Two years ago Europe's largest maternity hospital, Holles Street in Dublin, was faced with a terrible dilemma. As the hospital's Master Declan Keane told the Oireachtas Joint Committee on the Constitution's hearing on abortion this week, a woman had developed a condition called pre-eclampsia, in which pregnancy leads to a potentially fatal rise in blood pressure.
In this case, a specialist confirmed that the woman would not survive without an abortion. "This woman was going to die if her pregnancy did not end," said Dr Keane. So the medical team had to put the stark options to both the woman and her husband.
But this was not strictly a matter between the parents and the doctors. For, as Dr Keane said, the doctors also had to talk urgently to their legal team. As well as considering what was best for a patient whose life was in danger, the hospital had to consider the strange state of Irish abortion law, suspended somewhere between the 19th century Offences Against the Person Act and the Supreme Court judgment in the X case, which the Oireachtas has failed to embody in legislation.
The bizarre spectacle of lawyers at a hospital bedside is the reality that lies behind the apparently abstract discussions at this week's hearings.
As another of the committee's witnesses, Dr James Clinch, put it, "Medicine and law make very bad bedfellows." But the abject failure of the political system over the course of the last two decades to get to grips with the complexities of abortion has left the lawyers and the doctors trapped together. The committee's hearings are part of the delicate process of prising them apart.
The big question, though, is whether public life in Ireland has now matured to a point where the bitterness generated by the abortion debates of the 1980s and 1990s can be replaced by a workable consensus.
Some of the signs are undoubtedly encouraging. The committee's hearings this week were conducted in a calm, courteous atmosphere, free of overt rancour and high-octane rhetoric. This, in turn, reflects the broad welcome for the Government's informative and reflective Green Paper on abortion last year.
Except for the radical fringe represented by Youth Defence and its allies, there is little evidence that anyone wants to repeat the experience of the 1983 referendum campaign, described by The Irish Times at the time as "the second partitioning of Ireland".
While that campaign was understood by both sides as a symbolic struggle between conservatives and liberals for the soul of Ireland, that broader struggle has now been decided in favour of the liberals. This time, perhaps, abortion can be debated in its own terms.
Yet the evidence of this week's hearings is that consensus is as far away as ever. The debate may be conducted with more civility, but there are few signs of common ground on the core issues. If anything, a calmer debate has merely highlighted the fact that there is not even a consensus on what is being discussed.
The starkest fact to emerge this week is that there is not even agreement between doctors about the meaning of the word abortion.
During the opening exchanges on Tuesday, Jim O'Keeffe TD remarked that one of the committee's basic problems is that the Green Paper does not define what an abortion is. If, however, he was hoping for enlightenment from some of the country's most distinguished obstetricians and gynaecologists, he will have been disappointed. Two glaringly different definitions were offered by senior doctors.
The first, put forward by those in favour of a new constitutional ban, is that "abortion" means only the direct and deliberate killing of the foetus. If a medical procedure is carried out to treat, for example, pre-eclampsia or an ectopic pregnancy and if that treatment entails the certain death of the foetus, then it is not an abortion. Though the doctor knows that the foetus will be killed, the death is merely an unfortunate side effect.
Dr James Clinch, who co-wrote the current Medical Council guidelines on abortion, told the committee that in treating pre-eclampsia in a woman in the early stages of pregnancy "you deliver the baby at the same time, of course, as treating the woman for the blood pressure, and emptying the uterus of both the baby and the afterbirth".
But if the foetus "happens to die" as a result of the operation, "this is certainly not intended". Prof John Bonnar, chairman of the Institute of Obstetricians and Gynaecologists and one of the most prominent medical proponents of the 1983 amendment, told the committee that in treating an ectopic pregnancy in the cervix, the doctor would "nucleate" the foetus and "suck it out" but that this was "not an abortion" even though "the foetus sadly succumbs".
Even if this were an accepted medical definition, however, it would be very difficult to translate it into law. The idea that people do not "intend" the foreseeable consequences of their actions is foreign to legal reasoning.
And both Dr Clinch and Prof Bonnar accepted that the committee's task in trying to formulate a legal expression of their definition of abortion is formidable. Prof Bonnar said: "I personally think it is going to be difficult to get a wording . . . I cannot see a simple sound bite of half-a-dozen words covering the complexity of this situation."
But the complexity seems even greater than either man would allow, for it was clear at the hearings that their definition of abortion does not even amount to a medical consensus.
Dr Keane of Holles Street told the committee that "in the medical profession we have always defined - and in the clinical textbooks - an abortion as a pregnancy that is lost in the first trimester [the first 14 weeks] of pregnancy". By this definition, even a spontaneous miscarriage is an "abortion". So, clearly, is an operation to treat the mother that kills the foetus.
This is not just an abstract clash of definitions. For example, the committee has to keep in mind the effect of any constitutional amendment on methods of contraception such as the morning-after pill.
Dr Clinch told the committee that "we have got to presume" that life begins at the instant of conception. By his definition, therefore, anything which deliberately causes the expulsion of the foetus even a few hours after conception is an abortion and should be banned.
When asked about the morning-after pill, he denied that this was a problem because "if you actually believe that there is a child there, I don't think you will use the pill. If you don't believe there is a child there, you will use it."
Whether Irish law should be based on the assumption that only women who do not think they are pregnant use the morning-after pill is one of the many conundrums the committee will have to ponder.
fotoole@irish-times.ie