Sir, – I write as clinical adviser to the HSE's National Women and Infant's Health Programme on the implementation of termination of pregnancy services in response to the article "A model of how not to bring in a new service" (Analysis, January 8th).
First, the practice of open disclosure relates to communication between doctor and patient only, when an adverse incident has occurred. It does not refer to keeping journalists or the general public informed.
Every day since January 1st, people needing to avail of the new service have been successfully using the 24-hour HSE Freephone line and the MyOptions.ie website where they have been given appropriate advice and fully informed of what services are available, and where. All those needing to avail of termination services have been accommodated.
At least 200 GPs have signed up to provide the service, with good geographic spread around the country. This is more than enough for the numbers presenting. Travelling from one county to another is not comparable to the situation before January 1st where people had to leave their own country, alone and at their own expense, to seek treatment that was a criminal offence at home.
The full text of the Health (Regulation of Termination of Pregnancy) Act 2018 is published on the Oireachtas website and is therefore clearly available as guidance for doctors.
Both the Institute of Obstetricians and Gynaecologists and the Irish College of General Practitioners have developed and distributed guidelines for doctors. Extensive consultation and research, including travelling to countries that have well-established services, was undertaken in the development of these guidelines. Those who need the guidelines have received them.
The article is concerned with what might constitute the “exceptional circumstances” that might underlie the decision for a young person of 15 or under to seek a termination. One only has to think back to the X case for an understanding of the kind of exceptional circumstances that can occur. Doctors are faced with ethical decisions very regularly. In such situations both doctors and patients are supported by a range of professionals including social workers and psychiatrists.
Training has been provided since last September for those medical professionals who wished to avail of it and is being provided on an ongoing basis
It is not the case that the Medical Council guidelines have not been updated. On December 20th the council advised all registered doctors on updated revisions which remove “any conflict between the ethical guide and the legislation”. The current guidelines therefore are absolutely clear.
There have been teething problems, as expected, but few that would not have arisen no matter when the service was introduced.
Most of the issues relate to people getting used to a completely new service, and not to a lack of preparedness. Each issue that has arisen is being dealt with speedily and comprehensively.
I regret that there are some “naysayers” willing to spread negativity, some within the medical profession. It is not surprising that medical professionals not currently involved in the provision of termination services have an incomplete and inaccurate understanding of the actual situation.
Finally, confidentiality is a bedrock of the doctor-patient relationship. While interest in the roll-out of termination services in Ireland is understandable, it is essential that the right balance is struck between legitimate public interest and patient confidentiality. – Yours, etc,
Dr PETER BOYLAN,
Dublin 6.