The HSE has recently issued guidelines for doctors on the appeal process for women who are refused requests for terminations under the Protection of Life During Pregnancy Act.

However, these operational guidelines only deal with the appeals process aspect of the Act. Health professionals have yet to be issued a long-promised clinical guidance document on how the Act as a whole, which provides for abortion where there is a real and substantial risk to the mother's life, should be implemented.

This document, which was due to be issued at the beginning of this year, is expected to be published in the next week or so.

The HSE's head of quality and patient safety, Dr Philip Crowley early last month sent doctors 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 women 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 will mirror that of the original assessment on whether an abortion was permitted.

The Act provides for terminations where there is a real and substantial risk to the life of the mother and where the only treatment that will avert that risk is termination of pregnancy.

In the case of a risk to a woman's life arising from a physical health condition, the abortion assessment is carried out by an obstetrician and a second relevant specialist, who must jointly agree and certify that a termination is the only procedure that will save the woman's life. Where feasible, the women's GP will be consulted.

In the case of a threat to life from suicide the assessment process involves three specialists-one obstetrician and two psychiatrists, who must jointly and unanimously agree and certify that termination is the only treatment that will save the woman's life. In these cases too, the patient's GP can be consulted.

In the case of an emergency, where the risk to life is immediate, one doctor can make a termination decision.

As yet, however, health professionals, such as doctors and midwives, have no clear set of guidelines available on how all aspects of the legislation should be implemented, including the making of clinical decisions on whether or nor to carry out a termination in the first place, and the basis on which appeals should be considered.

Asked why operational guidelines on only one part of the process under the legislation had been issued in the absence of guidelines for health professionals on the implementation of the Act as a whole, the Department of Health told irishhealth.com the Act designates the HSE as the authority for the establishment and implementation of the review process under the Act.

"Therefore they (the HSE) may take whatever steps they consider appropriate to ensure that their functions and responsibilities under the Act are fulfilled, " a spokesman said.

The Department said a final draft of the guidance document for health professionals on the implementation of the abortion legislation had now been signed off by the Committee tasked with drawing it up.

The abortion legislation became operational in January. Some medical organisations have expressed concern over the fact that the legislation was introduced in the absence of clinical guidelines.

However, the Department says the Act does not include any provision with regard to the guidance document for health staff 'and therefore the completion and publication of such a document is not required for the implementation of the Act'.

Asked if it was known whether any terminations had been performed under the Act since January or if any decisions to refuse an abortion had come up for review, the Department said the Minister for Health must publish an annual report on the operation of the Act, which would include such statistics.

The first annual report will be published in June 2015, a spokesman said.

The HSE has not released the names of doctors in the review panel from which specialists are to be chosen to undertake reviews of decisions to refuse abortions under the Act.