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Irish Abortion Referendum: impact on patient safety

On Friday 25 May 2018 the Irish public will decided whether to remove or keep the Eighth Amendment in the Irish Constitution.

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Fiona is an associate solicitor in the clinical negligence department.  You can follow her on twitter as @FEHuddleston
As a Northern Irish woman (living in London) I have been following the referendum with particular interest.

There is a stark difference between the abortion laws in Ireland and those, across the water, in Great Britain.

The Abortion Act was passed in 1967. It legalised abortion in Great Britain (but not Northern Ireland) in certain circumstances. Circumstances include,  if the mother is less than 24 weeks pregnant and two doctors agree that continuing the pregnancy and having a baby would be worse for her physical or mental health (than having an abortion).

Whilst the Abortion Act does not confer a “right to abortion” in practice, as abortion is usually overall safer than giving birth, doctors typically agree to an abortion (at less than 24 weeks) without requiring the mother to justify this decision.

For women living in England, Scotland or Wales, it is therefore the mother’s choice (to an extent). Relevant factors in reaching this decision can include the mother’s circumstances (such as their social or financial circumstances).

In Ireland, women are denied this choice, even when the baby would be born with fetal abnormalities, when the fetus was conceived by rape or when continuing the pregnancy could put the mother’s health at risk of harm.

The Eighth Amendment was introduced to the Irish Constitution in 1983. It reads:

"The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right."

This therefore equates the life of the woman with that of a fetus or embryo. It was subsequently clarified that abortion can lawfully take place only when there is a “real and substantial” risk to the life of the mother. 1

If the Eighth Amendment is successfully repealed the Government can then introduce new legislation. The key proposals include unrestricted abortions up to 12 weeks and the provision of abortions after that date where there are fatal foetal abnormalities or where there is a risk of serious harm to the health or life of the mother.

In April I attended an event hosted by the Women’s Irish Network, on the Eighth Amendment, which included a panel discussion. Dr Rhona Mahony (Master of National Maternity Hospital, Dublin) was part of the panel and gave an impassioned address from the perspective of an obstetrician.

Dr Mahony commented on the ambiguity with the criterion (referred to above) and pointed out that patients can deteriorate rapidly and that it can often be difficult to predict this deterioration, as such, by the time a woman is deemed at a “real and substantial” risk of death, it may be too late.

Dr Mahony provided an insight as to the terrible position that obstetricians are faced with, in determining whether or not the threshold for a legal abortion is met and the consequences that could follow if they facilitate an illegal abortion.

Dr Mahony also emphasised that the present situation leads to “backstreet abortions” with many women resorting to obtaining abortions illegally, without medical supervision or support (or regulation). Dr Mahony pointed out that this is not only incredibly distressing for women, but is medically unsafe. 

The Together for Yes campaign has prompted a number of leading doctors alongside midwives, nurses and other medical professionals to throw their hats firmly into the ring, advocating for the Eighth Amendment to be repealed on the basis that it is harming their patients.

To me, it appears relatively clear cut, at present the Eighth Amendment serves not only to deny women a basic right (over bodily integrity and self- determination) but it is also a dangerous barrier to patient safety.

Whilst repealing the Eighth Amendment will sadly not give Irish women the same rights as women here in Great Britain, it will be a crucial step in the right direction.

1 The Protection of Life During Pregnancy Act 2013

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