Saturday 25 May 2019

Abortion law strangled at birth by unworkable guidelines

A candlelight vigil to mark the first anniversary of the tragic death of Savita Halappanavar at University Hospital Galway last year
A candlelight vigil to mark the first anniversary of the tragic death of Savita Halappanavar at University Hospital Galway last year
Protest after Savita Halapanavar's death - The current heated exchanges between the HSE and the Health Information and Equality Authority (Hiqa) regarding the latter’s report on the pattern of infant deaths in Portlaoise Hospital highlight a matter of the utmost importance – the accountability of senior managers when things go wrong

Mark Murphy

GUIDELINES helping doctors interpret the Protection of Life During Pregnancy Act (PLDPA) 2013 are to be formally published in the coming weeks.

Listening to Justice Minister Frances Fitzgerald's recent comments to the UN Human Rights Committee (HRC), one could assume that I, as a GP, will have greater clarity in how I manage a pregnant women whose health or life is in danger. But the leaked guidance document tells the same old story.

The law will force professional misconduct upon my personal practice and on every doctor who manages a crisis pregnancy. It prevents my conscientious commitment to treat women who choose abortion with compassion and respect. We have allowed an orthodox Catholic teaching from the 1983 'pro-life' referendum to dictate the medical management of all pregnant women.

Irish doctors should practice evidence-based medicine by international best practice, otherwise, we would not be medical doctors. So how can we accept a whole-scale avoidance of international guidance when it comes to the management of women in pregnancy, namely the provision of safe and legal abortion services for women if they choose?

The new law is a double speak of cowardice and spite towards women.

It fails both in its misguided ability to protect 'the unborn' for women have always - and will always require abortion services - and it also fails to protect Irish women.

It will impose even greater restrictions than those intimated during the Bill's development. The criminalisation of women and doctors with up to a 14-year prison sentence persists, for what is one of the most common gynaecological procedures an Irish woman will undergo (over 1 in 10 Irish women have had an abortion). A woman at risk of suicide will face multiple consultations with multiple doctors to in effect 'prove' the severity of her mental state. Mr Yuval Shany of the UN HRC said that this obligation fails to protect women "against mental torture". We are imposing the antithesis of compassionate care. The review process will be equally bureaucratic, probably rendering the Act unworkable. The requirement of 'risk of suicide' has also been escalated to 'risk of suicidal intent' - a deliberately higher degree of restriction.

The right of conscientious objection is mentioned; but what is the right of doctors, who believe Ireland's abortion laws are a human rights violation, to exert their conscientious commitment to the provision of abortion services to Irish women?

Yes, the guidelines will allow some women with a serious illness access an abortion if necessary, to save their life. But most Irish women with serious health complaints requiring an abortion will still have to travel abroad - for example, women who have cancer and require an abortion to obtain chemotherapy. Women who become pregnant as a result of rape and are suicidal at the prospect of delivering that child, will not want to face an inquisition of medical professionals - so they too will travel, isolated and alone.

Is this the standard of care doctors in Ireland should provide? As the UN human rights committee noted, coercing women with fatal foetal abnormalities - who choose to have an abortion - to travel abroad is especially inhuman.

The Irish State has a long history of forcing women to have children they do not want. We may choose to think of these events as a disgraceful epitaph in Irish history. We are scarred by stories of mother and baby homes and Magdalene laundries. We shudder in the knowledge that Ireland had inordinately high rates of puerperal suicide and infanticide in the 1950s - before women could travel to the UK for abortion services. Yet are we to remain deaf to the serious concerns raised by the UN HRC today? We cannot allow such cognitive dissonance to continue.

Last week, the UN HRC said Ireland should "revise its legislation on abortion, including its Constitution, to provide for additional exceptions in cases of rape, incest, serious risks to the health of the mother, or fatal foetal abnormality". Professor Sabaratnam Arulkumaran also recommended constitutional change in his report to the HSE on the death of Savita Halappanavar.

This is not just the opinion of an international committee or one medical expert: public opinion is completely at odds with current policy. And that threatens the heart of democracy itself.

The lack of progress with the PLDPA has forced women to take the matter into their own hands. I know of many women who have procured abortifacient pills, such as those from Women on Web. I entirely understand their predicament.

After all, they know that abortion is a very safe procedure and they do not want the trauma of having to travel abroad or may be unable to afford the cost. Internationally, early medical abortion is seen as a safe and quick consultation in a primary care setting. In Ireland ,these women, in their desperation, risk a 14-year prison sentence. What is going on here?

As a doctor, it is unconscionable that substandard medical practice - and unprofessional care - is forced upon me. I cannot welcome these guidelines. I implore the Government to recognise my right as a doctor to provide compassionate care to my patients. That can only come when we have a referendum to allow for safe and legal abortion services in Ireland.

Dr Mark Murphy is a GP in County Dublin and a member of Doctors for Choice. He is a lecturer and researcher with the Royal College of Surgeons in Ireland

Irish Independent

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