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The government has been urged to improve its draft legislation on abortion to stop doctors interpreting the new laws too conservatively.

A position paper by experts from Dublin City University, the University of Birmingham and Queen Mary University of London said that the government should consider asking doctors who have a conscientious objection to providing abortion care to declare it before the law comes into effect. Clinical guidelines that are due to be introduced alongside the legislation should clarify when and how a doctor who holds a conscientious objection should disclose it, it says.

“Hospitals and general practitioners should be required to publish information making patients aware of the fact that personnel hold a conscientious objection, for example, on websites, in practice leaflets and on posters in public areas,” the paper says.

The Times revealed last month that a new “code of ethics” drafted by the Irish Catholic Bishops suggested that Catholic hospitals could break the law and refuse to offer abortions in all circumstances.

“Clinical guidelines should address the intersection of the general scheme with Catholic medical ethics, to ensure equality of abortion access for all pregnant people. Additional research, or public hearings, may be required to identify likely areas of conflict,” the paper says.

The state should take steps to ensure all pregnant women can access the care they need equitably in the event that a mass conscientious objection makes abortion inaccessible in a particular area or hospital, they say.

The experts found that women in Ireland could still be denied abortions because doctors fear lengthy jail terms or refuse to terminate pregnancies because they object on principle. The authors say that the proposed bill does not make a strong enough break with abortion being a crime that carries the risk of up to 14 years’ imprisonment.

“It remains a serious offence for a doctor to carry out an abortion and much of the draft legislation’s language frames abortion in criminal terms, suggesting that termination remains an unusual and stigmatised procedure under Irish law,” said Máiréad Enright, a co-author from the University of Birmingham. “Residual criminalisation may see some doctors interpret the law more conservatively than the Oireachtas intends, for fear of prosecution. It also raises the prospect of ‘stings’ by anti-abortion activists, which may make service providers feel vulnerable to prosecution.”

The paper was co-written by Ms Enright, Professor Fiona de Londras, of the University of Birmingham, Dr Ruth Fletcher of Queen Mary and Dr Vicky Conway of Dublin City University.

The authors also say that exclusion zones are needed to protect healthcare providers and pregnant women from protest or interference with services.

The legislation proposes a three-day waiting period between a woman being granted access to an abortion pill and being prescribed it. The authors say that this should be removed. “Waiting periods do not necessarily function as periods for reflection, but exacerbate stress in abortion decision-making,” they say.

More than 66 per cent of voters backed repeal of the Eighth Amendment in the referendum in May.

Author: Jennifer Bray, Ireland Deputy Political Editor
Source: The Times

The Medical Council has said it is concerned “at the levels of inaccurate information” that are in the public domain as a result of the recent CervicalCheck difficulties.

It said that cancer screening saved lives every week but that screening was not a diagnostic exercise and there was an acceptable norm of false negative and false positive results.

In a statement issued this evening, headed ‘Statement from President of the Medical Council in relation to the Cervical Check Scandal’, its new President, Dr Rita Doyle, said the CervicalCheck programme had decreased the mortality rate by 7% year on year since its inception, reducing the number of women who die from cervical cancer.

Dr Doyle said this was “a good news story” but had been somewhat lost in the varying issues that have emerged.

She also said that if there are issues around professional performance or conduct, relating to individual doctors, they will be investigated and dealt with by the Medical Council, in a fair manner, according to its procedures and regulatory powers.

Dr Doyle said she was aware of reports of a recent development of a bottleneck in the analysis of cervical smears, whereby smears are not analysed in a timely fashion, forcing the women to re-attend and the doctor to repeat the smear.

She said this was unacceptable to both patients and doctors.

Dr Doyle said it could have the potential to have a further negative impact on public confidence in screening services, which would be very concerning.

After the controversy erupted, the Government said all women with concerns could have repeat smears.

In response to the Medical Council statement, Stephen McMahon of the Irish Patients Association, called on the council to “identify basically the fake news” that it is concerned about.

He said that many people from within the system and close to the sad events had done a lot to inform society.

Mr McMahon said that the Medical Council, an impartial regulatory body, in an “unprecedented statement”, had used the term “scandal” and this may cause problems in any of its future hearings of any complaints against a doctor, particularly if the council was to initiate a complaint.

He said it was also unfortunate that the council statement did not make any acknowledgement to the women and those close to them of their tragic experiences.

Asked by RTÉ News if the CervicalCheck statement had been approved by the full Medical Council – which has medical and lay members – a spokesperson said it was from and signed off by Dr Doyle, in her capacity as President of the council.

Minister for Health Simon Harris has said he thinks the role of the Medical Council in terms of promoting factual medical information and also its role in regulating the profession are not mutually exclusive.

He said it was perfectly appropriate for the council to provide factual information on cervical screening that helps reassure the public about screening programmes that save lives.

Author: Fergal Bowers
Source: RTE.ie

A fear of being sued is one of the main reasons obstetricians perform caesarean sections, according to the most comprehensive study of their views conducted.

The review found that financial benefits for the hospital and making doctors’ live more convenient were other contributing factors, along with a woman’s preference for a C-section over a vaginal birth.

Researchers at Trinity College Dublin conducted a review of 34 international studies that contained input from more than 9,000 midwives and obstetricians between 1992 and 2016. The scientists said that the research provided a detailed understanding of factors that influence the decision to perform a C-section.

In Ireland, the proportion of babies delivered by caesarean has more than quadrupled over the past 30 years, from 7 per cent of deliveries in 1984 to 30 per cent in 2014.

C-section rates are increasing worldwide despite health authorities recommending a vaginal birth as the preferred method because it results in fewer complications and a shorter hospital stay. Women who give birth vaginally also have a lower hospital readmission rate than those who have a C-section.

Sunita Panda, lead author of the study, said that obstetricians were more inclined than midwives to support a woman’s request for a C-section. “This was interesting because other studies have concluded that this had a small effect but when we analysed studies together, the research showed preference was a significant determinant,” she said.

A 2016 study by the Economic and Social Research Institute found that a rise in the use of caesarean sections was contributing to increased risks and costs. The number of mothers with risk factors, such as being older or overweight, has often been cited as the main cause of the increase.

Ms Panda said she wanted to conduct the research because there was a limited explanation of why the rise had continued.

The research was published on Friday in the journal Plos One. It was conducted as part of a study funded by the Health Research Board.

Author: Catherine Sanz, Ireland Reporter
Source: July 31 2018, 12:01am,
The Times

Her GP Dr Ciarán Regan denied liability and contended the deceased refused to submit to the recommended tests and referral, refused to attend for a smear test appointment and refused attempts to book her at later smear clinics in the practice.

The family of a woman who sued a GP over her alleged wrongful death has settled their action for € 475,000. The settlement was made without admission of liability.

Michelle Fitzpatrick Farrell, a mother of five, attended her GP in March 2007 after her fifth baby but was not physically examined or referred for a smear test until October 2008, it was claimed.

Her GP Dr Ciarán Regan denied liability and contended the deceased refused to submit to the recommended tests and referral, refused to attend for a smear test appointment and refused attempts to book her at later smear clinics in the practice.

Sara Moorhead SC, for the deceased’s partner, Robert Farrell, said there was a significant factual dispute in the case.

Approving the settlement on Thursday, Mr Justice Kevin Cross sympathised with the family on their loss.

The court heard, when Ms Fitzpatrick Farrell did have a smear test in October 2008, abnormalities were detected and a tumour was later found. She was told in November 2009 she could only be referred for palliative care and died on March 6th 2010.

Mr Farrell, the long term partner of Ms Fitzpatrick Farrell, Shevlin Court, Strokestown, Co Roscommon had sued Dr Regan who practises at the Health Centre, Strokestown, Co Roscommon, over the alleged wrongful death of his partner.

Ms Fitzpatrick Farrell was a patient of Dr Regan since June 2000.

She had her fifth child on March 15th, 2007 and suffered an ongoing vaginal discharge which was heavy and foul smelling.

It is claimed this caused Ms Fitzpatrick Farrell significant distress and she allegedly consulted with Dr Regan seeking medical advice on her ongoing gynaecological difficulties on different dates between March 2007 and October 2008.

She was allegedly treated on occasions with antibiotics for pelvic infection without, it was claimed, being subjected to any physical examination.

It was claimed there were further visits with the GP and in May 2008 she was to be booked for a smear test and swabs.

On September 4th, 2008, she completed a women’s health clinic questionnaire at the behest of the GP’s medical practice.

It was claimed she relayed the information she had been passing jelly like clots for the last eighteen months and was concerned.

It was alleged she had been given a smear test appointment for later in September which, it was claimed, was cancelled.

It was further claimed, despite repeat attendances at the medical practice, she was not physically examined or subjected to a smear test or swab taking.

It was alleged it was only on October 15th, 2008, when she attended a locum GP in the practice, the seriousness of her gynaecological difficulties were allegedly finally acknowledged and a diagnostic smear test arranged.

The smear test showed up abnormalities and she was referred for an urgent colposcopy but a tumour was later found.

She was not deemed a candidate for surgery and underwent chemotherapy and radiotherapy.

She was notified on November 6th, 2009 she could only be offered palliative care and died on March 6th, 2010.

It was claimed there was failure to investigate and treat her condition and her symptoms by way of physical examination and otherwise between March 22nd, 2007 and October 15th, 2008.

Dr Regan denied all the claims and contended Ms Fitzpatrick Farrell had re-attended at his surgery on March 10th, 2008 and was referred to physiotherapist for pelvic floor exercises and advised to accept a referral to a gynaecology department.

When she re-attended at the surgery at the end of March, it was claimed Dr Regan renewed his request for gynaecology referral but she refused to submit to recommended tests and and referral.

It was further alleged the doctor attempted to persuade the woman to address her gynaecological health by undergoing a cervical smear test or by accepting a referral to a gynaecological department.

It was claimed she was booked for the practice smear clinic but refused to attend for the June appointment and refused attempts to book her into the July clinics.

Author:Unknown
Source:The Irish Times