Protection of Life During Pregnancy Act 2013


The Protection of Life During Pregnancy Act 2013 was an Act of the Oireachtas which, until 2018, defined the circumstances and processes within which abortion in Ireland could be legally performed. The act gave effect in statutory law to the terms of the Constitution as interpreted by the Supreme Court in the 1992 judgment in the X Case. That judgment allowed for abortion where pregnancy endangers a woman's life, including through a risk of suicide. The provisions relating to suicide had been the most contentious part of the bill. Having passed both Houses of the Oireachtas in July 2013, it was signed into law on 30 July by Michael D. Higgins, the President of Ireland, and commenced on 1 January 2014. The 2013 Act was repealed by the Health Act 2018, which commenced on 1 January 2019.

Background

Under section 58 of the Offences against the Person Act 1861, unlawfully attempting to procure a miscarriage was a crime punishable by up to life imprisonment. A 1983 amendment to the 1937 Constitution guaranteed to vindicate the "right to life of the unborn" with due regard for "the equal right to life of the mother". Proponents of the amendment believed that it would guarantee abortion could never be allowed in any circumstances. However, in 1992 the Supreme Court ruled in the X Case that abortion was permitted where pregnancy presented "a real and substantial risk to the life, as distinct from the health, of the mother", including where the risk was through suicide. There were two attempts to amend the Constitution to explicitly rule out suicide as grounds for abortion. These were rejected at referendums in 1992 and in 2002; some no-voters felt the restriction was too strong and others that it was not strong enough. No legislation was passed to amend the 1861 Act in the light of the 1992 judgment.
In December 2010, in the case A, B and C v Ireland, the European Court of Human Rights non-statutory guidelines 2) statutory regulations 3) legislation only and 4) legislation plus regulations. In December, the government decided to pursue option 4 in the expert group's report: legislation plus regulations.

Provisions

The Act specified the number and specialty of medical practitioners who concurred that a termination was necessary to prevent a risk of death. Those criteria differed in three scenarios:
;Risk of loss of life from physical illness: Two physicians, one an obstetrician and the other a specialist in the field of the relevant condition, concurred. For example, if the woman had cancer, the two physicians were an obstetrician and an oncologist. Where relevant, the specialists also consulted the woman's general practitioner. The termination was an elective procedure performed at an [|appropriate institution].
;Risk of loss of life from physical illness in emergency: In a medical emergency, a single physician provided the diagnosis and performed the termination.
;Risk of loss of life from suicide:Three physicians concurred; an obstetrician, a psychiatrist with experience treating women during or after pregnancy, and another psychiatrist. At least one of them should consult the woman's GP with her consent. The termination was an elective procedure performed at an appropriate institution.
The physicians' diagnosis had to be "an opinion formed in good faith which has regard to the need to preserve unborn human life as far as practicable". Normal informed consent was required. Medical personnel with conscience objections to abortion were not required to participate in terminations, but had to transfer care of a patient in such cases. All terminations were notified to the Minister for Health within 28 days. The Minister made an annual report of such notifications.
Where a termination was requested but refused, a woman could appeal to the Health Service Executive. The HSE established a panel of at least 10 physicians, from whom a committee of two or three reviewed any application within three days. The committee members' specialties depended on whether the condition was physical or mental, in the same way as for the initial assessment. The HSE published an annual report on the review process.
The Act also repealed sections 58 and 59 of the 1861 Act; these criminalised attempted or actual procurement of miscarriage, and assisting such procurement. It replaced them with a new offence of "destruction of unborn human life", with a maximum penalty of 14 years' imprisonment. The director of a body corporate which performed such a procedure could be guilty of a similar offence. As required by the Constitution, the right to travel abroad for abortion, and to provide information about foreign abortion, were protected.
The Act defined the "unborn" whose life is protected as existing from implantation in the uterus until "complete emergence... from the body of the woman". Beginning at implantation conformed to a 2009 Supreme Court judgment on the beginning of pregnancy, rather than the Catholic view that personhood begins at conception. The aim of specifying the uterus was to avoid criminalising emergency contraception or treatment of ectopic pregnancy.
The Act empowered the Minister for Health to produce regulations detailing the procedures for all its provisions.
A "senior source" at the National Maternity Hospital told The Irish Times that terminations had been carried out there prior to the 2013 Act, and that the change brought about by the Act would be to remove the "fear of a possible Medical Council case".

Approved locations

Except in an emergency, a termination could only be carried out in an "appropriate institution". The Act listed several of these, and empowered the Minister to specify others. The draft bill's list of approved institutions included only maternity hospitals, but was extended to include other hospitals with intensive care units where the nearest maternity hospital did not have emergency medicine facilities.
Dublin
  • Beaumont Hospital
  • Coombe Women & Infants University Hospital
  • Mater Misericordiae University Hospital
  • National Maternity Hospital
  • Rotunda Hospital
  • St. James's Hospital
  • St. Vincent's University Hospital
  • Tallaght University Hospital
Provincial
  • Cavan General Hospital
  • Cork University Hospital and Cork University Maternity Hospital
  • Galway University Hospitals
  • Kerry General Hospital, Tralee
  • Letterkenny General Hospital
  • Mayo General Hospital, Castlebar
  • Midland Regional Hospital, Mullingar
  • Midland Regional Hospital, Portlaoise
  • Mid-Western Regional Hospital, Dooradoyle
  • Mid-Western Regional Maternity Hospital, Limerick
  • Our Lady of Lourdes Hospital, Drogheda
  • Portiuncula Hospital, Ballinasloe
  • Sligo General Hospital
  • St Luke's Hospital, Kilkenny
  • Tipperary University Hospital, Clonmel
  • Waterford Regional Hospital
  • Wexford General Hospital

    Enactment

The bill was drafted by the Government and then introduced by it into the Oireachtas or parliament. After both Houses of the Oireachtas passed it, it was signed into law by the President.

Draft

In January 2013, the Oireachtas Joint Committee on Health and Children held three days of discussions with interest groups on the government's plans. The meeting was held in the chamber of the Seanad, rather than a committee room, to allow more people to attend. Journalist Stephen Collins commented that it was an unusual and positive step to hold such a discussion before the drafting of a bill by the Office of the Parliamentary Counsel to Government. Health Minister James Reilly said in January 2014 that the process had "become now the standard for many bills".
The draft of the bill was published in April 2013. The official announcement stated that the provisions of the proposed legislation being published were strictly within the parameters of the X Case. In May 2013, the Oireachtas Joint Committee on Health and Children held three days of discussions on the draft bill with healthcare and legal professionals. Its report was laid before the Dáil on 30 May.

Dáil stages

The bill was introduced in Dáil Éireann, the lower House of the Oireachtas, on 16 June 2013. It was the subject of vigorous debate. From the government parties, TDs Terence Flanagan, Peter Mathews, Billy Timmins, and Brian Walsh were expelled from the Fine Gael parliamentary party on 2 July 2013 after voting against the bill's second stage in defiance of a party whip. Lucinda Creighton was likewise expelled on 11 July for voting against the bill's report stage; she was also forced to resign as Minister of State for European Affairs. Michael McNamara of Labour also voted against the bill, but the party later explained this had been a mistake. From the opposition parties, Peadar Tóibín was suspended by Sinn Féin for six months after voting no against the whip. While Fianna Fáil leader Micheál Martin favoured the bill, the party's TDs demanded a free vote, and 13 of 19 voted against. This contributed to media reports that Martin's continued leadership of the party was in doubt.
Six pro-choice technical group TDs voted against the bill: Clare Daly, Joan Collins, Richard Boyd Barrett, Mick Wallace, Joe Higgins and Luke 'Ming' Flanagan. They argued instead for a referendum to repeal the 1983 Constitutional amendment which places the life of the mother and the unborn on an equal footing. Boyd Barrett criticised the exclusion of fatal foetal abnormality in the bill, which he said “will force women whose pregnancies will inevitably end in tragedy to go full term or travel overseas for terminations".
At the bill's report stage, 165 amendments were proposed. Faced with such a large number, the government decided to let the debate run over the originally allocated time, rather than using a guillotine motion to curtail it. Such a motion might have prevented discussion of the bill's most contentious sections, thereby increasing controversy. The report stage began at 11.50am on 10 July, and was adjourned at 5am the following morning.
At about 2.40am, as deputies were awaiting a division, Tom Barry pulled Áine Collins, a fellow Fine Gael TD for Cork East, onto his lap. Barry apologised publicly and was reprimanded by Fine Gael. He admitted having drunk alcohol before the incident but denied being drunk. Some politicians called for an end to the practice of the Oireachtas members' private bar remaining open and serving alcohol whenever Oireachtas business is being conducted.
Debate resumed at 5pm that evening, and concluded with the final vote at 12.25am on the morning of 12 July. The bill was finally approved by 127 votes to 31.