Helen Polley (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I present the report of the Standing Committee on Finance and Public Administration on item 16525 in part 3 of schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2007, together with the Hansard record of proceedings and documents presented to the committee.

Ordered that the report be printed.

by leave—I move:

That the Senate take note of the report.

The Finance and Public Administration Committee were asked to inquire and report on a motion moved in the Senate by Senator Barnett to disallow item 16525 in part 3 of schedule 1 to the Health Insurance (General Medical Services Table) Regulations 2007. In particular, the committee were asked to report on the terms of the motion, the number of services receiving payments under this item and the costs of the payments, the basis upon which payments of benefits are made and the effects of disallowing this item.

The inquiry was well received and the committee received 484 public and 45 confidential submissions. I thank those people for taking the time to make their submissions. Further, I would like to thank all the people who gave their time, their expertise and their opinions on this very important issue. What appeared on the surface to be a black-and-white conscience vote turned out to be a very detailed interpretation of definitions and data and moral questioning on a number of issues surrounding pregnancy and the health of the mother and unborn baby.

The committee firstly had to gather information about item 16525. The Medicare Benefits Schedule describes item 16525 as the ‘management of second trimester labour, with or without induction, for intrauterine foetal death, gross foetal abnormality or life threatening maternal disease’. Second trimester is generally considered to range between 13 and 26 weeks of pregnancy. The committee were advised that fewer claims are processed under item 16525, second trimester, than under item 35643, first trimester. We were given figures that in 2007-08 there were 794 claims under item 16525 compared with 71,957 claims under item 35643.

The committee heard evidence about what is a life-threatening disease, termination methods, the impact on women’s health and wellbeing, the effects of disallowing item 16525, termination for foetal abnormality, the role of Medicare, the potential financial effect of a disallowance, the adequacy of the rebate and the potential effect on second trimester abortion numbers. What has been very evident during this inquiry is the lack of data on terminations in Australia. It has not been possible for the committee to have a clear understanding in relation to how many services receive payment under item 16525, because it includes spontaneous abortions—miscarriages—and medical or induced abortions, or terminations. There are a number of different data-gathering methods across the country, so we cannot compare apples with apples. There is a lack of consistency among the states and territories in how terminations of pregnancy are identified. An example is stillbirths. Some states can distinguish late terminations from stillbirths, but other states cannot differentiate them. There is also confusion over the use of terms ‘abortion’ and ‘termination’. These words were used in different contexts with different meanings by witnesses throughout the inquiry.

There is a lack of consistent definitions. To give you an example of what I am talking about, let me quote from some of the submissions that the committee received. The term ‘gross foetal abnormality’ is often used as the reason for termination under item 16525. However, many witnesses pointed to the lack of a definition or any guidance for the use of this term. One witness said—and I quote from comments made by the Department of Health and Ageing:

Generally, the term ‘gross’ in medical parlance indicates something that is macroscopically visible, that is, it does not require the aid of a microscope to identify. It is an abnormality that is obvious to the naked eye. While a pregnancy that is continuing, these days it is generally something that can be identified on ultrasound.

Professor David Ellwood stated:

My interpretation of the phrase ‘gross foetal abnormality’ really means a significant or severe foetal abnormality. The idea that it is something that is visible to the naked eye is nonsense. We use technology, ultrasound, genetic testing and metabolic testing these days. In my experience, it is not anything to do with whether or not this is something that you can see with the naked eye.

Witnesses said that it is now left to the practitioner’s clinical decision as to what constitutes a gross foetal abnormality. What has happened is that gross foetal abnormality has come to mean ‘any abnormality or considered defect’. The committee heard from Dr David Knight, who said:

I think it is probably a bad term and I think it is capable of being misunderstood. My understanding of it is that it is a lethal foetal deformity or a deformity of such magnitude that it would prevent a human being from leading a normal life. That would be my understanding of the word ‘gross’. However, I can see how it could be misinterpreted or misunderstood and I would think that perhaps a better term should be found.

The committee has recognised a need for an improvement in data quality and consistency so that a complete national picture can be easily recognised. Uniform data from all jurisdictions is required not only to improve data for the purposes of analysis and comparison but also to enable consistency in relation to definitions.

This could have been a much more emotive issue to deal with. It was not and nor was it ever intended to be a debate on abortion. We have been there; we have had that debate. It was purely relating to financing using taxpayers’ money. There was a lot of witnesses and a lot of evidence from people who would normally not support abortion but who wanted to make it very clear that they in no way would condone any additional stress placed on families who were suffering from miscarriages or stillbirths. I think it is important to put that on the record. I am sure other speakers will comment further on this during the debate.

The committee therefore recommends that the Australian Health Ministers Conference ensures prompt application of the Perinatal Society of Australia and New Zealand Perinatal Mortality Classifications across all states and territories. The committee also recommends that the Australian Health Ministers Conference secures an agreement with all jurisdictions to work towards providing complete and uniform data.

As I said, this was an emotive issue. I wish to place on record my appreciation to all my colleagues, senators, members of my committee, participating senators, those people who gave evidence over the two days for the way in which they cooperated with me as chair and for the dedication that they demonstrated to this very important issue.

I believe it has been a thorough and informed inquiry. Our recommendations will ensure that this very complex issue of second trimester terminations will continue to be discussed and debated once a uniform method of gathering data is established and clear definitions are used throughout the country.

I encourage all senators and the public to read this report, because it very clearly states the case for disallowance and, for those witnesses who believe it should not be disallowed, the case against disallowance. Only two recommendations came out of this report. I commend those recommendations. I would also like to place on record my thanks to the secretariat for the work that they did and the dedication and the timely way they were able to present the report.

Claire Moore (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

I wish to inform the Senate that informal arrangements have been made regarding the time allocation for this discussion.

John Williams (NSW, National Party) Share this | Link to this | Hansard source

I seek leave to incorporate Senator Barnett’s speech.

Leave granted.

Guy Barnett (Tasmania, Liberal Party) Share this | Link to this | Hansard source

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       http://www9.health.gov.au/mbs/search.cfin? 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

Ron Boswell (Queensland, National Party) Share this | Link to this | Hansard source

I wish to make some comments about a couple of the submissions made to the Senate Standing Committee on Finance and Public Administration. Firstly, the submission presented by the Australian Reproductive Health Alliance was the same as the submission from the Parliamentary Group on Population and Development. That in itself is cause for concern. Senator Moore, as chair of the PGPD, presented the submission to the committee. In the covering letter, she writes, ‘Thank you for the opportunity to present the PGPD’s views. Yours sincerely, Senator Claire Moore, Chair.’

However, not only was the submission a straight copy of another submission; it also did not have the support of the PGPD. It was wrong to claim that the submission represented the views of the PGPD. The submission was not put before all members of the parliamentary group to gauge their support or input. It was put forward as the group’s submission without consultation. I understand that several members of the Parliamentary Group on Population and Development have resigned or disassociated themselves from the submission. As a result of this submission going forward in their name, the credibility of the PGPD must now be seriously in question. There is a very good reason for disquiet from members of the PGPD. The submission essentially argues that abortion is a cheaper alternative to looking after children with severe disabilities. The submission includes a section entitled ‘The community impact of increased numbers of children with severe disabilities.’ It states:

The removal of item 16525 from the Health Insurance (General Medical Services Table) Regulations increases the likelihood of a greater number of persons being born with severe disabilities and high support needs … The cost and impact of an increased number of individuals with severe disabilities living in Australia cannot, however, be ignored …

       …         …         …

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 1652515. Adequately supporting an individual with high support needs costs the community and families far more than this.

I would like to know whether the government supports the approach that disabled children be aborted rather than put further strain on the disability services sector, because that is what is clearly implied by this offensive submission. Its underlying premise is that some lives are worth less than others because they will cost too much to support. This is the kind of thinking that was typical of the Hitler regime. It set itself up as judge of who deserved to live and who deserved to die. This revisiting of eugenics principles is repugnant to a society that prides itself on the contribution of all, regardless of whether they have disabilities. We are all human and equally deserve to live.

Claire Moore (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

I am going to speak shortly on the committee report, but in view of Senator Boswell’s comments I am going to make a personal explanation later in the day. I want to put on record now the intent of our joint submission. It was put in separately, but it was clearly meant to be a joint submission from the Parliamentary Group of Population and Development, whose secretariat is the Australian Reproductive Health Alliance, which produced the submission. It was never intended to impugn or make any statements about the costs or about people in our community. In fact, Senator Boswell, if you had read the earlier paragraph you would have seen the statement we made, but I am not going to use this short time to speak on that. I will possibly speak later in this evening’s adjournment debate on that issue.

At this stage I wish to acknowledge the work of our committee and the extreme effort put in by the chair and the secretariat to ensure that, as the chair said in her contribution, the whole debate was focused on the issue of Medicare funding as opposed to a general debate on the topic of abortion. I admit that at times it did tend to move into the wider context, as you would expect, because of the deep commitment and care that people have across the views on this issue. We saw many people, whom we have met on previous occasions with various committees in this place, who came forward with submissions and opinions and who feel intensely strongly about the issue of abortion in our community. However, the topic before us was looking at Medicare funding, and it is important that we understand that Medicare has been a longstanding component of Australian health and that the idea of Medicare is that it provides Australians with affordable, accessible and high-quality health care. It ensures that Medicare benefits are paid to eligible healthcare consumers for services provided by eligible health practitioners. That is what is happening with the item before us.

We had extensive evidence about Medicare from people from the department who talked about how the different provisions of Medicare are governed in this country, how different practices are put onto the Medicare schedule and how there is an intense process used to ensure that this is done in a professional and objective way. The business and administration of Medicare is governed under the Medicare Act 1973. This act does not cover the clinical aspects of Medicare. That is covered through aspects of the Health Insurance Act 1973 and its regulations. Through this debate, we are looking at a regulation. In the regulation, it sets out clinical descriptions of services and fees. They are published openly on the Medicare Benefits Schedule. We have a range of professional, administrative and advisory groups that determine what the medical practice is through that process. It is not something that is determined by people’s particular beliefs; it is a medical issue determined by professional provider and practitioners.

In that way, what should happen when we are looking at medical provision is a going back to the professional areas to ensure that they review what is going on if necessary. We questioned at length a series of doctors and professionals who work in this area to establish whether there had been any complaint at any time about medical practices under this item. They checked their records and found there had not been a complaint. There is a professional provision available in our community that people can refer to if they have complaints about what service is actually provided under these regulations. We questioned a number of the doctors and asked them whether they understood this process and if they knew how it could be activated. They agreed, from the head of the professional organisation down through various practitioners, that they understood this process and accepted that it was practice. Then, under questioning, Medicare advised that there had been no complaint. We heard from people from the obstetricians professional association that various clinics referred to in evidence had probably the most reviewed and consistently observed clinical procedures anywhere in the country and were without professional complaint under the regulation.

I refer people to this report because it puts forward the issues and the evidence, both for the Barnett motion and also for those who oppose it. I commend the people who participated in the debate. I commend the secretariat for their extremely professional work. We have in this country a health system that is available to all people. The issue is between the person—in this case, the woman—and her medical practitioner, using the services provided under our legislation.

Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Parliamentary Secretary for Immigration and Shadow Parliamentary Secretary Assisting the Leader in the Senate) Share this | Link to this | Hansard source

I rise to comment on the tabling of this report. This has been another difficult question for the Senate. Whilst the object of the inquiry was primarily about the management of second trimester labour, it nevertheless focused on the wider issue of abortion. It is always an issue which raises challenges and views across the spectrum of our community.

Some of the evidence given was not only graphic but also very confronting, and it is evidence which I am sure is not known by many in our community. Some of the evidence that was given referred to how babies were being born alive and left to die, the brutality of methods that are used in second trimester abortions, resulting in foetal pain, and what appears to be a eugenics agenda against the disabled, promoted in identically worded submissions, which have just been referred to, by the Australian Reproductive Health Alliance and the Parliamentary Group on Population and Development. These submissions appear to argue that Medicare funding should be retained for second trimester abortion because allowing disabled babies to be born would be a burden on the Australian taxpayer. The submission from the parliamentary group, from which I understand several members and senators have distanced themselves, is particularly troubling.

During the inquiry it became very clear that there is not only uncertainty about some of the descriptors under item 16525 but also a lack of clear data. The Medicare data contained in the report indicates the total number of services provided under the items; however, the data is only available for all services provided under the item and is not available for each indicator or the circumstances of the labour. In short, there is a lack of data on terminations performed in Australia. Better collection of data will have ramifications for healthcare policy and practice across the spectrum. Not only will better and more informed data ensure that government, the medical profession and the general public can be better informed, but it will also afford greater opportunities for better education in the area of perinatal and neonatal issues.

In conclusion, this is an emotive issue often presenting diametrically opposed views. It is important, as the chair said, that there be better information, because I think this will in turn ensure a greater respect for those different views which may be held for scientific, medical or ethical reasons. However, the dismissive attitude toward the views of others by some during the hearing was very regrettable.

Steve Fielding (Victoria, Family First Party) Share this | Link to this | Hansard source

There is a temptation, when talking about abortion, to skim over the tough emotional reality of the procedure and to try to engage with the issue of the termination of pregnancy on a more technical and removed level. When you do that, the emotional reality is sometimes not considered. We try not to think about abortion because it is such a difficult and troubling issue. But, as senators, we need to really engage with this issue. We need to acknowledge the emotions and the desperation of women who consider abortion and we need to acknowledge the reality of the unborn life that was lost.

The issue of whether the Senate should disallow Medicare item 16525 can seem like a technical issue. But it does have an impact on the lives of women and their unborn children, and that is why Family First has taken the issue so seriously. Family First opposes abortion and believes more should be done to help women facing a difficult pregnancy, which would help reduce the abortion rate. How can we make our community more supportive of mothers and their babies?

The proposal before the Senate is to disallow Medicare item 16525, which provides a direct subsidy of $273 for second trimester abortions. Disallowing item 16525 is unlikely to cut the number of abortions but it would send a clear signal that the parliament is not willing to give financial support for the abortion, at up to 26 weeks of gestation, of an unborn child, some of whom are old enough to be delivered.

But the issue is not that straightforward. 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. For example, item 16525 includes subsidising medical help for women suffering a spontaneous intra-uterine death—or, in lay terms, miscarriage. That assistance should obviously continue to be offered to women. The Department of Health and Ageing gave evidence that it is possible to relatively quickly redefine Medicare item numbers, so a subsidy for these non-abortion items could still be provided if item 16525 were disallowed. But, in evidence given to the Senate Standing Committee on Finance and Public Administration, it became clear that, whether item 16525 continues to exist or not, all of the procedures will still be offered at public hospitals. There were claims that abolishing item 16525 would impact unfairly on lower-income women. But those claims are not credible given that the $273 fee covers only a small proportion of the full cost of procedures. For a second-trimester abortion, a woman would have to cover the balance of the cost, which ranges from $1,250 to $4,000. Clearly, low-income women would attend a public hospital rather than go to that expense.

Family First do not believe second-trimester abortions should be allowed to occur in private for-profit abortion clinics. Family First believe that public hospitals are the only place where second-trimester abortions should be provided because they offer a greater level of safety for women. Private for-profit abortion clinics can be too easily distracted by financial and commercial interests and are not bound by the same level of public scrutiny and accountability that is required of public hospitals. Family First’s preference for public hospitals is relative because we still oppose the abortions offered. But at least the abortions are offered at an improved level of safety for women, and the number of abortions is not at the same risk of being driven by profits.

On a different matter, evidence given to the committee revealed a disturbing view that unborn children with disabilities should be aborted to save the public purse. That is unbelievable. I will say it again: evidence given to the committee 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 the Parliamentary Group on Population and Development. Nobody is perfect. It is exceedingly arrogant for people to both assume that the lives of people with disabilities are not worth living and to advocate that they not be allowed to be born because their care would cost money. It is clear that children with disabilities and their parents deserve much more support than is offered by governments and the community. Family First supports the motion to disallow Medicare item 16525 whilst wanting the other procedures under this item to be covered. Therefore, Family First will support the motion to disallow this particular item.

Barnaby Joyce (Queensland, National Party) Share this | Link to this | Hansard source

We have heard previously in this debate that there have been no complaints raised about item 16525. I think there is a very good reason for that: the people most likely to complain are all dead! The issue is that the purpose of this process is to kill people aged between 13 and 26 weeks. I agree with Senator Fielding that, at the very least, this process must be done in a public hospital with a public ethics committee to oversee what someone defines as a ‘gross foetal abnormality’. As there is no clear definition of this, it can be open to all sorts of interpretations. I find it completely and utterly abhorrent that people are being killed in private clinics because of some practitioner’s decision about what a gross foetal abnormality is. In fact, I find abortion utterly abhorrent because we are determining the value of someone’s life through our eyes and not through theirs. We do not even give them the opportunity of seeing life through their eyes at all. That is the crux of this issue.

I am also very disturbed about the Parliamentary Group on Population and Development and the fact that it has become apparent that people feel that they have been verballed by their inclusion in this process. That is also completely disheartening. In this debate we must ultimately move the pendulum back towards life, towards those who rely on us in this chamber as their only means of protection. We are their only vestige of hope, and we need to move from our completely anachronistic and arrogant stance that we are the determinants of the value of someone’s life.

This debate also reignited what is basically a eugenics type of approach. It is the ultimate in economic rationalism—if you cost too much we will kill you. That should be completely abhorrent in our nation. You cannot have it both ways. You have to be consistent; you either believe in the protection of life. Whether or not the death of an innocent person is paid for by the state is irrelevant; the crux of the issue is that you are killing them. That has to be brought back to mind. I hope and pray that at some stage in this debate people will start to consider exactly what we are doing here. As soon as there is an ultrasound, it should be game, set and match. I look forward to getting a result the next time that we approach this issue.

Cory Bernardi (SA, Liberal Party, Shadow Parliamentary Secretary for Disabilities, Carers and the Voluntary Sector) Share this | Link to this | Hansard source

I do not support abortion because I believe it violates the most basic human right, and that is the right to life. I find the notion, advanced by some in the evidence they put forward, of killing unborn children because they have a disability or are in some way less than perfect grotesquely offensive. I think it is offensive and an insult to every Australian with a disability and those that love and care for them. As the coalition spokesman for disabilities, I have spent the last 12 months fighting for those with a disability and their carers, and I am disappointed that this insult has been advanced. (Time expired)

I seek leave to continue my remarks later.

Leave granted; debate adjourned.