GPs have been issued with “interim” clinical guidelines for providing abortion services by their professional body.
The guidelines from the Irish College of General Practitioners (ICGP) will apply to family doctors who have agreed to provide termination of pregnancy services when they become legal next month.
The guidelines, seen by The Irish Times, lack detail in a number of key areas which, the document says, remain "in development". These include detailed referral pathways to secondary care, details on Anti-D availability, and notification and certification forms.
Under the new service, GPs will provide medical abortions to women up to nine weeks gestation, while terminations between nine and 12 weeks will be carried out in hospitals.
The ICGP says it has written to Minister for Health Simon Harris over its concerns at the "lack of clarity" around referral pathways to secondary care, when this is required, throughout the country.
The organisation said the promised MyOptions 24-hour helpline for the abortion service, and community supports to facilitate safe care for women, “must be in place and fully operational by the January 1st deadline”.
It also says it has highlighted to the Minister the concerns of some of its members who have conscientious objections to providing the service.
Earlier this month, dozens of GPs walked out of an extraordinary general meeting of the professional body held to discuss the issue. This group is now seeking to force a second EGM in the New Year to debate motions on conscientious objection, an alleged lack of consultation and other issues.
Conscientious objection
The guidelines provide “suggestions” for GPs who have a conscientious objection to abortion.
“A woman dealing with an unplanned pregnancy needs non-judgmental interaction with her doctor. At a minimum all doctors can listen as a woman articulates her situation and her feelings.
“Examples of ways of responding to a woman presenting in such a situation are: ‘It sounds like you might be going through a difficult time’ or ‘I imagine this is a difficult situation for you’.”
The doctor needs to consider how to respond “in order to provide best care for the patient while staying true to their own beliefs”.
Under the ICGP’s guidelines, a woman seeking a termination would have three consultations with a GP, with a three-day delay between the first and second consultation.
At the second consultation, a woman is given her first medication at the doctor’s surgery or clinic, with a second part of the “abortion pill” to be taken at home up to 48 hours later.
She is advised of possible complications, and encouraged to return. Long acting reversible contraception is offered.
The third consultation, usually within two weeks of the second, is to confirm “the cycle is completed”, offer counselling or contraception, and management of any complications.
Where the doctor is unsure of the woman’s gestation dates, s/he “must” be able to access an ultrasound for dating or complications, according to the ICGP.
If gestation is more than nine weeks, the woman is referred to a hospital for a surgical termination.
GPs should invite patients to consider screening for sexually transmitted infections, the guidelines also state.
