Abortion care and clinical governance in Ireland

In light of the recent debate in the Dail that a current patient of the Coombe Women and Infants University Hospital was denied treatment for a clinically diagnosed Fatal Foetal pregnancy by the Board of Guardians and Directors, AIMS Ireland calls on the Minister of Health Simon Harris to investigate the clinical governance issues at play here.

The Coombe hospital still not offering abortion services in Dublin

The Coombe is currently the only maternity hospital in the capital city Dublin, that has not offered termination of pregnancy services to its patients following the signing into law in December 2018 of the Regulation of Termination of Pregnancy Act. A variety of reasons, all plausible, have been given, but now this report is setting off alarm bells that perhaps there are other reasons as to why one of the largest maternity hospitals in Ireland is still not providing a service.

Conscientious Objection to abortion in the Irish Healthcare service

It is quite clear that there are many obstetricians within the hospital willing to provide a service and who have publicly declared themselves to be in favour of rolling out a service as soon as possible.

Obviously there are conscientious objectors in this hospital, the same as any other maternity hospital, and we fully appreciate an individual care giver has a right to conscientious objection, but its hard to believe that the lack of a service could be due to the influence of conscientious objectors within the hospital.

Hospital Governance at the Coombe

It is completely inappropriate that a Board of Guardians and Directors could take it upon itself to refuse the ongoing care of a patient in accordance with her clinical team’s diagnosis and care plan. This applies to all aspects of maternity care, not just termination of pregnancy and it applies to all hospitals not just The Coombe.

Patient Safety at the Coombe

Aside from the legal issues involved in such governance, there is the issue of patient safety, both physical and emotional. It is hard to believe that the Board of the Coombe could take a risk with patient safety at a hospital with such impeccable maternal morbidity and mortality rates.

Governance of the New National Maternity Hospital

This issue also raises concerns with respect to the new National Maternity Hospital due to be sited at the St Vincent’s Hospital Campus. There have been numerous objections to this co location, as the St Vincent;’s campus has a history of religious ethos. None the less the public have been repeatedly reassured that the Board in the new National Maternity Hospital would never be able to override clinical care or decision making, yet here we see reports of how easily it appears this type of governance can occur with the only recourse being the floor of the Dail.

We urge Minister Harris to set the public ‘s mind at rest and confirm that Boards of Management or Guardians or Directors in maternity hospitals cannot override clinical care, clinical diagnosis and patient choice with respect to TOP or any other aspect of maternity care.

Breach of Human Rights

Finally, we believe that this response by the Board of Guardians and Directors of the Coombe, if confirmed, is in breach of ECHR, as a current patient in a maternity hospital in Ireland is being denied legally available services.

Referral for abortion care

If these services are not currently available in the hospital in question, then patients should not be told to “wait four weeks to see if they miscarry”, neither should they feel obligated to continue to travel to the UK or beyond. At the very least they deserve a referral to another maternity hospital for the procedure to be carried out. At present the two other \Dublin maternity hospitals, The Rotunda and the NMH are fully compliant with their legal obligations under the new legislation.

Entire Coombe maternity network without abortion provision

We would also ask Minister Harris to account for why the other hospital in the Coombe’s maternity network (Portlaoise) is also not offering a service. The public were originally told that one hospital in every maternity network would be providing abortion services in the initial roll out of the service and yet this rework remains the only one in the country that is non compliant. Why?

Investigation into failure to provide abortion care

AIMS Ireland are asking everyone who cares about this issue to email Minister Harris and ask him to investigate.
Email: simon.harris@oireachtas.ie
Phone: 01 6183805 (Dáil)
Address: Dáil Office, Dáil Eireann, Leinster House, Kildare Street, Dublin 2D02 A272
Tel: 01 635 4000
Email: ministersoffice@health.gov.ie
Address: Department of Health, Block 1, Miesian Plaza,50 – 58 Lower Baggot Street, Dublin ,D02 XW14




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