The heads of the Protection of Life during Pregnancy Bill 2013 have several sound provisions. Where a real and substantial risk to a pregnant woman's life exists, clear procedures and explanations are provided for everyone involved.
Doctors must "in good faith" determine that the only way to avert the death of a pregnant woman is through termination of her pregnancy. Assessments and terminations must be carried out in facilities with all appropriate obstetric and mental health specialists to ensure women receive the best care available. The medical certification process is framed around current medical ethical principles and constitutional requirements that place a duty on doctors "to preserve the life of the unborn as far as practicable".
In such tragic circumstances, where one or two human lives will likely be lost, the ending of unborn human life can be ethically justified. The heads do not state that this is required, only that it is not an offence to carry out such terminations. The pregnant woman has a right to life, and in certain situations, terminating her pregnancy is the only way to save her life. Even then, all efforts must be made to sustain the unborn if he or she is potentially viable outside the womb. In some cases, however, the death of the unborn will result. The general prohibition of abortion in Ireland is upheld. No new "right to abortion" is conferred.
In addressing suicide, the provisions remain clear, but become highly problematic. Almost identical language is used when the risk to the pregnant woman's life arises from physical conditions or suicide. But these two situations have significant differences. Various tests, scans and vital signs can provide objective evidence of a real and substantial risk to the woman's life. Removal or treatment of the underlying condition can save the woman's life, and sometimes that will terminate her pregnancy.
Suicide is very different. When a pregnant woman threatens suicide, the risk to her life is unlike that with an infection or other physical problem. The heads of the bill require three doctors to give a reasonable opinion that the risk of death "can be averted only by" an abortion.
But abortion is not a reasonable treatment for suicide during pregnancy. Most Irish psychiatrists believe this, as reported in this newspaper in April. An international review published by the 'Australian & New Zealand Journal of Psychiatry' concluded: "There is no available evidence to suggest that abortion has therapeutic effects in reducing the mental health risks of unwanted or unintended pregnancy.
"There is suggestive evidence that abortion may be associated with small to moderate increases in risks of some mental health problems."
The heads of this bill call for decisions based on best medical practice, yet its guidelines go against best medical practice.
The problems go beyond evidence to ethical consistency. In a threatened suicide, the risk to the woman's life is not due to her pregnancy, but to various beliefs and ideation. She may believe the unborn life will destroy her life, but the unborn is not a threat like an infection or other medical condition. Ending her pregnancy does not address her beliefs and suicidal ideation.
Imagine a similar situation where a woman threatened suicide because she believed herself unable to care for a recently delivered baby. We would never consider allowing her to end the life of the baby to relieve her suicidal ideation. She needs access to the best care available for suicide, not a mechanism to end a life, either hers or any other life.
Our Constitution upholds the right to life of the unborn as well as the born. This helps keep notions of death as a treatment for any condition out of our healthcare services. The other heads of this bill go to great lengths to reaffirm our commitment to the lives of pregnant women and the unborn. The approach taken to suicide during pregnancy contradicts these commitments and questions the legitimacy of the proposed approach.
International medical evidence shows that abortion is not a safe treatment for suicide. Those parts of the bill should be removed, and a commitment given to provide the most effective, evidence-based treatments for pregnant women with suicidal ideation. That would better serve the health and rights of pregnant women and their unborn children.
The views expressed here are those of the author and are not presented as those of Dublin City University. Dr Donal O Mathuna is senior lecturer in ethics, decision-making and evidence at DCU