The Protection of Life During Pregnancy Act 2013 (Act No.35 of 2013; previously Bill No.66 of 2013) was an Act of the Oireachtas which, until 2018, defined the circumstances and processes within which abortion in Ireland could be legally performed. The act gave effect in statutory law to the terms of the Constitution as interpreted by the Supreme Court in the 1992 judgment in the X Case. That judgment allowed for abortion where pregnancy endangers a woman's life, including through a risk of suicide. The provisions relating to suicide had been the most contentious part of the bill. Having passed both Houses of the Oireachtas in July 2013, it was signed into law on 30 July by Michael D. Higgins, the President of Ireland, and commenced on 1 January 2014. The 2013 Act was repealed by the Health (Regulation of Termination of Pregnancy) Act 2018, which commenced on 1 January 2019.;
Background
Under section 58 of the Offences against the Person Act 1861, unlawfully attempting to procure a miscarriage was a crime punishable by up to life imprisonment. A 1983 amendment to the 1937 Constitution guaranteed to vindicate the "right to life of the unborn" with due regard for "the equal right to life of the mother". Proponents of the amendment believed that it would guarantee abortion could never be allowed in any circumstances. However, in 1992 the Supreme Court ruled in the X Case that abortion was permitted where pregnancy presented "a real and substantial risk to the life, as distinct from the health, of the mother", including where the risk was through suicide. There were two attempts to amend the Constitution to explicitly rule out suicide as grounds for abortion. These were rejected at referendums in 1992 and in 2002; some no-voters felt the restriction was too strong and others that it was not strong enough. No legislation was passed to amend the 1861 Act in the light of the 1992 judgment.
In December 2010, in the case A, B and C v Ireland, the European Court of Human Rights (ECtHR) ruled that the State had infringed a complainant's rights by not providing clear information on whether she was entitled to an abortion. The state had a year to respond officially, and after the 2011 general election, the coalition government decided in December 2011 to appoint an expert group to advise on how to implement the ECtHR judgment. Following the death of Savita Halappanavar in Galway on 28 October 2012 of maternal sepsis after a miscarriage, her husband and friends told local pro-choice groups they blamed her death on the denial of her request for an abortion; The Irish Times broke the story on 12 November and it fed into the wider abortion debate. On the day the story broke, the Irish government confirmed that the expert group handed in its report to the Department of Health the night before. The committee offered four possibilities: 1) non-statutory guidelines 2) statutory regulations 3) legislation only and 4) legislation plus regulations. In December, the government decided to pursue option 4 in the expert group's report: legislation plus regulations.
Provisions The Act specified the number and specialty of medical practitioners who concurred that a termination was necessary to prevent a risk of death. Those criteria differed in three scenarios: Risk of loss of life from physical illness Two physicians, one an obstetrician and the other a specialist in the field of the relevant condition, concurred.Protection of Life During Pregnancy Act 2013, §7 For example, if the woman had cancer, the two physicians were an obstetrician and an oncologist. Where relevant, the specialists also consulted the woman's general practitioner (GP). The termination was an elective procedure performed at an appropriate institution. Risk of loss of life from physical illness in emergency In a medical emergency, a single physician provided the diagnosis and performed the termination.Protection of Life During Pregnancy Act 2013, §8 Risk of loss of life from suicideThree physicians concurred; an obstetrician, a psychiatrist with experience treating women during or after pregnancy, and another psychiatrist.Protection of Life During Pregnancy Act 2013, §9 At least one of them should consult the woman's GP with her consent. The termination was an elective procedure performed at an appropriate institution.
The physicians' diagnosis had to be "an opinion formed in good faith which has regard to the need to preserve unborn human life as far as practicable".Protection of Life During Pregnancy Act 2013, §§7(1)(a)(ii), 8(1)(b), 9(1)(a)(ii) Normal informed consent was required.Protection of Life During Pregnancy Act 2013, §16 Medical personnel with conscience objections to abortion were not required to participate in terminations, but had to transfer care of a patient in such cases.Protection of Life During Pregnancy Act 2013, §17 All terminations were notified to the Minister for Health within 28 days.Protection of Life During Pregnancy Act 2013, §20(1)–(3) The Minister made an annual report of such notifications.Protection of Life During Pregnancy Act 2013, §20(4)–(7)
Where a termination was requested but refused, a woman could appeal to the Health Service Executive (HSE).Protection of Life During Pregnancy Act 2013, §10 The HSE established a panel of at least 10 physicians,Protection of Life During Pregnancy Act 2013, §11 from whom a committee of two or three reviewed any application within three days. The committee members' specialties depended on whether the condition was physical or mental, in the same way as for the initial assessment.Protection of Life During Pregnancy Act 2013, §12 The HSE published an annual report on the review process.Protection of Life During Pregnancy Act 2013, §15
The Act also repealed sections 58 and 59 of the 1861 Act;Protection of Life During Pregnancy Act 2013, §5 these criminalised attempted or actual procurement of miscarriage, and assisting such procurement. It replaced them with a new offence of "destruction of unborn human life", with a maximum penalty of 14 years' imprisonment.Protection of Life During Pregnancy Act 2013, §22General Scheme of the Protection of Life During Pregnancy Bill 2013, pp.33–34 "Head 19: Offence" The director of a body corporate which performed such a procedure could be guilty of a similar offence.Protection of Life During Pregnancy Act 2013, §23 As required by the Constitution, the right to travel abroad for abortion (13th amendment), and to provide information about foreign abortion (14th amendment), were protected.Protection of Life During Pregnancy Act 2013, §18General Scheme of the Protection of Life During Pregnancy Bill 2013, p.25 "Head 13: Travel and Information"
The Act defined the "unborn" whose life is protected as existing from implantation in the uterus until "complete emergence ... from the body of the woman".Protection of Life During Pregnancy Act 2013, §2(1) Beginning at implantation conformed to a 2009 Supreme Court judgment on the beginning of pregnancy,General Scheme of the Protection of Life During Pregnancy Bill 2013, p.5 "Unborn" rather than the Catholic view that personhood begins at conception. The aim of specifying the uterus was to avoid criminalising emergency contraception or treatment of ectopic pregnancy.General Scheme of the Protection of Life During Pregnancy Bill 2013, p.4 "Implantation"
The Act empowered the Minister for Health to produce regulations detailing the procedures for all its provisions.Protection of Life During Pregnancy Act 2013, §§3,4
A "senior source" at the National Maternity Hospital (NMH) told The Irish Times that terminations had been carried out there prior to the 2013 Act, and that the change brought about by the Act would be to remove the "fear of a possible Medical Council case".
Approved locations Except in an emergency, a termination could only be carried out in an "appropriate institution". The Act listed several of these, and empowered the Minister to specify others.Protection of Life During Pregnancy Act 2013, §3 and Schedule The draft bill's list of approved institutions included only maternity hospitals, but was extended to include other hospitals with intensive care units where the nearest maternity hospital did not have emergency medicine facilities.
Dublin Beaumont Hospital Coombe Women & Infants University Hospital Mater Misericordiae University Hospital National Maternity Hospital Rotunda Hospital St. James's Hospital St. Vincent's University Hospital Tallaght University Hospital Provincial Cavan General Hospital Cork University Hospital and Cork University Maternity Hospital Galway University Hospitals Kerry General Hospital, Tralee Letterkenny General Hospital Mayo General Hospital, Castlebar Midland Regional Hospital, Mullingar Midland Regional Hospital, Portlaoise Mid-Western Regional Hospital, Dooradoyle Mid-Western Regional Maternity Hospital, Limerick Our Lady of Lourdes Hospital, Drogheda Portiuncula Hospital, Ballinasloe Sligo General Hospital St Luke's Hospital, Kilkenny Tipperary University Hospital, Clonmel Waterford Regional Hospital Wexford General Hospital
Enactment The bill was drafted by the Government and then introduced by it into the Oireachtas or parliament. After both Houses of the Oireachtas passed it, it was signed into law by the President.
Draft In January 2013, the Oireachtas Joint Committee on Health and Children held three days of discussions with interest groups on the government's plans. The meeting was held in the chamber of the Seanad, rather than a committee room, to allow more people to attend. Journalist Stephen Collins commented that it was an unusual and positive step to hold such a discussion before the drafting of a bill by the Office of the Parliamentary Counsel to Government. Health Minister James Reilly said in January 2014 that the process had "become now the standard for many bills".
The draft of the bill was published in April 2013.General Scheme of the Protection of Life During Pregnancy Bill 2013 The official announcement stated that the provisions of the proposed legislation being published were strictly within the parameters of the X Case. In May 2013, the Oireachtas Joint Committee on Health and Children held three days of discussions on the draft bill with healthcare and legal professionals. Its report was laid before the Dáil on 30 May. and
Dáil stages The bill was introduced in Dáil Éireann, the lower House of the Oireachtas, on 16 June 2013. It was the subject of vigorous debate. From the government parties, TDs Terence Flanagan, Peter Mathews, Billy Timmins, and Brian Walsh were expelled from the Fine Gael parliamentary party on 2 July 2013 after voting against the bill's second stage in defiance of a party whip. Lucinda Creighton was likewise expelled on 11 July for voting against the bill's report stage; she was also forced to resign as Minister of State for European Affairs. Michael McNamara of Labour also voted against the bill, but the party later explained this had been a mistake. From the opposition parties, Peadar Tóibín was suspended by Sinn Féin for six months after voting no against the whip. While Fianna Fáil leader Micheál Martin favoured the bill, the party's TDs demanded a free vote, and 13 of 19 voted against. This contributed to media reports that Martin's continued leadership of the party was in doubt.
Six pro-choice technical group TDs voted against the bill: Clare Daly, Joan Collins, Richard Boyd Barrett, Mick Wallace, Joe Higgins and Luke 'Ming' Flanagan. They argued instead for a referendum to repeal the 1983 Constitutional amendment which places the life of the mother and the unborn on an equal footing. Boyd Barrett criticised the exclusion of fatal foetal abnormality in the bill, which he said “will force women whose pregnancies will inevitably end in tragedy to go full term or travel overseas for terminations".