Family First
Additional Comments
Summary
Family First opposes abortion and believes more should be
done to help reduce the abortion rate.
Disallowing item 16525 is unlikely to cut the number of
abortions, but would send a clear signal that the Parliament is not willing to
give financial support to the abortion of unborn children up to 26 weeks
gestation.
Item 16525 covers a range of procedures other than second
trimester abortion. Family First is concerned that these other legitimate
procedures should continue to be offered. It is clear that whether item 16525
continues to exist or not, all of the procedures will be offered at public hospitals.
Claims that abolishing item 16525 will impact unfairly on
lower income women are not credible, given the $273 fee covers only a small
proportion of the full cost of procedures. In terms of second trimester
abortion, a woman would have to cover the balance of the cost, which ranges
from $1,250 to $4,000.[1]
Clearly low income women would attend a public hospital rather than go to the
expense.
Evidence given to the Committee has revealed a disturbing
view that unborn children with disabilities should be aborted to save the
public purse. This view was even contained in a submission by a group of
parliamentarians.[2]
Nobody is perfect. It is exceedingly arrogant for people to
both assume the lives of people with disabilities are not worth living and to
advocate they not be allowed to be born because their care would cost money. It
is clear that the children with disabilities and their parents deserve much
more support than is offered by governments and the community.
Family First therefore supports the motion to disallow
Medicare item 16525.
Disallowance motion
The Finance and Public Administration Committee was
requested to examine Medicare item 16525 as a result of a disallowance motion proposed
in the Senate to abolish this item for second trimester abortion.
It is important to state at the outset that Family First
opposes abortion and believes more should be done to help reduce the abortion
rate. Family First believes its views are in line with the majority public
opinion in Australia:
The definitive study, conducted by the Southern Cross Bioethics
Institute in 2005, Give Women Choice: Australia Speaks on Abortion, showed
quite clearly that in spite of a general support for the right to abortion
(63%) the community rejects it morally, wishes to reduce its incidence, wants
mandatory counselling, and views late-term abortion with abhorrence. Another
national poll in 2005 also found that 67% of Australians were opposed to
Medicare funding for second trimester terminations.[3]
Family First therefore supports the motion to disallow
Medicare item 16525. Family First does not believe second trimester abortions
should be allowed to occur in private for-profit abortion clinics.
Disallowing item 16525 is unlikely to cut the number of
abortions, but would send a clear signal that the Parliament is not willing to
give financial support to the abortion of unborn children up to 26 weeks
gestation through Medicare funding:
The first effect of disallowing item 16525 would be to make a
clear statement to the Australian people that the Senate does not approve of
the use of taxpayer funds to pay abortionists to kill unborn children in the
second trimester of pregnancy through partial birth abortion, potassium
chloride injections into the beating heart of the child, live born delivery
followed by death by neglect and abandonment or any other means. This would be
in line with public opinion. Two out of three (67%) of Australians are opposed
to Medicare funding of abortions performed in the second trimester and only 14%
support this arrangement.[4]
The use of item 16525
It was clear from evidence presented to the inquiry that
item 16525 covers a broader range of procedures than just second trimester
abortion and therefore Family First believes there is a genuine and urgent need
to review the other procedures that are covered under item 16525.
Evidence from the Department of Health and Ageing stated
clearly the restrictions imposed on abortion providers:
The second trimester is generally considered to range between 13
and 26 weeks gestation. A Medicare rebate is not available for second trimester
labour outside the restrictions of this item. The item restrictions include
intrauterine fetal death, gross fetal abnormality or life threatening maternal
disease. It is a matter for the doctor's clinical judgement as to whether a
patient's condition meets these second trimester requirements. There is no
Medicare item for terminations in the third trimester.[5]
It was alarming to hear evidence submitted that many
abortions being performed did not fit these descriptors and that they were
being misinterpreted by means of loopholes in the current item number:
It is even more apparent to me having had the benefit of
listening to other witnesses than when I made my submission that the term
‘gross foetal abnormality’ has no fixed definition. We heard from the
department of health representatives yesterday that ‘gross’ in their view means
macroscopic, visible to the naked eye. That could include Down syndrome,
because there are some external features that can be picked up by ultrasound; a
missing digit; and so forth. We were told, though, by other expert witnesses
that it never occurred to them that that meaning of gross would be the one to
apply in this circumstance and that they interpreted gross in one common
dictionary meaning of ‘serious or grave’. Others have suggested that gross
means something close to lethal or at least incompatible, as one witness said
this morning, with a long life. Another witness, who is an expert in prenatal
testing, said that gross is not a word he uses in this context and so could not
define it.[6]
The Department of Health and Ageing stated that "for a
termination to be funded through Medicare it needs to be provided in accordance
with State and Territory law",[7]
but the Department later stated in the hearings that, despite this statement
suggesting there is strict oversight, it takes no role in assessing lawfulness
and instead trusts that the law is followed.[8]
Reasons for second trimester abortions
Dr Lachlan Dunjey gave evidence that from figures released
in Victoria that the vast majority of post-20 week abortions were for
psychosocial distress and not lethal abnormality:
From the figures in Victoria, I think it is clear that the vast
majority of abortions were for psychosocial distress and therefore, yes,
elected by the mother and agreed to by the doctor. Some were due to foetal
abnormalities of various descriptions and descriptions which, in my view,
certainly do not fit within the range of lethal abnormality. The vast majority
of these were for elective reasons and should not be given ipso facto national
approval by granting medical benefits for these procedures.[9]
Specifically, the concern with item 16525 is that this
item is being used for elective abortion in circumstances where the definition
of ‘life threatening maternal disease’ has come to mean ‘psychosocial distress’
and ‘gross foetal abnormality’ has come to mean ‘any abnormality or considered
defect’.[10]
Other procedures offered under item 16525
By separating out Medicare item numbers for spontaneous
intrauterine death (or miscarriage in lay terms) another item number for lethal
foetal abnormality and another for a mother at risk of death from deliberately
induced abortion would go a long way to closing these loopholes.
The introduction of a new Medicare item to cover rare
circumstances such as intrauterine foetal death and procedures unequivocally
necessary to prevent the death of the mother would ensure that women whose
unborn child dies from natural causes in utero continue to receive appropriate
care and assistance.[11]
Family First is concerned that these legitimate procedures
should continue to be offered. It is clear that whether item 16525 continues to
exist or not, the procedures will be offered at public hospitals which a vast
number of submitters clearly saw as best practice for these procedures.
It would be practice in the
public hospital system for that woman to be given extensive information and
counselling: input from skilled obstetricians, genetic counsellors, paediatricians,
social workers—whatever is required to ensure that she is fully informed about
what is going on. But in the public hospital system the counselling that is
provided is highly skilled and extensive.[12]
Public hospitals
Family First believes that public hospitals are the only
place second trimester abortions should be provided. Private for-profit
abortion clinics can be too easily distracted by financial and commercial
interests and are not bound by public scrutiny and accountability that is
required of public hospitals.
The point you make about public hospitals is very important
because that addresses the obvious concern of those very grave abnormalities
which are not lethal. That is a matter for terrible clinical agonising, not to
mention parental agonising. The only valid place for such a complex and unclear
clinical situation to be considered is in a major institution, a public or
private hospital with ethics committees, with specialists. I put it to the
committee: that sort of decision is not to be made by a commercial abortion
doctor on his own.[13]
These major publicly funded emergency hospitals provide life
saving scrutiny in a grey area. This public accountability is ultimately a
benefit for women:
It is our position, based on strong evidence, that the practice
of abortion in Australia lacks scrutiny. It is mostly an unregulated,
unaccountable industry which does not act in the best interests of women in
denying them information relevant to their future health and wellbeing. Abortion
providers, even those with questionable records and operating outside medical
and ethical requirements, have benefited from Medicare funding. Some
practitioners have been accused of rorting Medicare for early and late-term
abortions. This requires full investigation because it appears that the cases
that have been reported on are not isolated incidents.[14]
Disability
Family First was concerned that the birth of children with a
disability was cited as a reason to keep item 16525:
The financial cost of caring for a severely disabled individual
is high not only for the family, but for the greater community. Removing item
16525 would save the Commonwealth, by some estimates, $181,560 per year based
on 2007 utilisation of item 16525. Adequately supporting an individual with high
support needs costs the community and families far more than this.[15]
This disturbing attitude was echoed by Dr Weisberg for
Family Planning New South Wales:
You also have to look at what would mean to the community to
have an increase in the number of handicapped children who needed assistance,
because that would be a far greater cost than this Medicare item.[16]
It is interesting that those defending item 16525 on the
basis of the cost of people born with a disability listed the negatives or the
expense of a person born with a disability, but failed to acknowledge the
benefits each person brings to the world. It is a concern that a person's
disability can so dominate our attitude to them that we sometimes cannot see
their other characteristics.[17]
Conclusion
Family First therefore supports the disallowance of Medicare
item 16525 and does not agree that this will unfairly impact on women. Services
provided by this item number will continue to be provided by public hospitals,
offering women a safer and more accountable environment.
Senator Steve Fielding
Leader of Family First
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