Doctor knows best. Almost two decades after the equal right to life of the mother and the unborn was enshrined in the Constitution, four abortion-related referendums, the X and C cases, a Green Paper last year and the 700-page report of the All-Party Oireachtas Committee on the Constitution yesterday, the major party in Government intends to hand over responsibility to the Medical Council for the legal framework on abortion. The approach favoured by the Fianna Fail Party - the option most likely to succeed in current political circumstances - proposes to make the medical profession the guardians of citizens' right to life on this complex issue.
That is not the only controversial proposal in the long-awaited report of the All-Party Committee. The eight TDs and four Senators, representing Fianna Fail, Fine Gael, Labour and the Progressive Democrats, agreed a multi-million pound action plan to reduce the number of crisis pregnancies and the rate of abortion. The plan would comprise preventative measures, like a contraceptive programme, options in crisis pregnancies and post-abortion services on return from abroad. The members also agreed that a constitutional ban on abortion which compromised medical practice or essential treatment to protect the life of the mother would be "unsafe"; it would put the lives of expectant mothers at risk.
But, the Committee failed to reach a consensus on the central Irish question on abortion: how to address the Supreme Court's decision in the X case in 1992 that abortion is permissible in this State where there is a real and substantial risk to the life, as distinct from the health, of the mother, including the risk of suicide. This judgment has had no effect on current medical practice in Irish hospitals. At least 6,000 Irish women travel to England each year for their abortions.
Against this background, three distinct "views" are expressed by the Committee in the report. The first approach, favoured by Fine Gael, is to leave the legal position unchanged. They do not want legislation and "remain to be convinced" about the viability of a referendum. Above all, Fine Gael wants any abortion referendum to take place on its own, not on the day of a general election.
The Labour Party approach advocates that the issue of abortion in Ireland be examined "with some sense of reality". It proposes that legislation be introduced within the framework of the X case, including the risk of self-destruction. The party is opposed to another referendum.
Most attention will focus, however, on the third approach since the Fianna Fail leader, Mr Ahern, made a commitment in 1997 to put the abortion issue to the people in a referendum. Fianna Fail is proposing that current medical practice - on which eminent doctors differed during the Committee's hearings - be enshrined in legislation. Defences based on social, psychological or psychiatric grounds, including suicide, would be prohibited. Such legislation would require a referendum to row back on the X case. This approach raises many serious questions. Would there be different medical practices and different defences for doctors in public and private hospitals? Would the equal right to life of the mother be balanced differently? Would changes in medical practice be reflected in the future? The Committee did agree that "direct and indirect effect is an ethical principle which informs general medical treatment in Ireland. It forms a crucial element in the Medical Council ethical guidelines in this area. It would be unsafe to employ such a distinction in express legal terminology. The distinction between direct and indirect in law might make the law less certain and thereby inhibit doctors from carrying out procedures they currently carry out". How does this sit with the Fianna Fail approach to make the Medical Council, not the Dail nor the Supreme Court, the arbiters on abortion in this land?