Ireland votes to legalise abortion – a desperately sad day

On Friday 25 May 2018 Irish voters backed the legalisation of abortion by a majority of two to one in a national referendum.

The vote repeals the Eighth Amendment of the Constitution — a 1983 measure that conferred equal rights on the baby and the mother, making abortion legal only to save the life of the mother.

The national vote was 66.4% to 33.6% with only one of 40 constituencies, Donegal, voting against it and support was highest amongst urban women under 25, 90% of whom backed it.

Before the referendum, the government had pledged to pass legislation by the end of the year to allow unrestricted terminations up to 12 weeks (see picture), and between 12 and 24 weeks to protect the mother’s health, if the amendment was set aside.

The Eighth Amendment to Ireland’s constitution, or Article 40.3.3, ‘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’.

In other words, it treats the life of the mother and baby as equal. From now on that will no longer be so and babies up until 12 weeks will be able to be 'terminated' with impunity.

Ireland’s abortion law will thereby become more liberal that than in Britain which allows abortion only on medical grounds specified under the Abortion Act 1967, even though this law is largely flouted. 

Currently in Britain 98% of abortions are carried out on mental health grounds, when there is in fact no evidence to suggest that continuing a pregnancy poses any greater risk to a mother’s mental health than abortion.

Abortion is not healthcare - it treats no illness and offers no healthcare benefit and remains against the Hippocratic Oath. It is, at the end of the day, just killing.

What can we expect now in Ireland?

In 2016 3,265 Irish women travelled to England and Wales to have abortions. But once it is legal in Ireland the number of abortions in that country is expected to rise to 13,000 per year given abortion rates in Britain.

In 2016 in England and Wales, there were 696,271 live births and 185,596 abortions. That means over 1 in 5 pregnancies ends in abortion.

There have been over 9 million abortions in England and Wales since 1967 – an astonishing number equivalent to one and a half times the number of Jews who died in the Nazi holocaust. In fact, there are 43 million abortions every year around the world - almost one in two human deaths involving a doctor or other healthcare worker ending the life of an unborn baby.

Also 92% of all abortions in England and Wales are carried out under 13 weeks, so it is likely that a similar percentage will qualify in Ireland.

Today’s vote will leave Northern Ireland as the only place in the British Isles where abortion remains largely illegal.

Last year it was confirmed that there are 100,000 people alive in NI today because of the current law.

The right to life is the most fundamental of all rights and all other rights depend on it. Every individual human life begins at fertilisation and every abortion stops a beating heart.

But the Irish vote has confirmed that two thirds of voters there do not consider that life before birth has equal value to life after birth.

In other words, they believe that it is legitimate to treat babies before birth differently to those after birth – on the basis of their age, size, dependency and mental capacity.

This is profoundly discriminatory but is being advanced ironically on grounds of equality, diversity and tolerance.

That it has been welcomed by most Irish is a stunning judgement on just how far the country has slid in the last 40 years.

But the roots go back to the sexual revolution and the widespread acceptance of sex outside marriage - it is also stark witness to the ineffectiveness of free contraception in preventing conception and the legacy of believing that people who are not willing or ready to be parents should be having sex.

Ireland, having held out for some decades against the rest of the so-called developed world, has now joined the pack with a vengeance. A society will always be judged on how it treats its weakest members. Women are not the victims here.

It is a desperately sad day for Ireland. The fight for the unborn will go on, but it has just been made a whole lot harder.  

English and Welsh women are eight times more likely to abort a baby with Down’s syndrome than Irish women

If you have Down’s syndrome and your mother lives in Ireland then your chances of making it to birth are considerably greater than if you have the misfortune to be conceived in England or Wales.

English and Welsh women are 7.6 times more likely than Irish women to have an abortion for a baby with Down’s Syndrome, 6 times more likely to have an abortion for Edward’s syndrome and 4 times more likely to have one for Patau’s syndrome.

Furthermore the Irish birth rate for Down’s syndrome babies is about twice that for England and Wales.

The way these figures are derived is explained below. The calculations are not simple as many babies with all these conditions are not diagnosed until after birth.

Some of the most common congenital abnormalities accounting for abortions in England and Wales are ‘trisomies’, in which there are three copies of one particular chromosome rather than two.

The most common trisomies are Down's syndrome (trisomy 21), Edwards’ syndrome (18) and Patau syndrome (13). People with DS now have an average life expectancy of between 50 and 60 but those with ES and PS will all die in early childhood.

The National Down Syndrome Cytogenetic Register (NDSCR) was set up on 1 January 1989 and holds anonymous data from all clinical cytogenetic laboratories in England and Wales of cases of DS, ES and PS diagnosed before or after birth.

Its 2011 annual report was published in February 2013 and is available here. 

It shows that in 2011 there were 931 abortions for Down’s syndrome, 370 for Edward’s syndrome and 139 for Patau’s syndrome.

In the same year there were an estimated 725 babies born with Down’s syndrome accounting for approximately 1 in 1,000 live births.

How do these numbers compare with Ireland where abortion for fetal disability is currently illegal?

We know from Department of Health Statistics that 4,149 women with Irish addresses had abortions in Britain in 2011 as against 189,000 abortions that year involving women from England and Wales.

Just under 4.6 million lived in the Republic of Ireland in 2011 as against 56 million in England and Wales. So if Irish women were having abortions at the same rate as English and Scottish women there would be not 4,149 a year but over 15,500 (there were 723,913 births in England and Wales in 2011 and 74,377 in Ireland).

But what about babies with trisomy 13, 18 or 21?

According to the Department of Health Ground E abortions (those for fetal abnormality) for the years 2007 to 2011 were 27, 29, 42, 68 and 51 respectively – a total of 217.

Of this 217, the totals for DS, ES and PS were 48, 24 and 17 – or an average of 10, 5 and 3 per year respectively. 

Now for argument’s sake let’s assume the following:

1. Babies with DS, ES and PS are conceived with same frequency in Ireland, England and Wales (not unreasonable unless mothers are much older and therefore risk higher in England).

2. Babies with DS, ES and PS are diagnosed with the same frequency in Ireland, England and Wales (reasonable given the similar technology).

3. No abortions for any of these conditions take place in Ireland (as it is illegal).

4. All abortions on Irish babies with these conditions take place in England and Wales (as this is their nearest legal port of call).

5. The Department of Health statistics for abortions on babies with DS, ES and PS are accurate (although see comparison with NDSCR figures here).

If abortions on Irish babies with DS, ES and OS were occurring at the same rates as English and Welsh babies with these conditions we would expect not 10, 5 and 3 abortions per year (for DS, ES and PS) but rather 76, 30 and 11 (figures obtained by multiplying E/W figures of 931, 370 and 139 above by 4.6 and dividing by 56 to correct for population).

In other words English and Welsh women are 7.6 times more likely than Irish women to have an abortion for a baby with Down’s Syndrome, 6 times more likely to have an abortion for Edward’s syndrome and 4 times more likely to have one for Patau’s syndrome.

There are currently 60,000 people living with Down’s syndrome in England and Wales and 5,000 in Ireland – roughly similar if we correct for population size.

But whereas 120 babies are born with Down’s syndrome in Ireland every year the equivalent figure for England and Wales is 725 – about half the corrected Irish birth numbers of 1,460.

Discussion of the results and the derivation of the numbers is most welcome. 

Irish MP overinflates abortions for fatal fetal disability 300-fold to advance political agenda

The Irish ‘Protection of Life During Pregnancy Act’, signed into law last July, will allow abortions to be carried out where there is a threat to the life of the mother.

It does not, however, allow abortion when the life of the baby is at risk.

Campaigners in Ireland are now seeking to change this and are up to their usual tricks of inflating statistics.

On 13 November the Irish Journal reported on a campaign by a group called ‘Terminations for Medical Reasons’ (TFMR) who argued that 1,500 Irish women per year carried babies with fatal fetal abnormalities:

‘About 1,500 cases of fatal fetal abnormalities are reported each year in Ireland with about 80 per cent of the women travelling abroad for early inducement or terminations. Members of TFMR were devastated of the omission from the legislation this year but vowed to take their cases to Europe and beyond.’

80% of 1,500 is 1,200! Given that around 4,000 Irish women have abortions in England and Wales each year this would suggest that almost one third of them are having them for fatal fetal abnormalities. That sounds a wee bit high to me.

So where did this figure of 1,500 come from? The earliest reference to it that I can find seems to be from the same group (TFMR) on 27 May this year, reported in Breaking News Ireland.

Since this time it appears to have been picked up uncritically by the Irish media.

According to the Irish Times on 26 June, during the debate over the bill, Independent TD John Halligan (pictured below), ‘pointed out’ that 1,500 women in Ireland each year had to deal with a pregnancy where the baby would live for just minutes outside the womb (emphasis mine).

The figure was repeated uncritically by the Irish Examiner a day later.

To my knowledge not one of these news outlets has since retracted nor corrected the claim, with the exception of the Irish Independent who published an article by Niamh Ui Bhriain of The Life Institute on 25 November debunking the false statistics.

This encouraged us to obtain the statistics for Irish women having abortions in England and Wales for fatal fetal abnormalities from the Department of Health (DoH). According to the above there should have been 80% of 1,500 or about 1,200 each year.

So how many were there? According to the DoH Ground E abortions (those for fetal abnormality) for the years 2007 to 2011 were 27, 29, 42, 68 and 51 respectively.

But how many of these were for fatal abnormalities where, by John Halligan’s definition, the baby ‘would live for just minutes outside the womb’?

We are not told this specifically but we can make a reasonable estimate from the data available.

Of the 51 ground E abortions in 2011, 60% (31 in total) were for chromosomal abnormalities including Down’s syndrome (11), Edward’s syndrome (7) and Patau’s syndrome (7).

Of these the latter two conditions are very serious. Half of infants with Edward’s syndrome do not survive beyond the first week of life.The median lifespan is 5–15 days. About 8% of infants survive longer than one year.

More than 80% of children with Patau’s syndrome die within the first year of life.

Today the average life expectancy for a person with Down's syndrome is between 50 and 60. A considerable number of people with Down's syndrome live into their 60's.

So, even given the fact that these are all life-limiting conditions, it is extremely unlikely that any of these 31 babies, if born, would have died within minutes of birth.

There were 12 babies aborted for a range of other conditions including spina bifida (3) and cardiovascular disease (2). It would expected that most of these also would not die within minutes of birth. Unlike those babies with chromosomal abnormalities most of this group would be amenable to treatment of one kind or another.

The only category where the babies might arguably have fitted Halligan’s definition of ‘fatal’ was anencephaly. There were 8 abortions on Irish women for this condition in 2011.

55% of babies with anencephaly, who are not aborted, do not survive birth. If they are not stillborn, then they will usually die within a few hours or days after birth from cardiorespiratory arrest, although there are exceptional cases of babies with the condition surviving up to two or three years.

So let’s say that about half of those with anencephaly, about 4 in 2011, would fall into Halligan’s category of being stillborn or dying within minutes of birth.

That’s four versus Halligan’s figure of 1,200. So the TD was out by a factor of 300!

I am not in any way trying to suggest that carrying a baby that has a disability to term is not a huge challenge which requires great courage, grace and support (see my article on anencephaly here).

But if we are to have this debate at all, then we must have it based on the actual facts of the case, and not with reference to wildly spun statistics that have been simply plucked out of the air to advance a certain political agenda.

Telling lies in parliament is serious. If John Halligan didn’t know they were lies then he is rather gullible and probably also incompetent. If he did then it is a very serious matter indeed.

I wonder if he will be called to account for it? And I wonder if the Irish media will keep propagating his untruths?

See also

'Lies, damned lies and statistics' from the Alan Guttmacher Institute

Defending the ‘indefensible’? Twenty reasons to think twice about aborting a baby with anencephaly

Courageous MP thrown out of government for refusing to back legal abortion

Ireland's Europe minister quit last Thursday over plans to legalise abortion as Prime Minister Enda Kenny pressed ahead with legislation that has polarised the country.

Kenny has provoked a strong backlash by pushing for access to abortion when a woman threatens suicide, a move that opponents say could easily open the floodgates to abortion on demand.

Lucinda Creighton (pictured), once tipped as a possible leader of the Fine Gael party, was automatically expelled from its grouping in parliament for voting against an amendment to the new law and will now lose her role as minister for European affairs.

‘When it comes to something that is essentially a matter of life and death, I think it is not really possible to compromise,’ Creighton told state broadcaster RTE after the vote.

Ireland’s lower house of parliament passed the bill by 127 votes to 31 and acceptance in the upper house is considered by many now to be a formality.

Under the new bill abortions will be legal if ‘there is a real and substantial risk of loss of the woman’s life by way of suicide’ and if an abortion is the only way of averting the suicide. Three doctors must sign off on each case. No time limits are mentioned in the legislation.

Ms Creighton objected vehemently to this clause. She argued that it was unworkable and ‘has the potential to normalise suicidal ideation by enshrining suicide on our statute book for the first time’.

After the vote Ms Creighton said that she was very sad to be forced out of the party. But in a lengthy apologia, Ms Creighton told the Dail that she was not a ‘pro-life campaigner’ but that that abortion was not a ‘liberal’ cause. It was ‘a tool for the oppression of women’. She also disavowed a religious motivation for her principled stand:

‘There is an emerging consensus in Ireland which suggests that having a sense of morality has something to do with the Catholic Church…. This is deeply worrying. It is a lazy way of attempting to undermine the worth of an argument, without actually dealing with the substance. This is not just a Catholic issue, any more than it is a Protestant or Muslim issue. This is not a religious issue. It is a human rights issue… We all have the right to conscientious objection. It is enshrined in Article 18 of the United Nations, Universal Declaration on Human Rights.’

Martin Luther King Jr's argued in his influential ‘Letter from a Birmingham Jail’ - written 50 years ago in April 1963 – that conscience was the lodestar of an honourable man.

Professor John Wyatt has defended its use in medicine saying that ‘the right of conscience helps to preserve the moral integrity of the individual clinician, preserves the distinctive characteristics and reputation of medicine as a profession, acts as a safeguard against coercive state power, and provides protection from discrimination for those with minority ethical beliefs.’

But the right of conscientious objection is increasingly coming under attack from a number of prominent ethicists and writers. According to Oxford Professor Julian Savalescu, a prominent bioethicist:

'A doctor's conscience has little place in the delivery of modern medical care… If people are not prepared to offer legally permitted, efficient and beneficial care to a patient because it conflicts with their values, they should not be doctors’.

A recent article in the New England Journal of Medicine similarly stated:

'As the gate-keepers to medicine, physicians and other health care providers have an obligation to choose specialties that are not moral minefields for them. Do you have qualms about abortion, sterilization and birth control - do not practice women’s health.’  

As I have previously argued there is a strong biblical precedent for the exercise of conscience when governing authorities act to threaten innocent human life.

The Hebrew midwives when ordered by the king of Egypt to kill all male Hebrew children refused to do so and as a result we are told that God commended and rewarded them (Exodus 1:15-22).

Rahab the harlot similarly refused to co-operate with the king of Jericho in handing over the innocent Israelite spies (Joshua 2:1-14). She is later praised for her faith in so doing (Hebrews 11:31; Jas 2:25).

Moreover conscience was often exercised at great personal cost.

The prospect of death as a consequence of disobedience to state law did not stop Shadrach, Meshach and Abednego refusing to bow down to the image (Daniel 4:6-8), or Daniel persisting with public prayer (Daniel 6:1-10). They were defiant.

In the New Testament when Peter and John were commanded by the Jewish authorities not to preach the Gospel they replied,  'We must obey God rather than men' and went right on doing it (Acts 5:29).

As Ms Creighton has argued, abortion is not just an issue that concerns Christians.

It also runs counter to the Hippocratic Oath, the Declaration of Geneva, the International Code of Medical Ethics and the Universal Declaration of Human Rights. In fact the British Medical Association once called it ‘the greatest crime’.

Ms Creighton is to be commended for her courageous stand. What a shame that more did not stand with her. 

Marie Fleming loses Supreme Court appeal challenging ban on assisted suicide

A 59-year-old Irish woman today lost her Supreme Court challenge to the ban on assisted suicide.

Marie Fleming (pictured) is a 59 year old former Irish lecturer who has multiple sclerosis and wanted her partner to be able to help her kill herself without risk of prosecution (See Irish Times and BBC Europe reports).

She had argued the ban on assisted suicide breached her Constitutional rights and discriminated against her as a disabled person.

This morning, however, the Supreme Court’s seven judges concluded that “there is no constitutional right to commit suicide or to arrange for the determination of one’s life at a time of one’s choosing”.

Fleming's landmark case in Ireland is very similar to that of Debbie Purdy in Britain, who won a case in 2009 forcing the Director of Public Prosecutions (DPP) to make public the criteria he used in deciding to bring a prosecution for assisting suicide. These criteria were published in February 2010 and have been the subject of some controversy.

What makes the Fleming case particularly interesting is that her partner who wishes to avoid prosecution is none other than Tom Curran, the Coordinator for Exit International Europe (EIE), a pro-euthanasia lobby group (EIE is part of Exit International, which is headed by controversial Australian euthanasia campaigner Philip Nitschke). 

Suicide was decriminalised in Ireland in 1993, but Section 2.2 of the Criminal Law Suicide Act 1993 makes it an offence to ‘aid, abet, counsel or procure’ a suicide. Those convicted under this law still face a custodial sentence of up to 14 years.

The Irish Act is almost identical to the Suicide Act 1961 of England and Wales, with the exception that in the latter the words ‘aid, abet, counsel or procure’ were amended to ‘encourage or assist’ by the Coroners and Justice Act in 2009 in an attempt to make it easier to secure convictions in cases of internet suicide promotion where the guilty party did not personally know the victim.

In her case against Ireland, the Attorney General and Director of Public Prosecutions (DPP), Fleming claimed section 2.2 of the Criminal Law (Suicide) Act, which renders it an offence to aid, abet, counsel or procure the suicide of another, was unconstitutional on grounds that it breached her personal autonomy rights under the Constitution and European Convention on Human Rights (See more here)

Fleming argued that the absolute ban should and must be relaxed to meet her particular circumstances as a terminally ill person in severe pain who is mentally competent to decide when and how she wants to end her life but cannot do so without assistance. She claimed that the law discriminated against her as a disabled person who needed assistance to kill herself.

A three judge High Court ruled earlier that the absolute ban did not disproportionately infringe Ms Fleming's personal rights under the Constitution and was wholly justified in the public interest to protect vulnerable people.

The High Court also ruled that the Director of Public Prosecutions had no power to issue guidelines setting out what factors she would consider in deciding whether to prosecute cases of assisted suicide. However, the court was however ‘sure’ the Director would adopt a humane and sensitive approach to Ms Fleming's plight, Mr Justice Nicholas Kearns said.

Ms Fleming was not appealing against that aspect of the court's decision. Her appeal instead focussed on arguments that the absolute ban on assisted suicide breached her personal autonomy rights under the Constitution and European Convention on Human Rights and that, in her particular circumstances, this ban was not justified on public interest grounds but was disproportionate and discriminatory.

This claim has now failed, with the Supreme Court rejecting 'the submission that there exists a constitutional right for a limited class of persons, which would include the appellant. While it is clear that the appellant is in a most tragic situation, the Court has to find constitutional rights anchored in the Constitution... [and it] has not been the jurisprudence of the Constitution that rights be identified for a limited group of persons.'

Fleming’s case rested on the flawed assumption that, since suicide itself is not illegal, there is thereby a right to suicide. It is on this basis that she claimed that as a seriously disabled person she was being discriminated against for not being able to exercise that right, when able-bodied people can.

Dignity in Dying (the former British Voluntary Euthanasia Society) has used a similar line of argument.

However this is to misunderstand the basis and intention of the law.

When the British Parliament passed the Suicide Act in 1961 it was assured that the decriminalisation of suicide did not indicate any reduction of the seriousness with which either (a) suicide or (b) assisting suicide were viewed.

The Joint Under-Secretary of State for the Home Department, moving the Suicide Bill's Third Reading, said:

'Because we have taken the view, as Parliament and the Government have taken, that the treatment of people who attempt to commit suicide should no longer be through the criminal courts, it in no way lessens, nor should it lessen, the respect for the sanctity of life which we all share. It must not be thought that because we are changing the method of treatment for those unfortunate people, we seek to depreciate the gravity of the action of anyone who tries to commit suicide…..' (Hansard: HC Deb 28 July 1961 vol 645: 1961(a): Cols 822-823)

He went on:

'I should like to state as solemnly as I can….that we wish to give no encouragement whatever to suicide…..I hope that nothing that I have said will give the impression that the act of self-murder, of self-destruction, is regarded at all lightly by the Home Office or the Government.' (Hansard:HC Deb 19 July 1961 vol 644: Cols 1425-1426)

Fleming and others wish to argue that in some cases suicide is not serious and is in fact a morally good course of action. That is a position that needs to be strongly resisted at all costs.

It is one thing to argue that people who attempt suicide should be treated with mercy and compassion by the courts. But it is quite another to argue that committing suicide, taking one’s own life, is a moral good and thereby a right.

That would be a very dangerous precedent indeed, which once established would be used as a legal lever for more and more incremental extension.

Judgment Of the Supreme Court: Fleming v Ireland 

Savita Halappanavar - Medical misadventure verdict does not justify changing Ireland’s abortion law

The jury in the Savita Halappanavar inquest has returned a unanimous verdict of death by medical misadventure.

Savita Halappanavar (pictured), 31, was an Indian woman who tragically died in Ireland from overwhelming infection after allegedly being denied an abortion. 

Her case has been seized upon by the pro-choice lobby as grounds for liberalising Ireland’s abortion law.

Savita was 17 weeks pregnant when admitted to the University Hospital Galway on 21 October 2012 with an inevitable miscarriage.

At that time a fetal heart beat was detected and doctors opted not to end the pregnancy by inducing labour but instead waited for her to deliver naturally.

Her baby was born dead three days later on 24 October.

Savita died from multi-organ failure from septic shock due to an E coli infection on 28 October, four days after her baby’s birth.

The coroner, Dr Ciaran MacLoughlin, said the verdict of medical misadventure did not mean that deficiencies or systems failures in University Hospital Galway necessarily contributed to Mrs Halappanavar's death; these were just findings in relation to the management of her care.

The chief operating officer at the Galway Roscommon Hospital Group, Tony Canavan, acknowledged that there were lapses in the standards of care provided to Mrs Halappanavar and said that deficiencies identified during the inquest would be rectified by the hospital.

Leading obstetrician Peter Boylan outlined a number of deficiencies in her care, but stressed that none on its own was likely to have resulted in Mrs Halappanavar’s death.

The coroner’s nine recommendations  (summarised below) were strongly endorsed by the jury.

The key recommendation read as follows:

‘The Medical Council should lay out exactly when a doctor can intervene to save the life of the mother in similar circumstances, which would remove doubt and fear from the doctor and also reassure the public. An Bord Altranais should have similar directives for midwives so that the two professions always complement one another.’

The other eight recommendations involved improving hospital systems and procedures.

There are four key questions in this tragic case:

If the doctors had intervened earlier to induce labour when the baby’s heartbeat was still present would Savita have died? Quite possibly not, but at that stage there was no suggestion that her life was in danger.

If they had acted more quickly to diagnose and treat her E coli infection might she have been saved? Possibly. There were several acknowledged errors and omissions made in her care but it is impossible to prove that these led to her death.

Did Savita die because of the Irish abortion law? No, because Irish law already allows abortion when there is a risk to the life, as distinct from the health, of the mother.  Making this judgement, however, sometimes requires considerable skill and experience, which is why clearer guidance from the Irish Medical Council, within the existing law, is to be welcomed.

Does the Irish abortion law need changing? No. As I have previously argued in much more depth on this blog, Savita’s tragic death is not a reason to change the law.

Ireland remains one of the safest places in the world to have a baby. Its maternal mortality rate is just six deaths per 100,000 live births. This compares with 12 in the UK, 15 in the US and 200 in India.

As there are about 75,000 live births a year in Ireland this means that there is an average of just four maternal deaths per year from all causes.

Savita’s death was indeed a tragedy and there was medical misadventure involved in her care, but we should be very wary of knee-jerk legislation. It is far better to handle exceptional circumstances like this by way of guidance from the Medical Council. 

Ending a pregnancy to save the life of a mother by inducing labour when the baby is too young to survive outside the womb is sometimes necessary in extremely rare circumstances.  But this is already legal in Ireland.

Changing the law in Ireland to that of the UK would not save any mothers’ lives but instead would lead to around 11,000 more abortions annually.

The baby in the womb is the most vulnerable of human beings, worthy of wonder, respect, care and protection. The law should reflect that fact whilst allowing intervention to save one life (the mother) in cases where not intervening would mean that two lives (both mother and baby) are lost.

Summary of Coroner’s recommendations (from the Independent):

* The Medical Council should say exactly when a doctor can intervene to save the life of a mother, which will remove doubt or fear from the doctor and also reassure the public;

* Blood samples are properly followed up;

* Protocol in the management of sepsis and guidelines introduced for all medical personal;

* Proper communication between staff with dedicated handover set aside on change of shift;

* Protocol for dealing with sepsis to be written by microbiology departments;

* Modified early warning score charts to be adopted by all staff;

* Early and effective communication with patients and their relatives when they are being cared for in hospital to ensure treatment plan is understood;

* Medical notes and nursing notes to be kept separately;

* No additions or amendments to be made to the medical notes of the dead person who is the subject of an inquiry.

Ireland and abortion – a review of recent events and the current legislative predicament

The international spotlight is now on Ireland in the wake of the case of Savita Halappanavar who, it is alleged, died after being denied an abortion (the facts of the case are still subject to an investigation and are hotly disputed).

Abortion remains illegal in Ireland under statute law but two court cases have established precedent which has to some extent led to loss of clarity.

The ‘X case’ (in 1992) (Attorney General v. X, [1992] IESC 1; [1992] 1 IR 1) was a landmark Irish Supreme Court case which established the right of Irish women to an abortion if a pregnant woman's life was at risk because of pregnancy, including the risk of suicide.

The ‘ABC case’ ( A, B and C v Ireland [2010] ECHR 2032) was a landmark case of the European Court of Human Rights on the right to privacy under article 8 ECHR. It held there is no right for women to an abortion, although it also found that Ireland had violated the Convention by failing to provide an accessible and effective procedure by which a woman can have established whether she qualifies for a legal abortion under current Irish law.

An ‘expert group’ has now produced a report on the Judgement in A, B and C v Ireland which has put forward four options for the Irish government to consider. The Irish government is not obliged by the judgement of the European Court of Human Rights to legislate for abortion. However there is a lot of international pressure for it to do so.

Pat Buckley (pictured) of the European Life network has put up some very useful posts on the current dilemma faced by the Irish government.

Buckley draws attention to a report from the European Life network (ELN) on the expert recommendations and links to the full critique.

ELN essentially questions the entire basis on which the report is premised and rejects many of the assertions set out in it.

It concludes as follows:

By defining abortion as necessary medical treatment, and by undermining the absolute prohibition on abortion in the Irish Constitution and Irish statute law, the expert report sets the scene for legislation which will lead to ever-wider permissions for abortion.

The history of abortion law in Great Britain shows that, over time, court judgments, new statutes, regulations and professional guidelines form a trend towards de facto abortion on demand.

The Oireachtas must reject the expert group if it wishes to avoid this scenario. It must find a way to overturn the X case judgment and any other element of law or public policy in Ireland which fails to apply Ireland’s constitutional and statutory ban on intentionally ending the lives of unborn children from the point of conception onwards. This will also protect the lives and dignity of women, in a country whose maternal health record is one of the best in the world.

In another post Buckley reports on the statement of the Irish Catholic Bishops' Conference on 4 December who have issued their initial response to the Report of the Expert Group on the Judgement in A,B and C v Ireland.

I have quoted some key excerpts below but a fuller summary is available on Patrick Buckley’s blog.

A society that believes the right to life is the most fundamental of all rights cannot ignore the fact that abortion is first and foremost a moral issue.

As a society we have a particular responsibility to ensure this right is upheld on behalf of those who are defenceless, voiceless or vulnerable. This includes our duty as a society to defend and promote the equal right to life of a pregnant mother and the innocent and defenceless child in her womb when the life of either of these persons is at risk.

By virtue of their common humanity the life of a mother and her unborn baby are both sacred. They have an equal right to life. The Catholic Church has never taught that the life of a child in the womb should be preferred to that of a mother. Where a seriously ill pregnant woman needs medical treatment which may put the life of her baby at risk, such treatments are morally permissible provided every effort has been made to save the life of both the mother and her baby.

Abortion, understood as the direct and intentional destruction of an unborn baby, is gravely immoral in all circumstances. This is different from medical treatments which do not directly and intentionally seek to end the life of the unborn baby.

Current law and medical guidelines in Ireland allow nurses and doctors in Irish hospitals to apply this vital distinction in practice. This has been an important factor in ensuring that Irish hospitals are among the safest and best in the world in terms of medical care for both a mother and her unborn baby during pregnancy. As a country this is something we should cherish, promote and protect.

The Report of the Expert Group on the Judgement in A, B and C v Ireland has put forward options that could end the practice of making this vital ethical distinction in Irish hospitals. Of the four options presented by the Report, three involve abortion – the direct and intentional killing of an unborn child. This can never be morally justified. The judgement of the European Court of Human Rights does not oblige the Irish Government to legislate for abortion.

The Report takes no account of the risks involved in trying to legislate for so-called ‘limited abortion’ within the context of the ‘X-case’ judgement. The ‘X-case’ judgement includes the threat of suicide as grounds for an abortion. International experience shows that allowing abortion on the grounds of mental health effectively opens the floodgates for abortion.

The Report also identifies Guidelines as an option. It notes that Guidelines can help to ensure consistency in the delivery of medical treatment. If Guidelines can provide greater clarity as to when life-saving treatment may be provided to a pregnant mother or her unborn child within the existing legislative framework, and where the direct and intentional killing of either person continues to be excluded, then such ethically sound Guidelines may offer a way forward.

A matter of this importance deserves sufficient time for a calm, rational and informed debate to take place before any decision about the options offered by the Expert Group Report are taken.

I have previously argued, with reference to the Savita case, that Ireland should not be changing its law on abortion.

However, I agree with the Irish Bishops that ethically sound guidelines which clarify when life-saving treatment may be provided to a pregnant mother or her unborn child within the existing legislative framework may offer a way forward.

I have written more on the subject of abortion to save the life of the mother both here and here.

I would also urge medical professionals to sign the Dublin Declaration.

The point of this declaration is to make clear that there is a vast difference between

1.Separating the mother and fetus for purposes of saving the life of the mother, and
2.Intentional destruction of the life of the fetus for the purpose of producing a dead fetus

It is essential that we as medical professionals communicate now that pre-viable delivery to save the life of the mother is not the same as direct abortion, even if the preterm fetus cannot survive the process.

And direct abortion (a procedure performed with the primary intent to produce a dead fetus) is never medically indicated.

In this connection the Association of American Prolife Obstetricians and Gynaecologists (AAPLOG) statement on ‘Maternal mortality in Ireland’ is also well worthy of study.

Changing Ireland’s abortion law will not save any mothers and could lead to 11,000 more abortions annually

Savita Halappanavar was an Indian woman who tragically died on 28 October in Galway University Hospital, Ireland from overwhelming infection after allegedly being denied an abortion.

Her death, on 28 October, is now the subject of two investigations by Ireland's Health and Safety Executive (HSE) and by University Hospital Galway.

The death has led to an international campaign calling for Ireland’s abortion laws to be changed.

Currently abortion in Ireland is illegal under section 58 and 59 of the Offences against the Person Act 1861.

However in 1992 Ireland’s Supreme Court ruled in the X case that abortion is admissible in the case of a ‘real and substantial risk’ to the mother’s life (as opposed to her health).

Section 21.4 of Ireland’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners also recognises that in exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother.

So both Irish law and Irish medical professional codes already allow abortion to save the life of the mother (see detail on my earlier blog).

As I have previously argued if faced with a choice between intervening to save one life (that of the mother) or standing by and allowing two (both mother and baby) to die, then I would have no hesitation in intervening and have previously already done so in the case of ruptured ectopic pregnancy.

I have never heard a doctor say he or she would not intervene in this type of situation although some such doctors might possibly exist.

Thankfully bringing a pregnancy to a premature end in order to save the life of the mother is vanishingly rare. In the UK it was reported in 1992 that in the first 25 years of the operation of the Abortion Act 1967 only 0.013% of all abortions were performed 'to save the life of the mother' and it is even questionable whether many of these required such radical action.

Some people are arguing (for example see Jen Gunter’s blog) that this is a case of negligence or mismanagement and they may well be right. But there are already disputes about the real facts of the case as well documented here.

Personally I would like to see the full report before coming to a conclusion rather than relying solely on the testimony of Savita’s bereaved husband as reported in the Irish Times and Spectator.

But the real issue is whether Ireland’s law needs changing as a result of this case.

The issue has come to a high boil after the European Court of Human Rights issued a ruling in the A,B and C case saying that Ireland must ‘clarify’ under what circumstances abortion could be legal under the current law.

While the Court did not say that Ireland must legalise abortion, this has not stopped abortion activists from insisting that abortion be declared legal. The report on abortion’s legal situation by the government’s expert group, which has been expected imminently for months, was reportedly delivered to the Health Minister on Tuesday.

Minister for Health James Reilly has confirmed he will be bringing the report of the expert group on abortion to Cabinet on Tuesday week but said that it could be early 2013 before a clear Government position is made.

Amnesty International has also called on the Irish government to change the law.

Prochoice activists around the world, who were circulating emails announcing the case before it even appeared in the newspapers, have meanwhile mobilised people to protest in Irish cities and outside the Irish Embassy in London.

But it is clear that many of these groups are seeing this case as an opportunity to advance a much more radical agenda.

53 MEPs have signed a letter asking Ireland to legalise abortion when the mother's 'life or health' is at risk. This would be a quantum shift to a law like Britain's which has resulted in over seven million abortions since 1967.

The abortion ‘provider’ ‘Planned Parenthood’ is running a campaign to ‘support a woman’s right to make her own medical decisions’ which sounds to me like an appeal for abortion on request (see tweet below).

Remember #Savita. Support a woman's right to make her own medical decisions. ow.ly/i/18hwN @ppglobe

— Planned Parenthood (@PPact) November 15, 2012

Similarly ‘Education for Choice’ is asking its supporters to write to the Irish Prime Minister (Taoiseach) saying that ‘This tragic case demonstrates once again that the prohibition of abortion in Ireland is not just undermining the autonomy of the women across the country, it is leading to unacceptable suffering and even death’.

The pro-abortion group ‘Population institute’ has said that the case ‘is a tragedy that should never have happened, and unfortunately it is not an isolated incident. Tragedies like this happen every day in countries where abortions are illegal or highly restricted.’

So is it really true that tragedies like this happen ‘every day’ in Ireland? This is actually a very easy question to answer as maternal mortality statistics are readily available.

The maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.

Ireland actually has one of the lowest MMRs in the world at just six deaths per 100,000 live births. This compares with 12 in the UK, 15 in the US and 200 in India.

As there are about 75,000 live births a year in Ireland this means that there are an average of four maternal deaths per year from all causes.

So to suggest as the Population Institute does that ‘tragedies like this happen every day in countries where abortions are illegal or highly restricted’ is a gross misrepresentation of the truth.

In other words, despite the fact that abortion is illegal in Ireland, there are very few places where it is safer to have a pregnancy or delivery. The standards of Irish medical care are very high indeed.

Now it may transpire after this case has been fully investigated that there has been mismanagement or negligence but that will not be an argument for a change in the law if the object is really saving women’s lives.

But what about pre-born babies' lives?

We know from Department of Health Statistics that 4,149 women with Irish addresses had abortions in Britain last year. By contrast there are about 200,000 abortions in Britain each year involving women from England (189,000) and Wales (12,000).

Just under 4.6 million live in the Republic of Ireland as against 60 million in England and Wales. So if Irish women were having abortions at the same rate as English and Scottish women there would be not 4,149 a year but over 15,300.

In other words abortion being illegal in Ireland saves over 11,000 Irish pre-born babies from abortion every year (This assumes that a change in Irish law will mean that Irish abortion rates will approach British rates – a not unreasonable assumption given how British rates have escalated in spite of what is on the surface a very restrictive law).

If the law did change Ireland would probably still have a maternal death rate that was well below that in the UK (6 per 100,000 live births versus 12 per year 100,000 per year), that is, a total of four maternal deaths annually (that is if no women then die as a result of abortion).

But there would be thousands more babies who would lose their lives.

Of course if you think a preborn baby is nothing other than detritus then that won’t bother you.

But if you think it is worth anything at all then you will support the law in Ireland staying as it is.

Savita’s tragic death is not a reason to change Ireland’s law on abortion

Savita Halappanavar (pictured) was an Indian woman who tragically died in Ireland from overwhelming infection after allegedly being denied an abortion.

The ‘facts’ (yet to be confirmed) have been reported as follows:

‘On October 21, Savita Halappanavar visited Galway University Hospital, Ireland. The 31-year-old dentist was 17 weeks pregnant and suffering terrible back pain. Savita was told that she was having a miscarriage, so she requested an abortion. The doctors denied her request because they said that they detected a foetal heartbeat and that Irish law ruled out a termination. Savita’s pain continued for three days and she eventually died of septicaemia.’

The case has predictably evoked much criticism from the pro-choice lobby of the Irish abortion law, the Irish medical profession and the Catholic faith.

Savita’s death, on 28 October, is now the subject of two investigations by Ireland's Health and Safety Executive (HSE) and by University Hospital Galway.

I am reluctant to comment on the case itself before the full facts are established but there is a useful review of the medical management of mid-trimester miscarriage on Jen Gunter’s blog.

The judgement of whether there was mismanagement will turn ultimately on the actual sequence of clinical events and the management decisions made. Even then it may not be possible to know whether ending the pregnancy would have saved Savita's life.

Regardless, however, this case is not a reason to change Irish law or Irish medical guidelines because, even if inducing premature labour had indeed been necessary in order to save Savita's life, both law and guidelines would already have allowed this course of action. In addition many Christians, both Catholic and evangelical, would also have supported it.

The Irish law on abortion

Abortion remains illegal in Ireland under section 58 and 59 of the Offences against the Person Act 1861. However in 1983 the Irish electorate approved the Eighth Amendment to the Constitution of Ireland by referendum. It inserted the following paragraph into the constitution:

‘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.’

In 1992, Ireland’s Supreme Court ruled that it had jurisdiction derived from the constitution to allow abortion in the case of a ‘real and substantial risk’ to the mother’s life. This right did not exist if there was a risk to her health but not her life.

So if the doctors caring for Savita had felt that the continuance of the pregnancy posed a ‘real and substantive risk’ to her life the current law would already have allowed them to induce the baby’s premature delivery to save her.

Irish Medical Guidelines

Section 21.4 of Ireland’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners would also have allowed this course:

'In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby.'

At 17 weeks gestation the baby, even if it is alive at the time labour is induced, is too young to survive. But again Irish medical guidelines would not have stopped doctors inducing labour to save the mother's life.

In 2000, Professor John Bonnar, then chairman of Institute of Obstetricians and Gynaecologists, which represents 90%-95% of Ireland's obstetricians and gynaecologists, explained the situation to the All Party Oireachtas Committee's Fifth Report on Abortion as follows:

'In current obstetrical practice rare complications can arise where therapeutic intervention is required at a stage in pregnancy when there will be little or no prospect for the survival of the baby, due to extreme immaturity. In these exceptional situations failure to intervene may result in the death of both the mother and baby. We consider that there is a fundamental difference between abortion carried out with the intention of taking the life of the baby, for example for social reasons, and the unavoidable death of the baby resulting from essential treatment to protect the life of the mother.'

'We have never regarded these interventions as abortion. It would never cross an obstetrician’s mind that intervening in a case of pre-eclampsia, cancer of the cervix or ectopic pregnancy is abortion. They are not abortion as far as the professional is concerned, these are medical treatments that are essential to protect the life of the mother. So when we interfere in the best interests of protecting a mother, and not allowing her to succumb, and we are faced with a foetus that dies, we don’t regard that as something that we have, as it were, achieved by an abortion.

Abortion in the professional view to my mind is something entirely different. It is actually intervening, usually in a normal pregnancy, to get rid of the pregnancy, to get rid of the foetus. That is what we would consider the direct procurement of an abortion. In other words, it’s an unwanted baby and, therefore, you intervene to end its life. That has never been a part of the practice of Irish obstetrics and I hope it never will be.'

Speaking to the Irish Independent this week clinical professor of obstetrics and gynaecology at the Royal College of Surgeons in Dublin Dr Sam Coulter-Smith confirmed this view:

'I think most of us who work in obstetrics and gynaecology, there may be individual differences, but the majority would be of the view that if the health is such a risk that there is a risk of death and we are dealing with a foetus that is not viable, there is only one answer to that question, we bring the pregnancy to an end.'

Christian ethics

There may be differences of opinion amongst Christian commentators about whether ending a pregnancy to save a mother’s life can ever be ethical. But I was interested to see, for example, that Catholic Voices have argued there is nothing in Catholic teaching that would stop such an intervention.

Personally I would see this as a choice between intervening to save one life (that of the mother) or standing by and allowing two (both mother and baby) to die.

And as Christian doctor, husband and father I would intervene. In doing so I would not be saying that the baby's life is less important than that of the mother, but simply (since the baby will die regardless) that in a desperate situation one must simply try to do the most good one can.

I have personally operated in an emergency to save the life of a mother with a ruptured ectopic pregnancy not knowing whether the embryo, who could not have survived anyway, was alive or dead. I would have no hesitation in doing so again. And in the situation where labour needed to be induced to save the life of a mother in an emergency (as in severe sepsis or eclampsia) I would induce it if I sincerely believed that nothing I could do would save the baby.

Often in such situations, even if the baby is premature, it is sometimes possible to deliver it alive in such a way that the parents can have some short time to bond with it and say their goodbyes. But, even if not, such bonding is equally possible after death.

Thankfully bringing a pregnancy to a premature end in order to save the life of the mother is vanishingly rare. In the UK it was reported in 1992 that in the first 25 years of the operation of the Abortion Act 1967 only 0.013% of all abortions were performed 'to save the life of the mother' and it is even questionable whether many of these required such radical action. The 2009 Abortion Statistics for England and Wales do not report a single case meaning this is a scenario that the vast majority of doctors, and even most obstetricians, will never face in a lifetime of medical practice.

So let’s not be bumped by this extreme case into arguing for a relaxation of the law and professional guidance in Ireland when the existing law and guidance do not actually prevent doctors intervening to save a mother’s life. That would be to start Ireland down the slippery slope to the situation in Britain where we have over 200,000 abortions per year with most performed on grounds of failed contraception, economic difficulty, social inconvenience or unwanted pregnancy.

No, let’s rather support Ireland in upholding a law which is actually the best in Europe for both mothers and babies. It protects babies from abortion with its blanket prohibitions and stiff penalties, whilst at the same time making allowance for intervention to save a mother’s life in an emergency when her baby cannot be saved. And rather than trying to legislate for every situation it allows the courts to dispense justice with mercy in hard cases. It does not need changing.