Nearly seven months after the Protection of Life During Pregnancy Act came into effect, health professionals have to date only been issued with guidelines on how the appeals system where a woman is refused an abortion should operate.

This 'back to front' approach to guidance on the operation of the abortion law is known to be causing considerable concern among relevant health professionals.

Four months after the Department of Health promised they would be published shortly, guidelines on the overall operation of the abortion law, in particular how the system should work in the earlier stages when a woman presents seeking a termination, have yet to be produced.

The guidelines on how to act when a woman appeals a decision to refuse her a termination were sent to doctors by the HSE back in April. The Department of Health has been promising to produce guidelines for health professionals on the overall operation of the Act since early this year but has yet to officially publish them or distribute them to health staff.

The lack of complete guidelines are particularly relevant in the current controversy, in which a young woman who had been raped sought an abortion and later had the baby delivered by caesarean section.

While the full details of the case have yet to come to light, alleged delays in dealing with the case in its early stages have highlighted the lack of full operational guidelines for health professionals under the Act.

The Department of Health told irishhealth.com this week that its guidance document on the Act is currently been finalised and will then need to be submitted to the Minister for Health prior to publication.

It said the guidance was expected to be published shortly, adding that draft guidelines currently in the public domain, and which have been seen by some doctors, were not the final version.

The Department told irishhealth.com back in April that its guidance document, drawn up by an expert committee, had been signed off and would be ready for publication 'shortly'.

While health professionals have guidelines from the HSE on how the review system works following a decision to refuse a termination, they are essentially in the dark in terms of guidelines for other crucial operational components of the system in place under which termination requests are dealt with, in particular, the procedures to be followed when a woman presents to the health system seeking a termination.

Currently, doctors must largely rely on the legal terms of the Act, 'leaked' draft Department of Health guidelines which have not been finalised, HSE guidelines which only cover the latter part of the process if it comes into play, and their own clinical judgement.

The HSE guidelines on the appeals process under the abortion law, as reported by irishhealth.com in April, provide a 'flow chart' outlining the process to be followed under the review provisions in the Act in cases where a woman has been refused a termination and appeals the decision.

The chart outlines how once a woman has been refused a termination, she or somebody acting on her behalf, for example her GP, can make an application to the HSE for a review of the original decision.

The HSE has appointed a panel of medical specialists from which a review committee is convened to consider cases where an appeal against a refusal of an abortion has been made. This committee examines the case and decides either to uphold the original refusal or overturn it.

In the latter case, provisions can be made for the termination to be carried out in a designated hospital.

The HSE guidelines stipulate that the process where a review request is received and the review committee convened must not take longer than three days, while the process under which a decision on the appeal is made must take a maximum of seven days.

Under the Act, the specialist composition of the review panel should mirror that of the panel which made the original assessment on whether an abortion was permitted.

The Irish Times reported today that concerns for the psychological welfare of the young woman in the current controversy were brought to the HSE at the end of May, two months earlier than had previously been reported. This was when the woman was 16 weeks pregnant.

It is believed that at that point, the woman attempted to take her own life.

It is reported that in this case, the provisions of the abortion laws did not come into play until July, when the woman attended a GP and was then referred to a psychiatrist, and a termination request was subsequently formally considered. This has raised questions of apparently delays in dealing with this case at an earlier stage, where the woman was already under considerable psychological distress.

Her baby was delivered by Caesarean section earlier this month, at around 25 weeks gestation. The woman said she was was suicidal as a result of the pregnancy.

The woman said she was initially informed by doctors she could have an abortion but that this decision subsequently changed and the baby was then delivered by Caesarean. It has been reported that the obstetrician on the panel assessing the termination request felt the pregnancy had progressed far enough for a delivery to take place.

The HSE is to announce today the terms of reference for its inquiry into the case.

The probe is expected to focus, among other issues, on delays in dealing with the crisis pregnancy and will also attempt to bring more clarity to the details of the case, which to date have been confusing and contradictory to a certain extent.

Health Minister Leo Varadkar has pointed to this, stating that some of those commenting on the case do not know all the facts.

He said he wanted to read the HSE review report, due to be published next month, before engaging with the case in a detailed way and said he would encourage others to approach it in the same manner.

Abortion debate reignited