The realities of current medical practice are not addressed by the referendum, writes Dr Tom O'Dowd, who is concerned at the proposals on doctor/patient confidentiality
Every Monday morning, our practice nurse places four high-dose oral contraceptive pills together with two anti-nausea pills in each of 20 envelopes which the doctors then dispense over the next five days to women requesting emergency contraception.
Over a thousand women in Ireland approach their general practitioners and family planning doctors each week for emergency contraception, also known as the morning-after pill. It works best if given within 48 hours of sexual intercourse but some women defer coming to see us for five days.
Some general practitioners will either fit an intrauterine device or arrange for the fitting of the device for such women.
Both the morning-after pill and the emergency IUD are unconstitutional and will remain so if the referendum is passed. Giving the morning-after pill, or fitting an IUD before implantation, will not be a criminal act, but doctors may be pursued in the civil courts by pro-life activists.
The Crisis Pregnancy Study pointed out that medical check-ups after abortions are lamentably few among Irish women. Such check-ups are crucial to address physical and psychological issues that may arise and in the provision of contraception. Such visits risk declining further.
This aspect of the referendum Bill is simply an interference in attempts to provide good clinical care for women. Women have always had difficulty in trying to predict which doctors will not judge them and the only way they can know is by word of mouth.
One of the positive aspects of the current abortion debate is the engagement of doctors who are willing to support, rather than judge, women who seek abortions.
Over the years, most family doctors, like myself, provide medical care for a significant number of women who have undergone the trauma of rape.
Nowhere in the referendum is rape addressed. It is inconceivable society should demand that a woman who becomes pregnant through the violent act of rape should be forced to carry a pregnancy against her wishes.
Suicide is a phenomenon which is a societal issue and only comes to the attention of psychiatrists if the patient expresses suicidal tendencies or has risk factors such as previous attempts and concurrent psychiatric illness.
Many suicides occur without any medical or psychiatric intervention. Some women with unwanted pregnancies simply kill themselves without recourse to any medical help and pregnancy is only discovered at post mortem.
Closing off the option of suicide is painting both women and their doctors - not just psychiatrists - into a corner. Like many doctors, I would prefer to see the suicide option available with safeguards, such as the opinion of two psychiatrists, and not just a single medical practitioner being needed for diagnosis.
Widely published medico-legal advice about the new Bill, and in particular the new section on the making, keeping and confirmation of medical records, raises significant doubts about breaches of confidentiality. The Minister for Health has merely dismissed such advice.
Threats to confidentiality have serious implications for general practitioners in dealing with young women. This most vulnerable group is wary about the confidentiality of intimate issues in the hands of doctors. There are significant ethical and legal issues surrounding the confidentiality of under-age women.
The legislated breach of confidentiality in the Bill means a minister would require hospitals to make returns of information that are not anonymised.
Medical opinions will also have to be included in the process of confirmation of medical records. This exposes both the patient and her medical team to a breach of confidentiality which may eventually lead to investigation by the Gardaí in preparing a file for the DPP.
Anyone who read the recent letter to the Irish Times by Deirdre de Barra cannot help but be moved by both her courage and her plight. It highlights the narrowness, and indeed irrelevance, of the current pitiless and misanthropic debate that is more concerned with ideology than ordinary people.
In the area of life-threatening congenital anomalies, Irish obstetricians live in a fool's paradise. General practitioners like myself relieve them of the burden of having to carry out terminations on a foetus incapable of independent life by engaging the help of one or two sympathetic obstetricians in this country.
It is a pity the Masters of the Dublin maternity hospitals had to be bounced into admitting the Bill is deficient on the issue of severe abnormalities incompatible with life. Quite clearly future legislation on abortion is going to have to take such abnormalities into account.
The lack of clarity about emergency contraception and confidentiality in the referendum Bill gives pro-life activists a tool to make a doctor's actions accountable in the civil or criminal courts to the pro-life agenda.
For all our progress in the wider world it shows that when it comes to policy on reproductive health, our current government has simply not moved on. It also shows that much of the thinking on women's health over the last decade has simply passed Ireland by.
• Tom O'Dowd is a general practitioner in active practice and Professor of General Practice at Trinity College, Dublin. The views expressed here are his own