Medical Council stance on abortion a surprise


Last week's decision by the Medical Council to change the ethical guidelines concerning abortion is a surprise in terms of content but not timing.

The current council is now halfway through its term of office; it had not dealt with the issue of abortion in any substantial way until last week, and so the calling of a meeting to discuss the All-Party Oireachtas Committee Report on Abortion was not in itself unusual.

What caught some members by surprise was the introduction of two definitive motions after relatively few hours' discussion.

The last Medical Council was seen as having a broadly "pro-life" agenda. That there was support for some change among the members of this council would have been obvious to most seasoned observers.

In its 1998 Guide to Ethical Conduct and Behaviour, the last council had the following advice on the child in utero:

"The deliberate and intentional destruction of the unborn child is professional misconduct. Should a child in utero suffer or lose its life as a side-effect of standard medical treatment of the mother then this is not unethical.

"Refusal of 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."

These current guidelines do not mention the word "abortion".

In his evidence to the All-Party Oireachtas Committee on the Constitution, the president of the Medical Council, Prof Gerard Bury, said: "Abortion is a lay term. If it's going to be used technically, in my understanding as a GP it relates to any termination of pregnancy, for natural or other reasons, prior to about 14 weeks of the pregnancy."

He also recognised the inherent ambiguity of the guidelines.

"I think that the substance of that paragraph `The Child in Utero' deals with assurances to the doctor involved that a woman must be offered and made available to her whatever treatments are appropriate.

"Again, this comes back to direct and indirect effects . . . I would have to say to you that I don't want to get into speculating over the extent to which treatment may be defined as intended to treat the woman rather than bring about another effect . . . We recognise that certain types of treatment may bring about the death of the child. It depends on intent, it depends on purpose."

Despite Prof Bury's reluctance to specify the treatments which may bring about another effect, most doctors would accept that a foetus will not survive certain cancer treatments, for example.

There is no contention within the profession that, in a small number of defined circumstances, termination of pregnancy will be a side-effect of adequately treating the mother.

What is particularly significant about one of the motions approved by a majority of council members last week, which may in turn form the basis for a new set of ethical guidelines, is the apparent attempt to align the Medical Council view with that reached by the courts in the X case.

"The Medical Council recognises that termination of pregnancy can occur when there is a real and substantive risk to the life of the mother" is clearly driven by the wording of the X case judgment.

The second motion, "That termination of pregnancy can occur when the foetus is not viable", appears, in contrast, loose and poorly worded.

According to both legal and medical sources, if such a wording found its way into a set of ethical guidelines it would mean that, ethically at least, doctors could perform terminations on foetuses up to 24 weeks' gestation.

As Prof John Bonnar, of the Institute of Obstetricians and Gynaecologists, has said, this represents the most liberal position on abortion ever taken by any medical profession.

The dichotomy between the two motions begs the questions: was the first a preplanned one by a cohort of council members disposed to change, and did the second "enter from left field", unexpected and unwelcome?

While the wording of the first motion does not specifically mention suicide, it is not beyond the bounds of possibility that, with further discussion and debate, a formula could have been found with which all council members could have agreed.

With ongoing legal consultation, such a compromise now looks unlikely, at least in the short term.

Certainly, such a compromise could explore the area of realpoli- tik, where ethical, legal and political considerations coalesce.

The first motion, on its own, has potential to bring ethical guidelines into line with the legal status quo, and it may have been welcomed by politicians as they consider their options on the ever-thorny issue of abortion.

However, the council must now deal with the specific ramifications of the second motion.

If it is upheld at its meeting next week, members can expect to feel the heat of the profession for daring to bring in such a radical change without widespread consultation.

And, quite apart from the ethical considerations, proposing that "termination of pregnancy can occur when a foetus is not viable" would seem to be outside the law.

How ironic, if in attempting to align itself with the X case ruling, the Medical Council placed itself on the opposite side of the legal tracks.