X case legislation will not lead to 'intentional killing'


The provision of safe, legal abortion to protect the life of the mother would not lead to the "intentional killing of babies" in the womb, the Master of the National Maternity Hospital has said.

Speaking on the opening day of hearings in the wake of the expert group report on the European Court of Human Rights judgment against Ireland, Dr Rhona Mahony refuted assertions made by anti-abortion campaigners that legislating for the X case would result in “the direct and intentional killing of unborn children”.

She was responding to a question from Fine Gael TD Terence Flanagan, who asked whether it would be acceptable to carry out a termination of a pregnancy at 24 weeks.

“Please don’t talk about the ridiculous concept of terminating pregnancies at 24 to 30 weeks,” she said.

Where a termination of the pregnancy was necessary to save the mother’s life the foetus would be delivered rather than killed in the womb, she said. “Where there is any chance of preserving the life of the baby we will do so...What we are about today is saving women’s lives, not about killing [unborn foetuses].”

Master of the Rotunda, Sam Coulter-Smith told the committee: “In most situations it is possible to deliver the foetus rather than kill the unborn.”

In their statement last month, the four Catholic Archbishops of Ireland said Government plans to legislate for the Supreme Court ruling in the X Case would “pave the way for the direct and intentional killing of unborn children”. The Pro-Life campaign has said such legislation would lead to the “targeting of unborn in the womb”.

Dr Coulter-Smith said there had been six cases last year at the Rotunda where pregnancies were terminated to save the mothers’ lives.

Both he and Dr Mahony said they had never withheld such treatment from mothers where their lives were at risk, though both called for legislation to clarify when abortion was legal.

“I still contend that I need further clarity that I am protected under law,” said Dr Mahony, pointing out the 1861 Offences Against the Person Act, which criminalises carrying out abortion, stands.

Dr Coulter Smith said to his knowledge no woman had died in an Irish hospital due to being refused a termination, but added it was impossible to know whether or not women might have died if they had not been able to access abortion abroad.

Separately, the Bar Council of Ireland, scheduled to appear before the committee tomorrow, tonight pulled out of the engagement, saying it could not adequately represent the diverse opinion of its members.

The Irish Family Planning Association (IFPA) told the committee today that criminalisation of abortion did not deter women from seeking terminations or lead to lower rates of abortion.

Chief executive Niall Behan said it was their experience that for their clients “the choice of a termination is a rational response of a person” making a long-term decision. He said “once a woman has made this rational decision, she is extremely unlikely to change her mind regardless of the legalities”.

He added: “Her focus is on the practicalities of organising and financing the procedure in another country.”

Mr Behan also said there was “no bright line between life and health”. The chief executive said “no other countries in Europe forces doctors to make the distinction that is made in Irish law, permitting abortion to save a woman’s life but not to preserve her health”.

Professor Richard Greene, a member of the Maternal Mortality Working Group in Ireland said there had been two suicides in the State between 2009 and 2011, one during pregnancy and one after the woman delivered her baby. He said both women were well known to the medical services.

He said that in the three years there were 25 maternal deaths, six of them classified as direct, five indirect and six were attributed to coincidental causes. The direct deaths were from either pulmonary embolism, amniotic fluid embolism, uterine rupture or multi-organ failure.

Five of the indirect deaths were linked to cardiovascular disease, two to suicide and two to H1N1 influenza. Two were linked to epilepsy, one to chronic obstructive pulmonary disease and one to bleeding oesophageal varices.

Two of the coincidental deaths were cancer-related, one as a result of a road traffic incident, one from lymphoma and two were attributed to substance abuse.

Earlier, Dr Anthony McCarthy, consultant perinatal psychiatrist at the National Maternity Hospital in Dublin, told the committee that it was “a major disappointment’’ that no unit outside of the three Dublin maternity hospitals had dedicated perinatal psychiatry specialists.

He said that outside of those three hospitals, there was no routine assessment of, or screening for, major mental health problems in pregnant women.

This, he said, was at a time where appropriate advice and intervention could have such vital benefits, not only for the mother herself but for her bond with her new baby whose long term development depended so much on here well being.

Dr McCarthy said suicidal ideation in pregnancy was much more common than completed suicide and was a complex issue.

“However, much of the public debate about the issue of suicide and its risk in pregnancy has, in our view, been simplistic, sometimes harsh and judgemental, frequently uninformed or misinformed, and contrasts markedly with the way suicide and its risk is usually discussed in other circumstances,’’ he added.

Patricia Casey, professor of psychiatry at UCD and consultant psychiatrist at the Mater hospital, said women did express suicidal thoughts and sometimes engaged in self-harm in pregnancy, not primarily because of the pregnancy but because of interpersonal problems.

“In my clinical practice, as a consultant psychiatrist since 1985, I have never seen a pregnant woman for whom an abortion was the only, or last resort, treatment for suicidality,’’ she added.

Veronica O’Keane, professor of psychiatry in TCD, and consultant psychiatrist in Tallaght hospital, said the availability of abortion for women with serious mental health issues, including being suicidal, was a minimum and necessary requirement to protect the lives of those unable to travel to the UK.

Earlier, Irish Medical Council president Prof Kieran Murphy told the committee that doctors should not allow their personal moral standards to influence their treatment of pregnant women.

Prof Murphy said those with a conscientious objection to a course of action must explain this to patients and make the names of other doctors available to them.

"The right of conscientious objection must be balanced against the right of the patient, particularly in the case of a medical emergency," he added.

The committee has begun three days of hearings on the Government decision to legalise abortion in limited circumstances at some point next year. More than 40 witnesses and 20 groups will give evidence, among them medical and legal experts, the churches, civil society bodies, pro-choice and anti-abortion groups and politicians.

The evidence will range from complex and technical factual material to emotive advocacy from groups representing both sides of the debate. As such, it will be the first substantial foray into a debate that will dominate and divide Irish political discourse throughout 2013; as it did in 2002, in 1992 and in 1982/3.

The hearings are part of three-step process to arrive at a legislative solution to end the uncertainty over what is legally permissible with abortion.

The Oireachtas committee, chaired by Fine Gael TD Jerry Buttimer, will draw up a report for Minister for Health James Reilly. He and his officials will then publish draft legislation. There will be further public consultation.

Once that ends, the Bill will be published and debated in the Dáil. Dr Reilly has predicted that the fresh legislation can be enacted before the summer recess. In reality, it may be the end of the year.

The hearings have been divided into four discrete sections. Today, members will hear from medical experts, particularly in the areas of obstetrics, and psychiatry. Tomorrow, they will hear from legal experts, particularly from those with knowledge of the Constitution and medico-legal areas. On Thursday, the four main churches as well as the Islamic faith will make submissions.

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