Committee hearings and legislation
1st Committee Hearings - January 2013
The Oireachtas Committee on Health and Children has held three days of hearings from medical and legal experts and advocacy groups on the issue of abortion. They were held in the Seanad from 8 - 10th January 2013. The Life Institute and Youth Defence were amongst those who gave evidence and answered questions on the issue.
The key findings of the hearing were:
- All of the medical experts agreed that abortion is never a treatment for suicide
- None knew of a single case where a woman had committed suicide because she couldn't get an abortion.
- Evidence was given that abortion can actually increase the risk of suicide.
Experts testified that not one woman has died in this country since the X case because of our ban on abortion.
- Further, they agreed that Ireland was one of the safest places in the world for a mother to have a baby.
- They confirmed that doctors do not need to directly end the life of the unborn child in order to save a mother's life.
- Doctors reaffirmed that terminology is hugely important, and that is of enormous psychological importance to a woman who is having her pregnancy interrupted for a life-saving procedure whether we call that an abortion or a termination of pregnancy.
- While some doctors felt they required further legal clarity, others disagreed. All agreed that Irish doctors always intervened to save the mother's life even if that resulted in the unintentional death of the unborn baby.
- Pro-life advocates asked the government to protect mother and baby, a requirement which does not ever require legalising the direct and intentional killing of an unborn child. They also pointed out that official statistics showed that not one single abortion had been carried out on an Irish woman in Britain to save the life of a mother.
- Abortion supporters want to see abortion on demand legalised without term limit . They also support the 'right' to kill an unborn child simply because she is a girl.
Heads of Bill Published - April 2013
On 30 April 2013, the government published 33 pages of draft legislation for the Protection of Life during Pregnancy Bill 2013 (previously entitled Protection of Maternal Life Bill 2013) with the intention of enacting the legislation before the 2013 Dáil summer recess.
The Life Institute accused Fine Gael of caving in to Labour on abortion, while pointing out that the government had ignored all the medical evidence that confirmed abortion was not a treatment for suicide.
Niamh Uí Bhriain of the Life Institute said that no term limits were contained in the draft legislation and that abortions could be carried out through all nine months of pregnancy - something she said would horrify the Irish people.
"We've seen the horrors of the Kermit Gosnell case in the US in recent weeks, and just how horrific late term abortions are," she said. "Fine Gael's lack of regard for human life is downright disturbing."
"Fine Gael made a deal with Labour - 'support our austerity measure, and we'll give you abortion', but it is Fine Gael who will now become known as the abortion party," said Ms Uí Bhriain. "Labour represent less than 10% of the people now according to polls, yet they are deciding for the whole country on this issue of life and death."
"This government asked medical experts to give evidence on this issue, and the evidence they heard demolished the case for legalising abortion on suicide grounds, but now they have roundly ignored the evidence and moved to allow unborn children to be deliberately killed for the first time in Ireland," she said.
In April 2013 113 psychiatrists disagree with abortion proposal
113 psychiatrists have signed a statement saying that legislation, which would allow for abortion as a treatment for threat of suicide, has no basis in medical evidence.
Four leading psychiatrists who carried out the survey of around 300 psychiatrists in the country. They are Dr Martin Mahon, Connolly Hospital, Dr Bernie McCabe, Navan Hospital, Dr Richelle Kirrane, Connolly Hospital and Prof Patricia Casey of the Mater Hospital. Of those who replied, 14 of the doctors disagreed with the statement.
Dr McCabe said: “I am not surprised that so many of our colleagues agree that the proposed legislation is flawed. As members of the medical profession, we have a duty to our patients to adopt best practice and an evidence-based approach to everything we do.
“The fact is that there is no evidence that abortion is a treatment for suicidality in pregnancy and may in fact be harmful to women. The Government must take this into account and reconsider its proposals.”
She said: “In total, 302 letters were sent to consultant psychiatrists there was over a 40pc response. Doctors were given the option to sign their names or reply anonymously. Almost 90pc of respondents agreed with the statement.
2nd Committee Hearings - May 2013
The Oireachtas Committee on Health and Children has held a further three days of hearings from medical and legal experts on the issue of abortion. They were held in the Seanad from 17th - 22nd May 2013.
Friday, 17 May
Friday heard from obstetric experts from the main maternity hospitals and smaller units around the country. It opened with a speech from Minister James Reilly and then proceeded to Tony Holohan, the HSE's Chief Medical Officer.
The Master of Dublin's busiest Maternity hospital, Dr Sam Coulter Smith, has said the there are 'major ethical and moral dilemma' arising for Obstetricians from the draft legislation currently proposed by the government.
He also warned of a possible 'surge' in the number of abortions if the proposal became law.
Dr Coulter Smith said that there was no evidence that abortion was a treatment for suicidal ideation or intent and, obstetricians were required to provide and practice evidence-based
"In respect of loss of life from self-destruction there are a number of issues that need to be raised. First, this is an extraordinarily rare situation with the incidence of suicide in pregnancy of the order of one in 500,000 pregnancies as per United Kingdom figures. Second, our psychiatric colleagues tell us that there is currently no available evidence to show that termination of pregnancy is a treatment for suicidal ideation or intent and, as obstetricians, we are required to provide and practice evidence-based treatment," he said.
He said the legislation, therefore, created an ethical dilemma for any obstetrician who has requested to perform a termination of pregnancy for the treatment of someone with either suicidal ideation or intent.
Dr Coulter Smith said that the fact that there is no gestational limit in the legislation relating to suicidality was a "a major ethical issue for obstetricians".
"First, let us consider the case of a patient who is 25 weeks' gestation. If she is deemed to be sufficiently suicidal to require a termination of pregnancy by one or more psychiatric colleagues, an obstetrician who is tasked with dealing with this situation is faced with an enormous ethical dilemma. Delivering a baby at 25 weeks' gestation could lead to death, due to extreme prematurity or it could lead to a child with cerebral palsy or with other significant developmental issues for the future."
"This is a source of serious concern for myself and my colleagues," he said.
Dr Coulter Smith also said that many Obstetricians thought the legislation might lead to a surge in the number of abortion being sought.
"It is my view and the view of many of my colleagues that the inclusion of suicidality within the legislation may, and I stress may, in the long term lead to an increase in demand for termination in this country," he said.
Monday, 19 May
Monday heard from psychiatrists and other medical specialities. A total of 15 experts addressed the committee’s ongoing hearings on abortion, including 11 psychiatrists, an oncologist and a cardiologist.
Consultant perinatal psychiatrist Dr John Sheehan said psychiatrists could be seen to be the gatekeepers to abortion if the provision allowing for terminations where a pregnant woman is suicidal is enacted.
He pointed out that the three perinatal psychiatrists in Ireland, psychiatrists dealing with women during and after pregnancy, had never had a single case of suicidal intent during pregnancy in 40 years of practice.
Dr Sheehan said the actual incidence of suicide in pregnancy was between one in 250,000 and one in 500,000. In practice, therefore, it would be impossible for any psychiatrist to accurately predict who will die, he said. “It could lead to multiple false positives.”
Dr Kevin Malone, professor of psychiatry in UCD said that the Government’s plans to legislate for abortion could have the unintended consequence of pushing more young men towards suicide. By highlighting suicide, the State could be seen as legitimising it, thereby sending the wrong signal to young men who were most at risk, he warned.
The inclusion of a suicide clause in the legislation could cost more lives than it saved by “normalising” it.
A co-founder of the charity Turn the Tide of Suicide, he had earlier that day launched a major report on suicide among Irish males.
Consultant psychiatrist Dr Seán Ó’Domhnaill warned that the legislation would turn doctors into abortionists. Abortion had no role in modern medicine, he said and termination was a medieval response to crisis pregnancies.
Dr Ó’Domhnaill said: “ We outlawed the death penalty. The only person at risk to have death warrant is the unborn child.”
Consultant psychiatrist Dr Jacqueline Montwill said the legislation was not needed.
“ There was no situation when a pregnant woman presidents with suicidal ideation, where the risk of suicide could only be averted by termination,” she said. She said the appropriate treatment for any suicidal patient was to ensure their safety either at home or in hospital, to offer psychological support and counselling and psychotropic medication.
Dr Bernie McCabe, consultant psychiatrist at Navan hospital said the test that there had to be a real and substantial risk to the life of the woman that could only be avoided by abortion could not be met because suicide could not be predicted, even in those with mental illness.
- Legislation will most likely apply to teenage girls in care
- Abortion bill risks normalising suicide
- Suicide in pregnancy a real risk, says doctor
- Psychiatrist warn of unecessary terminations
Tuesday, 20 May
On Tuesday, the Oireachtas joint committee on health and children focused on the legal aspects of the heads and had witnesses from legal and medical ethics backgrounds giving their expert opinions. The main points made were:
- There is no legal obligation to legislate for abortion in the case of threatened suicide
- We are not obliged to legislate for X as it did not set a legal precedent because it was a conceded point not a legally established one.
- The x case is not the final or only case where suicidality was the defence's main argument. In the “Minister for Justice vs Cosma” case the argument was refuted for 3 reasons, all of which are relevant to X.
- Head 4 of the bill, on the threat of suicide, would allow for the direct and intentional termination of the life of the child right up until birth.
- The bill’s accommodation of medical ethics is dated, regressive, and potentially dangerous
- The deliberate targeting of the life of the unborn in Head 4 makes this legislation unconstitutional.
Predictably enough head 4 of the proposed legislation, which deals with the threat of self destruction, was the piece to cause the most vigorous debate. The discussion on the rest of the heads centred, for the most part, on wording details and clarity, all of which could be corrected with amendment of the wording.
From the testimonies it transpired that we are not bound by the ECHR or Supreme Court, following the X-Case ruling, to include in the bill provision for abortion when suicide is threatened. Citing legal precedent, Ii was stated by four legal experts, that we are not obliged by the X-case to legislate to allow for abortion for the threat of suicide. They said that the X-case ruling was only applicable to the case itself and was not precedent setting.
Barrister, Paul Brady, criticised the political protest of legal necessity to legislate for suicidality. He criticised the government for falling back on this argument, protesting that they have no choice but to legislate, continuously.
He said that Head 4 marks a clear change in the law because it creates a statutory basis in Irish law for what may be a direct and intentional termination of an unborn child’s life. Mr. Brady said that under Head 4 “that the aim of the procedure can be to bring about the death of the child”
Head 4 allows for an abortion to take place up to nine months, even on a partially delivered child (arising from the definition of unborn in Head 1).
But Mr. Brady argued that legislation on the X-case decision was not obligatory because the suicide principle in the X-case “was a conceded point and was never argued in the X-case.”
He explained that in the X-case there was no “legitimus contradictor” to argue against, and test the decision, and therefore it could only bind the particular case. Justice McCarthy referred to the same in his X-Case judgement.
In making this point he quoted Justice Brian Walsh who was a member of the ECHR, the Irish Supreme Court, and the law reform commission etc.
This point was backed up by Dr. Marie Cahill who citing “the Attorney General v. Ryan's Car Hire Ltd” explained that the threat of suicide as conceded in the X-case does not set a legal precedent and “the rhetoric that we are compelled to legislate for the X-case” is unsupported.
In layman’s terms, because the point was conceded in the X case - arguments were not made for or against – its constitutionality and legal weight was not tested and it was therefore not established as a principle of law.
The X-case judgment has been criticised for being flawed and for being dated considering the amount of evidence based medicine that rejects abortion as a treatment for suicidality, but far more pertinent to the heads of bill we learned that it has no weight as precedent because it was a conceded point. Unlike the government who constantly fall back on the obligation to legislate argument, not one of the legal witnesses who support the legislation contested this assessment.
Prof. William Binchy shared what seems a unanimous view that Head 2 and 3, which deal with treatments to women which require the termination of pregnancy rather than the explicit termination of the life of the child, are ethical and reflective of current medical practice. Head 4 however, “gives us the scenario that the existence of the child causes suicidal ideation” he said. So this clause allows intentional killing of the child right up until delivery.
Dr. Maria Cahill said that the deliberate targeting of the life of the unborn makes this legislation unconstitutional.
The UCC law lecturer added that since the X-case the suicide imperative has been used and overturned by the 2006 “Minister for Justice vs Cosma” case on 3 counts, all of which would be violated by head 4.
Dr. Ciarán Craven spoke strongly about legal ethics shortfalls in the heads. In particular he said that the notion of “good will” as used in the heads insufficiently regulated the nature of patient doctor relations. He said that while “good faith” was necessary, it is not sufficient.
He offered the opinion that the old models of good faith leads to a danger of clinical hegemony and potential abuse. He said that bad faith is virtually impossible to demonstrate but “by incorporating a reference to evidence based practice we are providing a template against which to measure”. He put it that “Good faith and proper professional practice are not interchangeable” and added that relying on good faith is insufficient, “the courts and the medical council don’t think so.