New abortion guidelines proposed for Ireland
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7364.565/a (Published 14 September 2002) Cite this as: BMJ 2002;325:565All rapid responses
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Muiris Houston draws attention to the fact that Ireland has one of
the most draconian abortion laws in the world. Abortion may only be
provided in Ireland where continuation of pregnancy poses a " real and
substantial risk" to a pregnant woman's life. The legal position is most
recently defined by the Supreme Court ( 1983) which ruled that a 13 year
old rape victim could receive an abortion in the UK on the grounds of her
risk of suicide. Medical interpretation of this Supreme Court ruling is
loose - and has never since been tested. However, well over 7000 women
travel to the UK each year, mostly self-referred, to avail of voluntary
abortion there.
The situation of exporting abortion has extremely negative
implications for women's heatlh. Most patients feel that they can neither
consult with a doctor to receive counselling, medical opinion, or advice,
either before their abortion nor seek follow-up upon returning. In
addition, an act of parliament written in 1984 specifically forbids
medical referral for a patient who requests abortion. For the General
Practitioner, the clinical dilemma's are enormous. The doctor must either
break the law, or risk his own patient's unsupervised self-referral. In
the case of patients with ongoing medical illness, on warfarin, diabetic,
with infections disease, with psychiatric illness etc, the clinical and
ethical issues surrounding a ban on medical referral for an invasive
procedure are countless. In addition, the ban on medical referral means
that patients who choose abortion in the case of foetal anomaly are
generally self-referring via the Yellow Pages or Womens magazine adverts -
this means that they generally do not receive counselling by their own
obstetrician, post-abortion genetic counselling, foetal post-mortem, or
bereavement counselling. Many of these couples have publically expressed
their distress at the lack of support which they have received from the
medical profession in Ireland, surrounding their decision to terminate a
deformed pregnancy. Terminations for Irish women are defacto delayed, as
patients have to save up money, organise childcare and accommodation
abroad, and cannot avail of mifepristone; therefore all terminations are
surgical, with a very high second trimester rate. Many of our colleagues
who work to provide abortions for Irish women have contacted us to
highlight the inadequacy of women's health care in Ireland, and the plight
of women who have to travel there for terminations.
UK Charities which provide abortion for Irish women are a hugely
important part of reproductive health care in Ireland, but Irish doctors
are forbidden by law from consulting with our colleagues who work there.
Many of these important clinical issues were raised by pro-choice
doctors during the February 2002 referendum on abortion, which concerned
an amendment to the Irish Constitution proposed by the Fianna Fail
govenement. The referendum, which proposed to further increase the
inavailability of abortion (by removing the supreme court ruling which had
tolerated the possibility of abortion in the case of suicidal risk), was
defeated. However, the clinical and political situation remains the same
- Irish women continue to be refused abortion here, and are inadequately
referred when they have to go abroad.
As the national voice for pro-choice doctors and for patients who
have chosen abortion, Doctors for Choice works to immprove this situation
by advocating for the provision of abortion services in Ireland,
expecially where pregnancy is as a result of rape, incest, poses a serious
risk to a woman's psychological well-being, and where termination is
chosen because of foetal anomaly. We are proud to have been part of the
effort to defeat the abortion referendum in 2002, and will continue to
campaign for access to full reproductive rights including contraception
and aboriton in Ireland. Part of this campaign is to highlight the
importance of the Irish Medical Council's stance on abortion, and to
attempt to remove this measure of misconduct from Irish doctors so that
patients can be managed in their own country, and no longer forced to
travel abroad.
We welcome the huge support and encouragement we have received so far
from our UK colleagues, and strongly encourage colleagues in Northern
Ireland to join us.
Dr Juliet Bressan
Doctors For Choice in Ireland
P.O. Box 6862 Dublin 2, Ireland
info@doctorsforchoice.org
www.doctorsforchoice.org
Competing interests: No competing interests
Correction
Re : typing error to my original letter. The dates of the Supreme
Court decision and the Regulation of Information act were 1992 and 1995
respectively. My sincere apologies for the typo.
Competing interests: No competing interests