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Thursday, 13 November 2008
Page: 14

Senator BARNETT (10:40 AM) —The incorporated speech read as follows

Introduction and Background

On 18 June 2008, I moved a motion in the Senate to disallow item 16525 in Part 3 of Schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2007. Item 16525 is described in the Medicare Benefits Schedule as follows:

MANAGEMENT OF SECOND TRIMESTER LABOUR, with or without induction, for intrauterine fetal death, gross fetal abnormality or life threatening maternal disease, not being a service to which item 35643 applies (Anaes.)

Fee: $267.00 Benefit 75% = $200.25 85% = $226.95.1

On 16 September 2008, the Senate passed the following resolution:

1.   That the subject of the motion for disallowance of item 16525 in Part 3 of Schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2007 be referred to the Finance and Public Administration Committee for inquiry and report on and not before 13 November 2008.

2.   That the committee in particular report on: (a)    the terms of item 16525 of part 3 of Schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2007; (b)    the number of services receiving payments under this item and the cost of these payments; (c)    the basis upon which payments of benefits are made under this item; and

the effects of disallowing this item.  

Following referral of the inquiry to the committee, I withdrew the motion to disallow item 16525 on 17 September 2008. I did this on the basis that I support full disclosure, putting the facts and figures on the table for all to see and to validate my own research on this matter. I am satisfied the Report has done this. But it has also unearthed disturbing new evidence on this issue which I believe many Australians would be concerned about.

Conduct of the Inquiry

The Committee received 484 public and 45 confidential submissions. Submissions in support of a disallowance generally focused on five key areas: termination for fetal abnormality; the use of psychosocial grounds for termination; the methods of termination used; the ‘unethical’ role of Medicare as a body responsible to preserve life and health; and the ill-effects on the physical and mental health of women who have undergone a termination.

A vast number of such submissions argued that item 16525 was utilised to terminate fetuses that could otherwise survive outside of the uterus and questioned both the validity of the definitions of the services provided under the item as well as the services actually claimed under the item number by medical practitioners.

Regarding the viability of fetuses, the second trimester covers from 14 to 26 weeks of pregnancy. Recent medical advances have led to an improvement in fetal viability so that infants born as early as 21 weeks have survived. Fetal surgery has also been successfully performed on unborn babies as early as 21 weeks of pregnancy. The concerns I raised on this issue in my briefing paper were shared by many who made submissions to the inquiry.

Some submitters to the inquiry in favour of the disallowance of the current item 16525 held that it was important to introduce alternative provisions for cases of lethal fetal abnormality, conditions which pose a significant risk of maternal death or intrauterine fetal death.2 This is a view I hold and have previously expressed. I, along with all witnesses at the inquiry, support the continued delivery of medical services for intra uterine death. This is not controversial at all in my mind.

Matters of Interpretation and Lack of Guidance

Evidence indicated that there is no shared understanding of the meaning of the phrases used to describe two indicators for claims under item 16525, that is, ‘gross fetal abnormality’ and ‘life-threatening maternal disease’. Dr David van Gend from the World Federation of Doctors Who Respect Human Life, for example, commented that although the item was ‘no doubt drafted in good faith’, because of loose definitions, ‘it is open to subjective interpretation by doctors, and terrible abuse’.3

Evidence gathered by the inquiry also demonstrated that the term ‘gross fetal abnormality’ is being interpreted by medical practitioners to include quite trivial, correctable disabilities such as a missing finger and cleft palate as well as common disabilities such as Down syndrome, dwarfism and spina bifida. The Report stated;

‘gross fetal abnormality’ was understood in contradictory ways by witnesses and a number of submissions pointed to the lack of a definition or any guidance given in item 16525 for the term.4

Funding abortions for fetal disability, in my view, contradicts our commitment to the elimination of discrimination on the grounds of disability. This view was strongly expressed and supported by a range of witnesses. Apart from being discriminatory, the evidence suggests that Australia may be in breach of a number of international treaties protecting the rights of the unborn, including the Convention on the Rights of Persons within Disabilities which Australia has recently ratified.

The term ‘management of second trimester labour’ is being interpreted to cover both partial birth abortion as well as prostaglandin induction of labour in which many babies are actually delivered alive and simply left to die, while others are killed by a lethal injection of potassium chloride to the fetal heart.

The term ‘life threatening maternal disease’ is being interpreted by medical practitioners to cover abortions for purely psychosocial reasons, effectively abortion on request.

These are issues I raised in my briefing paper earlier this year and which have been supported by the evidence put before the inquiry.

Recommendations in the Report —The Need for Better Data

As the Senate Report notes, the evidence before the committee points to a lack of data on terminations performed in Australia. The committee believes that there is an urgent need to improve the collection and recording of perinatal and neonatal data generally. The improvement of perinatal and neonatal data collection will have ramifications for health care policy and practice across Australia as it will provide improved data to inform government and the medical profession.

In order for this to be achieved, uniform data from all jurisdictions is required as well as the use of one classification system across the country. This would not only improve data for the purposes of analysis and comparison, but also enable consistency in relation to definitions.

As a result of these findings, the Committee has made the following recommendation which I fully support;

Recommendation 1

The committee recommends that Australian Health Ministers’ Conference ensure the prompt application of the Perinatal Society of Australia and New Zealand Perinatal Mortality Classifications across all States and Territories.

The committee recognises that improvement in data quality and consistency is essential for a complete national collection. The committee notes that the NMDS is reliant upon national agreement to provide uniform data as part of a national collection. It therefore encourages the Australian Health Ministers’ Conference to work with the National Perinatal Data Development Committee and other key stakeholders to ensure that, across all States and Territories, comprehensive uniform data is provided to the NMDS.

The committee has thus made the following recommendation, which I also support;

Recommendation 2

The committee recommends that Australian Health Ministers’ Conference secure an agreement with all jurisdictions to work towards providing complete and uniform data to the Perinatal National Minimum Data Set.

My Response to the Report

Confirmation of Previous Concerns

This inquiry confirms the concerns I raised in my briefing paper earlier this year, and the validity of the reasons why I put forward this motion in the Senate. I supported the inquiry, as I indicated when I withdrew my motion in September of this year.

The inquiry has confirmed that taxpayers have paid nearly S1.9million since January 1994 in support of 10,722 procedures under this item. Evidence given to the inquiry suggested that only a small number of these procedures would have been inductions following intrauterine fetal death.5 The overwhelming majority of these procedures would have been second trimester and late term abortions.

I believe the money expended on these abortions could be more appropriately used for pregnancy support services and I urge the government to seriously consider this initiative.

For the full details of the relevant statistics, costs and numbers of Medicare claims processed under item 16525, further detail can be found in the Report.

Disturbing New Evidence

The inquiry has also unearthed further disturbing evidence. Some of these disturbing issues include:

  • Fetal pain during abortion procedures is not properly understood or humanely managed;
  • The brutality of the abortion methods being used in Australia is worse than previously understood;
  • Babies are being born alive and simply left to die as part of the abortion process; and
  • The evidence strongly suggests a eugenics agenda against the disabled.

More specifically, there is confusion and ambiguity regarding the definition of gross fetal abnormality and life threatening maternal disease. It is interpreted in different ways by different people and is open to abuse.

For these and other reasons, and in response to this report, I will be writing to the Federal Government urging them to address the issues raised by the report, and to note the evidence that has come to light in the course of its investigations.

Pending the Government’s response, I will then consider whether or not to reintroduce my motion to disallow Medicare Funding for second trimester and late term abortions.

Concluding Remarks

The Report prepared by the inquiry into Medicare funding of second trimester and late term abortions has unearthed significant new evidence on the issues raised in my Senate motion. It has also confirmed the need for further discussion of these issues as we seek to develop a balanced response. I urge all people interested in this matter to read this Report which is available on the Senate’s website.

At this point, I would like to thank the Secretariat of the Committee, Christine McDonald and her hard working team, for their studious efforts in reviewing the submissions and preparing this Report.

I also acknowledge the Chair of the Committee, Senator Helen Polley, for her leadership on this issue and the manner in which she has overseen this process.

Public Interest —Petition Response

There has also been considerable interest in the community on this issue.

The inquiry received over 500 submissions for consideration, with a wide range of views being expressed. These views have been fairly and appropriately represented in the final form of the Report.

There has also been overwhelming support from around Australia on this issue and later today I will be providing 15,337 petition signatures to the supporting this motion which will be presented in the Senate on the next sitting day. These are in addition to the 12,982 signatures that have already been lodged in September and October of this year.

That makes a grand total of 28,319 signatures supporting this motion —one of the largest petition responses seen in the Parliament for some time.

Personal Thanks

In closing, I would also like to thank the many thousands of people around Australia, and indeed from overseas, who have personally supported and encouraged me in this endeavour. Your thoughts, prayers, letters, emails and action have all made a difference, and I thank you for it.

A special thankyou to Gianna Jessen, an abortion survivor from the USA, who visited our country two months ago to support my motion and to tell her story.

Together we have raised an important issue. With the help of the democratic process and the inquiry, we have seen important new information come to light.

I will now be writing to the Government calling on them to respond to the issues in the Report.

   1 q=1652586sopt=1 (Accessed 13.10.08).

   2       See for example, Catholic Health Australia, Committee Hansard, 29.10.08, pp2-3.

   3       Dr David van Gend, World Federation of Doctors Who Respect Human Life, Committee Hansard, 29.10.08, p.45.

   4       Finance and Public Administration Inquiry into Motion to Disallow Medicare Item 16525, Chapter 3, p.3.

   5       Dr David Knight, Committee Hansard, 30.10.08, p. 74