Health (Regulation of Termination of Pregnancy) Act 2018

PART 1 Preliminary and General

1. Short title and commencement

1. (1) This Act may be cited as the Health (Regulation of Termination of Pregnancy) Act 2018.

(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, and for the repeal of different enactments or provisions of enactments effected by section 5.

2. Definitions

2. In this Act—

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

“Act of 2013” means the Protection of Life During Pregnancy Act 2013;

“foetus”, in relation to a pregnancy, means an embryo or a foetus during the period of time commencing after implantation in the uterus of a woman and ending on the complete emergence of the foetus from the body of the 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;

“Minister” means the Minister for Health;

“prescribed” means prescribed by regulations made under section 3;

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

“termination of pregnancy”, in relation to a pregnant woman, means a medical procedure which is intended to end the life of a foetus;

“woman” means a female person of any age.

3. Regulations

3. (1) The Minister may by regulations provide for any matter referred to in this Act as prescribed or to be prescribed.

(2) Without prejudice to any provision 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 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.

4. Expenses

4. 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.

5. Repeals

5. The following are repealed:

(a) sections 16 and 17(1) of the Censorship of Publications Act 1929;

(b) sections 7(b) and 9(1)(b) of the Censorship of Publications Act 1946;

(c) section 10 of the Health (Family Planning) Act 1979;

(d) the Regulation of Information (Services outside the State for Termination of Pregnancies) Act 1995;

(e) the Act of 2013.

6. Transitional provisions

6. (1) Notwithstanding the repeal of the Act of 2013 by section 5(e)—

(a) a review committee established under section 12 of that Act before the commencement date which, on that date, has not completed a review of a relevant decision within the meaning of that Act shall continue in operation as if it had been established under section 15 and, for that purpose, sections 16 and 17 shall apply and have effect in relation to the review by the committee, and

(b) the Health Service Executive shall, in accordance with section 15 of that Act, not later than 6 months after the commencement date, prepare and submit to the Minister a final report on the operation of Chapter 2 of Part 2 of that Act in respect of such period as has not already been the subject of a report to the Minister.

(2) In this section, “commencement date” means the date on which section 5(e) comes into operation.

7. Review of operation of Act

7. The Minister shall, not later than 3 years after the commencement of this section, carry out a review of the operation of this Act.

PART 2 Termination of pregnancy

8. Definitions (Part 2)

8. In this Part—

“appropriate medical practitioner”, in relation to a medical practitioner and his or her assessment of the risk to the life, or of serious harm to the health, of a pregnant woman, means a medical practitioner appropriate to the care or treatment of the woman in respect of the risk;

“Executive” means the Health Service Executive;

“health” means physical or mental health;

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

“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 specialty of “Obstetrics and Gynaecology”;

“relevant decision” shall be construed in accordance with section 13;

“relevant specialty”, in relation to a medical practitioner and his or her assessment of the presence of a condition affecting a foetus that is likely to lead to the death of the foetus either before, or within 28 days of, birth, means a medical specialty—

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

(b) relevant to the diagnosis, care or treatment of such a condition;

“review”, in relation to a relevant decision, means a review under section 16;

“review committee”, in relation to a relevant decision, means the committee established under section 15(1) to review that decision;

“review panel” means the panel established under section 14(1);

“section 9 certification” means a certification referred to in section 9(3) or, as the case may be, a certification pursuant to section 16(2) as to the matters referred to in paragraph (a) of that subsection;

“section 10 certification” means a certification referred to in section 10(2);

“section 11 certification” means a certification referred to in section 11(3) or, as the case may be, a certification pursuant to section 16(2) as to the matters referred to in paragraph (b) of that subsection;

“section 12 certification” means a certification referred to in section 12(2);

“viability” means the point in a pregnancy at which, in the reasonable opinion of a medical practitioner, the foetus is capable of survival outside the uterus without extraordinary life-sustaining measures.

9. Risk to life or health

9. (1) A termination of pregnancy may be carried out in accordance with this section where 2 medical practitioners, having examined the pregnant woman, are of the reasonable opinion formed in good faith that—

(a) there is a risk to the life, or of serious harm to the health, of the pregnant woman,

(b) the foetus has not reached viability, and

(c) it is appropriate to carry out the termination of pregnancy in order to avert the risk referred to in paragraph (a).

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

(a) one shall be an obstetrician, and

(b) the other shall be an appropriate medical practitioner.

(3) A termination of pregnancy shall not be carried out under this section unless each of the medical practitioners referred to in subsection (1) has certified his or her opinion as to the matters referred to in that subsection.

(4) The termination of pregnancy to which the certification referred to in subsection (3)relates shall be carried out—

(a) by the obstetrician referred to in subsection (2)(a), or

(b) where the medical practitioner referred to in subsection (2)(b) is also an obstetrician, by that obstetrician or the obstetrician referred to in subsection (2)(a).

10. Risk to life or health in emergency

10. (1) Notwithstanding the generality of section 9, or any determination made or pending pursuant to section 16 of an application under section 13(2), a termination of pregnancy may be carried out in accordance with this section by a medical practitioner where, having examined the pregnant woman, he or she is of the reasonable opinion formed in good faith that—

(a) there is an immediate risk to the life, or of serious harm to the health, of the pregnant woman, and

(b) it is immediately necessary to carry out the termination of pregnancy in order to avert that risk.

(2) Where a medical practitioner proposes to carry out a termination of pregnancy under this section, he or she shall certify his or her opinion as to the matters referred to in subsection (1)—

(a) before carrying out the termination of pregnancy concerned, or

(b) where it is not practicable to do so before carrying out the termination of pregnancy, as soon as may be but, in any event, not later than 3 days after the carrying out of the termination of pregnancy concerned.

11. Condition likely to lead to death of foetus

11. (1) A termination of pregnancy may be carried out in accordance with this section where 2 medical practitioners, having examined the pregnant woman, are of the reasonable opinion formed in good faith that there is present a condition affecting the foetus that is likely to lead to the death of the foetus either before, or within 28 days of, birth.

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

(a) one shall be an obstetrician, and

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

(3) A termination of pregnancy shall not be carried out under this section unless each of the medical practitioners referred to in subsection (1) has certified his or her opinion as to the matters referred to in that subsection.

(4) The termination of pregnancy to which the certification referred to in subsection (3) relates shall be carried out—

(a) by the obstetrician referred to in subsection (2)(a), or

(b) where the medical practitioner referred to in subsection (2)(b) is also an obstetrician, by that obstetrician or the obstetrician referred to in subsection (2)(a).

12. Early pregnancy

12. (1) A termination of pregnancy may be carried out in accordance with this section by a medical practitioner where, having examined the pregnant woman, he or she is of the reasonable opinion formed in good faith that the pregnancy concerned has not exceeded 12 weeks of pregnancy.

(2) A termination of pregnancy shall not be carried out under this section unless the medical practitioner referred to in subsection (1) has certified his or her opinion as to the matter referred to in that subsection.

(3) The termination of pregnancy shall not be carried out by a medical practitioner unless a period of not less than 3 days has elapsed from—

(a) the date of certification under subsection (2) by that medical practitioner, or

(b) where a certification was previously made in respect of the pregnancy by another medical practitioner for the purposes of subsection (2), the date of that previous certification.

(4) A termination of pregnancy to which the certification referred to in subsection (2) relates shall be carried out as soon as may be after the period referred to in subsection (3)(a) or (b), as the case may be, has elapsed but before the pregnancy has exceeded 12 weeks of pregnancy.

(5) For the purposes of this section, “12 weeks of pregnancy” shall be construed in accordance with the medical principle that pregnancy is generally dated from the first day of a woman’s last menstrual period.

13. Application for review of medical opinion

13. (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 9(1) or 11(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 9 certification or section 11 certification, as the case may be,

(in this Part referred to as a “relevant decision”) he or she shall inform the pregnant woman in writing that an application may be made 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.

14. Establishment of review panel, etc.

14. (1) Subject to subsection (2), the Executive shall establish and maintain a panel of medical practitioners, appointed for such term and on such conditions as the Executive determines, for the purposes of the establishment of a review committee in relation to a relevant decision.

(2) The membership of the review panel shall consist of—

(a) medical practitioners who are registered in the Specialist Division of the register, and

(b) medical practitioners of relevant specialties.

(3) The Executive shall revoke the appointment of a member of the panel who ceases to be a medical practitioner referred to in subsection (2)(a) or (b).

15. Establishment of review committee, etc.

15. (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 13(2), the Executive shall establish and convene (or cause to be convened) a committee, the membership of which shall, subject to subsections (2) and (3), be drawn from the review panel to review the relevant decision that is the subject of the application.

(2) A review committee shall consist of—

(a) an obstetrician, and

(b) in the case of—

(i) a review of a relevant decision which relates to the circumstances referred to in section 9(1), an appropriate medical practitioner, or

(ii) a review of a relevant decision which relates to the circumstances referred to in section 11(1), a medical practitioner of a relevant specialty.

(3) 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.

16. Review of relevant decision

16. (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 15(1).

(2) Where the review committee, having examined the pregnant woman, has completed its review of the relevant decision and is of the reasonable opinion formed in good faith that—

(a) (i) there is a risk to the life, or of serious harm to the health, of the pregnant woman,

(ii) the foetus has not reached viability, and

(iii) it is appropriate to carry out a termination of pregnancy in order to avert the risk referred to in subparagraph (i),

or

(b) there is present a condition affecting the foetus that is likely to lead to the death of the foetus either before, or within 28 days of, birth,

the committee shall jointly certify their opinion as to the matters referred to in paragraph (a) or (b), as the case may be, and, as soon as may be, give notice in writing of its determination to the pregnant woman (or, if the application under section 13(2) concerned was made by another person on behalf of the woman, to that other person and the pregnant woman) and the Executive.

(3) Where the review committee makes a certification referred to in subsection (2), it shall make such arrangements as may be necessary for the carrying out of the termination of pregnancy to which that certification relates in accordance with section 9 or 11, as the case may be.

(4) Where the review committee has completed its review of the relevant decision and is not of the opinion referred to in subsection (2)(a) or (b), it shall, as soon as may be, give notice in writing of its determination to the pregnant woman (or, if the application under section 13(2) concerned was made by another person on behalf of the woman, to that other person and the pregnant woman) and the Executive.

(5) In this section, “jointly certify”, in relation to the review committee, means that the members of the committee jointly make the certification concerned.

17. Procedures of review committee

17. (1) The review committee may, for the purposes of its review of a relevant decision, by direction in writing require a medical practitioner or former medical practitioner at such time and place as may be specified in the direction—

(a) to produce to the committee such documents or other records in his or her possession or control as the committee may reasonably require and as are specified in the direction, or

(b) to attend before the committee and to give to the committee such assistance and answer such questions as it may reasonably require,

or both.

(2) The pregnant woman shall be entitled to be heard by the review committee and, where the woman or a person acting on her behalf informs the committee that she wishes to be heard, the committee shall make such arrangements as may be necessary in order to hear the woman or a person acting on her behalf.

(3) The review committee may, subject to the provisions of this Act, determine its own procedures.

(4) The Executive shall provide, or arrange for the provision of, such administrative facilities as may be necessary to enable the review committee to perform its functions.

(5) A member of the review committee shall be paid by the Executive, out of funds at its disposal, such remuneration and such allowances for expenses as the Minister may, with the approval of the Minister for Public Expenditure and Reform, determine.

(6) A person who attends the review committee pursuant to a direction under subsection (1) shall be paid by the Executive, out of funds at its disposal, such remuneration and such allowances for expenses as the Minister may, with the approval of the Minister for Public Expenditure and Reform, determine.

(7) A person who fails or refuses, without reasonable excuse, to comply with a direction under subsection (1) shall be guilty of an offence and shall be liable on summary conviction to a class C fine.

(8) Summary proceedings for an offence under subsection (7) may be brought and prosecuted by the Executive.