Rotunda head: No confusion

A senior consultant has said he sees no evidence of confusion in medical ranks in Ireland over whether or not a woman can have an abortion if her life is at risk.

Dr Sam Coulter-Smith, master of the Rotunda Hospital in Dublin and consultant in obstetrics and gynaecology, said it would be preferable to have legislation to bring clarity.

But he said that in his experience he has not seen confusion among doctors on whether a woman is entitled to an abortion on clinical grounds.

“No. Not in relation to where a mother’s health is at risk,” he said.

“I think most of us who work in obstetrics and gynaecology, there may be individual differences, but the majority would be of the view that if the health is such a risk that there is a risk of death and we are dealing with a foetus that is not viable, there is only one answer to that question, we bring the pregnancy to an end.”

Dr Coulter-Smith is also clinical professor of obstetrics and gynaecology at the Royal College of Surgeons in Dublin and has headed the Rotunda for the last three and a half years.

“It’s a complex area. There are a whole series of issues that need to be resolved,” he said.

Dr Coulter-Smith said he could not discuss Mrs Halappanavar’s death directly but that introducing laws would offer further clarity.

“This case probably does not have a lot to do with abortion laws,” he said.

“It is a clinical scenario – someone in the process of miscarriage and had infective complications as a result of that process, whether or not if the situation had been actively managed in the 24-36 hours proceeding the tragedy of the baby’s death, would that have changed anything? No-one can answer that.

“But from the medical point of view it would be nice to have clarity – what is and isn’t possible and feasible.

“What is reasonably clear is that in a position where senior clinicians feel a woman’s health and life is at risk then it is permissible in this country to end the pregnancy.

“There isn’t legislation but the issues that have been judged on have set a precedent. It would be nice if there was legislation.”

Ireland’s Medical Council regulations on abortion state that the procedure is illegal unless there is a real and substantial risk to the life (as distinct from the health) of the mother.

The Rotunda is one of the three main maternity hospitals in Dublin alongside Holles Street and the Coombe.

The Medical Council's Guide to Professional Conduct and Ethics for Registered Medical Practitioners, states:

“Under current legal precedent, this exception includes where there is a clear and substantial risk to the life of the mother arising from a threat of suicide. You should undertake a full assessment of any such risk in light of the clinical research on this issue.

“It is lawful to provide information in Ireland about abortions abroad, subject to strict conditions. It is not lawful to encourage or advocate an abortion in individual cases.

“You have a duty to provide care, support and follow-up services for women who have an abortion abroad.

“In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby.”