How should we define abortion? A number of terms were bandied about by doctors and politicians at the first session of the public hearings by the All Party Oireachtas Committee on the Constitution, which opened on Tuesday. These included "termination of the pregnancy", "killing the baby" and "medical procedures" which result in the destruction of the foetus.
Dr James Clinch and Prof John Bonnar, the two eminent obstetricians who gave evidence, stressed that such procedures, when used to safeguard the life of the mother, were not abortions as far as the medical profession was concerned. There is no deliberate intent to destroy the foetus, although this may be an inevitable result.
Not everyone agrees with this distinction. Some reject it as casuistry. To the lay observer it may sound as though abortion/killing the baby is acceptable when the medical practitioner judges it so. But doctors differ and even change their minds, as we have seen in their attitudes to contraception. These are difficult issues, and there will be many more which the Oireachtas committee will consider when advising the Government on whether to opt for another referendum or legislation, or a combination of the two.
Individual doctors, like individual citizens, are entitled to their own views on when it is permissible to terminate a pregnancy. But as the committee chairman, Brian Lenihan, observed trenchantly: "The law must provide a statutory, legal framework within which doctors operate".
That is not the case at the moment. Doctors do terminate pregnancies in Irish hospitals, but claim that these procedures are not abortions because they are not directed, primarily, at the destruction of the foetus. But they have made no attempt to implement the Supreme Court ruling in the X case, although there has been a clear onus on them to do so. In other words doctors, particularly specialists in gynaecology and obstetrics, are a law unto themselves.
No doubt they sincerely believe they are the best judges of what should and should not be allowed to take place in Irish hospitals. Doctors also seem reluctant to accept that there are much broader considerations - social, moral, economic, humanitarian - in legislating on this and other problematical issues.
The committee hearings are being held in public. Sort of. The sessions are being held in the Seanad chamber in Leinster House and if Sean Citizen (or, more likely, Sinead) wishes to attend he/she has to acquire a pass from a member of the Oireachtas. This is a pity. Abortion is an issue on which people in this State feel strongly, often with little knowledge to support their views.
Already the opening sessions have given a sense of the enormous complexity of this issue and the range of views involved. As important, it demonstrates that the debate can be conducted in a constructive and civil fashion.
I was immensely struck by two factors. First, how far the debate has advanced since the first constitutional referendum in l983. Then, the demand was for a blanket ban on abortion. I was involved in the campaign against the amendment and we heard heart-breaking stories of women denied medical treatment because of the danger to the foetus.
That has changed. Members of the medical profession, even those most opposed to any relaxation of the law, stress that this could not happen now. Prof John Bonnar told the committee: "Where there is a physical threat to the life of the mother, her life takes priority."
This raises more questions than it answers, not least about the present wording in the Constitution which gives equal right to the life of the unborn child. What about cases where there is not a direct threat to the woman's life, but her health and well-being may be severely damaged if she has to carry her pregnancy to term?
We have heard about those cases where a woman becomes pregnant as a result of rape, or incest. Some medical submissions to the committee highlight other problems. How is a doctor expected to advise a couple who already have a child with cystic fibrosis when the mother is diagnosed as carrying a foetus affected by the same disease?
According to a consultant paediatrician, Dr Brian Denham, Ireland has the highest incidence in the world of this condition which requires "`hours of arduous daily care, physiotherapy, exercise programmes, 40 to 100 tablets daily, special dietary requirements and so on."
The other factor which impressed but did not entirely surprise me was how emotionally involved doctors, particularly obstetricians, are with the abortion issue. Their entire professional practice is concerned with assisting at the safe birth of new life. The idea of destroying potential life in the womb is repugnant to them. That is entirely understandable. As Dr Clinch put it: "How would you feel if you went into a doctor's surgery and saw a sign, `I am anti-life'?"
There are other perspectives, even within the medical profession. The committee has yet to consider the much more mundane - but for the individual concerned, no less serious - reasons why an increasing number of women travel to Britain each year to have an abortion. Each journey involves a crisis pregnancy, a fact which the Irish medical profession has refused to accept.
Liz McManus put this well when she asked: "Isn't it a fact that there are Irish abortions? British obstetricians are prepared to do the work for you, but what would happen if that safety valve were to be removed?" It still has to be confronted. If we fail to meet the challenge then, as sure as night follows day, we will be faced with another X case which throws the country into turmoil on the issue. The committee's hearings provide the opportunity for the public to hear all sides of the debate. Ring your TD and organise a pass for yourself.