The Expert Group report on abortion, published today, outlines four approaches to dealing with the provision of abortion in this country where the mother's life is seemed to be at risk.

It indicates that the option of introducing new legislation backed up by regulations to allow for limited abortion would be the most feasible.

The report also says specific centres to carry out terminations should be set up, women should not be kept from accessing lawful treatment due to doctors' conscientious objections, two to three doctors should be involved in the decision-making process, and review panels should be set up for appeals of decisions where doctors say a termination is not required to avert a threat to the mother's life.

The review's general principles were that the entitlement to have the right to lawful termination ascertained should be established; that the State's constitutional obligations under the 'pro-life' amendment and the X Case judgement should be reflected in its proposals; that termination should be considered a medical treatment regardless of whether the risk to a woman's life arises on physical or mental health grounds; and that it will always be a matter for the patient to decide if she wishes to proceed with a termination following a decision that is clinically appropriate medical treatment

The group was tasked with reporting on the options for limited abortion for Ireland in the wake of the European Court of Human rights judgment in late 2010 which ruled that Ireland was in breach of the European Convention on Human Rights by failing to provide legal clarity on the circumstances under which a woman can have a legal abortion under current law, following the X Case 1992 judgement.

The report looks at four possible approaches to providing clarity on when limited abortion is permissible -  guidelines, regulations, legislation alone or legislation plus regulations.

It says guidelines in isolation do not fulfil all the requirements set by the European Court judgement. It says in a democracy, measures which affect rights must have a secure legal basis.

On regulations, the report says the Minister for Health could not issue regulations without being given the power to do so by enabling legislation, and this would not be likely to prove a speedier or superior solution than other legislative options.

On legislation alone, the review group says postulating all the details of an assessment and review process in primary legislation might be too rigid an approach. In this case, even minor changes that might arise following implementation or in light of scientific advances would require proposed legislation.

On legislation plus regulations, the report says this option would be constitutionally, legally and procedurally sound. Under this option, most aspects of the provision of lawful termination would be set out in primary legislation, with certain operational matters delegated to the Minister to govern by way of regulations.

The advantages of this option are that it fulfils the requirements of the European Court judgement, it provides for appropriate checks and balances between the powers of the legislature and the government, and would be amenable to changes that might arise out of clinical practice and scientific advances, the report says.

It says the legislation/regulations option would remove the 'chilling effect' of existing criminal provisions under the 1861 Offences Against the Person Act. The report says thereby, legal protection from prosecution could be attained by compliance with the proposed new legislation.

Under this option too, regulations could be amended relatively easily to address changes in clinical practice and scientific advances.

The review says under the above option the Government could either repeal the 1861 Act and replace it with a new abortion law or retain the 1861 Act and amend it to reflect the judgment in the X case.

The report points out that the Supreme Court, in the X Case, ruled that the correct test for termination was if it was established that there was a real and substantial risk to the mother's life, which could only be averted by a termination.

On procedures for determining entitlement and access to terminations if specific operating provisions were introduced, the report says although medical decisions may be difficult in particular cases, the complexities will not arise from the words of the test but from diagnostic and treatment issues.

It says doctors will have to consider whether it is practicable to preserve the life of the unborn in the process of terminating the pregnancy, without compromising the right to life of the woman.

The report says evidence of this consideration must be documented, and it stresses that doctors involved in the process of deciding on termination issues must have received sufficient training and be engaged in clinical practice at an appropriate level.

The diagnosis of the doctor as to whether the woman satisfies the 'risk to the life of the mother' test in the X case should be made expeditiously/or within a defined time limit, and should be formally notified to the woman.

It says in addition to consultants and GPs, other professionals such as nurses/midwives and psychologists could have a valuable input into the the decision-making process on terminations.

The report indicates that two to three specialist doctors should be involved in the decision-making process on determining entitlement to termination and offers options for which combinations of specialties could be involved.

It says GPs should be consulted as a matter of best practice in the course of the diagnostic process, which would not burden them with making a clinical decision on entitlement to termination, which would fall outside the scope of general practice.

The review body says in emergencies, if a doctor carries out a termination where the risk to the life of the woman 'is imminent and inevitable rather than real or substantial' he or she should not have any liability because of the failure to follow prescribed procedures.

In rare emergency cases where no additional medical personnel are available, the opinion of one doctor should suffice regarding a termination. However, the report debates whether it is necessary to provide specifically for emergency scenarios and suggests clinical practice could continue to operate as it does at the moment in these cases.

The report points to a potential lack of legal clarity if emergencies were not specifically covered under new arrangements.

It says the Health Minister should stipulate the criteria for licensing and regulating centres in which terminations are permitted and for monitoring these facilities.

It says terminations 'at the fringes of viability' even where survival is not anticipated, should take place in centres which have neonatal intensive care units, and be carried out at such a time and manner as to maximise the foetal chances of survival, without compromising the right to life of the woman.

The report says there should be formal review panels established to provide guidance as to the rights of a pregnant women who believes she may be entitled to a lawful termination of pregnancy but whose medical advisers do not believe this is required in order to avert a threat to her life.

It looks at the option of having a medical or a legal review model.

The report says where doctors might have conscientious objections about carrying out abortions, a balance ought to be achieved between ensuring a patient's access to lawful medical treatment while also recognising an individual's conscientious objection, insofar as possible. Conscientious objection needs to be provided for with limitations to ensure patients would not be kept from accessing lawful treatment from other doctors.

Decision on abortion by year's end

What women want - a safer health service

Medics outline grey areas on termination