Thursday 19 April 2018

We face the reality every day -we know why change is needed

Dr Rhona Mahony and Prof Fergal Malone make the clinical case for a change to the laws surrounding termination of pregnancy in Ireland

Dr Rhona Mahony in Holles Street. Photo: David Conachy
Dr Rhona Mahony in Holles Street. Photo: David Conachy

Dr Rhona Mahony and Prof Fergal Malone

In considering the clinical impact of the Eighth Amendment, it is important to define and understand what is meant by termination of pregnancy, defined as the "intentional procurement of miscarriage prior to foetal viability". Foetal viability is approached at approximately 24 weeks of gestation when sophisticated neonatal intensive care provides an approximate 50pc chance of foetal survival. Other factors also impact on the prospect of foetal viability, such as foetal size and the presence of foetal abnormalities. A baby who is born after viability has been reached and intensive care provided is defined as a delivery.

In Ireland, a woman qualifies for a termination of pregnancy if there is a real and substantial risk to her life that may be removed only by termination of pregnancy. The process that determines this qualification is cumbersome, and despite the fact that it relies on clinical judgment delivered in good faith to save a woman's life, it is framed in a criminal context in which an error may be punishable by a custodial sentence of up to 14 years for both the mother and her doctor.

In pregnant women with additional serious medical problems, such as cystic fibrosis or congenital heart disease, the added physiological burden of pregnancy can create significant maternal risk. It must be recognised that it is clinically difficult, if not impossible at times, to distinguish with certainty the difference between risk to health and risk to life. This is real-life medicine, but there is arguably no other circumstance in medicine where such risks to life are balanced in the shadow of criminality. The critical question arises as to how a substantial risk of mortality is defined. Is it a 10pc risk of death or an 80pc risk of death, or a requirement for intensive-care support? A woman will have a view as to what constitutes a substantial risk to her life, and her view deserves consideration.

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