Termination of Pregnancy Bill 2020 - Committee Stage

Extracted from Hansard - House of Assembly 18 February 2021

The Hon. R. SANDERSON: I also have a couple of clarification points. I, too, have an amendment, but it does not come up until clause 8A, regarding the mandatory provision of information about not only counselling but the possible health effects of an abortion, the possible mental health effects and the opportunity, if you should have your pregnancy to term, of adoption and how you would find out about adopting a baby. The information I saw from the ACT also had information about accessing Centrelink payments if you are a single mother or a single parent.

My aim is that everybody who inquires with a doctor, hospital or wherever they might go is given fulsome information, which could include where to get counselling but also all the effects of their decision, how that may affect their life, their body and their mental health, as well as the options should they not go ahead so that they are in full possession of all the information before they make what is a very serious decision. I do not believe that this would cover that off, so I would still have to move my amendment if it were the way it is.

The Hon. R. SANDERSON: I move:

Amendment No 1 [Sanderson–1]—

Page 5, after line 28—Insert

8A—Registered health practitioner to provide information about alternatives and risks

(1) A registered health practitioner must—

(a) when providing advice to a person about the performance of a termination; and

(b) in any case—before performing a termination on a person,

provide the person with information about the procedure, alternatives to terminating the pregnancy and the physical and mental health risks associated with terminating a pregnancy.

(2) A registered health practitioner will be taken to have complied with subsection (1) if the practitioner gives the person information in the prescribed form.

This amendment is in response to multiple constituents contacting me. One in particular stood out. She lives in regret of her decision and believes that had she been given the appropriate and fulsome information she may have been able to make a different decision.

I believe that at the point of seeing a doctor to find out about an abortion, you should be given all the information about the health risks, the mental health risks, as well as the options as far as adoption, Centrelink payments, assistance and counselling. I know we have already passed the counselling legislation; this could be incorporated. There is no penalty—I removed that. It was in there originally and I removed it as it is not meant to be about penalising the doctor for not doing it; it is meant to be about informing people to make an informed decision. It is not about changing a decision but just making the right decision and being aware of all the facts in order to do that.

I believe the counselling could be incorporated into this information, whether it is a pamphlet or an online service through the health department. It is important to make sure people have information on the full risks and alternatives available to them before they make such an important decision.

The Hon. R. SANDERSON: Just for clarification, the amendment that we passed earlier, from my understanding, was about requiring counselling. I am not wanting everybody to have to go to counselling to find out the information. I am wanting them to find all of the information they require in a brochure at the first point of call, at their local GP or wherever they have gone.

The women who have come to me and shared their very moving stories have made it sound to me that, when you go to a GP, you are in control, you are a working woman with a job, with a husband, with children already. You say you want an abortion. They just send you for an abortion. You are not given any other information. You are not given any alternatives or any other opportunity to think about it. It is just all booked in and it is done.

Those I have met with have then lived with regret about that decision for decades afterwards. It is too late to find out at the time of going into surgery. I think it needs to be information that is readily available. You should not have to wait weeks or however long it would take to get a booking with a counsellor. As soon as you make that appointment with a GP to find out, you should be given all of the information. If that is readily available, that is fantastic. From what I am being told from my constituents, it is not readily available and not given. If you go in and ask for an abortion, you are just sent for an abortion. Nobody gives you all of your options and your alternatives.

This might have been historical and maybe it has changed recently but I would like to make sure that people are given the facts and that the information is regularly updated, because the adoption legislation will be presented in March in this house, that will change adoption availability again as part of the Children and Young People (Safety) Act, so it is important that that is a regularly updated piece of information.

The Hon. R. SANDERSON: I thank the member for Reynell for the question. My understanding from constituents who have come to me is that when they have presented to a doctor saying they wish to have an abortion, they are simply referred directly to have an abortion. They were not given any information, they were not given any alternatives. Whether it was their emotional state—maybe it was explained in words but not given on paper that they could take home and then think about again.

When you are emotional you might not remember all the facts and all the information. Having something in writing that you could take home and discuss with your partner or that you can consider the next day, or before you go in for an operation, I think is quite important. I just looked up the SA Health website and found that, unfortunately, the adoption link says 'page not found error.' I have written to my CEO already to see that we can get that fixed. But there are many, many links.

If you go onto the SA Health website and search under 'abortion', there are about 30 different links. What I was looking for was something that is clear, concise and simple, such as the brochure I was given that was from the ACT government from 2001. I am sure it has been updated, but it made the risks very clear.

You would put there, 'Medical abortion, risks: bleeding to death; should be within 50 kilometres of a hospital,' and the different risks people have presented to me—for example, surgical, the time lines, other options, Centrelink payments that are available to you, adoption, where you can get help, where you can get counselling. It would be just having it in writing and in a very simple format.

I just looked it up, and there are many different links, about 30 or 40. I do not think many people are ever going to really go through that many. If you give them a brochure, it is simple. Give it to them at the first point of call, not when they are going into hospital to have an operation or when they already have a prescription and it is a bit too late, when they already have the tablets and they have made the decision. I think it should be something as early as possible. An informed decision I think is always the best way to go.

I am uncertain at what point the Attorney-General’s information is provided and in what form—whether it is just a series of a million links that are on the SA Health website. If English is your second language, if you are new migrant, if you are in an emotional state where you are not taking in information, it needs to be quite simple. I am just wanting to make it as failsafe as possible for people to make the right decision and have all the facts to do that.

The Hon. R. SANDERSON: Yes. That was explained to me as being flexible, so it could be in writing, or it could be online, or it could be a website you are directed to. It could be a QR code that you press, and then you get a brochure format online. It allows that in future, rather than opening the act again and specifying it has to be in writing, as technology changes and things change, it might be a podcast; I do not know. It could be all kinds of things. So 'prescribed form' leaves it in the regulations so it is more flexible without having to come back to the house to make any changes in the future.

The Hon. R. SANDERSON: I thank the member for Port Adelaide for raising these concerns. My amendment provides:

(1) A registered health practitioner must—

(a) when providing advice to a person about the performance of a termination…

So, if they are not providing any advice and they are saying, 'I can't help you with that, you need to go to the Pregnancy Advisory Centre,' or whatever, then they are not really providing advice. I do not see the harm in having brochures in the rooms of a doctor's surgery. There are so many brochures on diabetes, asthma—there are lots and lots of brochures and information.

It is really representations that have been put to me from women who have had an abortion who felt that they were not given adequate information. I do not know why; maybe they were and maybe they were emotional and did not hear it, but they do not recall being given information. They do not believe that they were given enough information to make an informed decision. That is why I am putting this amendment forward.

I know that the member for Torrens also raised the issues with mesh implants. Those doctors were also under the same obligation, yet how did this happen? How did so many women have silicone implants that were faulty and had to be removed? Why did those doctors not inform them as well? Just because a doctor has an obligation does not mean it is failsafe.

If there is a brochure or information that is produced by the state government, you would hope that it would always be updated and upgraded for new technologies and changes and that it would be readily available and trustworthy. That is what we want: trustworthy, failsafe information so that women making one of the most important decisions of their life are in possession of all the facts and that they are current and up to date at the time. That is the intent.

If it is already covered that is fantastic; that is fine, but as we have heard from the member for Torrens, there are other instances where that obligation of a doctor to give you full information is not failsafe and has failed previously.

The Hon. R. SANDERSON: I thank the member for his question. I have a copy of that act here. Of course, I trust parliamentary counsel to have considered other acts—that is their role when they do the drafting—however, I do not believe that there would be a contravention. When it was originally drafted there was a financial penalty, and I said that was not my intent. My intent is that women or people should be given the relevant information that is up to date so they could make their own decision. There is not a financial penalty for not doing it, so I do not see any reason why the Consent to Medical Treatment and Palliative Care Act would conflict with this amendment.

The Hon. R. SANDERSON: I thank the member for his question. My understanding is that the reason for using the term 'prescribed form' was to leave it open. If verbal is a prescribed form, then it would cover this and it would be the same. My preference would be that writing would be available, a written brochure or something online. I would prefer written because, from the women who have made representations to me, perhaps they were told at their initial consultation but they have no recollection because they were in an emotional state. They do not remember all the words, and they feel they were not given adequate information.

Whether that is the reality or not the reality, that is their recollection and their lived experience. So by having it in a prescribed form, my preference would be that it would be in writing and it would be a brochure that is produced by SA Health. It would be available at GPs and online, as well as a brochure that you could download and print yourself. In an emotional state while being given a verbal description of what could go wrong, I think there is no way you would be able to remember that unless you took a notepad and a pen and wrote all your notes down. I think it is much better to have that in writing.

The Hon. R. SANDERSON: My advice was from parliamentary counsel and certainly from the lived experience of the women who have written, many of the people who filled in my survey and also those who have come and met with me. Whether you determine it advice, I do not believe that every single woman who goes to a GP would be referred off to the Pregnancy Advisory Centre. I do not know. They would be pretty busy if that is the case. I think there is one in Woodville.

I do not know if people go straight from a GP and then they are booked into a hospital. That is what has been represented to me as the procedure. It is simply that there are women who want more information who feel aggrieved that they were not given that information. I am wanting to make that available. I am putting it before the house. I am happy to have it voted on. You can vote either way, but that is the intent. There is nothing underhanded here. It is about giving people full information to make an informed decision.

The Hon. R. SANDERSON: I thank the member for her question. For anyone who is reading Hansard in years to come, the intent of this is all about information; it is not about suing doctors. It is about having informed consent—literally informed consent, with physical information. If, in the instance that you gave, the person has been given the information before they have had the surgery, then they have received it. I am not saying every single person they ever saw had to give them the information or they could sue the one who forgot. They need to have had this information before they make a decision, and as early as possible is the preference.

My preference would be that it would be in the doctor's surgery along with the information on diabetes, heart attacks and asthma, and all the prevention things that you could do. The idea would be it is a piece of information that is readily available, it is online in a downloadable, nice brochure that you can easily read, and it is possibly in a multitude of languages so that people with English as a second language can understand it.

My concern is that the women who have come to me do not believe they were given that information at any point, and people who are in an emotional state making a very difficult decision do not seem to remember a verbal briefing on all the things that could go wrong. I think it is important to have it available in writing. Whether it is an online document that you download yourself or whether it is a brochure, I think it is important to have that information available.