Nurses Union, the Health Consumers Queensland submission, and the Children by Choice submissions to the Law Reform Commission Review as answers to Questions 3 and 4.

If a model is required, Queensland could consider adopting the example of the state of Victoria, where legislation stipulates that access to termination services are unrestricted up to 24 weeks, and after that point, a woman decides with information and support from two doctors (2).

Q-4 If yes to Q-3, what should the gestational limit or limits be? For example:
(a) an early gestational limit, related to the first trimester of pregnancy;
(b) a later gestational limit, related to viability;
(c) another gestational limit or limits.

See answer to Question 3.

Q-5 Should there be a specific ground or grounds for a lawful termination of pregnancy?

We agree with Children by Choice’s submission that:

If a staged gestational approach to law reform is legislated then informed consent should be the only basis for grounds for a lawful termination of pregnancy prior to 24 weeks.

Q-6 If yes to Q-5, what should the specific ground or grounds be?
For example: (a) a single ground to the effect that termination is appropriate in all the circumstances, having regard to: (i) all relevant medical circumstances; (ii) the woman’s current and future physical, psychological and social circumstances; and (iii) professional standards and guidelines; (b) one or more of the following grounds: (i) that it is necessary to preserve the life or the physical or mental health of the woman; (ii) that it is necessary or appropriate having regard to the woman’s social or economic circumstances; (iii) that the pregnancy is the result of rape or another coerced or unlawful act; vi Review of termination of pregnancy laws (iv) that there is a risk of serious or fatal fetal abnormality?

With reference to answers previously given for Questions 3-5; should a staged gestational approach to law reform be pursued, this should be the grounds to be met for a termination after 24 weeks. No grounds should apply for terminations sought prior to this gestation other than the pregnant person’s informed consent.

Q-7 If yes to Q-5, should a different ground or grounds apply at different stages of pregnancy?

In addition to informed consent, the only recommendation we suggest regarding termination of pregnancy after 24 weeks gestation is the support of RANZCOG’s assertion that “no specific clinical circumstance should qualify or not qualify a woman for termination’ as the ‘impact of any particular condition is highly individual and often complex” (3).

The medical, social, physical and psychological standards can vary greatly from woman to woman, and professional standards and guidelines should recognise that.

Consultation by the medical practitioner

Q-8 Should a medical practitioner be required to consult with one or more others (such as another medical practitioner or health practitioner), or refer to a committee, before performing a termination of pregnancy?

Should a staged gestational approach to law reform be pursued, legislation could require consultation with another medical practitioner after 24 weeks. as per current clinical practice in Queensland, under the Queensland Maternity and Neonatal Clinical Guideline on Therapeutic Termination of Pregnancy (4).

In other circumstances, there should be no need for consultation and the decision should be between the woman concerned and her health practitioner/s. No grounds should apply for terminations sought prior to this gestation other than the pregnant person’s informed consent.

If yes to Q-8: Q-9 What should the requirement be? For example: (a) consultation by the medical practitioner who is to perform the termination with: (i) another medical practitioner; or (ii) a specialist obstetrician or gynaecologist; or (iii) a health practitioner whose specialty is relevant to the circumstances of the case; or (b) referral to a multi-disciplinary committee?

See answer to Question 8.

Q-10 When should the requirement apply? For example: (a) for all terminations, except in an emergency; (b) for terminations to be performed after a relevant gestational limit or on specific grounds?

See answer to Question 8.

Conscientious objection

Q-11 Should there be provision for conscientious objection?

We support the advice the Australian Medical Association provides to its members on conscientious objection (6). While we understand that some medical providers believe they should be exempt from providing termination services due to reasons of conscience based on religious, moral or ethical grounds (5), all providers should be legally obligated to refer a pregnant person to another practitioner who does not hold a conscientious objection, in a timely manner, without discrimination or delay.

As the Atheist Foundation of Australia supports secularism in Australia, we therefore respect that there may be practitioners who wish to be legally able to conscientiously object to involvement in terminations of pregnancy, but this should not apply in cases of life threatening emergencies, or to prevent treatment of serious physical injury. We reiterate that they are responsible for referring a woman or pregnant person to an appropriate, named service provider and patient travel subsidy services if required, no matter what their personal beliefs may be, as we do not believe that there is an equitable situation for all women in Queensland (particularly in rural and remote areas) to be able to access same services.

Conscientious objection should not be applicable to administrative staff, services, facilities, organisations, or corporate entities.

Q-12 If yes to Q-11: (a) Are there any circumstances in which the provision should not apply, such as an emergency or the absence of another practitioner or termination of pregnancy service within a reasonable geographic proximity? (b) Should a health practitioner who has a conscientious objection be obliged to refer or direct a woman to another practitioner or termination of pregnancy service?

See answer to Question 11.

Counselling

Q-13 Should there be any requirements in relation to offering counselling for the woman?

There should be no requirement for counselling, but the availability of pre- and post-abortion counselling by independent services should be available for those who wish to have the option of seeking additional help. Research by Marie Stopes indicates that it is not necessary for all women (7) and The Victorian Law Reform Commission has previously examined the issue of mandatory counselling in their inquiry into the state’s abortion laws in 2007, regarding ineffective and unnecessary nature of mandated counselling (8).

As a result, we support that the options for women who feel that they may need the services should be available, but must not be mandatory. We also strongly support full disclosure of any counselling services if they are run on an anti-abortion basis, and all counselling services should be subject to the trade practices legislation that regulates misinformation and false advertising in that regard (9).

Protection of women and service providers and safe access zones

Q-14 Should it be unlawful to harass, intimidate or obstruct: (a) a woman who is considering, or who has undergone, a termination of pregnancy; or (b) a person who performs or assists, or who has performed or assisted in performing, a lawful termination of pregnancy?

Yes.

The Atheist Foundation of Australia strongly rejects the right of groups (religious or otherwise) to protest or hold vigils outside premises where termination of pregnancy services are provided, and/or engage in the harassment, intimidation and obstruction of those who seek those services and the staff involved, due to the risk of violence and harm that could ensue as a result of such activities (10).

Q-15 Should there be provision for safe access zones in the area around premises where termination of pregnancy services are provided?

Yes.

We are strongly supportive of the principle of safe access zones and agree with the statement by Victorian Health Minister Jill Hennessy that they are necessary “in order to prevent the harm and not just to respond to inappropriate conduct when it occurs” (11).

We also do not believe that safe access zones are an infringement to freedom of political communication, a point which has been previously raised by Human Rights Law Centre (12).

If yes to Q-15: Q-16 Should the provision: (a) automatically establish an area around the premises as a safe access zone? If so, what should the area be; or (b) empower the responsible Minister to make a declaration establishing the area of each safe access zone? If so, what criteria should the Minister be required to apply when making the declaration?

Victoria, Tasmania, and the Northern Territory have a legislated 150m safe access zone, which automatically applies around termination provider premises, and this should be considered as a standard nationwide for all times of the day, as well as for Queensland. This should also include penalties for harassment or intimidation and recording/publishing images of any person entering or leaving an abortion facility, due to the sensitive nature of consultation/s (13).

Q-17 What behaviours should be prohibited in a safe access zone?

See answer to Question 16.

Q-18 Should the prohibition on behaviours in a safe access zone apply only during a particular time period?

See answer to Question 16.

Q-19 Should it be an offence to make or publish a recording of another person entering or leaving, or trying to enter or leave, premises where termination of pregnancy services are performed, unless the recorded person has given their consent?

See answer to Question 16.

Collection of data about terminations of pregnancy

Q-20 Should there be mandatory reporting of anonymised data about terminations of pregnancy in Queensland?

We agree that timely and accurate collection of data of all health service provision in Queensland is vital to be able to plan, design, deliver, monitor and evaluate health services. We fully support the need for health services and medical providers to support equitable, efficient and wide-ranging support for public health, and data collection is an important part of that process.

 

REFERENCES:

(1) Berer, M. (2009). “Provision of abortion by mid-level providers: international policy, practice and perspectives” Reproductive Health Matters 2008, cited in Bulletin of the World Health Organization 2009; 87:58- 63. Available online at:
http://www.who.int/bulletin/volumes/87/1/07-050138/en/

(2) Your Health: Abortion, Family Planning Victoria. Available online at:
https://www.fpv.org.au/for-you/abortion

(3) Royal Australian and New Zealand College of Obstetricians and Gynaecologists, ‘Termination of Pregnancy’ (C-Gyn 17, July 2016), cited in Review into termination of pregnancy laws: Consultation Paper Queensland Law Reform Commission. December 2017; WP No 76; 48. Available online at:
http://www.qlrc.qld.gov.au/__data/assets/pdf_file/0010/547165/qlrc-wp-no-76-2017.pdf

(4) Review into termination of pregnancy laws: Consultation Paper Queensland Law Reform Commission. December 2017; WP No 76; 55. Available online at:
http://www.qlrc.qld.gov.au/__data/assets/pdf_file/0010/547165/qlrc-wp-no-76-2017.pdf

(5) Correspondence from Greenslopes Obstetrics and Gynaecology, submission dated 10th June 2016. Available online at:
https://www.parliament.qld.gov.au/documents/committees/HCDSDFVPC/2016/AbortionLR-WRC-AB2016/submissions/014.pdf

(6) Conscientious Objection Policy Statement, Australian Medical Association, 2013. Available online at:
https://ama.com.au/position-statement/conscientious-objection-2013

(7) What women want when faced with an unplanned pregnancy Research by WebSurvey, commissioned by Marie Stopes International Australia. November 2006. Available online at:
http://www.mariestopes.org.au/data-and-research/what-women-want-when-faced-with-unplanned-pregnancy/

(8) Law of Abortion: Final Report, Victorian Law Reform Commission, March 2008, pp125-126. Available online at:
http://www.lawreform.vic.gov.au/all-projects/abortion

(9) Transparent advertising and notification of pregnancy counselling services Bill 2005: overview of the Inquiry by the Senate Community Affairs Legislation Committee is available on the federal parliament website. Available online at:
http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/2004-07/pregnancy_counselling/report/c01

(10) Stack, Liam. (2015). A Brief History of Deadly Attacks on Abortion Providers. New York Times. Available online at:
https://www.nytimes.com/interactive/2015/11/29/us/30abortion-clinic-violence.html

(11) J. Hennessy (Minister for Health) (2015), ‘Statement of compatibility: Public Health and Wellbeing Amendment (Safe Access Zones) Bill 2015’, Debates, Victoria, Legislative Assembly, 22 October, pp. 3973–3974.

(12) Human Rights Law Centre submission to the Health (Abortion Law Reform) Amendment Bill 2016. Available online at:
https://www.parliament.qld.gov.au/documents/committees/HCDSDFVPC/2016/18-HealthAbortion/submissions/894.pdf

(13) Davey, M. (2014). “Albury’s only abortion clinic: protests ‘push women to point of self-harm’” The Guardian. Available online at:
https://www.theguardian.com/world/2014/dec/09/women-seeking-abortions-harassedby-protesters-to-point-of-suicide

 

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