12 September 2004

Care of Children Bill: SOP

This is a joint letter from the New Zealand Medical Association and the Royal New Zealand College of General Practitioners who are concerned at the Supplementary Order Paper proposed by Judith Collins (237 of 27 July) to amend the Care of Children Bill.

When the Contraception, Sterilisation and Abortion Act was passed in 1977, the Guardianship Act 1968 was amended as part of the abortion legislation to permit pregnant girls under 16 to apply for approval for an abortion without informing their parents or guardians, or requiring their consent. The Care of Children Bill (which it is proposed will replace the Guardianship Act) now under consideration after being reported back from the Justice and Electoral Committee, retains this provision, although some Opposition members said they oppose it.

3. Our concern relates to the proposal in the Supplementary Order Paper to amend the clause 37 to require parents or guardians to be notified before a girl under 16 is referred to a certifying consultant. The SOP also proposes a legal alternative whereby if the “female child” objects to such notification, she may appeal to a Family or District Court Judge who will authorise the application to the certifying consultant without notification “should the Judge determine that the female child’s best interests would be so served”. The College and the NZMA do not consider this to be an adequate alternative, placing additional pressures on an already fraught girl, and giving no guidance to her as to how a Judge might measure her best interests. It is also likely to be difficult to implement this mechanism of objection given the limited time frames of early pregnancy and legal representation problems for a girl under 16.

The SOP does not intend that a guardian’s consent would be required to approve the referral, but the fact of the pregnancy, and presumably of the girl’s options to seek a certifying consultant’s approval for an abortion, would be passed on to parents or guardians. The change proposed is therefore about information, and who must receive it. It is not about the legality of abortion (or who can decide to seek one), but about whether the information about a pregnancy should go beyond the pregnant girl and her general practitioner. The two medical organisations are strongly opposed to this proposed change.

First, from a medical practitioner’s point of view the girl is a patient, entitled to the same privileges of privacy, and the same measure of confidentiality between her and her general practitioner as any other patient. Confidentiality about the outcome of a medical consultation is absolutely crucial if an effective doctor/patient relationship is to be established. The patient must be absolutely certain that his or her privacy will be respected if all the information necessary for effective diagnosis and treatment is to be obtained. Confidentiality is at the core of ethical, safe and effective medical practice.

Secondly, the Contraception, Sterilisation and Abortion Act has been effectively operating largely unchanged since 1977. The Act is a careful balancing of the rights of a number of parties, and any attempts to revise part of it should be considered in that context, not in associated but different legislation.

It would be unfortunate if the proposed changes outlined in the SOP were seen as an attempt to limit abortion, in the guise of readjusting the balance of rights to information of girls under 16 and their guardians. If the intent is to make access to legal abortion more difficult and thereby to reduce its incidence, this should be clearly stated at the outset, and the debate can be considered in those terms.

Thirdly, it seems probable that the risk of dangerous self-induced or illegal abortions would increase sharply if the SOP were to be passed. While medical practitioners counsel pregnant girls to tell parents and seek support, some girls, especially those subject to abusive relationships, if they know the doctor will be compelled to tell their parents, will likely self administer pregnancy tests and seek illegal and dangerous abortions.

The College and the NZMA consider that there are important medical, ethical and clinical reasons for opposing the SOP, and a serious risk of returning to the era of dangerous illegal abortions if it is passed.

ENDS

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