Oireachtas Members Told of “Remaining Flaws” in New Abortion Law

As the Oireachtas Committee on Health and Children met this afternoon (28 May 2013) to finalise its abortion law report to Government, medical, legal and policy experts from three leading groups told TDs and Senators of the “remaining flaws” in the legislation.

Doctors for Choice (DFC), the Irish Council for Civil Liberties (ICCL) and the National Women’s Council of Ireland (NWCI) joined forces in Leinster House today to provide TDs and Senators with their expert analysis of the General Scheme of the Protection of Life during Pregnancy Bill 2013.

Dr Mark Murphy of DFC said “GPs alone manage uncomplicated pregnancies until 16 weeks gestation. If a woman presents in early pregnancy with a crisis it will be GPs in liaison with psychiatrists who will be managing her care. Obstetricians will not and need not be involved, as the pertinent issue will be mental health rather than obstetric health. GPs will not be “consulted” in clinical reality but will be the key clinician involved in the crisis pregnancy. The role of General Practice needs to be recognised and included in a redrafted Bill’.

DFC’s Dr Peadar O’Grady added that Doctors For Choice “recommend that two doctors certify, or not, the procedure in the situation of a threatened suicide: a GP and a Consultant Psychiatrist. We also recommend that the criminal sanction of 14 years for both woman and doctor be dropped from the proposed Bill, and that women with fatal foetal anomalies should be included in the scope of a redrafted  Bill”.

Deirdre Duffy, ICCL Senior Research and Policy Programme Manager said:

“By and large, we consider that this Bill is faithful to the settled constitutional position established under the X case. Not only would the very constitutionality of the proposed legislation be called into question by the omission of the suicide ground, it would be likely to leave Ireland in continuing breach of its international human rights obligations.”

“The ICCL is also obliged to point out that the State’s obligations in relation to abortion under the Convention run deeper than merely implementing the European Court judgment in A, B and C. The current treatment of women with pregnancies involving a defined set of lethal foetal abnormalities potentially falls foul of Ireland’s human rights obligations. The ICCL considers that it is constitutionally permissible under Irish law to provide for the termination of such pregnancies”, Ms Duffy concluded.

NWCI Director Orla O’Connor said: “We are extremely critical of the invisibility of women’s voices and women’s experiences in discussions on the Heads of Bill. Women must be at the heart of the debate.  In reality women will have real difficulty invoking their constitutional right to an abortion under the onerous procedures proposed by this Bill.”

“The NWCI have great concern over the continued criminalization of abortion in this country and the detrimental effect that it has on women’s physical and mental health. Criminalization will affect women accessing health services and deepen the chilling effect on both women and their doctors. Head 19 must be removed from the Bill to provide for full decriminalization of abortion in Ireland.”

14 Years Criminal Sanction Is Dangerous, Offensive and Manifestly Absurd For Women And Doctors

Doctors for Choice today have joined with Action on X and other groups in criticising aspects of the proposed Heads of the Protection of Life during Pregnancy Bill 2013.

Doctors for Choice welcome any improvement in the care of women who choose to have an abortion however it remains unclear whether this Bill would provide an ‘effective and accessible’ procedure for a woman in the position of Savita Halappanavar or in the X case.

 

Dr Peadar O’Grady has said “The inclusion of a criminal sanction of up to 14 years against women or doctors will hamper good practice and increase the risk of suicide in vulnerable patients through stigma and its emotional consequences: fear and distress.Fear of prosecution, a noted ‘chilling factor’, can onlycause further delays in access’

‘The notion that women who are forced to travel for an abortion in a situation of a fatal fetal anomaly are carrying out the equivalent of a gravely serious crime is particularly offensive’ he added.

‘The prospect of prosecuting children and/or their parents or those carrying out a home abortion with medication bought on the internet is also very concerning’ he said

He noted ‘The overwhelming support in 1992 for the constitutional right to travel for an abortion confirmed that Irish people do not consider abortion a grave crime; as did the lack of any prosecutions before then for abortions ‘procured’ abroad’

He added ‘To our knowledge, criminal sanction has not been seriously advocated by any party to the debate on access to abortion services. As criminal sanction is dangerous, offensive and manifestly absurd, it should be removed from the Bill’.

Doctors For Choice welcomes ICGP support for abortion

Doctors For Choice has  welcomed the Irish College of General Practitioners  support for abortion where there is a real and substantial risk to the life of the mother and for abortion where there are fatal foetal anomalies. 

Dr Mary Favier said ‘I  welcome the friendly amendment requesting that clarity in law for doctors was passed in respect of the first motion on real and substantial risk to the life of the mother, and particularly welcome the ICGP support for abortion where there are fatal foetal anomalies’.

2 out of 3 abortion motions were passed at the ICGP AGM in Galway this weekend.

Commenting on the successful motions that she proposed Dr Mary Favier said: ‘I’m so pleased for the Cork faculty that 2 of the 3 motions were passed. I think this sends a clear message to our patients that we actually care about women in these situations and that we are at the centre of healthcare that is required. It was refreshing to hear all the young pro-choice voices of newly qualified GPs at the AGM’.

‘I’m disappointed that the motion on rape and sexual assault was defeated by 3 votes, however I think that represents huge progress for the college’ she said.
She added  ‘but particularly important to me was the fact the motion on fatal foetal  anomalies and the provision of abortion in Ireland for women affected by that was  passed. I think this  was a really positive statement by the GPs of Ireland, that they understand the women affected in this situation, they believe that the situation they  face where they must travel to the UK for abortion is no longer appropriate and must change and this is a great day for those women who are affected by this situation’.

ICGP AGM – 2 of 3 motions relating to abortion passed

3 motions relating to abortion were brought to the ICGP AGM this weekend in Galway. 2 of the 3 motions were passed. These are listed below.

1) This meeting calls on the ICGP to call on the government to introduce clarity in the law, founded on evidence based medical guidelines where there is a real and substantial risk to the life of the mother.”

Carried 60 votes to 40 votes

2) The ICGP calls on the government to include within the proposed legislation the provision that women who become pregnant as the result of a criminal act, such as rape or incest, have access to the choice of legal abortion in the Republic of Ireland.

Defeated 55/ votes to 52 votes

3) The ICGP calls on the government to include within the proposed legislation the provision that women who are pregnant with non-viable foetal anomalies have access to the choice of legal abortion in the Republic of Ireland.

Carried 55 votes to 52 votes

Dr Mary Favier comments on the motions passed today:

Letter from Dr Mary Favier, a Doctors For Choice member, in today’s Irish Times

Sir, – In reference to the planned Protection of Life in Pregnancy Bill, Muiris Houston (Home News, May 1st) correctly questions how an expert in obstetrics can offer an opinion on suicide risk when it will be outside of their accepted skills and expertise? Without specific ongoing education and training in the area it will be a personal rather than an expert opinion and will need to be recorded as such.

Competent hospital risk managers will be soon minded to advise their obstetricians to continue to practise only within their established competencies so as to avoid likely legitimate complaint (and litigation) by a patient or family of a patient. This is likely to mean that obstetricians will not, and should not, offer a psychiatric or non-expert opinion on suicide risk. The Medical Council is also likely to have an opinion on any doctor opining outside their area of expertise. The proposed legislation as structured is fundamentally flawed and will need to be changed. – Yours, etc,

DFC Irish Times Letter

Letter from Dr Peadar O’Grady in The Irish Times

Sir, – Breda O’Brien (Opinion, April 27th) has grossly misrepresented the mental health evidence in relation to abortion. She derides the “faith-based dogma” of “fundamentalists” and praises “scientists” “adhering only to empirical evidence”.

Good scientists, however, do not rush to judgment on new research. The research Ms O’Brien quotes, by New Zealand academic David Fergusson and two colleagues, was just published in April in a relatively obscure psychiatric journal and has not yet been scientifically critiqued by Fergusson’s peers.

Good scientists do not ignore the previous research. Two previously published systematic scientific reviews in 2008 and 2011 by organisations representing tens of thousands of psychologists and psychiatrists have found no increase in mental health problems in women choosing an abortion. These studies have been critiqued by peers and their findings are well-founded scientifically. While Fergusson is correct that there is a lack of direct evidence of mental health benefits in abortion, there is indirect historical evidence that in countries where access to abortion is restricted the suicide rate in pregnancy is higher.

Most importantly, good scientists do not misrepresent the very evidence they are claiming to promote. In this same research paper David Fergusson concludes: “. . . it would be premature to conclude emphatically that this evidence is sufficient grounds for believing that abortion has adverse effects on mental health”.

Despite that Ms O’Brien emphatically did just that.

She also failed to mention Fergusson’s own conclusion in his paper of the alternative to certifying on mental health grounds: “On the face of it the most straightforward way of resolving these tensions between the law and clinical practice . . . is to extend these criteria to include serious threats to the social, educational, or economic wellbeing of the woman and her immediate family as legitimate grounds for authorising abortion”.

In other words, the only scientific paper the anti-choice movement can find which seems to back up its conclusion for restricting abortion actually recommends the opposite: an easing of the restrictions to make abortion more easily available. This means the fact stands that there is no scientific basis for restricting access to abortion unless, of course, we rely on the faith-based dogma of fundamentalists. – Yours, etc,

 

Response to Heads of Bill of Protection of Life During Pregnancy Bill 2013

Doctors for Choice welcomes steps to deal with the X-case. 21 years after the Supreme Court decision, compelled by the ECHR, the Irish Government has provided the first draft of legislation that will give those women who have a life threatening illness, and their doctors clarity on whether a termination can be legally performed. However, Doctors for Choice has concerns regarding the practical implications and limitations of this bill.

While Doctors for Choice welcome any improvement in the care of women who choose to have an abortion it remains unclear whether this Bill would provide an ‘effective and accessible’ procedure for someone in the position of Savita Halappanavar or the X case. Women in situations of rape, child sexual abuse and fatal foetal anomalies will have to wait for further legislation to allow for the option of abortion in those cases. Women who are unable to travel risk being denied an abortion or being harassed into travelling to England despite being unfit to do so.

  • In the case of the risk of suicide, imposing a requirement for three doctors is unnecessary and in excess of the maximum of two doctors recommended by the expert group
  • Certification for involuntary detention under the Mental Health Act only requires two doctors: a GP and a Consultant Psychiatrist. The requirement for an obstetrician to certify suicidal ideation is incomprehensible. No obstetricians claim skills in this area. GPs and psychiatrists are the doctors that routinely deal with this presentation.
  • That one obstetrician could veto the decision of two psychiatrists makes no sense except restriction for the sake of it.
  • There is no medical basis for differentiating between a medical emergency and a psychiatric emergency. All psychiatric emergencies are medical emergencies.
  • The requirement that psychiatrists work in a hospital will exclude most Child Psychiatrists who deal with children up to the age of 18 and will have to be amended to include them.
  • The inclusion of a 14 year prison sentence for women who have an abortion outside of these guidelines and describing that as due to the ‘gravity of the crime’ is particularly offensive. Every day more than a dozen women will have an abortion outside of these guidelines; only in a different country The right to travel for an abortion means that no-one in Ireland believes that choosing to have an abortion is a grave or serious crime and this odious section on criminal punishment should be removed.

The role and value of GPs is mentioned in Head 4. As primary care is the most common first point of contact in medicine, a suicidal woman in early pregnancy will most likely go to her GP and be cared for in this setting initially. In reality therefore a woman could be seen by at least 4 doctors before being ‘certified’ as requiring an abortion. A GP and a Consultant Psychiatrist would be the most relevant combination if two doctors were required.

We believe that the safest way to protect all women in Irish society is to decriminalise abortion, leaving medical matters outside the criminal law. This way we avoid legalistic terms and sanctions which have so far served solely to intimidate those who work in the field of medicine. Women should have the choice to access safe abortion services with fully informed consent. To achieve this we will need to repeal the 8th amendment.