Early warning over abortion legislation

The Government was warned before it passed the Protection of Life During Pregnancy Act that the law would create problems of the kind that have arisen in the current abortion controversy.

In presentations to public hearings of the Oireachtas Health Committee, Doctors for Choice (DfC) said the law would have a disproportionate impact on women who could not travel abroad for abortion.

Predicting that immigrant women would be left in particular difficulty, DfC said: “The failure to legalise abortion particularly affects women who have low incomes or have no independent source of income to cover the substantial cost of travel. It also affects women who have no right to travel due to their immigration status [usually asylum seeker women].”

DfC said that, because of the failure to legalise abortion on request here as a general right, “many women are forced to make public an otherwise private health matter”, which is what occurred in this case as the young woman had to go before an assessment panel and her case ended up in the courts.

It also highlighted the extra vulnerability of victims of sexual assault, as the woman in this case was. “If they then become pregnant, they have the trauma and degradation of the rape compounded by the failure of the Irish health service to provide access to safe and legal abortion,” said DfC.

Crucially, it warned that “suicide risk increases after a woman is refused an abortion as an option”. The woman in this case became increasingly distressed as her pregnancy progressed and became suicidal, eventually refusing all food and drink.

DfC also warned that “the bill contains elements that will cause unnecessary delay to access to abortion services causing an unnecessary prolonging of an emergency level of risk and requiring more complicated procedures”.

In the present case, decisions took so long that the foetus developed to the stage of viability and the woman was pushed into having a caesarean section which she did not want.

DfC argued that requiring an assessment panel of three doctors to certify a woman as suicidal would cause undue delay and were particularly concerned that the panel would comprise two psychiatrists and an obstetrician, the latter not being trained to assess mental health.

Predicting what ultimately happened in the current case, DfC said: “That an obstetrician could veto the decision of a psychiatrist leading to a review will serve only to restrict access and cause delay.”

Concerns about the involvement of obstetricians in the assessment process were also expressed from within the profession. Mary McCaffrey, an obstetrician at Kerry Hospital, told the hearing: “The general view among colleagues with whom I have consulted is that the diagnosis and treatment of patients presenting with suicidal ideation/intent can only be carried out by psychiatrists and that obstetricians are not trained to have an input in this diagnostic process.”

A barrister and former practicing doctor, Simon Mills, raised concerns about the lack of a time limit in the legislation beyond which an abortion should be declined and a caesarian or induced delivery performed. Dr Mills said it would be helpful to “make regulations stipulating a time of gestation beyond which a foetus may be deemed to be viable”.

The time limit should be based on published legal advice “to ensure that no arbitrary decision is taken to either unreasonably curtail or unreasonably extend the period during which a termination of pregnancy might be permissible”.