Maria Steen
Last week the Sunday Times reported that the Government may change the wording of the proposed abortion legislation. The Citizens’ Assembly and the Oireachtas Committee recommended that abortion be allowed where there is a “risk” to the life or health of the mother – including mental health. Now, there are rumours that the Government may upgrade the requirement to a “serious risk” rather than a “risk” when they publish the wording of their proposal in March.
The same newspaper also reported the comments of retired obstetrician Peter Boylan, who said: “I don’t really have a problem with them saying ‘serious risk’ because if the woman regards it as serious then it is. It should be the woman’s assessment of the risk that counts.”
It seems then, that though doctors will be used as the vehicle by which women are to avail of abortion in this country, they will be there as little more than a box-ticking exercise. Whatever medical advice or concerns they may have will be worthless, if “it’s the woman’s assessment of the risk that counts”.
In medicine, the suggestion that it should be the patient’s assessment of risk that should alone dictate treatment would seem preposterous. The fact, however, that the Chairman of the Institute of Obstetricians and Gynaecologists can say this with a straight face in relation to abortion highlights two things.
The first is that providing an abortion is not the practice of medicine, as it has been understood for centuries. It is not healing. It is just killing, and doctors should not set out deliberately to kill.
Assessment
The second is that Boylan is absolutely right. It is the woman’s assessment that will count, and it will not matter one whit whether the risk the legislation requires is described as “serious” or not. It will not matter if the doctor does not agree that there is a risk, serious or otherwise. We know this from the UK experience. The vast majority of abortions there are sought by healthy women who want to abort healthy babies.
Under the 1967 Abortion Act, two doctors are required to be of the opinion that a woman’s pregnancy involves risk, greater than if the pregnancy were terminated, of injury to her physical or mental health. 98% of abortions in the UK are carried out under this ground, and of those, 99% are under the mental health ground. This is despite the fact that as the Oireachtas Committee acknowledged, “the majority of terminations are for socio-economic reasons that are unrelated to foetal abnormality or to rape”.
In short, the requirement to satisfy two doctors that a pregnancy involves ‘risk’ to a woman’s health is no impediment to abortions being performed on women with healthy pregnancies because the babies in question are simply ‘unwanted’.
Doctors, it seems, are to be conscripted into Simon Harris’ new system. Not only is his plan without a moral compass – allowing terminally ill babies to be involuntarily euthanised and children who are simply not wanted to be killed – it appears to have been made without a thought as to the practical implications for the practice of medicine in Ireland.
As we know, Harris volunteered the country’s GPs to be on the front line in providing this new ‘service’ of abortion. (Gone are the days when we expected doctors to care for and heal patients, rather than provide services to clients.) Without consulting them, he decided that they should be the ones overseeing the vast majority of abortions, which happen in the first 12 weeks. (In Britain, 92% of abortions are carried out in the first trimester.)
However, despite his claim that abortion is “healthcare”, he seems to have given no thought to the potentially dangerous consequences for women of the abortion pill, which he expects GPs to prescribe on demand.
Complications
Many in favour of repeal would say that GPs ought to prescribe the abortion pill, which comes in two doses, and then send the woman home to pass the baby there. However, the complications that can arise from these serious drugs – mifepristone and misoprostol – are not negligible.
Consider this scenario. The woman returns home, bleeds heavily and assumes she has aborted the baby. Unbeknownst to her, she has an ectopic pregnancy, which in the absence of a scan, has not been detected by the GP. Her life is now at risk. What responsibility will the GP have to shoulder? What will this do to doctors’ professional indemnity insurance premiums?
In order to avoid this scenario, will GPs have to have ultrasound machines on their premises and facilities for women to stay and be observed as they are aborting? Who is going to pay for this? The whole thing seems to me to be practically unworkable.
The alternative is that women will have to present at hospitals to be scanned before being administered the drugs, and possibly have to stay for observation.
Last week the Irish Independent reported that senior obstetricians and health officials pointed out the obvious fact that liberalising the law on abortion will lead to a demand for more surgical terminations.
Dr Peter McKenna said that he expected about 40% of abortions to have a surgical input and that this would have resource implications. It was also reported that waiting lists for women in need of surgery for gynaecology procedures are already too long.
The implication being that additional pressure from surgical abortions would only increase this pressure on already stretched obstetrics and gynaecology services.
Cost
And what of the emotional cost to the women of Ireland? For those who wish to abort their children, they will do so in a maternity hospital where they can hear the cries of other women’s babies delivered alive.
For those women who give birth, they will do so on operating tables and in delivery suites where other women’s babies have been killed earlier that day. Is this what the women of Ireland want?
And what about doctors? Do those who entered the field of medicine to heal and cure really want a part in the deliberate killing of babies before they are born? Will they have a right of conscientious objection? I would hazard a guess that, whatever their views about the law, there is a significant number of doctors in this country that would not wish to be involved in the practice of abortion.
In my view, doctors should be very, very worried about what they may be forced to do. Remember, the charge is being led by a party that effectively excommunicated its own members for attempting to assert a right of conscientious objection back in 2013.
There has been no formal promise of such a right to conscientious objection. Even if the government offers some form of opt-out, as a sop to get the referendum over the line, without a constitutionally-protected right to conscientious objection there is nothing to stop a future Oireachtas from revoking any such concession.
In effect, repeal of the Eighth Amendment means handing the Oireachtas carte blanche to legislate for abortion and it leaves doctors in this country very vulnerable to being forced to take part in a procedure that goes against the first principle of medicine: do no harm.
