Protection of Life During Pregnancy Act 2013

PART 1 Preliminary and General

1. Short title and commencement

1. (1) This Act may be cited as the Protection of Life During Pregnancy Act 2013.

(2) This Act shall come into operation on such day or days as the Minister may appoint by order or orders either generally or with reference to any particular purpose or provision and different days may be so appointed for different purposes or provisions.

2. Interpretation

2. (1) In this Act—

“Act of 2007” means the Medical Practitioners Act 2007;

“Act of 2011” means the Nurses and Midwives Act 2011;

“appropriate institution” means—

(a) an institution that is specified in the Schedule, or

(b) an institution that is specified in an order under section 3;

“approved centre” has the meaning it has in section 63 of the Mental Health Act 2001;

“certification” means a section 7 certification, section 8 certification, section 9 certification or section 13 certification, and includes a copy of any such certification;

“certifying obstetrician”, in relation to a certification, means the obstetrician who made the certification;

“Executive” means the Health Service Executive;

“general practitioner”, in relation to a pregnant woman, means a medical practitioner who provides a general practitioner medical service to the pregnant woman;

“medical practitioner” means a medical practitioner who is for the time being registered in the register;

“medical procedure” includes the prescribing, by a medical practitioner, of any drug or medical treatment;

“medical speciality” means a medical speciality recognised by the Medical Council under section 89 of the Act of 2007;

“mental health services” has the meaning it has in the Mental Health Act 2001;

“midwife” means a person whose name is for the time being registered in the midwives division of the register of nurses and midwives established under section 46 of the Act of 2011;

“Minister” means the Minister for Health;

“nurse” means a person whose name is for the time being registered in the nurses division of the register of nurses and midwives established under section 46 of the Act of 2011;

“obstetrician” means an obstetrician and gynaecologist;

“obstetrician and gynaecologist” means a medical practitioner who is registered in the Specialist Division of the register under the medical speciality of “Obstetrics and Gynaecology”;

“pregnant woman”, in relation to a review, means the pregnant woman to whom the review relates;

“prescribed” means prescribed by regulations made under section 4;

“psychiatrist” means a medical practitioner who is registered in the Specialist Division of the register under a medical speciality of “Psychiatry”;

“register” means the register of medical practitioners established under section 43 of the Act of 2007;

“relevant decision” shall be construed in accordance with section 10;

“relevant speciality”, in relation to a medical practitioner and his or her assessment of the risk of the loss of a pregnant woman’s life, means a medical speciality—

(a) in respect of which the medical practitioner is registered in the Specialist Division of the register, and

(b) relevant to the care or treatment of the physical illness in respect of which the risk of such loss arises;

“review” means a review under section 13 of a relevant decision;

“review committee”, in relation to a relevant decision, means the committee established under section 12(1) to review that decision;

“review panel” means the panel established under section 11(1);

“section 7 certification” means a certification referred to in section 7(1)(a);

“section 8 certification” means a certification referred to in section 8(2);

“section 9 certification” means a certification referred to in section 9(1)(a);

“section 13 certification” means a certification referred to in section 13(3);

“unborn”, in relation to a human life, is a reference to such a life during the period of time commencing after implantation in the womb of a woman and ending on the complete emergence of the life from the body of the woman;

“woman” means a female person of any age.

(2) A section 13 certification shall be deemed to be—

(a) a section 7 certification where section 12(2) applies, and

(b) a section 9 certification where section 12(3) applies,

and the other provisions of this Act shall be construed accordingly.

(3) A reference in this Act to physical illness includes a reference to a physical injury but does not include a reference to suicide.

3. Appropriate institutions for purposes of Act

3. (1) The Minister may by order, where he or she thinks it appropriate for the purposes of this Act, specify any institution managed by the Executive, or by another person pursuant to an arrangement entered into under section 38 of the Health Act 2004—

(a) at which in-patient services are provided under the direction of medical practitioners from not less than 3 medical specialities and which is wholly or partly used for the care and treatment of women in relation to any one or more of the following:

(i) pregnancy;

(ii) childbirth;

(iii) post-partum care,

or

(b) at which in-patient services (including intensive and critical care services) are provided under the direction of medical practitioners from not less than 7 medical specialities,

and any institution so specified shall be an appropriate institution for the purposes of this Act.

(2) Every order made by the Minister under this Act shall be laid before each House of the Oireachtas as soon as may be after it is made and, if a resolution annulling the order is passed by either such House within the next 21 days on which that House sits after the order is laid before it, the order shall be annulled accordingly, but without prejudice to the validity of anything previously done thereunder.

4. Regulations

4. (1) The Minister may by regulations provide—

(a) for any matter referred to in this Act as prescribed, or

(b) for any matter that appears to the Minister to be necessary or expedient for bringing this Act into operation.

(2) Without prejudice to any provisions of this Act, regulations under this section may contain such incidental, supplementary and consequential provisions as appear to the Minister to be necessary or expedient for the purposes of the regulations.

(3) Every regulation made by the Minister under this Act shall be laid before each House of the Oireachtas as soon as may be after it is made and, if a resolution annulling the regulation is passed by either such House within the next 21 days on which that House sits after the regulation is laid before it, the regulation shall be annulled accordingly, but without prejudice to the validity of anything previously done thereunder.

5. Repeals

5. Sections 58 and 59 of the Offences Against the Person Act 1861 are hereby repealed.

6. Expenses

6. The expenses incurred by the Minister in the administration of this Act shall, to such extent as may be sanctioned by the Minister for Public Expenditure and Reform, be paid out of moneys provided by the Oireachtas.

PART 2 Medical Procedures Lawful under Act

Chapter 1 Risk of loss of life of pregnant woman

7. Risk of loss of life from physical illness

7. (1) It shall be lawful to carry out a medical procedure in respect of a pregnant woman in accordance with this section in the course of which, or as a result of which, an unborn human life is ended where—

(a) subject to section 19, two medical practitioners, having examined the pregnant woman, have jointly certified in good faith that—

(i) there is a real and substantial risk of loss of the woman’s life from a physical illness, and

(ii) in their reasonable opinion (being an opinion formed in good faith which has regard to the need to preserve unborn human life as far as practicable) that risk can only be averted by carrying out the medical procedure,

and

(b) that medical procedure is carried out by an obstetrician at an appropriate institution.

(2) Of the 2 medical practitioners referred to in subsection (1)(a)—

(a) one shall be an obstetrician who practises as such at an appropriate institution, and

(b) the other shall be a medical practitioner of a relevant speciality.

(3) If practicable, at least one of the medical practitioners referred to in subsection (1)(a) shall, with the pregnant woman’s agreement, consult with the woman’s general practitioner (if any) for the purposes of obtaining information in respect of the woman from that general practitioner that may assist the medical practitioners in their decision as to whether or not to make a section 7 certification in respect of the woman.

(4) Subject to section 19, the certifying obstetrician shall—

(a) forward, or cause to be forwarded, the section 7 certification to an appropriate institution, and

(b) make such arrangements as may be necessary for the carrying out of the medical procedure to which the section 7 certification relates at the appropriate institution.

8. Risk of loss of life from physical illness in emergency

8. (1) Notwithstanding the generality of section 7, or any determination made or pending pursuant to section 13 of an application under section 10(2), it shall be lawful to carry out a medical procedure in respect of a pregnant woman in accordance with this section in the course of which, or as a result of which, an unborn human life is ended where—

(a) a medical practitioner, having examined the pregnant woman, believes in good faith that there is an immediate risk of loss of the woman’s life from a physical illness,

(b) the medical procedure is, in his or her reasonable opinion (being an opinion formed in good faith which has regard to the need to preserve unborn human life as far as practicable) immediately necessary in order to save the life of the woman, and

(c) the medical procedure is carried out by the medical practitioner.

(2) Subject to section 19, where a medical practitioner—

(a) subject to paragraph (b), proposes to carry out a medical procedure referred to in subsection (1), he or she shall, before carrying out the medical procedure, certify the matters referred to in subsection (1)(a) and (b),

(b) proposes to carry out the medical procedure without first making such certification because it is not practicable to do so, he or she shall make such certification as soon as may be but, in any event, not later than 72 hours after carrying out the medical procedure.

9. Risk of loss of life from suicide

9. (1) It shall be lawful to carry out a medical procedure in respect of a pregnant woman in accordance with this section in the course of which, or as a result of which, an unborn human life is ended where—

(a) subject to section 19, three medical practitioners, having examined the pregnant woman, have jointly certified in good faith that—

(i) there is a real and substantial risk of loss of the woman’s life by way of suicide, and

(ii) in their reasonable opinion (being an opinion formed in good faith which has regard to the need to preserve unborn human life as far as practicable) that risk can only be averted by carrying out the medical procedure,

and

(b) that medical procedure is carried out by an obstetrician at an appropriate institution.

(2) Of the 3 medical practitioners referred to in subsection (1)(a)—

(a) one shall be an obstetrician who practises as such at an appropriate institution,

(b) one shall be a psychiatrist who practises as such at an appropriate institution, and

(c) one shall be a psychiatrist who practises as such—

(i) at an approved centre, or

(ii) for, or on behalf of, the Executive,

or both.

(3) Of the 2 psychiatrists referred to in subsection (2), at least one shall be a psychiatrist who provides, or who has provided, mental health services to women in respect of pregnancy, childbirth or post-partum care.

(4) If practicable, at least one of the medical practitioners referred to in subsection (1)(a) shall, with the pregnant woman’s agreement, consult with the woman’s general practitioner (if any) for the purposes of obtaining information in respect of the woman from that general practitioner that may assist the medical practitioners in their decision as to whether or not to make a section 9 certification in respect of the woman.

(5) Subject to section 19, the certifying obstetrician shall—

(a) forward, or cause to be forwarded, the section 9 certification to an appropriate institution, and

(b) make such arrangements as may be necessary for the carrying out of the medical procedure to which the section 9 certification relates at the appropriate institution.

Chapter 2 Reviews

10. Application for review of medical opinion

10. (1) Where a medical practitioner, who has been requested to give an opinion in respect of a pregnant woman in the circumstances referred to in section 7(1) or 9(1)—

(a) does not give an opinion, or

(b) gives an opinion but not such as would be required for the purposes of a section 7 certification or section 9 certification, as the case may be,

(in this Act referred to as a “relevant decision”) he or she shall inform the woman in writing that she may make an application in accordance with subsection (2) to review the relevant decision.

(2) A pregnant woman, or a person acting on her behalf, may make an application in the prescribed form and manner to the Executive for a review of a relevant decision.

11. Establishment of review panel, etc.

11. (1) Subject to subsection (2), the Executive shall establish and maintain a panel consisting of at least 10 medical practitioners appointed for such term and on such conditions as the Executive determines.

(2) The membership of the review panel shall consist only of medical practitioners and the Executive shall revoke the appointment of a member of the panel who ceases to be a medical practitioner.

(3) The Executive shall, in addition to appointing medical practitioners duly identified by it for appointment to the review panel, request—

(a) the Institute of Obstetricians and Gynaecologists,

(b) the College of Psychiatrists of Ireland,

(c) the Royal College of Surgeons in Ireland, and

(d) the Royal College of Physicians of Ireland,

to nominate medical practitioners for appointment to the panel.

(4) The Executive may, if it considers it appropriate to do so, appoint to the review panel one or more of the medical practitioners nominated under subsection (3).

12. Establishment of review committee, etc.

12. (1) As soon as may be but, in any event, not later than 3 days from the date on which it receives an application under section 10(2), the Executive shall establish and convene (or cause to be convened) a committee, the membership of which shall, subject to subsections (2) to (5), be drawn from the review panel, to review the relevant decision that is the subject of the application.

(2) In the case of a relevant decision which relates to the circumstances referred to in section 7(1), the review committee shall consist of—

(a) an obstetrician who practises as such at an appropriate institution, and

(b) a medical practitioner of a relevant speciality.

(3) In the case of a relevant decision which relates to the circumstances referred to in section 9(1), the review committee shall consist of—

(a) an obstetrician who practises as such at an appropriate institution,

(b) a psychiatrist who practises as such at an appropriate institution, and

(c) a psychiatrist who practises as such—

(i) at an approved centre, or

(ii) for, or on behalf of, the Executive,

or both.

(4) Of the 2 psychiatrists referred to in subsection (3), at least one shall be a psychiatrist who provides, or who has provided, mental health services to women in respect of pregnancy, childbirth or post-partum care.

(5) A medical practitioner shall be disqualified from sitting on the review committee where he or she has previously been consulted by the pregnant woman in relation to the matter that is the subject of the relevant decision to be reviewed by the committee.

(6) For the purposes of this Chapter, a relevant decision which falls within paragraph (a) of section 10(1) shall be treated as if it were a refusal to give an opinion such as would be required for the purposes of a section 7 certification (where the circumstances referred to in section 7(1) apply) or a section 9 certification (where the circumstances referred to in section 9(1) apply).

13. Review of relevant decision

13. (1) The review committee shall complete its review of a relevant decision as soon as may be but, in any event, not later than 7 days from the date on which the review committee was established and convened under section 12(1).

(2) The review committee shall, for the purposes of reaching a determination on its review of the relevant decision, examine the pregnant woman.

(3) Where the review committee has completed its review of the relevant decision and is satisfied in good faith that—

(a) there is a real and substantial risk of loss of the pregnant woman’s life from a physical illness or by way of suicide, as the case may be, and

(b) in its reasonable opinion (being an opinion formed in good faith which has regard to the need to preserve unborn human life as far as practicable) that risk can only be averted by carrying out a medical procedure referred to in section 7(1) or 9(1), as the case may be,

the committee shall, subject to section 19, jointly certify that it is so satisfied and, as soon as may be, give notice in writing of its determination to the woman (or, if the application under section 10(2) concerned was made by another person on behalf of the woman, to that other person) and the Executive.

(4) Where the review committee has completed its review of the relevant decision and is not satisfied as referred to in subsection (3), it shall, as soon as may be, give notice in writing of its determination to the pregnant woman (or, if the application under section 10(2) concerned was made by another person on behalf of the woman, to that other person) and the Executive.