Latest abortion controversy raises a number of dilemmas

Despite this latest abortion horror, it’s probably too soon for another round of debate, writes Caroline O’Doherty

The latest abortion controversy demonstrates once again how divisive the subject is and how difficult it is to legislate for but it also illustrates the deep personal trauma that can underlie any given case.

Here we look at some of the dilemmas — personal, professional and legal — that still remain despite decades of national soul-searching.

Q. What happened in this case?

A. An immigrant teenager made pregnant through rape was suicidal and sought an abortion in Ireland as her undetermined legal status in this country made it impossible for her to travel abroad. She made her request under the Protection of Life During Pregnancy Act 2013.

She was assessed by a panel of two psychiatrists and an obstetrician. She was declared a suicide risk but an abortion was not carried out. Instead, there was a delay until around the 24th week of pregnancy when the foetus was developed enough to be delivered by caesarean section.

Q. Was the young woman agreeable to this?

A. Not at first. She wanted an abortion and it is understood she sought one for some weeks. She became so distressed, she began refusing food and water and a court order had to be sought to allow her be forcibly hydrated.

She gave in only reluctantly and consented to a caesarean.

Q. Why was there a delay?

A. It’s not clear. If any or all of the members of the panel were undecided about whether to certify the young woman as suicidal, they may have taken time to satisfy themselves as to her state of mind and to provide a definitive answer. Or if any of the members declined to certify her as suicidal, there may have had to be an appeal which would also have taken time. But decisions and appeals are supposed to take place in a timely manner.

The young woman in this case feels the delay was unwarranted and questions whether it was deliberate in order that her pregnancy would progress to a point where a caesarean delivery became an option.

Q. How serious an allegation is that?

A. Very, if you look at it from the point of view of the doctors being there to do their best for the young woman whose trauma was undoubtedly prolonged and intensified by what happened. But the doctors are also tasked with doing their best for the unborn and if a doctor was not firmly convinced of a real and immediate suicide risk, it could be argued there was a case to wait and see how things progressed, particularly if the length of time between a foetus being terminated or delivered was not unduly long.

Q. Those are very significant ‘ifs’ — isn’t the law supposed to have clarified procedures in this area?

A. That might have been the intention of the Protection of Life During Pregnancy Act but it hasn’t been the outcome. Doctors have a lot of discretion under the law and with the best will in the world, discretion can lead to doubt, disagreement and dubious decisions.

Q. How could that piece of legislation be improved?

A. Depends on who you ask. Some say it can’t be improved and should be scrapped — followed swiftly by a return to the drawing board. Some argue there should be a stated time limit for the performance of an abortion. For example in Britain the procedure can be carried out up to 24 weeks’ gestation. That would remove some of the dilemma from a doctor faced with a request for an abortion in the second trimester. But others argue that wouldn’t help in a case where a woman becomes suicidal in the seventh month of pregnancy or even later.

If abortion wasn’t an option then, she would be effectively forced to have a caesarean section or induced delivery.

Q. Can a woman actually be forced in this way?

A. Probably. In the case in question, the young woman gave in to persuasion but if she had stood her ground, it is possible the doctors might have sought a court order to force her to undergo a caesarean.

Q. How is the young woman in this case doing?

A. Physically she is doing well but she is understood to be deeply upset by the circumstances of her pregnancy and how her case was handled although still adamant that she could not have carried the child to full-term.

Q. What has happened to the baby?

A. The baby was taken into the care of the State. The child is believed to be doing well but is still in need of medical attention. Foster parents will be sought in the immediate future and then long-term care plans made.

Q. What will happen to the legislation?

A. Justice Minister Frances Fitzgerald says she’ll keep its implementation under review but as it’s very new and rarely used, it could be a long time before there is a sufficient number of cases raising sufficient number of difficulties to make a convincing argument for amendments. Even then, it would be hard to find sufficient appetite in the Dáil for yet another round of debate, drafting and division on the subject.