What are the abortion referendum's implications for medical procedures? The Irish Times puts scenarios to medical and legal experts on both sides and asks what the consequences will be of a Yes and of a No vote
Do you know exactly what you'll be voting about in the referendum on March 6th? It seems many people are confused - even some of the experts. The proposed Twenty-Fifth Amendment of the Constitution (Protection of Human Life in Pregnancy) Bill, 2001 seems to raise more questions than it answers.
Risk of Suicide
You are a pregnant 14-year old who was raped by a relative. You are at risk of suicide.
If there is a Yes vote, risk of suicide would not justify a legal abortion in the State. You could not get an abortion in the Republic unless those willing to aid, abet or procure the procedure were willing to risk a 12-year jail sentence, a fine or both. You would, as a private individual of your own volition, have the right to travel to Britain for an abortion.
According to doctors and lawyers who favour a No vote, a Yes vote would mean a health board could not take a pregnant child in its care to Britain for an abortion. Lawyers Against the Amendment argue that the C case established that health boards may bring children to Britain only for procedures legal in the Republic. A Yes vote, they say, would eliminate risk of suicide as a justification for performing the procedure here, which would mean a child in the care of a health board could not go to Britain for an abortion.
An anti-abortion lawyer who advocates a Yes vote states the opposite: a Yes vote, in his view, would not disturb the existing legal position. He believes that health boards' general right in relation to children in their care was not addressed in the C-case decision. In his view, Judge Geoghegan's views are substantially at variance with the Supreme Court's understanding of the scope of the "travel" amendment of 1992. While Yes campaigners say health boards would be able to bring such a child to Britain for an abortion, they hope health boards would be guided by the medical view that an abortion would not be the right solution and would harm the child.
Two prominent psychiatrists have said that the issue of suicide in pregnancy is irrelevant and not a psychiatric issue. Other psychiatrists have countered that were the right to travel to Britain to be taken away, more pregnant women may commit suicide.
If there is a No vote, things stay the same. William Binchy, a prominent anti-abortion lawyer who favours a Yes vote, says a No vote would mean you could legally have an abortion in the Republic up to full-term, as a result of the Supreme Court's decision in the X case, although in practice we do not know of this occurring.
At present, health boards can help suicidal pregnant girls and women in their care to travel to Britain for abortion, according to No campaigners.
Bleeding in early pregnanacy
You are 12-16 weeks pregnant and have begun to haemorrhage; you may go into shock and die without a dilatation and curettage, a procedure better known as a D and C.
Your chances of dying would be greater, according to medical and legal opinion in support of the No vote. They argue that to save your life, a doctor must perform a D and C, but this could be done only in an approved centre.
The Bill defines neither where approved centres should be nor how many there should be. This is left to the discretion of the minister of the time. The present Minister cannot promise the decisions of future ministers.
As a haemorrhaging pregnant woman, you may therefore have to travel a great distance to reach an approved centre, putting your life at greater risk. If you arrived at an approved hospital and the doctor on call objected to the procedure, you would have to wait until a doctor willing to perform the dilatation and curettage could be found.
No doctor would be obliged to carry out a D and C.
Legal opinion on the Yes side says that the introduction of approved centres is meant to protect women, not harm them, and that there is no question of limiting the scope of available medical treatment.
The minister of the day would be guided by best medical opinion in this matter, as well as by the constitutional rights of mother and child.
You would be taken to the nearest place where you could be dealt with, as happens at present. Conscientious objection would not be an issue in the case of a No vote, because doctors are bound by medical ethics to deal with patients in life-threatening situations. Whether the vote is Yes or No, any pregnant woman would be wise to discuss these issues with her doctor before retaining that doctor as her obstetrician.
Morning-after pill
You were having sexual intercourse when the condom broke, and you fear you may be pregnant. You want the morning-after pill.
NB: Levonelle, the most effective and up-to-date form of the morning-after pill, which prevents implantation, is unavailable here. This is because the manufacturer, Schering-Plough, withdrew its licence application in July last year, after a Galway anti-abortion group threatened to take legal action against the Irish Medicines Board. The board does not consider the morning after pill to be an abortifacient, as it prevents implantation.
Pro-Yes legal opinion is that the Bill clarifies beyond argument that the use of the morning-after pill would not consititute an abortion. The Bill defines abortion as the "intentional destruction by any means of unborn human life after implantation in the womb of a woman". Because the morning- after pill prevents implantation of a fertilised egg, it cannot be an abortifacient according to this definition. (The same goes for the intrauterine device, or IUD, a method of birth control that prevents a fertilised egg implanting in the womb.) The morning-after pill and IUD would be protected by a Yes vote, according to pro-Yes legal opinion.
Legal and medical opinion in the No camp argues that the morning-after pill would still be in question, however, as the Bill does not mention it specifically.
The Referendum Commission's information booklet says that the constitutional positions of the morning-after pill and the IUD are open to doubt and that a Yes or No vote would make no difference.
No change in the situation where Levonelle is not available, but old-generation high-dose contraceptive pills can be prescribed to function as morning-after pills, even though there is no licence for this.
Threat to the life of the mother
You are pregnant and have cancer of the womb, heart disease, high blood pressure or some other life-threatening condition. Treatment would end the life of the foetus.
Legal opinion for the Yes campaign believes a Yes vote would strengthen doctors' ability to make medical decisions that may result in the death of the foetus, by making it clear that the law supports medical ethics.
The Bill says doctors may carry out procedures that result in the ending of unborn human life if, in the reasonable opinion of the practitioner, this is "necessary to prevent a real and substantial risk of loss of the woman's life other than by self-destruction" - that is, suicide.
The No campaign questions "reasonable opinion", however, which means "a reasonable opinion formed in good faith which has regard to the need to preserve unborn human life where practicable and of which a written record has been made and signed by the practitioner".
This written record may be requested and challenged by any minister who applies to look at the doctors' records. Medical and legal opinion in the No camp argues that this threatens doctor-patient confidentiality and that it is subject to court challenge.
Legal opinion in the Yes camp counters that there is no way a minister, or doctors, would want to implement a policy that put mothers' and, indeed, foetuses' lives at risk or violated patient confidentiality, a core value of medical practice.
Doctors may carry out procedures that result in the ending of a foetus's life right up to full-term, as explained by the ruling of the Supreme Court in the X case. The threat does not have to be immediate.
If a woman has a heart condition, she does not have to go into heart failure before the pregnancy is effectively terminated. Doctors follow their own ethical guidelines. No-vote campaigners believe that this is safeguard enough.
Right to travel
You are experiencing a crisis pregnancy and want an abortion in Britain.
The ballot result is irrelevant: either way, you can travel to Britain for an abortion.
Embryo experimentation
An egg has been fertilised in a lab, resulting in an embryo, which is frozen. A researcher wants to experiment on it.
Those favouring a No vote believe the Bill leaves the "unborn" undefined. It appears that an embryo is not defined as human life in the Bill, as the Bill defines abortion as "a means of unborn human life after implantation in the womb of a woman". Anyone wanting to prove that a pre-implanted embryo is human life, however, can refer to the existing constitutional provision that talks about the right to life of the "unborn", which must be protected and vindicated. Some No campaigners argue that, if passed, the Bill would qualify the right of the fertilised egg, because it is giving greater right after implantation. Legal opinion on the No side sees this part of the Bill as open to court challenge. The Yes side takes the opposite legal opinion. It says the right of the embryo is protected by Article 40.3.3 of the Constitution. The Bill being voted on relates only to abortion, which can occur only after implantation, and therefore makes no legal reference to an unimplanted embryo.
Vague and inconclusive definition of human life in Article 40.3.3 of the Constitution would remain the cornerstone.
You are pregnant and, because you are high risk, have decided to have prenatal testing. You discover your foetus is suffering from a severe abnormality.
You may go to Britain for an abortion, as long as you are a private individual doing so at your own volition and expense. Yes or No vote: no change
Tomorrow: how do women who have had abortions view the current debate?