Tuesday 16 April 2013
REPRODUCTIVE HEALTH (ACCESS TO TERMINATIONS) BILL 2013 (No. 24)
Second Reading Speech – Jacquie Petrusma MP – Liberal Member for Franklin
Ms PETRUSMA (Franklin) - Mr Deputy Speaker, I rise to speak on the Reproductive Health (Access to Termination) Bill 2013. I will not be supporting this bill, primarily because as a health professional I am appalled at the conscientious objection clauses that I will discuss in more detail later.
Despite what other members have inferred in their speeches tonight, abortion is already legal in Tasmania. A woman can obtain an abortion now if a specialist in obstetrics and gynaecology and another doctor both agree that the continuation of the pregnancy would involve greater risk of injury to the physical or mental health of the pregnant woman than if the pregnancy was terminated. This also applies to any stage of pregnancy up to birth. Furthermore, there is at present also no minimum age requirement for a woman undergoing an abortion and in the case of minors no requirement for parental consent or notification. Therefore at present a teenage girl can undergo a late term abortion in Tasmania without her parent's knowledge, and what also concerns me about this legislation tonight is that minors especially may see abortion as just some quick-fix medical procedure when it is so much more. Abortion is not just any ordinary medical procedure.
We have been told that decriminalising abortion will provide greater certainty to mothers and doctors, however since 2001 there have been zero prosecutions of doctors and/or mothers under the current law. As a bioethicist wrote to me tonight:
The existing legal framework does not criminalise women and doctors who terminate a pregnancy or impede access to abortion. It simply requires a basic level of medical consultation and counselling around a major life decision. As well, the current requirement for terminations to be legally justified protects the lives of at least some unborn human beings. Retaining these laws in the Criminal Code also serves as an important educative function within the community, reminding us that at every termination of pregnancy it involves the ending of a human life, an outcome which, while grave in itself, can also have serious implications for the woman.
I am a mother of four children and during my training as a registered nurse I witnessed a number of babies being born, as well as being present at the birth of my two grandchildren. To me the birth of a newborn baby is truly amazing. I found it empowering to have children myself, as well as an honour to have the privilege of witnessing other babies being born, as giving birth is an experience unique to women.
What concerns me, though, in this abortion debate tonight is that it is shrouded in dehumanising medical terminology by using the words 'uterine contents', 'product of conception' or 'foetus' instead of the word 'baby', and it is vigilantly protected by the mantra of choice. We are told that abortion is about choice, but to me how can it be about choice when the baby does not have a choice? A baby is not in the womb saying, 'Yes, mum, please abort me', and nowhere in this bill are the rights of the unborn child mentioned.
However, the Convention on the Rights of the Child Committee General Comment no. 5 2003, paragraph 10, states:
Article 6 of the Convention on the Rights of the Child affirms the child's inherent right to life and states parties' obligation to ensure to the maximum extent possible the survival and development of the child. The committee expects states to interpret development in its broader sense as a holistic concept embracing the child's physical, mental, spiritual, moral, psychological and social development. Implementation measures should be aimed at achieving the optimal development for all children.
In a presentation to the National Human Rights Consultation Committee at the Great Hall, Parliament House, Canberra, on 1 July 2009, Rita Joseph stated:
At present, Australia is not meeting its obligation to uphold and protect, in its legislation, the right to life of children at risk of abortion. Abortion constitutes arbitrary deprivation of life in breach of the International Human Rights law, as established by the Nuremburg principles and judgments and their codification in the International Bill of Rights.
In 1959, the United Nations General Assembly formally declared that the Universal Declaration of Human Rights recognised that the child, by reason of his physical and mental immaturity, is entitled to special safeguards and care including appropriate legal protection before as well as after birth. This means that the right to life protected under article 3 of the Universal Declaration is recognised as equally valid for the child before birth as for the child after birth.
This bill does nothing to protect the rights of the unborn child. In fact, it looks like the womb may well be the unsafest place for a child to be as it only from birth that the child is protected. The question must therefore be asked, is the embryo in the mother's womb a human being or not. I submit that there can only be one answer. Yes, the embryo is a human being. In fact, as science advances it becomes more and more obvious that the embryo is an individual human being. The physical parts and attributes of the embryo become clear at a very early stage so that specific, individual traits are already present.
An abortion is not the termination of just one life. For example, if my mother had an abortion with me then I would not have been born, my four children would not have been born and my two grandchildren would not have been born either. That is seven lives already that would not be here today from just one abortion. It is not just one life we are talking about here. The ongoing ramifications from just one abortion can be many lives as there are generations of children who would never be born.
When I was pregnant with my first child I could have had an abortion, as I was young, not married, and still completing my training as a registered nurse and I had, as people said to me, my whole life ahead of me. Yes, I ended up being a single mother for nine years so I know from personal experience how tough it can be, financially, to live on Centrelink and bring up a child on your own. But my daughter motivated me to get out to do my best for her so that we would not have to spend the rest of our days on Centrelink. Not only was I a registered nurse but I went on to university and studied a Bachelor of Commerce and an education degree while my daughter was at kinder and primary school. From there I was employed in the medical sales industry and went on to become one of the youngest and first female national sales managers in that industry, helping to break the glass ceiling that was very obvious in that industry at that time.
Today I am a member of parliament. I disagree with the argument that having a baby will stop a woman from having a career or set her back financially. I know from my own personal experience that having a child and being a single mum can be one of the most rewarding life experiences that you can ever have. My oldest child and I shared a wonderful journey together that I am all the more richer for and I am now a much better, more rounded person for going through the highs and lows of those years. It is those times as a single mum that was part of the motivation for me to run for parliament, to be an example to other single mums by encouraging them to dream big dreams.
My daughter was a young, single mum too. Yes, she too could have had an abortion, but she chose not to and every time my grandsons run up to me and throw their arms around my neck and call me Nanny, I am so thankful that they are here today. Even though I would not have judged or condemned my daughter for having an abortion, as I do not condemn or judge any woman who has had an abortion, inside I would have grieved for their loss. My daughter has gone on to get two masters degrees as single mum. Financially she too struggled along on Centrelink, but now she has a great job and two gorgeous sons to travel on their own journey together.
Age is another reason given as to why a woman may choose to end the pregnancy. I had my first child when I was young and I had my last child when I was old. Apart from it being a lot easier physically when I was young, both pregnancies were an empowering experience.
Something that greatly disturbs me is the finding of a 2005 study by Selena Ewing that the majority of women and girls who have abortions do so because of the lack of support from parents, partners and friends. Seventy per cent of women said that finding themselves in this situation they felt they had no alternative but to abort their babies. Therefore surely we need to actively increase supportive options to mothers during pregnancy so that the mother would be less likely to abort and would then really have a genuine choice.
As one GP who wrote to me stated the bill is simplistic in its premise that women alone make their own decisions about a pregnancy. In reality this is almost never the case. There is often strong external pressure on women from partners, parents or from the woman's own perceived expectations of employers or educational institutions.
In my experience the request for termination is often because women feel coerced or that they have no other option so surely the best way for Tasmanians to show due regard and care for women is to see them through whatever the difficulties are so that women know that there are alternatives to abortion. Abortion is always a symptom of something much greater. There is always a reason and most of those reasons do not even involve the baby.
If a woman seeks an abortion because of limited financial means we need to address her financial issues. If a woman seeks an abortion because of the fear of physical violence or desertion from a partner then we need to assist her. If a woman seeks an abortion because she fears the effect on her work or study options then those are the issues we need to help her with. The government should not instead want to push last resort legislation and should work to address the circumstances that leave women feeling so unsupported that the taking of their baby's life is seen as their only option. We need to build a culture of life, not death, in Tasmania.
What I know from having been a single mum is that we need to have more options available for women who find themselves pregnant so that women do not feel that they have no other choice. I note too that in the AMA submission that the federal council of the AMA also supports interventions to reduce Australia's abortion rate, such as provision of greater financial support to those raising children, such as federal government funding of 14 weeks paid maternity leave and an increase in the availability and affordability of childcare. For example, we should allow child care costs to be claimed as a tax deducible expense and allow employers to offer childcare as an FBT exempt salary sacrifice. Further, there should be maintenance of awareness of family planning issues, including fertility and contraception for older women and/or women who already have children including permanent forms of contraception; investment in return-to-school support programs for teenage mothers; and elimination of pregnancy discrimination related to employment.
I also find it hard to accept with this legislation that as shadow minister for disabilities I am supposed to fight for people living with a disability rights once they are born but not while they are in the womb. I would be in effect saying that you do not have any value or a life worth living if you are diagnosed with a disability in the womb and should be aborted. This is a very sad and distressing message to send to parents of a baby in the womb that has been diagnosed as having a disability that their child is not of equal value or equally deserving of protection.
Every human individual, including those with a disability, is equal to every other individual in respect to the right not to be directly or intentionally killed. The question also has to be asked how perfect do we want our children to be. I have two children diagnosed with dyslexia. Should I have chosen to abort them? One had low muscle tone and needed daily physiotherapy - should I have chosen to terminate them too? When pregnant with my third child I was informed that the baby had Down syndrome and was a boy. We were all prepared for the birth of a baby with Down syndrome and I even had packed baby boy clothes for the hospital. Imagine our surprise when the baby we had already been calling Joe popped out a healthy girl.
Throughout my nursing career I have also seen plenty of examples of misdiagnosis of babies who the parents were told would not have any quality of life. Against the odds they not only survived but thrived. This is why I am also concerned that if abortion is dressed up as a quick fix medical procedure healthy babies that have been misdiagnosed as having some type of disability may be aborted when in fact they would have been fine.
As Dr David Strong, the paediatrician at the Launceston General Hospital states, the legislation makes no requirement that the response to a request for late foeticide include the advice of a neo natologist or paediatrician so women with perceived risk of a foetal anomaly might be expected to make life versus death decisions without accurate, up-to-date information.
I am also very concerned that the 16 weeks will allow for sex selection to happen. At week 13 doctors are able to tell the sex of a baby by ultrasound with almost 100 per cent accuracy. In regard to sex selection, as a woman, what concerns me the most is that it is usually the females who are terminated. In 2011, it was estimated that 160 million fewer women are in the world because of sex selection. In the rush to be seen as pro-choice, it concerns me that my own sex is being terminated or exterminated, all in the name of female empowerment.
The lack of consultation on this bill is also of major concern. Like all the other members in this House, I have received thousands of emails. I believe that if Tasmanian citizens take the trouble to write a submission, send an email or sign petitions, they should be fairly heard and their views given the respect they deserve. However, the minister was so keen to rush this bill through that whilst submissions closed on Friday 5 April, the bill was tabled less than a week later on 11 April. While I acknowledge that a couple of changes were made to the bill, as the minister states in her press release:
Of the individual submissions received during the consultation period, around 87 per cent were critical of pregnancy terminations in general.
If the community consultation shows clearly that most people are not wanting this legislation, why is the government still proceeding with this bill? Why bother to have a consultation period if the majority of the views are to be ignored?
Tasmanians are quite rightly now concerned that the speed with which the legislation has been rushed into parliament suggests their submission has been inadequately reviewed or just dismissed. As one email I received today stated:
The public are not being adequately heard. One can only assume that private agendas are being enacted.
Also, The Examiner on 9 April 2013 reported that 900 submissions were received on the last day that submissions were due - that is, Friday 5 April. This means there were less than four working days to review these last 900 submissions prior to tabling the amended bill last Thursday, 11 April. If these 900 submissions were thoroughly and properly reviewed, how many staff were involved in doing this task in those four days? Were the staff working all day and all night to review all these submissions that were received on the last day? If numerous staff were not used, it would be a physical impossibility for all these submissions to be given the scrutiny and consideration they deserved.
It also appears the number of Tasmanian citizens who signed petitions against this bill are to be ignored as well. There were five petitions tabled against this legislation today, of which 8 197 Tasmanian citizens supported the petitions, 3 260 of which supported one petition over the last four days. There was also one petition tabled today in support of this legislation with only 921 citizens in support of the legislation. In other words, only 10 per cent of petitions were for the legislation versus 90 per cent against, or a ratio of 9:1 against, but it appears their views are to be dismissed, just as all the petitions were and just like the hundreds and hundreds of people who have attended pro‑life rallies in Launceston and Hobart today and over the last few weeks.
Mr McKim brought up the issue of reputable polling. Polling was conducted in February this year by reputable company Galaxy, which showed that Tasmanians are opposed to abortion for various reasons. For example, 73 per cent of Tasmanians say they oppose late-term abortions; 59 per cent oppose the abortion of a child with a mild disability; 92 per cent oppose sex-selection abortion; 66 per cent oppose abortion for financial hardship; 79 per cent oppose abortion for career reasons; and 79 pr cent also oppose abortion when the parents feel they have had enough children. This bill prevents none of these reasons from happening.
This bill is apparently based on the Victorian legislation but goes so much further than that legislation by effectively shutting down pro-life counselling to pregnant women. This bill provides that if a woman seeks pregnancy options advice from a counsellor, including a volunteer, if that person holds a conscientious objection to abortion the counsellor cannot simply advise about financial, accommodation, adoption services, et cetera. The counsellor must instead refer the woman to a counsellor who does not hold a conscientious objection to abortion. As one counsellor said to me:
I have witnessed first-hand the suffering of women after abortion during my time as a counsellor for the past 25 years, and I can honestly say that I have never seen or heard anyone saying that they were glad that they had their abortion. In fact it was exactly the opposite. The women spoke of regret and a wish to be able to turn the clock back, and some of these were 40 years since their abortion.
As a health professional myself I am appalled at the conscientious objection clauses in this bill. The bill, for example, also disallows the conscientious objection right of doctors to not refer patients for a procedure if they have a conscientious objection to abortion. Currently under the AMA code of ethics a doctor's conscientious objection is allowed with the proviso that the woman is informed early on of the objection and is allowed to seek an opinion elsewhere. There is no compulsion to refer as occurs with this legislation.
This bill is also contrary to the Australian Health Practitioner Regulation Agency Guidelines. Many doctors have written to me stating that this will fundamentally change the way medicine is practised and that they do not want to practise under these constraints. As well, a doctor in Victoria has already been found guilty this year because he wanted to exercise his conscience. One doctor stated that they:
… oppose the increased pressure that will be placed on doctors to prove that the woman's current and future physical, psychological, economic and social circumstances will not suffer as a result of the pregnancy and birth. Just what kind of assessment tools or crystal ball will I be provided with to ensure this?
In the AMA's media release yesterday Dr John Davis, president of AMA Tasmania, stated:
Politicians will be given a conscience vote on abortion legislation. However, this legislation denies this same consideration of conscientious objection to doctors as well as other workers who are at the coalface. This provision is totally unacceptable and must be removed.
Dr Davis also said:
Clearly no person should be subject to intimidation or harassment as they go about their legitimate business. However, the exclusion zones proposed around abortion clinics are an unnecessary and heavy-handed response to a problem that is non-existent in Tasmania.
This bill also heavily penalises with criminal and financial penalties anyone who counsels a pregnant woman and does not refer to services that include abortion. This is a fundamental shift in the way care is able to be delivered in our society. It makes conscientious objection, a basic human right, illegal. The increased sanctions against those providing counselling, including voluntary workers, will further reduce those prepared to work in this vital area. As one concerned service wrote to me today:
Thousands of women will be disadvantaged if the voluntary services were forced to withdraw because of this proposed law. It is ironic that those purporting to be supporting women's health outcomes would by this bill deprive them of support to many issues not connected to abortion. All members in this service must sign undertakings that all dealings will be non-judgmental and that they will not use manipulative methods or shock tactics. They do not give advice but do give information when needed. They do not take a position with regard to political, religious, or family planning issues and do not discriminate on race, colour, national origin or marital status. However, they do not advise, provide or refer directly or indirectly for abortions or abortifacients.
If this clause were to be implemented in Tasmania our local agency would not be able to perform the tremendous work it has done since 1975 and our national24/7 helpline would not be able to take calls from Tasmania. This would deprive hundreds of women of support when no one else is available and the concerns may have nothing to do with abortion.
As another counsellor wrote to me:
Counselling conducted by abortion providers where the provider pays the salary of the counsellor and conducted on the same premises should be the subject of greater concern. Also targeting incorporated bodies, currently accredited as charities with excessive penalties of $32 500, would simply cause these services to disappear. This would be to the detriment of the client base which these organisations service.
In regard to nurses, while in 1970 South Australia was the first state to legalise abortion, including up to 28 weeks if doctors considered it warranted, in 1988 nurses in public hospitals said they would no longer assist in abortions after 12 weeks as it was too traumatic. This was because nurses, who could be helping to save the life of a premature baby born at 24 weeks, could later be required to destroy a healthy unborn baby of the same age. It was for these nurses a devastating experience.
Many concerned citizens who have written to me are quite rightly asking when is the right week to terminate. Do we say that it is at week five when the heart, circulation, spine and brain are forming? Or should it be at week six to seven when the cerebral hemispheres of the brain, pain perception, the kidneys, stomach, eyes, nose, cranial nerves are also developing? Or week eight when the arms, legs, ovaries or testes, sense of smell are developing? Or week nine, with the hair follicles forming, hands and feet visible and limb movements detectable on ultrasound, as well, if the baby is a girl, the uterus is visible? Is it week 12 where the fingers and toes are formed, all organs and the blood vessel supply established and where the unborn child can suck his or her thumb and their tongue is visible, their teeth are starting to develop, respiratory efforts have been observed and in regard to pain, most of the nerves and cerebral areas are developed? Or is at week 16 when the baby is now 15 centimetres long with bones and muscles developing further, with calcification within bones noticeable and the unborn child is able to smell, taste and breathe? Or is it week 19 when the baby is now 20 centimetres long?
I am also concerned that no legislation in Tasmania addresses the pain that would be experienced by the baby in the womb during an abortion. Important neurobiological developments occur in a baby at seven weeks in regard to nerve and pain development, at 18 weeks, in regard to neuromediators and pain pathways, and at 26 weeks, in the thalamus, which is one of the brain processing areas of pain. As the adult thalamus works to lessen the perception of pain, it is highly likely that any tissue damage to the baby in the womb occurring after 18 or even at seven weeks, would cause more pain than a full-term baby. The unborn child is particularly vulnerable to any pain stimuli before 26 weeks.
As Dr David Strong, the paediatrician at the Launceston General Hospital states:
This legislation cruelly ignores the issue of foetal pain which remains important because much evidence points towards the belief that foetuses suffer severe pain in the process ofmid and late foeticide.
I note too the concerns of many medical practitioners who have contacted me. One stated that the central tenet of medical practice and the first thing taught to our medical students is primum non nocere - first do no harm. It is hard to escape the reality that termination of pregnancy extinguishes a human life no matter what legal status an unborn child may have in any jurisdiction. The issue becomes increasingly fraught with practical and ethical difficulty as intrauterine development proceeds. Late term abortions are especially problematic.
This bill allows for termination of pregnancy until birth on the demand of the pregnant mother. Termination of pregnancy as a medical procedure is not without risk, especially when performed later in the pregnancy. There are also long-term psychological consequences of the abortion on the woman. Also, there is an increased risk of premature labour in future pregnancies for those who have had an abortion.
Abortion is not a quick medical fix. There are complications and health risks to the mother including bleeding, pain, infection, uterine perforation, damage to the cervix and anaesthetic complications such as aspiration of stomach contents into the lungs, anaphylaxis to drugs, vomiting and death from cardiac arrhythmias caused by the drugs, et cetera. With a medical abortion done after 12 weeks that tends to be done for later terminations, the mini labour may also take several days for completion. This form of abortion is likely to cause the woman considerable distress. Longer-term complications of termination are infertility due to infection, cervical trauma and uterine perforation. If a woman becomes pregnant after a termination she is also more likely to have a pre-term birth with the next pregnancy and pre-term births are associated with more infant mortality according to 2013 United Kingdom data.
New 2013 figures from Christchurch have also shown a moderate increase in anxiety, alcohol misuse, illicit drug misuse and suicidal misbehaviour in those women having an abortion. The United Kingdom guidelines also mention the affects on long-term mental health as a complication of abortion and recommend that women be warned of this. In fact, Coleman in 2011 found that the overall risk of having a mental health problem was significantly increased in women who had an abortion.