Reproductive Health Bill
(Bills - Second Reading Debate, 8 August 2019, Legislative Assembly, NSW Parliament)
I thank all members who contributed to debate on the Reproductive Health Care Reform Bill—65 members representing all parts of New South Wales and all parts of this Parliament. As those who have watched it know, this has been an impassioned debate and I value all members' contributions regardless of their position on the bill. I pay a special tribute to the members, especially the women, who shared their deeply personal stories about sexual assault, domestic violence and abortion, and how life experiences have led them to a position that supports a woman's right to choose. I am grateful to the many members, religious leaders and supporters in the community who, during the course of this debate, have expressed strong support for this bill as a result of their faith.
The vast majority of people from all walks of life support a woman's right to choose and this comes from a moral position based on social justice, fairness and the fundamental human right to bodily autonomy. Ensuring women have access to safe and legal terminations is vital to protecting their health, welfare and control over their bodies and their lives. It is about women's rights to appropriate health care and it is our role as community representatives in this place to protect those rights. The need to end a pregnancy is a health matter, not a criminal matter and the Reproductive Health Care Reform Bill recognises this and removes abortions from the Criminal Code and regulates them as a medical procedure.
The current criminal framework is not appropriate. It threatens women, doctors and healthcare professionals with potential criminal conviction and enshrines judgement and shame on women over personal and sometimes difficult choices. No other medical procedure is governed in the Crimes Act and no other State or Territory has failed to address the criminal approach to abortions. Terminations are now safe procedures and the vast majority of people strongly believe that the law should finally respect women's rights to choose for themselves whether to end a pregnancy. The framework introduced under the bill for lawful and unlawful terminations is based on Queensland and Victorian laws, which come out of extensive law reform commission processes. It represents what is widely accepted as the best practice approach to safeguarding women's reproductive rights and giving doctors and healthcare professionals the legal clarity they seek.
Doctors already perform these important reproductive health services in licensed healthcare clinics by prescribing medications listed on the Pharmaceutical Benefits Scheme. Some speakers have said that this is a reason to retain the status quo, but this approach provides no legal guarantee against prosecution and is frankly a second-rate and grossly unacceptable approach to health care. One of the important provisions in the bill is its removal of any possibility that a woman who seeks, obtains or conducts a termination on herself is committing a crime. This is consistent with bodily autonomy and a harm minimisation approach to health care. We know that criminalisation does not reduce the demand for terminations, but it can reduce the safety of the procedures.
Ensuring women cannot be convicted for abortions performed on themselves ensures that if something goes wrong, women will always be able to seek help without fear of conviction. I hope that decriminalisation will reduce the fear and stigma that surrounds termination services and encourage more women, including young women, to discuss their reproductive healthcare needs with their general practitioners and get comprehensive medical advice about all their options before making a decision. Although this debate has been a long time coming—119 years coming—it has at times been very hard to listen to some of the statements both inside and outside this Chamber, which, in my view, have not taken into consideration the impact they may have on others, especially women in this building, in the gallery and across the State. It is important to note that abortions already occur—they occurred yesterday and they will occur tomorrow—and it is important to respect that NSW Health has a framework in place for the health care of women receiving these services. This bill protects that health care for women and doctors in law.
I will address some issues raised and I start with informed consent. In all forms of treatment duty of care obligations unquestionably require doctors to always ensure that patients have given informed consent. Any breach of that requirement will be subject to serious professional disciplinary action. Nothing in the bill changes these duties and women will be required to give informed consent before a termination procedure proceeds, as they are now. This involves information about procedure and possible risks and complications.
The obligation in the bill for doctors who have a conscientious objection to refer a woman seeking a termination to another doctor or a facility that would provide the service is consistent with existing Australian codes of conduct and ethical standards that require doctors not to use their conscientious objection to impede a patient's access to health care. As a time-critical procedure any delay will impact on the availability of terminations including the type, setting, potential complications and costs. This is especially important for women who experience disadvantage and family and domestic violence and who live in remote and rural areas with limited access to health care. Without a referral they may fail to get the health care they need.
The duty to refer a patient does not involve providing a specific referral, rather providing the contact details of another doctor or NSW Family Planning, for example, would suffice. Mrs Leslie Williams will be moving an amendment that I support to clarify this further. As the bill is drafted, the conscientious objection obligations apply to the termination—that is, the specific termination that a woman is asking for. The gestation period in the bill is appropriately set at 22 weeks. It follows the recommendations of the Australian Medical Association and the Queensland Law Reform Commission following an extensive review.
A gestation period of 22 weeks recognises that many fetal abnormalities will not be identifiable until the anatomical ultrasound which occurs at 18 to 20 weeks. It gives women time to make an informed decision without the pressure that any delay in her decision will force her to proceed with a different and more onerous approval path. We want women to have the time to make an informed decision. Any pressure or rush imposed by reducing the 22-week gestation period could have perverse impacts. I note that one of the first amendments to be dealt with risks imposing these perverse impacts on a woman and her health care situation. It is potentially one of the more dangerous amendments that we will be debating. The Queensland Law Reform Commission considered that any gestational limit earlier than 22 weeks would be "unduly restrictive and a potential barrier, particularly to vulnerable and disadvantaged women". Under the existing common law provisions there is no need for two doctors to approve terminations at any period of pregnancy.
In establishing a regulatory framework for lawful terminations, gestation periods have not been introduced in order to reduce women's autonomy but in recognition that late-term abortions warrant extra oversight due to the potential additional risks and complexities. We should trust the experts such as the AMA on the stage of pregnancy that this should occur. I note Mrs Leslie Williams will move amendments around ensuring that terminations post-22 weeks are in public hospitals. That is an amendment I will support. With regard to professional standards and conduct, I want to stress that doctors and health professionals absolutely must comply with professional standards when it comes to any medical procedure. Few medical procedures are governed in law yet this does not mean that doctors can do whatever they want. For the vast majority of procedures we rely on professional standards to govern how medical professionals operate and abortions are no different.
I understand other members may have amendments relating to this; however, Mrs Leslie Williams will move an amendment to ensure this clarity is in law and that is done in consultation with Health. While some of the members who are proposing mandatory counselling may be coming from a position of genuine concern for women and what could be a difficult decision, the notion that women need to be counselled before an abortion is offensive. We do not mandate counselling in law for any other procedure, including irreversible procedures like amputations and vasectomies. Women have the capacity and the right to make decisions about their bodies without interference and decide for themselves whether to seek counselling prior to an abortion.
For abortions under 22 weeks, many women will prefer to talk to their partners and support networks and may not want counselling. For them, mandatory counselling could cause distress and create unnecessary delays. Mandatory counselling was assessed by both the Queensland and Victorian law reform commissions, which concluded that it was neither necessary nor appropriate. Abortions over 22 weeks are almost always conducted in public hospitals under a NSW Health framework that requires counselling to be offered at various stages of tests and procedures. The implication made by a limited number of members that women either make decisions lightly or doctors do not provide necessary care shows a lack of regard and respect for women and their doctors.
Some members made reference to the consideration of social reasons and future issues as not being important. These considerations involve factors such as domestic violence, rape and incest and they can impact a woman at any stage of her life or pregnancy. These are important considerations and should not be taken lightly. All members need to remember that one of the big changes under this bill is the move to increase the scrutiny for terminations over 22 weeks. That scrutiny will be further increased should the amendments of Mrs Leslie Williams on public hospitals and other health facilities be passed. At times there seems to have been a lack of empathy for women over how difficult a termination after 22 weeks can be. They are usually in situations where a woman is looking forward to and planning to give birth and have a child and she is suddenly dealing with a very distressing situation completely outside of her control. She needs support and compassion as well as—as I have stressed—the support of two doctors as mandated in this bill, not additional moral judgement. These post 22-week terminations occur extremely rarely and must be treated as an issue between a woman and her doctor—or, under this bill, two doctors—without the moral judgement that comes from enshrining abortions in the criminal code.
I strongly feel that a majority of members are coming to this debate with compassion in their hearts rather than judgement in their minds, and there will be further issues to be resolved through amendments during consideration in detail. In closing, I will thank a number of people whose support during this process has been vital, including everyone at the Pro-Choice Alliance—I note that its chair, Wendy McCarthy, is here today—Our Bodies Our Choices, the Human Rights Law Centre, the Australian Medical Association and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. I pay special tribute to Sinead Canning, Claire Pullen, Adrianne Walters and Fiona Davies, who have all provided vital support and advice throughout this process. I also thank the many doctors, lawyers and health professionals who have given their time to members of this place to discuss aspects of this bill. I thank the many members who have engaged in detailed consultation both with those experts and their constituents.
I thank the people who brought this bill together: the Hon. Trevor Khan, the Hon. Penny Sharpe and the member for Summer Hill. Of course, I thank the health Minister for his strong support. I also thank the 15 co‑sponsors of this bill. Having so many co‑sponsors shows that it is truly a multi-partisan bill in support of women across New South Wales. I thank the staff who made up the working party, especially Richard Karaba from the office of the Hon. Trevor Khan, Matt and Zac from the office of the member for Summer Hill and, most of all, Tammie Nardone from my office. As many people know, Tammie is likely the hardest working person in this building. I also thank all of the co-sponsors in this place and the other place.
Our legal framework is no longer fit for purpose. It is archaic, it stigmatises women and it reduces their healthcare options, with the biggest impact being on women in rural and regional areas and women affected by physical or sexual violence. The law does not treat women with dignity or trust them to make decisions about their bodies, their life and their health care. This reform is long overdue; now is the time to decriminalise abortion in our law and give clarity to the medical profession, women and the wider community. This is an historical moment in our time. I urge all members to join the Premier, the health Minister, the Leader of the Opposition, the shadow Minister, the 15 co-sponsors of the bill and the many members who passionately spoke in support of it to right this wrong and to vote for a woman's right to choose. I commend the bill to the House.