Analysis

Monday 14 July 2014

Abortion: last great battleground in the fight for the soul of Ireland

Published 17/11/2012|05:00

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THERE has been a near collective rush to judgment, some of it bordering on near hysteria based on ill-founded comment, as the country engulfs itself in another abortion paroxysm.

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While acknowledging at the outset the terrible heartbreak of Savita Halappanavar's husband, following the tragic death of his wife, it is crucial that basic natural justice applies to all the medical and other staff involved in this case.

The presumption of innocence until proven guilty surely applies in a matter literally of life and death. Some very serious, and very simplistic allegations are being made, about a medical predicament which involves finely tuned and potentially high-risk decision-making by the medics involved.

Central to the current controversy is whether the cause of death can be directly and unequivocally linked to existing guidelines on abortion, as these are applied in practice by the medical profession.

It will be up to the inquiry now under way to answer this crucial question.

On a broader level, there is wide disagreement as to what kind of abortion regime should apply in both the Galway case and similar instances, which involve life-threatening health choices for a pregnant mother.

There are those who feel the immediate challenge is to introduce legislation to give legal effect to the the current reality on the ground, which of course does allow for abortion in certain circumstances, depending on the ruling of the doctors concerned.

But there are also those for whom such legislation is not enough.

They want to introduce "no-fault" abortion on demand, as for example exists in Britain. Under such a regime the fundamental decision as to whether a pregnancy should be terminated would essentially rest with the mother rather than the doctor.

In the meantime, while acknowledging legislation would provide better legal protection for doctors, and presumably widen the ambit of their decision making, it should be noted that despite the fallout from the Galway tragedy, existing Irish Medical Council guidelines are fairly clear-cut.

Doctors are told abortion is allowed where there is a real and substantial risk to the life – as distinct from the health – of the mother. And in what doctors deem to be exceptional medical circumstances termination of pregnancy is allowed to protect the mother's life, providing every effort is also made to preserve the life of the baby.

Proposed legislation may well bring further clarity to the implementation of these guidelines. But it won't change the bottom line. The mother will remain subject to the judgment of her doctor, as to whether an abortion is necessary to save her life.

One of the more insightful comments made this week came from a senior consultant, who said he currently sees no evidence that doctors are confused when deciding if a woman whose life may be at risk can have an abortion.

However, Dr Sam Coulter-Smith, Master of Dublin's Rotunda Hospital, did acknowledge it would be preferable to have legislation to bring more clarity to the existing guidelines.

But it is important to note he has not seen confusion among doctors when they have to decide if a woman is entitled to an abortion on clinical grounds. "Not in relation to where a mother's health is at risk," he said.

Could legislation giving legal effect to abortion on these existing limited medical grounds get through the Dail, despite the reservations of Taoiseach Enda Kenny, and some of the more socially conservative members of Fine Gael?

The answer is probably yes, in that the Government is essentially being asked to legislate for what is already constitutionally agreed, and more importantly for what has now become common medical practice.

But on the other hand any proposal to legislate for what can broadly be described as abortion on demand, based on the British model, is certain to convulse the entire political system.

The truth is that all the political parties would be deeply divided on any proposal of this nature, particularly Fine Gael and Fianna Fail, and in addition sharp divisions remain among the electorate at large.

The history of a particular kind of social legislation in Ireland has been a traumatic one, although the relentless march of time has created its own momentum. The Mother and Child scheme, which at one point the Catholic Church would have us believe was creeping communism, because it was "socialised medical care for the lower orders" is but a distant memory.

And when the one-time twin evils of contraception and divorce were introduced to Catholic Ireland the world didn't end.

Abortion is the last big issue in this area, but it's the most contentious and emotive of them all; there is nothing like a national consensus, politically or otherwise, as to what should be done.

In the past there was the opportunity to hide behind the old "Irish solution to an Irish problem" approach, and kick the can down the road, in the hope that time and tide would bring their own kind of resolution.

But when it comes to the singular issue of life and death – this may no longer be an option.

Irish Independent

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