Tuesday, January 15, 2013

Valuable debate complete with medical facts, figures (Opinion)

It wasn't the same as it used to be - there was objective information and, for the first time, dispassionate debate.

The public hearings of the Oireachtas Committee on Health and Children on the options on abortion were the most informative and interesting ever held on this contentious issue. 

They provided objective facts on Irish medical practice for the first time. We are in a different country and the debate has all changed now.

Anyone under the age of 30 would not have any personal knowledge of the viciousness and divisiveness that was visited on Irish society by the abortion issue in the run-up to the first referendum in 1983. It was the closest thing to the divisions in the Civil War: family member against family member. Indeed, there were busmen and taximen proclaiming their support or opposition to the amendment to insert a so-called pro-life anti-abortion clause into the Constitution.

The attorney general of the time, Peter Sutherland, warned publicly that the proposed wording could be the means of introducing abortion.

The leaders of the Pro Life Campaign, including William Binchy, Caroline Simons and others, derided and abused him. But, so it came to pass. It was that wording, not the Supreme Court, which brought lawful abortion into Ireland.

Anyone under the age of 21 would not know the effect of the X case in 1992 when a 14-year-old girl who was raped was prevented by the High Court from travelling to England for an abortion. The Supreme Court subsequently overturned that judgment. 

It held that if it was established as a matter of probability that there was a real and substantial risk to the life, as distinct from the health, of the mother and that this real and substantial risk could only be averted by the termination of her pregnancy, such a termination was lawful.

There have been more abortion questions put to the people in referendums than any other single issue in the history of the Constitution: including two unsuccessful attempts to exclude suicide as a ground for lawful abortion in 1992 and 2002. The people approved the right to information and the right to travel for an abortion in the 13th and 14th amendments in 1992.

This historical perspective is important to prove the point that it wasn’t the same as it used to be at the abortion hearings chaired by Cork Fine Gael TD Jerry Buttimer this past week. 

There was objective information and, for the first time, dispassionate debate. And, as Dr Simon Mills and Judge Catherine McGuinness noted in their separate contributions, a middle ground has emerged on the most contentious political issue which is not represented by the so-called pro-life nor pro-choice positions.

What was extraordinarily interesting at the committee hearings, in fact, was that these groups seemed to have lost some of their vigour.
 
No deference 

They had moved from the mainstream to the margins of the political debate. But, it was the position of the Catholic Church that had changed most of all. 

There was courtesy – but no deference – shown to its representatives, Bishop Christopher Jones, chair of the Catholic Bishops’ Council for Marriage and the Family, and Fr Timothy Bartlett.

It was clear that the Catholic Church had lost its moral authority to dictate policy on the life of the unborn after the dreadful disclosures on the way that it allowed the lives of the born to be abused and sodomised over the years.

So what was new to emerge at the hearings that will influence members of the Government and the Oireachtas in their decision-making on abortion legislation and regulation? 

The first thing stated most emphatically by the masters of the maternity hospitals was that they would always do all in their power to save the life of the mother and the baby during pregnancy. That was their job. It was important that they stated that without equivocation.

The second was that they wanted the Government to legislate on the termination of pregnancy and repeal the criminal provisions of the 1861 Offences Against the Person Act in order to protect doctors and obstetricians in the carrying out of their duties.

The president of the Medical Council, Prof Kieran Murphy, added weight to this view when he confirmed that doctors were expected to adhere to the council’s guidelines but that they were not a legal code. It will come as news to some politicians that abortion is covered in paragraph 21 of the current guidelines.

The hearings were particularly valuable because the medical representatives provided facts and figures about terminations of pregnancy in Irish maternity hospitals for the first time. 

There was no dispute about them. 

Dr Sam Coulter Smith, master of the Rotunda, said six terminations had taken place in his hospital last year. 

Dr Rhona Mahony, master of the National Maternity Hospital Holles Street, stated that three had taken place there. And pressed to speculate on the number nationally, they deduced that it could be as low as 10 or as high as 30.

The information on the risk of suicide during pregnancy was even more interesting. It would be fair to say that all medical experts before the committee said they were not aware of any such case in the last year. 

Prof Patricia Casey produced figures from a review of the three Dublin maternity hospitals 1980-2011 showing that no suicides were reported during pregnancy in that 31-year period, when 685,511 gave birth to live babies.

She did concede that it is presumed that among the 4,000 women who travel to Britain for abortions each year are women who are suicidal or potentially so. But, she said, there is no data to substantiate this claim since the UK figures do not classify suicide as a specific ground for abortion.

One of the most relevant contributions to the hearings was made by Dr Anthony McCarthy, consultant perinatal psychiatrist at the National Maternity Hospital since 1996, because he addressed the argument that legislating for the ground of suicide could “open the floodgates” to abortion. Suicide is rare in pregnancy, he said, but it does happen “and is a risk we always have to consider”.

Suicidal ideation 

He went to the nub of the political issue. Suicidal ideation in pregnancy – meaning that the person has ideas in their mind about ending their life – is much more common than completed suicide. 

There are very significant differences between suicidal ideation and suicidal intent and plans. 

“We are trained to assess whether patients have suicidal ideation or intention or both, to diagnose whether the person is suffering from a mental illness or not, and to make or recommend appropriate therapeutic interventions and plans,” McCarthy concluded.

It is clear from the committee hearings that suicide is the most contentious question to be addressed by the Government in its proposed legislation on the X case.

It is also clear that a number of unanticipated ancillary issues will have to be tackled. If sections of the 1861 Offences Against the Person Act are repealed, for example, won’t there need to be a provision somewhere banning abortion in circumstances outside the X case? 

What evidence-based procedures will be put in place for medical specialists to decide that there is a real and substantial risk to the life of the mother during a pregnancy? 

These are complex issues, but there is a political appetite to deal with them, in a restrictive way, for the first time.

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