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August/September VILLAGE
provisions for an independent committee
to make decisions on treating those with
“suicidal intent”, which was a key demand
among campaigners for reform.
Anti-choice campaigners focused so much
on the issue of suicide, because the state
was obliged to provide access for women
with sucidal ideation by the X case. The
Government could have legislated in good
faith to make access available for those enti-
tled to a legal abortion in the state. Instead
they bowed to pressure from a vocal minor-
ity, introducing a process that will inevitably
fail vulnerable women.
If a GP agrees, he or she will refer the
woman to three doctors – including one
obstetrician and two psychiatrists – who
will decide whether there is a real risk to the
woman’s life through suicide. If her request
is rejected, she will go through an appeal sys-
tem involving another two psychiatrists and
another obstetrician.
Veronica O’Keane, professor of psychia-
try at Trinity College Dublin, said the rules
would leave women “at the mercy of a local,
moral and political lottery”. The United
Nations Human Rights Committee, consid-
ered they constituted “an excessive degree of
scrutiny by medical professionals”. Yet this
is what we are told the law prescribes.
Meanwhile the profession’s own Medical
Council Guide which used to say it was not
lawful to “advocate or encourage an abor-
tion” even in case of risk of suicide or to life
now weirdly – and unlawfully it would ironi-
cally appear – merely makes it unlawful in
the event that information is being provided
with regard to abortion abroad.
T h e q u i et c h a ng e t o
the Medical Council’s
Guide in January
does though, for the
first time, assert the
lawfulness of abor-
tion in the event of a risk to the life of the
mother, a risk which while substantial may
not be immediate or inevitable.
Professionals are now, as they always
were, unable legally to intervene to manage
miscarriage, or to manage a risk to health
that could include heart, vascular and pul-
monary disease, extensive hernias and
benign tumours.
Cathie Doherty is
spokesperson for
the Abortion Rights
Campaign.
risk to health evolves into a risk to life.
The PLDPA perpetuates the systematic
ignoring of the agency, the autonomy, of
the pregnant woman. During the inquest
into the death of Savita Halappanavar, the
jury heard that she would probably still be
alive today if the law had allowed the abor-
tion she asked for, as she miscarried, before
there was a real risk to her life – when it was
too late to save her. Though the coroner was
keen to clarify that the medical deficien-
cies were not in themselves responsible for
her death, the clinical Director of Holles
St National Maternity Hospital, Dr Peter
Boylan, noted: “The real problem was the
inability to terminate the pregnancy prior
to Ms Halappanavar developing a real and
substantial risk of death. By that time it was
effectively too late to save her life”.
Indeed a draft of a ‘Guidance Document for
Health Professionals from the Department
of Health’, which has yet to be made public
but was obtained by the Guardian newspa-
per, is more assertively anti-abortion than
last year’s law.
In its introduction, the docu-
ment states that “the purpose
of this act is to restate the gen-
eral prohibition on abortion in
Ireland” (while regulating for
the X and A, B and C cases). Later
it notes that the act provides “a
clear criminal prohibition on
abortion” (with one exception).
The Guidance will give power to
doctors, obstetricians and psy-
chiatrists to prevent vulnerable
women from terminating their
pregnancies.
It would be interesting to see
the forces behind the Guidance
for they do not reflect the prevail-
ing ethos in , or indeed even
the constitution and last year’s
legislation. The document itself
was compiled by the Department
of Health “in collaboration with
a multi-disciplinary committee
of experts”, comprising repre-
sentatives of the usual worthy professional
bodies with an independent chair, Dr Declan
Bedford.
The -page guide does not include
A
BORTION remains sidelined in this
society, and others, to the point
where it is almost impolite to raise
the issue – which is “divisive”, “already dealt
with” or “an ongoing debate”. But when you
start to look at the reality of the law you
realise it is “ongoing debate”, that has pre-
vailed, with no government action to move
forward despite last year’s legislation, and
every risk of more hard cases that will show
up the gaps in our law. Although there have
been reports of abortions under the new
legislation, senior doctors have refused to
confirm this. Indeed it is unclear whether
there were abortions before the legislation
was introduced. Such egregious obfusca-
tion can only suggest a failure of empathy
for women’s rights.
It is despite the fact that opinion polls,
such as one last June, show that a majority
favours broadening access to abortion. The
Ipsos/Mori poll in the Irish Times records
very strong majorities in favour of abortion
in the case of risk to the women’s life (%)
and health (%); fatal foetal abnormal-
ity (%); and rape and abuse (%); and a
small majority (%) in the event or a threat
of suicide.
However, in a shocking subversion of the
democratic will of the people, the subsequent
passing of the Protection of Life During
Pregnancy Act (PLDPA), after a lengthy and
fractious debate, in fact changed very little
for abortion-seekers in Ireland. While it pro-
vides for terminations when there is a “real
and substantial” risk to the life of a preg-
nant woman, even on its face the law does
not provide for abortion in the case or rape
or incest, or in the case of fatal foetal dis-
orders; and most of all it does not provide
for abortions in the event of a risk to health,
creating a dangerous environment where
medical intervention is delayed while the
Government guidelines for doctors restate a “general prohibition on abortion”.
By Cathie Doherty
Little change on abortion
ABORTION POLITICS
If a GP agrees,
he or she
will refer the
woman to
three doctors.
If her request
is rejected,
she will go
through an
appeal system
involving
another two
psychiatrists
and another
obstetrician
“
VILLAGEAugust/September
beforehand, with no airing of more radical,
and reality-based, approaches.
Article .., the th Amendment to
the Constitution, a relic from a previous
simplistic era, is cited by government after
government as a reason for not legislating
to broaden access to abortion in Ireland.
Because of it, the current government intro-
duced flawed and unworkable legislation
which criminalises abortion and prevents
healthcare providers treating pregnant
patients to the best of their ability. Public
opinion has changed but still the government
hides behind the th Amendment – wilfully
ignoring the fact if they do not call for a ref-
erendum to repeal it, it is only a matter of
time before the nation will be once again
convulsed by a hard case, or an unneces-
sary death, illustrating that the complexity
of childbirth requires, in the interests of
freedom, equality and female autonomy, a
woman’s right to choose. •
March for Choice, September 27th, in Dublin;
www.abortionrightscampaign.ie
women may not seek assistance in the rare
event they do have complications (which are
likely to be similar to miscarriage complica-
tions), the fear of a -year sentence.
A majority in Ireland favoured broader
access to abortion than was permitted under
the PLDPA but conversations about abortion
in the media do not reflect this. Obliged by
the Broadcasting Authority of Ireland to
present abortion in a ‘balanced’ way, an arti-
ficial and skewed binary view divides those
who favour the existing regime from those
who favoured the regime that prevailed
Having, or providing for, an abortion
outside of the rigid parameters of the
PDLPA could now result in up to years in
prison.
In addition to the barriers placed in
front of medical professionals, only a small
number of women can obtain a legal abor-
tion in Ireland. Even then, abortion depends
on a panel and vetting process that seems to
reinforce the old stigma – pregnant women
in Ireland are not to be believed, or trusted
to know what’s best for them.
In practice for women in Ireland, abortion
is obtained by travelling to another jurisdic-
tion, or by (illegally) self-administering an
abortion in Ireland. By using a reputable
organisation – like Women on Web - women
in Irela nd have safely admin istered their own
abortions, using mifepristone and misopr-
ostol: the drugs used by abortion providers
in UK clinics. The abortion pill is a method
for inducing a miscarriage. The only real
dangers come from the secrecy and stigma
associated with them: the danger the site will
not provide the product promised, the risk
Woman presents or is referred
to a Psychiatrist or Obstetrician
1
Test Applied
Test Not Satisified
Clinical decision
accepted
Woman may seek
second opinion
Test Satisified
Referral to a second
Psychiatrist or Obstetrician
Test Satisified
Test Satisified
Referral to a second
Psychiatrist or Obstetrician
Joint Certification
Medical Procedure
Woman triggers
Review Panel
Test Not Satisified
Test
Three doctors are to clinically assess
the woman and jointly certify that:
i) There is a real and substantial risk of
loss of the woman’s life from the risk of
suicide.
ii) The risk can only be averted by the
termination of the pregnancy.
iii) The doctors have, in good faith, had
regard to the need to preserve the life
of the unborn child as far as
practicable.
Notes
1. Specific requirements for the doctors who may certify a medical procedure under the Act as set out in the Guidance Document and Summary
Tables. Each specialist should be responsible for the assessment in relation to his/her own specialty in accordance with existing medical best
practice. If a referring doctor has difficulty accessing a psychiatrist for an opinion, he/she can refer to the relevant Executive Clinical Director
(Mental Health), (see section 2.5)
2. Process as per child referral
3. There is nothing to prevent a woman seeking another specialist opinin if she so wishes. If the woman is unable to get an oopinion she can apply
for a formal review. (see section 7)
2
3
It would be interesting to see the forces
behind the guidelines for they do not reflect
the prevailing ethos in 2014, or indeed even
the constitution and last year’s legislation
“
Department of
Health’s abortion
Guidance in case
of suicidality
