Ethics and the Medical Council

Battleground: The Irish Medical Council and the fight to preserve pro-life medical ethics.

An important factor in protecting Irish babies and mothers has been the consistent support of the pro-life position by Irish medical practitioners.

The Institute of Obstetricians and Gynaecologists, the Irish Medical Organisation and the Irish Medical Council have all affirmed the right-to-life of all Irish children, born and unborn.

The Irish Medical Council regulates the medical profession, and the Ethics Guide is where the pro-life position of the Council is stated. The Council has held that it would be professional misconduct (leading to strike-off) for a doctor to perform an abortion. Since pro-abortion campaigners have had little success in convincing the majority of doctors that abortion should be legal, they have attempted to attack the Medical Council's position on many occasions, requiring pro-life doctors to take strong and decisive action.

Abortion advocates have been assisted in their agenda by successive Health Ministers, including Micheál Martin and Mary Harney. They have appointed political allies to the Council who have led a push to have the ethical guidelines banning abortion overturned. In 2008, despite huge opposition, Mary Harney pushed through the Medical Practitioners Act which gave the Health Minister the right to appoint a political majority onto the Medical Council.

This is a brief history and overview of what has happened with the Medical Council from 2001-2010, and the role leading pro-life doctors have taken to ensure human life continues to be protected.

 

2001: Defending the pro-life position from attack

  
The attack

The existing guidelines for doctors before May 2001 had stated that 'the deliberate and intentional destruction of the unborn is professional misconduct'.

Two motions proposing that the Council's ethical guidelines on abortion be changed to approve of abortion in a wide range of circumstances, including abortion of handicapped children, were put before the Medical Council in May 2001.

Both motions were carried by 12 votes to seven, but the Council meeting ended in controversy arose when seven members walked out in protest.

According to the Sunday Business Post on 3 June 2001:

'There was uproar and shouting in the council offices when council members voted by a slim majority to allow for termination of a pregnancy.....

The council also rejected -- again by a slim majority -- a proposal for widescale consultation with its membership before the guidelines were changed. The proposal to consult had been tabled by the incumbent chairman of the Medical Council, Professor Gerald Bury.'

The Council subsequently received advice from two senior counsel that the decisions which were made did not follow proper procedure.

The Sunday Business Post on 24 June 2001 also revealed that the move to overturn the pro-life guidelines "was initiated by Waterford GP Dr Abdul Bulbulia".

Bulbulia, who was appointed to the council by former minister for health Brian Cowen, is the husband of Katherine Bulbulia, a personal adviser to Tánaiste Mary Harney. (Katherine Bulbulia has been subsequently appointed to both the Irish Medical Council and the Crisis Pregnancy Agency by Mary Harney). Another Cowen appointee, Geraldine Feeney, also supported the push for abortion-friendly guidelines.

The Medical Council decided to meet again on September 12th to discuss the motions.

 
The defence

In the intervening months the Life Institute took action against this ambush on Irish medical ethics.

A widely-circulated leaflet pointed out that this crisis had been brought about by a a small number of doctors with their own agenda, who were trying to persuade the Medical Council to drastically change medical practice and ethics in Ireland. We explained that these few doctors were totally unrepresentative of the Irish medical profession whose pro-life ethos had made Ireland the safest place in the world for a mother to have a baby.

The leaflet advised people that Irish doctors needed to hear their support, so that they would be encouraged to oppose the motions in September. We listed the members of the Council on the leaflet and asked readers to contact them to explain their opposition to the motions and support for the pro-life cause. We also suggested to readers that they contact their GP's and ask them to make their opinions known to the Medical Council.

We then sent every GP in the country a letter signed by leading pro-life doctors which urged them to add their voices to the others being heard by the Council. Many doctors then sent submissions to the Council demanding that the motions be thrown out and that human life be protected.

Distribution of the leaflets was also concentrated around the areas where Council members practiced with notable effects. At least two members of the Council said that they were astounded by the reaction of people who had come to their surgeries to complain vigorously about any attempt by doctors to facilitate the legalisation of abortion.

The Irish Times reported that:

'Sources have confirmed that the council has been inundated with correspondence from doctors since the first meeting.

'Apart from those stating their views on the substantive ethical issue, a significant number of doctors have been critical of the council for not engaging in wide-ranging consultation with the profession before changing its position on such an important ethical issue.'

 
The result

On September 12th, the Council agreed new abortion guidelines for doctors. The motion proposed abortion of babies with disabilities had been dropped.

The new guidelines stated that 'termination of pregnancy can occur when there is a real and substantial risk to the life of the mother'. Commentators noted the distinction immediately: it was the pregnancy - not the life of the child - that could be terminated.

An appendix to the guidelines pointed out that this position was that approved by the Institute for Obstetricians and Gynaecologists - which held that abortion was never medically necessary but that there were rare complications in pregnancy where a termination of the pregnancy could result in unintended death of the baby.

The Institute statement to the All-Party Committee on the Constitution on abortion was also included in the Appendix.

"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 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."

What the guidelines were now saying therefore was that treatment for cancer and other conditions could always be given to pregnant mothers even if that meant the unintended death of their babies. That, in effect, meant no change to obstetric practise in Ireland and it effectively upheld the ban on abortion.

The Council meeting also agreed that suicide risk was not grounds for termination of a pregnancy.

However, doctors who performed abortions were no longer automatically culpable of professional misconduct - and the political forces targeting the Medical Council's pro-life guidelines were to strike again within two years.

 

2003/2004: Ethics and the human embryo

In 2003 Senator Geraldine Feeney took over the Chair of the Ethics Committee of fhe Medical Council. Ms Feeney, the first political appointee to chair the Committee, is a long time Fianna Fail activist. A protege of Brian Cowen, she was appointed to the IMC in 1999, despite possessing no medical qualifications, and then became Chairperson of its Ethics Committee.

P_MC_Embryo - Human embryo

Under her chair the Council drafted and approved its sixth Guide to Ethical Conduct and Behaviour and roped in the Irish Council for Bioethics (ICB) for discussions on ethics and the human embryo. (The ICB later went on to campaign for embryonic stem cell research).

Thankfully the pro-life ethos of the Irish Medical Council in regard to the protection of the human embryo was not diluted.

It's previous declaration that "the creation of new forms of life for experimental purposes, or the deliberate and intentional destruction of human life already formed, is professional misconduct", was unchanged.

Section 26.4 also included the following:

"Techniques such as IVF should only be used after thorough investigation has failed to reveal a treatable cause for the infertility. Prior to fertilisation of an ovum, extensive discussion and counselling is essential. Any fertilised ovum must be used for normal implantation and must not be deliberately destroyed."

The revised guidelines were approved on 5th February 2004.

Meanwhile, the results of the Irish Medical Council elections on 22nd of March showed a strong pro-life contention among the ten elected members.

It was now obvious that, in order to succeed in attacking pro-life medical ethics, abortion campaigners would have to ensure that a political majority would be appointed to the Medical Council - thereby ensuring that political appointees, not doctors, would decide medical ethics.

That was precisely what happened.

 

Mary Harney moves on the Medical Council

In 2006, Health Minister Mary Harney, first brought forward the Medical Practitioners Bill. The Bill proposed granting the Minister the right to appoint a political majority on the Medical Council - a move that would give political appointees the opportunity to devastate the medical ethics which had, thus far, opposed abortion and embryo research.

Over the next 18 months the extent of the political determination to seize control of medical ethics was truly astounding. It was an unprecedented power-grab.

Mary Harney's actions did not go unopposed. The Medical Council Membership Support Committee (MCMSC)  principled stand received strong support from some 1,200 doctors.

While the Irish Medical Organisation and others also opposed Harney's Bill, the MCMSC became the foremost body informing doctors as to the dangers in the Bill and led the campaign to have the Bill radically altered or scrapped.

A initial mailing brought a membership of almost 1,200 doctors to join the organisation within weeks. Numerous press releases and interviews were undertaken by the MCMSC whose hard-hitting adverts also called on doctors and concerned citizens to make their voices heard to the Health Minister, to the Dáil Committee (who rubber-stamped the Bill), and to local political representatives.

The MCSC wrote at the time:

"We also spent considerable time urging the major medical representative groups, such as the Irish Medical Organisation and the Irish Hospital Consultants Association, to get involved and take a stronger stand; to properly represent their members. We made our review of the Bill available to as many people as possible. We brought the message out into the open, over and over again, explaining all of the democratic deficits inherent in the Bill. Our work was recognised by the hundreds of doctors who contacted us to thank us for our efforts on their behalf of the Irish public, who will probably never realise how much work was done to ensure that they might have the best possible medical regulatory body to protect their interests. No effort was spared.

"The result of this enormous undertaking was that opposition to the Medical Practitioners Bill amongst the medical profession was not just widespread, but pretty much unanimous. Doctors were angry and rightly suspicious that the Minister is hell-bent on forcing through a measure which will be bad for medical practice and bad for the patient. So many called the Minister to express their adamant opposition to the Bill, that her decision to ignore the calls for change gave rise to an unanswered query: Just why does Minister Harney want so badly to be able to control medical ethics?"

"In advocating for the Bill, Mary Harney argued that a lay majority on the Medical Council would protect patients against malpractice but the spokesperson said that this was simply untrue - and pointed out that other countries have decided against a lay majority on Medical Committees since they realised that this would cause a decline in medical standards, which would cause patients to suffer.

"Dr Liam Twomey, the Wexford Fine Gael TD, raised objections to Mary Harney's proposals in the Dáil and expressed his concerns that the Bill would be used to enforce political views on abortion and embryo research. He was correct - but Mary Harney rushed to contradict him."

They concluded: "Her rebuttals were most unconvincing. The new Act specifies the duty of the Council to accept EU regulations passed to it from the Minister. We all know where the EU stands on embryonic stem cell research. We have reached a critical point in our fight to have Irish medical ethics protected from political interference. In spite of such fierce opposition, the Minister for Health, Mary Harney, has pushed ahead and the Bill is set to become law before the end of April".

The Medical Practitioners Act was passed into law in April 2007.

 
Comment

The May 2007 general election that followed was a disaster for the Progressive Democrats (PDs). The party lost all but two seats and quickly fell apart.

Yet for all that, then Taoiseach, Bertie Ahern decided, not only to include the PD's in government, but to re-appoint Mary Harney as Minister for Health. At first this seemed puzzling. Bertie didn't need the numbers, Harney wasn't a popular Health Minister (her vote slipped dramatically in the election, were it not for the addition of another seat to her constituency, she may not have managed to retain her seat) and, Lord knows, the Health Ministry could do with someone capable of tackling the mess it has become. Bertie Ahern is no fool, and neither does he grant political favours which do not directly benefit his own party. Why then did An Taoiseach offer this crucially powerful position to Mary Harney?

It could have been that the health ministry is seen as a poisoned chalice which Fianna Fáil (FF) would rather hand over to the PDs. Or could have been that Mary Harney is committed to an agenda which FF shrink from publicly supporting? Ms. Harney can attack pro-life ethics, fund pro-abortion agencies (the CPA) and support embryo research, while FF declare themselves innocent of any wrongdoing.

As Health Minister, Ms Harney took to making her appointments to the Medical Council. They included embryonic stem cell research supporter, Dr Deirdre Madden, and long-time adviser Katharine Bulbulia, whose husband Abdul had previously been appointed to the Council and had supported motions favouring abortion. (Clearly those making Irish political appointments are not worried about charges of nepotism.)

With the Council stacked with political appointees it wasn't long before the Ethical Guidleines came under review once again.

 

2007: A public consultation - which then ignored the public

In August 2007 the Medical Council advertised for public submissions in advance of a review of its Ethical Guidelines.

LI immediately spread the word, and provided assistance and crucial information to the huge number of people wishing to make a submission.

Although the Medical Council had given an extremely short timeframe for submissions, they later confirmed that more than 90% of the submissions received in relation to medical ethics supported the pro-life position. The Irish Medical Times reported that more than 6,500 submissions were made and that the "overwhelming majority" were pro-life.

The voice of the pro-life majority was emphatically heard - and it held the view that life should protected from conception.

In a lengthy submission we pointed out that: "Medical ethics should remain free from political influence and should not be compromised by connections to any industry or any service providers such as those who profit from the killing of unborn children.

In particular, we are concerned that political pressure is being brought to bear on the Ethics Committee to weaken the protection given to human life when it is most vulnerable."

We noted that: "Mary Harney, the current Minister for Health, has voted to fund embryo research at the European Council of Ministers; thereby funding a practice which is ethically outlawed by the Medical Council. Political appointees to the Medical Council have previously sought to weaken the prohibition on abortion which has always protected both mother and baby".

Our submission further stated: "Such political manoeuvres are contrary to the expressed wishes of the Irish people who have repeatedly expressed their opposition to the deliberate destruction of human life. It is our fervent hope that the MC members resist influences which would undermine the protection of vulnerable children and of the elderly in Ireland. The degradation of human life in other jurisdictions, such as the UK where calls are being made to kill disabled children after birth, or the Netherlands, where sick and elderly people feel obliged to carry cards stating their wish not to be euthanised, should be a warning to Irish practitioners."

"Irish medical professionals do a superb job, often in very difficult circumstances, for their patients. They are to be commended for recognising that a healing profession should play no part in the deliberate destruction of life. We join the great majority of Irish people who emphatically urge the Ethics Committee to ensure that their life-affirming ethics and practises continue."

Our submission then dealt with four main categories of concern: Abortion; Protection of the Human Embryo; Caring for the Seriously Ill and the Elderly, and Medical Vaccines: Making Ethical Alternatives Available.

The main points made in those categories are summarised below (the full submission can be read here

  • Medical ethics should remain free from political influence and should not be compromised by connections to any industry or any service providers such as those who profit from the killing of unborn children. A 2006 report from the UN re-affirms that our pro-life medical ethics have kept our maternal mortality enviably low.
  • In regard to Section 24.6 of the current Ethical Guidelines dealing with the child in utero, we believe the Guidelines should clearly prohibit abortion and we would like to see the guideline amended to read:
  • "The deliberate and intentional destruction of the unborn child is professional misconduct. Should a child in utero lose its life as a side-effect of standard medical treatment of the mother, then this is not unethical. Refusal by a doctor to treat a woman with a serious illness because she is pregnant would be grounds for complaint and could be considered to be professional misconduct."
  • Research on human embryos is immoral, unethical and has not produced any beneficial results. In regard to Section 24.1 of the current Ethical Guidelines we would like to see the protection of the human embryo retained and the section left entirely unchanged.
  • Euthanasia – widely touted as "mercy-killing" – is in, fact, neither merciful nor progressive. It is a form of medical homicide that violates the right-to-life, puts doctors in the role of killers, and creates a dangerous assumption that the lives of the gravely ill and disabled are of less value than the lives of others. We recommend that the Ethical Guidelines be explicit in stating that any action or omission undertaken to bring about the death of a patient is professional misconduct.
  • We would like to draw the Council's attention to the fact that vaccines currently offered to Irish parents – including the MMR vaccine – are derived from cell lines originally prepared from tissue taken from aborted babies. This gruesome fact has lead thousands of parents to refuse the MMR vaccine. Those parents would like to see an ethical alternative to this MMR vaccine made available here.

It took the Council a further 22 months to issue its revised guide - the Seventh 'Guide to Professional Conduct and Ethics for Registered Medical Practitioners'. The changes it made showed that a political agenda was still doing its utmost to overide the wishes of the people and Ireland's pro-life ethos.

P_MC_Doctor examining pregnant woman - Pregnant woman

 

The latest Ethical Guide

The Seventh 'Guide to Professional Conduct and Ethics for Registered Medical Practitioners' was issued by the Medical Council in November 2009.

They were described by the Life Institute at the time as being based on "an amalgam of natural law concepts, legal precedent and wishful thinking".

In relation to abortion the new guidelines in Section 21.1 stated:

"Abortion is illegal in Ireland except where there is a real and substantial risk to the life (as distinct from the health) of the mother. Under current legal precedent, this exception includes where there is a clear and substantial risk to the life of the mother arising from a threat of suicide. You should undertake a full assessment of any such risk in light of the clinical research on this issue."

Clearly this new section had been prompted by Dr Deirdre Madden who would have argued that the guide would merely state the current legal position.

However the guideline is based on two false premises:

1. On the rare occasions where there is a risk to a pregnant woman's life and medical intervention is required, this is not, and has never been, considered an abortion since the intention is not to harm the child.

2. The Council's interpretation of the X-case judgment (the current legal precedent referred to in the Guidelines) is incorrect. The relief granted by the Supreme Court X was to allow the right to travel to the UK for an abortion, and no legislation allowing abortion to take place in this country has ever been approved by the legislature or the people.

In section 2.4 the guidelines did recognise that:

"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."

It is noteworthy however that the Guide did not approach the issue of embryonic stem cell research - reflecting, perhaps, the strong public opposition to such research following extensive public awareness campaigns.