Abortion debate ill-served by hiding behind bland words

Listening to Morning Ireland last Monday I heard James Clinch, chairman of the Ethics Committee of the Medical Council, say that…

Listening to Morning Ireland last Monday I heard James Clinch, chairman of the Ethics Committee of the Medical Council, say that the council had received only one letter suggesting that when framing the guidelines on abortion, members should bear in mind the Supreme Court ruling in the X case.

I was profoundly depressed because I knew that solitary letter had been written by me. My dismay was not because I felt my concern was not shared by many colleagues but because, despite advertisements from the council looking for their views, obviously they felt there was little point in sending in submissions. Looking at the result of the council's deliberations perhaps they were right. The present council is considered to have quite a conservative disposition.

The Medical Council guidelines must be taken very seriously by doctors - the council has the power to "strike off" a practitioner. However an appeal of the decision can be made to the High Court and the Supreme Court judgment surely would be taken into account.

Last Saturday, Renagh Holohan, writing Quidnunc in this newspaper, said "there is no abortion in Ireland". This is not strictly true. Abortion is defined in medical dictionaries as "the termination of a pregnancy before the foetus is viable". No woman whose life is in danger because of her pregnancy will be denied an abortion here - it is just that it will be called "treatment".

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In the section entitled Reproductive Medicine, the Council writes: "The deliberate and intentional destruction of the unborn child is professional misconduct". What on earth does this cover? Of what practical significance is it? If a pregnant woman is bleeding uncontrollably at 18 weeks but the foetal heart can still be heard and the only action is to terminate the pregnancy - what could be more deliberate?

Or if she has an ectopic pregnancy at eight weeks and the foetal heart can still be heard, knowing that delay in operating to remove the foetus increases the risk to the mother (even though occasionally a foetus can come to maturity outside the womb and be delivered by Caesarean section), the foetus is removed - what could be more intentional?

I could go on writing about cases of cancer of the neck of the womb, uncontrollable high blood pressure - all rare cases, but ones which exist.

The guidelines continue: "Should a child in utero suffer or lose its life as a side effect of standard medical treatment of the mother, then this is not unethical. Refusal by a doctor to treat a woman with a serious illness because she is pregnant would be grounds for complaint and would be considered professional misconduct." All interventions apparently will come under "treatment" even though they plainly will involve the death of the foetus.

One could have wished that the Council's guidelines would have tried to embrace the very serious situation which exists. The Supreme Court ruling says if there is a real and substantial risk to the life of the mother - and the threat of suicide is included - abortion is legal. In case some maverick doctor arrives on the scene, and in view of the fact that we still have no legislation, could the guidelines not have included the stipulation that anyone carrying out "treatment" consult an experienced obstetrician first?

That if threats of suicide are the grounds on which the "treatment" is being carried out a psychiatrist should have been consulted? That, except if there is a dire emergency the "treatment" should take place in a State hospital? As well as giving greater guidance to doctors it might have helped to nudge our legislators forward.

The late Judge Niall McCarthy wrote in the X case judgment that the lack of legislation was to be deplored. Suggestions we should have yet another referendum will not solve the problem. The Christian Centrist Party's suggestion, in a recent letter to this newspaper, that an amendment which says medical treatment should be allowed to save the life of the mother "even if the treatment puts the life of the child at risk" will not cover situations where it is perfectly obvious the developing child will be dead.

Most abortions are carried out for socio-economic reasons. A cynic might think that the delay by the Government in publishing the Green Paper on Abortion is because it hopes to be rescued by another form of "treatment". Internationally oral medical abortifacients are used more and more. Early termination using this method was 92 per cent effective up to seven weeks and 77 per cent up to nine weeks in an American study published by the New England Journal of Medicine.

When contraception was illegal in this State but the pill was available it was known as a "cycle regulator". These medical abortifacients could be known as a "treatment" for overdue periods. The Medical Council is in a powerful position to initiate a debate on abortion but this word was not used in the ethical guidelines on Reproductive Medicine.

We cannot hide behind words like "treatment" - would the members of the Council describe late abortions done on a two-stage basis to ensure the child cannot be born alive as "treatment". I certainly would not.

Advances in medical technology now allow us to follow the development of the embryo from conception to the delivery of the child. The guidelines, I feel, missed a great opportunity to promote debate on the philosophy of these advances. They will have little practical effect on medical practice in Ireland.

Mary Henry is an Independent member of Seanad Eireann and a medical practitioner