Senator Hanson-Young -This is a question to both of you, so I guess you can take it in turns to answer. I completely understand that you object to abortion per se. You have already said that; you have put that on the record. Putting that aside, how do you respond to evidence presented to this committee that disallowing this particular item-and that is what we are talking about; let us stick to the terms of reference-
Mrs Tighe -Yes, I know.
Senator Hanson-Young -on the Medicare schedule is not necessarily going to stop women from going through this procedure and that in many cases, as the evidence has been presented, it may actually prolong the time it takes for a woman to go through the procedure and therefore it is done later in the pregnancy as opposed to earlier. How do you respond to that?
Mrs Tighe -By providing medical benefits for something like one of these abortions you are really putting the icing on the cake. You are saying to the people in the community, to the women having abortions, to the families, whatever, 'It is of benefit to you to have this abortion and therefore we will use healthcare moneys'-health care moneys which should be used to provide good health care for all Australians-'and we will apply them to the removal of your child.' So I believe that, by government funding something, it is giving a message to the community and encouraging the practice. It may not actually stop a number of these abortions-not initially; it would not. But nonetheless it is, I believe, a first step that should be taken, to be saying to the community: 'Hang on-we should not be funding these because they are the purposeful termination of a human life; for whatever reason, that child is being killed.' So that is my response to that.
Senator Hanson-Young -Mr Egan?
Mr Egan -In practical effect the rebate is $200 for an in-hospital treatment-$203 now, under the 2008 schedule-or $225 for an out-of-hospital treatment. The price for a first half of the second trimester abortion, as far as I can ascertain it, is at least $1,285; I have not been able to find a cheaper one than that. So I would agree that removing that rebate is unlikely to have an effect, because I think $200 compared to $1,200 is probably not going to be a deciding economic factor for any woman. So it is difficult to see how that creates the barriers that people have been suggesting-
Senator Hanson-Young -Can I just jump in there?
Mr Egan -If you want to clarify something, for sure.
Senator Hanson-Young -I know that you have participated in witnessing the proceedings over the last day and a half, and I guess the evidence that was given was that moving that option-particularly in rural areas-and for women to perhaps need to go through the public health hospital system means that barrier is there because of the waiting list.
Mr Egan -It does not necessarily move them to the public hospital. I think this is a bit of a misapprehension in a sense, because all it does is remove a $200 rebate from a $1,400 operation so you are paying $1,400 now for it instead of $1,200. I really cannot see-
Senator Hanson-Young -But some people's fortnightly pension-
Mr Egan -I appreciate that $200 for some people is a lot of money, but I do not think it is the deciding factor in whether you go to the nearest abortion clinic that is offering these, wherever that might be.
Senator Hanson-Young -No, that is right; the evidence is that that does not change the decision to undergo the procedure-it prolongs it.
Mr Egan -Nor where you go for it, I think. And in fact the women who are resorting to the private abortion clinics and getting this Medicare payment are doing it because the terms on which they want the abortion are not provided at the public hospital. As many of the witnesses from public hospitals have said, they are not offering abortions for maternal psychosocial indications in the second trimester, and that is what the private clinics are offering that the public hospitals are not. I just think there are some category confusions in these assertions that this is putting barriers in the way of women.
Senator Hanson-Young -Can I just turn to your submission. Under point 5 you have the effects of disallowing the item. At 5.1 you talk about ending official approval of second trimester abortion-which, I would argue, is a bit of a furphy because women can still undertake the procedure through a public hospital, which is, of course, publicly funded. You then make that point again down in 5.5. So even just in that section you seem to contradict yourself in terms of what message this is sending to people.
Mr Egan -No, I am looking at the terms of the item, and if the Senate were to vote in favour of a disallowance of this item there is no doubt how that would be read publicly. Publicly that would be read as: 'A majority of the Australian Senate think there is something wrong with taxpayer funding of second trimester abortions; presumably that therefore means they think there is something wrong with second trimester abortions.' So-
Senator Hanson-Young -So you agree that this is a discussion about abortion as opposed to whether it should be funded publicly or not?
CHAIR -Can I just remind you, Senator, to allow the witness to complete his answer.
Senator Hanson-Young -Sorry.
Mr Egan -No problem. The mechanics of the thing are to do with funding but, clearly, the decision is based on how one assesses the validity of second trimester abortion. It is certainly possible that someone could conclude that, apart from perhaps some very narrow indicators, abortion in the second trimester is not for valid medical reasons and therefore should not receive Medicare funding. You could hold that position and believe nonetheless that it should also be legally available. That is not my position but it is a logical coherent position. That is the position taken by those people in the US Congress who year after year pass the Hyde amendment which denies federal funding for abortions while the same numbers will not pass a law proscribing abortions. Clearly, in the US Congress, there are a number of people who think abortion should not be federally funded but should not be illegal.
Senator Hanson-Young -Putting your moral objection to abortion aside, what clinical evidence do you have to support the disallowance of this item?
Mr Egan -What we have established in the two days of hearings is that for this item, which on the face of it is provided for a very narrow range of indicators, there is no shared understanding of what those indicators mean. At least some practitioners who provide abortions and claim under this item number interpret gross foetal abnormality to mean any foetal defect whatsoever however trivial, interpret life-threatening maternal disease to mean simply that a woman does not want to be pregnant and that not wanting to be pregnant can be understood as posing sufficient threat in itself without any other compounding factors to her mental health and therefore, by extension, be called a life-threatening maternal disease. I think that has been well established over the hearing. I am not saying everyone shares that view but there are practitioners who share that view. It is plain at the freestanding abortion clinics claiming this item number for second trimester abortion that they agree, as they do, to offer an abortion to a woman at 16 or 18 weeks pregnancy without requiring any reason or without even inquiring what the reasons are, simply on demand. That is how freestanding abortion clinics operate. They are not into asking for reasons.
In Western Australia you do not have to give a reason. The law was changed in 1988 so that if a woman requests an abortion, it is to be provided. The abortion providers in Western Australia, the freestanding clinics, see themselves as simply offering an on demand service. There is no inquiring as to whether there are any other medical justifications for the abortion up to 20 weeks. In WA, unlike Victoria, there is a law that prohibits post 20 week abortions and they are, interestingly, permitted for a grave clinical condition in the foetus or the mother. There has not, as far as I can ascertain, been a single abortion post 20 weeks in Western Australia for any grave clinical condition in the mother. The reported literature from the panel that approves them shows that all the abortions are for foetal disability. I conclude from that there is, in a well-run public hospital system, no reason to abort for maternal health conditions post 20 weeks.
Mrs Tighe -I sent this article round to all the senators some time ago and I have it with me again today. This was published in the Age in 1998, which was 10 years ago. Let me assure you that things have not improved in relation to the rights of unborn children since then. I think this gives a very graphic account of the situation not just in the public hospitals but in the private area of these late-term abortions. You can see the graphic illustration. It was not Right to Life Australia who prepared this; it was the Age-surprise, surprise. I do not think that they would have prepared it today but they did then.
I was present in 1994 at a conference held by the Royal Australasian College of Surgeons in Melbourne, with all the august former presidents looking down from their portraits, and I could not believe what I heard. Dr Grundmann was describing how he carried out late-term abortions later than anybody else in Australia. He described, blow by blow, what he does. He had learnt the procedure in the United States, and he described how he inserts laminaria into the cervix and the woman has that in overnight because it will swell up and open the cervix. When a woman is having a baby nature closes-
Senator Hanson-Young -Madam Chair, on a point of order-
Senator TROETH -Madam Chair, on a point of order-
CHAIR -I can foresee what the point of order would be-that they do not like the evidence and that you are digressing-
Senator TROETH -Madam Chair, I have a legitimate point of order.
Senator Hanson-Young -Thank you. Mrs Tighe, I was just going to redirect you back to my question, and that was-
CHAIR -Sorry: your point of order was that Mrs Tighe was digressing and now Senator Troeth has the call on the point of order.
Mrs Tighe -Just repeat the question; sorry.
CHAIR -Can I just rule on the point of order-and that is, according to the standing orders of the Senate, you cannot direct a witness on how to answer a question. Therefore, the question has been put to the witness and how she deems to respond to that is entirely up to her.
Senator Hanson-Young -I would put it to you, Chair, that perhaps the witness has forgotten what the question was, because she was about to ask me.
CHAIR -Mrs Tighe has the call.
Mrs Tighe -Do you want to repeat the question, Senator Hanson-Young?
Senator Hanson-Young -Thank you, Mrs Tighe. My question was: what medical evidence do you have to support disallowing this item, putting the moral objections to abortion aside?
Mrs Tighe -It would depend on who you are getting the medical evidence from. You cannot put the moral objections to abortion aside because it is not a religious belief; it is a reality. You are talking about killing a child and you cannot put that aside. If that was not the case, it would be none of my business. As I said, it depends on who you get the medical evidence from. The reality is-and this is contained in this article; I will not read it out-that there are a significant number of social reasons why women will seek late-term abortions and they are covered in this article. The other thing is that in the state of Victoria recently we decriminalised abortion up to 24 weeks, no questions asked, and then after that up to birth if, in the opinion of two doctors, it is necessary because of psychological, physical or social reasons. So it is open slather. The reality is that, in continuing to fund these abortions, you will be funding even more of them because of the passage of the law in Victoria. In a way, when the Commonwealth continue to fund these procedures, they are really giving their assent to them. There is no doubt about it-they are.
Senator Hanson-Young -My final question is: what type of medical expertise do either of you have?
Mr Egan -I have no medical expertise, but I follow this as a very interested layman and have done for probably 23 years.
Mrs Tighe -My so-called medical expertise is that I have been a pharmacist-and I know that is not like being a doctor. I guess it was really my gut instinct when I first became a mother, when I realised that I was having a baby. As well as that, I have always had a very strong sense of injustice. I cannot stand the thought of somebody more powerful picking on somebody who is not so powerful, and I do apply that to other aspects of my life too. That is why I have been very opposed to abortion. I think it is unjust. Finally, I would just like to say this: I know a number of people who could have been the victims of abortion. Some members of my extended family are children of single mothers and some older ones are adoptees, and I think to myself, 'Wouldn't it have been tragic if they had never been born?' Their mothers could have easily sought an abortion. I see what a marvellous contribution they are making to the world. One classic example-although I would not be voting for him if I was in the United States because he is pro abortion-is Barack Obama. There is a classic example when you think of his background. His mother was a single mother and had to pass the baby to the grandmother et cetera. I think that every person is deserving of our respect and we should not be killing people because we consider them to be a problem, whatever the circumstances.
Senator Hanson-Young -Thank you, Mrs Tighe. I agree that each person needs to be given respect, and I guess that is why I support a woman's right to choose, but that is just for the record.