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Legislative Council - Fifty-Fourth Parliament, Second Session (54-2)
2020-12-02 Daily Xml
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Bills

Termination of Pregnancy Bill

Committee Stage

Clause 1.

The Hon. J.M.A. LENSINK: I rise to make a few remarks, which may assist members in terms of the procedure of this bill. I had foreshadowed earlier, during the second reading debate, that the Minister for Health and Wellbeing and I would make further contributions at clause 1 of the bill to address a number of issues raised by members during their speeches. I hope that this will help clarify some of the issues and address some of the concerns that have been raised before we proceed to further consider specific clauses and amendments of the bill.

One of the primary concerns that has been raised repeatedly about this bill is that it will allow for abortions to be performed up to birth, and that it will lead to a rush or an increase in the number of later term abortions. To be clear, there is no evidence to suggest that the bill will do either of those things. The bill in fact creates a medically-appropriate model for later term abortions, which recognises the inherent complexities and difficulties faced by women who may be considering a termination in these circumstances.

It creates a model whereby a termination of pregnancy may only be performed after 22 weeks and six days, where two medical practitioners consider that, in all the circumstances, the termination is medically appropriate, having regard to all relevant medical circumstances and professional standards and guidelines. The bill in fact gives those women and their families time to process and consider one of the most difficult decisions of their lives, without the pressure of being rushed to reach a decision because there is only a short window of time for them to have a termination.

What this bill in fact does is fundamentally place trust in women and their medical practitioners to reach the decision that is medically appropriate to their circumstances, whatever that decision may be. It has been suggested by some that the bill would allow for a woman to terminate a pregnancy at 38 weeks, or even right up to the birth, for no reason other than that the woman has simply changed her mind. I find that suggestion to be utterly offensive and farcical. Nor is that suggestion supported by the evidence.

We know that in South Australia the overwhelming majority of terminations are carried out in the first trimester of pregnancy. In fact, in 2017, 91.2 per cent of terminations in South Australia were performed under 20 weeks' gestation. Of the 111 pregnancy terminations that were conducted at 20 weeks gestation or later, 47.7 per cent, or 53, were for congenital anomalies; 49.55 per cent, or 55, were for the mental health of the woman; and 2.7 per cent, or three, were for specified medical conditions of the woman.

Similar arguments have been raised that a termination carried out for so-called psychological reasons is not a legitimate basis for seeking a termination. This term is often mischaracterised as a kind of catch-all phrase for women who may find themselves unexpectedly pregnant and who do not want a child for various social or economic reasons. To the contrary: terminations carried out for psychosocial reasons reflect a vast range of circumstances. For example, they can include situations involving the abuse of minors and vulnerable adults to sexual and physical violence, such as rape, incest and sexual slavery, women in violent and abusive relationships, as well as those dealing with mental health and addiction issues. It is unfair to characterise this phrase in such simplistic terms as some have sought to do.

To be clear, mental health is health and it is recognised as such by RANZCOG as a valid and legitimate reason for seeking a termination, including in the later stages of pregnancy. Furthermore, there is no evidence to suggest that the bill will increase the number of terminations in South Australia. We know that since 1999 there has been a steady decline in the rate of pregnancy terminations in South Australia, from 17.9 per 1,000 women aged 15 to 44 years to 13.2 per 1,000 in 2017.

There is also no evidence to suggest that legislative reform would increase the rate of pregnancy terminations in South Australia, based on the experience in other Australian states and territories. While statewide data is not available for all states and territories, the available data does show changes towards an increase in early medical terminations in contrast to surgical terminations.

In the Northern Territory, following legislative reform in 2017, there were substantial changes in relation to the method of termination, with an increase in the proportion of early medical terminations and a decrease in the proportion of surgical terminations. The rate of termination of pregnancy in the Northern Territory has remained unchanged since that reform. Victoria underwent legislative reform in 2008 and, while no statewide data is available, Marie Stopes reports that overall there was a slight decline in termination of pregnancy numbers but a change in termination type, with early medical and tele-abortion demand increasing and surgical terminations decreasing.

I will also briefly address the notion being suggested by some members that this bill somehow hinders or discourages adoption and foster care and other alternative options to abortion. It does no such thing. Adoption and foster care are vitally important initiatives that can have a profound positive impact on the life of a child and should be encouraged where viable and appropriate. This is undisputed.

However, for many women the choice to have a termination is because they do not want to be pregnant or continue to be pregnant or to give birth or to relinquish a child. A woman's decision to choose adoption or abortion requires services to be provided in a supportive non-judgemental manner that enables her to make the best decision for herself, and I believe the bill achieves this.

I also advise that the Minister for Health and Wellbeing will be managing amendments and clauses that specifically relate to health amendments and clauses in the legislation, so we have the benefit of his expertise and his advisers in this matter.

The Hon. S.G. WADE: I rise to address some matters raised by members in the second reading debate. Termination of pregnancy is a sensitive and polarising matter. Termination services are a health service that the state of South Australia has legally permitted and provided through public and private health services for 50 years.

In Australia, one-third of women experience an unintended pregnancy and one in five of those women will seek and obtain a termination. The rates of unintended pregnancy are higher amongst women who are socially demographically disadvantaged and those living in rural areas. Given these facts, restrictive legislation that inhibits equitable access impacts women and compounds disadvantage. This bill puts in place a well-considered and appropriate regulatory framework to support quality and safe health services for women wherever they live in the state.

As I have indicated in prior statements, there is an existing body of law that provides rigorous oversight of clinical practice and will, of course, remain in force whatever the outcome of the consideration of this bill tonight. These legal frameworks, bolstered by longstanding and rigorous high clinical standards and codes of conduct, preclude terminations of pregnancy to birth. All Australian doctors must comply with these standards at pain of legal or professional penalty. The law has and will continue to govern clinical practice, which will only be strengthened by this bill, which incorporates enhanced safeguards for clinical practice pertaining to terminations.

Some of the relevant and applicable legislation in South Australia that governs clinical practice can be found in legislation, such as the Controlled Substances Act, the Health Practitioner Regulation National Law, the Consent to Medical Treatment and Palliative Care Act and the Health and Community Services Complaints Act. In furnishing the council with these specific laws, I once again affirm that terminations up to birth do not and cannot subsist within the South Australian legal and clinical frameworks.

One of the concerns that has been raised in relation to this bill is that regional health practitioners with a conscientious objection could be pressured to perform terminations when there is no other health practitioner nearby to perform the procedure. In the healthcare context, conscientious objection is the refusal by health professionals to provide treatment that they oppose on religious or moral grounds. This bill recognises and accommodates the right of a health practitioner to raise a conscientious objection in a manner that ensures that the practitioner discharges their professional and ethical duty of care to the patient, whilst safeguarding women's access to services.

The bill requires only that the provider disclose their objections, and either transfers the care of a person to another health practitioner who can provide the services or provides the person with information on how to locate or contact such a registered health practitioner. As prescribed under the bill, the health practitioner with a conscientious objection will have discharged their professional, legal and ethical duty once they refer the woman to a willing provider and therefore are under no further obligation or pressure. The proposed prescribed form is for the sole purpose of ensuring both clarity and convenience for both parties by providing information, such as details of public health service providers across the state.

The bill strikes a balance between protecting a conscientious objection and the right of women to obtain a legal termination without delay. The bill's approach to conscientious objection reflects the prevailing law, not only in a broader Australian context but also in line with the recommendations of internationally recognised human rights bodies and organisations, such as the World Health Organization and the International Federation of Gynaecology and Obstetrics, as well as a host of international human rights committees that address conscientious objection.

South Australia is currently the only Australian jurisdiction that does not allow for telehealth services to be used in relation to terminations of pregnancy. There is strong evidence to support the use of telemedicine as a reasonable alternative for those who may not otherwise have access to safe, high quality and effective termination care. In cases of early medical termination, telehealth would mean that a woman seeking services would not require an in-person examination by a rural doctor who may have a conscientious objection. By facilitating access to early medical termination by means of telehealth, the bill further allays concerns of pressure being brought to bear on a rural health practitioner who may conscientiously object.

Concerns were also raised in the second reading debate that the bill may allow for private providers with profit models to operate termination clinics in South Australia. This concern is unfounded, particularly in the South Australian context. While most terminations in other states and territories operate under a private provider model, in South Australia most termination services are provided through the public system and will continue to be so under this bill. In South Australia, only 1 per cent of terminations are provided in private metropolitan facilities. By continuing to provide this health service to women in South Australia at low cost within the public system, there is little to no remit or incentive for private providers operating for profit in South Australia.

I would like to respond to comments made regarding further possible amendments to the bill. One of the amendments proposed is that terminations carried out by non-medical health practitioners only be performed with the prior approval of a medical practitioner. In practice, this would only serve to compound the very barriers this bill has been drafted to address.

The bill provides for a robust regulatory framework in the hands of non-medical health practitioners providing termination. Registered non-medical health practitioners who are authorised and appropriately accredited can perform only early medical terminations, that is, MS-2 Step. The non-medical health practitioner must also be acting within the ordinary course of their profession and be authorised to prescribe the drug under the Controlled Substances Act.

Such a proposed amendment would further impede access for women in this state, particularly those in regional South Australia, where access to a medical practitioner can be a challenge in and of itself. Furthermore, the procedural and logistical implications of the application of the proposed amendment could compromise a woman's ability to access a timely early medical termination, potentially necessitating a later term surgical abortion.

Another amendment to the current bill seeks to prohibit a medical termination where a woman is more than 50 kilometres away from a hospital or ambulance service. Firstly, it is important to note that most women do not require follow-up care after termination of pregnancy and, should such care be required, the management of complications arising from medical termination is no different from the management of complications arising from spontaneous miscarriage.

The Therapeutic Goods Administration, which regulates MS-2 step medication, and Marie Stopes International, which administers the MS-2 training for medical practitioners, have existing guidelines regarding follow-up protocols after medical termination, which includes access to emergency care. Marie Stopes International recommends that a woman be within a two-hour drive of a hospital capable of managing a miscarriage following treatment, in the unlikely event that such management is required. This is in addition to medical practitioners abiding by the further protocols provided in the SA Perinatal Practice Guidelines.

An email recently received by members of the Legislative Council from a medical practitioner providing terminations of pregnancy in rural South Australia outlined the challenges regionally based women face in accessing early medical terminations and the clinical measures in place to ensure it can be carried out safely and prevent rural women from having to travel long distances post termination to return home from metropolitan areas, as is often the case under the current legislation.

The process outlined by this medical practitioner is thorough and includes multiple appointments to review and confirm all options, medical conditions and medications, in addition to ensuring the woman resides within 30 minutes' drive of an emergency department and will be with a responsible adult post procedure.

This is in addition to verbal and written information about medical review, emergency contact details, follow-up appointments and future contraception needs. I respectfully submit, therefore, that medical and clinical protocols and procedures on follow-up care should remain in the hands of the drug and health professionals that administer medical termination rather than within the body of law, as suggested by the proposed amendment.

As we discuss this proposed legislation, we must not lose sight of the core imperatives that are upon us, namely, to ensure equitable access to high-quality and safe healthcare services for all women in South Australia. We need to ensure that we respect the right to personal moral agency and self-determination in relation to fertility—a right recognised in law and supported by health services.

In conclusion, I would like to make a couple of points in relation to my participation in the debate. As a member of this council, I support the bill. As Minister for Health and Wellbeing, I am very mindful of my duty to support this council to have an informed debate on the bill—informed not by my opinion but by the expert advice of a range of clinicians in SA Health. Unless otherwise indicated, the amendments moved and the information provided is substantially based on the advice of SA Health.

The Hon. C.M. SCRIVEN: I thank both ministers who have given their contributions at clause 1. I think we can pursue some of those statements further when relevant amendments or clauses arise; however, I want to make some general comments about the bill.

One of the crucial failings of this bill is that it attempts to make the unborn baby totally invisible. It removes any mention of the child from the law on this matter, with the current terminology of referring to 'a woman with child' being replaced with 'a pregnant person'.

The bill is on the whole based on recommendations that came out of the SALRI report; however, when reading that report the overriding impression is that a woman's autonomy is the principal, indeed almost the only, consideration in many cases. It is repeated over and over again and essentially takes precedence over all other matters. As a result of these features the bill treats the unborn baby as though he or she is a limb or another part of the mother and therefore a woman's autonomy, as mentioned, is considered essentially the only relevant factor.

The reality is there are two humans involved when someone is pregnant. It should not need to be said. It is a simple biological fact that there is both mother and baby, regardless of what language you wish to use, and after an abortion one of those lives has been ended. That is why abortion is not health care like any other, as some would claim. Other health care does not deliberately end a life.

Once a baby is viable—that is, able to live outside the womb, independently of the mother—it should be even more clear that he or she also has rights, but this bill does not afford any rights whatsoever to the baby. That is wrong. As I mentioned in my second reading speech, much of the discussion around abortion is that it is no-one's business except that of the woman, yet this is the type of argument we used to hear regarding family violence, 'It's not your business. It's my child. Don't interfere.' We need to be wary, extremely wary, of that type of an argument.

In terms of public opinion around this, we are told that large numbers support abortion. That may well be true, but this bill does allow abortion up to birth, despite what the minister has said, and we have seen in Victoria where it has been used up to and including 37 weeks, remembering that 40 weeks (nine months) is the standard accepted gestation for a baby.

I have received many emails and letters, and I think it is worth placing on the record that in favour of this bill I have received approximately 230, and against this bill I have received approximately 4,300, and that has actually increased, because since I wrote this speech there have been more coming in this evening while we have been sitting in the chamber. I think we need to recall that in the context—

The CHAIR: I will just bring—

The Hon. C.M. SCRIVEN: —and I have questions for the minister.

The CHAIR: —the honourable member back to the fact that we are at clause 1. I do recognise the fact that both the Hon. Ms Lensink and the Hon. Mr Wade have brought some facts and detail into the debate—

The Hon. C.M. SCRIVEN: I have actually finished, Mr Chair.

The CHAIR: —but you did just mention in your own words 'this speech'. So we are in clause 1. I have allowed you to do that because of the fact that we have already had similar things on the other side, but when you described this as a 'speech', that is not what clause 1 is all about. I will give you a little bit more latitude, but I think we all need to move on with questions and move on to the various clauses.

The Hon. C.M. SCRIVEN: Thank you, Mr Chair. I would just place on the record that I said, 'In my second reading speech I said', so I was not suggesting this was a speech. However—

The CHAIR: I thought you—anyway, we will not argue.

The Hon. C.M. SCRIVEN: —I appreciate your latitude and your guidance, and I have a number of other questions at other clauses. So as I mentioned, I have actually finished.

The Hon. D.G.E. HOOD: I just have one question. I do not seek to delay proceedings. I have a question which does not necessarily appear in any clauses I can see, so I will get to that in a moment, but can I just outline that I thank both ministers for their opening contributions. I think they were helpful in framing the relative positions. I also think it is appropriate—and I do not mean any disrespect—that I refer to them by their names during this discussion rather than their titles, because it is a private member's bill and not supported by all government members.

We have heard in the contributions—I actually cannot recall which of the members it was but in the opening contributions—that this bill will not allow further late-term abortions because they are already quite rare, and I accept that that is true. I understand that about 2.6 per cent, or something in that order, is the figure quoted from SA Health in terms of so-called late-term abortions.

The reason we have a fairly low—some would argue 2.6 might be high, but a relatively low—late-term abortion rate is that we have a clinical framework which doctors and nurses operate within in order to make their clinical decisions, if you like, which tends to make late-term abortions less common, which I think we would probably all agree is a good thing.

But we are not here to discuss clinical parameters. We are not charged with making clinical decisions tonight. We are charged with making legislation. That is our job as legislators. My question is a pretty simple one, and I am happy for either member, whoever feels best equipped, to address it. Which clause in this bill—this is what we are debating, the bill—would prohibit or make less likely abortions post 28 weeks, as the current law requires?

The Hon. J.M.A. LENSINK: There is a huge amount of practice that takes place within the health profession which is governed by ethics. I also point out that not everything that takes place, that comes under an act of parliament, is codified in the law. I think there is a tendency at times, as seen across the political spectrum, for members—sometimes particularly in this house—to seek to codify particular practices within legislation.

I will just reiterate some of the comments I made in my second reading summing up about health law. These are comments that come directly from the Australian Medical Association. I will repeat them because I think this is a really important point. It is one that I think a lot of the correspondence to our offices has not understood and one on which others have been misled, which has led to anxiety for those people. I think that is regrettable. I reiterate:

…the clinical decision-making and practices of doctors and other health professionals are governed by incredibly strong safeguards and regulations, which are sometimes called health law.

This is something that I understand they refer to themselves. I continue:

These include [firstly] codes of conduct under the Medical Board and AHPRA; [secondly] professional standards under professional bodies, such as the AMA and colleges; health service policies, procedures and credentialling requirements; and the overriding principles enshrined in medical and health ethics, which they must comply with.

Doctors must act ethically, and if they do not they [risk losing] their right to practice.

I think those are very important points to make. I think it is also important to point out that doctors undertake the Hippocratic oath and if one considers that a number of the medical professionals who are involved in these practices are obstetricians, their training is, by its very nature, that they wish to help pregnant women and they wish to deliver babies. I think we just need to bear that in mind, that it is something that is part of all of their practice and training, and not everything is going to be codified in an act of parliament, otherwise our statute book would be running into the thousands of pages.

The Hon. S.G. WADE: I certainly agree with the comments of the Hon. Michelle Lensink. I will give another very simple and clear example in response to the Hon. Dennis Hood's question. There is one very clear element which reduces the chance of late-term abortions under this bill compared with the current law. Under the current law, which was established in 1969, the parliament wanted to avoid the prospects of, if you like, abortion tourism—people from other states and territories coming to South Australia to have an abortion—so they put in a provision that said you had to be a resident for two months. That is still in the law.

We have a situation now where we are the last state in Australia to still have it in the criminal law, but we are actually making it more likely that women will have late-term abortions because if they are in South Australia and they have not been resident here for two months, they have to serve the time. That is a clear example where I think this change would reduce the chances of late-term abortion.

It also leads me to make a general point about this debate. I think honourable members need to appreciate that since 1969 there has been a broad consensus for abortion in South Australia. It has been lawfully permitted. South Australians have allowed their government to continue to provide services in public health services. For 50 years taxpayers in South Australia have funded this. I think there is minimal support for change of that framework and if this house does not take the opportunity to update the legislation the old legislation will stand for another 50 years. The fact of the matter is that this is an appropriate modernisation of a framework which has the support of the South Australian people.

I implore honourable members: do not think that, because you do not like the law that is there, you want to keep it outdated and inaccessible. If health services are to be provided in South Australia, they should be provided on a safe, equitable and accessible basis.

The Hon. D.G.E. HOOD: I thank both members for their response. I absolutely concede and agree with most of what they said; that is, we have a clinical framework that restricts late-term abortions, and that is embedded and common practice. I have no dispute with that. I take no issue with that, and I do not think anyone does. I even take the Hon. Mr Wade's point about the two-month requirement of domestic population, if you like, living in South Australia, that could potentially even increase the number of late-term abortions, but none of that was my question.

My question is simple: which clause in this bill specifically rules out or makes it more difficult to have late-term abortions? At the moment, the current law says that beyond 28 weeks—I am paraphrasing of course, but it is roughly this—it is difficult, even if two doctors agree, for an abortion to occur, unless the woman's or the baby's life is at risk. That is paraphrasing, but that is essentially what it says. Which clause in this bill makes it as crystal clear as that—that beyond a certain time an abortion cannot occur unless the mother's or the baby's life is at risk?

The Hon. S.G. WADE: The relevant clause is 6(1)(a), which provides:

(a) the medical practitioner considers that, in all the circumstances, the termination is medically appropriate…

The phrase 'medically appropriate' engages all the clinical framework the Hon. Michelle Lensink has referred to. I would also make the point that under that clause it will be available from 22 weeks and six days. The current law is from 28 weeks. That underscores the fact that our legal framework, our clinical framework in South Australia, has been extremely cautious. In spite of the fact that the law permitted abortions later into the pregnancy, South Australian health services, with both clinical oversight and legal oversight, pared that back, and this legislation reflects the more conservative approach.

The Hon. D.G.E. HOOD: This is the last question from me on this clause because I do not wish to delay proceedings. I thank the Hon. Mr Wade for his response. What seems clear to me is that it is not clear in this bill. There is no clear clause that does what I ask, and I think we all know that. It is not a mystery. The reason there has been such strong opposition to this bill—I, too, and I am sure all members, as the Hon. Ms Scriven said, have had more than 4,000 objections to the bill, or 4,200 or 4,400, something in that order—is that it is not clear in the bill specifically that there is a clear age over which abortion is very difficult, if you like, or almost impossible; that is, either the mother's life or the baby's life is at risk. That does not appear in this bill. I think that is clear and I will leave it at that.

Clause passed.

Clause 2 passed.

Clause 3.

The CHAIR: We have identical amendments from the Hon. Dr Centofanti and the Hon. Ms Scriven. The Hon. Dr Centofanti's amendment was filed first, so I call her.

The Hon. N.J. CENTOFANTI: I move:

Amendment No 1 [Centofanti–1]—

Page 3, after line 18—Insert:

prescribed hospital means a hospital, or hospital of a class, prescribed by the regulations;

This amendment is contingent on the main amendment that I am moving, which is amendment No. 2 [Centofanti-1], as it defines the term 'prescribed hospital', which I refer to in my second amendment. Perhaps if I could seek permission to speak to my main amendment prior to putting this amendment to a vote?

The Hon. S.G. Wade: It would certainly make it easier for me.

The Hon. C.M. SCRIVEN: May I provide an alternative? Because the amendment 'prescribed hospital' refers to amendments other than the Hon. Dr Centofanti's, I wonder if going down the course that the Hon. Dr Centofanti has suggested would mean that we are actually dealing with the substantive nature of a number of different amendments, all at this clause.

My suggestion, if members were willing to agree, would be, given that this actually makes no significant change to the bill—this inserts a definition of a prescribed hospital—if none of the amendments referring to a prescribed hospital get the support of this chamber then that definition would sit there and be irrelevant.

It is perhaps not ideal, but I do not think it would have any material effect whatsoever—I am happy to be told if I am wrong—in which case, it would be of no harm to simply pass this amendment, which is a definition and then deal with substantive amendments in their relevant clauses as they arise. That is just a suggestion for the committee to consider.

The Hon. T.A. FRANKS: I wish to indicate that I will oppose this particular amendment. While I understand that the Hon. Clare Scriven has said perhaps it does no harm because it may not have the consequential amendments then flow through and it would just sit there, I say that I will support at that point a recommittal of this clause to consider the question, should one of those other amendments that are consequential be successful.

The Hon. S.G. WADE: I had exactly the same thought as the Hon. Tammy Franks. The advice from the table is that if this clause is not otherwise amended—and I am not aware of any amendment to this clause other than the one that has been jointly proposed, if you like, by the honourable members—we can resolve to recommit it; in other words, put the clause aside and consider it at the end of the committee stage.

That being the case, it would logically be that the next amendment in the sequence in relation to each honourable member's proposed flow of amendments becomes a test clause for each respective flow, and this particular amendment does not need to be a test clause for either of them. I hope the table agrees with my interpretation, but that is my understanding.

The CHAIR: My advice is that we could postpone the clause. I think we have only moved one of the amendments. If that amendment was withdrawn at this point, we can then postpone the clause.

The Hon. N.J. CENTOFANTI: I seek leave to withdraw my amendment.

Leave granted; amendment withdrawn.

The Hon. S.G. WADE: I move:

That consideration of clause 3 be postponed and taken into consideration after clause 17.

Motion carried; clause postponed.

Clause 4 passed.

Clause 5.

The Hon. I. PNEVMATIKOS: I move:

Amendment No 1 [Pnevmatikos–1]—

Page 4, line 7 [clause 5(1)(a)]—Delete '22 weeks and 6 days' and substitute:

24 weeks

The reason I am moving this is because health practitioners, medical practitioners, advocacy groups, as well as SALRI, support that if there is to be a requirement for later term abortions to be approved by two doctors, then this should be at the 24-week stage.

I can go into some detail about this in terms of the SALRI recommendations which state that the relevant law in our state should provide that up to 24 weeks gestation an abortion can be performed by one health practitioner but, after 24 weeks gestation, consistent with their recommendations and recognising the woman’s autonomy, an abortion may be performed by a medical practitioner, but only after that medical practitioner has consulted with another medical practitioner and both are of the view that the proposed procedure is medically appropriate.

In addition, the presence of two medical practitioners and the requirement that they both approve after 24 weeks reflects current clinical practice and also recognises that terminations at this later stage often involve issues of disadvantage, distress, complexities and higher risk to the pregnant woman. The AMA believes that one qualified medical practitioner should be required for consultation and consent up to 24 weeks gestation and, at or after 24 weeks gestation, the AMA believes that consultation with a second medical practitioner should be necessary.

A serious foetal abnormality may not be detected until screening at 19 or 20 weeks. The AMA believes that a requirement for a second medical practitioner to approve a termination should occur at that 24-week gestation point. The provision will allow that individual some time to decide a course of action without an added requirement. Because there are significantly greater physical, ethical and psychological implications inherent in later term abortions, the involvement of a second medical practitioner after 24 weeks will give greater assurance to those ethical, psychological and physical implications to be considered.

It also will assist in doctors, medical professionals, being able to consult and share and discuss their assessment and ensure that all appropriate matters are considered in the clinical decision-making process. There are many supporters who provided evidence to the SALRI report who supported no formal gestational limits. I will list them as follows:

the Australian College of Midwives;

the Royal Australian and New Zealand College of Obstetricians and Gynaecologists;

Fair Agenda;

academics such as Dr Margie Ripper; Professor Heather Douglas; Beth Wilson, who is a former Victorian Health Service Commissioner; Professor Da Costa, who is a professor of obstetrics and gynaecology;

the Royal Australasian College of Physicians;

the Human Rights Law Centre;

the Southgate Institute;

Ceduna health practitioners;

SARC;

the Australian Women's Health Network;

Dr Erica Millar;

Associate Professor Catherine Kevin;

the Women's Electoral Lobby;

the Coalition of Women's Domestic Violence Services SA;

the AMA; and

the Women's Electoral Lobby Australia.

They all explicitly supported that there should be no informal gestational limit but, if there were to be a limit, it should be at the 24-week mark.

SALRI concluded, as a consequence of the various submissions, that in all the circumstances, and although acknowledging that there were differing opinions, 24 weeks' gestation was the most appropriate threshold for a change, if any, to the consideration of undertaking an abortion procedure. This recommendation not only reflects current clinical guidelines and practice but also likely advancements in the future.

SALRI reiterated its position that in the alternative to its preferred approach based on the ACT, the relevant law in South Australia should provide that up to 24 weeks' gestation a lawful abortion can be performed by one health practitioner, but that after 24 weeks' gestation, and recognising the woman's autonomy, an abortion may be performed by a medical practitioner but only after that medical practitioner has consulted with another medical practitioner and both are of the view that the proposed procedure is medically appropriate.

The 22 weeks and six days included in the current bill is nothing more than a legal date or term placed in the bill, whereas the scientific and medical evidence overwhelmingly supports a 24-week gestation to require the involvement of a second consenting doctor to the process.

The Hon. S.G. WADE: I will not be supporting these amendments, not only amendment No. 1 [Pnevmatikos-1] but also Nos 3, 4 and 5. In its report SALRI made alternative recommendations concerning gestational limits for lawful terminations of pregnancies. SALRI's preferred recommendation was that there should be no specified criteria or set gestational limits for when a termination of pregnancy may be lawfully performed.

Under this model, it was recommended that termination of pregnancies should be available at any gestational stage with the involvement of one health practitioner. In the alternative, SALRI recommended that termination of pregnancies should lawfully be available on request up to 24 weeks' gestation with the involvement of one health practitioner, and thereafter only with the approval of two medical practitioners who consider the termination is medically appropriate.

As evidenced by the SALRI report, the issue of gestational limits is a sensitive matter, and it is recognised that there are diverging views on the appropriate approach, but I specifically and respectfully disagree with the honourable member saying that the limit on the bill is a legal one rather than a health one. The decision to impose a gestational limit of 22 weeks and six days is supported and considered appropriate by the Australian Medical Association and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

The gestational limit of 22 weeks and six days has been set in this bill based on the advice of the Department for Health and Wellbeing that most closely reflects clinical practice and is more broadly consistent with the position of other jurisdictions. New South Wales and Queensland both impose an upper gestational limit of 22 weeks, while Victoria imposes an upper limit of 24 weeks.

The additional presence and approval of two medical practitioners after 22 weeks and six days' gestation also recognises that terminations at a later stage of pregnancy often involve disadvantage, distress and complexities that warrant the involvement of a second practitioner. I consider that the present specified limit of 22 weeks and six days should be retained, and I do not support the amendment.

The Hon. C.M. SCRIVEN: Mine is a question which is probably best addressed to the Hon. Mr Wade, notwithstanding that the amendment is from the Hon. Ms Pnevmatikos. What is the nature of the second medical practitioner being consulted? I appreciate that a lot of things have been covered in briefings. So that they are on the record, my understanding is that that could be, for example, a telephone call or similar. Can the minister outline what is meant by a second consultation?

The Hon. S.G. WADE: I would like to make two points in response to the honourable member's question. The first is that the consultation of the second practitioner is referenced in clause 6(1)(b):

a second medical practitioner is consulted and that practitioner considers that, in all the circumstances, the termination is medically appropriate.

I am advised that that consultation could occur by telephone call but, considering the practitioner needs to convince themselves that in all the circumstances the termination is medically appropriate, that may not be sufficient. It depends on the circumstances of the case. That is the law. I now want to make a very clear point about practice.

I think there is a tendency in this debate to, if you like, dramatise the potential of renegade medical practitioners, but we need to remember the context in which this law will operate. It will operate in the South Australian context. As I said earlier, we are, as I understand it, unique in Australia for overwhelmingly providing our abortions through the public health system. As I said earlier, 99 per cent of terminations in South Australia happen in the public health system.

Every termination beyond 22 weeks and six days in a public hospital would not only involve two medical practitioners, it would involve a multidisciplinary team, a very broad multidisciplinary team, including both health practitioners and other health professionals in the context of a rigorous ethical framework. As only SA Health can do, these frameworks are complex and well developed.

I want to assure the council that the prospect of this legislation going rogue is not well founded. We have had a well-established law that is significantly out of date and is inhibiting quality, safe health services. We believe that this legislation will sit comfortably within the rigorous clinical frameworks that are there that provide strong assurance to both this house and the community of South Australia.

The Hon. D.G.E. HOOD (22:09): I hope the Hon. Mr Wade is right. I hope, to use his words or something similar, that the potential for medical practitioners to go rogue, as he put it, using this legislation is limited. I sincerely hope that is right. But I cannot help but reflect on the comments made by Robin Millhouse not that long ago. He introduced his bill all those years ago but was interviewed just a few years ago and said, in his words, the doctors and the lawyers had gone much further than he expected. I think it is entirely possible that we are facing exactly the same risk right at the moment. I do not think we can rule out that possibility. Again, I am paraphrasing, but I think Robin Millhouse's words can certainly be interpreted to that effect.

Anyway, to return to the actual amendment, it will surprise no-one, I am sure, to hear that I will also be opposing the amendment. At the end of the day, what we are arguing about is essentially one week—22 weeks and six days versus 24 weeks. Some would argue it is not a great deal of time and, I guess, in a sense, that is right, but I am comforted by the fact that my understanding is that the AMA and the Department for Health and Wellbeing in South Australia recommend 22 weeks and six days as the appropriate time frame. I understand that the New South Wales legislation dictates 22 weeks even, as I understand it. I may stand to be corrected on that, but I think that it is right.

The Hon. S.G. Wade: Yes, it is right.

The Hon. D.G.E. HOOD: It is right. Thank you, minister. That is slightly less than what our bill proposes. To me, that seems to be about the right level, if we are going to go down this path.

I will just note for members' interest that when researching this particular amendment it is not hard to come across many different sources of information, but there is a website called babycenter.com.au, which I had never heard of until this week. It points out that at 23 weeks—that is pretty close to 22 weeks and six days—the baby weighs around half a kilogram or the same weight as a large mango. The baby can hear sounds clearly and may even respond to certain sounds. It goes on to say 'now is a great time to share your taste in music with your unborn baby' at 23 weeks.

For those reasons and others, I will not be supporting this amendment. I will also point out that SALRI does not particularly nominate a particular time of gestation, whether it be 22 weeks and six days or 24 weeks, so I am not obliged to support the amendment.

The Hon. R.I. LUCAS (Treasurer) (22:12): I rise to speak briefly. With great respect, I respectfully disagree with the views of the Hon. Mr Wade in relation to this particular issue. I agree with his position in opposing the amendment but disagree with his further explanation. As I outlined in my second reading explanation, I believe that the threshold established in this legislation to which we are now referring, that a second medical practitioner considers that the termination is medically appropriate, is a much lower threshold than the thresholds that currently exist within the legislation, albeit at different time periods.

I understand the Hon. Mr Wade's faith in the protocols and practices and conventions and booklets of SA Health, etc., in terms of the practices of medical practitioners, but as I outlined, I think, briefly in my second reading, my experience, with great respect to the medical profession, with all those practices, procedures and guidelines in relation to return-to-work legislation would leave me sceptical of the efficacy of many of these guidelines outlined by SA Health and indeed ethics committees and whatever else it might be in relation to the procedures of medical practitioners.

In saying that, let me acknowledge that the overwhelming majority of medical practitioners should not be judged by the actions of a limited few. As I seek to defend my own profession, in that the overwhelming majority of members of parliament should not be judged by the actions of a limited few, I say the same thing in relation to the medical profession. But one only needs, as we have seen in the return to work legislation over a period of time, a limited few in relation to being able to use these particular provisions. In particular, as the Hon. Mr Wade has indicated, it is possible that a second consultation could be by way of telephone consultation or the like. I remain concerned and leave my concerns on the public record for the passage of time to judge.

The Hon. S.G. WADE: I make a simple point: I never said 'trust the doctor'. As I said in my clause 1 contribution, we have a range of legislation that governs clinical practice, and the policies of SA Health operate under that. Of course, we need to hold doctors accountable, but I was responding to the Hon. Clare Scriven's point suggesting that one call was enough. That is not a fair representation of the way that health law and practice operates in South Australia.

The committee divided on the amendment:

Ayes 7

Noes 14

Majority 7

AYES
Franks, T.A. Hanson, J.E. Hunter, I.K.
Maher, K.J. Parnell, M.C. Pnevmatikos, I. (teller)
Wortley, R.P.
NOES
Bonaros, C. Bourke, E.S. Centofanti, N.J.
Darley, J.A. Hood, D.G.E. Lee, J.S.
Lensink, J.M.A. Lucas, R.I. Ngo, T.T.
Pangallo, F. Ridgway, D.W. Scriven, C.M.
Stephens, T.J. Wade, S.G. (teller)

Amendment thus negatived.

The CHAIR: We remain on clause 5 and we now move to clause 5, page 4, lines 12 and 13, amendment No.1 [Lensink-1], but we also have an overlapping amendment from the Hon. Ms Pnevmatikos, amendment No. 2 [Pnevmatikos-1], in which I have a process from my assistants, the Clerks, by which we will deal with those overlapping amendments, but I call the Hon. Mr Wade.

The Hon. S.G. WADE: I move the amendment standing in the name of the Hon. Ms Lensink:

Amendment No 1 [Lensink–1]—

Page 4, lines 12 and 13 [clause 5(1)(b)(ii)]—Delete subparagraph (ii)

This amendment seeks to delete clause 5(1)(b)(ii) to remove the specification of a 63-day limit in relation to early medical terminations performed by registered health practitioners—that is, terminations caused by the administration or prescription of a drug.

Clause 5(1)(b)(ii) of the bill currently provides that an early medical termination performed by a registered health practitioner may only be performed on a person who is not more than 63 days' pregnant. The current specification of a 63-day gestational limit in clause 5(1)(b)(ii) is based on the current approved time limit for the use of the abortion drugs mifepristone and misoprostol, also known as MS-2 Step, as set by the Therapeutic Goods Administration.

Notwithstanding, it was submitted by a number of stakeholders that the approved time limits for the use of MS-2 Step have been extended by the TGA in the past, and it is likely that they will be extended again in the near future. These stakeholders include the Australian Nursing and Midwifery Federation (SA Branch), Marie Stopes Australia, Children by Choice, the Law Society of South Australia, the Human Rights Law Centre, the Public Health Association, SHINE SA and the South Australian Abortion Action Coalition.

It is noted that Marie Stopes health, which is the sponsor of the MS-2 Step in Australia, is currently in the process of reviewing its risk management plan with the TGA, with the intention of extending the use of MS-2 Step up to 70 days' gestation. Indeed, the United States Food and Drug Administration has already licensed the use of mifepristone up to 70 days' gestation. Stakeholders also argued that it is unnecessary to expressly prescribe a time limit for the use of termination drugs in these circumstances, as such limits will necessarily be established by the TGA in line with pharmaceutical advice.

As such, many stakeholders who were consulted on the bill recommended that this provision be removed from the bill to reflect potential further advancements in clinical evidence and evolving models of care in the future. In the absence of a specified limit in clause 5(1)(b)(ii), it should be noted that a registered health practitioner will only be authorised to administer or prescribe such drugs in accordance with the requirements set by the TGA.

Any registered health practitioner who sought to prescribe or administer such drugs in a manner inconsistent with those requirements for early medical termination would be acting outside the ordinary course of their profession and would be performing a termination contrary to the act. Such conduct may also lead to the registered health practitioner being subjected to disciplinary proceedings and/or civil or criminal proceedings.

It should be noted that this amendment would only affect terminations of pregnancy performed by registered health practitioners. This amendment does not impact on the ability of medical practitioners to perform early medical terminations of pregnancy, which is provided for separately in clause 5(1)(a) of the bill.

The CHAIR: The Hon. Ms Pnevmatikos, would you like to move your amendment?

The Hon. I. PNEVMATIKOS: No, I will not be moving my amendment No. 2 [Pnevmatikos-1]. I will be supporting the amendment moved by the Hon. Michelle Lensink.

The Hon. C. BONAROS: I rise to indicate my support for this amendment, but in so doing will just reflect on what has just transpired, and do so without questioning the result of that vote or anything like that. But I just want to place this on the record, because I think what is abundantly clear, by virtue of the fact that we are having this debate, generally and in relation to this particular amendment as well, is that these matters take time. I would like to say that it is a process of baby steps, but I will not say that because in my firm view that is a term that has been used and over abused in this debate.

What I do suggest, however, is that once a review into the changes has taken place, and we have all realised that the sky has not fallen in and that doctors have not gone rogue, and that their ethical and professional responsibilities and obligations have not been thrown out the window, it is my view that there will be opportunity to reflect on further changes that could be made in line with some of the proposals that are being put tonight. I want to place that on the record because I think it is important that I do so, and in doing so also indicate my support for the current amendment that we are dealing with.

The Hon. N.J. CENTOFANTI: I rise to indicate that I will not be supporting this amendment. The Hon. Mr Wade indicated that the registered health professionals will only be acting under the guidelines of the TGA, and the TGA guidelines for the MS-2 Step currently say 'should only be prescribed by doctors with the appropriate qualifications and certified training'. With that in mind, I indicate that I will not be supporting the amendment of removing the 63 days because, quite frankly, I find the fact that we are allowing health practitioners to prescribe these medications concerning.

The Hon. T.A. FRANKS: I will be supporting the amendment. It will come as no surprise to the mover, given that I raised a concern that by locking ourselves into a 63-day time frame we are actually not following what may happen in the future with changes of different types of medication becoming available. It used to be RU486; we are now referring to MS-2 Step.

Now the TGA regulates the training required, the timing required and the other clinical requirements around this particular medication, and our bill reflects those particular requirements, but actually our act should reflect what the TGA determines, because medications come and go and the requirements will be properly regulated through the TGA.

I, for one, do not want to be back here in five years' time because we have locked in 63 days and the medication that is then currently being used is not reflective of the days that this parliament has just chosen, without any clinical reason to in the future.

The Hon. D.G.E. HOOD: I will not be supporting the amendment. The basic reason is that, if this amendment should pass, what it does is essentially move the law ahead of current medical practice. Yes, it allows for future changes, if you like, but I am reminded of the words of Robin Millhouse, as I mentioned before, that the doctors and lawyers (not all of them, of course, but some of them) had moved well beyond his intentions. I think that by removing the specific 63-day requirement in this legislation from the bill, we open that potential at least for it to be misused, and for that reason I cannot support it.

The Hon. T.A. FRANKS: Can I add, Chair, that the days may actually go down. They do not necessarily go up, and that is one of my concerns. If you have a medication on the market being used by medical professionals, the days and the other requirements should reflect that medication, not one particular medication that we currently use.

The Hon. I. PNEVMATIKOS: In relation to that, to put in a particular figure in terms of days does not appreciate changes that occur in terms of medical developments and innovation, and that is the reality. The current bill has functioned for 50 years. If we want the same, in terms of the bill having a long life, we should allow some flexibility there to take into account technological and medical innovations. By eliminating the 63-day time frame, you can do that. I agree with the Hon. Tammy Franks that it may be that there are medications that actually reduce that time frame, not increase it.

The Hon. C.M. SCRIVEN: On that point of the Hon. Ms Pnevmatikos and the Hon. Ms Franks, if the current provision was to stay there, that would not prevent that. It says, 'on a person who is not more than 63 days pregnant', so if the timing was to reduce, that would not require a change.

The Hon. S.G. WADE: I just make the tangential point that we have had this legislation for 50 years. This parliament has not shown a great willingness to tweak it and keep it up to date. To highlight that point, I would make the point that early medical termination of pregnancy has been available in this state for 11 years.

This legislation is particular unsuited to that medical approach, yet this parliament only now is opening it. Let's not think that every time the TGA changes its guidelines we are going to rush into the parliament and consider whether we want to apply it in South Australia. I think we need to make sure that we are futureproofing this legislation in a way that supports good clinical practice.

Amendment carried.

The Hon. C.M. SCRIVEN: I move:

Amendment No 2 [Scriven–1]—

Page 4, after line 15 [clause 5(1)(b)]—After subparagraph (iii) insert:

and

(iv) a medical practitioner has determined that the termination is safe; and

(v) the registered health practitioner—

(A) administers the prescription drug within 50 kilometres of a prescribed hospital; or

(B) gives the person a notice stating that the drug must be administered or taken within 50 kilometres of a prescribed hospital and identifying the location of each such prescribed hospital.

My amendment is to indicate that these types of terminations could only be done once a medical practitioner has determined that the termination is safe and the health practitioner administers the drugs or gives notice that it must be administered within 50 kilometres. The reason for the first part is to take into account the medical guidelines for these sorts of drugs.

According to guidelines, and I am referring to SA Health guidelines and also the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, it is important that a woman has an examination for cervical screening, STI swabs and, most importantly, an ultrasound to confirm viability and dates and to exclude multiple pregnancy, molar pregnancy and an ectopic pregnancy.

SA Health guidelines for the medical management of miscarriage, as it is called, which is using misoprostol, clearly state that:

Access to 24-hour telephone advice and emergency facilities within 30 minutes of a woman's place of residence including O negative blood and surgical management are conditions of undertaking medical treatment of miscarriage. SAAS [ambulance service] membership is strongly advised.

Further, the publication from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists about the use of mifepristone for medical abortions states:

…up to around 5% of women will need surgical evacuation of the uterus for heavy or prolonged bleeding or for continuing pregnancy.

So there is either excessive bleeding or not all of the baby has been delivered, or perhaps none; and up to 5 per cent will need surgical evacuation. Under 'Staff and facilities for early medication abortion', up to 63 days, it states:

The prescribing practitioner must supervise and take responsibility for arrangements for the entire process of abortion from administration of mifepristone through to confirmation of abortion and completion of follow-up including implementation of a contraceptive plan.

These arrangements must include 24 hour access to specific telephone advice and—

And I emphasise this section—

support and to provision of surgical uterine evacuation or other interventions required for the management of complications, for example through on call arrangements or in an emergency department resourced to respond to women's health needs (such as required for miscarriage care).

Where early medical abortion is offered suitable emergency care (in a service accepting this responsibility) should be available.

I emphasise again that that was a quotation from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists about the use of this drug for abortion.

That kind of support—emergency support, emergency departments, the ability to access surgical uterine evacuation or other interventions—is often not available in many rural and regional areas. As a regional woman myself, I say it is not acceptable to present this as a solution for regional women when RANZCOG itself is saying that 5 per cent of women will need to have surgical evacuation of the uterus. This amendment will therefore improve the bill because it will ensure that abortion drugs are administered to a woman within approximately 30 minutes of her residence, which is the SA Health recommendation.

I acknowledge that the 50-kilometre requirement to be near a prescribed hospital is not perfect. Within 30 minutes of her residence, which is the SA Health guideline, is of course dependent on exactly where you live and the traffic conditions and so on. I acknowledge that it is not perfect, but it does at least acknowledge that you need to be within a short space of time of being able to access those services.

I think the Hon. Mr Wade mentioned in his contribution to clause 1 that many of these things are needed to deal with spontaneous miscarriage—ordinary miscarriage—and that women have spontaneous miscarriages more than 30 minutes from emergency care and that, of course, is true. The difference is that we know that mifepristone will cause miscarriage—that is the point of it; that is what the abortion is—and we know that 5 per cent, according to these documents, will require surgical evacuation of the uterus. So in this case we are managing a known risk rather than something we cannot know, which is in the case of a spontaneous miscarriage.

The argument will be raised that this can be left to the guidelines. That is not the view of many medical practitioners who are firmly of the view that such important matters do need to be in legislation. In fact, they have written to the AMA to object to the bill, and specifically to this part. There are 54 doctors who are signatories to the letter, most working in women's health, including obstetricians and gynaecologists. I will read an extract from that letter. It states:

We draw your attention to the unacceptably high risk to which pregnant women living in rural and regional areas of the State will be subjected through the application of an EMA [early medication abortion] through tele-abortion and by permitting non-medical health practitioners to have prescribing rights. If 'safety' is defined in terms of maternal mortality (death rate) and morbidity (ie the complication rate), then Early Medication Abortion (EMA) is less safe then early surgical abortion.

The literature indicates that up to eleven times as many women die from early medication abortion compared with early surgical abortion, and EMA has a higher infection-related mortality than live births or abortions at all gestations. For every death from EMA, there are 70 reported (and up to 700 unreported) severe and life-threatening adverse events from complications such as severe bleeding, serious infection…and ruptured ectopic pregnancy. Early medication abortion in SA is 9.2 times more likely to fail than surgical abortion and 4.9% of women require a D&C. Compared with surgical abortion, EMA has a four to seven-fold higher overall complication rate.

Women in rural and remote areas are at greater risk of complications from EMA than women in built-up areas due to:

1. The non-availability of pre-treatment blood screens, clinical examination for cervical screening and STI swabs, and ultrasound to confirm viability and dates, and to exclude multiple pregnancy, molar pregnancy and an ectopic pregnancy.

2. There being no post-treatment access to a hospital providing vacuum aspiration to complete the abortion or for the control of haemorrhage.

Support for access to 24 hour emergency care for women receiving mifepristone and misoprostol comes from guidelines approved by Therapeutic Goods Administration and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

As you know, the medical management of miscarriage as per the SA Perinatal Practice Guideline lists no immediate access (>30 minutes) to emergency facilities as an exclusion criterion. On page 12, the Guideline stipulates that 'access to 24-hour telephone advice and emergency facilities within 30 minutes of a woman's place of residence, including O negative blood and surgical management, are conditions of undertaking medical treatment of miscarriage.'

That is the end of the quote from the letter. I note that the Hon. Mr Wade talked about Marie Stopes giving advice that being within two hours was appropriate, which is in contrast to these particular guidelines, the SA Perinatal Practice Guidelines. The doctors who wrote to the AMA also said:

The Bill should be amended to mandate that access to 24-hour telephone advice, and emergency facilities within 30 minutes of a woman's place of residence, including O negative blood and surgical management, are conditions of undertaking Early Medication Abortion.

That is the view of those 54 medical practitioners who have written to the AMA. I am sure there are many others, but they are the 54 who have written. Knowing that they are working within the health systems, both public and private, they do not consider that this should be left simply to guidelines and practice.

They are of the view that it should be in the legislation, and I think the Hon. Mr Hood has made very valid points, in that the intent when the law was passed for the current abortion legislation back in 1969 was well exceeded in the last 50 years. Doctors and lawyers went much further than we expected, as Mr Hood quoted Mr Millhouse.

This amendment would go some way to meeting those criteria that doctors have asked for. I would suggest that, since they are currently in all of these guidelines, which we are told underpin the practice of abortion in the state, if they are already there, there is no problem in having them in the legislation.

As I say, I do acknowledge that a 50-kilometre limit is not the perfect option in terms of trying to manage within 30 minutes of a woman's place of residence, but it does go some way towards meeting those criteria and certainly far more than the current version of the bill would do.

The Hon. J.M.A. LENSINK: I will leave the comments in relation to the specifics of the safety guidelines and the like to the Hon. Mr Wade. In relation to the letter that the honourable member has quoted from, my understanding from my discussions with the AMA is that it has been written by a member who has recently rejoined the AMA.

The Australian Medical Association in South Australia has some 1,300 members and my understanding is that, while the letter and its alleged signatories may well be published in tomorrow's paper, not all of the names who are associated with that letter were necessarily asked their permission to have their names published.

The CHAIR: I will go to the Hon. Mr Wade unless that is particularly relevant.

The Hon. C. BONAROS: I have a question for the mover of the amendment.

The Hon. C.M. SCRIVEN: I will perhaps just respond to the Hon. Ms Lensink first. Would you be willing to accommodate that, Ms Bonaros?

The Hon. C. BONAROS: Sure.

The Hon. C.M. SCRIVEN: I would like to correct the Hon. Ms Lensink. The letter was authored specifically by three people and then the remaining medical practitioners were apprised of the contents of the letter and they agreed to be part of that.

One of the authors has been a member of the AMA for many decades and has resigned on several occasions partly because of the lack of action by the AMA on protecting doctors on these sorts of matters. Interestingly, a number of other medical practitioners who are signatories to the letter have also resigned at various times because they feel the AMA is not supporting them in the way that it should.

Nonetheless, all of the aspects that are raised in the letter that I quoted are in regard to current guidelines and requirements in those other documents—the SA Health guidelines and the RANZCOG guidelines.

The Hon. C. BONAROS: I am glad I gave a member the opportunity to clarify. Can the minister also tell us if she has details of the total number of medical practitioners in South Australia?

The CHAIR: The Hon. Ms Scriven has just been promoted, but I will allow you to answer.

The Hon. C.M. SCRIVEN: Yes, apparently I am the minister now. No.

The Hon. C. BONAROS: And would the minister—I am really promoting you—would the member be surprised to learn that there are more than some 8½ thousand medical practitioners in South Australia?

The Hon. C.M. SCRIVEN: No, of course I am not surprised to learn that that might be the number. The relevance is that there are many medical practitioners who are saying that it is not sufficient to have these things only in the guidelines and that they do need to be in legislation. They obviously feel that that is necessary both for their own protection and also for better policy in the state, because doctors and lawyers sometimes do go beyond what is expected, and they are of the view—and I am led to believe there are others—that it would be best put into the legislation.

The Hon. C. BONAROS: Given that we have 1,300 members of the medical profession who have signed up to the AMA, and the AMA as a representative body has indicated its overwhelming support for this bill, and given that we have some 8,500, 8,800—I am not even sure of the precise figure—would the member not expect there to be more than 54 doctors who would sign up to a letter opposing these provisions?

The Hon. J.M.A. Lensink: And they're not all South Australians.

The Hon. C.M. SCRIVEN: I heard the interjection that they are not all South Australian. My understanding is that the 54 doctors are all South Australian, and then there are other doctors in addition to those 54 who also put their names to the letter—doctors from other states who have no doubt experienced difficulties in the legislation that is present in those other states. But I think the honourable member's question is: do I think more would have signed? Yes I am sure; that is quite possibly so—

The Hon. C. Bonaros: Fifty four out of 8½ thousand.

The Hon. C.M. SCRIVEN: I would ask the member herself: is she aware of whether the AMA surveyed all of its members before coming out and saying it supported this bill?

Members interjecting:

The CHAIR: I did have the Hon. Ms Pnevmatikos on her feet.

The Hon. I. PNEVMATIKOS: Just a question for the mover of the amendment—

Members interjecting:

The CHAIR: Order! We will not have a conversation across the chamber. The Hon. Ms Pnevmatikos has the call.

The Hon. I. PNEVMATIKOS: The Hon. Clare Scriven, as a representative of rural South Australia, how does the member envisage that this amendment is going to assist women in rural and remote areas? I raise that in terms of some of the consequences that can occur with this 50 kilometre requirement in terms of stress being placed on women, the need for them to locate accommodation, the undue financial burden that this will place on rural and remote women, the economic restrictions, not to mention those that are victims of domestic violence and who are in remote locations.

The Hon. C.M. SCRIVEN: My answer is that it will help them because it will keep them safe. The requirements under RANZCOG, under SA Health guidelines, is that women should be within 30 minutes of emergency facilities. So if they are not within 30 minutes of emergency facilities, they are not safe. So that is how it would help regional women.

The Hon. S.G. WADE: I do not want to engage too much in the AMA debate, but what I would simply say in relation to that is that the AMA is no different from the South Australian community. There is a diversity of views, a diversity of moral frameworks in relation to abortion, but for 50 years the South Australian community has operated on the basis of a broad consensus, which any one of us may not feel comfortable with, but this parliament has not seen fit to change that legislative framework.

For those of us who agree with the legislation and those of us who disagree with the legislation, the fact that we would not make a choice under a piece of legislation does not mean that other people should not be able to make that choice. Whether it is 54 out of 1,300 AMA members who do not support the legislation, in a pluralist society it is somewhat irrelevant. I would also like to reiterate the point we made in clause 3, that this is a test clause for this particular issue.

The amendment provides that in addition to the requirements already set out in the bill, terminations may only be performed where a medical practitioner has determined that the termination is safe and the registered practitioner has either administered the prescription drugs within 50 kilometres of a prescribed hospital or given the person a notice stating that the drug must administered, or taken within 50 kilometres of a prescribed hospital, and identifying the location of each such prescribed hospital.

The amendment adds an unnecessary layer of complexity by requiring that a medical practitioner must determine that the termination is safe before a registered health practitioner can administer a prescription drug. It was an express recommendation of SALRI that the performance of an abortion should not necessarily be confined to a medical practitioner but should, where appropriate, be able to be undertaken by a health practitioner. It was observed that the current restrictions in this regard have served to impede and restrict equitable and effective regional, rural and remote access.

In particular, SALRI noted the importance of the evolving clinical landscape in this space and the need for any legislation to have sufficient flexibility to accommodate changes in clinical practice and procedure. The safety of a termination is a fundamental consideration of quality clinical practice exercised by all registered health practitioners. In addition, the distance from an emergency facility is always a consideration of the treating health practitioner who makes a judgement on the risks involved.

There are further clarifications in the MS-2 Step guidelines and for hospitals only within the SA perinatal practice guidelines in relation to proximity to hospitals. I respectfully submit therefore that the medical and clinical protocols and procedures should remain in the hands of the drug and health professionals who administer medical termination, rather than within the body of law, as suggested by the proposed amendment.

It is also observed that it was the prevailing view from professional health bodies and health practitioners that current health law and regulations, policy and clinical guidelines are sufficient to ensure that health practitioners are only involved in abortion procedures to the extent that is appropriate considering their qualifications, experience and scope of practice. The bill reflects this position by ensuring that early medical terminations may only be performed by those health practitioners who are suitably credentialled and qualified within the ordinary scope of their practice to administer such drugs and in accordance with the regulations.

More generally, it is noted that there are some aspects of the amendments that are likely to be unenforceable in practice. For example, there is no obligation for the woman to comply with the requirements of the notice. Relevantly, there would be no consequences in the event that a woman chose to take medication in a location which is more than 50 kilometres from a prescribed hospital. Similarly, there will be no penalties for a registered health practitioner in the event that the woman does not comply with the notice, as the practitioner's obligations under the provisions would only require that the practitioner provide the patient with the relevant notice.

As such, while the intention of the amendment is to enhance protections to ensure the safety of women in the event of complications associated with early medical termination, the amendments as drafted do not ensure that this will in fact actually occur in practice. It is therefore considered that the proposed amendment is unnecessary in the circumstances. Given the technical nature of the issues that this amendment raises, I seek the support of the council to have an adviser on this issue.

The CHAIR: It is unusual to have advisers even in the box for what is a private member's piece of legislation. However, I have considered the potential for the debate to be facilitated—to be assisted, I think, in its facilitation—by having that at a complex stage, so I am willing to allow you to have an adviser sit next to you if you are in the Treasurer's position.

The Hon. S.G. WADE: Thank you, Mr Chairman.

The Hon. N.J. CENTOFANTI: I ask the Hon. Mr Wade a question: given that health practitioners who are not doctors do not have the same degree of medical training as doctors, would they be held to the same standards with regard to negligence as a medical practitioner would usually be under this legislation?

The Hon. S.G. WADE: I am advised that the whole range of health practitioners are subject to professional registration. AHPRA has a range of health professions that are registered by them, and AHPRA is itself governed by states and territories, including the state of South Australia.

Under the registration process you are required to have professional indemnity insurance, whether you are a doctor or a nurse or the like, and health practitioners would need to act both within the professional registration framework of AHPRA but also in accordance with the scope of practice of the credentialling of the health setting in which they work.

The Hon. D.G.E. HOOD: I support the amendment. The reason is fairly straightforward, and that is that I understand that the Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommend in the use of these medications that the patients, if you like, are within 30 minutes of a treatment facility. This amendment mentions 50 kilometres on a country road—50 kilometres of travel is roughly 30 minutes—so I think that might be where the mover is coming from with that. I think we need to be honest and acknowledge that these drugs are not without risk.

In fact, my understanding of the actual label of the drugs is that they acknowledge a 5 per cent complication rate, which is one in 20 women, and that is not insignificant. I think we need to be careful. As someone who comes from the pharmaceutical industry originally, I can assure you that not all medication is harmless; side effects are real. This particular medication has been associated with some very serious side effects over time, and I think it would be prudent of us to put in place steps that would help protect that one in 20 woman who will be affected adversely by this drug, according to the manufacturer's own statements.

The Hon. I.K. HUNTER: I accept the mover of the amendment's assertion that, in moving the amendment, she wants to provide a level of protection for women, particularly in rural and regional South Australia. However, I am persuaded by the Hon. Mr Wade's comments that in fact the amendment will do no such thing, that the amendment is without effect, that there is no sanction involved in the amendment, that there is no mechanism for enforcing the intent of the amendment and, indeed, that the woman, once provided with the drugs, can decide for herself where she actually takes those drugs. In that respect, I think it is rather pointless to have an amendment that sets out an intention but in fact cannot deliver on it, so I will be opposing it.

The Hon. C.M. SCRIVEN: I have a couple of things. First of all, I think clause 13 covers what the Hon. Mr Wade raised, conduct and performance of registered health practitioners. That is referring to someone who is involved in an abortion in a way other than in accordance with this act, which would include that change if this amendment passes.

I would also like to query the Hon. Mr Wade's previous answer that was in response to the Hon. Dr Centofanti. My understanding was that the Hon. Mr Wade said that essentially there would be liability and responsibility and accountability for whoever was prescribing to the same level as a medical practitioner. Was that my correct understanding of what the Hon. Mr Wade said?

The Hon. S.G. WADE: No, I would characterise that as a significant misrepresentation of what I said. What I said was that health professionals are professionally registered within their scope of practice and within that professional registration they have professional indemnity insurance.

The Hon. C.M. SCRIVEN: Thank you for that clarification. There were people talking and it was a little bit difficult to hear. I would just point out that clause 13(4) says that any duty for a registered health practitioner has to comply with professional standards and guidelines that apply to health practitioners, so I think the implied query that the Hon. Dr Centofanti raised was that if there was someone other than a medical practitioner prescribing that raises problems of liability, potentially, where something goes wrong.

The Hon. S.G. WADE: With all due respect, my understanding is that the Hon. Clare Scriven is drawing an inappropriate parallel with medical management of miscarriage. In the South Australian Perinatal Practice Guidelines, the 30-minute limit relates to the medical management of miscarriage. It is our understanding that that is also the case in relation to RANZCOG.

Medical management of miscarriage is significantly different from early termination of pregnancy. Medical management of miscarriage involves pregnancy that is non-viable, and the foetus has passed away but pregnancy products remain inside the uterus. In this setting, women are more sensitive to both mifepristone and misoprostol and as such are much more likely to bleed, compared with the use of those medications in the context of a termination of pregnancy where the foetus remains viable.

Hence, the practice recommendations around 30-minute access to hospital facilities are in the setting of medical management of miscarriage. These recommendations are not relevant in the setting of termination of pregnancy via early medical termination MS-2 Step. The protocols produced by Marie Stopes International do not specify either a time frame or a distance from hospital.

The Hon. N.J. CENTOFANTI: I rise to indicate that I will be supporting this amendment. The TGA website, under the definition of prescription medicines, states:

You need a doctor's prescription to buy prescription medicines from a pharmacist. Otherwise, only authorised health care professionals can supply them, such as in a hospital setting.

I think this statement alone should be evidence enough for every member in this house to support the Hon. Ms Scriven's amendments to this clause.

I would like to emphasise the term 'supply' in this passage. Authorised healthcare professionals can only supply, not prescribe, prescription medicines. This must be done by a medical practitioner for the safety and quality of health services in South Australia. What clause 5(1)(b) allows for is a health practitioner, other than a doctor, to be able to prescribe abortion medication without the need for safeguards and completely ignoring the TGA's very own definition and advice. So I think that this is a fundamental flaw in the proposed legislation that we can correct here today and I think that, if we do not, then we will be negligent in our duty as elected lawmakers.

Currently, pharmacists and nurse practitioners dispense a wide range of medications that have been prescribed by a doctor. Medications such as antibiotics, heart medications and other medications to treat various other medical conditions, but what they cannot do in any of these and a magnitude of other situations is prescribe these medications themselves. These medications are prescription medications and have serious side effects.

It is critical for the health of these women, particularly those in rural and regional areas, that these medications are given only once a medical practitioner has deemed it safe to do so and, essentially, has prescribed these medications. I believe it is also critical that these medications are given within 50 kilometres or half an hour to an hour's reach of a prescribed hospital in the case of an emergency, which can include a severe haemorrhage requiring an emergency blood transfusion or an incomplete abortion which has the potential to cause sepsis. Both of these situations can therefore lead to death if left untreated.

As the Hon. Ms Clare Scriven has pointed out, the Minister for Health and Wellbeing stated in his contributions in clause 1 that side effects to MS-2 Step are no different to a miscarriage. I respectfully disagree with this position. Miscarriage is an unforeseeable process, the same as a heart attack or any other serious acute life-threatening emergency.

In stark contrast, serious acute life-threatening side effects of any medical abortion are completely foreseeable. We all know the risks. In fact, the risks of side effects of medical abortions are 10 per cent higher than that of surgical abortions. Therefore, I think it is absolutely essential that this legislation provides framework about these standards if we are going to allow people who have not undergone a medical degree, not only to dispense but to be able to prescribe these early abortion medications.

The Hon. S.G. WADE: Just to put to bed the suggestion that under the current law only medical practitioners can prescribe medications, I would refer honourable members to the Controlled Substances Act 1984, section 18—Regulation of prescription drugs, which states:

A person must not prescribe a prescription drug (not being a drug of dependence) except as follows:

(a) a registered health practitioner may prescribe a prescription drug (not being a drug of dependence) for a person if he or she is acting in the ordinary course of the practitioner's profession and—

(i) the practitioner is a dentist, medical practitioner or nurse practitioner;

or

(ii) the practitioner's registration is endorsed under section 94 of the Health Practitioner Regulation National Law…or

(iii) the practitioner is authorised to prescribe the drug by the regulations;

It goes on. There is already a framework for health practitioners, other than medical practitioners, to prescribe drugs. I hasten to add that only medical practitioners can currently prescribe MS-2 Step medications and this legislation would not change that situation.

The Hon. C.M. SCRIVEN: Could the Hon. Mr Wade explain that final comment that medical practitioners currently are the only ones who can prescribe this medication and that that would not change under this legislation? Could he explain why that is the case?

The Hon. S.G. WADE: I hasten to add I was talking in the context of early medical termination of pregnancy. I am advised that only medical practitioners can prescribe MS-2 Step drugs for early medical termination.

The Hon. N.J. CENTOFANTI: Can the minister then tell the chamber who will be authorised to prescribe MS-2 Step in the event that this legislation does pass?

The Hon. S.G. WADE: I am advised that what this bill does is set up a framework so that if, in the future, the Therapeutic Goods Authority were to expand the scope of practice, we would have a mechanism to allow that to happen. In relation to a particular registered health profession, I respectfully suggest the most likely is nurse practitioners.

If the scope of practice of nurse practitioners were to be expanded, the TGA would provide clarity in terms of the expansion of the scope of practice, but also in South Australia the practitioner would need to be authorised to prescribe the drugs by regulation under the Controlled Substances Act section 18(1)(iii). In that context, this parliament would then have the opportunity to disallow those regulations.

If the TGA thinks it a good idea for nurse practitioners to be able to prescribe MS-2 Step medications this parliament, through regulations, would have an opportunity to express a view on that. I think that is a good, clinically-based framework for the well-considered expansion of the scope of practice with, also, oversight of the parliament through the regulations.

The Hon. N.J. CENTOFANTI: Is the minister saying that we are creating laws for situations that have not yet occurred?

The Hon. S.G. WADE: I am very keen that this legislation can have responsible futureproofing. We only deal with this legislation once every 50 years.

Ayes 9

Noes 12

Majority 3

AYES
Centofanti, N.J. Hood, D.G.E. Lee, J.S.
Lucas, R.I. Ngo, T.T. Pangallo, F.
Ridgway, D.W. Scriven, C.M. (teller) Stephens, T.J.
NOES
Bonaros, C. Bourke, E.S. Darley, J.A.
Franks, T.A. Hanson, J.E. Hunter, I.K.
Lensink, J.M.A. Maher, K.J. Parnell, M.C.
Pnevmatikos, I. Wade, S.G. (teller) Wortley, R.P.

Clause 6.

The Hon. N.J. CENTOFANTI: I move:

Amendment No 2 [Centofanti–1]—

Page 4, lines 24 to 27 [clause 6(1)(a) and (b)]—Delete paragraphs (a) and (b) and substitute:

(a) the medical practitioner considers that, in all the circumstances—

(i) the termination is necessary to save the life of the pregnant person or save another foetus; or

(ii) there is a case, or significant risk, of serious foetal anomalies associated with the pregnancy that are incompatible with survival after birth; and

(b) a second medical practitioner is consulted and that practitioner considers that, in all the circumstances—

(i) the termination is necessary to save the life of the pregnant person or save another foetus; or

(ii) there is a case, or significant risk, of serious foetal anomalies associated with the pregnancy that are incompatible with survival after birth; and

(c) the termination is performed at a prescribed hospital.

I spoke at length about my reasons for this second amendment in my second reading speech. This amendment seeks to narrow the circumstances in which a termination can occur after 22 weeks and six days to allow for situations where it is medically necessary, rather than the current wording of 'appropriate'. I seek to define the situations where it is medically necessary rather than leave the interpretation open to individuals, as in the case of the existing legislation with the term 'medically appropriate'.

The amendment allows for termination of a pregnancy after 22 weeks and six days after two medical practitioners have consulted and believe that in all the circumstances the terminations are necessary to save the life of a person, life of a foetus or in the case of serious foetal anomalies that are incompatible with life.

As I mentioned in my speech, I understand that there are some heartbreaking situations that can occur when exceptional medical circumstances mean a child may pass away in the womb or soon after birth because of a severe, often genetic, anomaly, or another circumstance where the mother may discover she has a certain type of cancer and must undergo chemotherapy at, say, week 23 of a pregnancy to save her own life, or in the situation of twins, where the health of one twin may significantly impact that of another. In these circumstances, I believe that termination of a pregnancy needs to be considered and an option.

As the Treasurer pointed out in his second reading speech, different doctors have the potential to interpret the legislation in different ways. Whilst this number may be small, I do think we need to be quite specific with this legislation to ensure we do not share the same regrets that the late Hon. Mr Millhouse did when he said the doctors and lawyers interpreted the legislation too widely. I think these specific situations I have outlined speak for themselves.

The Hon. I. PNEVMATIKOS: This amendment implies that you have no trust in the medical practitioners, their codes of conduct, codes of ethics and the general governance of medical practitioners. So can you be certain that with the amendment you propose you have set out provisions for the best possible health care to be available to all women seeking an abortion? And further, what makes you more qualified than medical practitioners to dictate when an abortion is or is not appropriate?

The CHAIR: I will just remind the Hon. Ms Pnevmatikos that she should refer through the Chair, but I will give the Hon. Dr Centofanti a chance to respond.

The Hon. N.J. CENTOFANTI: I thank the honourable member for her question. As members are aware, this is a conscience vote, and consequently these amendments are my contribution to the debate and an indication as to where I feel the line should be drawn regarding legislation on late-term abortions. Other members are entitled to their opinions. I also feel that we do need to allow for situations when it may be required, but we also need to protect the situations where it is not required.

The Hon. I. PNEVMATIKOS: Whilst I appreciate it is a conscience vote, it does not mean that we should be making legislation on the basis of whim. There should be some scientific basis for why we are making the legislation that we are making, because we are relying on health issues. There are no credible resources that support the amendments that you propose. It runs contrary to the recommendations provided by SALRI. So I am asking you, through the Chair, which specific groups or people did you consult to reach this amendment?

The Hon. N.J. CENTOFANTI: I thank the honourable member for her question. I would suggest that my amendments are based on science and medicine. I have outlined the situations where it is medically necessary, in a number of situations, for health practitioners and women and mothers to have the option of an abortion.

As I stated earlier, in putting my amendment forward, what I am doing is seeking to narrow the circumstances in which a termination can occur post 22 weeks and six days, to allow for situations when it is medically necessary, and defining the situations when it is medically necessary rather than leaving the interpretation open.

The Hon. C. BONAROS: I have a question for the mover. The SALRI report refers to the fact that abortions occurring later in gestation are especially likely to involve complex medical circumstances, including serious or fatal foetal abnormalities—including where a prognosis is uncertain or the foetus is one of a multiple pregnancy, as I think the member referred to—or complex personal circumstances, including late recognition of pregnancy, delayed access to services, social and geographic isolation, domestic or family violence, socio-economic disadvantage or even mental health issues.

One of the factors that often results in a late-term abortion is rape. The example given to illustrate this is a case involving a minor with an intellectual disability who became pregnant as a result of sexual abuse by a family member. Given her intellectual disability, she was unable to appreciate or understand her pregnancy until she was at a late gestational stage. When her situation became known, the girl was clear that she did not wish to proceed with her pregnancy and a late-term abortion was carried out. The severe and adverse effects on her had she continued with the pregnancy were noted as the reasons for this.

My question to the mover is: does she consider this medically necessary or medically appropriate, and does she also accept that, in this instance, a young person with a mental disability—who is not able to comprehend the nature of the condition that she finds herself in and is not able to understand that, at a very late stage, she is actually carrying a foetus—would potentially not have access to an abortion, to her detriment?

The Hon. N.J. CENTOFANTI: I thank the honourable member for her question. In that situation, I would be asking: where was the support for this young girl and why did she get into this situation?

The Hon. C. Bonaros: It is irrelevant.

The Hon. N.J. CENTOFANTI: Well, I do not think it is irrelevant.

The Hon. C. Bonaros: Are you going to force her, make her have it, give birth?

The CHAIR: Order!

The Hon. N.J. CENTOFANTI: I do not believe it is irrelevant.

The CHAIR: Order! There is an honourable member on her feet.

The Hon. N.J. CENTOFANTI: I think it comes to the real point of the matter. I think we really need to look at the support structure around these situations. I would also argue to the member that my amendment potentially allows for this situation. If the medical practitioner considers in good faith that, in all the circumstances, a termination is required to save a woman's life, then he or she is acting within the scope of the legislation.

The CHAIR: I know the Hon. Mr Wade was going to make a contribution. I will let the Hon. Ms Bonaros respond to that, then I will come to the Hon. Mr Wade and the Hon. Ms Scriven.

The Hon. C. BONAROS: I would like to know if the member is honestly asking us to accept that a failure of the support systems around a young person with a disability who has been raped by a family member and cannot understand the consequences of that—something that the SALRI report said was far from uncommon in practice—would be a reason to say that that young person should have to go through that pregnancy, knowing the implications that will have.

The Hon. N.J. CENTOFANTI: I refer the member to my earlier answer, in that I said I believe that my amendment actually allows for that situation.

The Hon. C. BONAROS: Sorry, I would like to know which part of the termination that is necessary to save the life of the pregnant person or save another foetus does what you are saying it will do.

The Hon. N.J. CENTOFANTI: If the medical practitioner considers in good faith that this young person's—

The Hon. C. Bonaros: Life is at risk.

The Hon. N.J. CENTOFANTI: —life is at risk—

The Hon. C. Bonaros: And what if their life is not at risk? What if it is just going to damage—

The CHAIR: We are not having a conversation here.

The Hon. N.J. CENTOFANTI: I refer the member to my original answer.

The Hon. C. BONAROS: My question is: are we talking about a situation where her life is at risk because of the pregnancy and, irrespective of whether the life is at risk because of the pregnancy, is the member actually suggesting that if a young person were to take their life as a result that her amendment goes far enough to deal with those instances? Which one is your amendment aimed at?

The Hon. N.J. CENTOFANTI: I refer the member to my original answer.

The CHAIR: I am going to go to the Hon. Mr Wade now.

The Hon. C. BONAROS: Well, Chair, I have questions about the amendment.

The CHAIR: You have had several questions. I will come back to you. I am going to go to the Hon. Mr Wade.

The Hon. S.G. WADE: The amendments proposed are directly contrary to the SALRI report, which expressly recommended that there should be no specified criteria for when a later term termination may be performed. The issue of gestational limits and specified criteria for later term abortions was considered at length by SALRI. While SALRI acknowledge there were divergent views on the role and value of specified criteria, it ultimately found that there is no merit in specifying criteria as to when abortion should be permitted. Notably, SALRI stated:

Any such criteria will undermine the crucial autonomy of the woman. It has the inevitable effect of transferring the decision-making from the patient to the medical practitioner, a role that many medical practitioners told SALRI in consultation that they neither welcomed nor felt equipped to undertake.

Of specific concern are the proposed amendments which would limit the availability of later term abortion in circumstances concerning serious foetal anomalies. In particular, it is unclear what would constitute a serious foetal anomaly which is, to quote the amendment, 'incompatible with survival after birth'.

For example, this may be obvious in the case of a fatal condition of a foetus, which means that regardless of the level of medical treatment administered it is inevitable that the child would degenerate and pass away soon after its birth; however, the application of this test becomes less clear in circumstances where, although the foetus has a serious congenital condition which will result in extremely low quality of life, their condition may not necessarily be incompatible with survival after birth. As such, adopting the proposed amendments in these extremely difficult circumstances would only serve to have the effect of removing the choice for parents to make the best decision for the child and their family.

The time frame for what constitutes survival after birth is also ambiguous. For example, it is unclear whether this means simply a matter of hours or it could mean days or even months. It is also worth noting that the proposed amendments would create a more restrictive model for later term abortions than the current law, which presently allows for terminations to be carried out up to 28 weeks where two medical practitioners consider the termination is immediately necessary to save the life or to prevent grave injury to the physical or mental health of the pregnant woman.

As asserted by SALRI, it is unhelpful and arbitrary to draw a line about which later term abortions are justifiable and those that are not. The evidence from SALRI is that the decision to terminate a pregnancy, whether early on or at a later stage, is always difficult. The bill recognises this reality and seeks to achieve an appropriate balance by creating a model for later term abortions which is based on what is medically appropriate in all the circumstances for all the parties involved. I will therefore be opposing the amendment.

The Hon. C.M. SCRIVEN: I will be supporting this amendment. Something that has not been mentioned so far in the consideration of this amendment is that the 22 weeks and six days is what is considered viability, so when a baby can be delivered and have a reasonable chance of survival.

Obviously, the later it goes past that 22 weeks and six days the greater the chance of the baby being born without significant disability, and the less medical intervention that would be required. Essentially, this amendment is saying that, up to the time a baby could be born and have a good chance of survival, the abortion will simply be for any reason really, given the emphasis on the autonomy of the woman, but after that time it is different. After that time, many people will acknowledge that a child that can live independently of its mother has some rights.

After that time, if the amendment was to pass, it would only be for very serious situations that involve saving the life of the pregnant person, to save the other foetus or in terms of serious foetal abnormalities that are incompatible with survival after birth. That is the difference, and that is why it should be different, because after that time the baby has a chance of living independently of the mother. So in that tragic situation the Hon. Ms Bonaros mentioned, that baby could have been delivered and cared for by someone other than the biological mother, and been given the best chance to survive.

It may be that if the child was delivered very early it would not have survived, so that would be the same outcome as an abortion. We need to remember that, regardless of whether it is done through delivery or abortion, either way the baby needs to be delivered in some way. I do not particularly want to go into the detail of how some late-term abortions are done because it is very graphic and very difficult to hear. I know that some people feel that, if it is going to be done, we should hear about it. I am not intending to go into that in my contribution tonight, but either way the baby has to be removed in some way. Why can the baby not be removed alive and be given the best chance of survival?

In the very sad circumstance the Hon. Ms Bonaros mentioned, that baby could be offered for adoption, which we know is not a perfect solution, but from that baby's perspective I think it is likely to be a better one, in that the baby's life would not have been ended. In terms of the actions in relation to the Hon. Dr Centofanti's comments about the support, this comes back to comments I made in my second reading speech. When a woman has difficult circumstances, the answer is not to say that your only choice is to end the life of the child you are carrying in the womb, especially when that life is capable of surviving outside the womb. That is not dealing with the complex and difficult circumstances a women is facing.

That is where we need to be rethinking our approach, that somehow abortion is solving problems; often abortion is ignoring the problems and not coming up with a solution. As I said in my second reading speech, the very fact that women are offered abortion supposedly as the solution gives excuses to our society not to provide real, ongoing solutions. I have some other contributions on this clause, but I wanted to place those comments on the record.

The Hon. C. BONAROS: I want to go back to the same point I was making earlier, and that is that on the plain reading of this amendment I could say 'any lawyer in this room', but I think it is clear to any person capable of interpreting legislation in this room that the intent of the amendment being proposed by the mover clearly means that the saving of the person's life is intrinsically linked to the pregnancy itself.

The suggestion I have made that this amendment could somehow be used in the case of the risk of somebody taking their own life, as opposed to being at risk of losing their life as a result of the pregnancy, of carrying the foetus, is one that warrants an explanation by the member. If the member does not know the answer, I suggest she make that clear, but I am disturbed that we would place information like that on the record when, clearly, on reading this amendment, there is no way that the scenario that I have outlined would be covered under the interpretation given to us by the member.

The Hon. N.J. CENTOFANTI: I thank the honourable member for her question. We have had lots of commentary tonight about being able to trust the health professionals. I again go back to the amendment, which states:

(a) the medical practitioner considers that, in all the circumstances—

(i) the termination is necessary to save the life of the pregnant person or save another foetus; or

(ii) there is a case, or significant risk, of serious foetal anomalies associated with the pregnancy that are incompatible with survival after birth…

The Hon. C. BONAROS: Given the case that I am putting to you, it is fine to say that perhaps we have made a mistake, but there is a big difference between this being a case of medically necessary or medically appropriate. It is very clear that this would not fall within the category that you have suggested it would fall. In the instance that I have outlined, this young woman would not fall within the grasp of this amendment.

The Hon. I. PNEVMATIKOS: I will not be supporting this amendment. I oppose this amendment. In essence, it is a life or death amendment that narrows the options and the choices available and ignores the complexities that can occur and the various permutations that can occur that are not necessarily life or death. The example the Hon. Connie Bonaros gave of the disabled girl who was the victim of incest and rape would not fit within this category of this amendment. It is far too narrow and restrictive as it reads. It is life or death; no other option.

The Hon. D.G.E. HOOD: I will be supporting the amendment, and there is a number of reasons why. I cannot speak for the Hon. Dr Centofanti, but I imagine the reason that she has landed on 22 weeks and six days is because that is what it actually says in the bill. That is one of the markers, if you like, that is set in the bill as a marker of determining a period in the bill where it says one doctor is required to approve the abortion and after that two doctors are required. I think that is not an unreasonable thing to do. I cannot speak for the Hon. Dr Centofanti, but it seems to me that she has chosen to lower the bar, if you like, which I am inclined to support.

Another thing is that the Hon. Ms Scriven said—and I think the obvious point is—that that is generally considered to be the age of viability. There is some debate on that, but I think that is broadly accepted as the age of viability, and I presume that is why the Attorney used that particular marker, if you like, as that stage of gestation in the bill when she was originally drafting the bill. I understand that she consulted widely and that was the medical advice given to her. I can only accept that.

There are going to be circumstances that are incredibly difficult when you are dealing with a matter like abortion, and I have empathy. I presume that is a real case or is it hypothetical?

The Hon. C. Bonaros: No, it is a real case. It is one of a number of real cases.

The Hon. D.G.E. HOOD: A real case that the Hon. Ms Bonaros has outlined. There will be some, and it is terribly unfortunate, but ultimately it comes down to a philosophical decision of what is the right thing to do in those circumstances? That is what we all need to grapple with. In my view, I think there needs to be an upper gestational limit on abortion in almost all circumstances, because I think that is just simply appropriate to put it there. There will be members with different views and that is fine. That is my view and that is why I am supporting the amendment.

The Hon. F. PANGALLO: I will be supporting the measure. I believe it is a sensible amendment. I was not going to speak too much on this bill, but I want to give another real-life scenario example, following what my colleague raised. In the 1980s, I met a wonderful person called Sue McKenzie. She was a young adult living in Murray Bridge. She had a very severe arthritic condition, and that condition meant that she was never going to grow beyond the size of a toddler. Apart from that, her features were quite normal.

Sue fell pregnant to a male who was around six feet tall. Her doctors told Ms McKenzie that to carry the child to full gestation would kill her, and there was enormous pressure from the family as well to have a termination. Sue resisted that pressure, she put her life at risk, and she carried the child and gave birth to a beautiful daughter who would be in her mid-30s today. Sue became known as Australia's tiniest miracle mum. Had she taken the doctor's advice she would not be blessed with the child that she has today—a child that has brightened her life—so I fully support the amendment by the Hon. Nicola Centofanti.

The CHAIR: I will call the Hon. Ms Pnevmatikos and the Hon. Ms Scriven because they have both indicated they want to speak, then I am going to move to determine this amendment.

The Hon. I. PNEVMATIKOS: Through the Chair, the example that the Hon. Mr Pangallo has given us is not on point; it has nothing to do with the issues we are discussing. At the end of the day, whether a woman chooses to have an abortion or not is a choice that she makes. That is her decision. Good on this woman for deciding to continue with her pregnancy. That should not apply to all circumstances, and that should not dictate how we deal with all circumstances.

In another instance, another woman may have made a different decision. All we are talking about is the right for a woman to be able to choose based on the medical advice that she receives and based on her assessment, and the doctor's assessment, in terms of the circumstances and complexities of the case—no issue.

The Hon. C.M. SCRIVEN: I think the Hon. Mr Pangallo has raised a very valid point. The pressure that is applied to women who are pregnant, where there is a diagnosis of disability of the baby, is considerable. I have experienced it in my close family, as I have alluded to in my second reading contribution. A couple of weeks ago, some people were invited here to speak to members, including a woman whose son was diagnosed as having Dandy-Walker Syndrome. She was told that he would not survive and, instead, he is now a very healthy, bright and fun six year old.

Here I think, I am sure in the majority of cases, it is with the best of intentions when medical professionals try to point out the difficulties that people might face with a child with a disability, but it often goes beyond that, and there are many people who can attest to that. I talked about my relative, where a medical practitioner called unannounced at her home because she was refusing to have an abortion because her second child had been diagnosed as having spina bifida. And that child is now 19 years old and living a full and wholesome life, with some medical issues, but not major ones. So the issue of pressure from the medical profession is real.

Secondly, the problem with some of the argument that is coming is the suggestion that, in the tragic case that the Hon. Ms Bonaros read in the SALRI report, the abortion solves the problem. In that case, the delivery of the baby could have solved the problem equally well. I asked a woman some years ago, in terms of the obviously terribly difficult circumstance of rape, 'Why don't you support abortion in the case of rape?' Incidentally, she had worked at an abortion clinic for I think about 22 years and then had come to see that this actually was not helping women in the way that she had originally signed up to do. She said, 'Well, instead of one terrible scar the woman has two terrible scars.'

However, to come back to this amendment, various people have put forward that there are very few late-term abortions in South Australia, but I think clearly that is because they are currently illegal. If we are talking about very late abortions, after 28 weeks they are illegal, so of course the number of late-term abortions is going to be very low in South Australia at the moment. In many submissions and in many conversations, the view has been put forward that late-term abortions are generally done only for major complications such as severe foetal abnormality.

However, this is not borne out by the evidence from Victoria, which has had legislation somewhat similar to what is being proposed here. Victorian perinatal morbidity and mortality statistics report all births whether live, stillbirth or by termination after 20 weeks gestation. I seek leave to table a table that sets out the number of late-term abortions in Victoria from 2000 to 2017, and it separates those abortions done for psychosocial indicators—

The CHAIR: Honourable member, are you seeking leave to table?

The Hon. C.M. SCRIVEN: I seek leave to table this table.

Leave granted.

The CHAIR: I will ask you to bring this to a conclusion. I think it is time. We have canvassed these issues very well on this clause and at other stages so I ask you to—

The Hon. C.M. SCRIVEN: I shall be concise, thank you, Mr Chairman. The table reports those abortions done for psychosocial indications and those done for congenital abnormality. I will point out that there were some years where the abortions done for psychosocial indications were greater than the number done for congenital abnormality—those years being 2005, 2006, 2008, 2009, 2010. One of those abortions for psychosocial reasons was carried out at 37 weeks of pregnancy, so that is just three weeks before the due date.

This is not to suggest that psychosocial reasons mean frivolous reasons. I have heard allegations of that suggestion, but I have not heard anyone actually make the suggestion that late-term abortions are done for frivolous reasons. They are likely to be very difficult circumstances, but I reiterate again: when a woman has difficult circumstances, the answer is not to say, 'Your only choice is to end the life of the child you are carrying.' The answer is to give that woman support to potentially deliver the baby early, if she cannot for whatever reason or does not want to carry to term, because when we are looking at this amendment we are talking about the lives of babies who can live independently of the mother.

The Hon. C. Bonaros: Where's the choice in that?

The Hon. C.M. SCRIVEN: The choice is to no longer be pregnant.

The Hon. C. Bonaros interjecting:

The Hon. C.M. SCRIVEN: Can I have some order?

The CHAIR: We are not having a conversation across the chamber. I have asked the honourable member to conclude and I would like her to do so very soon.

The Hon. C.M. SCRIVEN: The choice is to be no longer pregnant, so if a woman has an abortion she is no longer pregnant; if a woman delivers the baby, she is no longer pregnant. There is an option.

The Hon. C. Bonaros: That is so cruel and callous.

The CHAIR: Order!

The Hon. C.M. SCRIVEN: The interjection to say that that is cruel while suggesting that a baby who could be delivered alive and stay alive to have their life ended is anything other than that, I think represents a view which is not in keeping with much of the community. Much of the community is appalled at the idea of late-term abortions where the baby could be delivered alive and cared for.

The committee divided on the amendment:

Ayes 9

Noes 12

Majority 3

AYES
Centofanti, N.J. (teller) Hood, D.G.E. Lee, J.S.
Lucas, R.I. Ngo, T.T. Pangallo, F.
Ridgway, D.W. Scriven, C.M. Stephens, T.J.
NOES
Bonaros, C. Bourke, E.S. Darley, J.A.
Franks, T.A. Hanson, J.E. Hunter, I.K.
Lensink, J.M.A. Maher, K.J. Parnell, M.C.
Pnevmatikos, I. Wade, S.G. (teller) Wortley, R.P.

Amendment thus negatived.

The PRESIDENT: We remain on clause 6. We move to amendment No. 3 [Centofanti-1]. I call the Hon. Dr Centofanti.

The Hon. N.J. CENTOFANTI: This amendment is consequential, so I will no longer be moving it.

The PRESIDENT: Thank you. And you have another, amendment No. 4 [Centofanti-1] on clause 6?

The Hon. N.J. CENTOFANTI: Again consequential. I will no longer be moving that amendment.

Clause passed.

Clause 7 passed.

Clause 8.

The Hon. C.M. SCRIVEN: I move:

Amendment No 1 [Scriven–2]—

Page 5, lines 8 to 29 [clause 8(1) to (3)]—Delete subclauses (1) to (3) and substitute:

(1) Subject to subsection (2), no person is under a duty, whether by contract or by any statutory or other legal requirement, to—

(a) perform a termination on a person; or

(b) assist in the performance of a termination on a person; or

(c) provide advice to a person about the performance of a termination,

if the person has a conscientious objection to doing so, but in any legal proceedings the burden of proof of conscientious objection rests on the person claiming to rely on it.

(2) Nothing in subsection (1) affects any duty to participate in treatment which is necessary to save the life, or to prevent grave injury to the physical or mental health, of a pregnant woman.

Clause 8 refers to conscientious objection. I will not be supporting this clause because it in fact does not protect doctors who have a conscientious objection to abortion. Some doctors who have contacted me have said that in the bill presently before the parliament the Attorney-General is trying to persuade the parliament to run roughshod over the conscientious objection of health professionals to play any part in the direct and intended taking of an innocent human life, in this case the child while still in the womb.

The amendment restores the existing provisions in the existing act to a large extent. Obviously, there need to be some minor changes, but essentially it restores the existing provisions in regard to conscientious objection. The bill that is before us does not give doctors the right to a conscientious objection because it says that they must refer to another health practitioner who provides abortion—I am paraphrasing, obviously—or they must provide information about how the person can access an abortion.

I will point out a number of things. First of all, referral is not needed for abortion. In the frequently asked questions that were distributed from the Attorney-General's office this week, it states at question 13 that there is no referral required from a GP to access public services, and women can self refer. So first of all, there is no need for referral. A doctor who has a conscientious objection to abortion has a conscientious objection to doing anything that enables abortion. It is absolutely outrageous that they would be asked to act against their conscience and be threatened with the loss of their registration because they cannot be involved in providing information about an abortion.

I draw members' attention to the situation of Dr Hobart in Victoria. Dr Hobart exercised good clinical judgement in refusing to refer for a sex selective abortion of a healthy 19-week baby girl and, under the Abortion Reform Act 2008 in Victoria, was threatened with deregistration. We also know of another doctor—I know him personally—who moved from Victoria to South Australia to avoid the conflict between his conscience and the pressure to comply with an unjust law. This doctor, who wrote to me, has appealed for the restoration of the current status quo.

In the SALRI report, it said that the bill, as we see it before us, or roughly the wording, supposedly provides a balance between the conscientious objection of doctors and the autonomy of the woman or what is called the right to have access to these services. It does not provide that balance. It requires the doctor to provide information about how abortions can be accessed. In other forms of law we recognise the concept of being an accessory to an act. If there was an armed robbery, for example, and someone was driving the getaway car, that driver is not exempt from culpability.

We accept that in other areas of the law and yet in this we are saying, 'No, even though you think this is the taking of a life, we are going to force you to provide information about someone else who will take that life.' That is not providing conscientious objection. This will also potentially have a perverse impact on rural and regional areas. If, because of their location, a GP is the only doctor in the region who would be able to provide an abortion service, it may be that they are required to provide information or even potentially, under various interpretations of the current proposed bill, participate in some other way.

What that means in reality is that some doctors will be deterred from taking up roles in regional areas. Indeed, those who are already there and have a conscientious objection to abortion may well feel that they would be better protected if they were in a metropolitan area. Those doctors who do not want to be placed in that position will not deliberately seek out a position in a regional location when that problem is exacerbated. I think it is an important point for members to appreciate that we actually have difficulty getting medical professionals to go into regional areas.

I saw on social media a reaction by someone of 'good' to the idea that health professionals who do not want to be involved in abortion would not be in country areas. I suggest that that reaction really misunderstands the reality of the health workforce in regional areas. There are shortages of staff in many areas. Some areas do not have a permanent GP within a 100-kilometre radius.

If those who are currently there feel obliged to move to the city so that they are not forced to participate in abortions, either directly or indirectly, the result will be no permanent medical practitioners at all in some of those rural areas. So local people will not only be unable to get access to abortions but they will not be able to access other medical services either, because we will be deterring practitioners from being in those areas.

It would actually be a perverse outcome that results in fewer services for regional people, not more services. I will give a short quote from an obstetrician gynaecologist association publication, which states that they recognise that:

…an obstetrician/gynaecologist is called to care for two patients. His or her Hippocratic obligation requires that he/she treat each of his/her patients with beneficence and respect. He/she must maximise the good for each patient he cares for, and avoid intentionally inflicting harm.

So to arrange in any way for the life of one of their patients to be taken is certainly to be intentionally inflicting harm, and that is why a doctor with a conscientious objection could not in good conscience do so.

I noticed that the Hon. Mr Wade mentioned in his clause 1 contribution that this basically would not happen. The case in Victoria of Dr Hobart was that he refused a sex selection abortion in good conscience. He did not think it was clinically necessary; it was a sex selection abortion for no reason other than a social reason, and he refused that. He was taken to the registration board and threatened with deregistration because of that.

So it does happen, and it will happen if this current proposed bill progresses with the current wording, and that will be an absolute infringement on the rights of health practitioners, and medical practitioners in particular, to not participate in abortion and not be involved in any way. It is a severe dilution of the current provisions, and that is why my amendment restores those current provisions to their greatest extent.

The Hon. S.G. WADE: This amendment is directly contrary to the intention of the bill on the recommendations of SALRI in relation to the issue of conscientious objection. The question of whether a health practitioner who holds a conscientious objection to abortion should be required to refer a patient to another practitioner who does not hold a conscientious objection was discussed at length by SALRI.

SALRI heard that a number of medical practitioners viewed the referral procedure as inherently contradictory to health practitioners' underlying principles of preserving life and reducing harm. It suggested that compelling a health practitioner to refer a patient in respect of a potential termination undermines freedom of conscience and is tantamount to making the practitioner complicit in the process. On this point, SALRI had regard to the views of the Queensland Law Reform Commission, which observed that:

A referral does not necessarily mean that a termination will take place but enables a woman to access a practitioner who can offer her a range of options, including termination.

Many parties also wrote to SALRI about the compounded effects of conscientious objection in rural and remote areas. It was noted by many that, even though a referral may be provided in these circumstances, women in these areas may be especially disadvantaged in obtaining timely access, where the nearest next available practitioner may be located some 300 kilometres away.

The conscientious objection provisions in the bill have been carefully drafted in close consultation with the Australian Medical Association to ensure that they strike an appropriate balance between a health practitioner's right to freedom of conscience and a woman's right to seek a termination of pregnancy in a safe and timely manner.

Further, it is notable that, while all jurisdictions reserve the right of conscientious objection, they also all require health practitioners with a conscientious objection to refer the patient to another practitioner who does not hold a conscientious objection to abortion or to provide the patient with sufficient information about alternative service providers to enable them to seek further information.

I just want to reassure the committee that this is hardly onerous. I have been provided, for example, with the referral form that is offered by New South Wales Health. It is a simple one-page information sheet, which—ironically—uses a QR code to link women seeking termination services to the pregnancy options webpage at New South Wales Health.

I have the utmost respect for people who conscientiously object to providing termination pregnancy services and want to rely on conscientious objection, but we expect every health practitioner to act professionally, and in a situation where they are not able to provide services within their own moral framework, they should offer other people respect for their moral frameworks and make appropriate referrals. The current provisions in this bill are in line with the position of other jurisdictions, and the proposed amendment would put South Australia behind every other jurisdiction in this regard and should not be supported.

The Hon. D.G.E. HOOD: I have had a good look at this amendment for some time now. This particular amendment has only come out today—I think it was today, or yesterday—but I have been aware that it was coming for a little while, so I have been having a good think about this issue. In doing so, I consulted with some medical practitioner acquaintances—not friends, but acquaintances I have had for a number of years.

I was moderately comfortable with the provisions in the bill—I would not say 100 per cent comfortable, but moderately comfortable—but I was concerned when I consulted some of these acquaintances, half a dozen in total. Two of them said to me point-blank that they simply would not be prepared to operate under what the bill requires of them. When I pushed them on that and said, 'If push came to shove and you were in a situation where it meant no longer practising, what would you do?' Both of them independently, in separate meetings, said to me that they would simply walk away.

You are talking about two high-quality, I presume, qualified medical professionals who have just decided that they will not operate under those circumstances. I think that should give all of us some concern. These are very decent people, as far as I am aware. I do not know them well, but I know them well enough, and certainly I know that they have been practising for a long period of time, as far as I am aware, without any significant problems. It seems to me that they are exactly the sort of people we want in our health system, not out of it.

My understanding of the Hon. Ms Scriven's amendment is that it essentially brings the law to how it stands. Is that a reasonable summary? That is how it was explained to me; somewhat similar to how it stands. For that reason, I am inclined to support the amendment. One of these individuals said to me, 'I simply won't do it,' and that was probably what pushed me over the edge. I will be supporting the amendment.

The Hon. N.J. CENTOFANTI: I rise to also speak in support of the Hon. Ms Scriven's amendment. The current laws protect the rights of persons, including doctors and nurses, to conscientiously object to playing any part in the performance of an abortion. The bill before us risks potentially requiring medical practitioners to be complicit in the performance of an abortion despite their conscientious objection. I believe the Hon. Ms Scriven's amendment seeks to reinstate the protections for nurses and doctors as they stand in the current law.

I note in this debate the interest of improving services available to those in regional areas. Under the proposed bill, doctors with a conscientious objection to abortion may actually be deterred from working in our regions in South Australia. I believe this amendment removes this likelihood and also the potential that doctors may face coercion to perform abortions in regional areas despite their conscientious objection, and so I will be supporting this amendment.

The Hon. S.G. WADE: I would make the simple point to reiterate what I said in my earlier contribution. All other states and territories have this responsibility to provide options to the client, and I am not aware of mass exoduses of medical practitioners from the profession.

The other point to be made is that the Australian Medical Association has been intimately involved with the Attorney-General. I remember in our discussions in relation to this bill, I was aware of the AMA and the Attorney-General having ongoing discussions to resolve this issue. If the peak medical body believes that we have struck the balance right, I would urge honourable members to support the bill but not to support the amendment.

The Hon. C.M. SCRIVEN: First of all, I have a question for the Hon. Mr Wade. Is he aware of whether the AMA surveyed all its members about this or indeed any aspect of the bill?

The Hon. S.G. WADE: The Australian Medical Association has well-established position statements, both at the national and the state level. My understanding is that the South Australian branch was acting in consistency with that framework.

The Hon. C.M. SCRIVEN: I think we can gather from that that the answer is no. They did not survey all of their members, to the honourable member's knowledge. I am aware of many doctors who are most upset with the AMA for this reason among others because it does not provide that appropriate balance.

The Hon. Mr Wade has given an example of what is in New South Wales. It may well be that doctors will still have a concern with that because it is still being complicit. Remember women do not have to have a referral, so it would still potentially be complicit. Also, I point out that we do not know whether that is the kind of information that will be required under clause 8(2) which provides that a registered health practitioner will be taken to have complied with an obligation if the practitioner gives the person information in the prescribed form. But we do not have that prescribed form because that will be set by the regulations.

The Hon. S.G. Wade: Which you can disallow.

The Hon. C.M. SCRIVEN: The minister says which we can disallow. I think he is being a little disingenuous there. He knows how difficult it is to do that with regulations when it is separated from the context of a major bill and consideration of such a major issue such as this. I acknowledge the contribution of the Hon. Mr Hood and the doctors he has spoken to who have said that they would simply stop practising. I have mentioned a doctor I know who moved from Victoria to South Australia, specifically because of this.

I am sure there are people in this chamber or elsewhere who do not think that doctors should be able to exercise conscientious objection at all and there are others who think they should and they do think this is an appropriate balance. I will point out, to use an analogy, what this does. You can have the analogy of someone coming to me and saying that they wanted to have a gun and kill someone and where could they get the gun and someone who was willing to kill. If they came to me and asked would I kill someone for them, I would say, 'No, I will not do that but I know someone else who will and here is their number or here is where you can contact them.' That is the similarity for a doctor who has a conscientious objection about ending the life of one of their—

The Hon. C. BONAROS: A point of order, Chair.

The CHAIR: The Hon. Ms Scriven will resume her seat. A point of order.

The Hon. C. BONAROS: I think it is highly inflammable and—

The Hon. J.M.A. Lensink: Inflammatory.

The Hon. C. BONAROS: Inflammatory—that's what I want; I am flustered—and inflammable, if we throw a bit more gas on it, that the member would be suggesting that what we are talking about is the same as giving somebody a gun and offering for them to kill somebody. It is offensive at the most basic level and completely and utterly false.

The CHAIR: We will not be debating it.

The Hon. C. BONAROS: Well, I am saying it is wrong and the member should withdraw her comments.

The CHAIR: The honourable member can resume her seat, as she has. There is no point of order. But the hour is late. I would suggest that there are some comments that are not going to help the debate and I would ask the honourable member to draw her remarks to a conclusion.

The Hon. C.M. SCRIVEN: Thank you; I am happy to do that, Chair. However, I will respond to the—

The Hon. C. Bonaros: Don't bother, please. You have said enough.

The Hon. C.M. SCRIVEN: Excuse me?

The CHAIR: Order! The Hon. Ms Bonaros has had her say. It is a point of order. I have ruled on that. I have asked the honourable member to draw her remarks to a conclusion, and I am sure she will do so.

The Hon. C.M. SCRIVEN: Thank you, Chair. To suggest that an analogy is somehow offensive is quite a remarkable statement to make.

The Hon. C. Bonaros interjecting:

The Hon. C.M. SCRIVEN: Can we have some order, please?

The CHAIR: Order! We are not going to have a conversation here. I have asked you to conclude your remarks.

The Hon. C.M. SCRIVEN: Thank you, Chair; I will if I get the opportunity to do so. When a doctor has two patients, a pregnant woman and a baby, and the life of one of those patients is ended, I think it would be clear why there is a similar analogy.

If a doctor says, 'I will not end the life of that baby but I will lead you to someone who will,' then that doctor, understandably, feels they are complicit in that act. Whether that is providing information, whether it is directly referring, whether it is so-called transfer of care, all those things are leading to the potential death of that second patient.

The quote the Hon. Mr Wade gave, saying that a referral or whatever does not guarantee the termination will take place, is not really relevant in the sense that you are giving information of where that second life can be ended. Therefore, the provision in the bill does not give the protection of conscientious objection to doctors. Hence, anyone who seriously does support conscientious objection—

The CHAIR: I have asked the honourable member to conclude.

The Hon. C.M. SCRIVEN: —I ask them to support this amendment.

The Hon. T.A. FRANKS: I strongly support the clause as is, and I thank the AMA of South Australia for the particular conversations they have had with me on this particular matter of conscientious objection. Members have noted that there are a range of views about conscientious objection, and I think this strikes a nice balance and is supported, in that case, by the AMA in consultation, both with the participation and the recommendations of SALRI and, of course, the Attorney-General, as the Minister for Health and Wellbeing has touched on.

I note that this bill removes the criminality of abortion and treats it as a healthcare issue, so analogies around being an accessory to a robbery and a getaway car, or getting a gun to kill someone, are analogies that refer to abortion as a crime. Myself, I do not believe abortion is a crime: I believe it is health care, and I will treat it as such.

I certainly also do not want to see doctors who say that they will leave their profession, having had years of medical training, having committed themselves to that vocation, because of this, for having to pass on a piece of information to their patient, that they will quit that vocation, rewarded for that stance. I believe that it is, in fact, the duty of our medical professionals to ensure that people have informed consent and have information.

When you go to a doctor you are often seeking their assistance, and that assistance should include the full range of information. Should they not be providing you with that full range of information, they should have to make that known to you. We know there are doctors who refuse to tell their patients about the full range of options, and in fact they are the people we see having to have abortions in later stages of that pregnancy because they have not been given the medical assistance early on that they should have been given by those medical professionals.

We saw from the SALRI report that it does not stop just with the termination of that pregnancy. It also continues when that girl or that woman returns home—perhaps to Kangaroo Island, to name one of the examples covered in the SALRI report—and is refused after-care when things go wrong because they are continuing to judge that girl or woman for her choice to have had an abortion. She is left on that small island without access to health care that is her human right, and which should be afforded to her in full dignity.

If doctors are going to quit their jobs over having to pass on a piece of information to give that patient the full range of options then I say good on them—they should quit that profession because they are not worthy of the name of doctor.

The CHAIR: The Hon. Mr Wade, and then I am going to get very close to putting this amendment.

The Hon. S.G. WADE: I rise to vigorously refute what I regard as the unbalanced presentation of conscientious objection put forward by the Hon. Clare Scriven and in particular her attempt to denigrate the Australian Medical Association SA branch in their working with the Attorney-General to develop this clause. I believe in doing so they have acted completely within the policy and ethical framework of the Australian Medical Association nationally, and to that end I would like to quote from the AMA position statement 2019, three clauses in particular. Clause 1.4 states:

It is acceptable for a doctor to refuse to provide or to participate in certain medical treatments or procedures based on a conscientious objection.

I might just pause to stress this statement is not about abortion: it is about a conscientious objection in whatever medical context. It affirms that a doctor does have the right to refuse to participate in certain medical treatment or procedures based on a conscientious objection. It states:

1.5 A doctor's refusal to provide, or participate in, a treatment or procedure based on a conscientious objection directly affects patients. Doctors have an ethical obligation to minimise disruption to patient care and must never use a conscientious objection to intentionally impede patients' access to care.

Subsequently, section 2.3, the section dealing with patient care, explicitly states, and the first three dot points only because the Chair's patience would run out at the third dot point, I am sure:

2.3 A doctor with a conscientious objection, should:

inform the patient of their objection, preferably in advance or as soon as practicable;

inform the patient that they have the right to see another doctor and ensure the patient has sufficient information to enable them to exercise that right;

take whatever steps are necessary to ensure the patient’s access to care is not impeded;

I vigorously refute the suggestion from the Hon. Clare Scriven that her amendment represents a balanced view of conscientious objection, and I commend the Attorney-General for the work that has been done with the AMA to give us what is good law.

The CHAIR: I am going to put the amendment.

The Hon. D.G.E. HOOD: If I may respond, Mr Chairman, just briefly.

The CHAIR: Very briefly, because we have canvassed these issues.

The Hon. D.G.E. HOOD: Yes, we have.

The Hon. S.G. Wade: It will turn into debate.

The Hon. D.G.E. HOOD: No, I would ask the Hon. Mr Wade to hear me out before he suggests what I am about to say. I was merely going to clarify my earlier comments. I think some people may have misinterpreted them. Perhaps I was not eloquent enough; it is getting late, so forgive me for that. Of the six doctors I spoke to, four said that they, in effect, make it work. Basically, that was the comment to me. They did not necessarily like it, but they would make it work.

Two had a stronger objection to it and, it seemed to me, would ultimately refuse to do it, but it is not that they are going to leave their practice tomorrow or anything to that effect. If push came to shove at some later point, and they were forced to in some way cooperate to end in a termination, they said they would probably refuse to do it. I just want to clarify those remarks and be clear about what was said to me.

The Hon. C.M. Scriven interjecting:

The CHAIR: No, I am going to put the amendment.

The Hon. C.M. SCRIVEN: I think I have the right to sum up before we move on.

The CHAIR: You do not really, and the reality is we have canvassed these issues at great length. I am going to put the amendment.

Ayes 9

Noes 12

Majority 3

AYES
Centofanti, N.J. Hood, D.G.E. Lee, J.S.
Lucas, R.I. Ngo, T.T. Pangallo, F.
Ridgway, D.W. Scriven, C.M. (teller) Stephens, T.J.
NOES
Bonaros, C. Bourke, E.S. Darley, J.A.
Franks, T.A. Hanson, J.E. Hunter, I.K.
Lensink, J.M.A. Maher, K.J. Parnell, M.C.
Pnevmatikos, I. Wade, S.G. (teller) Wortley, R.P.

Clause 9 passed.

Clause 10.

The CHAIR: We move to amendment No. 5 [Centofanti-1].

The Hon. N.J. CENTOFANTI: This amendment is consequential, therefore I will not be moving it.

The Hon. I. PNEVMATIKOS: I have a point of clarification. In terms of clause 10, I have a question. To whom is this section intended to apply? Would it apply to husbands, boyfriends, sisters or friends, for example, who assist in providing abortion pills sourced online or brought in from overseas? This may be relevant for international students or others who come from overseas or those who source pills online.

The Hon. S.G. WADE: I am advised that the honourable member is correct, it is potentially possible. I would refer the honourable member to clause 11, where it states 'DPP's consent required for prosecution under Part'. One would certainly expect the DPP to consider all relevant circumstances.

The honourable member raises the circumstances of international students. I would respectfully suggest that this legislation again reduces the harm to women because it means an international student who has not been in South Australia for two months is able to access services in a timely fashion.

Clause passed.

New clause 10A.

The CHAIR: We now move to the insertion of a new clause 10A, proposed by the Hon. Mr Hood. You have two amendments, sir. Would you clarify?

The Hon. D.G.E. HOOD: Amendment No. 1 [Hood-1] I will not be moving. I move:

Amendment No 1 [Hood–2]—

Page 6, after line 20—Insert:

10A—Termination of pregnancy for sex selection unlawful

(1) Subject to subsection (2), a person who performs or assists in a termination of a pregnancy for the purposes of sex selection is guilty of an offence.

Maximum penalty: $20,000.

(2) It is a defence to a charge of an offence against this section relating to a termination if the defendant proves that a medical practitioner was satisfied that there was a significant risk that the person born after the pregnancy (but for the termination) would suffer a sex-linked hereditary medical condition that would result in significant disability to that person.

This is fairly straightforward. I think members know what the intention of this amendment is. I think it comes down to a philosophical position. Essentially, this amendment will make sex selection abortions unlawful, that is, someone basing their decision for having an abortion purely on the sex of the baby.

People may have different views, and that is fine. I will be very frank about it: I do not like the idea of it. I do not like the idea of somebody deciding that because it is a girl, they do not want that particular child or because it is a boy, they do not want that particular child. There are reasons why a sex selection abortion should be okay or should proceed, if you like, and I have tried to allow for that in proposed new subsection (2).

There are certain conditions. It is interesting what you find when you research these things. There are certain conditions that are more likely to occur in certain sexes as the genetics of the parents are passed down to their offspring. In those cases, this amendment would allow a sex selection abortion. That is, for a particular couple, a medical condition that one of them has is more likely to be passed on to a girl than to a boy. The baby is a girl; therefore, the abortion proceeds. That can happen under this amendment. That will be perfectly legal under this amendment.

But when none of those circumstances exist and it is just somebody deciding they do not want a girl or they do not want a boy, for example, this amendment would make that unlawful. I think it is fundamental that one gender should not be treated more importantly than another. ScienceDaily has quoted that some overseas countries—you hear about this in the news from time to time—have strong biases, typically towards boys in some of the Asian countries in particular.

I found on their site, sciencedaily.com, that in China, India and South Korea there are about 125 boys born for every 100 girls. It is quite a significant difference. It is not to say that necessarily would happen in Australia; in fact, I think there is little evidence that it is happening in Australia—some, but little. The result in overseas countries where it is legal is that we have seen a significant percentage of male population as opposed to female population, as I have said, in those countries in particular.

Another thing that should be noted here is that the 20-week scan is typically the time when people find out what sex their child will be. I remember our 20-week scan. I remember it well still, some 14 years ago almost. I remember finding out that we were having a little girl. It was a very exciting time, as you can imagine. But those scans, as they tell you at the time, are not always 100 per cent accurate; that is, they can be wrong. Sometimes they will say it is a boy and it turns out to be a girl, etc. So if you were making an abortion decision based at that time purely on the fact that it is going to be a girl or it is going to be a boy, you need to allow for the fact that the scan may not be accurate, that it may be wrong.

Finally, just briefly, I believe there is significant public support for these types of amendments. In the USA, the Charlotte Lozier Institute published a study recently that showed 77 per cent of Americans oppose sex selection abortion. In the UK, in a ComRes report, 80 to 84 per cent of UK residents were against sex selection abortion. In 2019 in Australia, a YouGov Galaxy poll asked the question: 'Should abortion be permitted on the basis of the gender of an unborn child?' That is exactly word for word what was asked. The yes responses, supporting sex selection abortion, were 8.6 per cent; the no responses were 83.9 per cent; and the rest were undecided.

The Hon. E.S. BOURKE: I thought I had better get up and say something. I would just like the Hon. Stephen Wade to clarify in the chamber today whether the intention under what was clarified as a lawful termination covers that a termination of pregnancy cannot be based on gender at any stage throughout a pregnancy and whether that is covered under the professional standards and guidelines that apply to the medical practitioner in relation to the performance of the termination. Can the Hon. Stephen Wade confirm within the chamber if this amendment is necessary or if that would fall under that requirement?

The Hon. S.G. WADE: I thank the honourable member for her question. My advice is that post 22 weeks and six days it will need to be medically appropriate, and it is arguable that it would be medically appropriate to perform an abortion on the basis of gender selection, but it is possible in less than that threshold. In terms of professional standards, I am advised that there are not specific provisions, but the expectation is that most practitioners would not undertake an abortion in those circumstances.

In terms of my comment on the amendment, if I may, recommendation 36 of the SALRI report explicitly considered the issue of terminations of pregnancy on the basis of gender selection. Whilst it was acknowledged by SALRI that the practice of gender selection has been the subject of strong concern by international human rights bodies, especially in the context of violence and discrimination against women, it found that there was little evidence to support the view that gender selective abortion is occurring in South Australia.

Furthermore, it was SALRI's view that any attempt to legislatively prohibit gender selective abortion is likely to be unworkable and unenforceable as this would effectively require medical practitioners to investigate and assess the motivation behind a patient's decision for seeking a termination. This provision would also serve to delay access to termination services, undermining the intent.

It was also found that there may be legitimate reasons for gender-based abortion where there is a real risk of a detrimental sex-linked condition being passed on to a child, and I acknowledge that the Hon. Dennis Hood has made efforts to address this issue by proposing that a termination performed for these reasons would be a defence to the proposed offence, but it does make clear that this is a complex and nuanced issue which requires careful consideration. These are significant issues.

I am sure it is for that reason that SALRI recommended that any concerns regarding gender selective abortion practice should be considered further as part of the recommended five-year review of abortion laws. As the honourable member highlights the concerns in this area, I would suggest that this issue could be appropriately addressed as part of the five-year review of the legislation that the bill establishes.

The Hon. C.M. SCRIVEN: Before I address that, I would like to respond to something the Hon. Mr Wade put on the record that I think is incorrect: when he accused me of denigrating the AMA. I will just draw members' attention to the fact that all I did was ask whether the AMA had surveyed all their members on this issue, which I do not think should be rightfully characterised as denigration.

However, on this the Hon. Mr Wade has said that most would not undertake the process. Whilst acknowledging it could certainly be done, he said that most practitioners would not undertake the process. I am not sure if he was quoting from his advice there or from the SALRI report; I think it was the former. However, I would draw to members' attention the situation of Dr Hobart, who I have mentioned before, who was under investigation by the Medical Board of Victoria because he refused to provide an abortion when his patient and her husband requested sex selection abortion after an ultrasound determined the foetus was female.

Under the Victorian situation, apparently he was obliged to refer the patient to a doctor he knew would terminate the pregnancy, but he did not know a doctor who would agree to terminate a pregnancy for sex selection reasons. However, the couple found another doctor who did undertake the sex selection abortion, and Dr Hobart found himself being brought before the Medical Board of Victoria and risked losing his licence.

The SALRI report, as quoted by the Hon. Mr Wade, said that there is no or little evidence of sex selection abortion happening in South Australia, and I would point out that that is clearly because it is currently illegal. If it was not illegal, then there may be instances of it, and we are aware of circumstances interstate where it has occurred. The response that SALRI gave, which was that one would need to investigate the reasons for an abortion, I do not think is necessarily the case. What we would be talking about is where a couple come and say that they want an abortion because of sex selection.

Obviously there is a way around it; people who know this can come along and not say that it is for sex selection—they can just say it is for any other reason—and that is a limitation. However, I think it is an important signal, I guess, to society that we will not tolerate abortions purely because, in the majority of cases, it is the girl who would be aborted rather than the boy if we look at some of the biases that have been experienced. I think it is an important amendment. Those circumstances, however common or rare, where there is a sex-determined hereditary medical condition would be accounted for in this, and therefore it should assuage anyone's concerns about supporting it.

The Hon. I. PNEVMATIKOS: The example the Hon. Clare Scriven raised about Dr Hobart was not an issue in terms of his refusal to provide an abortion because the couple had asked for the abortion on gender selection grounds: the issue was that he did not refer the clients on—that was the issue.

The Hon. C.M. Scriven: He didn't know anyone who would do it.

The Hon. I. PNEVMATIKOS: The issue was he did not refer—he could have referred on. That is the issue for Dr Hobart and deregistration. In any event, one problem I have with these amendments is that they may encourage racial and cultural profiling. I would like to ask the Hon. Dennis Hood what consultation he had with multicultural groups and community groups on this issue.

The Hon. D.G.E. HOOD: None whatever, because I did not do it for that reason. I did it because I object to aborting of a baby on the basis of their sex, regardless of what culture they are from.

The committee divided on the new clause:

Ayes 10

Noes 11

Majority 1

AYES
Bourke, E.S. Centofanti, N.J. Hood, D.G.E. (teller)
Lee, J.S. Lucas, R.I. Ngo, T.T.
Pangallo, F. Ridgway, D.W. Scriven, C.M.
Stephens, T.J.
NOES
Bonaros, C. Darley, J.A. Franks, T.A.
Hanson, J.E. Hunter, I.K. Lensink, J.M.A.
Maher, K.J. Parnell, M.C. Pnevmatikos, I.
Wade, S.G. (teller) Wortley, R.P.

New clause thus negatived.

Clauses 11 to 14 passed.

Clause 15.

The Hon. S.G. WADE: I move:

Amendment No 2 [Lensink–1]—

Page 8, lines 1 to 6 [clause 15(2)(c)]—Delete paragraph (c)

Clause 15 of the bill sets out the circumstances in which the personal information of a person may be disclosed by a person engaged in connection with the operation of the act. Relevantly, clause 15(2)(c) allows for personal information to be disclosed to a relative, carer or a friend of the person if the disclosure is reasonably required for the treatment, care or rehabilitation of the person and there is no reason to believe that the disclosure would be contrary to the person's best interests. However, clause 15(3) provides that this information cannot be disclosed where the person has issued a clear direction for the information not to be disclosed.

While there may be legitimate circumstances in which the disclosure of personal information is reasonably required for the treatment, care or rehabilitation of the person, it is recognised that the disclosure of personal information in the context of a termination of pregnancy is more nuanced. Some submissions pointed out that disclosure in these circumstances may inadvertently compromise the safety of the woman and place her at risk of harm.

For example, many women choose not to disclose a termination of pregnancy for fear of stigma, pressure or coercion to not terminate a pregnancy from a partner, family member or friend. For some women, there may also be a very real risk of domestic or family violence for having sought a termination. Unlike other health procedures, where there may be a legitimate need for certain information to be disclosed, it is difficult to envisage a scenario where disclosure of a termination would be reasonably required for the treatment or care of the person.

In those circumstances, where the disclosure of such information may be appropriate or necessary, it is noted that disclosure of information would still be permitted under the bill with the consent of the person, that is, in accordance with clause 15(2)(b) or where it is otherwise required or authorised by or under law, which is in clause 15(2)(a). It is therefore considered appropriate that this provision should be removed.

The Hon. C.M. SCRIVEN: What was the reason for this being included originally as a clause, and would not the issues that the Hon. Mr Wade has referred to come under the banner of 'contrary to the person's best interests' if it was to be revealed?

The Hon. S.G. WADE: I am putting forward the amendment. I did not draft the bill.

The Hon. C.M. SCRIVEN: Perhaps the Hon. Ms Lensink would like to answer it then.

The Hon. J.M.A. LENSINK: My understanding is that when this bill was drafted, the clauses are standard clauses in health care but I think, given the sensitivities of this, it was raised by people in consultation and some of our colleagues that it was inappropriate that some of these clauses should continue in this piece of legislation.

The Hon. E.S. BOURKE: This was an issue I raised in my second reading contribution and also in forums outside this room, that the intent of this being within the bill could be taken the wrong way. I support the amendment that has been put forward because you would not want a situation where a young child went to have an abortion and the local GP was advised because they were the family doctor, and unwillingly that happened.

So, yes, I support that this is required to happen. My understanding is that the reason this was within the bill is because a lot of the health requirements were carried over from previous legislation and therefore this is actually a double-up of what is required for health professionals to follow anyway, so this being removed is not going to have an impact.

The Hon. I. PNEVMATIKOS: I also support the amendment and withdraw mine, which mirrored this.

The Hon. C. BONAROS: I indicate for the record that I will be supporting this amendment.

Amendment carried.

The Hon. S.G. WADE: I move:

Amendment No 3 [Lensink–1]—

Page 8, lines 18 to 20 [clause 15(2)(e)]—Delete paragraph (e)

If the council would be agreeable, I suggest that this could be treated as consequential.

Amendment carried.

The Hon. S.G. WADE: I move:

Amendment No 4 [Lensink–1]—

Page 8, lines 26 and 27 [clause 15(3)]—Delete subclause (3)

I would also submit that this is consequential on amendment No. 2 [Lensink-1].

Amendment carried; clause as amended passed.

Clause 16.

The Hon. T.A. FRANKS: I move:

Amendment No 1 [Franks–1]—

Page 9, lines 6 and 7 [clause 16(1)]—Delete subclause (1) and substitute:

(1) The Minister must cause a review of this Act and Part 5A of the Health Care Act 2008 (including the administration and operation of this Act and that Part) to be conducted on the expiry of 4 years from the commencement of this section.

This simply ensures that the debate we had previously on safe access zones around abortion healthcare services is also part of the review of this act, as was discussed in that previous debate, and this amendment simply ensures that safe access zones are also reviewed.

The Hon. C. BONAROS: I rise to indicate my support for the amendment, especially in light of the fact that we have covered off on the other issue that we had in relation to those health access zones which we had a clear commitment to deal with as part of this bill.

The Hon. D.G.E. HOOD: I rise to support the amendment and I thank the Hon. Ms Franks for following through on the commitment she made in the previous debate.

Amendment carried; clause as amended passed.

New clause 16A.

The Hon. I. PNEVMATIKOS: I move:

Amendment No 8 [Pnevmatikos–1]—

Page 9, after line 11—Insert:

16A—Minister to cause review of policies etc of certain providers of terminations to be undertaken

(1) The Minister must, within 12 months after the commencement of this section, cause a review to be undertaken of the policies and practices (however described) of each prescribed termination provider to determine the extent to which the policies and practices are consistent with the operation of this Act.

(2) The Minister must cause a report of the review—

(a) setting out the extent to which the policies and practices of each prescribed termination provider are consistent with the operation of this Act; and

(b) setting out details of any policies and practices of a prescribed termination provider that limit, or are otherwise inconsistent with, the operation of this Act; and

(c) containing any information required by the regulations,

to be prepared and provided to the Minister within 1 month after the completion of the review.

(3) The review and report need only consider such policies and practices of prescribed termination providers as may relate to terminations.

(4) The Minister must cause a copy of the report to be laid before both Houses of Parliament within 6 sitting days after receiving the report.

(5) In this section—

Minister means the Minister to whom the administration of the Health Care Act 2008 is committed;

prescribed termination provider means—

(a) the Women's and Children's Hospital; and

(b) the Pregnancy Advisory Centre located at 21 Belmore Terrace, Woodville; and

(c) each incorporated hospital (within the meaning of the Health Care Act 2008) at which terminations are, or are to be, performed.

This amendment creates additional clause 16A, which is a review of practices and procedures. In essence, because up until now we have been functioning under a criminalised model and we are moving to a healthcare model, this amendment would require the minister to review policies of certain providers of terminations to be undertaken.

This will ensure that the procedures and practices conform to the bill that will be passed today in this chamber. Up until now, the procedures have been functioning based on a criminalised model. If we are transferring it to the health code, we need to make sure that the various providers and units are working appropriately within the health code.

The Hon. S.G. WADE: I do not support this amendment. The proposed amendment from the honourable member recommends a review of policies of certain providers of terminations to be undertaken within 12 months of the commencement of this bill. Whilst I appreciate the good intent behind the amendment, I cannot support it due to the problematic practical implications. This amendment would in effect require me as minister to interfere in matters of clinical governance and practice of health services.

It should be noted that clinical governance and the practice of health services sit within the remit of health services for all other health conditions, and it is my recommendation that this should remain the case in terms of the matter of terminations as well. The honourable member makes the point about the transition from a criminal model to a healthcare model. Let's be clear, the SA Health networks have never treated outpatients as criminals. It has been problematic to deliver patient-centred health care under a criminal model but I would stress that the model of care has been and will be focused on health services.

Only yesterday we made substantial progress on the second stage of the Health Care (Governance) Amendment Bill and, God willing, later this morning we will be continuing the consideration of that bill. That bill is fundamentally supporting local health networks to develop clinical governance frameworks, clinician engagement frameworks and consumer engagement frameworks to deliver quality and safe care. It is those frameworks that will make sure that the enhancements to the law that this parliament is considering in this bill will be rolled out and implemented.

The boards have a particular responsibility to comply with legislation. I think we should let them get on with the job. In that context, I would not start treating abortion as a special health condition when, after all, this legislation is about stopping treating it as a crime and treating it as a health condition.

The Hon. C.M. SCRIVEN: I have a question for the mover. Why has she only included (a), (b) and (c) in terms of what prescribed termination provider means—so only the Women's and Children's Hospital, the Pregnancy Advisory Centre at Woodville and incorporated hospitals?

The Hon. I. PNEVMATIKOS: Because those are the providers of abortion services to date.

The Hon. C.M. SCRIVEN: Indeed, but this bill will allow other than those, so I was interested in the answer to that question. I will not be supporting this amendment. I find it ironic, after all the argument we have had saying that things do not need to be in legislation and they can just be in guidelines, that we would then put something like this in legislation.

New clause negatived.

Clause 17.

The Hon. S.G. WADE: I move:

Amendment No 5 [Lensink–1]—

Page 9, line 17 [clause 17(2)(a)]—Delete 'or the Department' and substitute:

, the Department, or an attached office attached to the Department

This amendment seeks to amend clause 17(2)(a) of the bill to provide that data or statistics collected pursuant to regulations made under the act may be provided to an attached office attached to the department. Clause 17(2) allows for the Governor to make regulations to require any registered health practitioner, hospital or private day procedure centre to collect and provide the minister or the department with data and statistics in relation to services connected with the performance of terminations.

As currently drafted, it is unclear whether 17(2) would allow for data or statistics collected under the regulations to be provided to an attached office of the department. Data and statistics in relation to the termination of pregnancy is currently collected and managed by Wellbeing SA, which is an attached office of the Department for Health and Wellbeing. For the avoidance of doubt, this amendment would clarify that such information may be provided directly to Wellbeing SA.

The ACTING CHAIR (Hon. T.T. Ngo): Minister, do you want to move amendment No. 6 too, because they are pretty much the same?

The Hon. S.G. WADE: Yes, I am happy to move:

Amendment No 6 [Lensink–1]—

Page 9, line 21 [clause 17(2)(b)]—Delete 'or the Department' and substitute:

, the Department, or an attached office attached to the Department

This amendment similarly expands the provision of information to the attached office.

The Hon. C.M. SCRIVEN: I just have a question. I note that the legislation says the regulations 'may' require this information. I realise that legislation normally will say 'may' rather than 'must' provide such information in terms of collecting data. My question is in regard to whether we will be able to compare data following the passage of this bill, if it is successful, to the sort of data that has been provided so far. Hopefully that question is clear. I am happy to elaborate if necessary but, if not, I will not.

The Hon. S.G. WADE: I thank the honourable member for the opportunity to say yet again, 'How great is South Australia?' Over the 50 years of the criminal law consolidation custody of abortion law, SA Health and its various iterations back—not as far back as Sir Lyell McEwin, but in 1969 he might have even still been called the chief secretary at that stage. I am not sure if it was even the Minister for Health.

However, over 50 years SA Health and its various iterations have maintained a very good dataset. It is certainly the intention that we will continue that tradition. We have the best dataset in Australia and we certainly anticipate that it maintains continuity with the dataset over the years, but of course we will take the opportunity to look at this legislation and refresh it so that it can continue to grow over the next 50 years.

Amendments carried; clause as amended passed.

Clause 3.

The CHAIR: Now we revert back to clause 3 with the amendments, as I indicated earlier, one from the Hon. Dr Centofanti and one exactly the same from the Hon. Ms Scriven.

The Hon. C.M. SCRIVEN: I indicate that I will not be proceeding with the amendment.

The Hon. N.J. CENTOFANTI: I also indicate that I will not be moving my amendment.

The CHAIR: They have now indicated that they are not moving them, so the question is that clause 3 stand as printed.

Clause passed.

Schedule and title passed.

Bill reported with amendment.

Third Reading

The Hon. J.M.A. LENSINK (Minister for Human Services) (01:11): I move:

That this bill be now read a third time.

The Hon. D.W. RIDGWAY (01:12): I would like to make a few comments. I have sat and listened to the debate in my office and in the chamber this evening. As members know, I supported the second reading of this bill a couple of week ago. I have listened to the debate and listened to the amendments but mostly the ones I have supported have been lost.

The one I wanted to make particular comment about was the Hon. Mr Hood's gender selection amendment. That was a very close vote in the end but I think it demonstrates to me that this chamber really has not had the health and wellbeing in mind of either the mother or the child when they were not prepared to support the Hon. Mr Hood's amendment about gender selection.

For me personally, that is an important issue: to say that you can use this particular bit of legislation or this framework or these rules, or whatever you like to call it, to actually choose whether to have a boy or a girl. I find that somewhat offensive, being a father of two girls and a boy, and would have been happy to have three girls, three boys, or whatever combination you could have.

I wanted to put on the record that I will not be supporting the bill at the third reading because I think it has shown that some people participating in this debate really have not been—that particular issue demonstrates to me that they actually have not fully understood the joy of being a parent, the joy of having children. I have always been a pro-choice person but to allow, at some point, a set of rules or laws or regulations that allow parents to choose what gender their child should be, I do not believe I can support that, so I will not be supporting the third reading.

The council divided on the third reading:

Ayes 12

Noes 9

Majority 3

AYES
Bonaros, C. Bourke, E.S. Darley, J.A.
Franks, T.A. Hanson, J.E. Hunter, I.K.
Lensink, J.M.A. (teller) Maher, K.J. Parnell, M.C.
Pnevmatikos, I. Wade, S.G. Wortley, R.P.
NOES
Centofanti, N.J. Hood, D.G.E. Lee, J.S.
Lucas, R.I. Ngo, T.T. Pangallo, F.
Ridgway, D.W. Scriven, C.M. (teller) Stephens, T.J.

Third reading thus carried; bill passed.


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