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IS it morally justifiable to allow a suicidal pregnant woman to go ahead and kill herself – so as to prevent other women from using a threat of suicide as part of their argument for requesting an abortion in Ireland?
This fundamental point of life and death has emerged as the central issue in the abortion debate, which looks certain to become increasingly vitriolic in the weeks ahead.
One of the most disconcerting dimensions of the discussion so far is the dogmatism and certainty displayed by extremists on both sides. The fact remains that precisely balancing the right to life of a pregnant woman, with that of her unborn child, is by definition an impossibility in cases of serious physical and psychological illness.
What is often ignored is that if a mother's health is at risk because of pregnancy, then both action, and more importantly inaction, by the medical staff involved may have serious and unforeseen consequences.
As things stand, doctors are allowed to interfere with a pregnancy only if there is a real and substantive risk to the life, as distinct from a risk to the health, of a mother.
But this highly nuanced divide can bring about some excruciating choices for all concerned, especially for medical staff.
The key problem is that the diagnosis and treatment of health complications, taken in isolation at a particular point in time, may eventually emerge as being too limited and too narrow. If a doctor was allowed to adopt a more far-seeing proactive approach, as is the case with other medical conditions, this could in some instances prevent the death of a patient whose illness eventually proves to have been progressive.
It's a conundrum that will be central to the findings in the case of Savita Halappanavar.
The very essence of professional medical care is that where serious sickness is involved, the doctors concerned, above all else, need to be far-seeing as regards all possible eventualities.
They need to have a free hand to take whatever preventative action is necessary before their options narrow and it is too late.
Another complicating factor is the subjective views of the doctor concerned on the overall abortion issue. In a minority of very finely balanced cases, a doctor who is instinctively pro-choice may subconsciously favour the mother, while the medic who is very much pro-life, may err on the side of the foetus.
But while the choices may be very finely balanced as regards physical illness, the matter is profoundly more complicated when it comes to mental issues, which may encompass a vast range of psychiatric and psychological problems.
It would seem many people in the pro-life movement are on no account willing to accept that a woman who insists she is suicidal, and who argues that if her pregnancy is to go to full term she will kill herself, should have this threat taken at face value. It is also argued that this needs to be assessed by a psychiatrist to try and some way establish its validity.
But psychiatric assessment is no guarantee against possible suicide. If the woman's sincerely held views are not given precedence over medical opinion, and if she should eventually commit suicide because of being forced to go ahead with her pregnancy, is this not tampering with the right to life of the mother as suggested in the Constitution?
There have been various instances where individuals have gone ahead and killed themselves, even though the psychiatric risk assessment process suggested this would not happen.
And what should be the correct course of action when a psychiatrist cannot arrive at a definitive conclusion one way or the other, as may be the case in a complicated depressive illness? Should the patient have any say at all?
There is a sad irony that the often secretive, inexplicable, and much misunderstood world of suicide, should now be emerging as central to our latest abortion controversy. All the statistics, but most of all word of mouth and anecdote, show that Ireland has a terrible problem with what seems to be a growing number of people who try and resolve troubles by taking their own lives.
The argument has been made that hard cases make bad law. It is suggested that if women who threaten suicide on the grounds they are denied an abortion are to be taken at face value, it will "open the floodgates'' because pregnant mothers cannot be relied upon to necessarily tell the truth on such matters.
On the other hand, if the suicide option is not catered for, there will be at least some women, however minuscule a number, who may well go ahead and kill themselves rather than bring their pregnancy to full term.
For those who describe themselves as pro-life this is something to ponder, even though they may argue it is a price worth paying in order to protect what they would describe as the common good.
But those who will allow a mother with serious psychological problems to die, because the State will not facilitate her request for an abortion, must also live with the consequence of their beliefs.
Irish Independent
